Perceptions, Characteristics, and Behaviors of Cigarette and Electronic Cigarette Use among Pregnant Smokers

Cigarette and E-Cigarette Harm Perceptions During Pregnancy

BACKGROUND

Research suggests that pregnancy status (prior, current, and future intention) is associated with differences in perceived harm of electronic cigarette (e-cigarette) use during pregnancy. However, perceptions of health outcomes attributed to cigarette and e-cigarette use during pregnancy have not been explored among a sample of pregnant women who smoke.

OBJECTIVES

The purpose of this study was to explore differences in perceived harms of cigarette and e-cigarette use and perceived birth and health outcomes associated with cigarette and e-cigarette use during pregnancy among a sample of pregnant women who currently smoked.

METHODS

Using a cross-sectional online survey, we examined perceptions about cigarette and e-cigarette use during pregnancy among a sample of U.S. pregnant women ( n = 267) who smoked in the past 30 days. Participants were grouped into categories based on e-cigarette use status (current, past, and never e-cigarette users). Differences between e-cigarette use status and perceived harm (absolute of cigarettes, e-cigarettes, and relative of e-cigarettes) and perceived health outcomes attributed to smoking/e-cigarette use were examined.

RESULTS

Among our sample, 45.7%, 39.7%, and 14.6% were current, ever, and never e-cigarette users, respectively. Associations existed between e-cigarette use status and absolute perceived harm of cigarettes, relative perceived harm of e-cigarettes, and perceived health outcomes. Current e-cigarette users believed pregnant women who smoked cigarettes were more likely to lose a child because of miscarriage or sudden infant death syndrome or give birth to a child with low birth weight, reduced lung function, cleft lip, reduced brain function, or attention-deficit/hyperactivity disorder than never e-cigarette users. No associations were found between perceived birth and health outcomes of e-cigarette use by e-cigarette user status.

DISCUSSION

Pregnant women who smoked and used e-cigarettes had lower risk perceptions about e-cigarette use during pregnancy than those who only smoked. Health messages and research about the harms of nicotine exposure during pregnancy should address the risks of dual-use versus only e-cigarette use. In addition, messages about the relative harm of e-cigarettes compared to cigarettes are needed for pregnant women who smoke and have trouble quitting.

Predictors of Quitting Dual Use of Electronic Cigarettes and Cigarettes During Pregnancy

Background and Aims: There is limited research surrounding dual maternal use of cigarettes and electronic cigarettes (e-cigarettes). We aimed to assess predictors of maternal quitting of cigarettes, e-cigarettes, and both during late pregnancy. Materials and Methods: We analyzed dual use (n = 4,006) and exclusive e-cigarette use (n = 1,685) among mothers using data from the 2016 to 2019 phase of the Pregnancy Risk Assessment Monitoring Systems (PRAMS), a nationally representative sample of the United States. Dual use and exclusive e-cigarette use were defined based on use reported during the 3 months before pregnancy and quitting was assessed during the last 3 months of pregnancy. Multinomial and binomial logistic regression models estimated the odds ratios and 95% confidence intervals for predictors of quitting status among mothers who reported dual use and exclusive e-cigarette use, respectively. Separate predictor analyses were conducted in the dual and exclusive e-cigarette use groups to see predictors of quitting e-cigarettes, cigarettes, or both. Results: The highest proportion of mothers who used cigarettes and e-cigarettes before pregnancy quit both during late pregnancy (46.2%), followed by those who quit e-cigarette use only (26.5%) and those who quit cigarette use only (6.6%). Among mothers who reported dual use, those who were African American or Asian, of Hispanic ethnicity, consumed alcohol before pregnancy, had higher education, were married, had diabetes, had higher annual household income, had nongovernmental health insurance, had more prenatal care visits, had a higher frequency of e-cigarette use before pregnancy, had a lower frequency of cigarette use before pregnancy, and smoked hookah around pregnancy had a higher likelihood of quitting both cigarette and e-cigarette use during late pregnancy. Conclusions: Quitting use of cigarettes and/or e-cigarettes was fairly common among mothers who reported dual use or e-cigarette use only. Sociodemographics, pregnancy characteristics, and use of other tobacco products predicted quitting use of both cigarettes and e-cigarettes during late pregnancy.

