Household Indoor E-Cigarette Use and Frequent or Severe Headache in U.S. Children: A Cross-Sectional NSCH Study

Abstract Background Evidence concerning household indoor e-cigarette use and headache among children is limited. We examined whether caregiver-reported household indoor e-cigarette use was associated with current frequent or severe headache among U.S. children. Methods This cross-sectional analysis used 2022–2024 National Survey of Children's Health data for children aged 3–17 years. Survey-weighted modified Poisson regression estimated adjusted prevalence ratios (aPRs), accounting for the complex survey design, survey year, indoor combustible-tobacco use, and prespecified demographic and household covariates. Predictive margins estimated adjusted prevalences and prevalence differences. Six family income-to-poverty ratio implicates were combined using Rubin's rules. Results Among 130,077 children, 6,383 (weighted 4.76%) lived in homes with reported indoor e-cigarette use and 3,960 had current frequent or severe headache. Reported indoor e-cigarette use was associated with headache (aPR, 1.75; 95% confidence interval [CI], 1.42–2.16). Adjusted prevalence was 4.56% among exposed children and 2.59% among unexposed children, a difference of 1.97 percentage points (95% CI, 1.04–2.90). There was no evidence of exposure-by-year interaction (P=.276). Among children aged 3–11 years, the estimate was imprecise (aPR, 1.45; 95% CI, 0.97–2.16). Conclusions Caregiver-reported indoor e-cigarette use in the home was associated with a higher prevalence of caregiver-reported frequent or severe headache. The cross-sectional data could not establish causality or distinguish secondhand exposure from adolescents' own use.