screening, diagnosis & monitoring of vaping among adolescents
TRANSCRIPT
INDIANA UNIVERSITY SCHOOL OF MEDICINE
DEPARTMENT OF PSYCHIATRY
Screening, Diagnosis & Monitoring of Vaping among Adolescents
Allyson L. Dir, Ph.D., HSPP
Assistant Professor, Licensed Clinical Psychologist
IUH Methodist Addiction Treatment & Recovery Center
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Disclosures
1. I have no conflicts to disclose.
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Overview
• Screening tools
• Important questions to ask when assessing for vaping in teens
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Screening
1. Brief, validated measures to screen for substance use
– BSTAD (Brief Screener for Tobacco, Alcohol, and Other Drugs; Kelly, 2014)
– CRAFFT (Knight, 2002)
– Timeline Follow-back (Sobell & Sobell, 1992)
2. Framing questions as “how often do you use” rather than “Have you ever
used”
INDIANA UNIVERSITY SCHOOL OF MEDICINE
BSTAD
INDIANA UNIVERSITY SCHOOL OF MEDICINE
BSTAD
INDIANA UNIVERSITY SCHOOL OF MEDICINE
CRAFFT
INDIANA UNIVERSITY SCHOOL OF MEDICINE
CRAFFT
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Timeline Follow-Back (TLFB)
INDIANA UNIVERSITY SCHOOL OF MEDICINE
DSM-5 Tobacco Use Disorder A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least
two of the following, occurring within a 12-month period:
1. Larger quantities of tobacco over a longer period then intended are consumed
2. Persistent desire or unsuccessful efforts to quit or reduce intake of tobacco
3. Inordinate amount of time spent acquiring or using tobacco product
4. Cravings, strong desire, or urge to use for tobacco
5. Failure to attend to responsibilities and obligations at work, school, or home due to tobacco use
6. Continued use despite adverse social or interpersonal consequences
7. Forfeiture of social, occupational or recreational activities in favor of tobacco use
8. Tobacco use in hazardous situations
9. Continued use despite awareness of physical or psychological problems directly attributed to tobacco use
10. Tolerance for nicotine, as indicated by:
a. Need for increasingly larger doses of nicotine in order to obtain the desired effect
b. A noticeably diminished effect from using the same amounts of nicotine
11. Withdrawal symptoms upon cessation of use as indicated by
a. The onset of typical nicotine associated withdrawal symptoms is present
b. More nicotine or a substituted drug is taken to alleviate withdrawal symptoms
APA, 2013
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Challenges to Assessing Vaping
• Variety of types of e-cigarettes and types of “juice” or fluid
• 0mg, 3mg, 6mg up to 36mg nicotine/mL
• Typically 1mL e-juice = 100 "hits" = ½ pack cigarettes
• 1 juul pod = 200 "hits" = 1 pack cigarettes
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Additional Challenges1
• Lack of standardized, validated screening tools for vaping/e-cig use
• Labels are often ambiguous (ex: “low/medium”) or even inaccurate2
• Fluids obtained from multiple sources
• Youth may have limited insight into volume of use
1 Adams, Kwon, Aalsma, Zapolski, Dir, & Hulvershorn2 Eaton, Kwan, Stratton, 2018
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Questions to Ask
How many hits do you take at a time?
How often throughout the day do you hit?
How long does it take you to go through a cartridge?
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Other E-Cig/Vaping Measures
1. Penn State E-Cigarette Dependence Index 1
– 10 items; Ex: Do you use an e-cigarette now because it is really hard to quit?
Do you ever have strong cravings to use an e-cigarette?
2. Heaviness of Vaping Index (HVI) 2
– Combines time to first e-cig use on awakening and number of daily sessions
– Based on Heaviness of Smoking Index, derived from Fagerstrom Test of
Cigarette Dependence
3. E-Cigarette Addiction Severity Index (EASI) 3
– Self-described addiction – “On a scale of 0 (not)—100% (extremely),
how addicted to e-cigarettes do you think you are?”1 Foulds et al., 20152 Liu et al., 20173 Vogel, Prochaska, & Rubinstein, 2020
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Monitoring
• Self-report: TLFB
• Biospecimens
• Nicotine / cotinine testing
• Detectable for about 1-3 days post nicotine use
• THC testing
• UDS detects for up to a few weeks depending on volume of use, body fat, etc.
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Questions