E-cigarette Screening and Clinical Intervention Behaviors Among Pediatric Primary Care Providers, Docstyles 2021

Background: Despite evidence that e-cigarette use is not safe for youth, e-cigarettes currently comprise the most commonly used tobacco product among US adolescents. Pediatric primary care providers are uniquely situated to assess youths’ use of tobacco products and to provide counseling for tobacco prevention and cessation. Recent estimates of pediatric care provider e-cigarette screening and intervention are lacking, and the degree to which providers’ screening youth for e-cigarette use correlates with their provision of tobacco-related interventions remains unknown.

Methods: This cross-sectional study used data from the 2021 DocStyles survey, a web-based panel survey of 1,753 actively practicing US health professionals conducted by Porter Novelli from March to May, 2021. Survey respondents included in this study were 1,050 actively practicing US healthcare professionals who reported caring for pediatric patients (“pediatric care providers”). Pediatric care providers were asked to select statements which generally described their clinical practice with patients less than 18 years old: I ask pediatric patients if they use e-cigarettes (“screen”); I counsel pediatric patients to not start using e-cigarettes (“counsel prevention”); I counsel pediatric patients who use e-cigarettes to stop using them (“counsel cessation”); I prescribe cessation medication to pediatric patients with nicotine dependency (“prescribe”); I refer pediatric patients who use tobacco to cessation treatment services (“refer”). Chi-square tests were used to assess associations between screening and all other behaviors; statistical significance was set at p<0.05.

Results: Over half of respondents indicated they screen pediatric patients for e-cigarette use (n=729, 69.4%), counsel e-cigarette prevention (n=670, 63.8%), and counsel cessation (n=703, 67%). Fewer respondents indicated that they prescribe (n=198, 18.9%) and refer (n=240, 22.9%). Respondents who indicated that they screen pediatric patients for e-cigarette use were significantly more likely to counsel prevention, counsel cessation, prescribe, and refer (Table 1).

Conclusion: While most pediatric care providers reported screening for e-cigarette use, approximately 1 in 3 did not counsel prevention, despite recommendations from both USPSTF and AAP that healthcare professionals provide clinical tobacco prevention interventions to youth. Additionally, approximately 1 in 3 pediatric care providers reported not counseling e-cigarette cessation, with even fewer providing cessation interventions such as prescribing medications and referring for cessation treatment services. Further, providers that screened for e-cigarette use were more likely to provide prevention and cessation interventions. These data suggest that opportunities exist to increase and improve clinical pediatric e-cigarette interventions, particularly among pediatric care providers who are not already screening for youth e-cigarette use. Public health and healthcare partners can collaborate to improve tobacco-related clinical interventions for youth through clinical quality improvement processes, health systems changes to integrate tobacco screening and treatment into routine care, and development of educational and clinical resources for pediatric providers.