The effects of electronic cigarette use patterns on health-related symptom burden and quality of life: analysis of US prospective longitudinal cohort study data

Objective This study aimed to examine the association between e-cigarette (EC) use patterns and health-related symptoms (fatigue, pain, and emotional problems) as well as general quality of life (QoL). Methods Data were analyzed from 7,225 adults across Waves 1-6 of the US Population Assessment of Tobacco and Health (PATH) study. Current combustible cigarette (CC) or EC use patterns included dual CC/EC use, exclusive EC use, non-current use of CC or EC, and exclusive CC smoking. Multivariate linear mixed-effects models were used to investigate longitudinal associations between EC use patterns, and symptom burdens/QoL scores. Results Those who were not currently smoking or vaping reported the lowest fatigue, pain, and emotional problems, and the best QoL, among the four groups (all p < 0.001). Compared to exclusive CC smoking, exclusive EC use was associated with a significant decrease of 0.065 units in average fatigue (95% confidence interval [CI]: -0.121, -0.009), of 0.206 units in average pain (95% CI: -0.355, -0.058), and of 0.103 units in average QoL scores (95% CI: -0.155, -0.051), with emotional problems similar over time. Conclusion Exclusive EC users had less health-related symptoms and better QoL than those who were exclusive CC smokers. This should be taken into account when assessing the harm reduction potential of ECs.