Association between e-cigarette use, physical activity and cardiorespiratory fitness: protocol for a systematic review

BackgroundElectronic (e-) cigarettes are increasingly popular tobacco products on the US market. Traditional tobacco products are known to cause vascular dysfunction, one of the earliest indicators of cardiovascular disease (CVD) development. However, little is known about the effect of regular e-cigarette use on vascular function. The purpose of this study was to investigate the impact of regular e-cigarette use on vascular function and cardiovascular health in young, healthy adults.MethodsTwenty-one regular users of e-cigarettes (ECU) and twenty-one demographically matched non-users (NU) completed this study. Vascular health was assessed in the cutaneous microcirculation through different reactivity tests to evaluate overall functionality, endothelium-dependent vasodilation (EDD), and endothelium-independent vasodilation (EID). Macrovascular function was assessed using flow-mediated dilation (FMD).ResultsOur results suggest that regular users of e-cigarettes present with premature microvascular impairment when compared to non-users. Specifically, they exhibit lower hyperemic (p = 0.003), thermal (p = 0.010), and EDD (p = 0.004) responses. No differences in EID between the groups were identified. We also identified that individuals who use e-cigarettes for longer than 3 years also present with systemic manifestations, as observed by significantly reduced macrovascular (p = 0.002) and microvascular (p ≤ 0.044) function.ConclusionsOur novel data suggests that young, apparently healthy, regular users of e-cigarettes present with premature vascular dysfunction in the microcirculation when compared to non-users. We have also identified systemic vascular dysfunction affecting both the micro and macrovasculature in those young individuals who used e-cigarettes for longer than 3 years. Taken together, these findings associate regular e-cigarette use with premature vascular dysfunctions and adverse cardiovascular outcomes.

Electronic nicotine delivery systems, often referred to as e-cigarettes, are popular tobacco products frequently advertised as safer alternatives to traditional cigarettes despite preliminary data suggesting a potential negative cardiovascular impact. Cardiorespiratory fitness is a critical cardiovascular health marker that is diminished in individuals who consume traditional tobacco products. Whether the use of e-cigarettes impacts cardiorespiratory fitness is currently unknown. Thus, the purpose of this study was to investigate the impact of regular e-cigarette use on cardiorespiratory fitness in young healthy adults. Twenty-six users of e-cigarettes (ECU, 13 males, and 13 females; age: 24 ± 3 yr; e-cigarette usage 4 ± 2 yr) and 16 demographically matched nonusers (NU, 6 males, and 10 females; age: 23 ± 3 yr) participated in this study. Cardiorespiratory fitness was measured by peak oxygen consumption (V̇o2peak) during a cardiopulmonary exercise test. Measurements of chronotropic response, hemodynamic, oxygen extraction, and utilization were also evaluated. Our results suggest that regular users of e-cigarettes exhibited significantly lower peak oxygen consumption when compared with nonusers, even when controlled by fat-free mass and lean body mass. Hemodynamic changes were not different between both groups during exercise, whereas lower chronotropic responses and skeletal muscle oxygen utilization were observed in users of e-cigarettes. Results from the present study demonstrate that young, apparently healthy, regular users of e-cigarettes exhibit significantly reduced cardiorespiratory fitness, lower chronotropic response, and impaired skeletal muscle oxygen utilization during exercise. Overall, our findings contribute to the growing body of evidence that supports adverse effects of regular e-cigarette use on cardiovascular health.NEW & NOTEWORTHY E-cigarettes are tobacco products frequently used by youth and young adults. Little is known about the long-term health effects of their prolonged use. Results from the present study demonstrate that young, apparently healthy, regular users of e-cigarettes exhibit significantly reduced cardiorespiratory fitness, a marker of cardiovascular health and a predictor of all-cause mortality. We also identified that the young users of e-cigarettes present with lower chronotropic response and impaired skeletal muscle oxygen utilization during exercise.

