Attitudes and Screening Practices for Adolescent E-Cigarette Use in Pediatric Primary Care

Burr W, Gorzkowski J, Camenga D, Hadland S, Zoucha K

Presented at the 2023 Pediatric Academic Societies Annual Meeting

Background: Despite recent declines, e-cigarettes remain the most common tobacco product used by youth. In 2022, 14% of high school students indicated they currently use e-cigs. E-cigs have both short- and long-term health effects. The pediatric visit presents important opportunities to screen and intervene for e-cig use.

Objective: Describe primary care pediatricians’ attitudes and screening practices around adolescent e-cig use; Examine practice characteristics associated with screening and having seen a patient who quit e-cigs in the past year.

Methods: The 2021 AAP Periodic Survey, a nationally representative survey of non-retired US AAP members (residents excluded), collected data on pediatricians’ attitudes on adolescent e-cig use, screening practices for e-cig use, and frequency of seeing patients quit e-cigs. 43% completed the survey; data weighted for age non-response bias. Analytic sample includes pediatricians who provide health supervision (n=471). Chi square tests examined practice characteristics (i.e., practice area, US region, setting, and % patients who are adolescents and % experiencing financial hardship) and 1) frequency of screening adolescent patients for e-cig use (Always vs Often/Occasionally/Rarely/Never), 2) frequency of using a formal checklist when screening adolescent patients for e-cig use (Always vs Often/Occasionally/Rarely/Never), and 3) reporting at least one patient successfully quitting e-cigs in the last 12 months.

Results: Nearly all primary care pediatricians agreed/strongly agreed “E-cig use will have a long-lasting impact on adolescents who use” (93%)[Figure]. Most also agreed/strongly agreed “Parents are often unaware when adolescents are using e-cigs” (87%) and “Patients believe e-cigs are a safer or less harmful alternative” (82%). Many pediatricians always screen adolescent patients specifically for e-cig use (45%); fewer always use a formal checklist when doing so (15%). Most reported having at least one patient successfully quit e-cigs in the last 12 months (62%). Pediatricians in the Northeast were more likely than those in other US regions to always screen for e-cig use and to always screen with a formal checklist (p<0.01). No significant associations were found between practice characteristics and patients quitting [Table 1].

Conclusion: Although pediatricians recognize the adverse health impacts of adolescent e-cigarette use, e-cigarette screening rates vary by region. Further resources and approaches are needed to improve the adoption of standardized screening practices in pediatric primary care.

Figure 1. Primary care pediatricians’ attitudes on adolescent e-cigarette use

Table 1. Primary care pediatrician practice characteristics associated with adolescent e-cigarette screening and treatment