Vaping: Impact of Improving Screening Questioning in Adolescent Population: A Quality Improvement Initiative

The use of Electronic Nicotine Delivery Systems (ENDS) increased dramatically over the past decade, making them the most common tobacco product used among youth. While physicians often screen for the use of tobacco, very few screen for vaping product usage. This quality improvement project aimed to increase the screening rate of ENDS use among adolescents to 85% to match the Healthy People 2020 screening target of 83.3% for smoking.

We collected data from weekly chart reviews of all adolescent visits with a primary care provider by using keywords such as "vapor," "e-cigs," and "vaping" to document screening for ENDS use. The project consisted of 4 PDSA cycles: (1) education of the Adolescent Clinic staff about screening; (2) the addition of the specific question for e-cigarette use in the facility's Electronic Health Record; (3) house staff lecture about the importance of screening; and (4) reinforcement about screening to adolescent physicians.

The percentage of screening for traditional tobacco use was consistently higher than ENDS use in all months. ENDS use assessment increased since the first intervention, going from 0% at baseline to 90% at the end. The addition of a specific question for ENDS use in EPIC was the most significant intervention and increased the screening percentage to 78%.

To adequately assess for the use of ENDS, the nonspecific question, "do you smoke?" is not sufficient. A direct approach is necessary. A specific question in the EHR is the most significant way to increase screening for ENDS use.