Abstract

Tobacco use begins in adolescence for the majority of smokers. The purpose of this study was to increase screening and reporting of tobacco use in hospitalized adolescents at a tertiary care children’s hospital. We completed a nursing focus group to understand challenges and completed four iterative Plan-Do-Study-Act cycles, which included: (1) in-person nursing education regarding tobacco use screening, (2) addition of an e-cigarette-specific screening question, (3) the creation and dissemination of an educational video for nursing, and (4) adding the video as a mandatory component of nursing orientation. Run charts of the percentage of patients screened who reported tobacco use were created. Absolute counts of tobacco products used were also captured. From January 2016 to September 2018, 12,999 patients ≥13 years of age were admitted to the hospital. At baseline, 90.1% of patients were screened and 4.8% reported tobacco use. While the absolute number of adolescents reporting e-cigarette use increased from zero patients per month at baseline to five, the percentage of patients screened and reporting tobacco use was unchanged; the majority of e-cigarette users reported use of other tobacco products. This study demonstrates that adding e-cigarettes to screening increases reporting and suggests systems level changes are needed to improve tobacco use reporting.

Highlights

  • Tobacco use and tobacco smoke exposure is the leading cause of preventable death and is associated with a multibillion dollar economic burden in the United States [1]

  • Children’s of Alabama (COA) had begun screening adolescents (≥13 years of age) by adding tobacco use screening questions to the admission Nursing Intake Form, which is required to be completed by nursing within 24 hours of admission

  • In January 2017, workgroups with nursing leaders discussed optimization of adolescent tobacco use screening throughout the hospital

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Summary

Introduction

Tobacco use and tobacco smoke exposure is the leading cause of preventable death and is associated with a multibillion dollar economic burden in the United States [1]. Over 90% of adult smokers begin using tobacco by age 19 years [1]. Over 24% of high schoolers report current use of tobacco products and almost 21% report current use of electronic cigarettes [2]. 2018, tobacco use dramatically increased in high schoolers by 38% for any type of tobacco and by. In Alabama, rates of youth and adult tobacco product use are higher than national averages. In 2015, 35.5% of Alabama high schoolers reported any type of tobacco use in the last 30 days compared to 31.4% nationally [4,5]

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