Epilepsy and nicotine use: Exploring disparities in ENDS and cigarette use among US adults with epilepsy

Introduction: Individuals with epilepsy are at greater risk for tobacco use, which may exacerbate their health challenges. This study examines the prevalence and sociodemographic correlates of electronic nicotine delivery systems (ENDS), cigarette, and dual use among US adults with and without epilepsy. Methods: Data from the 2021-2023 National Health Interview Surveys were analyzed (N = 86,655 adults aged >= 18 years), including 1,579 (1.89 %, estimated 14.5 million US adults) with self-reported epilepsy (outcome variable). Participants were categorized into mutually exclusive groups: never-use of either product [reference group], current (used on some days or daily) cigarette-only use, ENDS-only, dual-use, former cigarette-only, former ENDS-only, and former dual-use. Weighted logistic regression models assessed the relationship between epilepsy and tobacco use, adjusting for sociodemographic characteristics. Results: Adults with epilepsy had higher rates of cigarette-only (16.51 % vs. 9.27 %), ENDS-only (5.56 % vs. 3.95 %), and dual use (3.53 % vs. 1.50 %) compared to those without epilepsy. Relative to never use, current cigarette-only use (AOR = 1.66, 95 %CI: 1.36-2.01), current ENDS-only use (AOR = 1.51, 95 %CI: 1.08-2.13), and current dual use (AOR = 2.29, 95 % CI: 1.56-3.48) were associated with higher odds of epilepsy after adjusting for demographic and health factors. Among adults with epilepsy, identifying as gay, lesbian, or bisexual was linked to higher odds of cigarette, ENDS, or dual use compared to straight individuals. Lower levels of education were associated with higher odds of cigarette smoking, while having health insurance was associated with lower odds among adults with epilepsy. Adults >= 35 were more likely to smoke cigarettes and less likely to use ENDS compared to younger age groups. Conclusion: Cigarette, ENDS, and dual use rates were higher in adults with epilepsy than in those without epilepsy. Social factors like sexual orientation, education, and insurance status further influence tobacco use within this population. Tailored cessation interventions are warranted for this vulnerable population to reduce disease burden.