Edited by: Rajendra D. Badgaiyan, The University of Texas Health Science Center at San Antonio, United States
Reviewed by: Dimitra Kale, University College London, United Kingdom; Laurie Solomon, University of Florida Health Florida Recovery Center, United States
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This study aimed to explore whether African American/Black and Hispanic/Latino adolescents are being asked about electronic cigarette (e-cigarette) use (vaping) and advised not to use them.
In 2021, adolescents (
In total, 12% of African American/Black and 5% of Hispanic/Latino participants reported not seeing a health professional in the year prior to enrollment. Of the participants who reported visiting a health professional, 50.8% reported being asked and advised about vaping. Over one-quarter (28.4%) of participants were neither asked nor advised regarding vaping. Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to be asked about e-cigarette use (45.2 vs. 63.9%,
Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to self-report being asked about e-cigarette use and advised not to use them. Moreover, Hispanic/Latino and female adolescents were significantly less likely to self-report being advised not to use e-cigarettes compared to their Black/African American and male counterparts. Future research is needed to improve health professional attention toward asking about and advising against vaping among adolescents.
Since 2014, electronic cigarettes (e-cigarettes) have been the most commonly used nicotine and tobacco product among middle and high school students in the United States (U.S.) (
Routine healthcare visits provide an opportunity to address vaping among adolescents. The Ask, Advise, and Refer (AAR) model is a well-established approach for health professionals worldwide to address nicotine and tobacco use among patients, including adolescents (
This study is a secondary data analysis of a randomized controlled trial (RCT) designed to assess the immediate impact of vaping prevention graphic messages on the susceptibility of future vaping among Black and Latino adolescents (
In 2021, Black and Latino adolescents were recruited by a team of diverse, bilingual (English and Spanish), trained recruiters using proactive and reactive strategies. Adolescents aged 12–17 years with no history of e-cigarette use who self-identified as African American/Black and/or Hispanic/Latino and able to read and speak English and/or Spanish were included in the RCT. Parents'/guardians' permission and adolescents' assent were obtained from all subjects involved in the study. Details and results of the recruitment, eligibility, and permission/assent have been reported in a previous publication (
All assessments described in this study were completed in the language of preference of the participant, either English or Spanish, at baseline. The baseline survey collected information on demographics (e.g., age, gender, sexual preference, race, ethnicity, language of preference, grade, and parent or caregiver nicotine and tobacco use). The baseline survey also assessed whether participants were being asked if they use e-cigarettes and/or advised not to use them. Questions included “Think about when you have visited a doctor, dentist, nurse, or other health professional in the past 12 months. During any of these visits, were you asked if you use e-cigarettes?” and “Think about when you have visited a doctor, dentist, nurse, or other health professional in the past 12 months. Were you given advice not to use any e-cigarettes?” (
For this study, participants who reported having not seen a health professional in the past 12 months were not included in the analyses. Sociodemographic characteristics of participants were described between those who were and were not asked about e-cigarette use and among those who were and were not advised about vaping. Fisher's exact test was used to compare proportions in categorical variables and crude odds ratios (OR) were reported. Student's
At baseline (
Of the Hispanic/Latino participants who reported visiting a health professional in the previous 12 months, 64% of participants reported English as their preferred language and 36% reported Spanish as their preferred language. Hispanic/Latino participants who reported Spanish as their preferred language were significantly less likely to be asked (45.2 vs. 63.9%,
Sociodemographic characteristics of participants who were vs. who were not asked or advised about e-cigarette use.
| 15.0 | 14.9 | 0.654 | 15.0 | 15.0 | 0.886 | |
| Male | 62.6% | 37.4% | 0.291 | 68.2% | 31.8% | |
| Female | 56.4% | 43.6% | 51.3% | 48.7% | ||
| Heterosexual/straight | 61.1% | 38.9% | 0.669 | 63.5% | 36.5% | 0.829 |
| Non-heterosexual/non-straight | 68.0% | 32.0% | 60.0% | 40.0% | ||
| African American/Black | 62.3% | 37.7% | 0.574 | 68.6% | 31.4% | |
| Hispanic/Latino | 58.7% | 41.3% | 52.9% | 44.2% | ||
| English | 63.9% | 36.1% | 66.9% | 33.1% | ||
| Spanish | 45.2% | 54.8% | 40.3% | 59.7% | ||
| 6th−9th | 56.6% | 43.4% | 0.295 | 62.3% | 37.7% | 1.000 |
| 10th−12th | 62.7% | 37.3% | 61.7% | 38.3% | ||
| At least one parent/caregiver currently smokes tobacco-related products | 60.0% | 40.0% | 1.0 | 56.0% | 44.0% | 0.348 |
| At least one parent/caregiver currently uses e-cigarettes | 72.7% | 27.3% | 0.138 | 72.7% | 27.3% | 0.192 |
| No parent/caregiver currently smokes tobacco-related products or e-cigarettes | 59.4% | 40.6% | 0.595 | 62.6% | 37.4% | 0.689 |
Bold indicates statistical significance.