Perinatal Smoking and E-cigarette Use and Their Relationship with Breastfeeding: PRAMS 2015-2020

Introduction: Electronic cigarette (e-cigarette) use poses concerns among women of child-bearing age. We examined prevalence of breastfeeding among the U.S. women and characteristics associated with exclusive use of cigarettes, e-cigarettes, or both products. Materials and Methods: Our study is based on pooled cross-sectional data from 2015-2020 Pregnancy Risk Assessment Monitoring System. Two outcomes were breastfeeding initiation and breastfeeding duration for over 6 months, as recommended by the American Academy of Pediatrics (AAP). Binary logistic regressions were used to examine associations between each outcome and type of tobacco products unadjusted and adjusted for potential confounders, with post hoc estimation of average adjusted predictions, marginal effects, and contrasts of margins in Stata. Results: Adjusted prevalence of breastfeeding initiation was significantly higher in women who used e-cigarettes (86.15%) than conventional cigarettes (72.16%) or both products (79.54%). Similarly, a significantly higher percentage of women who used e-cigarettes continued breastfeeding after 6 months (49.20%) than women who smoked conventional cigarettes (31.30%) or both products (29.83%). Among women who neither smoked nor used e-cigarettes, 85.29% initiated breastfeeding and 57.20% continued breastfeeding as recommended by the AAP. Conclusion: Likelihood of breastfeeding initiation and continuation in women using e-cigarettes was comparable to those who neither smoked nor used e-cigarettes. Future research needs to elucidate differences in breastfeeding by sociodemographic and health-related characteristics of women who smoke or use both products compared to those who use e-cigarettes. Understanding women's motivation behind use of a particular tobacco product is also important, so mothers who smoke e-cigarettes are not incorrectly perceived as safer users and excluded from tobacco cessation interventions.

The perceived risks of e-cigarettes to others and during pregnancy

BACKGROUND

Public Health England has concluded that e-cigarettes are much safer than cigarettes for the user and for secondhand exposures, but it has not reached a definitive conclusion regarding pregnancy risks. How people perceive the risks to others is less well understood.

METHODS

This study uses an online UK sample of 1041 adults to examine perceived e-cigarette risks to others and during pregnancy. The survey examines relative risk beliefs of e-cigarettes compared to cigarettes and the percentage reduction in harm provided by e-cigarettes.

RESULTS

A majority of the sample believes that secondhand exposure to e-cigarette vapors poses less risk than secondhand smoke from cigarettes, but almost two-fifths of the sample equate the secondhand risks from e-cigarettes to those from cigarettes. There is somewhat greater perception of e-cigarette risks during pregnancy compared to beliefs regarding secondhand risks of vaping. About two-fifths of the population believe that e-cigarettes are less risky than cigarettes during pregnancy. Respondents believe that e-cigarettes reduce the harm to others by 39% and the harm to babies by 36%.

CONCLUSION

There is a general sense that e-cigarettes pose less risk than cigarettes, but there is a need for further risk communication regarding comparative e-cigarette risks.

Maternal electronic cigarette use during pregnancy affects long-term arterial function in offspring

