Pediatric primary healthcare providers’ preferences, experiences and perceived barriers to discussing electronic cigarettes with adolescent patients

ABSTRACT

Introduction: Our aim is to investigate pediatric primary healthcare providers' (PPCPs) perceptions about e-cigarettes and current e-cigarette-related clinical practices with adolescents.

Methods: In-depth interviews were conducted with 25 PPCPs who regularly counsel adolescents about preventive care. Prompts included topics about e-cigarettes PPCPs felt it was important to discuss in counseling, strategies for facilitating these conversations and barriers to these discussions.

Results: Important topics included debunking myths and addressing risks associated with e-cigarette use, identifying the behavior as a potential gateway substance, and emphasizing lack of e-cigarette regulation. Strategies included emphasizing medical uncertainty, utilizing motivational interviewing, and providing outside resources. Barriers included a lack of medical knowledge, unfamiliarity with adolescents' motivations and slang, inadequate screening tools, and lack of time.

Discussion: Providers negotiated the tension between discouraging e-cigarette use while not overstating the known harms of vaping with adolescent patients. Providers generally felt underprepared to have in-depth clinical conversations about e-cigarettes.

KEYWORDS:

• Behavioral counseling
• vaping
• patient-provider communication
• Adolescent
• Electronic Nicotine Delivery Systems
• Motivational Interviewing
• Behavior change
• Tobacco Products

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Emily B. Peterson is a Cancer Research Training Award Fellow in the Division of Cancer Control and Population Sciences at the National Cancer Institute. Improving the patient-provider relationship is the driving force of her research, with her past work focused on patient-centered care throughout the cancer continuum, cancer screening discussions, and pediatrician-adolescent counseling about nicotine and tobacco.

Carla L. Fisher is an Assistant Professor in the Advertising Department and Affiliate Member of the STEM Translational Communication Center and UF Health Cancer Center. She was a Pre-doc Fellow with the National Institute on Aging (NIA) with summer postdoc training from the National Cancer Institute (NCI). Using a life-span, developmental lens, she examines the importance of family communication to health in the family environment and clinical setting.

Xiaoquan Zhao is an associate professor in the Department of Communication at George Mason University. His research focuses on health message design and effects, evaluation of public communication campaigns, health information seeking, information disparities affecting vulnerable populations, news effects on health and risk perceptions, and the role of the self in health behavior and persuasive communication. The substantive topics of his work include smoking, drug use, cancer, medical adherence and climate change.