The Provider’s Role: Screening for E-Cigarette Use
As a primary care provider, you are in a key position to open a dialogue about vaping with your adolescent and young adult patients. Texas Health Steps recommends that providers include discussion about tobacco and substance use as part of anticipatory guidance for every youth beginning at age 9 years. This anticipatory guidance should include inquiries and discussion about vaping.
Annual preventive medical checkups for adolescents and young adults provide an ideal opportunity for early detection and discussion of e-cigarette use by your young patients. “Do not recommend e-cigarettes as a tobacco-dependence treatment product,” states the AAP’s policy statement on e-cigarettes (2019).
Motivational interviewing strategies can help you encourage healthy habits and behavioral changes. Be honest, straightforward and age appropriate. Your ability to show empathy and be a good listener can help young patients feel more comfortable and be willing to open up.
Do not use judgmental statements or questions such as “I hope you don’t smoke.” or “You don’t use e-cigarettes, do you?” Ask open-ended questions such as:
- What do you and your friends think about e-cigarettes?
- What have you learned about e-cigarettes online?
- How do you and your friends learn about the health effects of vaping?
- What does your school teach students about vaping?
Counseling Tips
“Teenagers are more likely to get information on health issues from their parents and their health care providers than from peers, the internet, or social media,” according to the CDC (n.d.). “Findings from a 2015 Northwestern University study confirm that the internet is a supplement—not a replacement—for parents, teachers, and doctors as sources of credible health information.”
As a trusted primary care provider, you can help address dangerous myths about e-cigarettes by providing your young patients and their families with credible, accurate information about e-cigarettes and the damage they can do. You and your staff can compile a list of resources for patients and families to help them understand how using e-cigarettes can harm a young user’s health. See Helpful Resources for Patients and Families in the Appendix for fact sheets, apps and other resources that can be shared.
Case Examples
As a primary care provider, you can counsel youth during their annual preventive medical checkups. Always ask about e-cigarette use when discussing substance use and other risky behaviors.
Soledad: I know people who vape. I’ve only tried it a couple of times. We know e-cigs aren’t going to cause lung cancer when we’re old people like real cigarettes do.
Provider: I’m glad you told me this, Soledad. Would it be okay for me to share some information about vaping? (Waits for Soledad to say yes.) Medical studies show that e-cigarettes may contain lots of chemicals that can cause cancer, and may increase your chances of having a heart attack and developing asthma or other serious and irreversible lung conditions. Public health officials are warning teenagers and other people not to use e-cigarettes because of this risk of severely damaging your lungs. One thing you might be interested in is that e-cigarette labels may not show all the chemicals they contain, so that’s a red flag warning right there. Also, most e-cigarettes contain nicotine, which is the chemical in tobacco cigarettes that causes smokers to become addicted. Nicotine can harm your brain in ways that could reduce your ability to think, remember things, and do well in school so you can get the kind of job you want. Vaping can cause problems while you’re still young. And the truth is, we still don’t know what the effects may be when you get older.
Stewart: Well, yeah, I do like to vape. My parents both smoke cigarettes and they cough and wheeze a lot. But there’s no smoke from e-cigs. They’re safe because it’s just water vapor and not tobacco smoke.
Provider: Thanks for letting me know, Stewart. Would it be okay for me to share some information about e-cig vapor? (Waits for Stewart to say yes.) You might be interested in knowing that e-cig vapor isn’t just harmless water vapor. In fact, e-cigs don’t contain water at all. They include chemicals that can cause cancer, and just like cigarette smoke, the vapor is breathed in by you and the people around you. You might also want to know that e-cigs contain nicotine, which is what causes people to get addicted in the first place. If you are interested, we could work together on a plan to keep you healthy and safe from e-cig vapor.
Stewart: Whoa. Yeah. I sure don’t like all the cigarette smoke around my parents. But I didn’t really realize vapor could be serious too. So, well, yeah, ok. I think I would like to see what we could do about this.
Lorenzo: Well, I guess I gotta tell you that I started smoking cigarettes last year. But my girlfriend hates it. She says I smell bad and won’t even kiss me until I chew gum. I heard that JUULing is supposed to help smokers quit, so I started vaping recently. Right away, it felt better on my throat. I like the mint flavor.
Provider: I appreciate your honesty, Lorenzo, and I congratulate you for wanting to quit smoking tobacco. Would it be okay for me to share some information about JUULing? (Waits for Lorenzo to say yes.) Cigarettes can cause addiction, lung cancer and other breathing diseases. But there is not strong evidence that e-cigarettes can help people quit smoking regular cigarettes. Medical studies show that vaping can cause many of the same problems as cigarettes because e-cigarettes also have nicotine and lots of toxic chemicals. E-cigarettes are especially dangerous for teenagers and young adults because the human brain is still developing until about age 25. The nicotine in the vapor can hurt your brain’s ability to develop properly. So e-cigarettes could reduce your ability to think and remember things, and to keep up with school or your responsibilities on a job. And medical studies show that e-cigarettes may contain lots of chemicals that can cause cancer, and may increase your chances of having a heart attack, developing asthma, or other serious and irreversible lung conditions. What other ways have you tried to quit smoking?
Lorenzo: No one ever told me that. I see people vaping everywhere. Is there a website or an app that I could use to help me figure all this out?
Provider: Sure. My office keeps a list of those apps and other resources. We can text those to you or you can pick up a copy at the front desk. And Texas has a toll-free counseling help line called the Texas Quitline that you can call. It’s confidential and here’s the number—877-937-7848.
Texas Efforts to Prevent Adolescent Vaping
Texas law mirrors federal law: it is illegal in Texas to sell or give tobacco products, including e-cigarettes, to anyone age 20 years or younger. Texas law also prohibits young adults and children 20 years and younger from possessing or using those tobacco products. The only exceptions are active-duty military personnel and individuals who turned 18 prior to the law taking effect on September 1, 2019.
Violations are a Class C misdemeanor. Retailers can be fined up to $500. In addition, the Texas Comptroller of Public Accounts can suspend or revoke a retailer’s cigarette or tobacco product permits for violating the 2019 law, and fines could increase up to $1,000 for multiple violations.
Minors who violate the law could be fined up to $100 and be required to attend an e-cigarette or tobacco awareness program (Texas Youth Tobacco Awareness Program, TYTAP) or perform community service.
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