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Huntley AP, Verdi M, Conway AE, Sharma H, Stukus D, Nanda A, Shaker M, Herbert L. Growing up with allergies: Transitioning from adolescence to adulthood. Ann Allergy Asthma Immunol 2024; 132:572-578. [PMID: 37984706 DOI: 10.1016/j.anai.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
Allergic disease management for adolescents and young adults requires consideration of unique psychosocial challenges and opportunities. Erik Erikson's model for the Stages of Psychosocial Development is a useful lens through which we can understand adolescent and young adult experiences with allergic and immunologic disease, particularly with regard to identity and relationship development. It is important to provide anticipatory guidance for patients who are transitioning environments (eg, home to college), with attention to the anxiety-provoking demands for increased responsibility on top of new stressors such as academic and vocational demands. It is critical that health care professionals use an empathetic, shared decision-making approach regarding the emotional impact of allergy on a patient's social engagement. A patient's ability to develop positive lifelong habits is also shaped by their environment's "culture of wellness," and clinicians can encourage habits to promote healthy choices and effective disease management. Social media provides opportunities and challenges as a conduit for both social connection and possible misinformation. Overall, allergic disease management in adolescents and young adults is a "high-risk, high-reward" period of time-and with awareness, anticipation, and proactive action, health care professionals can better serve patients by leveraging this transitional period to promote positive approaches to management of allergies and asthma, trusting relationships, and personal responsibility.
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Affiliation(s)
| | - Marylee Verdi
- Dartmouth College Student Health, Hanover, New Hampshire
| | | | - Hemant Sharma
- Division of Allergy and Immunology, Children's National Hospital and Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
| | - David Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Anil Nanda
- Asthma & Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; Department of Medicine and Pediatrics, Section of Allergy, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Linda Herbert
- Division of Allergy and Immunology, Children's National Hospital and Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
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Mays D, Macisco JM, Hawkins KB, Sleiman MM, Yockel MR, Xie S, Phan L, Luta G, Lobo T, Abraham A, Prokhorov AV, Tercyak KP. A multilevel intervention in pediatric primary care for youth tobacco control: Outcomes of implementing an Ask, Advise, and Connect model. Transl Behav Med 2024; 14:241-248. [PMID: 38330454 DOI: 10.1093/tbm/ibae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Multilevel interventions in healthcare settings (e.g. Ask, Advise, and Connect; AAC) can reduce tobacco product use among adult patients: their effectiveness in pediatric practice is largely unknown. We implemented an AAC model in pediatric primary care to deter children's tobacco use, and evaluated its effectiveness in a single-arm trial. At wellness visits, young patients (ages 12-17) completed a tablet-based assessment (Ask) of lifetime and current tobacco use. These data were made available within the electronic health record to pediatric primary care providers for preventive counseling (Advise). Providers then referred patients to an e-health evidence-based tobacco control intervention (Connect). Tobacco control outcomes were examined in the clinic population (N = 2219) and in a sample of patients (N = 388, 62% female, 39% non-White, M age = 15) over time, along with intervention engagement. Population use of tobacco products decreased following introduction of AAC (more than 2-fold). At the patient level, most children (80.9%) engaged with the intervention: those who were Black or African American, who never used tobacco products/were not susceptible to use, and who used fewer non-cigarette tobacco products were more likely to engage, but only after multiple prompts versus a single prompt. Engagement was positively associated with lowering children's susceptibility to using tobacco at follow-up. A pediatric AAC model holds promise in deterring youth tobacco use, including among historically marginalized populations who may require additional support.
