TDNet Discover

Background: The smoking of electronic cigarettes (e-cigarettes) has drastically increased in the past several decades, particularly in the youth and adolescent populations. Few attempts have been made to understand why this has become such an epidemic among the youth, or how to prevent it. In contrast to traditional cigarette smoking, there is also a lack of knowledge and guidelines for prevention and cessation of e-cigarette use from a healthcare provider’s perspective. Objectives: To review all literature currently addressing e-cigarette smoking in adolescent populations, focusing on current interventions, provider knowledge, and risk factors to make a provider recommendation on prevention strategies.Methods: A systematic review of literature regarding youth (ages ten to nineteen) e-cigarette use was performed by searching three databases, Google Scholar, JAMA, and PubMed. Articles were reviewed by all researchers for content, quality (“poor”, “fair”, and “good”), and fulfillment of inclusion and exclusion criteria. In total, ten articles were selected and analyzed through the “Quality Assessment of Systematic Reviews and Meta-Analyses” assessment tool on the National Heart, Lung, and Blood Institute’s website. A data extraction was performed and articles were categorized into one of three themes;with two addressing current provider knowledge, three addressing at-risk populations, and five addressing existing interventions. Results: The ten articles supporting the research question included a controlled study, a cross sectional analysis, six observational cohort studies, and two systematic reviews. Three studies determined that those who are younger students and alcohol users are at a higher susceptibility of use, while those who are caucasion, have higher family income, perceive e-cigarette use as less harmful, and/or have disability status have a higher incidence rate of e-cigarette use. Three 5 observational cohort studies determined 83% of providers self-reported “little” or “no” knowledge of e-cigarettes, 89% reported a desire for more knowledge on the subject of ecigarettes, and only 14% reported screening for e-cigarette use. A controlled study determined that incorporating a question into EHR increased screening rates by 95%. Lastly, three studies found that 409 students benefited from education on the dangers of e-cigarettes.Conclusion: A thorough examination of the available research demonstrated a lack of consensus on the most effective way to approach e-cigarette smoking in youth. Studies agree on some risk factors for e-cigarette use, including prior smoking of traditional cigarettes, exposure to cigarette or e-cigarette smoking by peers or by household members, older age, higher socioeconomic status, and holding the belief that e-cigarettes are less dangerous than traditional cigarettes. Studies also show that there is no streamlined method ofscreening for e-cigarette use in the younger populations, and that healthcare providers demonstrate a significant lack of knowledge on the subject as well as desire for education on the subject. We recommend a study be done in which providers participate in a course with instructions and education on screening adolescents. We recommend an analysis be performed evaluating the efficacy of this intervention. Despite a clear lack of evidence and little implementation, provider intervention provides a promising method of smoking and vaping prevention in adolescents.