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Larcombe AN, Chivers EK, Huxley RR, Musk A(BW, Franklin PJ, Mullins BJ. Electronic Cigarette Usage Patterns and Perceptions in Adult Australians. TOXICS 2023; 11:290. [PMID: 36977055 PMCID: PMC10056955 DOI: 10.3390/toxics11030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Despite their increasing popularity, and Australia's unique regulatory environment, how and why Australian adults use e-cigarettes and their perceptions of their safety, efficacy and regulation have not been extensively reported before. In this study, we screened 2217 adult Australians with the aim of assessing these questions in a sample of current or former e-cigarette users. A total of 505 out of 2217 respondents were current or former e-cigarette users, with only these respondents completing the full survey. Key findings of this survey included the high proportion of respondents who indicated they were currently using e-cigarettes (307 out of 2217 = 13.8%), and the high proportion of current e-cigarette users that were also smokers (74.6%). The majority of respondents used e-liquids containing nicotine (70.3%), despite it being illegal in Australia without a prescription, and the majority bought their devices and liquids in Australia (65.7%). Respondents reported using e-cigarettes in a variety of places, including inside the home, inside public places (where it is illegal to smoke tobacco cigarettes), and around other people-which has implications for second and third hand exposures. A significant proportion of current e-cigarette users (30.6%) thought that e-cigarettes were completely safe to use long-term, although in general, there was a large amount of uncertainty/ambivalence with respect to perceptions of e-cigarette safety and efficacy as smoking cessation tools. This study shows that e-cigarette use is common in Australia, and that appropriate dissemination of unbiased research findings on their safety and efficacy in smoking cessation is urgently required.
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Affiliation(s)
- Alexander N. Larcombe
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA 6009, Australia
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Emily K. Chivers
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Rachel R. Huxley
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
- Faculty of Health, Deakin University, Burwood, VIC 3125, Australia
| | - Arthur (Bill) W. Musk
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Peter J. Franklin
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
| | - Benjamin J. Mullins
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA 6845, Australia
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Ballbè M, Fu M, Masana G, Pérez-Ortuño R, Gual A, Gil F, Olmedo P, García-Algar Ó, Pascual JA, Fernández E. Passive exposure to electronic cigarette aerosol in pregnancy: A case study of a family. ENVIRONMENTAL RESEARCH 2023; 216:114490. [PMID: 36220444 DOI: 10.1016/j.envres.2022.114490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/20/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Passive exposure to the aerosols of electronic cigarettes (e-cigarettes) has been little studied. We assessed this exposure in late pregnancy in a woman and her 3-year-old child, exposed through e-cigarette use by another household member. METHODS This prospective longitudinal case study involved a family unit consisting of an e-cigarette user, a pregnant woman who delivered an infant during the study, and the couple's older 3-year-old son. At 31, 36, and 40 weeks of the pregnancy, we measured biomarkers (nicotine metabolites, tobacco-specific nitrosamines, propanediols, glycerol, and metals) in the urine and hair of all three participants and in the saliva of the adults, in cord blood at delivery, and in the breast milk at the postpartum period. RESULTS Samples from the e-cigarette user showed quantifiable concentrations of all analytes assessed (maximum urinary cotinine concentration, 4.9 ng/mL). Among samples taken from the mother, nicotine and its metabolites were found mainly in urine and also in saliva and hair, but not in cord blood. During the postpartum period, we found cotinine concentrations of 2.2 ng/mL in the mother's urine and 0.22 ng/mL in breast milk; 1,2-propanediol was generally detected in urine and saliva, but not in cord blood or breast milk. The maximum urinary cotinine concentration in the 3-year-old child was 2.6 ng/mL and propanediols also were detected in his urine. Nitrosamines were not detected in samples taken from the mother or the 3-year-old. Metals found in the refill liquid were detected at low levels in both the mother and the 3-year-old. CONCLUSIONS We detected low but not negligible concentrations of e-cigarette-related analytes (including cord blood and breast milk) in an exposed pregnant non-user and in a 3-year-old child also living in the home. Passive exposure to e-cigarette aerosols cannot be disregarded and should be assessed in larger observational studies.
