Harm perceptions of secondhand e-cigarette aerosol among youth in the United States.

E-cigarette use among youth remains a public health concern. Although extant literature has examined the perceived harms of cigarette use and secondhand smoke, perceptions of harms associated with secondhand e-cigarette aerosol (SHA) are not well understood. Therefore, we used data from the 2020 U.S. National Youth Tobacco Survey (n = 13,292) in which participants indicated whether SHA caused no harm, little harm, some harm, or a lot of harm. We dichotomized SHA harm perceptions as harmless vs harmful. We included sociodemographics (i.e., age, sex, race/ethnicity, sexual orientation, urbanicity), e-cigarette use characteristics, and SHA exposure as covariates and estimated associations between SHA harm perceptions and each covariate using adjusted logistic regression. Most youth perceived SHA as harmful (87.9 %) compared to harmless (12.1 %). Older youth (vs younger youth) had higher odds of perceiving SHA as harmless, whereas male (vs female) youth had 49 % higher odds (95 % CI: 1.29-1.72) of perceiving SHA as harmless. As the number of days of e-cigarette use in the past 30 days increased (vs non-users), odds of perceiving SHA as harmless increased. Youth exposed to SHA (vs no exposure) in the past 30 days had 35 % higher odds of perceiving SHA as harmless (95 % CI: 1.16-1.57). To conclude, youth SHA harm perceptions varied overall and by sociodemographic characteristics, e-cigarette use, and SHA exposure. Educational campaigns to inform youth of the health risks associated with e-cigarettes and SHA are needed to reduce overall nicotine intake and disparities in nicotine exposure.

Exposure to secondhand aerosol from electronic cigarettes at homes: A real-life study in four European countries.

Electronic cigarette (e-cigarette) use emits potentially hazardous compounds and deteriorates indoor air quality. Home is a place where e-cigarettes may frequently be used amid its increasing prohibition in public places. This study assessed the real-life scenario of bystanders' exposure to secondhand e-cigarette aerosol (SHA) at home. A one-week observational study was conducted within the TackSHS project in four countries (Greece, Italy, Spain, and the United Kingdom) in 2019 including: 1) homes of e-cigarette users living together with a non-user/non-smoker; and 2) control homes with no smokers nor e-cigarette users. Indoor airborne nicotine, PM2.5, and PM1.0 concentrations were measured as environmental markers of SHA. Biomarkers, including nicotine and its metabolites, tobacco-specific nitrosamines, propanediol, glycerol, and metals were measured in participants' saliva and urine samples. E-cigarette use characteristics, such as e-cigarette refill liquid's nicotine concentration, e-cigarette type, place of e-cigarette use at home, and frequency of ventilation, were also collected. A total of 29 e-cigarette users' homes and 21 control homes were included. The results showed that the seven-day concentrations of airborne nicotine were quantifiable in 21 (72.4 %) out of 29 e-cigarette users' homes; overall, they were quite low (geometric mean: 0.01 µg/m3; 95 % CI: 0.01-0.02 µg/m3) and were all below the limit of quantification in control homes. Seven-day concentrations of PM2.5 and PM1.0 in e-cigarette and control homes were similar. Airborne nicotine and PM concentrations did not differ according to different e-cigarette use characteristics. Non-users residing with e-cigarette users had low but significantly higher levels of cotinine, 3'-OH-cotinine and 1,2-propanediol in saliva, and cobalt in urine than non-users living in control homes. In conclusion, e-cigarette use at home created bystanders' exposure to SHA regardless of the e-cigarette use characteristics. Further studies are warranted to assess the implications of SHA exposure for smoke-free policy.

Nicotine-naïve adolescents who live with tobacco products users, 2018 Florida Youth Tobacco Survey.

OBJECTIVE: We assessed the prevalence and factors associated with living with tobacco/nicotine product users among nicotine-naïve adolescents. METHODS: Data were from the 2018 Florida Youth Tobacco Survey that included 34,183 adolescents who were never-tobacco product users and provided information about living with tobacco/nicotine users. RESULTS: More than a quarter of adolescents lived with a tobacco/nicotine user. Girls were more likely than boys and middle-schoolers were more likely than high-schoolers to live with someone who uses cigarettes, cigars, and poly-tobacco. Compared to non-Hispanic Whites, Hispanics were less likely to live with someone who uses cigarettes, electronic nicotine delivery systems, cigars, and poly-tobacco. Adolescents who reported currently having asthma were more likely to report living with someone who smokes cigarettes, hookah, and poly tobacco. CONCLUSIONS: To reduce and ideally eliminate exposure to smoke/aerosol emitted from tobacco products in nicotine-naïve adolescents, individual and family-centered interventions, coupled with state-wide tobacco prevention strategies are warranted.

Harm Perceptions of Tobacco/Nicotine Products and Child Exposure: Differences between Non-Users, Cigarette-Exclusive, and Electronic Cigarette-Exclusive Users.

