Physician Leadership and Burnout: The Need for Agency; a Qualitative Study of an Academic Institution.

Purpose: Organizational approaches to physician burnout are limited. Training physician leaders to influence the organizational environment is a growing area of study. This study explored perceived physician leadership behaviors in response to burnout from the viewpoint of faculty physicians not in formal leadership positions. Understanding physician leadership behaviors from the viewpoint of those faculty being led can inform organizational strategy and leadership training to address physician burnout. Subjects and Methods: Interview requests were sent to 70 randomly identified faculty physicians from a roster containing all 1145 physician faculty that excluded the Pediatric Department, at an academic health care institution in Southern California. The first ten respondents were asked to participate in a 30-to-40-minute semi-structured virtual interview via Zoom. The interviewees were asked two questions pertaining to burnout and their perception of how leadership responded. The two questions were "What has leadership done to address burnout?" and "If you had five minutes to advise your leaders on burnout, what would you say?" The recorded interviews were transcribed, redacted, and then sent to two reviewers. Thematic analysis through iterative coding was completed, and categories were constructed that aligned with the two interview questions. Results: Overall, five themes were identified. These themes were organized according to the interview questions and broadly categorized as physician leadership behaviors observed that corresponded to the interview question of what leadership had done to address burnout and physician leadership behaviors desired corresponding to the second interview question of what advice should be given. Leadership behaviors observed in the context of burnout included three themes; referral to individual wellness programs, increased number of meetings and events, and a lack of agency in addressing wellness issues. The two themes of leadership behaviors desired were the obtainment of more resources and the granting of greater appreciation and recognition for work done through enhanced communication. Conclusion: This small study of faculty physician perceptions of leadership behaviors identified several themes that had been identified in previous studies of leadership and burnout; need for relationship building through communication, need for resources to address work issues, and referral to wellness programs. However, the identification of a lack of agency in addressing factors in the wellness environment has not been identified in the previous burnout and physician leadership literature. Further study into the causes of this perceived lack of agency should be explored. Understanding the root causes of physician leaders' lack of agency can further inform physician leadership education as an organizational approach to burnout.

Young adult perspectives on their respiratory health symptoms since vaping.

Background: Vaping among young adults (YA) has been associated with adverse respiratory health outcomes. However, key gaps remain in the literature including perspectives from YA vapers on perceived respiratory health symptoms since vaping, how they describe those symptoms and related experiences, and factors to which they attribute their respiratory health symptoms. Methods: Participants (N = 35) were 18-25 years old and self-reported as currently vaping at least once per week. In-depth, semi-structured qualitative interviews were conducted using an open-ended interview guide designed to elicit respondents' subjective vaping-related experiences. We used a thematic analysis to interpret the transcripts. Results: Participants reported adverse respiratory health symptoms (e.g., phlegm, cough, pain in lungs) that some attributed to vaping. Participants compared what is known about vaping to what is known about combustible cigarettes and described continued use of vaping products despite perceived adverse respiratory health consequences. Some participants attributed their symptoms to preexisting medical conditions (e.g., asthma) and to heavy vaping. Some described a decline in exercise-related endurance since vaping. Some participants also reported that they experienced worse respiratory symptoms when using specific brands and products (e.g., JUUL and nicotine salt formulation). Conclusions: This study provides powerful accounts from YA vapers about their experience of respiratory health symptoms that they ascribe to vaping. Future research is needed to evaluate the prevalence and severity, as well as the risk and protective factors, of adverse respiratory health symptoms associated with vaping. Addiction prevention and treatment efforts for YA vapers may help curtail adverse respiratory health impact from vaping.

Accessing Vaping Products When Underage: A Qualitative Study of Young Adults in Southern California.

INTRODUCTION: California implemented multiple strategies, such as a Tobacco 21 law and compliance checks, to reduce high rates of youth e-cigarette use. However, the prevalence of use among underage youth and young adults continues rising. Little is known about how underage individuals obtain e-cigarettes. AIMS AND METHODS: We conducted structured qualitative interviews with 61 young adult (18-25 years old) vapers in the Los Angeles, CA area between June 2018 and June 2019. Interviews were comprehensive and designed to elicit information on participants' thoughts, feelings, and experiences related to vaping. We queried participants on where and how they obtained vaping products, and participants discussed their experiences accessing products while under the legal age for sale. Directed content analysis was used to analyze interviews. RESULTS: Four concepts emerged: (1) early experimentation of e-cigarettes with peers often occurred in a school setting, (2) continued use of e-cigarettes commonly obtained through peer sales, (3) inconsistent implementation of age restrictions at in-person retailers, and (4) at online retailers. Participants had peers purchase products on their behalf and frequented in-person and online retailers with few to no age verification processes. Few participants faced challenges when purchasing products from retailers. CONCLUSIONS: The current study's findings offer insight into where and how underage individuals obtain vaping products despite restrictions to prevent them from doing so. Participant accounts of mixed ease of underage purchasing in-person and online suggest retailer education is needed, along with additional research to inform more effective policies to reduce underage access to vaping products. IMPLICATIONS: Despite legal age restrictions, e-cigarettes remain accessible to underage individuals, but specific strategies that underage youth utilize to evade legal age restrictions are largely unknown. We found that participants often accessed vaping products for the first time at school. Sales between peers were common, and participants also reported frequenting in-person retailers that inconsistently enforced age restrictions. Many participants reported little to no age verification online, though some believed online age verification measures were increasingly difficult to surpass. Knowledge of strategies underage youth utilize to access e-cigarettes can inform enforcement efforts.