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

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Abstract

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.

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Acknowledgements

The project was also supported by the NIH National Center for Advancing Translational Sciences through Grant No. UL1TR001998, through use of the REDCap research project database through the University of Kentucky Clinical and Translational Research Center.

Funding

This work was supported by the National Institute on Drug Abuse at the National Institutes of Health under Award Number R01DA040694-01 to K. Ashford, and in part by the NIH National Center for Advancing Translational Sciences through Grant No. UL1TR001998. Additionally, Dr. Breland’s effort (co-author) is supported in part by the National Institute on Drug Abuse of the National Institutes of Health under Award Number U54DA036105 and the Center for Tobacco Products of the U.S. Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH or the FDA.

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Correspondence to Andrea McCubbin.

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The authors declare that they have no conflict of interest.

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Ashford, K., McCubbin, A., Barnett, J. et al. Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use. Matern Child Health J 25, 1175–1181 (2021). https://doi.org/10.1007/s10995-021-03161-z

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  • DOI: https://doi.org/10.1007/s10995-021-03161-z

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