Title:

The additive effect of cigarette, e-cigarette, and alcohol use on heart disease risk among college students, ages 18-24

Background: Heart disease is the leading cause of death for people of all genders and races in the U.S. Cigarette use, e-cigarette use, and alcohol consumption are modifiable lifestyle factors associated with heart disease risk. Co-usage of different substances on heart disease risk among young adults is an area that warrants further research. Objective: To characterize the current prevalence and pattern of co-usage of cigarettes, e-cigarettes, and alcohol among college students ages 18-24, and investigate the relationship of these substances on heart disease risk assessed by blood pressure, HDL-cholesterol, and triglyceride (TG) levels. Study Design, Setting, Participants: Data were collected between 2021-2023 through the College Health and Nutrition Assessment Study, an ongoing cross-sectional study at a northeastern, public land-grant university in the U.S. that aims to understand factors affecting young adult health. Measure Outcome/Analysis: The use of cigarettes, e-cigarettes, and alcohol of the participants was self-reported through an online survey; fasting HDL, TG, and blood pressure levels were collected during an in-person assessment and evaluated for group differences using ANCOVA with adjustments for BMI and gender. Results: Overall, 38.0% of the participants (n=798, 36% male) did not report any use of cigarette, e-cigarette, or alcohol; 38.3% reported current e-cigarette use; 3.8% reported current cigarette use, and 55.1% reported binge drinking in the past 30 days. About one-third (30.5%) reported regular use of one substance, 28.1% reported two, and 3.5% reported three. Triglycerides increased in each group of users (nonusers, 1, 2, and 3 substances: 80.12.4, 83.82.7, 88.42.8, 102.58.1 mg/dL, respectively, p=.02). HDL increased according to level of binge drinking (non-drinkers, infrequent, and frequent: 52.60.7, 54.61.0, 57.00.9 mg/dL, respectively; p<.01). No group differences were observed for blood pressure. Conclusions: These findings support the need for further research on the additive effect of substance use on heart disease. Further, the data provide evidence to incorporate substance use management into health interventions that aim to reduce the burden of future disease for young adults. Funding: Funded by New Hampshire Agriculture Experiment Station, USDA National Institute of Food and Agriculture Project 1010738, and the state of New Hampshire.

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