Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Maike K. Kahr, Shannon Padgett, Cindy D. Shope, Emily N. Griffin, Susan S. Xie, Pablo J. Gonzalez, Judy Levison, Joan Mastrobattista, Adi R. Abramovici, Thomas F. Northrup, Angela L. Stotts, Kjersti M. Aagaard, Melissa A. Suter

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Studies 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.

Methods

Eleven 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.

Results

Analyses 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.

Conclusions

Although 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.
Literature
1.
Suter MA, Mastrobattista J, Sachs M, Aagaard K. Is There Evidence for Potential Harm of Electronic Cigarette Use in Pregnancy? Birth Defects Res A Clin Mol Teratol. 2014;103(3):186–95.CrossRefPubMedPubMedCentral
2.
Pisinger C, Dossing M. A systematic review of health effects of electronic cigarettes. Prev Med. 2014;69:248–60.CrossRefPubMed
3.
Collaco JM, Drummond MB, McGrath-Morrow SA. Electronic cigarette use and exposure in the pediatric population. JAMA Pediatr. 2015;169(2):177–82.CrossRefPubMed
4.
Notes from the field: electronic cigarette use among middle and high school students - United States, 2011–2012. MMWR Morb Mortal Wkly Rep. 2013;62(35): 729–30.
5.
Grekin ER, Ayna D. Waterpipe smoking among college students in the United States: a review of the literature. J Am Coll Health. 2012;60(3):244–9.CrossRefPubMed
6.
7.
8.
Burstyn I. Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health. 2014;14:18.CrossRefPubMedPubMedCentral
9.
10.
Richardson A, Ganz O, Vallone D. Tobacco on the web: surveillance and characterisation of online tobacco and e-cigarette advertising. Tob Control. 2014;24(4):341–7.CrossRefPubMed
11.
Pepper JK, Emery SL, Ribisl KM, Southwell BG, Brewer NT. Effects of advertisements on smokers' interest in trying e-cigarettes: the roles of product comparison and visual cues. Tob Control. 2014;23 Suppl 3:iii31–6.CrossRefPubMedPubMedCentral
12.
McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014;12, CD010216.
13.
Coleman T, Chamberlain C, Cooper S, Leonardi-Bee J. Efficacy and safety of nicotine replacement therapy for smoking cessation in pregnancy: systematic review and meta-analysis. Addiction. 2011;106(1):52–61.CrossRefPubMed
14.
Coleman T, Cooper S, Thornton JG, Grainge MJ, Watts K, Britton J, et al. A randomized trial of nicotine-replacement therapy patches in pregnancy. N Engl J Med. 2012;366(9):808–18.CrossRefPubMed
15.
Berlin I, Grange G, Jacob N, Tanguy ML. Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy. Bmj. 2014;348:g1622.CrossRefPubMedPubMedCentral
16.
Coleman T, Chamberlain C, Davey MA, Cooper SE, Leonardi-Bee J. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2012;9, CD010078.
17.
Cooper S, Taggar J, Lewis S, Marlow N, Dickinson A, Whitemore R, et al. Effect of nicotine patches in pregnancy on infant and maternal outcomes at 2 years: follow-up from the randomised, double-blind, placebo-controlled SNAP trial. Lancet Respir Med. 2014;2(9):728–37.CrossRefPubMed
18.
Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tob Control. 2004;13(4):327–33.CrossRefPubMedPubMedCentral
19.
Haddad L, El-Shahawy O, Ghadban R, Barnett TE, Johnson E. Waterpipe Smoking and Regulation in the United States: A Comprehensive Review of the Literature. Int J Environ Res Public Health. 2015;12(6):6115–35.CrossRefPubMedPubMedCentral
20.
Gathuru IM, Tarter RE, Klein-Fedyshin M. Review of hookah tobacco smoking among college students: policy implications and research recommendations. Am J Drug Alcohol Abuse. 2015;41(4):272–80.CrossRefPubMed
21.
Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food Chem Toxicol. 2003;41(1):143–52.CrossRefPubMed
22.
Sajid KM, Akhter M, Malik GQ. Carbon monoxide fractions in cigarette and hookah (hubble bubble) smoke. J Pak Med Assoc. 1993;43(9):179–82.PubMed
23.
Martinasek MP, Gibson-Young LM, Davis JN, McDermott RJ. Waterpipe tobacco smoking impact on public health: implications for policy. Risk Manag Healthc Policy. 2015;8:121–9.CrossRefPubMedPubMedCentral
24.
Noonan D, Kulbok PA. New tobacco trends: waterpipe (hookah) smoking and implications for healthcare providers. J Am Acad Nurse Pract. 2009;21(5):258–60.CrossRefPubMed
25.
Suter MA, Anders AM, Aagaard KM. Maternal smoking as a model for environmental epigenetic changes affecting birthweight and fetal programming. Mol Hum Reprod. 2013;19(1):1–6.CrossRefPubMed
