Understanding current assessment of ends use, variation, and opportunities for change in primary care

The National Institute on Drug Abuse awarded Oregon Health & Science University $905,044 for a Project Grant (R21DA063855) under the Drug Use and Addiction Research Programs (CFDA 93.279), effective May 1, 2026.

The recipient will conduct a mixed-methods study examining current assessment and electronic health record documentation of electronic nicotine delivery systems (ENDS) use in primary care settings, with focus on patients aged 12 and older. The study spans 22 primary care clinics serving more than 154,000 patients and aims to identify patient, provider, and clinic characteristics associated with ENDS use assessment and documentation of cessation assistance offers for patients who wish to quit. The research is guided by the Consolidated Framework for Implementation Research (CFIR) and the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework.

Work is performed in Oregon. The period of performance runs through April 30, 2028.

Abstract

Health care authorities including the US preventive services task force, american academy of pediatrics, and american academy of family physicians recommend that primary care clinicians screen for electronic nicotine delivery systems (ends) use and talk with patients about the potential harms of use. Studies have found that assessment of ends use in primary care settings is low, (ranging from 1-34%). Findings about patient characteristics associated with ends use assessment are mixed, and studies are limited to individuals ≥18, users of combustible tobacco (CT), or reports from clinician surveys. Primary care is an important source of information and assistance for tobacco cessation, but nearly half of clinicians report lacking knowledge and confidence to talk with patients about ends use. This is important because recent studies show that about 60% of both young people and adults report wanting to quit ends use. We currently have little insight about the frequency with which ends use cessation assistance is offered to primary care patients who wish to quit ends use. Understanding current practices and patient, clinician and health care setting factors associated with ends use assessment and cessation assistance documentation can inform opportunities and strategies for improvement. We propose a mixed methods study of 22 primary care clinics providing care to more than 154K patients. This study aims to identify the current assessment and electronic health record documentation of ends use among 12+ year old primary care patients and examine patient, provider and clinic characteristics associated with both ends use assessment and offers of cessation assistance for those who want to quit. Guided by the consolidated framework for implementation research (cfir) and the exploration, preparation, implementation, and sustainment (epis) framework, this study also uses a series of community engagement studios to ground our understanding of the key challenges and opportunities. Collectively, we aim to generate stakeholder-centered recommendations for embedding ends use assessments into workflows and to identify the needs and strategies to prepare for, adopt and implement guideline-based ends cessation assistance. This study will inform current practices to assess ends use and offer cessation assistance; identify multi-level factors associated with assessment and assistance; and establish data- and experience- informed solutions generated by primary care and patient stakeholders faced with these challenges. Our study will also inform the development of implementation strategies for the routine assessment and discussion of the risks of ends use, and provision of cessation assistance for those who want to quit.