Assessing adolescent tobacco use in a substance use treatment program with self-report and biological measures.

Tobacco use in adolescents can alter their lifetime health outcomes. Despite the importance of early identification and treatment, adolescent tobacco use, including that of electronic vapor products (e.g., e-cigarettes), is often missed. In a state-funded substance use treatment program, we added biological measures, including urinary cotinine and exhaled carbon monoxide to self-report measures to assess recent and lifetime tobacco use. We conducted a retrospective review of the de-identified charts to examine the feasibility of screening for self-report and biological measures of tobacco use. Self-report, urinary cotinine, and exhaled carbon monoxide samples were obtained at every visit, including intake and follow-up. There were 52 adolescents with a total of 400 clinic visits to the program. Of those 400 visits, 258 included self-reported tobacco use and 142 included a denial of using any form of tobacco. However, of those 142 visits with a negative self-report of tobacco, 31 tested positive for cotinine and 6 had positive exhaled carbon monoxide. Although 111 of the 142 had negative cotinine, 5 had positive carbon monoxide, but all of those self-reported recent cannabis use. Despite using a sensitive measure of self-report of tobacco use, almost 22% of visits had a discordant self-report with a biological measure that indicated tobacco use. Considering the lifelong impact of adolescent tobacco use, clinicians should consider augmenting self-report with biological measures of tobacco use. Identification of tobacco use in adolescents with substance use can assist clinicians in providing education about tobacco use, such as electronic vapor products, and individualizing treatments.

E-cigarette Use and Beliefs Among Urban Public High School Students in North Carolina.

PURPOSE: The aim of this study was to examine the prevalence, attitudes, and risk factors associated with electronic cigarette (e-cigarette) use among high school students in tobacco growing state. METHODS: A 47-item e-cigarette questionnaire modeled after Monitoring the Future with additional information about demographics, adolescent and family nicotine use, and school and health care interventions was designed, piloted, and administered to public high school students (N = 3,298) in May 2013, in an urban county in North Carolina. RESULTS: Completers (2,769/3,298) were aged 16.4 years (standard deviation ± 1.4) with 48.9% males and 43.9% African-American, 38% white, and 4.6% Hispanics. The majority (77.3%) knew about e-cigarettes; 15.2% reported that they had tried an e-cigarette, and 60% reported that e-cigarettes were safe or had minimal health hazards. Only 5.4% reported that schools had offered information about e-cigarette use. One quarter (24.9%) reported ever cigarette smoking, and 13.3% reported ever using smokeless tobacco. E-cigarette use was positively associated with older age, tobacco use, male gender, Caucasian race, mother's e-cigarette use, biological parents' tobacco use, and lower academic performance, whereas negatively associated with having a mother who never used e-cigarettes, not knowing any e-cigarette users, and living with mother (p < .05). CONCLUSIONS: E-cigarette use and awareness is evident among high school students in North Carolina. A high number of smokers and smokeless tobacco users are using e-cigarettes simultaneously, and many perceive e-cigarettes as healthy and with minimal health hazards. Also, there is limited school-based education about e-cigarettes.