The Association of Electronic Cigarette Use and the Subjective Domains of Physical and Mental Health: The Behavioral Risk Factor Surveillance System Survey

Introduction Individuals who use electronic cigarettes (e-cigarettes) may have a poor perception of physical and mental health. We, therefore, studied the association of e-cigarettes with subjectively reported health domains. Methods We utilized cross-sectional data from the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey. All variables were self-reported. E-cigarette use was characterized as never, former, or current. Health domains included overall health, physical health, and mental health, which was assessed as the frequency of emotional support, life satisfaction, and feeling stressed. Weighted multivariable-adjusted logistic regression models were used to examine the association between e-cigarette use and these health domains. Results Our study population consisted of 755,355 (79%) never e-cigarette users, 111,940 (16%) former users, and 28,917 (5%) current users. There was a significant association between e-cigarette use and the less favorable perceived state of overall health, physical health, or mental health. For example, the OR (95% CI) for the association of current e-cigarette use with health domains was as follows: good perception of overall health: 0.78 (0.74,0.83), physical health: 0.69 (0.66,0.73), adequate emotional support: 0.89 (0.79,0.99), feeling satisfied: 0.83 (0.71,0.96), or being free of stress: 0.64 (0.53,0.76). Similar results were obtained in younger individuals (aged 18-34 years). Conclusions E-cigarette use is associated with a less favorable perception of physical and mental health as compared to never use, particularly among younger adults. These results have important implications for clinicians for patient counseling and regulatory agencies to regulate e-cigarette sales.