Association between the use of e-cigarettes and heated tobacco products and asthma prevalence in adolescents: A secondary dataset analysis of the Korea Youth Risk Behavior Survey 2022-2024

Abstract

INTRODUCTION Adolescent tobacco use is a major public health concern due to its adverse effects on respiratory health, including asthma. Novel tobacco products such as e-cigarettes (ECs) and heated tobacco products (HTPs) are increasingly used by youth, yet their respiratory health impacts remain insufficiently understood. This study examined associations between tobacco use patterns and asthma prevalence among Korean adolescents. METHODS This secondary analysis used cross-sectional data from the nationally representative Korea Youth Risk Behavior Survey (KYRBS, 2022-2024), including 159383 students in grades 7-12. Current tobacco use (past 30 days) was classified into eight groups: non-users; exclusive users of combustible cigarettes (CCs), ECs, or HTPs; dual users; and triple users. Asthma was defined as a self-reported physician diagnosis within the past 12 months. Multivariable logistic regression adjusted for key covariates with survey weights applied. RESULTS Asthma prevalence was 1.7%. Compared with non-users, adjusted odds ratios (AORs) were 1.34 (95% CI: 1.28-1.39) for CC-only users, 4.34 (95% CI: 4.17-4.51) for EC-only users, 9.16 (95% CI: 8.63-9.72) for HTP-only users, and 13.72 (95% CI: 13.25-14.22) for EC-HTP dual users. Triple users had an AOR of 5.15 (95% CI: 5.02-5.28). Secondhand smoke exposure, alcohol use, stress, and physical activity were also associated with asthma. CONCLUSIONS Use of ECs and HTPs among Korean adolescents was associated with a higher prevalence of asthma. Concurrent EC and HTP use showed higher odds than single-product use, indicating a graded association across tobacco use patterns. These cross-sectional findings demonstrate robust associations but do not establish causality.