Parental e-Cigarette Use May Increase Pediatric AD Risk

Parental e-cigarette use was associated with increased pediatric atopic dermatitis (AD) risk, according to a research letter published in JAMA Dermatology.¹

The researchers explained that AD has previously been associated with environmental factors, like in utero tobacco exposure and secondhand smoke.² Also, although a previous study found an association between AD and e-cigarettes, they noted that the link between pediatric AD and parental e-cigarette use has not been well established.

Because of the increasing prevalence of e-cigarette use and the lack of research on its impact on the health of nearby family members, the researchers conducted a retrospective, cross-sectional analysis to determine if pediatric AD and parental e-cigarette use are connected.¹

To do so, they used data from the CDC’s 2014 to 2018 National Health Interview Survey (NHIS), “a face to face, nationally representative survey of the civilian population.”³ The NHIS uses geographic clustering to sample about 35,000 US households annually. The CDC chooses a child younger than 18 years old from each included household and asks the adult caregiver additional questions.

The researchers determined if the children had pediatric AD based on caregiver answers to the question, “During the past 12 months, has [name] had…eczema or any kind of skin allergy?”⁴ Similarly, they defined e-cigarette use based on caregiver responses to the question, “Have you ever used an e-cigarette even one time?” More specifically, the researchers determined parental e-cigarette use history by matching the children to their adult caregiver respondents.

From January to March 2024, the researchers conducted a statistical analysis of eligible patients;¹ they used survey weights to create a nationally representative sample. They excluded participants missing data for age, pediatric AD, parental smoking, or e-cigarette use.

Of the 48,637,111 weighted participants with a mean age of 8.4 years (95% CI, 8.3-8.4), they identified 6,354,515 individuals (13.1%) with a history of AD; the mean age of this subgroup was 8.0 years (95% CI, 7.8-8.1 years). Additionally, parental e-cigarette use was prevalent in 14.4% (95% CI, 13.9-15.0) of the non-AD population and 18.0% (95% CI, 16.5-19.0) of the AD population.

Through a multivariable analysis adjusted for numerous covariates, including respiratory allergies, parental smoking history, and sociodemographic factors, the researchers determined that children with parental e-cigarette use had higher AD risk (adjusted odds ratio [aOR], 1.24; 95% CI, 1.08-1.42). Also, the subgroup analyses of both smoking (aOR, 1.37; 95% CI, 1.05-1.78) and non-smoking cohorts (aOR, 1.19; 95% CI, 1.02-1.39) found similar trends; these trends persisted regardless of the parent’s sex.

The researchers acknowledged their limitations, one being that the cross-sectional survey design prevents any conclusions on causality between AD and parental e-cigarette usage. Also, their definition of AD only asks about AD over the past 12 months. Consequently, the data can only support the conclusion that household e-cigarette use may be associated with past-year pediatric AD. Lastly, data on pediatric cigarette or e-cigarette use, which the researchers identified as another potential confounder, were unavailable; the researchers made future research suggestions based on the latter limitation.

“Further studies with additional populations or predictive validation are needed to better understand this association,” the researchers concluded.

References

1. Youn GM, Sarin KY, Chiou AS, Chen JK, Honari G. Parental E-Cigarette Use and Pediatric Atopic Dermatitis. JAMA Dermatol. doi:10.1001/jamadermatol.2024.1283
2. Smith B, Engel P, Collier MR, et al. Association between electronic-cigarette use and atopic dermatitis among United States adults. J Am Acad Dermatol. 2023;89(1):163-165. doi:10.1016/j.jaad.2023.02.027
3. Blewett LA, Rivera Drew JA, King ML, et al. IPUMS Health Surveys: NationalHealth Interview Survey, version 7.3 [dataset]. 2023. Accessed May 21, 2024. https://www.ipums.org/projects/ipums-health-surveys/d070.v6.2
4. Silverberg JI, Patel N, Immaneni S, et al. Assessment of atopic dermatitis using self-report and caregiver report: a multicentre validation study. Br J Dermatol. 2015;173(6):1400-1404. doi:10.1111/bjd.14031