Reducing Rates of Adolescent Electronic-Cigarette Use by Effective Primary Care: A Quality Improvement Project

Background: Primary care providers have the ability to combat false perceptions about electronic cigarettes' safety. Research shows screening and education are needed in primary care. Despite the increased use of electronic cigarettes (EC) among adolescent youth (AY) populations ages 11-18 years-old, primary care providers have not increased their attempts to screen for use in the primary care setting. Methods: An 8-question pre-intervention survey was performed evaluating provider comfort levels in screening and providing anticipatory guidance in a small family medicine clinic in rural Wyoming. The intervention was evaluated using an 11-question post-intervention survey. Results: Post-intervention, this study shows a statistical significance in provider comfort level with screening adolescent youth measured by Wilcoxon Signed Rank Sum Test, producing a Wstat of 0 and Wcrit of 2 showing a positive impact of the interventions. Comparing pre-and post-intervention surveys, 100% of the providers now include education related to E-cigs during encounters (pre-66.7%), 100% state education materials are available (Pre-33.3%), and 100% feel strongly they are more comfortable discussing E-cigarette use with Adolescents alone and with a parent in the room (66.7% and 0%, respectively). The study interventions improved screening frequency in the clinic and were measured by Fisher Exact Test and Chi-Squared Test producing a p-value of 0.0000002 and 0.0000006, respectively. Conclusions: Our findings suggest that introduction of macros used in the electronic health record is sufficient to overcome barriers to screening recognized from previous research, and show improved provider comfort with having sensitive conversations with teens about electronic cigarette use. A larger provider sample and longer duration of observation are needed to fully understand the clinical impact this study offers. It is our recommendation that providers screen teens at every clinic encounter for use of electronic cigarettes and provide education on the hazards and risks associated with such use to mitigate current and future use.