Evidence map›Paper›PMID 33973130›Full record

ArticleMaternal and child health journal2021

Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use.

Kristin Ashford, Andrea McCubbin, Janine Barnett, Lisa M Blair, Feitong Lei, Heather Bush, Alison Breland

Open access · greenAbstract read
In one paragraph

Article in Maternal and child health journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 3 pooled it
1.4field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 3 syntheses or guidelines pooled it, 14 citations in OpenAlex.

  1. Birth outcomes following intrauterine exposure to electronic nicotine delivery systems: a systematic review and meta-analysis.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Kristin AshfordPerinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA.
Andrea McCubbinPerinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA. Akmccu0@uky.edu.ORCID http://orcid.org/0000-0003-3034-9468
Janine BarnettPerinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA.
Lisa M BlairPerinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA.
Feitong LeiDepartment of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA.
Heather BushDepartment of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA.
Alison BrelandDepartment of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA.
University of Kentucky · USVirginia Commonwealth University · US

Funding

Kentucky Center for Clinical and Translational ScienceUL1TR001998 · NCATS · UNIVERSITY OF KENTUCKY · PI HARTMANN, KATHERINE E, KERN, PHILIP A · 2016 to 2025
$34.2M
Project 4: Using a prospective cohort survey to test population-level predictions generated by Projects 1-3U54DA036105 · NIDA · VIRGINIA COMMONWEALTH UNIVERSITY · PI BRELAND, ALISON · 2018 to 2022
$20.8M
The impact of electronic cigarettes (e-cigs) on perinatal immune responsiveness and birth outcomes in AppalachiaR01DA040694 · NIDA · UNIVERSITY OF KENTUCKY · PI ASHFORD, KRISTIN H. · 2015 to 2018
$2.5M
NCATS NIH HHS UL1 TR001998NIDA NIH HHS R01 DA040694NIDA NIH HHS R01DA040694-01NIDA NIH HHS U54 DA036105
6 · The paper itself

Abstract

introductionIn the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both.

methodsThis was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05.

resultsAt enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters. DISCUSSION: Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.

Indexed as

Electronic Nicotine Delivery SystemsPremature BirthTobacco ProductsAdultFemaleHumansInfant, NewbornLongitudinal StudiesPregnancyBirth outcomesElectronic cigarettesENDSPregnancySwitching behaviors

Identifiers

PMID33973130
PMCPMC8314381
OpenAlexW3162085059

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.