Teenagers and young adults with cystic fibrosis (CF) appear less likely to smoke cigarettes — tobacco or electronic — and marijuana than their peers, according to a U.S. study. Still, e-cigarette and marijuana use is not uncommon in this patient group, with 18- to 21-year-olds being most at risk.

As with others at these ages, younger people with CF generally perceived e-cigarettes and marijuana as posing fewer health risks than traditional cigarettes.

Parents and healthcare providers varied in addressing this use with a patient, with reasons for failing to do so ranging from incorrect assumptions of non-use to a lack of familiarity with the products, especially e-cigarettes.

A better understanding of substance use and perceptions “will guide parent and provider education of high-risk individuals,” the researchers wrote, which is particularly important as “social norms and misinformation continue to blunt the health consequences of combustible e-cigarettes and marijuana.”

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The study, “Concern over tobacco and marijuana perceptions and use among adolescents and young adults with cystic fibrosis,” was published in the journal Addictive Behaviors.

E-cigarette use among young people in the U.S. is on the rise, as is the use of marijuana, whose “social influences are likely to become more pervasive” as states continue to “move toward cannabis legalization,” the researchers wrote. Adolescents and young adults also tend to consider these products less risky than tobacco cigarettes, despite the dangers they pose to lung health.

Exposure to irritants such as smoke could be particularly harmful for CF patients, whose airways are marked by substantial inflammation and mucus buildup that promotes infections.

A pair of researchers at California universities investigated smoking habits and perceptions among young CF patients starting at age 13, and surveyed parents and health professionals.

Their analysis involved 436 CF patients, with a median age of 25, who completed a 53-item online survey with questions related to cigarettes, e-cigarettes, and marijuana smoking. Most (92%) were living in the U.S., and almost half of these respondents (204 or 46.78%) were between the ages of 13 and 26.

Minor-age children, patients 13 to 17 years old, reported at least one use of cigarettes (11.6%), e-cigarettes (20.9%) or marijuana (15.4%), with “ever use” rates for these teenagers lower than rates among age-matched peers in the general population, the researchers noted.

E-cigarette use was highest among 18- to 21-year-olds, 31.8% of whom reported using them at least once. Likewise, these patients most frequently reported previous use of marijuana (37.1%) and of having smoked it in the last 30 days (17.1%).

This age range also spans the period “when many patients transfer care from pediatric to adult CF centers and are most likely to have gaps in care,” the researchers wrote.

Lower risks seen with e-cigarettes, marijuana than tobacco among CF patients

For patients ages 13 to 21, e-cigarettes use was more frequent than traditional cigarettes, while among older patients having smoked at least one tobacco cigarette was more common.

Most patients also reported being “very unlikely or unlikely” to use cigarettes (98.3% ), e-cigarettes (96.3%), or smoked marijuana (92.7%) in the next six months.

Among the 204 respondents ages 13 to 26, there was a general perception that CF put them at a higher risk of needing antibiotics, and of a hospitalization or death than someone without this disease.

But they also saw a “significantly lower risk” across such categories with e-cigarette use relative to that of tobacco, and smoking marijuana versus a traditional cigarette “was thought to carry the lowest risk in all risk perception categories,” the researchers wrote. Categories mentioned were cough, CF exacerbations, need for antibiotics, hospitalization, risk of death, and addiction risk.

Still, these respondents agreed that CF patients with a history of such smoking would be at a higher risk of an exacerbation, antibiotic need, or hospitalization within six months than those with no such history. This finding shows they “recognize the inherent dangers associated with use, as well as the increased dangers these products pose to patients with CF,” the team added.

Patients with any history of cigarette, e-cigarette or marijuana use, in general, perceived the risks of using them to be lower than patients who had never used these products.

“More education and prevention is needed to correct misperceptions, increase understanding of risk, and reduce use in the general AYA [adolescent and young adult] population,” the researchers wrote.

Among the 226 parents or caregivers who responded to the survey, it was observed that cigarette avoidance was more likely to be discussed than e-cigarettes or marijuana, and such talks were mostly with patients ages 13 to 17.

Parents who had no such discussions cited reasons that included being reassured by their child that they weren’t using these products, and assuming that risk education was being given by others, like a teacher or doctor.

Among 93 healthcare providers who responded, 82% said they discussed cigarette avoidance with every patient at least once, 69% discussed e-cigarettes, and 74% discussed marijuana.

The other providers most often noted not having such talks because they assumed the patient was already avoiding smoking, and nearly all these respondents mentioned a “lack of familiarity” with e-cigarettes.

“In both 13-17 and 18-21 age groups, ever-use of e-cigarettes exceeded that of traditional cigarettes, reflective of national data among adolescents in the general population,” the researchers concluded.

“With the growing popularity of e-cigarettes among the AYA population as well as an epidemic of vaping related lung injuries … familiarity among pediatric lung specialists will improve with time,” they added.

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