Despite high rates of teen use of e-cigarettes, doctors still focus counseling efforts on traditional tobacco products

September 3, 2015

A faculty member and an alumna of the UNC-Chapel Hill Gillings School of Global Public Health are co-authors of the first national study to examine how pediatricians and other doctors interact with teenage patients regarding e-cigarettes.

Dr. Jessica Pepper

Dr. Jessica Pepper

Dr. Noel Brewer

Dr. Noel Brewer

Jessica K. Pepper, PhD, postdoctoral fellow at UNC’s Lineberger Comprehensive Cancer Center and 2014 alumna of the Gillings School, is lead author of the study. Noel T. Brewer, PhD, associate professor of health behavior at the Gillings School and UNC Lineberger member, is a co-author.

Recently, multiple surveys have found that more teens now use electronic cigarettes than regular cigarettes. There is no federal regulation of e-cigarettes, and teenagers often have easy access to them.

From a public health perspective, this is concerning. Using e-cigarettes may make teens more likely to smoke conventional cigarettes in the future. Further, most e-cigarettes contain nicotine, which is harmful to the developing teenage brain.

In the published national study, researchers analyzed a sample of 776 United States pediatricians and family medicine physicians who provide primary care to adolescent patients in order to understand the messages they share with teenagers about e-cigarettes.

Despite high rates of e-cigarettes use by teens, many fewer physicians reported routinely screening for e-cigarette use (14 percent) than for cigarette use (86 percent). Similarly, routine counseling to help teens avoid cigarette smoking was far more common than counseling for avoidance of e-cigarette use (79 versus 18 percent).

A substantial minority of physicians (24 percent) reported that they would recommend e-cigarettes to teens for smoking cessation. (Suggesting e-cigarettes as a smoking cessation aid for adolescent patients is inadvisable, given the lack of evidence for efficacy in that population.)

In addition, 41 percent of the physicians surveyed said they would, if asked, tell teenage patients that e-cigarettes are less harmful than cigarettes.

Overall, support for government regulation of e-cigarettes was notably high among physicians, with 91 percent endorsing policies that prevent minors from buying e-cigarettes.

The survey also revealed that many doctors are concerned about the health harms of e-cigarettes and want to learn more detailed information about the topic.

“These primary care physicians are on the front lines of helping to prevent risk-taking behaviors among teenagers,” said Pepper. “It is important that they know about e-cigarettes and talk directly with their teenage patients about them.”

The study, titled “Physicians’ Counseling of Adolescents Regarding E-Cigarette Use,” was published online August 19 by the Journal of Adolescent Health.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

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