• Mohammed M Alqahtani, Gregory Pavela, Donald H Lein, Ruzmyn Vilcassim, and Peter S Hendricks.
• Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; and Department of Physical and Occupational Therapy, School of Health Profession, University of Alabama at Birmingham, Birmingham, Alabama. Qahtani4@uab.edu.
• Respir Care. 2022 Jul 1; 67 (7): 814822814-822.

BackgroundAdults with chronic lung disease use electronic cigarettes (e-cigarette) at higher rates than those without chronic lung disease. Because e-cigarettes have now been shown to cause adverse pulmonary effects and impair immune responses, it is particularly important to identify the factors that contribute to e-cigarette use in individuals with chronic lung disease. We tested whether mental health explains the association between chronic lung disease and e-cigarette use, and whether the association between chronic lung disease and e-cigarette use is conditional on the presence of respiratory symptoms.MethodsData were obtained from the 2018 Behavioral Risk Factor Surveillance System. Logistic regression was used to test the association between chronic lung disease status and e-cigarette use when controlling for demographic variables and comorbidities. Structural equation modeling was then used to evaluate (a) whether the number of bad mental health days in the past 30 days explained the association between chronic lung disease and e-cigarette use, and (b) if respiratory symptoms moderated the association between chronic lung disease and e-cigarette use.ResultsThe prevalence of lifetime and current e-cigarette use was significantly higher in those with than in those without chronic lung disease, as was the number of bad mental health days in the past 30 days. Mediation analysis indicated a statistically significant indirect effect of chronic lung disease on the likelihood of e-cigarette use (lifetime and current) through mental health. However, our analyses did not indicate a statistically significant interaction between chronic lung disease and respiratory symptoms in the likelihood of e-cigarette use.ConclusionsThe association between chronic lung disease and e-cigarette use may be due, in part, to poorer mental health among individuals with chronic lung disease. These findings provide preliminary evidence that improving the mental health of individuals with chronic lung disease could reduce e-cigarette use in this vulnerable population.Copyright © 2022 by Daedalus Enterprises.

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