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Affiliation(s)
- Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Joseph M Macisco
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kirsten B Hawkins
- MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, DC, USA
| | - Marcelo M Sleiman
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Mary Rose Yockel
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Shoulong Xie
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Lilianna Phan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tania Lobo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Lin C, Mathur Gaiha S, Halpern-Felsher B. E-cigarette and combustible cigarette cessation patterns, reasons, and methods among adolescents, young adults, and adults. Addict Behav 2024; 150:107918. [PMID: 38070362 PMCID: PMC10845159 DOI: 10.1016/j.addbeh.2023.107918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
Research is limited regarding adolescents' and young adults' (AYA) patterns, methods of, and reasons for cigarette or e-cigarette cessation. Further, while adults may try to use e-cigarettes to quit combustible cigarettes, little is known about how adults then quit e-cigarettes. This study utilizes a national, cross-sectional online survey of 6131 diverse participants aged 13-40 years to examine reasons for quitting e-cigarettes or cigarettes, quit methods, and quit attempt outcomes among AYAs and adults. In our sample, 3137 (51.2%) had ever used an e-cigarette, of whom 2310 (37.7%) were aged 13-24 years and 827 (13.5%) were 25-40 years old; 2387 (38.9%) had ever used a combustible cigarette (1440 [23.5%] were 13-24 years old and 947 [15.4%] were 25-40 years old). Among e-cigarette ever-users, 39.4% of 13-24-year-olds intended to quit in the next 6 months, and 36.9% had a serious plan for quitting in the next 30 days; 25.2% wanted to decrease the amount they used while 34.8% wanted to quit completely. Similar rates were found among e-cigarette ever users aged 25-40 years, as well as past 30-day e-cigarette users, cigarette ever-users, and past 30-day cigarette users across all ages. "Cold turkey" (41.0%) followed by "tried to cut down slowly by vaping/smoking less often or fewer puffs" (25.5%) was the most common quit method among e-cigarette ever-users and cigarette ever-users of all ages. Further study of effective tobacco cessation methods to help both AYAs and adults successfully quit nicotine, whether from cigarettes or e-cigarettes, is urgently needed.
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Affiliation(s)
- Crystal Lin
- Stanford School of Medicine, Stanford University, Palo Alto, CA, United States; REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Shivani Mathur Gaiha
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Bonnie Halpern-Felsher
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, United States.
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Tildy BE, McNeill A, Robins J, Dregan A, Richardson S, Brose LS. How is nicotine vaping product (e-cigarette) use monitored in primary care electronic health records in the United Kingdom? An exploratory analysis of Clinical Practice Research Datalink (CPRD). BMC Public Health 2023; 23:2263. [PMID: 37974094 PMCID: PMC10655457 DOI: 10.1186/s12889-023-17200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) could identify long-term health effects of nicotine vaping. We characterised the extent to which vaping is recorded in primary care EHRs in the UK, on a population level. METHODS We performed descriptive analysis of Clinical Practice Research Datalink (CPRD), primary care electronic health records of 25% of the UK population (~ 16 million patients). Patients aged ≥ 18 years whose vaping status was recorded using medical codes between 2006 and 2022 were identified. We reported the frequency of vaping codes; their distribution by patient age, gender, and ethnicity; trends in vaping recording over time (including interrupted time series analyses); and transitions in patient smoking status. RESULTS Seven medical codes indicated current or former vaping, from 150,114 patients. When their vaping status was first recorded, mean patient age was 50.2 years (standard deviation: 15.0), 52.4% were female, and 82.1% were White. Of those recorded as currently vaping, almost all (98.9%) had records of their prior smoking status: 55.0% had been smoking, 38.3% had stopped smoking, 5.6% had never smoked. Of those who were smoking prior to being recorded as vaping, more than a year after the vaping record, over a third (34.2%) were still smoking, under a quarter (23.7%) quit smoking, 1.7% received a 'never smoked' status, and there was no smoking status for 40.4%. The 'e-cigarette or vaping product use-associated lung injury' (EVALI) outbreak was significantly associated with a declining trend in new records of current vaping between September 2019 and March 2020; and an immediate significant increase in new records of former vaping, followed by a declining trend. CONCLUSIONS Few patients are being asked about vaping. Most who vape had smoked, and many quit smoking after starting vaping. To enable electronic health records to provide stronger evidence on health effects, we recommend improved completeness, accuracy and consistency.
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Affiliation(s)
- Bernadett E Tildy
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK.
- SPECTRUM Consortium, London, UK.
