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E-cigarette usage has grown significantly in recent years, with over 5 million US middle and high school students reporting recent usage. The long-term health consequences of these devices are still being investigated, but it is known that e-cigarette aerosol could contain harmful substances including nicotine, heavy metals, and carcinogens. Therefore, it is important for physicians to ask patients about e-cigarette usage specifically, as this may contribute to future health problems. The goal of this study was to investigate if and how medical students screen for e-cigarette usage. Screening language was reviewed in standardized patient encounters, which are a type of assessment that medical students undergo in order to observe how they interact with simulated patients. Video-taped patient encounters were coded to examine the specific phrasing of questions related to tobacco usage, including initial and follow-up questions. The majority of students (97%) did not ask about e-cigarettes specifically. Most students (66%) simply asked, “Do you smoke?” Overall, the evidence shows that e-cigarette and vaping device usage is not being addressed specifically in these interactions. These results demonstrate a need for updated patient screening in regards to tobacco use. Because the majority of e-cigarette users report not knowing that the product contains nicotine, physicians must be made aware of their unknown effects on patient outcomes and the need to screen specifically about e-cigarette usage separately from smoking. Continuing medical education may also help address this gap since many cohorts of practicing physicians were training before the popularity of these types of devices.

Publication Date

Spring 2020


e-cigarette; tobacco; medical students; smoking; MERA


Medical Education

Screening for E-cigarette and Tobacco Use in Standardized Patient Encounters