Association of Attention-Deficit/Hyperactivity Disorder With E-Cigarette Use

The use of e-cigarettes and vaping devices has increased exponentially in recent years, primarily affecting teenagers and young adults. These products have been widely accepted as safer alternatives to traditional smoking, often marketed as aids for smokers looking to avoid the tar and toxins associated with regular cigarettes. However, despite their popularity, e-cigarettes pose serious health risks, necessitating stronger public policies to mitigate their dangers. The recent surge in vaping, particularly among young people, has raised significant health concerns. According to the 2024 National Youth Tobacco Survey (NYTS) conducted by the CDC, e-cigarette use among youth remains a severe public health threat. The survey found that 5.9% of middle and high school students—equivalent to 1.63 million individuals—reported current use of e-cigarettes in 2024. Alarmingly, 38.4% of these users reported frequent use, while 26.3% reported daily use, indicating signs of nicotine addiction. Although e-cigarettes are perceived as less harmful than conventional cigarettes, they are not entirely safe. Users are exposed to dangerous substances such as nicotine, heavy metals, and volatile organic compounds. Most e-cigarette products contain nicotine, the primary addictive component, which can lead to dependence. The health risks associated with e-cigarette use include worsening asthma symptoms, increased frequency of bronchitis, and a higher risk of lung infections. Additionally, nicotine raises heart rate, increases blood pressure, and may irritate blood vessels. A particularly concerning issue is E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), which emerged as a serious health condition in 2019. Symptoms of EVALI include cough, difficulty breathing, chest pain, nausea, and fatigue. The rising prevalence of adolescent e-cigarette use underscores the urgency of addressing this public health crisis. Governments worldwide are taking action to combat the e-cigarette epidemic. For instance, the UK government has introduced legislation to ban the sale of single-use vapes starting June 1, 2025. This initiative aims to reduce environmental impact and curb the growing youth vaping trend. Policymakers must take stronger measures to mitigate the associated health risks. Strict regulations on the marketing and sale of e-cigarettes are essential, as these products often target underage individuals through misleading advertisements. Flavored e-cigarettes, which appeal to younger users, should be banned entirely. Additionally, only adult smokers seeking to quit should have access to e-cigarettes, with stricter age verification measures ensuring compliance. Public health campaigns play a crucial role in educating both young people and adults about the risks of vaping. These initiatives should focus on dispelling the myth that e-cigarettes are risk-free and emphasize the potential for nicotine addiction and long-term health consequences. Raising awareness about the dangers of vaping is vital to preventing the next generation from developing nicotine dependency. While e-cigarettes may have a place in harm reduction strategies for adult smokers, their widespread use—especially among youth—poses significant public health challenges. A comprehensive approach involving stricter regulations, targeted education, and ongoing research is necessary to mitigate the risks associated with e-cigarette use and prevent a new generation from becoming addicted to nicotine.

Diverse e-cigarette regulations in the Asia Pacific: A health economic perspective.

Use of electronic cigarettes (e-cigarettes) among young adults (i.e., individuals aged 18 - 24) has increased substantially in recent years. Consistent with an established reciprocal model of pain and substance use, evidence demonstrates that pain increases risk for initiation and continued use of e-cigarettes, as well as dual use of e-cigarettes and other tobacco products. Meta-analytic findings also indicate that many young adults experience chronic pain (~ 12%); however, we are not aware of any prior research examining associations between pain, e-cigarette use, and dependence among young adults. Data was drawn from 10,267 young adults (68% White; 50% Female) aged 18 - 24 who participated in Wave 7 (2022 - 2023) of the Population Assessment of Tobacco and Health (PATH) Study. Logistic regression models indicated that moderate/severe pain (vs. no/low pain) was associated with greater odds of lifetime, current, and daily e-cigarette use. Moderate/severe pain was associated with greater odds of exclusive e-cigarette use, exclusive use of other tobacco products, and dual use of e-cigarettes and other tobacco products. Linear regression analyses further revealed that moderate/severe pain was positively associated with tobacco dependence. These findings suggest that moderate/severe pain may serve as a risk factor for e-cigarette use, dependence, and dual e-cigarette and other tobacco product use among young adults. Future prospective research is needed to clarify temporal precedence in the onset of moderate/severe pain and e-cigarette use among young adults. Clinical interventions focused on e-cigarette prevention and cessation among young adults with chronic pain may also be warranted.

