In the JournalsPerspective

Few PCPs provide patients with information regarding e-cigarettes

Primary care physicians were frequently not their patients’ main source of information when it came to e-cigarette use, according to findings recently published in the Journal of the American Board of Family Medicine.

“Given the emergence of widespread use of e-cigarettes and the frequency of health claims being made by the e-cigarette industry, surprisingly little is known about how patients and PCPs discuss e-cigarettes during clinic visits,” Mark P. Doescher, MD, MSPH, of the department of family and preventive medicine at the University of Oklahoma Health Sciences Center and colleagues wrote. “The role of PCPs in advising patients regarding the health risks or potential benefits of using e-cigarettes remains unclear at the same time that many patients are using these products and undoubtedly asking their PCPs about them.”

Researchers conducted a cross-sectional survey regarding several e-cigarette topics of 568 adult patients at a single-family medicine clinic in Oklahoma. Of that total, 29% of respondents had last used an e-cigarette in the past 30 or more days, and 10% had used them in the past 30 days or less.

Doescher and colleagues found that 30.2% of the surveyed patients “disagreed that their PCP knew a lot about e-cigarettes.” In addition, 25% of all the surveyed patients wanted their PCP to talk about e-cigarettes with them, while 62% of e-cigarette users in the past 30 days wanted such a conversation. In addition, 27.3% said they knew about the health effects tied to quitting cigarettes, secondhand smoke and e-cigarettes. Most respondents (56.6%) said television advertisements provided their education on e-cigarettes; other sources of information included family and friends (49.9%), e-cigarette shops (25.5%), and physician offices (6%).

Also, e-cigarette use was significantly higher in the respondents who smoked traditional cigarettes, were less educated and were younger, but use did not fluctuate by the patient’s health status or sex.

“The few reports on e-cigarette counseling by PCPs indicate that when counseling occurs, it tends to be in the context of recommended e-cigarettes as a cigarette cessation aid, despite the fact that little evidence exists that e-cigarettes are effective in smoking cessation and may even be associated with fewer quit attempts in ‘real-world’ clinical settings,” Doescher and colleagues wrote. “It seems inevitable that PCPs will increasingly discuss e-cigarettes with patients, so efforts to better characterize the possible role of e-cigarettes on smoking behaviors, such as cigarette cessation are needed, as is research to help provide PCPs with evidence-based information on these products.”

Researchers also said their findings “underscore the need” for clinicians to provide information on e-cigarettes to their patients, instead of having patients depend on sources that may not be objective or may be motivated by profit. – by Janel Miller 

Disclosure: The authors report no relevant financial disclosures.

Primary care physicians were frequently not their patients’ main source of information when it came to e-cigarette use, according to findings recently published in the Journal of the American Board of Family Medicine.

“Given the emergence of widespread use of e-cigarettes and the frequency of health claims being made by the e-cigarette industry, surprisingly little is known about how patients and PCPs discuss e-cigarettes during clinic visits,” Mark P. Doescher, MD, MSPH, of the department of family and preventive medicine at the University of Oklahoma Health Sciences Center and colleagues wrote. “The role of PCPs in advising patients regarding the health risks or potential benefits of using e-cigarettes remains unclear at the same time that many patients are using these products and undoubtedly asking their PCPs about them.”

Researchers conducted a cross-sectional survey regarding several e-cigarette topics of 568 adult patients at a single-family medicine clinic in Oklahoma. Of that total, 29% of respondents had last used an e-cigarette in the past 30 or more days, and 10% had used them in the past 30 days or less.

Doescher and colleagues found that 30.2% of the surveyed patients “disagreed that their PCP knew a lot about e-cigarettes.” In addition, 25% of all the surveyed patients wanted their PCP to talk about e-cigarettes with them, while 62% of e-cigarette users in the past 30 days wanted such a conversation. In addition, 27.3% said they knew about the health effects tied to quitting cigarettes, secondhand smoke and e-cigarettes. Most respondents (56.6%) said television advertisements provided their education on e-cigarettes; other sources of information included family and friends (49.9%), e-cigarette shops (25.5%), and physician offices (6%).

Also, e-cigarette use was significantly higher in the respondents who smoked traditional cigarettes, were less educated and were younger, but use did not fluctuate by the patient’s health status or sex.

“The few reports on e-cigarette counseling by PCPs indicate that when counseling occurs, it tends to be in the context of recommended e-cigarettes as a cigarette cessation aid, despite the fact that little evidence exists that e-cigarettes are effective in smoking cessation and may even be associated with fewer quit attempts in ‘real-world’ clinical settings,” Doescher and colleagues wrote. “It seems inevitable that PCPs will increasingly discuss e-cigarettes with patients, so efforts to better characterize the possible role of e-cigarettes on smoking behaviors, such as cigarette cessation are needed, as is research to help provide PCPs with evidence-based information on these products.”

Researchers also said their findings “underscore the need” for clinicians to provide information on e-cigarettes to their patients, instead of having patients depend on sources that may not be objective or may be motivated by profit. – by Janel Miller 

Disclosure: The authors report no relevant financial disclosures.

    Perspective
    Harold J. Farber

    Harold J. Farber

    In the study by Doescher and colleagues, patients at a large resident (in training) physician practice at an academic medical center in Oklahoma were asked to complete a brief survey about electronic cigarettes. The survey results show how aggressive marketing has pushed e-cigarettes into this community, how it is attracting young people, and how it is attracting former and never-smokers. Information about e-cigarettes reached their patients mostly by advertising, vape shops and word of mouth — only a small percentage got their information from physicians, even though most recent e-cigarette users wanted their physicians to discuss it with them.

    In the major lawsuit against the tobacco industry in 2006 under the Racketeering Influenced and Corrupt Organizations (RICO) Act — the act written to target organized crime — U.S. District Judge Janet Kessler found, “Defendants have marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.” We are seeing the e-cigarette and vape industry following in the well-trodden tracks of the tobacco industry in their deceptions. 

    Almost every month, new research demonstrates more and more about the harms of e-cigarette use. Furthermore, research has failed to demonstrate any clear benefit of e-cigarettes for stopping smoking — in fact youth who use e-cigarettes and other electronic nicotine delivery systems are more likely go on to smoke cigarettes, and less likely to stop smoking. Other studies suggest adult smokers who use e-cigarettes are less likely to stop smoking compared to those who don’t. Close to one-third of nonsmoking individuals who have tried an e-cigarette go on to conventional cigarette smoking. 

    This study shows the need for physicians to become better informed about e-cigarettes and other electronic nicotine delivery systems in order to better counsel their patients. This study shows patients want to hear about this from their doctors. This study also highlights the importance of regulation of e-cigarette promotion. Exaggerated and nonevidence-based health claims or implied claims (such as “just vapor”) are common. Our young people deserve better.

    • Harold J. Farber, MD, MSPH
    • Associate professor of pediatrics, pulmonary section Baylor College of Medicine and Texas Children’s Hospital

    Disclosures: Farber reports serving as vice chair of the American Thoracic Society Tobacco Action Committee and associate medical director for Texas Children’s Health Plan, as well as being a past executive committee member and policy chair for the AAP section on tobacco control.