Nearly Half of US Middle and High School Students Report Secondhand E-Cigarette Exposure

The findings of a research letter published in JAMA Network Open show that nearly half of US middle school and high students reported being exposed to secondhand aerosol (SHA) from e-cigarettes between 2015 and 2018, with a growing trend found in 2018.

Researchers assessed data from a sample of 76,447 participants of the National Youth Tobacco Survey, which took place from 2015 to 2018. The sample comprised: 17,711 (63.4%) respondents in 2015; 20,675 (71.6%) respondents) in 2016; 17,872 (68.1%) respondents in 2017; and 20,189 (68.2%) respondents in 2018. Subsequent to approval from the US Centers for Disease Control and Prevention institutional review board, and parents providing either active or passive permission forms, the participants were asked how often in the past 30 days did they inhale smoke from someone smoking tobacco products, and how often they breathed in vapor from someone using an e-cigarette in doors, (e.g., school building, sports arena, or restaurant) or outdoors, (e.g., park, stadium, or parking lot).

The participants’ response options were specified as 0, 1 or 2, 3 to 5, 6 to 9, 10 to 19, 20 or 29, or all exposure throughout all 30 days. The researchers categorized all recorded responses as no exposure (0 days) vs exposure (≥1 day). Study factors included sex, school type, race/ethnicity, speaking non-English language at home, e-cigarette use, past-30-day use of other tobacco products, living with someone who used e-cigarettes, and living with someone who used other tobacco products. Researchers compared the prevalence of exposure to SHS and SHS yearly utilizing bi-variate logistic regression, and statistical significance was using StataCorp and weighed to account for the diverse survey design. They set statistical significance at P < .05, and all tests were 2-tailed.

A Dangerous Upward Trend

According to the survey results, between 2015 and 2018, prevalence of SHA exposure increased from approximately 1 of 4 students between 2015 and 2017 to 1 of 3 students in 2018, with a significant upward trend in 2018 (2015, 25.2%; 2016, 26.5%; 2017, 25.6%; 2018, 33.2%). While nearly half of students also reported secondhand smoke (SHS) exposure during that same time, researchers observed a significant downward trend in 2017 and 2018 (2015, 52.6%; 2016, 53.4%; 2017, 50.5%; 2018, 48.7%). “Although 16 states and more than 800 municipalities have introduced laws to restrict e-cigarette use in 100% smoke-free or other venues, including schools, over the past few years, an increasing proportion of US youth reported exposure to SHA in public places in 2018 compared with previous years,” the research authors wrote in their conclusion. “This may be owing to the increase in youth using pod-based e-cigarettes and other devices, fewer vape-free policies than smoke-free policies, and fewer people who are willing to speak up against others vaping in public places.”

The researchers added that “beyond accelerating implementation of clean air laws, surveillance of SHA exposure trends, education about potential SHA harms for parents and youth, and interventions to reduce youth vaping are needed to protect young people from being exposed to all forms of tobacco product emissions, including from e-cigarettes.”