TY - JOUR
T1 - Influenza-like illness in cigarette smokers and electronic-cigarette users
T2 - a secondary analysis from the PAIVED study
AU - Jones, Rachael D C
AU - Schmidt, Kat
AU - Schofield, Christina
AU - Ganesan, Anuradha
AU - Campbell, Wesley
AU - Hrncir, David
AU - Lalani, Tahaniyat
AU - Mende, Katrin
AU - Markelz, Ana E
AU - Berjohn, Catherine M
AU - Housel, Laurie
AU - Tilley, Drake H
AU - Saperstein, Adam
AU - Williams, Alan
AU - McClenathan, Bruce
AU - Collins, Limone
AU - Spooner, Christina
AU - Seshadri, Srihari
AU - Maves, Ryan C
AU - O'Connell, Robert J
AU - Pollett, Simon
AU - Simons, Mark P
AU - Powers, John H
AU - Coles, Christian L
AU - Colombo, Rhonda E
AU - Burgess, Timothy H
AU - Richard, Stephanie A
N1 - Publisher Copyright:
Copyright © 2026 Jones, Schmidt, Schofield, Ganesan, Campbell, Hrncir, Lalani, Mende, Markelz, Berjohn, Housel, Tilley, Saperstein, Williams, McClenathan, Collins, Spooner, Seshadri, Maves, O’Connell, Pollett, Simons, Powers, Coles, Colombo, Burgess and Richard.
PY - 2026
Y1 - 2026
N2 - 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.
AB - 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.
KW - Humans
KW - Male
KW - Female
KW - Adult
KW - Influenza, Human/epidemiology
KW - Electronic Nicotine Delivery Systems/statistics & numerical data
KW - Middle Aged
KW - Vaping/epidemiology
KW - Cigarette Smoking/epidemiology
KW - Smokers/statistics & numerical data
KW - United States/epidemiology
KW - Military Personnel/statistics & numerical data
KW - Incidence
KW - Influenza Vaccines/administration & dosage
UR - https://www.scopus.com/pages/publications/105038171283
U2 - 10.3389/fpubh.2026.1725232
DO - 10.3389/fpubh.2026.1725232
M3 - Article
C2 - 42077984
SN - 2296-2565
VL - 14
SP - 1725232
JO - Frontiers in Public Health
JF - Frontiers in Public Health
ER -