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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.

Background: In the USA, many states do not pre-empt municipalities from enacting stricter tobacco-control policies than state or federal laws. Several municipalities in Massachusetts have passed progressive local laws aimed at reducing adolescent tobacco use. We exploited this variability to examine the associations between county-level flavoured tobacco product restrictions, tobacco 21 policies and smoke-free laws prohibiting e-cigarettes with adolescent cigarette and e-cigarette use in Massachusetts, and to assess whether policy effects varied by age., Methods: We conducted difference-in-differences models to link changes in county-level tobacco-control policies to changes in adolescents' use of cigarettes and e-cigarettes using 2011-2017 biennial Massachusetts Youth Health Surveys., Results: Counties with greater implementation of flavoured tobacco product restrictions were associated with a decrease in the level of cigarette use among users (Coefficient -1.56; 95% CI -2.54 to -0.58). A significant interaction (p=0.03) revealed the largest reductions among 14 and 18 year olds. Increasing flavoured tobacco product restrictions were also associated with reductions in the likelihood of e-cigarette use (Coefficient -0.87; 95% CI -1.68 to -0.06). Increasing tobacco 21 restrictions were associated with decreases in cigarette use only among 18 year olds, while there was no evidence of associations between smoke-free laws with use of either tobacco product., Conclusions: Adolescents in Massachusetts decreased their use of cigarettes and e-cigarettes in response to local restrictions that limited the sale of flavoured tobacco products to adult-only retail tobacco stores. Local legislation can reduce adolescent tobacco use and municipalities should enact stricter tobacco-control policies when not pre-empted by state law., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The substance use policy context continues to evolve. As tobacco control policies have become more restrictive, marijuana legalization has increased access to marijuana. Data suggest that prenatal conventional cigarette use is declining, while e-cigarette and marijuana use are increasing among persons preconception, prenatally, and postpartum. Policy evaluations have found that increasing cigarette taxes reduces prenatal smoking and improves birth outcomes; however, there have been few studies of e-cigarette policies or marijuana legalization on prenatal use or birth outcomes. It is important for clinicians to screen for prenatal substance use, as recommended by American College of Obstetricians and Gynecologists (ACOG), and understand how policies influence use among their patients., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Given the rapid expansion of recreational marijuana legalization (RML) polices, it is essential to assess whether such policies are associated with shifts in the use of marijuana and other substances, particularly for adolescents, who are uniquely susceptible to negative repercussions of marijuana use. This analysis seeks to provide greater generalizability, specificity, and methodological rigor than limited prior evidence., Methods: Youth Risk Behavior Survey data from 47 states from 1999 to 2017 assessed marijuana, alcohol, cigarette, and e-cigarette use among adolescents (14-18+ years; N = 1,077,938). Associations between RML and adolescent past-month substance use were analyzed using quasi-experimental difference-in-differences zero-inflated negative binomial models., Results: Controlling for other state substance policies, year and state fixed effects, and adolescent demographic characteristics, models found that RML was not associated with a significant shift in the likelihood of marijuana use but predicted a small significant decline in the level of marijuana use among users (incidence rate ratio = .844, 95% confidence interval [.720-.989]) and a small increase in the likelihood of any e-cigarette use (odds ratio of zero use = .647, 95% confidence interval [.515-.812]). Patterns did not vary over adolescent age or sex, with minimal differences across racial/ethnic groups., Conclusions: Results suggest minimal short-term effects of RML on adolescent substance use, with small declines in marijuana use and increase in the likelihood of any e-cigarette use. Given the delayed rollout of commercial marijuana sales in RML states and rapid expansion of RML policies, ongoing assessment of the consequences for adolescent substance use and related health and behavioral repercussions is essential., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Little is known about why males are more likely to use electronic cigarettes (ECs) compared with females. This study examined gender differences in reasons for vaping and characteristics of EC used (device type, device capacity, e-liquid nicotine strength, and flavor)., Methods: Data were obtained from 3938 current (≥18 years) at-least-weekly EC users who participated in Wave 2 (2018) ITC Four Country Smoking and Vaping Survey in Canada, the United States, England, and Australia., Results: Of the sample, 54% were male. The most commonly cited reasons for vaping in females were "less harmful to others" (85.8%) and in males were "less harmful than cigarettes" (85.5%), with females being more likely to cite "less harmful to others" (adjusted odds ratio [aOR] = 1.64, p = .001) and "help cut down on cigarettes" (aOR = 1.60, p = .001) than males. Significant gender differences were found in EC device type used (χ  2 = 35.05, p = .043). Females were less likely to report using e-liquids containing >20 mg/mL of nicotine, and tank devices with >2 mL capacity (aOR = 0.41, p < .001 and aOR = 0.65, p = .026, respectively) than males. There was no significant gender difference in use of flavored e-liquids, with fruit being the most common flavor for both males (54.5%) and females (50.2%)., Conclusion: There were some gender differences in reasons for vaping and characteristics of the product used. Monitoring of gender differences in patterns of EC use would be useful to inform outreach activities and interventions for EC use., Implications: Our findings provide some evidence of gender differences in reasons for vaping and characteristics of EC used. The most common reason for vaping reported by females was "less harmful to others," which may reflect greater concern by female vapers about the adverse effects of secondhand smoke compared with male vapers. Gender differences might be considered when designing gender-sensitive smoking cessation policies. Regarding characteristics of EC products used, we found gender differences in preferences for e-liquid nicotine strength and device capacity. Further studies should examine whether the observed gender differences in EC use reasons and product characteristics are predictive of smoking cessation. Furthermore, studies monitoring gender-based marketing of ECs may be considered., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Vaping is the act of inhaling an aerosol generated by an electronic cigarette (e-cigarette), a battery-powered device that heats a reservoir of liquid, typically nicotine-containing, to deliver contents to the user. E-cigarettes were initially introduced as a means of smoking cessation, although evidence of their effectiveness is limited. There is a widespread perception that these products are a safer alternative to conventional cigarettes, driven in large part by marketing efforts by e-cigarette manufacturers. Yet to achieve vaporization, temperatures are so high that components of the device hardware, such as metals, plastics, rubber and foam, are aerosolized and inhaled along with the vaporized e-liquid containing nicotine, flavoring and solvents. We do not fully understand the health consequences of such aerosol exposure, particularly long-term effects, but short-term negative cardiovascular and respiratory effects have been demonstrated. Very few studies have evaluated the reproductive effect of e-cigarette use. We do not know whether vaping during pregnancy affects birth outcomes or the lifelong health of the fetus. There has been an exponential rise in the use of e-cigarettes in the United States since their introduction, particularly among youths, while concurrently there has been a laudable reduction in conventional cigarette use. It is imperative that obstetrician-gynecologists have a basic understanding of e-cigarettes, screen all patients as is consistently done for conventional smoking, and provide resources to patients about potential negative consequences of use., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Although the use of alternative tobacco products has been increasing among women and adolescents, research on the use of ENDS during pregnancy has been limited. This study examines the prevalence and sociodemographic characteristics of ENDS and cigarette use during pregnancy., Methods: This cross-sectional analysis of the 2016 Pregnancy Risk Assessment Monitoring System used data on self-reported use of ENDS and cigarettes during the last 3 months of pregnancy among 33,964 women from 29 states and New York City. Data were analyzed in 2019., Results: The overall prevalence of prenatal ENDS use was 1.2% and cigarette use was 7.7%, varying from 0.6% and 1.8% in New York City to 4.4% and 22.7% in West Virginia. In adjusted models, white women were more likely to use ENDS (AOR=4.68, 95% CI=2.91, 7.54) than black women. Women with increasing years of education were also less likely to use ENDS. Women who used cigarettes during pregnancy were 11.05 times (95% CI=7.40, 16.48) more likely to also use ENDS prenatally. Associations between sociodemographic characteristics and cigarette use during pregnancy were consistent with the findings for ENDS., Conclusions: Pregnant women across the U.S. are using ENDS and cigarettes. Surveillance is essential to continue monitoring trends in prenatal use of tobacco products and understand the implications on pregnancy and infant outcomes., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)