Adolescents more likely to report informal sources for nicotine and THC containing products

1. Adolescents with e-cigarette, or vaping, product use–associated lung injury (EVALI) were more likely to report informal sources for obtaining nicotine- and THC-containing products than young adults and adults.

2. EVALI adolescents were more likely than young adults and adults to report a history of ADHD, asthma, and gastrointestinal issues.

Evidence Rating Level: 2 (Good)

As of mid-December 2019, states have reported a total of 2,506 hospitalized or deceased cases of e-cigarette or vaping product use-associated lung injury (EVALI). Due to limited available data on the clinical characteristics of adolescents with EVALI, this cross-sectional study sought to determine the unique differences between these adolescents and their adult counterparts. A total of 360 hospitalized or deceased adolescents (age range 13 to 17 years, 32.1% female), 859 young adults (age range 18 to 24 years, 27.6% female), and 936 adults (age range 25 to 49 years, 34.4% female) with EVALI were included in this study. Among the adolescent group, 81.7% reported using tetrahydrocannabinol (THC)-containing products, 62.4% reported any nicotine-containing product, and 50.8% reported using both product types. This group was also more likely to report informal sources for obtaining these products (96.5% THC, 50.5% nicotine) compared to both young adults (86.9% THC [adjusted PR 1.11, 95% CI 1.05 to 1.18; 19.8% nicotine [adjusted PR 2.49, 95% CI 1.78 to 3.46) and adults (75.1% THC [adjusted PR 1.29, 95% CI 1.19 to 1.40]); 24.3% nicotine [adjusted PR 2.06, 95% CI 1.49 to 2.84]). THC products have been found to be diluted by vitamin E acetate, an EVALI-associated chemical. Adolescents reported a 400% greater likelihood (18.1%) of a history of Attention-Deficit/Hyperactivity Disorder (ADHD) than adults (4.9%, adjusted PR 3.74, 95% CI 1.92 to 7.26). Asthma was also reported for frequently among adolescents than adults (adjusted PR 1.53, 95% CI 1.14 to 2.05). Lastly, gastrointestinal symptoms were more common among adolescents than adults (difference 19.2%, adjusted PR 1.20, 95% CI 1.13 to 1.28 vs adjusted PR 1.03, 95% CI 1.00 to 1.06, respectively). While data collection methods varied across jurisdictions, occasionally resulting in small sample sizes, and medical histories were self-reported, this study still holds value in describing unique characteristics of EVALI adolescents. It is important to consider factors such as ADHD and asthma in adolescents and educate on the risks posed by e-cigarette or vaping products.

Click to read the study in JAMA Pediatrics

Image: PD

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