{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:42:01Z","timestamp":1790790121423,"version":"4.1.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2022,4,2]],"date-time":"2022-04-02T00:00:00Z","timestamp":1648857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Center for Tobacco Products, Food and Drug Administration","award":["HHSN271201100027C"],"award-info":[{"award-number":["HHSN271201100027C"]}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["HHSN271201100027C"],"award-info":[{"award-number":["HHSN271201100027C"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>We examined the relationship between current tobacco use and functionally important respiratory symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Longitudinal cohort study of 16 295 US adults without COPD in Waves 2\u20133 (W2\u20133, 2014\u20132016) of the Population Assessment of Tobacco and Health Study. Exposure\u2014Ten mutually exclusive categories of tobacco use including single product, multiple product, former, and never use (reference). Outcome\u2014Seven questions assessing wheezing\/cough were summed to create a respiratory symptom index; cutoffs of \u22652 and \u22653 were associated with functional limitations and poorer health. Multivariable regressions examined both cutoffs cross-sectionally and change over approximately 12 months, adjusting for confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All tobacco use categories featuring cigarettes (&amp;gt;2\/3\u2019s of users) were associated with higher risk (vs. never users) for functionally important respiratory symptoms at W2, for example, at symptom severity\u2005\u2265\u20053, risk ratio for exclusive cigarette use was 2.34 [95% CI, 1.92, 2.85] and for worsening symptoms at W3 was 2.80 [2.08, 3.76]. There was largely no increased symptom risk for exclusive use of cigars, smokeless tobacco, hookah, or e-cigarettes (adjustment for pack-years and marijuana attenuated the cross-sectional e-cigarette association from 1.53(95% CI 0.98, 2.40) to 1.05 (0.67, 1.63); RRs for these products were also significantly lower compared to exclusive use of cigarettes. The longitudinal e-cigarette\u2013respiratory symptom association was sensitive to the respiratory index cutoff level; exclusive e-cigarette use was associated with worsening symptoms at an index cutoff\u2005\u2265\u20052 (RR\u2005=\u20051.63 [1.02, 2.59]) and with symptom improvement at an index cutoff of\u2005\u2265\u20053 (RR\u2005=\u20051.64 [1.04, 2.58]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Past and current cigarette smoking drove functionally important respiratory symptoms, while exclusive use of other tobacco products was largely not associated. However, the relationship between e-cigarette use and symptoms was sensitive to adjustment for pack-years and symptom severity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>How noncigarette tobacco products affect respiratory symptoms is not clear; some studies implicate e-cigarettes. We examined functionally important respiratory symptoms (wheezing\/nighttime cough) among US adults without COPD. The majority of adult tobacco users smoke cigarettes and have higher risk of respiratory symptoms and worsening of symptoms, regardless of other products used with them. Exclusive use of other tobacco products (e-cigarettes, cigars, smokeless, hookah) was largely not associated with functionally important respiratory symptoms and risks associated with their use was significantly lower than for cigarettes. The association for e-cigarettes was greatly attenuated by adjustment for cigarette pack-years and sensitive to how symptoms were defined.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntac080","type":"journal-article","created":{"date-parts":[[2022,4,2]],"date-time":"2022-04-02T17:31:13Z","timestamp":1648920673000},"page":"1607-1618","source":"Crossref","is-referenced-by-count":41,"title":["Tobacco Use and Respiratory Symptoms Among Adults: Findings From the Longitudinal Population Assessment of Tobacco and Health (PATH) Study 2014\u20132016"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8213-8868","authenticated-orcid":false,"given":"James D","family":"Sargent","sequence":"first","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth , Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8703-3811","authenticated-orcid":false,"given":"Michael J","family":"Halenar","sequence":"additional","affiliation":[{"name":"Westat , Rockville, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn C","family":"Edwards","sequence":"additional","affiliation":[{"name":"Westat , Rockville, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Woloshin","sequence":"additional","affiliation":[{"name":"Dartmouth Institute for Health Policy and Clinical Practice, The C. Everett Koop Institute at Dartmouth, The Lisa Schwartz Foundation , Lebanon, NH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Dartmouth Institute for Health Policy and Clinical Practice, The C. Everett Koop Institute at Dartmouth, The Lisa Schwartz Foundation , Lebanon, NH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Emond","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth , Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5077-8337","authenticated-orcid":false,"given":"Susanne","family":"Tanski","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth , Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristie A","family":"Taylor","sequence":"additional","affiliation":[{"name":"Westat , Rockville, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0075-7471","authenticated-orcid":false,"given":"John P","family":"Pierce","sequence":"additional","affiliation":[{"name":"Moore\u2019s Cancer Center, University of California at San Diego , San Diego, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Liu","sequence":"additional","affiliation":[{"name":"Westat , Rockville, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej L","family":"Goniewicz","sequence":"additional","affiliation":[{"name":"Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Niaura","sequence":"additional","affiliation":[{"name":"New York University , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Anic","sequence":"additional","affiliation":[{"name":"U.S. Food and Drug Administration, Center for Tobacco Products , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanling","family":"Chen","sequence":"additional","affiliation":[{"name":"U.S. Food and Drug Administration, Center for Tobacco Products , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Callahan-Lyon","sequence":"additional","affiliation":[{"name":"U.S. Food and Drug Administration, Center for Tobacco Products , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3340-2818","authenticated-orcid":false,"given":"Lisa D","family":"Gardner","sequence":"additional","affiliation":[{"name":"U.S. Food and Drug Administration, Center for Tobacco Products , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Thekkudan","sequence":"additional","affiliation":[{"name":"U.S. Food and Drug Administration, Center for Tobacco Products , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolette","family":"Borek","sequence":"additional","affiliation":[{"name":"U.S. Food and Drug Administration, Center for Tobacco Products , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8278-0095","authenticated-orcid":false,"given":"Heather L","family":"Kimmel","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K Michael","family":"Cummings","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina , Charleston, SC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hyland","sequence":"additional","affiliation":[{"name":"Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0713-8745","authenticated-orcid":false,"given":"Mary","family":"Brunette","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth , Lebanon, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,4,2]]},"reference":[{"key":"2022101716270520000_CIT0001","volume-title":"The Health Consequences of Smoking\u201450 Years of Progress: A Report of the Surgeon General","author":"US Department of Health and Human Services.","year":"2014"},{"issue":"19","key":"2022101716270520000_CIT0002","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1056\/NEJMoa1505971","article-title":"Clinical significance of symptoms in smokers with preserved pulmonary function.","volume":"374","author":"Woodruff","year":"2016","journal-title":"N Engl J Med."},{"issue":"5","key":"2022101716270520000_CIT0003","first-page":"707","article-title":"The UCLA population studies of chronic obstructive respiratory disease. VIII. 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