Relationship Between Chronic Lung Disease Diagnosis and Susceptibility to E-Cigarette Use in Adults: The Mediation Effects of Psychosocial,Cognitive Influences,and the Moderation Effect of Physiological Factors

Abstract

Background:

There is a paucity of studies on e-cigarette use among adults with chronic lung disease. Hence, little is recognized about the factors that may lead to e-cigarette use in this population. In the present study the researchers aim to assess whether psychosocial or cognitive factors elucidate the relationship between chronic lung disease and susceptibility to e-cigarette use and whether the relationship between chronic lung disease and e-cigarette use is conditional on the presence of respiratory symptoms.

Methods:

We recruited adults aged ≥ 18 years in Alabama with chronic lung disease from university medical clinics and those without chronic lung disease as a reference group. Questionnaires were completed by the subject groups to gather sociodemographic data and evaluate susceptibility to e-cigarette use, psychosocial factors, and cognitive factors. Mediation analysis was then used to assess a) whether the psychosocial factors or cognitive factors explained the association between chronic lung disease and susceptibility to using e-cigarettes and b) moderation analyses were conducted to decide if the respiratory factors would change the association between chronic lung disease and susceptibility to e-cigarette use.

Results:

Psychosocial factors (stress, depression, anxiety) and e-cigarette positive expectancy were predominantly high among individuals with chronic lung disease. Having chronic lung disease was associated with a lower likelihood of susceptibility to e-cigarette use. Higher levels of stress, smoking status, boredom, taste/sensor motor manipulation, and social facilitation were associated with higher odds of susceptibility to using e-cigarettes. Mediation analysis indicated a statistically significant indirect effect of chronic lung disease on the susceptibility to using e-cigarettes through stress and boredom reduction. However, our analyses did not reveal a statistically significant interaction between chronic lung disease and respiratory symptoms in the susceptibility to using e-cigarettes.

Conclusions:

Our findings call for further exploration to evaluate the temporal relationship between chronic lung disease status, psychosocial factors, cognitive factors, and susceptibility to using e-cigarettes.