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Affiliation(s)
- Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; CIBER of Respirarory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain.
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; CIBER of Respirarory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat (Barcelona), Spain.
| | - Guillem Masana
- Barcelona Clinic Schizophrenia Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER of Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Fernando Gil
- Department of Legal Medicine and Toxicology, School of Medicine, Universidad de Granada, Granada, Spain.
| | - Pablo Olmedo
- Department of Legal Medicine and Toxicology, School of Medicine, Universidad de Granada, Granada, Spain.
| | - Óscar García-Algar
- Neonatology Unit, ICGON, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain.
| | - Jose Antonio Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain.
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Av. Gran Via de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat (Barcelona), Spain; CIBER of Respirarory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat (Barcelona), Spain.
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Hosokawa Y, Zaitsu M, Okawa S, Morisaki N, Hori A, Nishihama Y, Nakayama SF, Fujiwara T, Hamada H, Satoh T, Tabuchi T. Association between Heated Tobacco Product Use during Pregnancy and Fetal Growth in Japan: A Nationwide Web-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11826. [PMID: 36142098 PMCID: PMC9517232 DOI: 10.3390/ijerph191811826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Combustible cigarette smoking impacts fetal growth during pregnancy. However, the risk associated with heated tobacco products (HTPs) remains unclear. This nationwide cross-sectional study investigated whether HTP use during pregnancy is associated with small for gestational age (SGA) outcomes among 5647 post-delivery women with singleton pregnancies, which were divided into four groups: lifetime never-smokers, former smokers before pregnancy, and current smokers for each of the tobacco products during pregnancy (sole HTP and sole combustion smokers). Information on the prevalence of SGA, defined as birth weight and height below the 10th percentile, was retrieved from the Maternal and Child Health Handbooks of post-delivery women. Using logistic regression, the association between sole HTP smokers during pregnancy and SGA, adjusted for covariates, with lifetime never-smokers as reference, was investigated. The prevalence was: current sole HTP smokers during pregnancy, 1.8% (102/5647); and SGA, 2.9% (164/5647). Sole HTP smokers during pregnancy had a higher prevalence of SGA (5.9% [6/102] vs. 2.7% [111/4144]) with an adjusted odds ratio (OR) of 2.50 (95% confidence interval [CI], 1.03-6.05) than lifetime never-smokers. Among sole combustion smokers, the adjusted OR for SGA was 1.95 (95% CI, 0.81-4.67). In Japan, HTP smoking during pregnancy may be associated with an increased risk for SGA.
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Affiliation(s)
- Yoshihiko Hosokawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Masayoshi Zaitsu
- Center for Research of the Aging Workforce, University of Occupational and Environmental Health, Kitakyushu 807-8556, Japan
| | - Sumiyo Okawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Ai Hori
- Department of Global Public Health, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Yukiko Nishihama
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba 305-8506, Japan
| | - Shoji F. Nakayama
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba 305-8506, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Hiromi Hamada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
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Galderisi A, Perilongo G, Caprio S, Da Dalt L, Di Salvo G, Gatta M, Giaquinto C, Rizzuto R, Robb A, Sly PD, Simonelli A, Staiano A, Vettor R, Baraldi E. Pediatric Preventive Care in Middle-High Resource Countries-The Padova Chart for Health in Children. Front Pediatr 2022; 10:803323. [PMID: 35498805 PMCID: PMC9047691 DOI: 10.3389/fped.2022.803323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Importance The Padova Chart for Health in Children (PCHC) aims to gather the evidence of healthcare promotion and protection for chidren and adolescents (i.e., aged <18 y) into a single document in order to guide families, healthcare providers and social actors on healthy choices. No more than 2% of Europeans and North Americans aged <30 y have a healthy lifestyle. This, together with metabolic and brain plasticity during childhood, creates the ideal opportunity to implement preventive strategies. Guided interventions promoting healthy lifestyle in children and families therefore have a key role in abating the unprecedented pandemic of non-communicable diseases (NCDs) in adulthood. Observations The PCHC is divided into four sections: nutrition, cardiovascular health, respiratory health, and mental and social health. Each section is structured in an ALICE approach (assessment, lobbying, intervention, call-for-action, evaluation): assessment of necessity, describing relevance to healthcare; lobbying to identify those who can effect the proposed interventions; interventions involving family, school and peers; a call-for-action to define priorities among the proposed interventions; and objective evaluation measures that can be applied on a population basis. Conclusions and Relevance Interventions promoting health in childhood require joint action from multiple institutional, local and family representatives, with the shared goal of promoting health across the entire age group. These lifestyle interventions have the potential to change the lifetime risk trajectory for NCDs.
