Research Article
E-Cigarette Use Patterns and High-Risk Behaviors in Pregnancy: Behavioral Risk Factor Surveillance System, 2016–2018

https://doi.org/10.1016/j.amepre.2020.02.015Get rights and content

Introduction

The prevalence of e-cigarette use has increased dramatically in the last decade in the U.S. Understanding the prevalence, patterns of use, and risk factor associations of e-cigarette use in pregnant women is particularly important, as this could have potential health implications for the mother and the developing child.

Methods

Using Behavioral Risk Factor Surveillance System Survey data from 2016 to 2018, adult women of reproductive age (18–49 years) who reported being pregnant (n=7,434) were studied. Self-reported current e-cigarette use was the main exposure. Other measures included combustible cigarette smoking status and high-risk behaviors (including other tobacco, marijuana, or heavy alcohol use; binge drinking; and others). All analyses were done in 2019.

Results

Approximately 2.2% of pregnant women reported current e-cigarette use, of whom 0.6% reported daily use. The highest prevalence of e-cigarette use was observed in the youngest age group of pregnant women (3.2%), with 41.7% of all pregnant current e-cigarette users being aged 18–24 years. There was a marked increase in the prevalence of current use of e-cigarettes among pregnant women from 1.9% in 2016 to 3.8% in 2018. Approximately 46% of pregnant current e-cigarette users reported concomitant cigarette smoking. Compared with pregnant never e-cigarette users, pregnant current e-cigarette users had a higher prevalence of other tobacco product use, marijuana use, heavy alcohol intake, binge drinking, and other high-risk behaviors.

Conclusions

These findings underscore the need to strengthen prevention and policy efforts, specifically in the vulnerable subgroup of pregnant women.

Section snippets

INTRODUCTION

Since their introduction into the U.S. market in 2007, awareness about e-cigarettes and their subsequent use has increased, with ever-use of e-cigarettes among adults increasing from 1.8% in 2010 to 15.3% in 2016.1, 2, 3 Current use of e-cigarettes among adults has also increased significantly from 0.3% in 2010 to 4.5% in 2016,2,4 affirming the increased popularity of these products.

Although many pregnant smokers are aware of the harms associated with smoking during pregnancy and are motivated

METHODS

The BRFSS is the largest health survey system in the world, established by the Centers for Disease Control and Prevention to collect information on the health-related risk behaviors, chronic health conditions, and use of preventive services among U.S. residents aged >18 years from all 50 states as well as the District of Columbia and 3 U.S. territories.27 Cross-sectional BRFSS survey data from 2016 to 2018 were pooled and analyzed.

The BRFSS is a publicly available data set with deidentified

RESULTS

There were 7,434 pregnant adult women of reproductive age (18–49 years) within the study population. About 54.2% of participants were aged 18–29 years. Almost 50% were white, 56.5% were married, 57.6% currently employed, and 55.8% were living >200% above the poverty line (Table 1). Compared with nonpregnant women, pregnant women were more likely to be younger and married, and other sociodemographic characteristics were distributed similarly across the two groups (Appendix Table 1, available

DISCUSSION

Using BRFSS, the largest nationally representative data on e-cigarette use to date, this study found that e-cigarette use during pregnancy is substantial, with a prevalence of 2.2% in this cohort. Given that there were approximately four million live births annually in the U.S. in 2016 and 2017,29 this translates to approximately 88,000 babies potentially exposed to e-cigarettes each year in utero. In addition, it is concerning that the prevalence of e-cigarette use doubled between 2016 and

CONCLUSIONS

The prevalence of e-cigarette use among pregnant women in the U.S. is 2.2%, with a 2-fold increase in the prevalence of use from 2016 to 2018. The youngest age group of 18–24 years had the highest burden of use. Among pregnant women, current e-cigarette users had a higher prevalence of concurrent cigarette smoking, other tobacco use, marijuana use, heavy alcohol intake, binge drinking, and other high-risk behaviors, including intravenous drug use and exchange of sex for money, than never

ACKNOWLEDGMENTS

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, Food and Drug Administration, or American Heart Association.

This research was supported by the National Heart, Lung, and Blood Institute of the NIH and the Food and Drug Administration Center for Tobacco Products under award numbers P50HL120163 and U54HL120163.

APD has received research grants from the NIH, Astra Zeneca, Ionis Pharmaceuticals, and private donors. He is also a

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