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Figure 1.  Prevalence of Electronic Cigarette Use Among US Adults With at Least 1 Child in the Household by State, Behavioral Risk Factor Surveillance System, 2016 to 2017
Prevalence of Electronic Cigarette Use Among US Adults With at Least 1 Child in the Household by State, Behavioral Risk Factor Surveillance System, 2016 to 2017

In the continental United States, prevalence ranged from 2.3% (95% CI, 1.5-3.4) in the District of Columbia to 7.7% (95% CI, 6.5-9.0) in Oklahoma. Data not shown: Puerto Rico, 0.85%; US Virgin Islands, 1.3%; and Guam, 8.4%.

Figure 2.  Prevalence of Electronic Cigarette Use Among US Adults With at Least 1 Child Living in the Household by Current Asthma Status of Selected Child
Prevalence of Electronic Cigarette Use Among US Adults With at Least 1 Child Living in the Household by Current Asthma Status of Selected Child

Results are shown overall and among current combustible cigarette smokers (16.3% of overall population), people who never smoked combustible cigarettes (64.2% of overall population), and former combustible cigarette smokers (19.5% of overall population; Behavioral Risk Factor Surveillance System, 2016-2017).

1.
Nguyen  KH, Tong  VT, Marynak  K, King  BA.  Perceptions of harm to children exposed to secondhand aerosol from electronic vapor products, styles survey, 2015.  Prev Chronic Dis. 2017;14:E41. doi:10.5888/pcd14.160567PubMedGoogle ScholarCrossref
2.
U.S. Department of Health and Human Services.  E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016.
3.
Centers for Disease Control and Prevention. Behavioral risk factor surveillance system overview: BRFSS 2017. https://www.cdc.gov/brfss/annual_data/2017/pdf/overview-2017-508.pdf. Accessed November 27, 2018.
4.
Bieler  GS, Brown  GG, Williams  RL, Brogan  DJ.  Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data.  Am J Epidemiol. 2010;171(5):618-623. doi:10.1093/aje/kwp440PubMedGoogle ScholarCrossref
5.
Gentzke  AS, Homa  DM, Kenemer  JB, Gomez  Y, King  BA.  Rules to prohibit the use of electronic vapor products inside homes and personal vehicles among adults in the U.S., 2017.  Prev Med. 2018;114:47-53. doi:10.1016/j.ypmed.2018.05.025PubMedGoogle ScholarCrossref
6.
Barrington-Trimis  JL, Berhane  K, Unger  JB,  et al.  Psychosocial factors associated with adolescent electronic cigarette and cigarette use.  Pediatrics. 2015;136(2):308-317. doi:10.1542/peds.2015-0639PubMedGoogle ScholarCrossref
Research Letter
May 6, 2019

Electronic Cigarette Use in US Households With Children: The “New” Secondhand Smoke

Author Affiliations
  • 1Department of Medicine, Maine Medical Center, Portland
  • 2Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Scarborough
  • 3Muskie School of Public Service, Public Health Program, Portland, Maine
JAMA Pediatr. 2019;173(7):693-695. doi:10.1001/jamapediatrics.2019.1139

Electronic cigarette (e-cigarette) aerosols are widely perceived as safe to nonusers.1 However, these aerosols contain potentially harmful compounds, including nicotine, volatile organic compounds, heavy metals, and ultrafine particulates,2 that nonusers can be exposed to through inhalation, ingestion, or dermal contact with aerosols exhaled into the environment. The US Office of the Surgeon General has recommended prohibiting e-cigarette use in enclosed areas to avoid probable harm because of secondhand exposure.2 Previous studies have estimated the prevalence of e-cigarette use among US adults and adolescents,2 but, to our knowledge, the prevalence of households with children exposed to secondhand aerosols is unknown.

Methods

We used pooled data from the 2016 to 2017 US Behavioral Risk Factor Surveillance System, a nationally representative, cross-sectional telephone survey conducted in 50 states, the District of Columbia, and 3 US territories.3 Adults were asked about current e-cigarette use, defined as daily or occasional use of e-cigarettes or other “vaping” products. A subset of respondents (ie, from 32 states in 2016 and 28 states plus the District of Columbia in 2017) were asked whether a randomly selected child living in the household had a current diagnosis of asthma by a health care professional.

