Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; and Department of Physical and Occupational Therapy, School of Health Profession, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
Respir Care. 2022 Jul;67(7):814-822. doi: 10.4187/respcare.09579. Epub 2022 Apr 19.
Adults with chronic lung disease use electronic cigarettes (e-cigarette) at higher rates than those without chronic lung disease. Because e-cigarettes have now been shown to cause adverse pulmonary effects and impair immune responses, it is particularly important to identify the factors that contribute to e-cigarette use in individuals with chronic lung disease. We tested whether mental health explains the association between chronic lung disease and e-cigarette use, and whether the association between chronic lung disease and e-cigarette use is conditional on the presence of respiratory symptoms.
Data were obtained from the 2018 Behavioral Risk Factor Surveillance System. Logistic regression was used to test the association between chronic lung disease status and e-cigarette use when controlling for demographic variables and comorbidities. Structural equation modeling was then used to evaluate (a) whether the number of bad mental health days in the past 30 days explained the association between chronic lung disease and e-cigarette use, and (b) if respiratory symptoms moderated the association between chronic lung disease and e-cigarette use.
The prevalence of lifetime and current e-cigarette use was significantly higher in those with than in those without chronic lung disease, as was the number of bad mental health days in the past 30 days. Mediation analysis indicated a statistically significant indirect effect of chronic lung disease on the likelihood of e-cigarette use (lifetime and current) through mental health. However, our analyses did not indicate a statistically significant interaction between chronic lung disease and respiratory symptoms in the likelihood of e-cigarette use.
The association between chronic lung disease and e-cigarette use may be due, in part, to poorer mental health among individuals with chronic lung disease. These findings provide preliminary evidence that improving the mental health of individuals with chronic lung disease could reduce e-cigarette use in this vulnerable population.
患有慢性肺部疾病的成年人使用电子烟（电子烟）的比率高于没有慢性肺部疾病的成年人。由于电子烟现已被证明会引起肺部不良反应并损害免疫反应，因此，特别重要的是要确定导致患有慢性肺部疾病的个体使用电子烟的因素。我们测试了心理健康是否可以解释慢性肺部疾病与电子烟使用之间的关联，以及慢性肺部疾病与电子烟使用之间的关联是否取决于是否存在呼吸道症状。
数据来自 2018 年行为风险因素监测系统。在控制人口统计学变量和合并症的情况下，使用逻辑回归测试慢性肺部疾病状况与电子烟使用之间的关联。然后，使用结构方程模型评估（a）过去 30 天内不良心理健康天数的数量是否解释了慢性肺部疾病与电子烟使用之间的关联，以及（b）呼吸道症状是否调节了慢性肺部疾病与电子烟使用之间的关联。
与没有慢性肺部疾病的人相比，患有慢性肺部疾病的人终生和当前使用电子烟的比例以及过去 30 天内不良心理健康天数的比例均较高。中介分析表明，慢性肺部疾病通过心理健康对电子烟使用（终生和当前）的可能性具有统计学上显著的间接影响。但是，我们的分析并未表明慢性肺部疾病和呼吸道症状之间在电子烟使用可能性方面存在统计学上显著的相互作用。
慢性肺部疾病与电子烟使用之间的关联可能部分归因于患有慢性肺部疾病的个体的心理健康状况较差。这些发现初步表明，改善患有慢性肺部疾病的个体的心理健康状况可能会减少该脆弱人群中电子烟的使用。
