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Abstract
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BACKGROUND AND AIMS: Responses to the 2019 US outbreak of 'e-cigarette or vaping product use-associated lung injury' (EVALI) ranged from temporary restrictions on nicotine e-cigarette sales to critiques of state cannabis policies. Yet, if either mass-marketed nicotine e-cigarettes or cannabis use per se drove this outbreak, as opposed to an additive in regionally available black market e-liquids, states' rates of vaping and/or cannabis use should predict their EVALI prevalence. This study tests that relationship.
DESIGN: Observational study of EVALI data from US states' health departments SETTING: United States PARTICIPANTS: All US states (N=50) MEASUREMENTS: The outcome of interest was each state's total EVALI cases per 12-64-year-old resident-an age-group covering most EVALI patients-as reported in the second week of January 2020. Predictors are 2017-2018 rates of adult e-cigarette use and past-month cannabis use, by state.
FINDINGS: The average state EVALI prevalence was 1.4 cases per 100,000 12-64-year-olds. Maps suggest a high-prevalence cluster comprising seven contiguous states in the northern Midwest. EVALI cases per capita were negatively associated with rates of vaping and past-month cannabis use, with the preferred specification's coefficients at -0.239 (95% Confidence Interval [CI]: -0.441, -0.037; P=0.02) and -0.086 (95% CI: -0.141, -0.031; P=0.003), respectively. Robustness checks supported the finding.
CONCLUSIONS: In the US, states with higher rates of e-cigarette and cannabis use prior to the 2019 'e-cigarette or vaping product use-associated lung injury' (EVALI) outbreak had lower EVALI prevalence. These results suggest that EVALI cases did not arise from e-cigarette or cannabis use per se, but rather from locally distributed e-liquids or additives most prevalent in the affected areas.
Language: en |