Vaping and smoking in individuals with eating disorders: associations with diagnoses and behaviors

Abstract Background Smoking commonly co-occurs with eating disorders (EDs) but less is known about the relationship between EDs and vaping. We investigated associations of lifetime vaping and smoking as forms of nicotine use with lifetime ED diagnoses (i.e., anorexia nervosa [AN], bulimia nervosa [BN], and binge-eating disorder [BED]) and ED behaviors. Methods Participants ( N = 6,128, 95% female; mean age = 34.9 years) were from the United States site of the global Eating Disorders Genetics Initiative (EDGI) with lifetime diagnoses of AN only, AN + another ED, BN only, BN + BED, BED only, or screened controls with no ED or component ED behaviors. Participants reported lifetime ever/never nicotine use: Never Used (50%), Vaped Only (6%), Smoked Only (22%), or Vaped + Smoked (22%). We used Chi-square tests, ANOVA, and multinomial logistic regression to examine associations between nicotine use and ED diagnoses and behaviors. Results Our cohort consisted of lifetime diagnoses of AN only (37%), AN + another ED (21%), BN only (11%), BN + BED (14%), BED only (10%), or screened controls (7%). Lifetime nicotine use was more common among ED groups than controls (FDR p < 8.63 × 10 − 3 ). Compared to the AN Only group, the BN Only, AN + Other ED, and BN + BED groups had higher odds of smoking or dual use (FDR p < 3.79 × 10 − 3 ). Furthermore, ED behaviors were strongly associated with lifetime nicotine use. Purging was linked to greater likelihood of any lifetime nicotine use (FDR p < 0.017). Binge eating and all compensatory behaviors, except excessive exercise, were associated with higher odds of lifetime ever smoked or dual use versus never used nicotine (FDR p < 7.85 × 10 − 4 ). Conclusions Findings highlight the relevance of lifetime nicotine use among individuals with EDs. Clinicians should routinely assess for both lifetime smoking and vaping and should consider how nicotine use is interrelated with ED pathology.