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E-Cigarettes and Eating Disorders: Current Research

Electronic cigarettes, or e-cigarettes, are nicotine delivery devices that produce aerosol for inhalation through the combustion of flavored nicotine-containing liquids known as e-liquids (Glasser et al., 2017). As smoking traditional cigarettes is declining (Jamal et al., 2018), the use of e-cigarettes, or vaping, is increasing, especially among young people (Kasza et al., 2017; U.S. Department of Health and Human Services, 2016). Adults aged 18-24 years reported significantly more vaping in the past 30 days than adults over age 25 (13% vs. 6%, respectively; Kasza et al., 2017). Young adulthood is a high risk period for several behaviors that can influence health long term, and they often co-occur. Young adults are also most at risk for the development of eating disorders; the mean age of onset for eating disorders ranges from 18-21 years (Hudson, Hiripi, Pope, & Kessler, 2007; Volpe et al., 2016). Additionally, women with eating disorders—particularly bulimia nervosa and binge-eating disorder—report a higher prevalence of traditional cigarette smoking and greater nicotine dependence than healthy controls (Anzengruber et al., 2006). A logical next question is whether there is an association between vaping and eating disorders.

Limited studies have examined the association between these two traits. Among individuals who use e-cigarettes, vaping to control appetite has been positively associated with body concern among college students (Napolitano, Lynch, and Stanton, 2018). Adults who reported vaping for weight loss or weight control purposes were more likely to use e-cigarettes frequently, be overweight, and restrict their calories than those who use e-cigarettes for purposes other than weight loss or weight control (Morean and Wedel, 2017). Further, e-cigarette users who reported having a current eating disorder were more likely to vape on a daily basis, to do so to lose or control weight, and to experience more relief from negative emotions as a consequence of vaping than e-cigarette users who did not report having a current eating disorder (Morean and L’insalata, 2017). Finally, Bennett and Pokhrel (2018) reported a significant association between weight concerns and current vaping frequency, such that increased weight concerns were associated with a higher frequency of e-cigarette use. However, other research has found no association between risk of eating disorders and e-cigarette use (Tavolacci et al., 2016).

Although e-cigarettes are generally viewed as less harmful than traditional cigarettes (Glasser et al., 2017), this might not be accurate. E-liquids may negatively affect human cell viability (Sassano et al., 2018) and 58.2% of e-cigarette users report experiencing at least one adverse symptom, such as cough, dry/irritated mouth or throat, dizziness/lightheadedness, and headache/migraine (King et al., 2019). Due to the novelty of e-cigarettes, the long-term consequences of vaping are unknown; however, e-cigarette aerosols cause tissue and DNA damage that could plausibly promote disease in long-term users (Helen & Eaton, 2018). As the potential harms of e-cigarettes and vaping continue to emerge, further researching the association between e-cigarette use and eating disorders could provide information useful for clinicians treating these conditions.