Cancer screening adherence among e-cigarette users in the United States

Tobacco use patterns have dramatically shifted, with electronic cigarettes (e-cigarettes) rapidly increasing in popularity despite uncertainty about their health impacts. This study examines adherence to preventive cancer screening guidelines among cigarette smokers, e-cigarette users, and non-smokers, addressing a critical gap in understanding how tobacco use influences engagement in preventive healthcare.

A total of 445132 adult respondents were queried from the 2022 Behavioral Risk Factor Surveillance System data. Analytic samples were restricted to age- and sex-eligible sub-cohorts for each cancer type, therefore including adults 50-75 years, women 50-74 years, and women 21-65 years for colon, breast and cervical screening, respectively. Within these analytic samples, we assessed the association between socioeconomic characteristics, smoking status, and screening adherence using weighted logistic regression, adjusted for relevant factors.

Screening adherence was lowest among cigarette smokers, intermediate among e-cigarette users, and highest among non-smokers. Compared to non-smokers, cigarette smokers had significantly lower odds of adhering to colorectal (AOR=0.75; 95% CI: 0.58-0.81), breast (AOR=0.57; 95% CI: 0.52-0.61), and cervical cancer screening (AOR=0.67; 95% CI: 0.62-0.72). E-cigarette users also showed reduced adherence to colorectal (AOR=0.90; 95% CI: 0.81-0.95) and breast cancer screening (AOR=0.75; 95% CI: 0.70-0.81) but not cervical cancer screening.

E-cigarette users exhibited suboptimal adherence to recommended cancer screenings, suggesting that perceptions of reduced risk associated with vaping do not translate into improved preventive healthcare behaviors. Targeted public health initiatives addressing risk misconceptions and healthcare access barriers are necessary to improve screening rates among all tobacco users.