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- SPECTRUM Consortium, London, UK
- NIHR Applied Research Collaboration South London, London, UK
| | - John Robins
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- NIHR Applied Research Collaboration South London, London, UK
| | - Alexandru Dregan
- Psychological Medicine Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Mingli Building, Haidian District, Beijing, 100083, China
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, UK
- SPECTRUM Consortium, London, UK
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Agbonlahor O, Mattingly DT, Rai J, Hart JL, McLeish AC, Walker KL. Differences in health care provider screening for tobacco use among youth in the United States: The National Youth Tobacco Survey, 2021. Prev Med 2023; 175:107718. [PMID: 37793477 PMCID: PMC10681140 DOI: 10.1016/j.ypmed.2023.107718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Health care providers (HCP) are encouraged to screen youth for tobacco product use as a key step in preventing such use and associated health outcomes. However, recent data examining differences in HCP tobacco screening by sociodemographic characteristics and tobacco use is scant. METHODS Data from the 2021 National Youth Tobacco Survey (N = 14,685) were analyzed. Three types of HCP screening were examined: no screening, any e-cigarette use (e-cigarette only, e-cigarette and other tobacco), and non-e-cigarette tobacco product use. Differences by HCP screening were examined using multinomial logistic regression adjusted for age, sex, gender identity, sexual orientation, race/ethnicity, and tobacco use (non-current, sole, dual/poly). RESULTS Among the sample, 42.8% were screened for any tobacco use, with 30.6% screened for any e-cigarette use and 12.2% for non-e-cigarette tobacco product use only. Youth who were older (vs. younger) (OR = 5.98, 95% CI: 4.78-7.49) and gay/lesbian (vs. heterosexual) (OR = 1.47, 95% CI: 1.02-2.12) were more likely to be screened for e-cigarette use. Youth who were non-Hispanic Black (vs. non-Hispanic White) were less likely to be screened for e-cigarette use (OR = 0.53, 95% CI: 0.42-0.67) and more likely to be screened for non-e-cigarette tobacco use (OR = 1.34, 95% CI: 1.10-1.63). Current sole tobacco use (vs. non-current use) and dual/poly tobacco use (vs. non-current use) increased the likelihood for HCP screening for e-cigarette use. CONCLUSIONS The majority of U.S. youth continue to not be screened for tobacco use by their HCP. Evidence of disparities in tobacco use screening suggest the need for policies and training that promote equity in screening.
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Affiliation(s)
- Osayande Agbonlahor
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Delvon T Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA; Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jayesh Rai
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Joy L Hart
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA; American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA.
| | - Alison C McLeish
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA; American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA; Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kandi L Walker
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA; American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
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Ederle HM, Finley KM, Reisinger ME, Hartman AL. Opportunities to improve high-risk behavior screenings during well-child examinations. J Am Assoc Nurse Pract 2023; 35:646-651. [PMID: 37255454 DOI: 10.1097/jxx.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Nurse practitioners serve an essential role in the completion of age-appropriate adolescent high-risk behavior screenings including tobacco/nicotine, alcohol, illicit drug use, and sexual activity during well-child examinations (WCEs). LOCAL PROBLEM Midwestern adolescents demonstrate a suboptimal rate of engaging in annual preventative medical visits in comparison to national data. METHODS This mixed-methods quality improvement pilot sought to evaluate health care providers' beliefs, general clinic processes, and the overall quality of WCEs among adolescents aged 11-17 years in two midwestern primary care clinics. Quantitative data were obtained through queried reports and manual electronic health record chart audits. Qualitative data were obtained through focus group interviews. INTERVENTIONS Interventional strategies included providing education to key stakeholders regarding data analysis findings indicating process deficiencies regarding adolescent WCEs. Project members championed integration of advanced practice nurses as leaders of change within urban, multisite tertiary health care systems. RESULTS Results demonstrate that the lack of standardized assessment during an adolescent WCE can lead to fragmentation of high-risk behavior screenings. CONCLUSIONS This quality improvement pilot demonstrates the need for nurse practitioners to be at the forefront of interprofessional committees advancing the implementation of evidence-based guidelines and practice improvement initiatives. Standardization of high-risk behavior screening as part of the WCE in adolescence provides the foundation for health promotion and chronic disease prevention spanning into adulthood.
