People Often Underestimate Harm from Electronic Nicotine Products

Catherine B. Kemp, BSN, MHA

While tobacco product users acknowledge that smoking is harmful for children, a significant number of them underestimate the risk nicotine exposure poses to children, particularly from electronic nicotine delivery systems (ENDS), according to a recent study.

Study lead author Catherine B. Kemp, BSN, MHA, of the Georgia State University School of Public Health and Tobacco Center of Regulatory Science (TCORS) expressed concern for the rise in child nicotine exposure case reports to MD Magazine®.

“The available research on what people think about nicotine suggests that most people are aware that it’s addictive, but there is very little research focusing on what they know about nicotine’s harmfulness to children,” Kemp said.

The Centers for Disease Control and Prevention (CDC) reports that in 1965, 42.4% of adults smoked, compared to 15.5% in 2016. However, in recent years, an alternative to cigarettes has emerged: ENDS or e-cigarettes, an electronic device that holds liquid nicotine.

A recent CDC study found that many current smokers try to use e-cigarettes to quit smoking, although the US Food and Drug Administration (FDA) has not approved ENDS as a nicotine replacement therapy. Unfortunately, these nicotine users fail to quit and end up simply replacing regular cigarettes with e-cigarettes.

An additional concern is the rise of e-cigarette use among the adolescent population. In 2016, more that 2 million middle schoolers (4.3%) and high schoolers (11.3%) used e-cigarettes in the previous 30 days, according to the CDC.

Researchers for this study obtained data from 2 Tobacco Products and Risk Perceptions Surveys (2015; 2016) that are administered annually by the Georgia State University Tobacco Center of Regulatory Science.

Of the 11,959 adults surveyed, 83.2% (95% CI; 82.3 - 84.1) view nicotine as “definitely harmful” to children, 6.2% (95% CI: 5.7 - 6.8) as “maybe harmful," 1.7% (95% CI: 1.3 -2.0) as “unlikely harmful," 0.6% (95% CI; 0.4 - 0.8) as “not harmful”, and 8.3% (95% CI; 7.6 - 9.0) responded “don’t know.”

Of current tobacco users, 32.8% (95% CI; 30.7 - 34.9) reported having at least 1 minor child living in their home.

There were significant differences in perception of nicotine harm to children among subgroups. Compared with women, men were less likely to view nicotine as “definitely harmful”. Tobacco users had lower odds of agreeing that nicotine is “definitely harmful” or “don’t know” than non-users. African-Americans, Hispanics, and “other” non-Hispanics had lower odds of seeing nicotine as “definitely harmful” or “maybe harmful” than white individuals.

Kemp said what she found most concerning is both how consistently tobacco users, regardless of what product-type they used, underestimated the risks nicotine exposure posed to children and the high rates of multiple tobacco use. The harm of ENDS products were also underestimated.

“ENDS products are so new and have evolved so rapidly, unintended and unanticipated issues are emerging as they are used more widely,” Kemp said. “For instance, people may not be aware that nicotine is readily absorbed though the skin so that even a child slapping his hand on spilled e-liquid would give them a sizable dose of nicotine.”

This study is the first in a series of investigations that Kemp is working on. Subsequent studies will focus on how e-cigarette users and the adults who live with them perceive the harm from nicotine to young children who live in their homes.

Kemp also wants to examine how those perceptions influence the way nicotine fluids are handled and stored in homes where young children are present.

“This type of research will help raise awareness of the dangers of children being exposed to nicotine, understand the factors that are putting children at greater risk, and hopefully lead to developing policy recommendations and guidelines that will encourage safer handling practices of nicotine-containing products,” Kemp said.

The study, "Adults’ Perceptions of Nicotine Harm to Children," was published online in Pediatrics on Monday.