Global study zeroes in on vaping's respiratory risks among exclusive e-cigarette users

By Dr. Sanchari Sinha Dutta, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Nov 8 2023

The global cross-sectional VERITAS survey involving six different regions throughout the world has been designed by a team of international scientists to exclusively explore the impact of vaping on respiratory health.

Study: Global health survey of people who vape and never smoked. Protocol for the Vaping Effects: Real-world InTernAtional Surveillance (VERITAS) Study. Image Credit: New Africa / Shutterstock.com

*Important notice: Preprints publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Background

Electronic cigarettes are battery-operated electronic devices that vaporize nicotine for inhalation. Due to their non-combustion mode of action, e-cigarettes do not produce smoke, which causes many people to perceive e-cigarettes as a lless harmful alternative to conventional tobacco cigarettes.

In addition to nicotine, e-cigarettes contain a variety of chemicals, including flavoring agents. Current evidence indicates that these chemicals, along with nicotine, might have harmful effects on respiratory health.

To date, most studies investigating the long-term health effects of vaping have included people with a history of smoking. This makes it difficult to differentiate the actual health effects of vaping from those caused by previous smoking habits.

The current global cross-sectional study has been designed to explore the long-term respiratory health effects of frequent vaping. Self-reported respiratory symptoms of never smokers who vape daily will be compared with those without a history of smoking, vaping, or using any other nicotine products.

Study design

The current multi-country cross-sectional survey plans to initially screen interested candidates for their eligibility through an online survey. This will be followed by a telephone or email-based conversation with potential participants to confirm their eligibility for the final survey.

After final screening, the selected participants will be subjected to a web- or mobile-based survey for data collection. After successful completion of the survey, participants will be provided with an Amazon or Take-A-Lot gift card code of an equivalent value of $30 USD as a token of appreciation for their participation in the survey.

Study population

The study plans to recruit a total of 750 people who are eligible for inclusion in either the “vaper cohort,” which will comprise participants who vape regularly but never smoked, or the “control cohort,” which will include participants without a history of vaping or smoking. The participants will be selected from six world regions, including Africa and the Middle East, North America, Latino and South America, Asia-Pacific, Western Europe, and Eastern Europe.  

Enrollment for the vapers cohort will be conducted by a team of carefully selected recruiters through social media channels, WhatsApp groups, google email groups, posters in vape shops and universities, recommendations from other participants, and recommendations from local vape shop owners.

For the control cohort, participants will be selected among friends and acquaintances of the vaping participants. They will be age- and sex-matched to the extent possible.

Eligibility of participants

For inclusion in the study, participants should be adults aged 18 years or older and non-smokers or have a very limited history of smoking. All participants should provide written informed consent to participate in the study.  

For the vaper cohort, participants should be vaping regularly and using commercially available vaping products daily. These individuals should be vaping for at least three consecutive months before enrollment. Furthermore, these cohort participants should not have a smoking history at all or should not have been smoking in the past six months.

For control cohort inclusion, participants should not be smoking, vaping, or using any nicotine-based products.

Study procedure

The VERITAS web-based Internet survey software will be used for data collection. This software is intended to optimize material presentation for study participants and facilitate data submission across various devices, including laptops, smartphones, and tablets. The software is compatible with all web browsers, including Chrome, Safari, Firefox, and Internet Explorer.  

Using the online survey questionnaire, the vaper cohort participants will be asked about their historical and current patterns of using three types of vaping products, including disposable vaping products, rechargeable pre-filled pod vaping products, and rechargeable refillable vaping products.  

All participants will then be asked to complete the Respiratory Symptom Experience Scale (RSES), which is a validated scale to assess the frequency of experiencing five respiratory symptoms in the past 30 days. These symptoms include morning cough with mucous, daily coughing frequency, breathlessness hampering normal daily activities, frequency of breathlessness during normal daily activities, and wheezing or whistling in the chest while not doing any physically strenuous daily activities or exercise.

RSES scores will be compared between the vape and control cohorts. In addition, the study will collect information to characterize the vape group participants by age of vaping initiation, reasons for initiation, types of products used, flavor preference, frequency and level of nicotine use, weekly frequency of vaping, and number of flavors used monthly.

The recruitment of participants started in April 2023, and study enrollment is expected to complete by November 2023. This study will be the first of its kind to provide a detailed overview of the respiratory health effects of vaping among regular vapers who do not have a history of smoking.

*Important notice: Preprints publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.