Behavioral Health and Substance Use Correlates of E-Cigarette Use in Early Pregnancy

Am J Prev Med. 2026 Jun 7:108477. doi: 10.1016/j.amepre.2026.108477. Online ahead of print.

ABSTRACT

INTRODUCTION: Rates of prenatal e-cigarette use are increasing, but little is known about whether behavioral health characteristics are associated with use during early pregnancy, when intervention may have greatest impact.

METHODS: This cross-sectional study examined pregnancies in a Northern California healthcare system (11/2020-12/2024) with universal screening for prenatal e-cigarette use, depression, intimate partner violence (IPV), and other substances (alcohol, cannabis, prescription opioids, stimulants, and other tobacco products). Adjusted prevalence ratios for e-cigarette use were estimated using modified Poisson regression. Analyses were conducted in 2025.

RESULTS: Among 180,350 pregnancies, 1.1% reported prenatal e-cigarette use. In mutually adjusted models, e-cigarette use was more prevalent among individuals with depression (aPR=1.72;95%CI=1.45-2.04); IPV (aPR=1.39;95%CI=1.15-1.66); and other substance use (aPRs=1.97-4.59;p<.05). Increasing frequency of alcohol, cannabis, and opioids was associated with higher e-cigarette prevalence.

CONCLUSIONS: Prenatal e-cigarette use was uncommon but concentrated among individuals with behavioral health conditions and other substance use, highlighting the need for integrated, prevention-focused care in prenatal settings.

PMID:42259400 | DOI:10.1016/j.amepre.2026.108477