E-cigarette use among adults with cardiometabolic conditions

Adults with cardiometabolic conditions are at high risk of smoking-related morbidity and mortality. However, little is known about patterns and predictors of e-cigarette use in this population.

The study therefore aims to examine the prevalence and predictors of current e-cigarette use among adults with cardiometabolic conditions.

We analysed data from 6633 adults with cardiometabolic conditions who participated in the 2017, 2018, 2019, and 2021 waves of the Scottish Health Survey. For this study, cardiometabolic conditions were defined broadly to include diabetes, high blood pressure, angina, heart attack, and stroke, as well as other physician-diagnosed cardiovascular conditions (irregular heart rhythm, heart murmur, and other heart conditions). Current e-cigarette use was defined as self-reported present use of an e-cigarette or vaping device. Firth penalised multivariable logistic regression was used to examine sociodemographic, behavioural, and health related predictors of e-cigarette use, reporting adjusted odds ratios (AORs), 95 % confidence intervals (CIs), and p values.

Overall, 5.2 % (95 % CI: 4.6-5.8) of adults with cardiometabolic conditions were current e-cigarette users, with prevalence ranging from 4.6 % (95 % CI: 4.0-5.2) among those with high blood pressure to 8.0 % (95 % CI: 6.1-10.5) among stroke survivors. E-cigarette use was more common in younger adults. Compared with those aged 16-24 years, adults aged 25-34 years (AOR 0.39, 95 % CI: 0.18-0.87, p = 0.021) and those aged 75+ years (AOR 0.05, 95 % CI: 0.02-0.12, p < 0.001) had lower odds of current e-cigarette use. Compared with never smokers, odds were substantially higher among current smokers (AOR 31.27, 95 % CI: 13.19-74.14, p < 0.001) and ex-smokers (AOR 39.65, 95 % CI: 18.06-87.06, p < 0.001). Reporting a desire to quit smoking was associated with higher odds of e-cigarette use compared with not wanting to quit or not smoking (AOR 2.12, 95 % CI: 1.38-3.25, p = 0.001). Higher odds were also observed among individuals with no educational qualifications (AOR 1.75, 95 % CI: 1.18-2.59, p = 0.005) and those reporting poor general health (AOR 1.36, 95 % CI: 1.04-1.77, p = 0.023). Sex, ethnicity, deprivation, psychological distress, and alcohol consumption were not significantly associated with use in the adjusted model.

Among adults with cardiometabolic conditions, e-cigarette use was more common among younger adults, current smokers, ex-smokers, those who wanted to quit smoking, individuals with lower educational attainment, and those reporting poorer health. These findings suggest the need for clinicians managing patients with cardiometabolic conditions to address e-cigarette use in the context of smoking cessation and secondary prevention.