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Studies of e-cigarette use among people without an established smoking history are informative for this question. A cross-sectional survey was administered across six geopolitical world regions to adults aged 18+ without a history of established cigarette smoking or regular use of other nicotine\/tobacco products. Two cohorts were defined based on e-cigarette use: \u201cVapers Cohort\u201d (N\u2009=\u2009491) who used e-cigarettes in the past 7\u00a0days and \u201cControl Cohort\u201d (N\u2009=\u2009247) who never regularly used e-cigarettes. Frequency of respiratory symptoms (Respiratory Symptom Evaluation Score (RSES)) were compared between cohorts, adjusting for sociodemographics. Tobacco use history and patterns of e-cigarette use was also examined. Respiratory symptoms were rare among both the Vapers and Control Cohorts: 83.3% and 88.4%, respectively, reported \u201crarely\u201d or \u201cnever\u201d experiencing all five RSES items (<jats:italic>p<\/jats:italic>\u2009=\u20090.125). The Vapers (vs. Control) Cohort reported modestly more frequent respiratory symptoms (adjusted mean RSES 1.61 vs. 1.43, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001); however, this difference (0.18) did not reach the threshold of clinical relevance (0.57). The Vapers (vs. Control) Cohort more often reported former cigarette experimentation (30.8% vs. 12.1%) and former infrequent use of other nicotine\/tobacco products (18.1% vs. 5.8%). The Vapers Cohort most often used disposable devices (63.7%) and multiple flavors (approximately 70\u201380% across primary device type). In this cohort of adults without a history of established combustible tobacco use, e-cigarette use was statistically linked to more frequent respiratory symptoms, though not in a clinically meaningful way. The cross-sectional design of this study cannot establish causality between e-cigarette use and respiratory symptoms.<\/jats:p>","DOI":"10.1038\/s41598-024-80221-8","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T18:52:29Z","timestamp":1731955949000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Respiratory symptoms among e-cigarette users without an established smoking history in the VERITAS cohort"],"prefix":"10.1038","volume":"14","author":[{"given":"Jefrrey Zamora","family":"Goicoechea","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Boughner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Jos\u00e9 Cirion","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Mahajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Yeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maris","family":"Sproga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Russell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Coughlan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arielle","family":"Selya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Caci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Caponnetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venera","family":"Tomaselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Polosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"key":"80221_CR1","doi-asserted-by":"publisher","unstructured":"Lindson, N. et al. 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None of these organizations had any role in, or oversight, of this study. AB is serving Pro Bono as Vice President, American Vapor Manufacturers \u2014Prescott, AZ. Serving Pro Bono as Ambassador, World Vapers Alliance Serving Pro Bono as President, South Carolina Vapor Association, Charleston, SC JJCL is the President of the board of Mexico y el Mundo Vapeando O.N.G. and a scholarship recipient from Knowledge-Action-Change, which received funding from the Foundation for a Smokefree World (FSFW). None of these organizations had any role in, or oversight, of this study. Court Lawyer for vaping industries AM is a recipient of two scholarships from Knowledge-Action-Change, which receives funding from the Foundation for a Smokefree World (FSFW). This organisation has not had any role in, or oversight, of this study. KY is the Co-Founder of the Consumer Advocacy movement Vaping Saved My Life (VSML) Act as a consultant for the Vapour Products Association of South Africa (VPASA), an industry association for vapor product manufacturers and retailers. A member of the Advisory Board for the World Vapers Alliance (W.V.A.), a global consumer advocacy group. Recipient of the Tobacco Harm Reduction Scholarship Programme and Advanced Scholarship Programme from Knowledge Action Change(K.A.C.). K.A.C. receives funding from the Foundation for a Smoke-Free World. MS is a co-founder of Smoke-Free Baltic tobacco harm reduction initiative and a recipient of a scholarship from Knowledge\u2014Action\u2014Change, which received funding from the Foundation for a Smokefree World (FSFW). None of these organizations had any role in, or oversight, of this study.  CR is Director of Russell Burnett Research and Consultancy Ltd, which has received research funding and\/or consultancy fees from manufacturers of e-cigarettes\/vaping products to conduct or consult on studies of individuals\u2019 perceptions and use of tobacco and nicotine products, including e-cigarettes\/vaping products. Michael Coughlan is a recipient of a scholarship from Knowledge-Action-Change, which received funding from the Foundation for a Smokefree World (FSFW). None of these organizations had any role in, or oversight, of this study. AS provides consulting services on tobacco harm reduction to Juul Labs, Inc. (JLI) through PinneyAssociates. She also individually provides consulting services on behavioral science to the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) through ECLAT Srl., which received funding from the Foundation for a Smokefree World (FSFW). None of these funders had any role in, or oversight, of this study. GC declares no conflict.  PC declares no conflict. VT declares no conflict. RP is full tenured professor of Internal Medicine at the University of Catania (Italy) and Medical Director of the Institute for Internal Medicine and Clinical Immunology at the same University. He has received grants from U-BIOPRED and AIR-PROM, Integral Rheumatology & Immunology Specialists Network (IRIS), Foundation for a Smoke Free World, Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A\/S, Sandoz, Merk Sharp & Dohme, Boehringer Ingelheim, Novartis, Arbi Group Srl., Duska Therapeutics, Forest Laboratories, Ministero dell Universita\u2019 e della Ricerca (MUR) Bando PNRR 3277\/2021 (CUP E63C22000900006) and 341\/2022 (CUP E63C22002080006), funded by NextGenerationEU of the European Union (EU), and the ministerial grant PON REACT-EU 2021 GREEN- Bando 3411\/2021 by Ministero dell Universita\u2019 e (MUR) \u2013 PNRR EU Community. He is founder of the Center for Tobacco Prevention and Treatment (CPCT) at the University of Catania and of the Center of Excellence for the Acceleration of Harm Reduction at the same university. He receives consultancy fees from Pfizer, Boehringer Ingelheim, Duska Therapeutics, Forest Laboratories, CV Therapeutics, Sermo Inc., GRG Health, Clarivate Analytics, Guidepoint Expert Network, and GLG Group.  He receives textbooks royalties from Elsevier. He is also involved in a patent application for ECLAT Srl. He is a pro bono scientific advisor for Lega Italiana Anti Fumo (LIAF) and the International Network of Nicotine Consumers Organizations (INNCO); and he is Chair of the European Technical Committee for Standardization on \u201cRequirements and test methods for emissions of electronic cigarettes\u201d (CEN\/TC 437; WG4).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study protocol received approval from the Ethics Review Board of the Dipartimento di Scienze della Formazione Sezione di Psicologia at the University of Catania (approval date, 25 November 2020). All participants provided written informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"28549"}}