title: Primary Care Physicians' Beliefs and Practices Regarding E-Cigarette Use by Patients Who Smoke: A Qualitative Assessment.
abstract: We explored primary care physicians' (PCPs') beliefs and practices about e-cigarettes. Cross-sectional, semi-structured interviews with PCPs in 2014 were conducted and audio-recorded. Participants were 15 general internal and family medicine physicians practicing in two settings in Virginia, USA. Interview recordings were transcribed, and the content analyzed using the Constant Comparative Method to identify key themes regarding PCPs' reported current practices and beliefs. Five themes were identified: (1) existing clinic processes do not include mechanisms to screen for noncombustible tobacco products (such as e-cigarettes); (2) e-cigarette discussions are becoming commonplace with patients initiating the discussions and seeking physician guidance regarding e-cigarette use; (3) a lack of knowledge regarding the potential harms and benefits of e-cigarettes, yet a willingness to support their patients' desire to use e-cigarettes (4) believing e-cigarettes are a safer alternative to smoking combustible tobacco products; and (5) abandoning concerns regarding the potential harms of e-cigarettes in the context of highly addicted patients and those with extensive comorbidities. Despite acknowledging limited knowledge regarding e-cigarettes, findings suggest that some PCPs are currently recommending e-cigarettes to their patients for smoking cessation and relative harm reduction, often personalizing recommendations based on the patient's perceived addiction level and current health status. Physicians need to be informed about the evolving evidence regarding the risks and benefits of e-cigarettes.
authors.affiliation: Section on Tobacco, Alcohol and Drug Use, Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA. omar.elshahawy@nyumc.org.|Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, UAE. omar.elshahawy@nyumc.org.
authors.forename: Omar
authors.initials: O
authors.lastname: El-Shahawy
authors.affiliation: Department of Health Behavior and Policy, School of Medicine and Massey Cancer Center, Virginia Commonwealth University; Richmond, VA 23284, USA. richard.brown@vcuhealth.org.
authors.forename: Richard
authors.initials: R
authors.lastname: Brown
authors.affiliation: Department of Health Behavior and Policy, School of Medicine and Massey Cancer Center, Virginia Commonwealth University; Richmond, VA 23284, USA. jennifer.elston-lafata@vcuhealth.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elston Lafata
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000523:psychology*; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000523:psychology*; D012307:Risk Factors; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D014768:Virginia
keywords: decision making; e-cigarettes; harm reduction; primary care; smoking cessation