* Abbreviation: E-cigarette — : electronic cigarette In a longitudinal study in this month’s issue of Pediatrics , Bold et al1 examined past-month cigarette and electronic cigarette (e-cigarette) use in high school students from 2013 to 2015 in Connecticut. They found that having used an e-cigarette in the past month significantly and strongly predicted combustible cigarette use. The odds of e-cigarette use at each wave predicting future cigarette use was 7.08 from wave 1 to 2 and 3.87 from wave 2 to 3. Not surprisingly, e-cigarette use leads to traditional product use. In contrast, traditional combustible cigarette use did not predict future e-cigarette use. And a substantial proportion of both cigarette and e-cigarette users progressed to heavy use, reporting that they smoked 21 to 30 days in the past month at the 2-year follow-up. This is consistent with patterns of use seen with young people’s increasing addiction to nicotine in numerous studies.2 E-cigarette products were not part of … Address correspondence to Jonathan D. Klein, MD, MPH, Pediatrics, University of Illinois at Chicago, 820 S. Wood St, Chicago, IL 60612. E-mail: jonklein{at}uic.edu

Purpose To evaluate the effects of a combination of wheelchair mobility skills (WMS) training and exercise training on physical activity (PA), WMS, confidence in wheelchair mobility, and physical fitness. Methods Youth using a manual wheelchair (n = 60) participated in this practice-based intervention, with a waiting list period (16 weeks), exercise training (8 weeks), WMS training (8 weeks), and follow-up (16 weeks). Repeated measures included: PA (Activ8), WMS (Utrecht Pediatric Wheelchair Mobility Skills Test), confidence in wheelchair mobility (Wheelchair Mobility Confidence Scale), and physical fitness (cardiorespiratory fitness, (an)aerobic performance) and were analysed per outcome parameter using a multilevel model analyses. Differences between the waiting list and training period were determined with an unpaired sample t-test. Results Multilevel model analysis showed significant positive effects for PA (p = 0.01), WMS (p < 0.001), confidence in wheelchair mobility (p < 0.001), aerobic (p < 0.001), and anaerobic performance (p < 0.001). Unpaired sample t-tests underscored these effects for PA (p < 0.01) and WMS (p < 0.001). There were no effects on cardiorespiratory fitness. The order of training (exercise before WMS) had a significant effect on confidence in wheelchair mobility. Conclusions A combination of exercise and WMS training appears to have significant positive long-term effects on PA, WMS, confidence in wheelchair mobility, and (an)aerobic performance in youth using a manual wheelchair. Implications for rehabilitation Exercise training and wheelchair mobility skills (WMS) training can lead to a sustained improvement in physical activity (PA) in youth using a manual wheelchair. These combined trainings can also lead to a sustained increase in WMS, confidence in wheelchair mobility, and (an)aerobic performance. More attention is needed in clinical practice and in research towards improving PA in youth using a manual wheelchair.

BackgroundThe use of electronic cigarettes (e-cigarettes) is rising globally, including in the UAE. They are often marketed as harm reduction tools and potential aids for smoking cessation, but their long-term health effects remain unclear.ObjectiveTo determine the prevalence and patterns of e-cigarette and tobacco use among adults in the UAE, and to assess sociodemographic and behavioral factors influencing e-cigarette use.MethodsA cross-sectional study was conducted in 2024 using a structured, self-administered questionnaire. Participants aged 18 years and older were recruited through convenience sampling across public places in the UAE. The questionnaire, available in English, Arabic, Urdu, and Hindi, included items on demographics, smoking and vaping behavior, quit attempts, and influencing factors. Data were analyzed using SPSS version 29. Chi-square tests were used for bivariate analysis to identify associations (p ≤ 0.05). Multivariable logistic regression was performed to determine independent predictors of e-cigarette use, with adjusted odds ratios (AOR) and 95% confidence intervals reported.ResultsAmong the 1,500 participants, 27.6% reported ever using tobacco products, and 14.1% were current smokers. Cigarettes were the most common product used (22.3%), followed by e-cigarettes (6.1%), shisha (5.6%), and dhokha (1.4%). E-cigarette use was more prevalent among younger adults (10.1% among 18–24-year-olds), females (7.8%), those with higher education, singles, and students. Behavioral factors such as stress, curiosity, social influence, and coping mechanisms were significantly associated with e-cigarette use.ConclusionE-cigarette use in the UAE is influenced by a combination of sociodemographic and behavioral factors. The findings highlight the importance of separating e-cigarette use from traditional tobacco consumption in public health research and interventions, particularly when targeting younger populations.

