March 13, 2019

Stanton A. Glantz, PhD

Another way that e-cigs are causing harm: Undermining smokefree home and car policies

Jeremy E. Drehmer and colleagues just published “Parental Smoking and E-cigarette Use in Homes and Cars“ in Pediatrics showing that adults with children who are dual users of cigarettes and e-cigarettes are less likely to have and enforce smokefree policies in their homes and cars than parents who just smoke.  This matters because it is yet another way that the advent of e-cigs is harming the health of children (and their parents and other bystanders).

As the authors point out, most people think e-cigs are safer than cigs (even “safe”).  This perception seems to be spilling over to affect policies even when the same people are smoking cigs.  The authors repot, “a perception may exist among many parents that e-cigarette aerosol is safe for their children because the majority of dual users had a strictly enforced smoke-free home policy (63.8%), whereas a statistically significant lower percentage of these parents had a strictly enforced vape-free home policy (26.3%)... Additionally, parents who dual use cigarettes and e-cigarettes were less likely to have strictly enforced smoke-free policies for the car and vape-free policies in the home and car than parents who only use traditional cigarettes."

The evidence shows that bystanders absorb nicotine and other toxins that e-cigs put in the air.  The toxic mix is probably different, but it is still there.  What this paper shows is that a side effect of parents using e-cigs is an increase in kids’ exposure to secondhand tobacco smoke, too.

The take-home message for parentsis the same as before eicgs:  Parents should not allow anyone to smoke or vape in their houses or cars.  If they can’t quit, they should at least smoke outside away from their kids and other family members.  There is good data that such smokefree home policies help people quit.  (Nicotine replacement therapy even works better if smokers have smokefree homes.)  Undermining smokefree homes and cars is probably one of the reasons that, for most smokers, e-cigarettes make it harder (not easier) to quit.

Here is the abstract:

OBJECTIVES: To determine how smoke-free and vape-free home and car policies differ for parents who are dual users of cigarettes and electronic cigarettes (e-cigarettes), who only smoke cigarettes, or who only use e-cigarettes. To identify factors associated with not having smoke-free or vape-free policies and how often smoke-free advice is offered at pediatric offices.

METHODS: Secondary analysis of 2017 parental interview data collected after their children’s visit in 5 control practices participating in the Clinical Effort Against Secondhand Smoke Exposure trial.

RESULTS: Most dual users had smoke-free home policies, yet fewer had a vape-free home policies (63.8% vs 26.3%; P < .01). Dual users were less likely than cigarette users to have smoke-free car (P < .01), vape-free home (P < .001), or vape-free car (P < .001) policies. Inside cars, dual users were more likely than cigarette users to report smoking (P < .001), e-cigarette use (P < .001), and e-cigarette use with children present (P < .001). Parental characteristics associated with not having smoke-free or vape-free home and car policies include smoking ≥10 cigarettes per day, using e-cigarettes, and having a youngest child >10 years old. Smoke-free home and car advice was infrequently delivered.

CONCLUSIONS: Parents may perceive e-cigarette aerosol as safe for children. Dual users more often had smoke-free policies than vape-free policies for the home. Dual users were less likely than cigarette-only smokers to report various child-protective measures inside homes and cars. These findings reveal important opportunities for intervention with parents about smoking and vaping in homes and cars.

The full citation for the paper is: Jeremy E. Drehmer, Emara Nabi-Burza, Bethany Hipple Walters, Deborah J. Ossip, Douglas E. Levy, Nancy A. Rigotti, Jonathan D. Klein and Jonathan P. Winickoff.  Parental Smoking and E-cigarette Use in Homes and Cars.. Pediatrics Mar 2019, e20183249; DOI: 10.1542/peds.2018-3249.  It is available here.


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