26.
Suter MA, Aagaard K. What changes in DNA methylation take place in individuals exposed to maternal smoking in utero? Epigenomics. 2012;4(2):115–8.CrossRefPubMed
27.
Aagaard-Tillery K, Spong CY, Thom E, Sibai B, Wendel Jr G, Wenstrom K, et al. Pharmacogenomics of maternal tobacco use: metabolic gene polymorphisms and risk of adverse pregnancy outcomes. Obstet Gynecol. 2010;115(3):568–77.CrossRefPubMedPubMedCentral
28.
Nuwayhid IA, Yamout B, Azar G, Kambris MA. Narghile (hubble-bubble) smoking, low birth weight, and other pregnancy outcomes. Am J Epidemiol. 1998;148(4):375–83.CrossRefPubMed
29.
Bryce R, Robson SJ. E-cigarettes and pregnancy. Is a closer look appropriate? Aust N Z J Obstet Gynaecol. 2015;55(3):218–21.CrossRefPubMed
30.
Mark KS, Farquhar B, Chisolm MS, Coleman-Cowger VH, Terplan M. Knowledge, Attitudes, and Practice of Electronic Cigarette Use Among Pregnant Women. J Addict Med. 2015;9(4):266–72.CrossRefPubMed
31.
Farquhar B, Mark K, Terplan M, Chisolm MS. Demystifying electronic cigarette use in pregnancy. J Addict Med. 2015;9(2):157–8.CrossRefPubMed
32.
33.
Novick G. CenteringPregnancy and the current state of prenatal care. J Midwifery Womens Health. 2004;49(5):405–11.CrossRefPubMed
34.
Massey Z, Rising SS, Ickovics J. CenteringPregnancy group prenatal care: Promoting relationship-centered care. J Obstet Gynecol Neonatal Nurs. 2006;35(2):286–94.CrossRefPubMed
35.
Manant A, Dodgson JE. CenteringPregnancy: an integrative literature review. J Midwifery Womens Health. 2011;56(2):94–102.CrossRefPubMed
36.
Kidd PS, Parshall MB. Getting the focus and the group: enhancing analytical rigor in focus group research. Qual Health Res. 2000;10(3):293–308.CrossRefPubMed
37.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
38.
Levison J, Nanthuru D, Chiudzu G, Kazembe PN, Phiri H, Ramin SM, et al. Qualitative assessment of attitudes and knowledge on preterm birth in Malawi and within country framework of care. BMC Pregnancy Childbirth. 2014;14:123.CrossRefPubMedPubMedCentral
39.
Wigginton B, Lee C. Stigma and hostility towards pregnant smokers: does individuating information reduce the effect? Psychol Health. 2013;28(8):862–73.CrossRefPubMed
40.
Borland T, Babayan A, Irfan S, Schwartz R. Exploring the adequacy of smoking cessation support for pregnant and postpartum women. BMC Public Health. 2013;13:472.CrossRefPubMedPubMedCentral
41.
Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014;23(2):133–9.CrossRefPubMed
42.
Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf. 2014;5(2):67–86.CrossRefPubMedPubMedCentral
43.
44.
Baeza-Loya S, Viswanath H, Carter A, Molfese DL, Velasquez KM, Baldwin PR, et al. Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bull Menninger Clin. 2014;78(3):243–52.CrossRefPubMedPubMedCentral
45.
England LJ, Anderson BL, Tong VT, Mahoney J, Coleman-Cowger VH, Melstrom P, et al. Screening practices and attitudes of obstetricians-gynecologists toward new and emerging tobacco products. Am J Obstet Gynecol. 2014;211(6):695. e1-7.CrossRefPubMedPubMedCentral
Metadata
Title
A qualitative assessment of the perceived risks of electronic cigarette and hookah use in pregnancy
Authors
Maike K. Kahr
Shannon Padgett
Cindy D. Shope
Emily N. Griffin
Susan S. Xie
Pablo J. Gonzalez
Judy Levison
Joan Mastrobattista
Adi R. Abramovici
Thomas F. Northrup
Angela L. Stotts
Kjersti M. Aagaard
Melissa A. Suter
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2586-4

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Application of the Intervention Mapping protocol to develop Keys, a family child care home intervention to prevent early childhood obesity

Research article

Factors associated with HIV counseling and testing behavior among undergraduates of universities and vocational technical training schools in Tbilisi, Georgia

Research article

The gender gap in sickness absence from work and the influence of parental absence on offspring absence 15 years later: register-based cohort of Norwegians born in 1974–1976

Research article

The complex relationship between human immunodeficiency virus infection and death in adults being treated for tuberculosis in Cape Town, South Africa

Research article

Household food (in)security and nutritional status of urban poor children aged 6 to 23 months in Kenya

Research article

Capacity building through cross-sector partnerships: a multiple case study of a sport program in disadvantaged communities in Belgium