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Background The effects of environmental tobacco smoke is a risk factor for everyone, but more so for individuals living with asthma. Most studies have focused on youth and young adults as the vulnerable population affected by secondhand smoke with policies related to secondhand smoke enacted to lessen such exposure given the known negative health effects. Most individuals are aware that secondhand exposure to tobacco smoke is not healthy, yet there is a shortage of literature on the secondhand vapor associated with electronic nicotine delivery systems (ENDS). Suggestions for nicotine, metals, and carcinogens in secondhand vapor are beginning to emerge in the literature but are still not common knowledge to the public. This study aims to look at the demographic differences among young adults (college students) with asthma and non-asthma concerning ENDS use. A secondary aim will also look at the difference in perceived health status and perception of harm in the relationship between asthma and ENDS use in these two populations.  Methods:  A cross-sectional online survey was designed and disseminated to two independent southeastern colleges. The survey was prepared following a comprehensive review of the literature by a group of experts focused on ENDS usage. The survey examined self-reported usage of and perceptions of ENDS within college students with and without asthma.  Results:  Approximately 50% of college-age students' perceived ENDS vapor as less harmful than traditional cigarette smoke. Around 24% of the students stated they use ENDS daily with over 50% of these students utilizing ENDS in the past 30 days. Asthma was a significant predictor in reporting lower perceived health status than students without asthma and perceived health status was a significant predictor of reporting fewer ever use of ENDS. Higher than the national average, 19% of students self-identified with an asthma diagnosis, and the use of ENDS was 20% in students without asthma and 27% in students with asthma.  Conclusions:  There are limited studies on perceptions related to ENDS and exposures in college students with and without asthma. Since 2007, various alternative forms of ENDS devices have been marketed. ENDS have gained popularity with young adults and college-age students, while rates of traditional cigarette usage have declined. College students report less perceived harm with ENDS over traditional cigarettes, yet studies acknowledge the high levels of the addictive substance nicotine. Of great concern is the lack of knowledge that college students have regarding nicotine based on their perceptions and the increasing use of these devices in those individuals with underlying respiratory conditions.

Examining electronic nicotine delivery system use and perception of use among college students with and without asthma across the South