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Affiliation(s)
- Alfonso Galderisi
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Giorgio Perilongo
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Sonia Caprio
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Liviana Da Dalt
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Giovanni Di Salvo
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Michela Gatta
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Carlo Giaquinto
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Rosario Rizzuto
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Adelaide Robb
- Division of Psychiatry and Behavioral Sciences, Children's National Hospital, Washington, DC, United States
| | - Peter David Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy
| | - Roberto Vettor
- Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Eugenio Baraldi
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
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Abstract
The use of electronic (e)-cigarettes was initially considered a beneficial solution to conventional cigarette smoking cessation. However, paradoxically, e-cigarette use is rapidly growing among nonsmokers, including youth and young adults. In 2019, this rapid growth resulted in an epidemic of hospitalizations and deaths of e-cigarette users (vapers) due to acute lung injury; this novel disease was termed e-cigarette or vaping use-associated lung injury (EVALI). Pathophysiologic mechanisms of EVALI likely involve cytotoxicity and neutrophilic inflammation caused by inhaled chemicals, but further details remain unknown. The undiscovered mechanisms of EVALI are a barrier to identifying biomarkers and developing therapeutics. Furthermore, adverse effects of e-cigarette use have been linked to chronic lung diseases and systemic effects on multiple organs. In this comprehensive review, we discuss the diverse spectrum of vaping exposures, epidemiological and clinical reports, and experimental findings to provide a better understanding of EVALI and the adverse health effects of chronic e-cigarette exposure.
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Affiliation(s)
- Jin-Ah Park
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA;
| | - Laura E Crotty Alexander
- University of California at San Diego, La Jolla, California, USA.,Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; .,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
Importance Substance use during pregnancy is a major health issue for both the mother and the fetus, but it also represents an important public health concern. Objective The aim of this review was to summarize and compare recommendations from recently published guidelines on substance use during pregnancy and especially regarding alcohol, smoking, and drug use. Evidence Acquisition A descriptive review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on substance use was conducted. Regarding the term "substance use," the most recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition substances were used. Results All the reviewed guidelines recommend appropriate counseling and screening women regarding alcohol, smoking, and drug use during the antenatal period, while the management options vary. More specifically, the prompt management of alcohol dependence is emphasized by all the guidelines except from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which makes no recommendation upon. The use of alcohol during breastfeeding should be avoided. Regarding smoking cessation, all guidelines recommend the use of certain psychosocial, behavioral interventions, and pharmacotherapy. All the guidelines, except the one from the WHO, suggest screening drug users for coexistent sexually transmitted infections. Brief interventions are considered beneficial, while a gradual decrease in benzodiazepines is suggested, as well as the discontinuation of marijuana and methamphetamine use. However, there is controversy regarding breastfeeding in those women as the WHO recommends in favor, whereas the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists recommend against this practice. Finally, all the guidelines state that, following delivery, close monitoring of the neonate is needed. Conclusions The diversity of guidelines' recommendations concerning substance use reflects the different ways of the management of pregnant women during routine antenatal care due to absence of strong evidence. More research in the areas of dispute may allow the adoption of an international consensus, in order to early detect and appropriately manage pregnant women with harmful addictions.
