title: A qualitative assessment of the perceived risks of electronic cigarette and hookah use in pregnancy.
abstract: BACKGROUND
  Studies reveal that electronic cigarette (e-cigarette) and hookah use are increasing among adolescents and young adults. However, the long-term health effects are unknown, especially with regards to pregnancy. Because of the increased use in women of reproductive age, and the unknown long-term health risks, our primary objectives were to determine the perceived risks of e-cigarette and hookah use in pregnancy, and learn common colloquial terms associated with e-cigarettes. Furthermore, we sought to determine if there is a stigma associated with e-cigarette use in pregnancy.
  
  
  METHODS
  Eleven focus groups including 87 participants were conducted immediately following regularly scheduled CenteringPregnancy® prenatal care with women at three different clinics in the greater Houston area. A minimum of two facilitators led the groups, using ten lead-in prompts, with Spanish translation as necessary. Facilitators took notes which were compared immediately following each group discussion and each group was audio recorded and transcribed. Three facilitators utilized NVivo 9.0 software to organize the transcribed data into nodes to identify major themes. To increase rigor, transcripts were further analyzed by two obstetricians who were instructed to find the major themes.
  
  
  RESULTS
  Analyses revealed contradicting themes concerning e-cigarette use. In general, e-cigarettes were perceived as safer alternatives to regular tobacco cigarettes, especially if used as smoking cessation devices. A major theme is that use in pregnancy is harmful to the fetus. However, it was perceived that use for smoking cessation in pregnancy may have fewer side effects. We found that a common term for e-cigarettes is "Blu." In our discussion of hookah use, participants perceived use as popular among teenagers and that use in pregnancy is dangerous for the fetus.
  
  
  CONCLUSIONS
  Although a strong theme emerged against hookah use, we found contradicting themes in our discussions on e-cigarette use in pregnancy. It is possible that e-cigarette use will not carry the same stigma as regular cigarette smoking in pregnancy. In addition, the impression of e-cigarettes as a healthier alternative to smoking may influence use in pregnancy. Clinicians need to be prepared for questions of e-cigarette safety and efficacy as smoking cessation devices from their pregnant patients who smoke, and women who smoke and are planning to become pregnant.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. maike.sachs@bcm.edu.
authors.forename: Maike K
authors.initials: MK
authors.lastname: Kahr
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. Shannon.padgett@bcm.edu.
authors.forename: Shannon
authors.initials: S
authors.lastname: Padgett
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. cshope@bcm.edu.
authors.forename: Cindy D
authors.initials: CD
authors.lastname: Shope
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. emily_griffin@me.com.
authors.forename: Emily N
authors.initials: EN
authors.lastname: Griffin
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. Susan.Xie@bcm.edu.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Xie
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. Pablo.Gonzalez@bcm.edu.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Gonzalez
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. jlevison@bcm.edu.
authors.forename: Judy
authors.initials: J
authors.lastname: Levison
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. mastroba@bcm.edu.
authors.forename: Joan
authors.initials: J
authors.lastname: Mastrobattista
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA. Adi.Abramovici@uth.tmc.edu.
authors.forename: Adi R
authors.initials: AR
authors.lastname: Abramovici
authors.affiliation: Department of Family and Community Medicine, University of Texas Health Science Center at Houston, 6431 Fannin Street, JJL 324, Houston, TX, 77030, USA. Thomas.F.Northrup@uth.tmc.edu.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Northrup
authors.affiliation: Department of Family and Community Medicine, University of Texas Health Science Center at Houston, 6431 Fannin Street, JJL 324, Houston, TX, 77030, USA. Angela.L.Stotts@uth.tmc.edu.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Stotts
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. aagaardt@bcm.edu.
authors.forename: Kjersti M
authors.initials: KM
authors.lastname: Aagaard
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. masuter@bcm.edu.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Suter
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects* / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D011247:Pregnancy; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology*; D055815:Young Adult