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7
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Connolly M, Croft D, Ramírez-Palacios P, Cai X, Hill B, Orfin RH, Rivera MP, Wilson KM, Li D, McIntosh S, Ossip DJ, Cupertino AP, Cartujano-Barrera F. Are Black and Latino adolescents being asked if they use electronic cigarettes and advised not to use them? Results from a community-based survey. Front Public Health 2023; 11:1222184. [PMID: 37637819 PMCID: PMC10449479 DOI: 10.3389/fpubh.2023.1222184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Objective This study aimed to explore whether African American/Black and Hispanic/Latino adolescents are being asked about electronic cigarette (e-cigarette) use (vaping) and advised not to use them. Methods In 2021, adolescents (N = 362) with no vaping history, self-identified as African American/Black and/or Hispanic/Latino, and able to read and speak English and/or Spanish were recruited through partner schools and community-based organizations. Participants completed a survey reporting sociodemographic characteristics (e.g., race/ethnicity, gender, and language of preference) and they were asked about e-cigarette use and/or were advised not to use them by a health professional. Results In total, 12% of African American/Black and 5% of Hispanic/Latino participants reported not seeing a health professional in the year prior to enrollment. Of the participants who reported visiting a health professional, 50.8% reported being asked and advised about vaping. Over one-quarter (28.4%) of participants were neither asked nor advised regarding vaping. Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to be asked about e-cigarette use (45.2 vs. 63.9%, p = 0.009) and advised not to use them (40.3 vs. 66.9%, p < 0.001). Moreover, compared to African American/Black participants, Hispanic/Latino participants were significantly less likely to be advised not to use e-cigarettes (52.9 vs. 68.6%, p = 0.018). Furthermore, compared to male participants, female participants were significantly less likely to be advised not to use e-cigarettes (51.3 vs. 68.2%, p = 0.003). Conclusion Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to self-report being asked about e-cigarette use and advised not to use them. Moreover, Hispanic/Latino and female adolescents were significantly less likely to self-report being advised not to use e-cigarettes compared to their Black/African American and male counterparts. Future research is needed to improve health professional attention toward asking about and advising against vaping among adolescents.
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Affiliation(s)
- Margaret Connolly
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Daniel Croft
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Paula Ramírez-Palacios
- Unidad de Investigación Epidemiológica y en Servicios de Salud Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | - Beverly Hill
- Community Engagement Division, Ibero American Action League, Rochester, NY, United States
| | - Rafael H. Orfin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - M. Patricia Rivera
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Karen M. Wilson
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Deborah J. Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
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Kaliamurthy S, Camenga DR. Clinical approach to the treatment of e-cigarette use among adolescents. Curr Probl Pediatr Adolesc Health Care 2022; 52:101203. [PMID: 35534404 DOI: 10.1016/j.cppeds.2022.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
E-cigarette use remains a serious public health threat for adolescents in the United States. Pediatric providers can intervene early to prevent the adverse, and sometimes life-long, health consequences of e-cigarette use. This article reviews the clinical management of e-cigarette use among adolescents using the "Ask-Counsel-Treat" model. This model was recently introduced by the American Academy of Pediatrics to help pediatric healthcare providers manage e-cigarette screening, counseling, and treatment. Behavioral treatments for e-cigarette cessation can be delivered via multiple formats, including via text, in-person, or online. Additionally, pediatric healthcare providers may consider the off-label use of nicotine replacement therapy in individuals less than 18 years of age to alleviate some of the symptoms of nicotine withdrawal. Further research is needed to inform the design and implementation of effective e-cigarette cessation strategies for adolescents.
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Affiliation(s)
- Sivabalaji Kaliamurthy
- Children's National Hospital, Washington, DC, USA; Department of Psychiatry, Yale University, New Haven, CT, USA.
| | - Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Becker TD, Rice TR. Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations. Eur J Pediatr 2022; 181:453-462. [PMID: 34396473 PMCID: PMC8364775 DOI: 10.1007/s00431-021-04220-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/24/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
Worldwide, youth electronic cigarette use (vaping) has risen significantly over the past decade. This public health concern has spurred many high-quality studies characterizing country-specific prevalence, risk factors, physical and behavioral health complications, and optimal methods of assessment and counseling for youth vaping. Clinicians remain underexposed to this recent work, limiting translation of evidence into higher quality patient care. This review aims to provide pediatricians and other clinicians working with youth a clinically focused survey of key research findings and considerations based on recent evidence. This narrative review surveys emerging trends in EC use across different countries, reasons for youth vaping, characteristics of vaping materials that promote youth use, associations with combustible cigarette use, relation with cannabis and other illicit substances, physical and behavioral health risks associated with vaping, and methods of assessment, counseling, and intervention for problematic vaping in youth. Since vaping remains a relatively new phenomenon, long-term health consequences remain unknown.Conclusion: Youth vaping is an increasingly well-studied phenomenon with both physical and behavioral health risks. Pediatricians and other youth-focused clinicians can apply the lessons of recent research in work with youth and their families. What is Known: • Youth vaping is an increasingly prevalent public health concern. • Recent research demonstrates physical and behavioral health risks associated with vaping as well as methods for assessment, counseling, and intervention. What is New: • The current review summarizes the latest evidence in a clinically focused framework to facilitate translation of emerging knowledge to practice.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1230, New York, NY, 10019, USA.
| | - Timothy R Rice
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1230, New York, NY, 10019, USA.