OBJECTIVE: This study examined caregiver perception of harm and child secondhand exposure to nicotine in a sample of e-cigarette-exclusive, cigarette-exclusive, and non-tobacco/nicotine users (non-users). METHODS: Cigarette-exclusive (n = 19), e-cigarette-exclusive (n = 12), and non-users (n = 20) and their children (N = 51, Mage = 10.47) completed self-report questionnaires about perceptions of harm, child secondhand exposure, and provided urine to assess child nicotine exposure (cotinine). ANOVAs examined differences between caregiver use status on tobacco harm perceptions and child cotinine levels. Independent samples t-test compared differences in caregiver-reported child secondhand exposure in the home and car. RESULTS: All 3 caregiver groups rated cigarettes as highly harmful (P = .14), but e-cigarette users rated all 3 types of e-cigarette products (Cartridge-based: P < .001; Tank: P < .001; Box Mod: P < .001) as less harmful than cigarette users and non-users. Caregivers from the e-cigarette user group reported greater child secondhand exposure than caregivers using cigarettes (past 7-day in-home exposure (P = .03); past 7-day exposure in-home + in-car exposure (P = .02); in-home exposure by caregivers and other people exposure (P = .02)). Children from the cigarette user group had significantly higher levels of cotinine (M = 16.6, SD = 21.7) compared to children from the Non-User group (M = .43, SD = .95; P = .001), but no significant difference when compared to children from the E-Cigarette User group (M = 6.5, SD = 13.5). DISCUSSION: In this sample, caregivers who used e-cigarettes perceived them as less harmful, reported using them more frequently at home and in the car, even when their children were present, compared to cigarette users. As a result, children appear to be exposed to nicotine at levels similar to children living with cigarette users. Future caregiver prevention and intervention efforts should target education around the potential harms of secondhand e-cigarette aerosol to children.

Estimating the Carcinogenic Potency of Second-Hand Smoke and Aerosol from Cigarettes and Heated Tobacco Products.

The revised Promotion Act, enforced in April 2020, allows the establishment of dedicated smoking rooms for heated tobacco products (HTPs). Since carcinogenicity assessment is unable to determine the safe level of secondhand smoke, we estimated excess lifetime cancer risk using previously reported risk factors. Assuming that nicotine inhalation is proportional to cancer potency, the lifetime cancer risk for HTP IQOS is expected to be below 10-5 (1/100,000), which is three orders of magnitude lower than that for cigarettes.

Exposure Assessment of Environmental Tobacco Aerosol from Heated Tobacco Products: Nicotine and PM Exposures under Two Limited Conditions.

It is too early to provide a clear answer on the impact of exposure to the second-hand aerosol of heated tobacco products (HTPs) in the planning of policy for smoke-free indoors legislation. Here, we conducted a preliminary study to evaluate indoor air quality with the use of HTPs. We first measured the concentration of nicotine and particulate matter (PM2.5) in the air following 50 puffs in the use of HTPs or cigarettes in a small shower cubicle. We then measured these concentrations in comparison with the use equivalent of smoking 5.4 cigarettes per hour in a 25 m3 room, as a typical indoor environment test condition. In the shower cubicle test, nicotine concentrations in indoor air using three types of HTP, namely IQOS, glo, and ploomTECH, were 25.9-257 µg/m3. These values all exceed the upper bound of the range of tolerable concentration without health concerns, namely 3 µg/m3. In particular, the indoor PM2.5 concentration of about 300 to 500 µg/m3 using IQOS or glo in the shower cubicle is hazardous. In the 25 m3 room test, in contrast, nicotine concentrations in indoor air with the three types of HTP did not exceed 3 µg/m3. PM2.5 concentrations were below the standard value of 15 µg/m3 per year for IQOS and ploomTECH, but were slightly high for glo, with some measurements exceeding 100 µg/m3. These results do not negate the inclusion of HTPs within a regulatory framework for indoor tolerable use from exposure to HTP aerosol, unlike cigarette smoke.

Secondhand exposure to e-cigarette aerosols among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC Europe Surveys.

INTRODUCTION: Electronic cigarette (e-cigarette) use has grown significantly in some European Union (EU) Member States (MS). A better understanding of the exposure to secondhand e-cigarette aerosols (SHA) is necessary to develop and implement comprehensive regulations on e-cigarette use in public places. This study aims to assess the observation of e-cigarette use in public places, the self-reported exposure to SHA, and the level of users' comfort using e-cigarettes in the presence of others. METHODS: This is a cross-sectional study of the Wave 1 International Tobacco Control 6 European Countries Survey recruiting adult smokers (n=6011) across six EU MS: Germany, Greece, Hungary, Poland, Romania, and Spain, within the EURESTPLUS Project. A descriptive analysis was conducted to estimate the prevalence (%) of observed e-cigarette use in different places, frequency of self-reported exposure to SHA, and level of comfort using e-cigarettes in the presence of others. RESULTS: In all, 31.0% of smokers observed others using e-cigarette in public places, 19.7% in indoor places where smoking is banned, and 14.5% indoors at work. Almost 37% of smokers reported to be ever exposed to SHA, ranging from 17.7% in Spain to 63.3% in Greece. The higher prevalence of observed e-cigarette use and passive exposure to SHA was reported by smokers of younger age, of higher educational level and those being current or former e-cigarette users. Part (8.8%) of the smokers who were also e-cigarette users reported feeling uncomfortable using e-cigarettes in the presence of others. CONCLUSIONS: A third of smokers from six EU MS reported being exposed to SHA. Prevalence differences were observed among the countries. In the context of scarce evidence on long-term health effects of exposure to SHA, precautionary regulations protecting bystanders from involuntary exposure should be developed.