Response to: More Detail Needed for Pilot E-Cigarette Treatment Trial in Youth and Young Adults.
Response to: More Detail Needed for Pilot E-Cigarette Treatment Trial in Youth and Young Adults.
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回应：青少年和年轻人电子烟治疗试点试验需要更多细节。
DOI：
10.1093/ntr/ntab103
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Fiks,AlexanderG
中科院分区：
文献类型：
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作者：
Jenssen,BrianP;Hannan,Chloe;Kelly,MaryKate;Ylioja,Thomas;Schnoll,RobertA;Fiks,AlexanderG
作者感谢沃克博士要求我们的研究“无法在大型儿科卫生系统内招募青少年进行电子烟戒烟试验”的更多信息。由于我们的研究年龄范围在 14 岁至 21 岁之间，Walker 博士关于青少年和青年人这一感兴趣人群的观点是正确的。我们的研究主要集中在通过我们基于实践的研究网络招募 14-18 岁的青少年。然而，在通过临床实践难以识别青少年电子烟使用者后，我们将研究资格标准扩大到 21 岁，并与当地大学校园合作，希望能增加招募人数。对于通过临床实践筛查电子烟和香烟使用情况的青少年，我们可以提供额外的数据，但由于这些数据是由临床医生在现实世界的临床环境中收集的，因此并不完善。我们拥有有关烟草或电子烟使用的初步广泛筛查问题的完整数据：“在过去的一年中，您是否使用过烟草产品，例如香烟、电子烟（电子烟设备，如罐装、mods 或 Juul）或小雪茄？”然而，对于询问所使用的特定产品和使用频率的后续问题，这些数据并不完整。为此，在使用筛查呈阳性的青少年（12-18 岁）中，824/1603 人报告了过去一年使用过电子烟，而 217/1603 人报告了过去一年使用过香烟。对于其余青少年，我们缺乏有关使用香烟和/或电子烟的比例的具体数据。为了进一步按年龄组以及当前与日常电子烟使用情况对这些数据进行分层，我们发现 12-14 岁的用户分别为 26/37（当前）和 11/37（日常）； 153/304（当前）和 151/304（日常）适合 15-17 岁的孩子； 106/196（当前）和 90/196（每日）适用于 18 岁及以上的人。对于吸烟者来说，7/11（当前）和4/11（每天）是12-14岁吸烟者； 15-17 岁的学生为 29/86（当前）和 57/86（每日）； 18 岁及以上的用户为 27/70（当前）和 43/70（每日）。我们没有专门收集有关特定电子烟装置是否含有尼古丁的数据，主要原因有两个。在美国，绝大多数青少年使用的电子烟产品都含有尼古丁，绝大多数青少年电子烟使用者吸食的是含有尼古丁的产品。 1 此外，由于这些信息是在现实世界的临床环境中收集的，因此我们的目标是筛查一般卷烟和电子烟的使用情况，但不会询问含尼古丁的产品，从而使临床医生负担过重。在回答对“只有 2.4% 的青少年报告使用过电子烟或烟草的情况——与基于学校的国家估计值形成鲜明对比”这一声明的讨论的询问时，我们认为这一发现更有可能是由于社会期望偏见或青少年中的保密问题，而不是戏剧性的保密问题我们的诊所人口与学校人口之间的人口统计差异。正如本文所述，以学校为基础的全国估计值 2 远高于我们报告的以初级保健为基础的人群的估计值（19.6% 与 2.4%）。在我们基于临床的筛查中，与青少年有持续专业关系的临床医生面对面询问青少年潜在的电子烟使用情况。这种方法可能会影响披露率，因为青少年可能不想承认电子烟的使用，因为担心让他们的儿科医生失望和/或担心儿科医生可能会向父母透露他们的使用情况。对美国青少年进行的基于学校的电子烟使用调查是匿名的，这可能会增加对健康风险行为的披露……
The authors thank Dr Walker for the request for more information from our study,“Inability to Recruit Adolescents for a Vaping Cessation Trial Within a Large Pediatric Health System.” Dr Walker makes a valid point about the population of interest being youth and young adults due to our study age range being between 14 and 21 years. Our study was primarily focused on recruitment of adolescents aged 14–18 years through our practice-based research network. However, after having difficulty identifying adolescent e-cigarette users through clinical practice, we expanded our study eligibility criteria up to 21 years of age and engaged with our local university campus in the hope of boosting recruitment. For youth screened for e-cigarette and cigarette use through clinical practice, we can provide additional data, but because the data were collected in real-world clinical settings by clinicians, it is imperfect. We have complete data for the initial broad screening question about tobacco or e-cigarette use:“In the past year, have you used a tobacco product, like cigarettes, e-cigarettes (vaping devices such as tanks, mods, or Juul), or cigarillos (little cigars)?” The data, however, are incomplete for subsequent questions that ask about specific products used and frequency of use. To that end, of youth (age 12–18) who screened positive for use, 824/1603 reported past year e-cigarette use, while 217/1603 reported past year cigarette use. For the remaining adolescents, we lack specific data on the proportion who use cigarettes and/or e-cigarettes. To further stratify these data by age group and current versus daily e-cigarette usage, we found 26/37 (current) and 11/37 (daily) users for 12–14-year-olds; 153/304 (current) and 151/304 (daily) for 15–17-year-olds; and 106/196 (current) and 90/196 (daily) for those 18 and older. For cigarette smokers, 7/11 (current) and 4/11 (daily) were users among 12–14-year-olds; 29/86 (current) and 57/86 (daily) for 15–17-year-olds; and 27/70 (current) and 43/70 (daily) for those 18 and older. We did not specifically collect data on whether or not the particular e-cigarette device contained nicotine for two main reasons. In the United States, the vast majority of e-cigarette products used by youth contain nicotine, and the vast majority of youth e-cigarette users vape nicotine-containing products. 1 Further, as this information was collected in real-world clinical settings, our goal was to screen for general cigarette and e-cigarette use but not overburden the clinicians by asking about nicotine-containing products.In response to the query on providing discussion to the statement “Only 2.4% of adolescents reported any e-cigarette or tobacco use—a stark contrast with the rates from school-based national estimates,” we believe this finding was more likely due to social desirability bias or confidentiality concerns among the adolescents than dramatic differences in demographics between our clinic population compared with school-based populations. As noted in the paper, the school-based national estimates 2 are much higher than what we reported in our primary care-based population (19.6% vs. 2.4%). In our clinical-based screening, adolescents were asked about potential e-cigarette use face-to-face by clinicians with whom they have an ongoing professional relationship. This approach likely affects disclosure rates, as youth may not want to admit e-cigarette use out of fear for disappointing their pediatrician and/or concern that the pediatrician may disclose their use to their parents. School-based surveys of e-cigarette use administered to adolescents in the United States are anonymous, which likely increases disclosure of health risk behaviors …