Back to table of contents Previous article Next article Government NewsFull AccessE-Cigarette Use Rising SharplyLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:28 Sep 2018https://doi.org/10.1176/appi.pn.2018.10a51AbstractWhile the FDA was focused on youth use of combustible cigarettes, another tobacco product has caught on like wildfire among adolescents: e-cigarettes.The FDA delayed implementation last year of an Obama-era law that would have more tightly regulated e-cigarettes and banned flavoring. These products are now sold in youth-enticing flavors, such as creme brulee, cotton candy, gummi bear, and “unicorn milk” and are easy for teens to buy online. The FDA is now reconsidering its decision. To try to address this epidemic, the FDA launched a multimedia campaign last month to educate youth about the dangers of e-cigarettes, “The Real Cost Youth E-Cigarette Prevention Campaign.” In addition, the FDA issued warning letters and fined 1,300 retailers who illegally sold the products to minors. The FDA also requested manufacturers to provide plans on how to curtail use of their products by minors. Fueling the epidemic among adolescents is a specific type of e-cigarette known as “pod mods,” particularly the Juul brand, according to an article last month in the New England Journal of Medicine (NEJM). The authors of the NEJM study, Jessica L. Barrington-Trimis, Ph.D., and Adam M. Leventhal, Ph.D., pointed out that just one of the Juul-brand pod mods delivers as much nicotine as an entire pack of cigarettes, and they come in appealing flavors like mango, creme brulee, and fruit medley. The slim devices, which closely resemble a portable charger or memory stick, are rechargeable and easy to conceal. Fun “skins” are available to personalize them. Because pod mods are so easy to use and don’t produce smoke, kids can use them without the awareness of teachers, parents, and other adults with whom they interact. The majority of 15- to 24-year-olds surveyed (63 percent) did not know that nicotine is present in all Juul products, the authors wrote. “Nicotine adversely affects the developing brain and causes addiction,” the authors noted. “Adolescent exposure to nicotine is associated with an increased risk of mood and attention problems. Given the high nicotine concentrations in pod mods, the nicotine-related health consequences of use by young people could be worse than those from most e-cigarette products.” Pod mods have few of the deterrents of combustible cigarettes, such as the noxious taste and sensations of the initial smoking experience, which may explain why 80 percent of 15- to 24-year-olds who try Juul continue to use the product. Because of the high nicotine content, pod mods may also increase the risk of switching to combustible cigarette smoking.“Comprehensive actions are urgently needed to counteract adolescents’ use of pod mods and other e-cigarettes. In the meantime, we advise physicians and parents to remain on alert regarding this emerging public health concern,” the authors concluded. ■“Adolescents’ Use of ‘Pod Mod’ E-Cigarettes—Urgent Concerns” can be accessed here. The FDA’s statement on the steps it has taken to address the epidemic of youth use of e-cigarettes is available here.See related article: FDA’s ‘Real Cost’ Campaign Cuts Cigarette Smoking by Teens. ISSUES NewArchived

To examine the predictive strength of cardiorespiratory fitness (CRF), motor competence (MC), maternal educational status, and parental perception of their children's favorite leisure activities for meeting physical activity (PA) guidelines of each gender among children aged 3-6 years. This is a cross-sectional study with 367 preschoolers (53% girls), assessing CRF (PREFIT 20m shuttle run), MC (battery of motor skills), PA (accelerometry), maternal education and parental perception of children's preferred leisure (questionnaires). Factorial analysis of covariance, multiple logistic regression, and chi-square tests were conducted. In both genders, CRF was associated with meeting PA guidelines (girls: odds ratio [OR] 1.10; 95% confidence interval [CI] 1.03-1.18; boys: OR 1.12; 95%CI 1.05-1.19), independently of maternal education or parental perception of children's leisure activities. For girls, active leisure with balls (OR 28.91; 95%CI 6.88-121.50) and without balls (OR 4.32; 95%CI 1.95-9.57) enhanced the odds of compliance with PA guidelines, without effect of maternal education. For boys, maternal education was inversely associated with meeting the PA guidelines. Boys of lower-educated mothers were more likely to have activities with balls as favorite leisure, which was a stronger predictor and enhanced the odds of meeting the guidelines (OR 4.09; 95%CI 1.71-9.79) regardless of maternal education. Boys had a higher prevalence of active leisure with balls than girls (42.8 vs. 7.7%). Regardless of CRF or MC, family and sociocultural circumstances influenced PA according to gender. Health policies should encourage equal gender participation in culturally significant sports or activities of a particular region/country, specifically within the family context.

ABSTRACTA variety of electronic cigarettes (e-cigarettes) are sold in Japan and targeted toward young people. However, few studies have considered who uses e-cigarettes and why they use them. This study examined factors associated with e-cigarette use and the reasons for their use among the young population in Japan. Our internet-based cross-sectional study was conducted between February and March 2019. We analyzed the data of 2,414 participants aged 15–29 years to identify factors associated with e-cigarette use in the last 12 months and assess the reasons participants gave for their use. We found 4.3% of the participants had used e-cigarettes in the past 12 months. The multivariable logistic regression showed that the use of combustible or heated tobacco and perceiving e-cigarette use as an attractive behavior were associated with having used e-cigarettes. Interest in fruit flavors, stylish design and function of e-cigarettes, and the influence of friends using e-cigarettes were major reasons for their use. Although e-cigarette users are still a minority among this population, the flavors and design of e-cigarette products attract young people, and gain popularity in the youth community. This highlights an urgent need for the monitoring of e-cigarette and tobacco use among the young population in Japan.

In recent years, the popularity of alternative nicotine delivery systems (ANDS)including electronic cigarettes, heated tobacco products (HTPs), nicotine pouches, snus, and nicotine gums-has rapidly increased, particularly among adolescents and young adults.This review summarizes current literature regarding the composition and toxicity of aerosols generated by e-cigarettes and other ANDS, emphasizing their cytotoxic, oxidative, and inflammatory effects.Researchers increasingly discuss the potential of these products to induce both acute conditions (e.g., EVALI) and chronic respiratory diseases (e.g., chronic obstructive pulmonary disease [COPD], asthma).The review places special focus on the toxicity of flavoring agents and the disproportionate risks faced by vulnerable populations, particularly youth.In Europe, approximately 12-15% of adolescents report regular e-cigarette use, with increasing consumption of other products such as snus and nicotine pouches.While ANDS may reduce certain risks compared to combustible cigarettes, accumulating evidence demonstrates that they are not harmless.Further longitudinal and comparative studies are necessary to comprehensively assess the health impacts of these diverse nicotine delivery products.

Gendered associations between e-cigarette use, cigarette smoking, physical activity, and sedentary behaviour in a sample of Canadian adolescents.

Dual use of electronic cigarettes (e-cigarettes) and combustible cigarettes is a major public health issue. It is generally accepted that exclusive e-cigarette use is less harmful than exclusive combustible cigarette use, but most e-cigarette users continue to smoke combustible cigarettes as well. To what extent the use of e-cigarettes reduces harm in people who continue to smoke combustible cigarettes has been debated. The aim of this study was to explore the utility of biomarkers as measures of dual use. In two human studies of participants who used e-cigarettes only or both combustible cigarettes and e-cigarettes, we measured urine concentrations of the metabolites of nicotine (total nicotine equivalents) as well as two biomarkers of tobacco exposure: 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a tobacco-specific carcinogen metabolite, and nicotelline, a tobacco alkaloid not found in significant concentrations in e-cigarette products. The presence of nicotine metabolites indicates either e-cigarette or combustible cigarette use. Nicotelline (half-life of 2-3 hours) indicates recent combustible cigarette use and NNAL (half-life of 10 days or more), indicates combustible cigarette use occurring within several weeks prior to sample collection. Nicotelline and NNAL are useful biomarkers for combustible tobacco use in users e-cigarettes. The application of these biomarkers provides a tool to help assess whether, or to what extent, dual use of e-cigarettes and combustible cigarettes reduces harm compared to sole use of combustible cigarettes. These biomarkers can also verify exclusive use of e-cigarettes over short (24 hour) or long (several week) time periods. To what extent dual use of e-cigarettes and combustible cigarettes reduce harm compared to smoking combustible cigarettes only is of considerable public health interest. We show that the levels of the minor tobacco alkaloid nicotelline and the nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are extremely low in electronic cigarette fluids. The urine biomarkers nicotelline and the NNK metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) are indicative of cigarette smoking and can be used to assess recent and past smoking in dual users.