Introduction: As electronic cigarette (e-cigarette) use becomes more prevalent, understanding how populations perceive the harms associated with use is vital for tailoring public health interventions. Our aims in this study were to explore the perceptions of health risk associated with e-cigarettes among young patients in the emergency department (ED) who consume e-cigarettes as well as similarly aged medical students regardless of e-cigarette use and to determine medical students’ perception of their curriculum to prepare them for future counseling of patients on e-cigarette use.
\nMethods: A cross-sectional survey was completed by 276 participants: 90 ED patients 18-35 years of age who had ever used e-cigarettes (4.2% response rate) and 187 medical students from a U.S. allopathic medical school (17.7% response rate). Our primary outcomes were perceptions of health risks associated with e-cigarette use and medical student perceptions of the medical school curriculum. The secondary outcome was perceptions of e-cigarettes compared to tobacco cigarettes and perceptions of medical students’ readiness to counsel patients on e-cigarette use. Bivariate analyses using chi-square tests assessed differences between groups.
\nResults: We received 90 completed surveys from ED patients, and 187 from medical students. The majority of ED patients reported believing that e-cigarette use can lead to lung injury (77.8%), heart disease (30%), and cancer (82.2%). Medical students were more likely than ED patients to associate e-cigarette use with harm (lung injury, 94.7% vs 77.8%, P < .001; heart disease, 84.0% vs 70.0%, P = .007; and cancer 90.9% vs 82.2%, P = .037). A modest proportion of ED respondents stated that e-cigarette use did not carry risk of lung injury (22.2%), heart disease (30%), and cancer (17.2%). Most medical students (61.0%) believed that their medical school curriculum did not prepare them for future conversations with patients about e-cigarettes, and over half of the students (54.0%) expressed low confidence in counseling patients.
\nConclusion: In our population, a significant proportion (20-30%) of ED patients did not perceive risk with e-cigarette use, suggesting room for education and intervention in this population. Medical education is likely associated with increased awareness of risk of e-cigarette use. Medical students generally did not feel prepared for the growing need to counsel patients on e-cigarette use, suggesting medical curricula could be adapted to meet this need.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"e-cigarette"},{"word":"Substance use"},{"word":"Public health"},{"word":"Medical Education"},{"word":"addiction"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/65d8q9vs","frozenauthors":[{"first_name":"Hope","middle_name":"","last_name":"Smelser","name_suffix":"","institution":"University of Kansas School of Medicine, Wichita, Kansas","department":""},{"first_name":"Cameron","middle_name":"","last_name":"Heying","name_suffix":"","institution":"The University of Kansas Health System, Kansas City, Kansas","department":""},{"first_name":"Lindsay","middle_name":"","last_name":"Maguire","name_suffix":"","institution":"The University of Kansas Health System, Kansas City, Kansas; University of Kansas School of Medicine, Kansas City, Kansas","department":""}],"date_submitted":"2025-08-19T15:45:53.703000Z","date_accepted":"2025-12-30T16:43:38.042000Z","date_published":"2026-04-08T17:22:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/50709/galley/50346/download/"}]}