Cati G Brown-Johnson1, Andrea Burbank2, Eric J Daza1, Arianna Wassmann3, Amy Chieng4, Geoffrey W Rutledge5, Judith J Prochaska6. 1. Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California. 2. Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California; Center for Tobacco Control Research and Education, University of California, San Francisco, California. 3. Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California; Product Development Regulatory, Genentech, South San Francisco, California. 4. Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California; Department of Psychology, University of California, Berkeley, California. 5. HealthTap, Palo Alto, California. 6. Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California. Electronic address: jpro@stanford.edu.
Abstract
INTRODUCTION: E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. METHODS: An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. RESULTS: An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. CONCLUSIONS: Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches.
INTRODUCTION: E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. METHODS: An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. RESULTS: An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. CONCLUSIONS: Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches.
Authors: Aruni Bhatnagar; Laurie P Whitsel; Kurt M Ribisl; Chris Bullen; Frank Chaloupka; Mariann R Piano; Rose Marie Robertson; Timothy McAuley; David Goff; Neal Benowitz Journal: Circulation Date: 2014-08-24 Impact factor: 29.690
Authors: Ralph S Caraballo; Ahmed Jamal; Kimberly H Nguyen; Nicole M Kuiper; René A Arrazola Journal: Am J Prev Med Date: 2015-12-10 Impact factor: 5.043
Authors: Thomas H Brandon; Maciej L Goniewicz; Nasser H Hanna; Dorothy K Hatsukami; Roy S Herbst; Jennifer A Hobin; Jamie S Ostroff; Peter G Shields; Benjamin A Toll; Courtney A Tyne; Kasisomayajula Viswanath; Graham W Warren Journal: J Clin Oncol Date: 2015-01-08 Impact factor: 44.544
Authors: Tushar Singh; René A Arrazola; Catherine G Corey; Corinne G Husten; Linda J Neff; David M Homa; Brian A King Journal: MMWR Morb Mortal Wkly Rep Date: 2016-04-15 Impact factor: 17.586
Authors: Shu-Hong Zhu; Jessica Y Sun; Erika Bonnevie; Sharon E Cummins; Anthony Gamst; Lu Yin; Madeleine Lee Journal: Tob Control Date: 2014-07 Impact factor: 7.552
Authors: Kelly C Young-Wolff; Daniella Klebaner; Bruce Folck; Andy S L Tan; Renee Fogelberg; Varada Sarovar; Judith J Prochaska Journal: Prev Med Date: 2018-01-31 Impact factor: 4.018
Authors: Kelly C Young-Wolff; Daniella Klebaner; Bruce Folck; Lisa Carter-Harris; Ramzi G Salloum; Judith J Prochaska; Renee Fogelberg; Andy S L Tan Journal: Prev Med Date: 2017-08-16 Impact factor: 4.018
Authors: Shannon Gravely; James F Thrasher; K Michael Cummings; Janine Ouimet; Ann McNeill; Gang Meng; Eric N Lindblom; Ruth Loewen; Richard J O'Connor; Mary E Thompson; Sara C Hitchman; David Hammond; Bryan W Heckman; Ron Borland; Hua-Hie Yong; Tara Elton-Marshall; Maansi Bansal-Travers; Coral Gartner; Geoffrey T Fong Journal: Addiction Date: 2019-03-07 Impact factor: 6.526
Authors: Katia Gallegos-Carrillo; Inti Barrientos-Gutiérrez; Edna Arillo-Santillán; Luis Zavala-Arciniega; Yoo Jin Cho; James F Thrasher Journal: Int J Environ Res Public Health Date: 2020-01-09 Impact factor: 3.390