Effects of E-cigarette Education in Adolescents and Young Adults in Primary Care

Approximately one in five high school student and 1 in 20 middle school students currently use e-cigarettes. The burgeoning number of e-cigarette users from 2017 to 2018, 1.5 million more, prompted the U.S. Surgeon General to declare an e-cigarette epidemic among teens. Serious health problems, such as bronchiolitis obliterans, DNA damage, increased risk for developing asthma and COPD, seizures, anoxic brain injury, elevated blood pressure, elevated heart rate, and myocardial infarction has been associated with exposure of toxic chemicals in the e-liquids that is heated to produce an aerosol and inhaled into the lungs. The long-term effects of e-cigarettes is unknown with research still in its infancy with only a little over 10 years since first introduced in the U.S. Despite a recent decline in the estimated users in 2020, adolescents and young adults continue to use e-cigarettes. The purpose of this scholarly project is to educate teens and young adults about the harmful effects of e-cigarettes in an effort to reduce e-cigarette use among current users. Objectives were to evaluate participants knowledge of perceived harms, implement e-cigarette education, and determine if the education encouraged a reduction in use or promote e-cigarette cessation. A quasi-experimental pre-posttest intervention quality improvement project was implemented at a rural family practice clinic in the southeastern region of the U. S. Participants were between the ages of 13 – 24 who vaped daily, randomized between an intervention group and control group, and administered 3 questionnaires (Initial Questionnaire, PESCDI, and E-cigarette Reasons for Use Scale). Intervention group viewed an educational video on the harms of e-cigarettes. PESCDI was administered as a posttest 2-4 weeks following appointment in the clinic. Initial Questionnaire results revealed that 76% of participants were female and the top 2 reasons for use were curiosity/peer-pressure/friends that use and flavors/tastes good. Majority believed that e-cigarettes were equally harmful (41%) and less harmful (41%) than tobacco cigarettes. Wilcoxon signed-rank test analysis of the PSECDI did not show that the educational intervention was statistically significant, however, median scores in the intervention group decreased indicating an overall decrease in nicotine dependency. Median scores in the control group did increase on posttest denoting a higher nicotine dependence on follow-up. Fisher’s exact tests compared pre and posttests according to categories, although not statistically significant, revealed that the intervention groups posttest PSECDI dependency decreased in the medium and low dependency categories and increased in the not dependent category representative of a clinically significant decline in nicotine dependency. One participant progressed from not dependent to low dependency. Limitations of the project include a small sample size due to small rural family practice and COVID-19 pandemic limiting the number of patients in the office. Future implications include replicating project at multiple sites for larger sample size to determine a statistical significance.