Background
Patient Information
14 y/o Hispanic female attending IOP for alcohol use disorder
HPI:
- Moderate alcohol use disorder with binge drinking pattern, and depression
- Past history of suicidal ideation
- Admitted to hospital previously for severe concussion incurred during severe alcohol intoxication
PMH:
- Depression with SI-followed by psychiatrist and pediatrician
ROS (pertinent positives):
- Patient reports tobacco use as whatever is available at the time
- Parents report grades and mood change and social withdrawal
- Parents unaware of tobacco use, aware of alcohol drinking
Other Info:
- Heterosexual; pronouns: she/her
Ask
Screen for Tobacco Use With Every Youth Age 11+ at Every Clinical Encounter.
* Products used may vary between communities. Visit the Considerations for Clinicians page to view illustrations of common products.
Create a Space for Confidentiality & Trust
Case Study Sample Dialogue: Part 1 of 3
Clinician: Do your friends or family use tobacco or vaping products?
Patient: Yes, when we are partying.
Clinician: Have you ever tried tobacco products, like cigarettes, blunts, or dip?
Patient: Sometimes, but not really.
Clinician: What about e-cigarettes, vapes, or pod devices?
Patient: Yes, sometimes. On weekends at parties, and sometimes during the week.
Clinician: How many times a month do you use vapes at parties on the weekends?
Patient: 3 or 4 times a month.
Clinician: How often during the week do you typically use?
Patient: About 10 or 15 times-it helps clear my mind.
Counsel
Counsel All Patients Who Use Tobacco About Quitting, Regardless of Amount or Frequency of Use
Clinician: Thank you for sharing that with me. As your doctor, I care about you and I want to help you stay as healthy as possible. Because your brain is still developing, it's not safe for you to use any tobacco or nicotine product, including e-cigarettes. I want to help you stay as healthy as possible. Quitting smoking and vaping is an important way to keep you healthy. What do you think about quitting?
Patient: I don’t know. I don’t really vape that often. Mainly just when partying with friends.
Clinician: I think you will find that cutting out nicotine, even when just partying, will help with any alcohol cravings too. Quitting is hard, but I believe you can do it. Are you interested in quitting today?
Patient: Not really, but don’t I have to? I’m stuck here.
Treat
Link Youth to Appropriate Behavioral Supports
Clinician: Sometimes, I like to give my patients a 2-week challenge. For 2 weeks, I would ask you to completely stop your tobacco use and then we can talk about how you feel. Would you be willing to try that?
Patient: Sure.
Clinician: Awesome! Sometimes I find when my patients agree to a 2-week challenge, they can use some support. There are resources I can offer -web, telephone, text. Most of these resources are built for people who are quitting, but I think the information is helpful for anyone who uses tobacco. Would being connected to a resource like that be of interest.
Patient: Ummmm....I guess so.
Clinician: Okay, if you take out your phone, I can show you a place that I think will be helpful. Go to a web browser, and type in teen.smokefree.gov -there is a lot of information there about withdrawal and stress and craving that I think will be helpful.
Patient: Okay thank you.
*Additional behavioral support options can be found at www.aap.org/help2quit
Cessation Support & Additional Follow Up
* Case Study 2 explores the use of NRT in tobacco users < 18 years old.
**AAP Recommendations for NRT Prescription can be found at aap.org/NRT
Download Full Case Study View Full Youth Clinical Considerations
Additional case studies were developed to show the variations in clinical settings, common products, screening techniques, motivational interviewing, patient response, and clinician considerations. Please return to the home page to see additional case studies.
Last Updated
05/07/2024
Source
American Academy of Pediatrics