Date of Award

Fall 12-21-2018

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Terry F. Pechacek, Ph.D.

Second Advisor

Claire A. Spears, Ph.D.

Third Advisor

David L. Ashley, Ph.D.


Electronic nicotine delivery systems (ENDS) use has grown rapidly over the past decade. ENDS-specific harms have emerged among children (particularly those < 6 years), related to exposures to nicotine e-liquids (NEL) used in ENDS. Children have been identified as a priority population in terms of the potential and actual NEL-caused harm in the United States (US). Evidence is lacking examining contextual factors such as adults’ risk perceptions related to child NEL exposures and how these materials are handled in homes where children are present. Guided by the Protection Motivation Theory (PMT), this dissertation focuses on adults’ risk perceptions of children’s exposure to nicotine and NEL handling practices in the home.

Study 1 examined risk perceptions related to children’s (< 13 years) exposure to nicotine generally (not product-specific) among a representative sample of US adults, and found that current tobacco product users, males, and persons from racial/ethnic minority backgrounds were significantly less likely to perceive nicotine as harmful to children. Study 2 examined risk perceptions related to children’s (< 6 years) exposure to NEL in two dose-levels by five exposure modes, among adults who lived with at least one child (< 6 years) and were ENDS users, non-users living with a user, or never-users in never using homes. Study 2 found that ENDS-users were significantly less likely (versus never users from never-user homes) to perceive NEL exposure as moderately or very dangerous in 7/10 of dose/mode dyads examined. Study 3 examined relationships between perceptions of NEL-related risk to children and NEL handling practices among adult ENDS-users and non-users living in ENDS using homes who also had a child (< 6 years). This study found that being a non-user was significantly associated with not knowing about the NEL handling practices in their home, and perceiving child NEL exposure as very dangerous was significantly associated with always using childproof caps.

These findings highlight the need to educate adults about nicotine’s harmfulness to children and to develop measures to protect children from nicotine and NEL exposures. Opportunities to improve all adults’ NEL-related knowledge to improve safety for children are also discussed.