A study led by MassGeneral Hospital for Children (MGHfC) researchers is the first to examine parents’ rules about prohibiting both electronic cigarette and regular cigarette use in homes and cars. The paper published in Pediatrics shows that parents who use e-cigarettes – whether or not they also smoke traditional cigarettes – were much more likely to permit e-cigarette use inside both homes and cars than parents who smoke only traditional cigarettes.

“Our results suggest parents may perceive that it is safe to use electronic cigarettes and are not taking the same precautions they do to protect their children from exposure to traditional cigarettes,” says Jeremy Drehmer, MPH, CPH, of the MGHfC Division of General Academic Pediatrics and the Massachusetts General Hospital (MGH) Tobacco Research and Treatment Center (TRTC), lead author of the report. “This study shows that parents who are dual users of e-cigarettes and traditional cigarettes are much less likely to prohibit vaping inside their homes than to prohibit smoking.”

This research was developed by a team led by Jonathan Winickoff, MD, MPH, of the MGHfC Division of General Academic Pediatrics and director of Pediatric Research in the MGH TRTC, as part of the CEASE (Clinical Effort Against Secondhand Smoke Exposure) program, which trains pediatric office staff members to ask the parents of patients whether anyone uses tobacco products in their homes or cars and to provide assistance to help those who smoke to quit. The CEASE study was conducted at 10 pediatric practices – two each in the states of Ohio, Virginia, Tennessee, North Carolina and Indiana – and the current study was conducted at control practices where the CEASE training had not been initiated.

Based on interviews with more than 750 parents who reported currently using cigarettes, e-cigarettes or both, the study found that only 19 percent of e-cigarette users and 21 percent of dual users had strictly enforced policies banning vaping in both the home and car. Similarly, only 19 percent of e-cigarette users and 24 percent of dual users had specific vape-free policies for their cars; and of those who did not have vape-free car policies, 56 percent of both e-cigarette users and of dual users reported that people used e-cigarettes in their cars when children were present.

“The finding that a large majority of parents who use e-cigarettes permit vaping inside homes and cars is an alarming trend,” says Drehmer. “We are concerned that parents have been misled by the marketing of vaping products and now believe that the aerosol produced by these products is harmless to children. Pediatric health care providers need to help set the record straight and inform parents that e-cigarette vapor is not safe for children.”

Although 63 percent of dual users, 61 percent of cigarette users and 74 percent of e-cigarette users reported having strict smoke-free policies in their homes, only 38 percent of parents who smoked cigarettes and 22 percent of those who were dual users had strictly enforced policies banning cigarette use in both the home and car. “This study found that most parents who smoke and did not attend a CEASE practice were not even asked or advised about keeping homes and cars smoke-free at their child’s doctor’s visit,” Drehmer says. “The low percentages of smoking parents who were advised about keeping homes and cars smoke-free highlights that critical opportunities to protect children from these dangerous exposures are being missed.”

Senior author Winickoff, a professor of Pediatrics at Harvard Medical School, adds, “Frankly, it’s frightening – it’s where we were with the exposure of children to combusted tobacco 25 years ago. Big tobacco markets e-cigarettes as healthy products without any consideration or warnings about the harms to infants and children. The truth is that all vape products create an invisible plume of nicotine and ultrafine toxic particles that spreads into the air and coats surfaces. Do the American people really want to wait another 25 years to see how this corporate experiment ends?”

Additional co-authors of the Pediatrics paper are Emara Nabi-Burza, MBBS, and Bethany Hipple Walters, PhD, MPH MGHfC General Academic Pediatrics and MGH Tobacco Research and Treatment Center; Deborah Ossip, PhD, University of Rochester Medical Center; Douglas Levy, PhD, and Nancy Rigotti, MD, MGH Tobacco Research and Treatment Center; and Jonathan Klein, MD, MPH, University of Illinois at Chicago College of Medicine. The study was supported by National Cancer Institute grant RO1-CA127127.



Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $925 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2018 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."