Screening, Diagnosis & Monitoring of Vaping among Adolescents

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


Disclosures

1. I have no conflicts to disclose.


Overview

• Screening tools

• Important questions to ask when assessing for vaping in teens


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”


BSTAD


BSTAD


CRAFFT


CRAFFT


Timeline Follow-Back (TLFB)


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


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


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


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?


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


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.


Questions

Documents

Screening, Diagnosis & Monitoring of Vaping among Adolescents