Second- and thirdhand exposure
Concerning e-cigarettes impact on pediatric population, an often-underestimated aspect is second- and third-hand smoke. Approximately 20% of parents using e-cigarettes follow strictly enforced vape-free home and car policies; among dual users, 64% has a smoke-free and only 26% a vape-free home policy, which implies a general misperception about e-cigarettes safety. Furthermore, younger parents are more likely to lack a home and car policy100. There is evidence that nicotine metabolites in serum, as well as saliva and urine cotinine levels, are superimposable among non-using adults secondhandedly exposed to e-cigarettes and conventional cigarettes101. Even secondhand particular matter exposure levels can equal that of traditional smoking102 and appear to be greater in nicotine-free devices103.