Vaping, or electronic cigarette (ecig) use, is prevalent among pregnant women, although little is known about the effects of perinatal ecig use on cardiovascular health of the progeny (even when using nicotine-free e-liquid). Maternal toxicant inhalation may adversely affect vital conduit vessel development. We tested the hypothesis that perinatal exposure to maternal vaping would lead to a dose-dependent dysfunction that would persist into later life of offspring. Pregnant Sprague-Dawley rats were exposed to either nicotine-free (ecig0) or nicotine-containing ecig aerosol (18 mg/mL, ecig18) starting on gestational day 2 and continued until pups were weaned (postnatal day 21). Pups were never directly exposed. Conduit artery function (stiffness and reactivity) and structure were assessed in 3- and 7-mo-old offspring. At 3 mo, pulse wave velocity (PWV) in the ecig0 and ecig18 offspring was significantly higher than controls in both the 20 puffs/day (6.6 ± 2.1 and 4.8 ± 1.3 vs. 3.2 ± 0.7 m/s, respectively, P < 0.05, means ± SD) and in 60 puffs/day exposure cohort (7.5 ± 2.8 and 7.5 ± 2.5 vs. 3.2 ± 0.5 m/s, respectively, P < 0.01). Wire myography revealed (range of 23%-31%) impaired aortic relaxation in all ecig exposure groups (with or without nicotine). Incubation of vessels with TEMPOL or Febuxostat reversed the aortic dysfunction, implicating the involvement of reactive oxygen species. Nearly identical changes and pattern was seen in vascular outcomes of 7-mo-old offspring. The take-home message from this preclinical study is that maternal vaping during pregnancy, with or without nicotine, leads to maladaptations in vascular (aortic) development that persist into adult life of offspring.NEW & NOTEWORTHY We observe a significant alteration in arterial structure and function in adolescent and adult offspring due to developmental exposure to toxicants resulting from perinatal maternal vaping. Taken together with previous work that described lasting dysfunction in cerebral microvasculature in offspring, these data underscore the adverse consequences of maternal exposure to electronic cigarette aerosol in conduit and resistance vessels alike, irrespective of nicotine content.

The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review

INTRODUCTION

Many adult cigarette smokers use electronic cigarettes (e-cigarettes) to cut down on or quit smoking cigarettes. E-cigarettes with higher abuse potential and appeal might facilitate complete switching. E-liquid nicotine concentration and flavor are two of the characteristics that may affect the abuse potential and appeal of e-cigarettes. The objective of this systematic review was to compile results from survey, animal, human laboratory, and clinical studies to understand the possible effects of nicotine concentration and flavor on abuse potential and appeal of e-cigarettes in adult current and former cigarette and e-cigarette users.

AIMS AND METHODS

A comprehensive literature search was conducted in Ovid Medline and PsycINFO followed by citation tracking in Web of Science Core Collection. Peer-reviewed studies published in English between 2007 and August 2020 were selected that analyzed differences between e-liquid nicotine concentration and/or flavors, had outcome measures related to abuse potential and/or appeal, and included adult humans (18+) or animals. A total of 1624 studies were identified and screened. A qualitative synthesis of results was performed.

RESULTS

Results from 104 studies included in this review suggest that higher nicotine concentration and access to a variety of flavors are likely to be associated with higher abuse potential and appeal of e-cigarettes for adult current and former cigarette and e-cigarette users.

CONCLUSIONS

Higher nicotine concentrations and the availability of a variety of flavors in e-cigarettes might facilitate complete substitution for cigarettes. Future e-cigarette regulations should take into account their impact on smokers, for whom e-cigarettes may be a cessation tool or reduced-harm alternative.

IMPLICATIONS

E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers.

Association Between Electronic Nicotine Delivery Systems Use and Breastfeeding Duration

Background: Breastfeeding is beneficial for both mothers and infants. Unfortunately, some infants are not breastfed for the recommended duration of time. Previous studies have identified several demographic, socioeconomic, biological, and behavioral factors that impact breastfeeding practices. Studies examining the influence of electronic nicotine delivery systems (ENDS) on breastfeeding practices are currently lacking. Materials and Methods: This population-based, cross-sectional study used data from the 2016-2018 Pregnancy Risk Assessment and Monitoring System (n = 42,827). Chi-squared tests and multivariable logistic regression analyses were performed. Results: The prevalence of prenatal ENDS use was 0.9%. Only 40.8% of women who used ENDS during pregnancy breastfed for at least 3 months compared with 68.5% of women who did not use ENDS during pregnancy. In the multivariable model, the odds of breastfeeding for at least 3 months were significantly lower in women who used ENDS during pregnancy compared with those who did not use ENDS; odds ratio (95% confidence interval) 0.63 (0.44-0.89; p = 0.010). Conclusion: Prenatal exposure to ENDS is negatively associated with breastfeeding duration, independent of potential confounders. This finding suggests that screening for ENDS use during pregnancy can play a vital role in identifying women at-risk for suboptimal breastfeeding and offering ongoing support to improve breastfeeding practices.

Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy II: Perinatal Outcomes Following ENDS Use During Pregnancy

Purpose of Review

This review examines the risk of adverse perinatal outcomes following electronic nicotine delivery system (ENDS) use during pregnancy, and considers whether there are sufficient data to support ENDS as a harm reduction approach during pregnancy.

Recent Findings

Seven papers assessed perinatal outcomes following ENDS use during pregnancy. There was evidence that ENDS use was associated with increased risk for some adverse perinatal outcomes (e.g., small for gestational age). However, the repeated use of data sets, insufficient data (e.g., timing of ENDS use, type of ENDS products used), and limited samples size, contributed to mixed findings on the degree to which ENDS use (alone or in combination with combustible cigarettes (CC)) impacts the risk of adverse perinatal outcomes relative to CC smoking alone.

Summary

The current data are still insufficient to support ENDS as a harm reduction approach, though findings do warrant concern and more detailed investigation of ENDS use during pregnancy. Future research directions, as well as implications for clinical recommendations and tobacco regulatory science are discussed.

Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy I: ENDS Use Behavior During Pregnancy

PURPOSE OF REVIEW

This review examines Electronic Nicotine Delivery Systems (ENDS) use behavior during pregnancy, including the prevalence of and transitions in use during pregnancy.

RECENT FINDINGS

Twenty-two papers addressed the prevalence of and/or transitions in ENDS use during pregnancy. Findings show a complex landscape of ENDS use. A minority (0.4%-7.0%) of pregnant persons use ENDS; most commonly this occurs in the form of dual use (ENDS and combustible cigarettes (CC); 75%). Many pregnant persons report using ENDS because they perceive them to be a lower-risk alternative and/or potential cessation aide for CC smoking. However, while a subset of those who use ENDS do quit all tobacco product use during pregnancy, only a small proportion switch from exclusive CC smoking to exclusive ENDS use.

SUMMARY

ENDS are a somewhat new addition to the tobacco product landscape. The perception of ENDS as a lower-risk alternative may contribute to ENDS use in pregnancy. There is insufficient evidence to support the notion that ENDS facilities the cessation of tobacco product use during pregnancy.

Pregnant Smokers' Intention to Switch From Cigarettes to E-Cigarettes: A Reasoned Action Approach

INTRODUCTION

This study used the reasoned action approach (RAA) to examine 1) factors associated with pregnant smokers' intention to switch from cigarettes to e-cigarettes and 2) the influence that intention to switch had on future expectations to resume cigarette use postpartum.

METHODS

U.S. pregnant women (N = 267) who reported past 30-day use of cigarettes completed an online cross-sectional survey between November and December 2019. A 30-item scale measured RAA constructs (intention, instrumental attitudes, experiential attitudes, injunctive norms, descriptive norms, perceived autonomy, and perceived capacity). A confirmatory factor analysis confirmed and structural equation modeling tested the RAA constructs' association with intention to switch and the relationship between intention to switch and future expectations to resume smoking after pregnancy.

RESULTS

The confirmatory factor analysis confirmed the seven-factor measurement model. Structural equation modeling found instrumental attitudes (β = 0.43; p < .001) and descriptive norms (β = 0.53; p < .001) were associated with intention to switch from cigarettes to e-cigarettes. However, there were differences between the constructs' relationships with intention between those who did and did not use e-cigarettes in the past 30 days. Intention to switch was inversely related with future expectations to resume smoking postpartum (β = -0.13; p < .001).

