Influenza-like illness in cigarette smokers and electronic-cigarette users: a secondary analysis from the PAIVED study
Year: 2026
Type: article
Abstract: Background: The Pragmatic Assessment of Influenza Vaccine Effectiveness in the Department of Defense (PAIVED) study was a clinical trial of three influenza vaccines in military beneficiaries enrolled at 10 military treatment facilities over four influenza seasons (2018/19-2021/22). This secondary analysis aimed to assess the relationship between cigarette smoking and e-cigarette use and influenza-like illness (ILI) incidence and severity. Methods: Demographic information, including cigarette smoking and e-cigarette use, was collected at enrollment. ILIs were identified during the influenza season of enrollment using weekly surveys. ILI symptoms were reported using the inFLUenza Patient-Reported Outcome (FLU-PRO) instrument. The relationship between smoking status and risk of reporting an ILI was estimated using Poisson regression; ILI severity was compared by cigarette smoking and e-cigarette use using multivariable linear regression. Results: Among 8,708 participants with cigarette smoking status, 4.3% were current smokers and 11.9% were former smokers. Current cigarette smokers reported higher respiratory domain scores (0.24 (95% CI: 0.07, 0.41)) than non-smokers; former cigarette smokers were at higher risk of reporting an ILI than non-smokers [rate ratio 1.11 (95% CI: 1.02, 1.20)] and reported ILI episodes that were on average 1.23 days longer in duration (95% CI: 0.29, 2.17). Among 8,119 participants with e-cigarette use status, 3.9% were current users and 2.6% were former users. Current e-cigarette users reported more than one additional day with limited activity (1.14 days, 95% CI: 0.10, 2.18) and 0.78 additional days with fever (95% CI, 0.20, 1.35); former e-cigarette users were at higher risk of reporting an ILI than nonusers [rate ratio 1.20 (95% CI, 1.04, 1.38)] and reported higher respiratory domain scores than non-users (0.27 (95% CI 0.08, 0.46)). Conclusion: We observed slightly higher ILI risk in former cigarette smokers and e-cigarette users, longer symptom duration in former cigarette smokers, and higher respiratory symptom scores in current cigarette smokers and former e-cigarette users compared to non-smokers/users. Findings in this secondary analysis are exploratory and hypothesis-generating; additional studies are needed to confirm the relationships reported here.
Source: Frontiers in Public Health
Authors: Rachael D. C. Jones, Kat Schmidt, Christina Schofield, Anuradha Ganesan, Wesley Campbell, David Hrncir, Tahaniyat Lalani, Katrin Mende, Ana E. Markelz, Catherine M. Berjohn, Laurie Housel, Drake H. Tilley, Adam Saperstein, Alan Williams, Bruce McClenathan, Limone Collins, Christina Spooner, Srihari Seshadri, Ryan C. Maves, Robert J. O’Connell, Simon Pollett, Mark P. Simons, John H. Powers, Christian L. Coles, Rhonda E. Colombo, Timothy H. Burgess, Stephanie A. Richard
Institutions: Uniformed Services University of the Health Sciences, Henry M. Jackson Foundation, Madigan Army Medical Center, Walter Reed National Military Medical Center, Wilford Hall Ambulatory Surgical Center, Carl R. Darnall Army Medical Center, Defense Health Agency, Naval Medical Center Portsmouth, Naval Medical Center San Diego, Womack Army Medical Center, Wake Forest University, Frederick National Laboratory for Cancer Research
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7154574053