Use and Perceptions of Electronic Cigarettes Among Caregivers of Infants and Children with Bronchopulmonary Dysplasia

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease associated with prematurity and very low birth weight. These children have increased morbidity and mortality associated with environmental exposures, such as cigarette smoke. As of 2015, 3.5% of US adults report current use of electronic cigarettes (e-cigarettes) with use increasing over time. Perceptions of e-cigarette harm are poorly understood, and there are no data among caregivers of children with BPD. Methods: Subjects (n = 119) in this study were recruited from the outpatient Johns Hopkins BPD Clinic from January to October 2015. Parental use and perceptions of e-cigarettes were assessed using a questionnaire adapted from the 2012 National Youth Tobacco Survey. Chi-square, t-test, and logistic regression analyses were used to assess characteristics associated with e-cigarette use and caregiver perceptions. Results: A total of 119 caregivers completed the questionnaire with 8% reporting current e-cigarette use and 14% reporting current conventional cigarette use. Households who used conventional cigarettes were eleven times more likely to also use e-cigarettes [odds ratio: 11.3 (95% confidence interval: 2.6-48.2); P = 0.001]. Households reporting conventional cigarette use were less likely to perceive e-cigarette emissions as harmful compared with nonsmoking households. Perceptions of e-cigarette emissions as less harmful to others were associated with conventional cigarette use, current e-cigarette use, and having public insurance. Conclusions: Among our population, both conventional cigarette and e-cigarette smoking households had decreased perceptions of harm regarding e-cigarette emissions to self and others. Our study suggests that e-cigarette use among caregivers is an underrecognized environmental exposure in households of children with BPD.