A qualitative assessment of the perceived risks of electronic cigarette and hookah use in pregnancy

Abstract

BackgroundStudies reveal that electronic cigarette (e-cigarette) and hookah use are increasing among adolescents and young adults. However, the long-term health effects are unknown, especially with regards to pregnancy. Because of the increased use in women of reproductive age, and the unknown long-term health risks, our primary objectives were to determine the perceived risks of e-cigarette and hookah use in pregnancy, and learn common colloquial terms associated with e-cigarettes. Furthermore, we sought to determine if there is a stigma associated with e-cigarette use in pregnancy.MethodsEleven focus groups including 87 participants were conducted immediately following regularly scheduled CenteringPregnancy® prenatal care with women at three different clinics in the greater Houston area. A minimum of two facilitators led the groups, using ten lead-in prompts, with Spanish translation as necessary. Facilitators took notes which were compared immediately following each group discussion and each group was audio recorded and transcribed. Three facilitators utilized NVivo 9.0 software to organize the transcribed data into nodes to identify major themes. To increase rigor, transcripts were further analyzed by two obstetricians who were instructed to find the major themes.ResultsAnalyses revealed contradicting themes concerning e-cigarette use. In general, e-cigarettes were perceived as safer alternatives to regular tobacco cigarettes, especially if used as smoking cessation devices. A major theme is that use in pregnancy is harmful to the fetus. However, it was perceived that use for smoking cessation in pregnancy may have fewer side effects. We found that a common term for e-cigarettes is “Blu.” In our discussion of hookah use, participants perceived use as popular among teenagers and that use in pregnancy is dangerous for the fetus.ConclusionsAlthough a strong theme emerged against hookah use, we found contradicting themes in our discussions on e-cigarette use in pregnancy. It is possible that e-cigarette use will not carry the same stigma as regular cigarette smoking in pregnancy. In addition, the impression of e-cigarettes as a healthier alternative to smoking may influence use in pregnancy. Clinicians need to be prepared for questions of e-cigarette safety and efficacy as smoking cessation devices from their pregnant patients who smoke, and women who smoke and are planning to become pregnant.

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

“…192–194,214,288,325–327,332,335,336,338,353,354,361,369,372,374,382,384,389,390,446,448,449,453–457,461–464,467,471–474,476,477,484,485,488,490,492,493,495,502,503 In the U.S. and Great Britain, this belief has eroded over time with more individuals mistakenly believing ENDS are as harmful or more harmful that cigarettes. 391,414 Studies suggest that ENDS are also perceived as less addictive than cigarettes, 367,375,403,446 tools that may help users reduce or quit smoking, 320,327,330,338,357,374,448,453,455,458,461,464,467,481,483,485,486,488,493,495,499 less expensive than cigarettes, 335,338,447,455,456,472,499 and more convenient or easier to use than cigarettes. 335,338,357,400,499 …”

The impact of perinatal nicotine exposure on fetal lung development and subsequent respiratory morbidity

“…These have all been a cause for serious concern; however, two recent developments in the field have greatly added to the importance of the consequences of smoke/nicotine exposure on the developing fetus: It has been unequivocally demonstrated that the effects of maternal smoke/nicotine exposure on the developing fetus are not limited to the exposed progeny, but are also transmitted to subsequent generations' offspring, even though those generations never encountered smoke or nicotine (Rehan et al, ; Rehan, Liu, Sakurai, & Torday, ). These findings provide a renewed Lamarckian perspective to the effects of smoke/nicotine exposure on the developing fetus (Pilpel & Rechavi, ; Skinner, ). Because e‐cigs are perceived by many as a safer alternative during pregnancy, their use has increased sharply among women of reproductive age (Baeza‐Loya et al, ; Kahr et al, ; Li, Saad, Oliver, & Chen, ; Nguyen, Tong, Marynak, & King, ; Oncken et al, ; Wapner et al, ). Sales data project that the use of e‐cigs will soon surpass compared to conventional cigs; hence, the problem will likely become worse ( https://www.cnbc.com/id/100991511).…”

Developmental toxicity of e‐cigarette aerosols

“…Such measures are aimed at their removal from shelves and websites that are accessible to minors. In addition, an increasing number of pregnant women, and women of reproductive age, are turning to electronic cigarettes as an alternative to tobacco-based cigarettes in an effort to diminish the adverse developmental effects of exposure to cigarette smoking (Baeza-Loya et al, 2014;Kahr, Padgett, Shope, et al, 2015;Kurti et al, 2017;McCubbin, Fallin-Bennett, Barnett, & Ashford, 2017;Oncken, Ricci, Kuo, et al, 2017;Suter, Mastrobattista, Sachs, & Aagaard, 2015;Wagner et al, 2017).…”