Use of electronic nicotine delivery systems (ENDS) among U.S. women of reproductive age: Prevalence, reported reasons for use, and toxin exposure.

Introduction:
This text provides an analysis of the use of Electronic Nicotine Delivery Systems (ENDS) among U.S. women of reproductive age. The study uses data from the Population Assessment of Tobacco and Health (PATH) Study (2013–17) to compare exclusive ENDS users, dual users of ENDS and cigarettes, and exclusive cigarette smokers within and between pregnant and not-pregnant women. The text also examines reasons for use and toxin exposure among these groups.

Key Points:

* The study found that exclusive ENDS use was less prevalent than dual use among not-pregnant women, but prevalence of exclusive ENDS and dual use did not vary by pregnancy status.
* Most women reported ENDS were used to help quit smoking and for appealing flavors, and endorsement rates did not differ by use pattern or pregnancy status.
* Exposure to toxins such as nicotine metabolites, tobacco specific nitrosamines, polycyclic aromatic hydrocarbon metabolites, volatile organic compounds, and heavy metals was substantially lower for exclusive ENDS users relative to dual users and exclusive cigarette smokers, regardless of pregnancy status.
* Pregnant and not-pregnant women regularly reported using ENDS for help with quitting smoking and for appealing flavors.
* The study sample was limited to women between the ages of 18-49 years who reported using ENDS and/or conventional cigarettes and no other tobacco products.
* The study used data from the PATH Study, which is an ongoing national longitudinal cohort study that comprehensively examines nicotine and tobacco consumption in the U.S. noninstitutionalized population.
* The study controlled for variation in renal function by dividing the biomarker value by the urinary creatinine value.
* The study used Logistic Regression for reasons for ENDS use and ANCOVA for toxin exposure, followed by post-hoc tests, using Bonferroni corrections, to examine pair-wise differences.

Main Message:
The main message of the text is that while no type or pattern of tobacco/nicotine use is safe, especially during pregnancy, using ENDS exclusively is consistent with lower overall toxin exposure for pregnant and not-pregnant women. This study advances understanding of ENDS use and toxin exposure in women of reproductive age, a population highly vulnerable to the effects of nicotine/tobacco consumption. The findings may be helpful in developing effective policy to regulate ENDS and informing efforts to further reduce harm associated with tobacco and nicotine consumption.

Coleman SRM, Bunn JY, Nighbor TD, et al. Use of electronic nicotine delivery systems (ENDS) among U.S. women of reproductive age: Prevalence, reported reasons for use, and toxin exposure. Preventive medicine. 2021;152:106582. doi:10.1016/j.ypmed.2021.106582