Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Supporting Young Adults Who Use E-Cigarettes


When talking with young patients about tobacco dependence, first create a judgment-free zone and ask open-ended questions to understand why they use the product. 

The notion of “quitting” should be eliminated from clinical practice. We don’t tell patients to “quit” having diabetes, or “quit” having hypertension. Instead, we discuss with our patients how we will manage them. We emphasize how to gain control over these diseases and maximize health. 


The same is true for the management of tobacco dependence, especially in the time of the youth usage epidemic of electronic cigarettes. Being told to “quit” without a true understanding of why the patient uses the product, what motivates them to use it, and why they’re struggling to stop, will keep them from truly having their tobacco dependence disease managed effectively. 


Here are a few things to keep in mind when supporting patients who use e-cigarettes: 


1. Create a judgment-free zone. Be aware of any biases you may have.


 2. Understand why they use the product.

The anxiolytic effects of nicotine should not be underestimated. Many vape to ease anxiety and stress. Others may use e-cigarettes due to peer pressure and peer usage. Ask open-ended questions to try to understand why your patient is using them. This may help you recommend therapies, like counseling and mindfulness classes, for managing stress and anxiety with e-cigarettes. 


3. Discuss pharmacotherapy.

Note that none of the current medications approved by the FDA for tobacco dependence management will “slap” the electronic cigarette out of the user’s hands. Thus, pharmacotherapy should be used to supplement the counseling and mindfulness. The medications simply help make it easier to stop and transition to being a non-vaper. 


4. Ask about support networks.

Most of the reinforcement to stop vaping will come from outside of the clinical space. Work with patients to help identify people in their lives that can help them become vape-free. 


Stopping vaping is the start of the process. The goal is to become a non-vaper. With the above recommendations, we can help prevent youth who currently vape from becoming patients with debilitating diseases in the future. 






This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.