We calculated prevalence of e-cigarette use among adults with at least 1 child (age ≤18 years) in the household overall and by state. We used average marginal predictions from logistic regression models4 to calculate the prevalence difference for adult e-cigarette use by child asthma status overall and by combustible cigarette status. We used survey procedures to account for the survey design and weighted estimates to represent the adult population. We performed analyses using SAS, version 9.4 (SAS Institute), and SUDAAN, release 11.0.1 (RTI International). The University of Southern Maine institutional review board did not consider this study to be human subjects research.

Results

During 2016 to 2017, 4.4% (95% CI, 4.3-4.5) of US adults reported current use of e-cigarettes. The prevalence of e-cigarette use was higher among adults with a child in the home (4.9%; 95% CI, 4.7-5.1) and varied across the United States (Figure 1). Electronic cigarette use was more prevalent among adults living with a child with (5.6%) vs without (4.8%) asthma (prevalence difference = 0.8%; 95% CI, −0.05 to 1.7). The prevalence of e-cigarette use did not vary by child asthma status when stratified by coexposure to combustible cigarettes (Figure 2).

Discussion

In a nationally representative sample of US adults, we found that e-cigarette use was higher among adults living with vs without children, possibly reflecting the relatively young age of e-cigarette users or other factors.2 Furthermore, e-cigarette use was higher among adults living with children with asthma vs without asthma, which may be because of higher coexposure to combustible cigarettes among children with asthma.

The limitations of this study include our inability to estimate the amount of e-cigarette use that occurred in the presence of household children. However, because e-cigarettes users generally perceive secondhand aerosols as safe for children and only one-fifth of users voluntarily prohibit e-cigarette use in their home or vehicle,1,5 we speculate that most of these children have some secondhand aerosol exposure. We did not account for secondhand aerosol exposure resulting from e-cigarette use by other adults, siblings, or peers.

Nearly 5% of US adults living in a household with children are e-cigarette users; these children are potentially exposed to secondhand aerosols, an amalgam of compounds with yet unknown health consequences. In addition to risks from secondhand aerosols, children in the same household as e-cigarette users are more likely to themselves initiate e-cigarette use6 and may be more likely to accidentally ingest refill liquid and experience burn injuries.2 Further information on the characteristics and exposure levels of children exposed to e-cigarette aerosols is warranted, especially as use of e-cigarettes appears to be increasing in the United States.2

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Article Information

Corresponding Author: Jenny L. Carwile, ScD, MPH, Division of Applied Health Care Delivery Science, Department of Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME 04102 (jcarwile@mmc.org).

Published Online: May 6, 2019. doi:10.1001/jamapediatrics.2019.1139

Author Contributions: Dr Ahrens had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Carwile, Fleisch, Ahrens.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Carwile.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Ahrens.

Administrative, technical, or material support: Young.

Supervision: Carwile, Ahrens.

Conflict of Interest Disclosure: Dr Fleisch received support from the National Institutes of Health grant K23ES024803. Dr Ahrens is supported by a grant from the Maine Economic Improvement Fund.

References
1.
Nguyen  KH, Tong  VT, Marynak  K, King  BA.  Perceptions of harm to children exposed to secondhand aerosol from electronic vapor products, styles survey, 2015.  Prev Chronic Dis. 2017;14:E41. doi:10.5888/pcd14.160567PubMedGoogle ScholarCrossref
2.
U.S. Department of Health and Human Services.  E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016.
3.
Centers for Disease Control and Prevention. Behavioral risk factor surveillance system overview: BRFSS 2017. https://www.cdc.gov/brfss/annual_data/2017/pdf/overview-2017-508.pdf. Accessed November 27, 2018.
4.
Bieler  GS, Brown  GG, Williams  RL, Brogan  DJ.  Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data.  Am J Epidemiol. 2010;171(5):618-623. doi:10.1093/aje/kwp440PubMedGoogle ScholarCrossref
5.
Gentzke  AS, Homa  DM, Kenemer  JB, Gomez  Y, King  BA.  Rules to prohibit the use of electronic vapor products inside homes and personal vehicles among adults in the U.S., 2017.  Prev Med. 2018;114:47-53. doi:10.1016/j.ypmed.2018.05.025PubMedGoogle ScholarCrossref
6.
Barrington-Trimis  JL, Berhane  K, Unger  JB,  et al.  Psychosocial factors associated with adolescent electronic cigarette and cigarette use.  Pediatrics. 2015;136(2):308-317. doi:10.1542/peds.2015-0639PubMedGoogle ScholarCrossref
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