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7
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Zaitsu M, Hosokawa Y, Okawa S, Hori A, Kobashi G, Tabuchi T. Heated tobacco product use and hypertensive disorders of pregnancy and low birth weight: analysis of a cross-sectional, web-based survey in Japan. BMJ Open 2021; 11:e052976. [PMID: 34548366 PMCID: PMC8458368 DOI: 10.1136/bmjopen-2021-052976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Knowledge on the impact of heated tobacco product (HTP) use in pregnant women with associated maternal and neonatal risks for hypertensive disorders of pregnancy (HDP) and low birth weight (LBW) is limited. We aimed to assess the status of HTP use among pregnant women in Japan and explore the association of HTP use with HDP and LBW. DESIGN Cross-sectional study. SETTING Data from the Japan 'COVID-19 and Society' Internet Survey study, a web-based nationwide survey. PARTICIPANTS We investigated 558 postdelivery and 365 currently pregnant women in October 2020. PRIMARY AND SECONDARY OUTCOME MEASURES Information on HDP and LBW was collected from the postdelivery women's Maternal and Child Health Handbooks (maternal and newborn records). We estimated the age-adjusted ORs and 95% CIs of ever HTP smokers for HDP and LBW and compared them with those of never HTP smokers in a logistic regression analysis. RESULTS The prevalence of ever and current HTP use were 11.7% and 2.7% in postdelivery women and 12.6% and 1.1% in currently pregnant women, respectively. Among currently pregnant women who were former combustible cigarette smokers, 4.4% (4/91) were current HTP smokers. Among postdelivery women, ever HTP smokers had a higher HDP incidence (13.8% vs 6.5%, p=0.03; age-adjusted OR=2.48, 95% CI 1.11 to 5.53) and higher LBW incidence (18.5% vs 8.9%, p=0.02; age-adjusted OR=2.36, 95% CI 1.16 to 4.87). CONCLUSIONS In Japan, the incidence of ever HTP use exceeded 10% among pregnant women, and HTP smoking may be associated with maternal and neonatal risks.
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Affiliation(s)
- Masayoshi Zaitsu
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Japan
| | - Yoshihiko Hosokawa
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Japan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ai Hori
- Department of Global Public Health, University of Tsukuba, Tsukuba, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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8
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Liu B, Du Y, Wu Y, Sun Y, Santillan MK, Santillan DA, Bao W. Prevalence and Distribution of Electronic Cigarette Use Before and During Pregnancy Among Women in 38 States of the United States. Nicotine Tob Res 2021; 23:1459-1467. [PMID: 33693836 DOI: 10.1093/ntr/ntab041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/05/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION To examine the prevalence and the changing pattern of e-cigarette use from preconception to pregnancy. AIMS AND METHODS This is a cross-sectional study using data from the multi-site Pregnancy Risk Assessment Monitoring System in the United States, 2016-2017. All participating mothers with information on e-cigarette use before and during pregnancy were included. Self-reported information about e-cigarette use were assessed using questionnaires. Weighted prevalences of e-cigarette use before and during pregnancy were calculated. Multivariable logistic regressions were used to examine the association between various demographic characteristics and e-cigarette use before or during pregnancy. RESULTS This study included 69 508 pregnant women from 38 states in the United States. The weighted prevalence of e-cigarette use before pregnancy and during the last 3 months of pregnancy was 3.6% (95% confidence interval [CI] 3.4%-3.9%) and 1.1% (0.9%-1.2%), respectively. The prevalence varied across states, ranging from 1.3% to 8.3% for e-cigarette use before pregnancy and from 0.1% to 3.4% for e-cigarette use during the last 3 months of pregnancy. Among women who used e-cigarettes before pregnancy, 24.4% (21.7%-27.1%) continued to use e-cigarettes during pregnancy. Among women who used e-cigarettes during pregnancy, 62.3% (56.5%-68.0%) were dual users. In multivariable analyses, cigarette smoking was most strongly associated with e-cigarette use. The adjusted odds ratio comparing smokers with nonsmokers before pregnancy was 11.10 (95% CI 9.34-13.20) for e-cigarette use before pregnancy and 6.72 (95% CI 4.38-10.31) for e-cigarette use during pregnancy. CONCLUSIONS