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10
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Theophilopoulos JM, LeLaurin JH, Williams M, Bright M, Thompson LA, Salloum RG. Provider documentation of electronic nicotine delivery systems use among patients prescribed contraception at an academic health center in the Southeastern United States. Prev Med Rep 2021; 24:101632. [PMID: 34976685 PMCID: PMC8684032 DOI: 10.1016/j.pmedr.2021.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/08/2021] [Accepted: 11/06/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose Women on combined hormonal contraception (CHC) who use electronic nicotine delivery systems (ENDS) may be vulnerable to adverse cardiovascular events. To date, no study has examined whether clinicians screen for ENDS use when prescribing CHC. Therefore, we investigated documentation of ENDS screening and counseling in the electronic health record (EHR) of women prescribed CHC. Methods We conducted a retrospective EHR review and content analysis at an academic health center in the Southeastern United States. We randomly selected 500 records of female patients 12 years and older who had been prescribed contraception and had ENDS documented in their records identified via keyword match. Records prior to July 2020 were reviewed between June-September 2020. Results Of the 500 patients, 245 (49%) were ENDS users and 227 (45.4%) were non-ENDS users. Among ENDS users, there were 82 contraception-related encounters with ENDS documentation. In 55 (67.1%) of these encounters, only ENDS use status was documented. The provider counseled against ENDS use in 17 (20.7%) records. Six (7.3%) notes documented provision of patient education materials instructing patients on contraception to refrain from using ENDS. Among non-ENDS users, there were 43 contraception-related encounters with ENDS documentation; 35 (81.4%) documented the patient did not use ENDS and 3 (7%) documented provision of patient education materials. Conclusion ENDS use is under-documented in contraception-related encounters. Improvements in documentation may help assess long-term effects of concurrent ENDS and CHC use. These results illustrate the need to clarify EHR prompts and increase provider awareness to improve ENDS documentation.
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11
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Merianos AL, Gordon JS, Lyons MS, Jandarov RA, Mahabee-Gittens EM. Evaluation of tobacco screening and counseling in a large, midwestern pediatric emergency department. Tob Prev Cessat 2021; 7:39. [PMID: 34056146 PMCID: PMC8145199 DOI: 10.18332/tpc/134751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The study objective was to assess tobacco screening and cessation counseling practices of pediatric emergency department (PED) and urgent care (UC) nurses and physicians, and factors associated with these practices. Secondarily, we assessed factors associated with performing tobacco smoke exposure reduction and tobacco cessation counseling. METHODS We conducted a cross-sectional survey of 30 PED/UC nurses and physicians working at one large, urban, Midwestern children’s hospital. Measures included current practices of performing the 5 As of tobacco counseling (Ask, Advise, Assess, Assist, Arrange), and attitude and practice factors that may influence practices. RESULTS Overall, 90.0% of participants had not received recent tobacco counseling training, 73.3% were unaware of the 5 As, and 63.3% did not have a standardized, routine screening system to identify patients exposed to secondhand smoke. The majority of participants reported that they: asked about patients’ secondhand smoke exposure status (70.0%) and parents’ tobacco use status (53.3%), and advised parental smokers to not smoke around their child (70.0%) and to quit smoking (50%). One in five participants reported they assessed smokers’ interest in quitting smoking, and 16.7% talked with smokers about cessation techniques and tactics; of these, 10% referred/enrolled smokers to the Tobacco Quitline or cessation program, and 6.7% made a quit plan or recommended nicotine replacement therapy medication. CONCLUSIONS Key findings identified are the need for professional tobacco counseling training, standardizing efforts during visits, and emphasizing pediatric patients’ potential health benefits. This information will be used for developing a PED/ UC-based parental tobacco cessation and child tobacco smoke exposure reduction intervention.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, United States.,Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, United States
| | - Judith S Gordon
- College of Nursing, The University of Arizona, Tucson, United States
| | - Michael S Lyons
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, United States.,Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, United States
| | - Roman A Jandarov
- Department of Environmental and Public Health Sciences, Division of Biostatistics and Bioinformatics, College of Medicine, University of Cincinnati, Cincinnati, United States
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, United States
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Boykan R, Gorzkowski J, Wellman RJ, Jenssen BP, Klein JD, Krugman J, Pbert L, Salloum RG. Pediatric Resident Training in Tobacco Control and the Electronic Health Record. Am J Prev Med 2021; 60:446-452. [PMID: 33131991 DOI: 10.1016/j.amepre.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
