title: Physicians' Counseling of Adolescents Regarding E-Cigarette Use.
abstract: OBJECTIVE
  Electronic cigarette (e-cigarette) use now surpasses the use of conventional cigarettes among U.S. adolescents. Given the important role of physicians in preventing adolescent risk behaviors, we sought to understand how physicians communicate about e-cigarettes when counseling adolescent patients and their parents. We also explored physicians' support for regulations aimed at discouraging adolescents' e-cigarette use.
  
  
  METHODS
  A national U.S. sample of 776 pediatricians and family medicine physicians who provide primary care to adolescent patients completed an online survey in Spring 2014.
  
  
  RESULTS
  Many physicians (41%) would, if asked, tell their patients that e-cigarettes are less harmful than cigarettes, and a substantial minority (24%) would recommend e-cigarettes to adolescents for smoking cessation. Most physicians reported routinely screening adolescent patients for cigarette smoking but few routinely screened for e-cigarette use (86% vs. 14%; p < .001). Routine counseling was similarly more common for avoiding cigarette smoking than for avoiding e-cigarette use (79% vs. 18%; p < .001). Support for government regulation of e-cigarettes was high, with 91% of physicians endorsing policies that prevent minors from buying e-cigarettes.
  
  
  CONCLUSIONS
  Physicians infrequently screen or counsel their adolescent patients about e-cigarette use, although e-cigarettes often come up during visits. Additional efforts by physicians could help prevent future use by adolescents. Recommending e-cigarettes as a smoking cessation aid to adolescent patients is inadvisable given the lack of evidence for efficacy in that population. As federal regulation of e-cigarettes remains in limbo, pediatricians and family medicine physicians can offer a powerful voice for informing regulations aimed at reducing use by adolescents.
authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Electronic address: pepper@unc.edu.
authors: Jessica K
authors: JK
authors: Pepper
authors: Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors: Melissa B
authors: MB
authors: Gilkey
authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
authors: Noel T
authors: NT
authors: Brewer
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine; D003142:Communication; D003376:Counseling; D066300:Electronic Nicotine Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014481:United States
keywords: Adolescents; Cigarette smoking; Counseling; E-cigarettes; Electronic cigarettes; Prevention; Tobacco products