Higher rates of e-cigarette use did not result in more vaping-related ‘EVALI’ lung injuries during last year’s outbreak, a US study has found.
The study considered the relationship between a state’s total reported per capita cases of ‘of e-cigarette, or vaping, product use associated lung injury’ as of January 2020 and the pre-outbreak rates of adult vaping and cannabis use.
The results, from Yale School of Public Health, showed that higher rates of e-cigarette and cannabis use were associated with fewer EVALI cases per capita.
Assistant Professor Abigail Friedman, author of the study, said:
“If e-cigarette or cannabis use per se drove this outbreak, areas with more engagement in those behaviours should show a higher EVALI prevalence, this study finds the opposite result.
“Alongside geographic clusters of high EVALI prevalence states, these findings are more consistent with locally available e-liquids or additives driving the EVALI outbreak than a widely used, nationally-available product.”
The lung injury outbreak motivated number of states and the federal government to restrict the sales of nicotine-containing e-cigarettes.
This included a temporary ban on all e-cigarette sales in Massachusetts in 2019 then bans on flavoured e-cigarette sales in New York.
The study suggests that if the goal was to reduce the EVALI risk, the regulators may be targeting the wrong behaviour.
It also suggests that the lung injury cases did not arise from e‐cigarette or cannabis use per se, but rather from locally distributed additives most prevalent in the affected areas.
Meanwhile, well-established and legal markets may have driven down demand for more harmful ‘informally sourced’ e-liquid, Friedman said.
All of the five earliest states to have legalised recreational cannabis had fewer than one EVALI case per 100,000 residents.
None of the highest EVALI-prevalence states (Utah, North Dakota, Minnesota, Delaware and Indiana) allowed recreational cannabis use.
“If this policy led some recreational marijuana smokers to switch to vaping THC, perhaps in order to avoid detection, it would have increased their likelihood of exposure to contaminated e-liquids when those came on the market.
“This may have contributed to the higher EVALI prevalence in those states.”
Story Source: Wiley Online Library