Differences persisted after adjusting for significant associations with being asked and/or advised about e-cigarette use (i.e., gender, race/ethnicity, and language of preference), with Spanish-speaking adolescents self-reported as being significantly less likely to be asked (AOR = 0.43, 95% CI: 0.22–0.81) and advised (AOR = 0.39, 95% CI: 0.20–0.75) about e-cigarette use in comparison to English-speaking adolescents. Similarly, female participants remained significantly less likely to be advised about e-cigarette use by a health professional when compared to male participants (AOR = 0.52, 95% CI: 0.32–0.85). Finally, Hispanic/Latino adolescents were significantly less likely to be advised relative to African American/Black adolescents (OR = 0.58, 95% CI: 0.37–0.91;
Impact of sociodemographic factors on adolescents' self-reported rates of being asked or advised by a health professional about e-cigarette use.
| Male | Reference | Reference | Reference | Reference |
| Female | 0.77 (0.49–1.23) | 0.85 (0.53–1.37) | ||
| African American/Black | Reference | Reference | Reference | Reference |
| Hispanic/Latino | 0.86 (0.55–1.34) | 1.23 (0.73–2.08) | 0.82 (0.48–1.40) | |
| English | Reference | Reference | Reference | Reference |
| Spanish | ||||
OR, odds ratio; 95% CI, 95% confidence interval; AOR, adjusted odd ratio. “a” indicates that Model 2 controls for the variables gender, race/ethnicity, and language of preference. *p < 0.05. ** p < 0.01. Bold indicates statistical significance.
To the best of our knowledge, this is the first study to assess (1) whether African American/Black and Hispanic/Latino adolescents are being asked whether they use e-cigarettes and/or advised not to use them and (2) the unique associations of being asked and/or advised about vaping with sociodemographic characteristics. In this study, only half of the adolescents who reported having seen a health professional within the previous year self-reported being both asked and advised about e-cigarette use. Furthermore, one-quarter of the participants were neither asked nor advised regarding e-cigarette use. Primarily Spanish-speaking adolescents self-reported significantly lower rates of being asked and advised about e-cigarette use during healthcare visits when compared to English-speaking adolescents. This difference persisted even after controlling for significant associations with being asked and/or advised about e-cigarette use. Additionally, Hispanic/Latino and female participants self-reported lower rates of being advised about e-cigarette use in comparison to African American/Black and male participants, respectively.
There are many possible factors contributing to this low rate of addressing e-cigarette use at healthcare visits. Electronic health record tools have the potential to assist with reminding health professionals to address smoking and vaping among adolescents. However, the use of these tools remains low, with a 2019 study finding that, on review of 518 adolescent well visits, none documented assessment of e-cigarette use (
Our study showed that female participants did not significantly differ from male participants in the likelihood of being asked about e-cigarette use. However, female participants were significantly less likely to be advised against e-cigarette use when compared to male participants. One possible reason for this observed difference is that health professionals may perceive that vaping is higher among male adolescents compared to their female counterparts. However, according to the 2022 U.S. National Youth Tobacco Survey, the prevalence of current vaping is higher among female adolescents compared to male adolescents (10.5 vs. 8.3%, respectively) (
Spanish-speaking adolescents in this study were significantly less likely to be asked or advised about e-cigarette use in comparison to English-speaking adolescents. Language barriers and poor access to or quality of translation services have previously been identified as significant factors contributing to reduced smoking cessation support provided to Spanish-speaking Latino patients (
There are several limitations to this study. First, data are self-reported, and there is a possibility that participants felt compelled to offer socially desirable responses or did not remember whether they were asked and/or advised about vaping. Second, the study did not assess who asked and/or advised the adolescent about vaping (e.g., the doctor, dentist, nurse, and/or other health professional). This information could guide future-targeted interventions to increase the AAR model. Third, given that this study focused on adolescents who have not vaped, we did not assess whether participants were referred—the third pillar of the AAR model—to vaping cessation resources. Fourth, the exclusion of adolescents who did not self-identify as African American/Black and/or Hispanic/Latino (e.g., non-Hispanic/Latino white adolescents) prevented the study from shining light on other potential racial and ethnic disparities. Lastly, this is a non-probability sample of African American/Black and Hispanic/Latino adolescents which limits generalizability to the broader population of Black and Latino adolescents.
In this study, compared to English-speaking participants, Spanish-speaking participants were significantly less likely to self-report being asked about e-cigarette use and advised not to use them. Moreover, Hispanic/Latino and female adolescents were significantly less likely to self-report being advised not to use e-cigarettes compared to their Black/African American and male counterparts. Future research is needed to improve health professionals' attention to asking about and advising against vaping among adolescents.
The datasets generated for this study are available on request to the corresponding author.
The studies involving human participants were reviewed and approved by University of Rochester Medical Center. Written informed consent for participation was not provided by the participants' legal guardians/next of kin because: Parents'/guardians' permission and adolescents' assent were obtained from all subjects involved in the study.
MC, DC, SM, DO, AC, and FC-B: conceptualization. PR-P and XC: formal analysis. RO: project administration. MC, DC, and FC-B: writing—original draft preparation. PR-P, XC, BH, RO, MR, KW, DL, SM, DO, and AC: writing, reviewing, and editing. All authors have read and agreed to the published version of the manuscript.
Research reported in this publication was funded by the National Cancer Institute of the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) Center for Tobacco Products under Award Number U54CA228110. MC was supported by Award Number T32 HL066988 Multidisciplinary Training in Pulmonary Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.
The authors are grateful to the individuals who participated in this study. Moreover, the authors are grateful to the organizations that opened their doors to implement this study.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.