Using data from 38 states in the United States, we showed geographical variations in the prevalence of e-cigarette use before and during pregnancy. Among women who used e-cigarettes before pregnancy, a quarter of them continued to use e-cigarettes during pregnancy. Conventional cigarette use is a strong risk factor for e-cigarette use before and during pregnancy. The prevalence of e-cigarette use needs to be monitored continuously. IMPLICATIONS This study provides important information to understand the status and changing patterns of e-cigarette use in pregnant women in the United States. Among pregnant women in 38 states in the United States, 3.6% of them used e-cigarettes during the 3 months before pregnancy and 1.1% used them during the last 3 months of pregnancy. The prevalence varied across states. A quarter of women who used e-cigarettes before pregnancy continued to use e-cigarettes during pregnancy. Cigarette smoking is the strongest predictor of e-cigarette use. Future research about health effects of e-cigarette use during pregnancy is in urgent need.
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Affiliation(s)
- Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yang Du
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yuxiao Wu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Mark K Santillan
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA, USA
| | - Donna A Santillan
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA, USA
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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9
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E-Cigarette Use among Current Smokers Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073691. [PMID: 33916203 PMCID: PMC8037859 DOI: 10.3390/ijerph18073691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
Two-thirds of cigarette smokers experiencing homelessness report using alternative tobacco products, including blunts, cigarillos (little cigars) or roll-your-own tobacco or electronic nicotine delivery systems such as e-cigarettes. We examined attitudes toward e-cigarette use and explored whether e-cigarette use patterns were associated with past-year cigarette quit attempts among current smokers experiencing homelessness. Among the 470 current cigarette smokers recruited from homeless service sites in San Francisco, 22.1% (n = 65) reported the use of e-cigarettes in the past 30 days ('dual users'). Compared to cigarette-only smokers, dual users considered e-cigarettes to be safer than cigarettes. Patterns of e-cigarette use, including the number of times used per day, duration of use during the day, manner of use and nicotine concentration were not associated with past-year cigarette quit attempts. Studies that examine the motivations for use of e-cigarettes, particularly for their use as smoking cessation aids, could inform interventions for tobacco use among people experiencing homelessness.
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Mescolo F, Ferrante G, La Grutta S. Effects of E-Cigarette Exposure on Prenatal Life and Childhood Respiratory Health: A Review of Current Evidence. Front Pediatr 2021; 9:711573. [PMID: 34513764 PMCID: PMC8430837 DOI: 10.3389/fped.2021.711573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/30/2021] [Indexed: 01/23/2023] Open
Abstract
In the last decade, widespread use of E-cigarettes (EC) has occurred all over the world. Whereas, a large amount of evidence on harm to children from conventional cigarette exposure is available, data on health effects in this population throughout different vulnerability windows are still a matter of concern. Exposure to EC during pregnancy may compromise placental function, resulting in fetal structural abnormalities. Specifically, this may cause physio-pathologic changes in the developing lung, which in turn may impair respiratory health later in life. Furthermore, there is evidence that using EC can cause both short- and long-term respiratory problems in the pediatric population and there is great concern for future young people with nicotine addiction. The low parental perception of the risks connected to EC exposure for children increases their susceptibility to harmful effects from passive vaping. This minireview aims to summarize the current evidence focusing on: (i) prenatal effects of EC passive exposure; (ii) post-natal respiratory effects of EC exposure in youth; (iii) parental attitudes toward EC use and perception of children's health risks connected to EC exposure; and (iv) addressing gaps in our current evidence.
