title: Use of Electronic Cigarettes Among U.S. Adults With Medical Comorbidities.
abstract: BACKGROUND
  Electronic cigarette (e-cigarette) use is rising in the U.S. Smokers with comorbidities may increasingly use e-cigarettes if they believe e-cigarettes reduce smoking-related harm. This study examined e-cigarette use among adults with medical comorbidities.
  
  
  METHODS
  In 2016, this study analyzed 68,136 U.S. adults in the 2014 and 2015 National Health Interview Survey. Prevalent e-cigarette use by medical comorbidities and adjusted odds of e-cigarette use were calculated.
  
  
  RESULTS
  Among current cigarette smokers, ever use of e-cigarettes was more often reported by adults with one or more medical comorbidity versus those without comorbidity (18-24 years: 73.5% vs 61.4%; 25-44 years: 60.6% vs 54.3%; 45-64 years: 46.5% vs 40.3%; ≥65 years: 35.2% vs 19.4%; all p<0.05). Current smokers aged 25-64 years with one or more comorbidity reported current e-cigarette use more often than those without comorbidity (25-44 years, 17.8% vs 14.3%, p=0.03; 45-64 years, 15.9% vs 11.5%, p=0.02). Current smokers with chronic obstructive pulmonary disease, asthma, and cardiovascular disease had higher odds of ever e-cigarette use versus those without comorbidity. Current smokers with asthma and cardiovascular disease had higher odds of current e-cigarette use. Former smokers with chronic obstructive pulmonary disease had higher odds of ever and current e-cigarette use and former smokers with cancer had lower odds of current e-cigarette use.
  
  
  CONCLUSIONS
  E-cigarette use by current and former smokers with medical comorbidities is substantial, especially among individuals with chronic lung or cardiovascular disease. Clinicians should routinely ask these patients about e-cigarette use, actively consider all pathways to help their patients quit combustible cigarettes, and recommend evidence-based treatments.
authors.affiliation: Division of General Internal Medicine, Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;; Harvard Medical School, Boston, Massachusetts. Electronic address: gkruse@mgh.harvard.edu.
authors.forename: Gina R
authors.initials: GR
authors.lastname: Kruse
authors.affiliation: Division of General Internal Medicine, Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;; Harvard Medical School, Boston, Massachusetts.
authors.forename: Sara
authors.initials: S
authors.lastname: Kalkhoran
authors.affiliation: Division of General Internal Medicine, Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;; Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology