Dear AJPM reader,


According to the Truth Initiative , high school student use of e-cigarettes in the past 30 days has increased from 11% in 2017 to 27.5% in 2019. In 2011, 0.6% of middle school students used e-cigarettes compared to 10.5% in 2019. Although e-cigarettes first became available on the market in 2007, the rapid acceleration in uptake has only occurred in recent years. Given the precipitous increase in use, their growing appeal to adolescents and young adults, and the lack of long term studies on the topic, more research is urgently needed on e-cigarettes and other electronic nicotine delivery systems (ENDS). This is especially true because some researchers have suggested they contribute to smoking cessation and harm reduction while others maintain ENDS are associated with greater health risk and may ultimately lead to combustible cigarette use. 

AJPM is pleased to feature several recent articles on ENDS that contribute importantly to the evidence base needed to clarify the long term impact of e-cigarette use. In our March issue, Parekh et al. estimate stroke risk for users of e-cigarettes and combustible cigarettes, while Osei and colleagues examine the association between e-cigarette use and development of COPD. In our previous issue (February), Bhatta and Glantz found an association between e-cigarettes and respiratory disease, with dual users at the highest risk.  

We hope you find these articles and the rest of our March issue to be timely, topical, and informative. 

Parek T, Pemmasani S, Desai R.
  • This study found current dual users of e-cigarettes and combustible cigarettes had 2.91 times higher odds of stroke than non-smokers and 1.83 times higher odds than current sole combustible cigarette users. 

Osei AD, Mirbolouk M, Orimoloye OA, et al.
  • Current e-cigarette users who had never smoked combustible cigarettes were found to have 75% higher odds of chronic bronchitis, emphysema, or chronic obstructive pulmonary disease compared with never e-cigarette users.

Bhatta DN, Glantz SA.
  • This longitudinal study found former and current e-cigarette use at Wave 1 was associated with having incident respiratory disease at Waves 2 or 3. Dual e-cigarette and combustible cigarette use was found to be riskier than using either product alone.

Yours in prevention and health,


Matthew L. Boulton, MD, MPH
Editor-in-Chief

American Journal of Preventive Medicine