Given the dangers posed by tobacco use and tobacco smoke exposure, pediatricians should address tobacco use and exposure with patients and parents at every opportunity, but this is not consistently done in practice. One reason may be that many medical residents do not receive education on how to address tobacco use and tobacco smoke exposure with patients and their parents. In a 2012 survey of U.S. pediatric program directors, 65% of programs reported covering tobacco control in their curricula, but most training programs focused on tobacco's health effects and not intervention strategies for clinical practice. Since that survey, electronic health records have been implemented broadly nationwide and utilized to address tobacco smoke exposure. Investigators surveyed U.S. program directors in 2018 and residents in 2019 to explore the ways in which the residents learn about tobacco use and tobacco smoke exposure, components and use of the electronic record specific to tobacco use and tobacco smoke exposure, and perceived resident effectiveness in this area. All the program directors and 85% of the residents valued training, but 21% of the residents reported receiving none. Moreover, a minority of the residents assessed themselves as effective at counseling parents (19%) or adolescents (23%), and their perceived effectiveness was related to small group learning and active learning workshops, modalities that were infrequently implemented in training. Respondents also reported infrequent use of electronic health record prompts regarding tobacco and the absence of prompts about critical issues (e.g., addressing tobacco smoke exposure in vehicles or other settings or offering treatment or referrals to parents who smoke). This paper provides recommendations about augmenting pediatric resident training in simple ways.
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Affiliation(s)
- Rachel Boykan
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.
| | - Julie Gorzkowski
- AAP Julius B. Richmond Center of Excellence, Itasca, Illinois; Pediatric Population Health, Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Robert J Wellman
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan D Klein
- AAP Julius B. Richmond Center of Excellence, Itasca, Illinois; Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Jessica Krugman
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Lori Pbert
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
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Bailey SR, Fankhauser K, Marino M, Schmidt T, Giebultowicz S, Ezekiel-Herrera D, Heintzman J. Smoking Assessment and Current Smoking Status Among Adolescents in Primary Care Settings. Nicotine Tob Res 2021; 22:2098-2103. [PMID: 32556337 DOI: 10.1093/ntr/ntaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Initiating tobacco use in adolescence increases the risk of nicotine dependence and continued use into adulthood. Primary care visits provide opportunities for the assessment and treatment of tobacco use; however, little is known about prevalence and correlates of assessing smoking status and current use among adolescents in these settings. AIMS AND METHODS Using electronic health record data from the OCHIN network, we identified adolescents with greater than or equal to one primary care visit to a study clinic (n = 366 clinics from 15 US states) during January 1, 2016 to December 31, 2017. We estimated odds ratios of smoking assessment and current smoking status by patient covariates. RESULTS Of 140 887 patients, 87.4% were assessed for smoking. Being Latino or Black (adjusted odds ratio = 1.22, 95% confidence interval: 1.13-1.32; adjusted odds ratio = 1.17, 95% confidence interval: 1.07-1.29, respectively, vs. non-Hispanic White), publicly insured, having more visits, and having an asthma diagnosis or other respiratory symptoms were associated with higher odds of assessment. Odds were lower if the patient was male and uninsured. Of those assessed, 1.6% identified as current smokers. Being older, having more visits, an asthma diagnosis, other respiratory symptoms, and lower household income was associated with higher odds of being a current smoker. Latinos and Blacks had lower odds than non-Hispanic Whites. CONCLUSIONS Although some commonly reported tobacco-related disparities were not present, smoking assessment and current smoking status differed significantly by most patient demographics. Implementation of adolescent tobacco assessment protocols and the development of interventions to target subpopulations of adolescents with higher rates of smoking could mitigate disparate rates of assessment and smoking, respectively. IMPLICATIONS Clinical guidelines recommend screening adolescents for tobacco use in primary care settings. We found that most adolescents seen in US safety-net primary care clinics were assessed for smoking. We also found that smoking assessment and current smoking status differed significantly by most patient demographics. Implementing tobacco assessment protocols specific to adolescents could mitigate disparate rates of assessment and ensure accurate documentation of all forms of tobacco use, given the evolution of alternative tobacco products and poly use among adolescents. Interventions to target subpopulations of adolescents with higher smoking rates are needed to prevent the negative health effects of continued smoking.
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Affiliation(s)
- Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Katie Fankhauser
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | | | | | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR.,OCHIN, Inc., Portland, OR
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Sussman S. Tobacco use topography and etiology: Similarities and differences among teens and emerging adults. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_53_19] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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