Physicians' Counseling of Adolescents Regarding E-Cigarette Use

doi:10.1016/j.jadohealth.2015.06.017

Journal of Adolescent Health

Volume 57, Issue 6, December 2015, Pages 580-586

https://doi.org/10.1016/j.jadohealth.2015.06.017 Get rights and content

Abstract

Purpose

Electronic cigarette (e-cigarette) use now surpasses the use of conventional cigarettes among U.S. adolescents. Given the important role of physicians in preventing adolescent risk behaviors, we sought to understand how physicians communicate about e-cigarettes when counseling adolescent patients and their parents. We also explored physicians' support for regulations aimed at discouraging adolescents' e-cigarette use.

Methods

A national U.S. sample of 776 pediatricians and family medicine physicians who provide primary care to adolescent patients completed an online survey in Spring 2014.

Results

Many physicians (41%) would, if asked, tell their patients that e-cigarettes are less harmful than cigarettes, and a substantial minority (24%) would recommend e-cigarettes to adolescents for smoking cessation. Most physicians reported routinely screening adolescent patients for cigarette smoking but few routinely screened for e-cigarette use (86% vs. 14%; p < .001). Routine counseling was similarly more common for avoiding cigarette smoking than for avoiding e-cigarette use (79% vs. 18%; p < .001). Support for government regulation of e-cigarettes was high, with 91% of physicians endorsing policies that prevent minors from buying e-cigarettes.

Conclusions

Physicians infrequently screen or counsel their adolescent patients about e-cigarette use, although e-cigarettes often come up during visits. Additional efforts by physicians could help prevent future use by adolescents. Recommending e-cigarettes as a smoking cessation aid to adolescent patients is inadvisable given the lack of evidence for efficacy in that population. As federal regulation of e-cigarettes remains in limbo, pediatricians and family medicine physicians can offer a powerful voice for informing regulations aimed at reducing use by adolescents.

Section snippets

Participants

We conducted an online survey of pediatricians and family physicians (the specialties responsible for most adolescent primary care) in Spring 2014. The survey focused on administration of adolescent vaccines but also included questions about beliefs and behaviors relevant to other preventive care services, including prevention of tobacco and e-cigarette use. Respondents were members of an existing national panel of physicians that was initially constructed from American Medical Association

Results

Of the 776 participating physicians, 53% were pediatricians, and 47% were family medicine physicians (Table 1). Most physicians were male (68%), in private practice (85%), and worked in multiphysician practices (37% worked in practices with two to four physicians and 49% in practices with five or more physicians). About half had been in practice for at least 20 years (55%). Most physicians saw at least 10 adolescent patients per week (45% saw 10–24 patients, and 38% saw 25 or more).

Discussion

Pediatricians and family medicine physicians are concerned about the health effects of e-cigarettes, interested in learning more about the topic, and supportive of regulatory action to prevent e-cigarette use among youth. Physicians are also initiating and engaging in discussions about e-cigarettes with their adolescent patients and their families. However, vastly fewer physicians routinely screen and counsel for e-cigarette use than those for cigarette smoking, which may reflect the novelty of

Acknowledgments

The authors thank Dr. Kurt Ribisl for his assistance with this project.

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: Conflicts of Interest: The authors have no conflicts of interest to disclose.

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Original articlePhysicians' Counseling of Adolescents Regarding E-Cigarette Use

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Participants

Results

Discussion

Acknowledgments

Drug Alcohol Depend

Prev Med

J Adolesc Health

Prev Med Rep

J Adolesc Health

Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013

Nicotine Tob Res

Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions, and beliefs: A systematic review

Tob Control

Tobacco use among middle and high school students—United States, 2011-2014

MMWR Morb Mortal Wkly Rep

Electronic cigarettes and nicotine clinical pharmacology

Tob Control

Development of a questionnaire for assessing dependence on electronic cigarettes among a large sample of ex-smoking e-cigarette users

Nicotine Tob Res

Developmental neurocircuitry of motivation in adolescence: A critical period of addiction vulnerability

Am J Psychiatry

Adolescent development of forebrain stimulant responsiveness: Insights from animal studies

Ann N Y Acad Sci

Nicotine alters limbic function in adolescent rat by a 5-HT1A receptor mechanism

Neuropsychopharmacology

Effects of nicotine during pregnancy: Human and experimental evidence

Curr Neuropharmacol

The impact of electronic cigarettes on the paediatric population

Tob Control

Carbonyl compounds in electronic cigarette vapors: Effects of nicotine solvent and battery output voltage

Nicotine Tob Res

Original article
Physicians' Counseling of Adolescents Regarding E-Cigarette Use