E-Cigarette Counselling by Physicians and Dentists: Results from a National Survey

Special Article – Tobacco and Smoking Cessation

J Fam Med. 2016; 3(10): 1091.

E-Cigarette Counselling by Physicians and Dentists: Results from a National Survey

Drouin O¹, McMillen RC2,3, Klein JD³ and Winickoff JP1,3*

¹Department of Pediatrics, Harvard Medical School, Harvard University, USA

²Social Science Research Center, Mississippi State University, USA

³Julius B Richmond Center of Excellence, American Academy of Pediatrics, USA

*Corresponding author: Winickoff JP, Department of Pediatrics, Harvard University, 125 Nashua Street, Suite #860, Boston (MA) 02114, USA

Received: September 28, 2016; Accepted: October 19, 2016; Published: October 21, 2016


Introduction: Use of e-cigarettes has increased rapidly in recent years, yet little is known about how physicians and dentists counsel their patients about these devices. This paper presents results from the first national survey to report and characterize that counselling.

Methods: Respondents were recruited from a nationally representative dual-frame sample in 2014. Adults who had ever used e-cigarettes were asked if their doctor, dentist or child's doctor had discussed e-cigarettes in the past 12 months.

Results: Among the 3,030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those, 355 respondents (67.8%) had seen their doctor in the past year with 26 (7.3%) reporting the physician discussed the potential harm of e-cigarettes, and 20 (5.8%) reporting having discussed their potential benefits. Of 120 e-cigarettes ever users who had seen their child’s doctor, 12 (10.0%) reported being counselled about the harms of e-cigarettes, and 11 (9.3%) reported being counselled about their potential benefits. Of 349 respondents who had seen their dentist in the past year, 6 (1.7%) reported that their dentist had discussed the harms of e-cigarettes and 13 (3.7%), reported being counselled about potential benefits. Rates were comparable when analysis was limited to current e-cigarette users or those who reported using both e-cigarettes and combusted tobacco.

Conclusions: Few physicians or dentists are discussing either the harms or benefits of e-cigarettes. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.

Keywords: E-cigarettes; Electronic cigarettes; Counselling; Primary care


E-cigarette use is increasing, and there are unknown and contested risks and potential benefits to these products [1,2]. Some researchers have suggested that these products have potential to help with smoking cessation even though the emerging scientific research on this issue suggests otherwise [3].

If randomized clinical trials with long-term follow-up ultimately demonstrate health benefits to smokers who switch from combustible tobacco products to e-cigarettes, potential risks remain. E-cigarettes appeal to children who would not otherwise have started using cigarettes, and might appeal to former smokers [4]. There are also concerns that e-cigarette users may be at an increased risk for initiating or transitioning to cigarette smoking [5]. Finally, increased use of these products could re-normalize smoking in society [1].

While data are still accumulating, the medical and public health community have tried to provide clinicians with information to guide counselling, but recommendations have been varied and not always consistent [6-8].

The public often relies on physicians to provide health information that can be trusted about a variety of health topics [9]. Even when scientific uncertainty exists, ethicists have argued that sharing this uncertainty is autonomy promoting, and patients still express desire to receive information and guidance from clinicians [10]. Consequently, it is important for physicians to communicate accurate and reliable health information to patients to help them make informed decisions and mitigate potentially negative health behaviors, even when the full extent of risks and benefits are not definitively understood.

As a recent phenomenon, it is unknown what type of counselling about e-cigarettes, if any, physicians and dentists provide to their patients. This national survey is the first to report counselling provided by clinicians for e-cigarette use. In this paper, we explore whether clinicians were more likely to discuss either the harms or the benefits of these products, and whether any difference in counselling rates could be observed between different categories of clinicians.

Materials and Methods

The sample for this study was drawn from cross-sectional dualframe surveys representing national probability samples of adults, administered in 2014. This approach has previously been published and showed reliability and national representativeness [11]. The design included a landline phone Random Digit Dialing (RDD) frame and an internet panel frame developed from a probability sample of U.S. adults. The internet panel frame was used in order to reduce non-coverage issues arising from wireless substitution [11].

Surveys were administered to both frames from October to December in 2014. Data were weighted to adjust for age, race, gender, and region, as well as frame overlap among internet panel respondents who also had a landline telephone, and were therefore also eligible for the RDD frame.

The results presented here are part of a larger national survey on tobacco product use and other factors conducted by the American Academy of Pediatrics Julius B. Richmond Center of Excellence with funding from the Flight Attendant Medical Research Institute and the Truth Initiative. Details about the survey and results from its other components have previously been published [11,12]. As part of the survey, respondents were asked: “Have you ever used an e-cigarette, even one or two times?” The subset of participants who had ever tried e-cigarettes, thereafter referred to as “ever users” represents the sample for this study.

Participants were then asked: “How often do you now vape or use e-cigarettes? Every day, some days, or not at all”. Respondents who reported using these products every day or some days were considered to be current e-cigarette users (the other ones being considered trial users). The participants were asked the following questions: “In the past 12 months, has your doctor (or dentist, or child’s doctor) discussed the potential benefits (or harms) of e-cigarettes with you?” The survey also asked participants: “In the past 12 months, has your doctor (or child’s doctor) discussed the potential harms of e-cigarettes inside of your home (or around children)?”

Outcomes of interest included reporting having been counselled about the benefits or the harms of e-cigarettes. Covariates that were analyzed included basic demographics, status as e-cigarette trial user versus current user, concurrent use of regular tobacco product and e-cigarettes (hereafter referred to as “dual use”), and having seen one’s own doctor, child’s doctor or a dentist in the previous 12 months. All covariates were obtained by self-report.

Statistical Methods

Chi-square analyses were performed to compare responses between risks and benefits for each type of clinician as well as to look at difference between clinician type for each benefit and harm. Subgroup analyses (for current e-cigarette users and dual users) were performed. Adjusted logistic regression model were not informative given the low prevalence of the outcomes of interest.


3,030 adults completed the survey. In the RDD frame, of 1,739 eligible respondents contacted, 1,511 completed surveys (completion rate, 86.9%). For the internet panel frame, 2,699 panelists were randomly drawn from the probability panel; 1,518 responded to the invitation, yielding a final stage completion rate of 56.0%.

Among the overall sample, 523 (17.2%) had ever used e-cigarettes in the past. Current use of e-cigarettes was reported by 217 adults (41.5% of ever users and 7.2% of the overall sample). Interestingly, among the 2537 participants who had never tried e-cigarettes, 373 (14.7%) responded that they were thinking of trying e-cigarettes within the next 12 months. Ever use of e-cigarettes (21.4% vs 13.4%) as well as current use (8.8% vs 5.7%) was higher in the RDD panel. Participants who had ever used e-cigarettes were more likely to be male, younger, and have lower educational achievement than participants who had never tried e-cigarettes (Data not shown).

Among ever users, 92.1% had seen a physician in the previous 12 months, 66.7% had seen a dentist, and 73.9% of adults with children had seen their child’s doctor. Weighted sample characteristics are presented in Table 1.

Citation:Drouin O, McMillen RC, Klein JD and Winickoff JP. E-Cigarette Counselling by Physicians and Dentists: Results from a National Survey. J Fam Med. 2016; 3(10): 1091. ISSN: 2380-0658