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Affiliation(s)
- Federica Mescolo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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Guerra S, Lombardi E, Stern DA, Sherrill DL, Gilbertson-Dahdal D, Wheatley-Guy CM, Snyder EM, Wright AL, Martinez FD, Morgan WJ. Fetal Origins of Asthma: A Longitudinal Study from Birth to Age 36 Years. Am J Respir Crit Care Med 2020; 202:1646-1655. [PMID: 32649838 PMCID: PMC7737573 DOI: 10.1164/rccm.202001-0194oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
Rationale: Deficits in infant lung function-including the ratio of the time to reach peak tidal expiratory flow to the total expiratory time (tptef/te) and maximal expiratory flow at FRC (V̇maxFRC)-have been linked to increased risk for childhood asthma.Objectives: To examine the individual and combined effects of tptef/te and V̇maxFRC in infancy on risk for asthma and abnormalities of airway structure into mid-adult life.Methods: One hundred eighty participants in the Tucson Children's Respiratory Study birth cohort had lung function measured by the chest-compression technique in infancy (mean age ± SD: 2.0 ± 1.2 mo). Active asthma was assessed in up to 12 questionnaires between ages 6 and 36 years. Spirometry and chest high-resolution computed tomographic (HRCT) imaging were completed in a subset of participants at age 26. The relations of infant tptef/te and V̇maxFRC to active asthma and airway structural abnormalities into adult life were tested in multivariable mixed models.Measurements and Main Results: After adjustment for covariates, a 1-SD decrease in infant tptef/te and V̇maxFRC was associated with a 70% (P = 0.001) and 55% (P = 0.005) increased risk of active asthma, respectively. These effects were partly independent, and two out of three infants who were in the lowest tertile for both tptef/te and V̇maxFRC developed active asthma by mid-adult life. Infant V̇maxFRC predicted reduced airflow and infant tptef/te reduced HRCT airway caliber at age 26.Conclusions: These findings underscore the long-lasting effects of the fetal origins of asthma, support independent contributions by infant tptef/te and V̇maxFRC to development of asthma, and link deficits at birth in tptef/te with HRCT-assessed structural airway abnormalities in adult life.
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Affiliation(s)
- Stefano Guerra
- Asthma and Airway Disease Research Center
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, College of Medicine – Tucson
- Mel and Enid Zuckerman College of Public Health
| | - Enrico Lombardi
- Asthma and Airway Disease Research Center
- Department of Medical Imaging, College of Medicine – Tucson, and
| | | | - Duane L. Sherrill
- Asthma and Airway Disease Research Center
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | | | | | - Eric M. Snyder
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona; and
| | | | | | - Wayne J. Morgan
- Asthma and Airway Disease Research Center
- Geneticure, Rochester, Minnesota
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12
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Nagpal TS, Green CR, Cook JL. Vaping During Pregnancy: What Are the Potential Health Outcomes and Perceptions Pregnant Women Have? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:219-226. [PMID: 33187893 DOI: 10.1016/j.jogc.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Abstract
The prevalence of electronic nicotine delivery systems, such as vaping, is a growing public health concern, and there is limited information on the use of these devices during pregnancy. The objective of this rapid review was to summarize the available literature on human studies of the potential maternal or fetal health effects of vaping or women's perceptions of vaping during pregnancy. A systematic search was completed in the following databases: Medline, EMBASE, Scopus, Web of Science, and CINAHL. A search strategy was developed combining the terms pregnancy and vaping. Findings were divided into two groups and summarized as: 1) Health outcomes following vaping during pregnancy; and 2) Perceptions pregnant women have related to vaping during pregnancy. A total of 760 articles were retrieved and, after applying the inclusion/exclusion criteria and screening, 19 studies were included. Five included studies provided evidence on potential health outcomes and 14 were focused on perceptions. There is emerging evidence that vaping during pregnancy may increase the risk of small for gestational age newborns. Pregnant women generally report that they used vaping products during pregnancy for smoking cessation and perceived that this was a healthier alternative to traditional cigarettes. Overall, there was consensus that there is a lack of information on maternal and fetal health outcomes following vaping during pregnancy. Based on the findings of this rapid review, there is an urgent need for high-quality studies in pregnant women to evaluate the potential in utero and long-term effects of exposure to prenatal vaping.