CONCLUSIONS

This study examined multiple facets of behavioral decision-making that may influence pregnant smokers' intention to switch to e-cigarettes during pregnancy. In this sample, pregnant people who believed switching from cigarettes to e-cigarettes was important and that other smokers commonly switched during pregnancy reported greater intention to switch. Novel theories, such as the RAA, may provide an optimal lens to understand pregnant smokers' behavioral decision-making process as they consider switching from cigarettes to e-cigarettes.

Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use

INTRODUCTION

In the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both.

METHODS

This was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05.

RESULTS

At enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters.

DISCUSSION

Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.

Factors Associated With Quitting Smoking During Pregnancy Among Women Veterans

INTRODUCTION

Little is known about the rates of smoking among pregnant veterans. Our objective was to examine rates of smoking during pregnancy and factors associated with quitting smoking during pregnancy.

METHODS

We used data from a cohort study of pregnant veterans from 15 Veterans Health Administration facilities nationwide. Veterans who reported smoking during pregnancy were included in this analysis. Poisson regression models were used to estimate the relative risk (RR) of quitting smoking during pregnancy.

RESULTS

Overall, 133 veterans reported smoking during pregnancy. Among this group of women who smoked, the average age was 31.6 years, 20% were Black, and 14% were Hispanic/Latino. More than one-half of women (65%) who reported smoking at the start of pregnancy quit smoking during pregnancy. Multivariable models, adjusted for history of deployment and age, indicated that prenatal care initiation at 12 or fewer weeks compared with more than 13 weeks (relative risk [RR], 2.06; 95% confidence interval [CI], 1.18-3.58), living without household smokers compared with any household smokers (RR, 1.58; 95% CI, 1.14-2.17), and first pregnancy (RR, 1.51; 95% CI, 1.17-1.95) were significant predictors of quitting versus persistent smoking during pregnancy.

CONCLUSIONS

Women veterans who quit smoking may be different than those who continue to smoke during pregnancy. Establishing prenatal care early in pregnancy, which likely includes counseling about smoking cessation, seems to be an important factor in quitting. Those for whom it is not a first pregnancy and who live with other smokers may especially benefit from such counseling.

Associations between electronic nicotine delivery systems and birth outcomes

OBJECTIVES

Nicotine crosses the placenta and is a known teratogen. The use of electronic nicotine delivery systems (ENDS) has increased among pregnant women in the US, but there is limited knowledge about their effects on birth outcomes. We examined the associations between ENDS and cigarette use during pregnancy with birth outcomes.

METHODS

We conducted a cross-sectional analysis of 57,046 respondents from 32 US states in the 2016-2017 Pregnancy Risk Assessment Monitoring System. Respondents self-reported use of ENDS and cigarettes during the last 3 months of pregnancy; this was linked with birth outcomes documented on the birth certificate, including birth weight, gestational age, small-for-gestational age, and preterm birth.

RESULTS

During the last 3 months of pregnancy, 0.5% of women used ENDS only, 0.8% were dual users of ENDS and cigarettes, and 8.0% used cigarettes only. In adjusted models, infants of women who used ENDS only weighed 57.8 grams less (95% CI -134.2, 18.6; p = .14) and were born 0.21 weeks earlier (95% CI -0.45, 0.03; p = .09) than infants of non-users. Infants born to dual users were 193.9 grams less (95% CI -274.9, -112.8; p < .01) and had a 1.93 higher odds of being born small-for-gestational age (95% CI 1.31, 2.83; p < .01) than infants of non-users.

CONCLUSIONS

Our results provide some indication that prenatal ENDS use may adversely affect birth outcomes by reducing birth weight and gestational age. Estimates were imprecise, suggesting that larger samples of ENDS users with more detailed information about patterns of use are needed.

Knowledge, Attitude and Smoking Patterns Among Pregnant Women: A Jordanian Perspective

Background:

Smoking during pregnancy is one of the main modifiable factors associated with perinatal morbidity and mortality and maternal complications. Literature is scant regarding smoking habits of pregnant women in Jordan.

Objectives:

To investigate smoking patterns and attitudes of Jordanian pregnant women towards smoking.

