Research shows that children get less nicotine from second-hand e-cigarettes than from cigarettes

Children who live in homes where adults use e-cigarettes are exposed to significantly less nicotine through secondhand aerosol than children in homes where adults use traditional cigarettes, a new study finds. But vaping still exposes children to nicotine and can pose other risks as well. To keep kids completely nicotine-free, researchers say, people shouldn’t smoke or vape around children at all. The researchers said they did the study in part because of the perception that e-cigarettes are safer than traditional cigarettes and because people use them more than regular cigarettes in the home. The study was published Thursday in the journal JAMA Network Open. Vaping has been promoted to adults as a healthier alternative to traditional cigarettes and as a potential smoking cessation aid, though experts say more research is needed. One reason some doctors prefer that their patients use e-cigarettes is because they expose users to fewer toxic chemicals than tobacco and the dozens of other carcinogens found in cigarettes, such as N-nitrosamines and aldehydes, which can cause cancer and other serious health problems. But what the new study shows, experts say, is that harm reduction for the user doesn’t necessarily equal harm removal for everyone around them — and that could be a major issue for children, whose lungs are still developing. The study looked at the lives of 1,777 children who were part of the National Health and Nutrition Examination Survey, a racially diverse government study designed to continuously assess the health and nutrition of American children and adults. Tobacco use in the home was reported by parents or caregivers. More than 270 of the children were exposed to secondhand smoke at home, 45 were exposed only to secondhand smoke from e-cigarette vapor, and 1,476 had neither type of user in their home. Scientists enrolled children between the ages of 3 and 11 because they were less likely to use nicotine products than older children. The researchers measured the children’s nicotine levels using blood samples taken between 2017 and 2020. While new vaping devices have been introduced in the U.S. since then and exposure levels can vary by device, the authors say their study can provide a good general idea of ​​nicotine exposure in the home. The exposure levels in the study are generally considered to be underestimates, they said. The children in the study who had the most nicotine exposure by far were those who lived with people who smoked traditional tobacco products like cigarettes. These products expose children to nicotine at two points: when the user exhales and between puffs, when a lit cigarette or cigar is left in an ashtray. It is estimated that e-cigarette users inhale 99% of the nicotine they inhale, but some of it is released when they exhale after taking a puff from their device. The children in the study with the lowest nicotine levels were those who had not been exposed to any form of secondhand aerosols at home. Children who were exposed to e-cigarettes had some nicotine in their bodies, but they absorbed 84 percent less than those who lived in homes with people who only smoked tobacco. The conclusion of the study, the authors said, is that people should stop vaping or smoking at home. “Vaping in the home near children should be avoided because, although nicotine itself has a limited risk profile, the increased absorption of nicotine from secondhand vapor suggests that the children were also exposed to other potentially harmful e-cigarette admixtures,” the study said. Previous studies have found similar nicotine exposure among children in homes with cigarette and e-cigarette users. Dr. Terry Gordon, a professor in the Department of Medicine at NYU Langone Health who has researched nicotine exposure, said he was surprised that nicotine levels were not higher in homes with e-cigarette users. Some of his research has shown much higher nicotine levels in e-cigarette households than the new study. Still, he said, all of this research should serve as a reminder to vape users to be careful around others, especially children. “Most of us toxicologists believe that e-cigarettes are safer, but no one is willing to say they are safe because of the primary users of the devices and those who are exposed to secondary aerosols,” said Gordon, who was not involved in the latest study. Scientists are still trying to figure out exactly how harmful secondhand vape aerosols might be. It took years to understand that with cigarettes, said Dr. Panagis Galiatsatos, a pulmonologist and volunteer medical spokesman for the American Lung Association. Secondhand smoke from cigarettes has done real harm, said Galiatsatos, who was not involved in the new study. He said he has treated a generation of people who developed cancer and other lung problems not because they smoked but because they grew up with adults who did. In 2020, Galiatsatos published what is believed to be the first study documenting significant injuries in an adult exposed to secondhand e-cigarettes. He says adults shouldn’t take chances with a child’s health by vaping near them. “A child who is growing, their lungs are so fragile,” he said. “We don’t fully know what the effect is going to be on the next generation, just like we didn’t know what secondhand smoke did, but why would you put your child in a position where they’re going to be a future patient?”