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Affiliation(s)
- Taniya S Nagpal
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON; Department of Human Kinetics, University of Ottawa, Ottawa, ON.
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON; Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON
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Supporting Parents Living in Disadvantaged Areas of Edinburgh to Create a Smoke-Free Home Using Nicotine Replacement Therapy (NRT): A Two-Phase Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197305. [PMID: 33036327 PMCID: PMC7579591 DOI: 10.3390/ijerph17197305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022]
Abstract
Exposure to second-hand smoke (SHS) in the home is largely associated with socio-economic disadvantage. Disadvantaged parents face specific challenges creating a smoke-free home, often caring for children in accommodation without access to outdoor garden space. Existing smoke-free home interventions largely fail to accommodate these constraints. Innovative approaches are required to address this inequality. In this two-phase study, we engaged with parents living in disadvantaged areas of Edinburgh, Scotland, to explore tailored approaches to creating a smoke-free home and develop and pilot-test an intervention based on their views and preferences. In Phase 1, qualitative interviews with 17 parents recruited from Early Years Centres explored alternative approaches to smoke-free home interventions. In Phase 2, an intervention based on parents’ views and preferences was pilot-tested with parents recruited through Early Years and Family Nurse Partnership centres. Seventeen parents took part in an interview to share their views/experiences of the intervention. Data from both study phases were thematically analysed. Phase 1 findings suggested that parents associated nicotine replacement therapy (NRT) with quit attempts but supported the idea of NRT use for temporary abstinence to create a smoke-free home, viewing this as a safer option than using e-cigarettes indoors. In Phase 2, 54 parents expressed an interest in accessing NRT to create a smoke-free home, 32 discussed NRT product choice during a home visit from a smoking adviser, and 20 collected their free NRT prescription from the pharmacy. NRT was used for up to 12 weeks in the home, with ongoing advice available from pharmacy staff. During qualitative interviews (n = 17), parents self-reported successfully creating a smoke-free home, quitting smoking, and reduced cigarette consumption, often exceeding their expectations regarding changes made. The intervention was acceptable to parents, but the multi-step process used to access NRT was cumbersome. Some participants were lost to this process. Parents living in disadvantaged circumstances may benefit from access to NRT for temporary abstinence in the home to assist them to protect their children from SHS exposure. Further research using a more streamlined approach to NRT access is required to determine the feasibility and cost-effectiveness of this approach.
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Abstract
Electronic cigarettes (e-cigarettes) are alternative, non-combustible tobacco products that generate an inhalable aerosol containing nicotine, flavors, propylene glycol, and vegetable glycerin. Vaping is now a multibillion dollar industry that appeals to current smokers, former smokers, and young people who have never smoked. E-cigarettes reached the market without either extensive preclinical toxicology testing or long term safety trials that would be required of conventional therapeutics or medical devices. Their effectiveness as a smoking cessation intervention, their impact at a population level, and whether they are less harmful than combustible tobacco products are highly controversial. Here, we review the evidence on the effects of e-cigarettes on respiratory health. Studies show measurable adverse biologic effects on organ and cellular health in humans, in animals, and in vitro. The effects of e-cigarettes have similarities to and important differences from those of cigarettes. Decades of chronic smoking are needed for development of lung diseases such as lung cancer or chronic obstructive pulmonary disease, so the population effects of e-cigarette use may not be apparent until the middle of this century. We conclude that current knowledge of these effects is insufficient to determine whether the respiratory health effects of e-cigarette are less than those of combustible tobacco products.
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Affiliation(s)
- Jeffrey E Gotts
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sven-Eric Jordt
- Department of Anesthesiology, Duke University, Durham, NC, USA
- Yale Center for the Study of Tobacco Products and Addiction, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, CA, USA
| | - Robert Tarran
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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