Methods:

A cross-sectional survey of patterns and attitudes towards smoking among 436 mothers attending healthcare facilities in the Governorate of Irbid, Jordan, between August and September 2019.

Results:

Out of 436 pregnant women in the Governorate of Irbid, Jordan, 13 (2.9%) quit smoking once pregnancy was conformed, and 77 (17.6%) continued to smoke.

Pregnant non-smokers believed that hookah and electronic cigarettes are as bad to health as cigarettes, while smokers believed that hookah and electronic cigarettes are less hazardous than cigarettes (5.19% versus 21.99%, p = 0.001, and 6.49% versus 19.37%, p = 0.009, respectively).

Non-smokers were significantly more aware regarding the hazards of smoking on perinatal outcomes, such as abortion (31.94% versus 10.39%, p = 0.001), placental abruption (31.94% versus 10.39%, p = 0.001), intrauterine growth restriction and fetal malformations (36.65% versus 14.29%, p = 0.007), fetal death (30.89% versus 6.49, p < 0.001), neonatal pulmonary diseases (44.50% versus 24.68%, p = 0.024), neonatal asthma (47.12% versus 28.57%, p = 0.038), and ear diseases (42.41% versus 20.8%, p = 0.012).

Conclusion:

There is a high prevalence of smokers among pregnant women in Jordan. The level of awareness regarding long-term consequences of tobacco use remains low. Educational programs should include information about the hazards of all forms of smoking. Pregnancy provides a good opportunity for promoting smoking cessation.

Incarceration exposure and electronic cigarette use during pregnancy: Findings from the pregnancy risk assessment monitoring system, 2016-2018

Smoking during pregnancy is a serious public health concern that poses risks for maternal and infant health. Considering the rise of electronic cigarette use in recent years, there is also growing concern about electronic cigarette use during pregnancy. Recent research has begun to explore correlates of electronic cigarette use among pregnant women. While research has revealed a strong connection between incarceration and smoking, scholars have yet to examine the connection between a woman's exposure to incarceration in the year prior to birth - either personally or vicariously through her husband or partner - and prenatal electronic cigarette use. The current study uses data from 74,554 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic regression and multinomial logistic regression models were used to assess the association between incarceration exposure and electronic cigarette use. The findings indicate a robust association between incarceration exposure and electronic cigarette use during pregnancy. Specifically, analyses demonstrate that incarceration-exposed women were approximately 2.7 times (AOR = 2.699, 95% CI = 1.939, 3.755) as likely to use electronic cigarettes after adjusting for a host of demographic, economic, health, and pregnancy related characteristics. Additional analyses reveal this association remains after accounting for conventional cigarette use during pregnancy. Considering the potential harmful health ramifications for electronic cigarette use during pregnancy, these findings suggest a need for interventions targeting electronic cigarette use among incarceration-exposed populations and point to electronic cigarette use among pregnant women in particular as an important area of focus for both criminal justice and public health practitioners.

Effects of E-Cigarette Exposure on Prenatal Life and Childhood Respiratory Health: A Review of Current Evidence

In the last decade, widespread use of E-cigarettes (EC) has occurred all over the world. Whereas, a large amount of evidence on harm to children from conventional cigarette exposure is available, data on health effects in this population throughout different vulnerability windows are still a matter of concern. Exposure to EC during pregnancy may compromise placental function, resulting in fetal structural abnormalities. Specifically, this may cause physio-pathologic changes in the developing lung, which in turn may impair respiratory health later in life. Furthermore, there is evidence that using EC can cause both short- and long-term respiratory problems in the pediatric population and there is great concern for future young people with nicotine addiction. The low parental perception of the risks connected to EC exposure for children increases their susceptibility to harmful effects from passive vaping. This minireview aims to summarize the current evidence focusing on: (i) prenatal effects of EC passive exposure; (ii) post-natal respiratory effects of EC exposure in youth; (iii) parental attitudes toward EC use and perception of children's health risks connected to EC exposure; and (iv) addressing gaps in our current evidence.