Screening rates for e-cigarette use in primary care lower than for other substances

Screening for e-cigarette use is much lower than screening for other substances in primary care, according to the results of a study published in the American Journal of Preventive Medicine.

The CDC estimates that more than 2.5 million middle and high school students in the United States report using e-cigarettes. The FDA has recently cracked down on manufacturers, denying marketing for some e-cigarettes that are popular among youth and fining some manufacturers for illegally selling their products.

Brandon T. Sanford, PhD, a postdoctoral fellow at the Medical University of South Carolina, wrote that alcohol use, illicit drugs and smoking are commonly documented in electronic health records, but less is known about screening for e-cigarette use in primary care settings.

“Although e-cigarettes may represent harm-reduction for those transitioning from combustible cigarettes, they are not without potential negative health consequences,” they wrote. “Perhaps most importantly, up to two-thirds of adults who use e-cigarettes report a desire or a plan to quit. Primary care represents an important point of contact for assessing adult e-cigarette use and associated health risks.”

The researchers evaluated data from 134,931 adults, 61.2% of whom were women and 65.3% of whom were white, who visited one of 41 primary care clinics between June 2021 and June 2022. Through EHRs, they learned about demographics and the use of alcohol, illicit drugs, combustible tobacco like cigarettes and cigars and e-cigarettes.

Sanford and colleagues reported that “screening rates for e-cigarette usage were almost two-thirds lower than those of combustible tobacco, alcohol and illicit substances.”

Overall, the rate of e-cigarette screening was 34.8% in the primary care clinics. But screening rates for use of tobacco, alcohol and illicit drug use were all above 90%: 99.5%, 96.2% and 92.6%, respectively.

Being younger or using illicit substances or combustible tobacco was linked to a higher likelihood of being screened, according to the researchers.

Among those who were screened for e-cigarette use, just 3.6% reported being a current user, which is “consistent with recent estimates of the national adult prevalence.” Of the participants with documented nicotine use, the vast majority — 76.3% — used cigarettes or cigars exclusively, 17.2% reported using only e-cigarettes and 6.6% reported using both.

The lack of screening, the researchers wrote, might be because of the recent rise in e-cigarette use, a lack of training on e-cigarette use screening or the fact that e-cigarette use was only recently added to the EHR. This is unfortunate, “as over 60% of people who use e-cigarettes report they would like to discuss their use with their primary care provider,” Sanford and colleagues wrote.

“Given the observed prevalence of e-cigarette usage, improving the rate of e-cigarette screening for adult patients remains vital,” they wrote. “One potential improvement could be to integrate the e-cigarette screening item into the combustible tobacco section. Additionally, to reduce burden on staff, flags for screening could be selectively utilized for younger patients or those with a history of combustible tobacco use.”