Assessing adolescent tobacco use in a substance use treatment program with self-report and biological measures

•Adolescent visits to a SUD treatment clinic included multiple tobacco use screens.•22% of visits had discordance between self-reported tobacco and biological measures.•Fourteen of 52 (27%) patients had at least one discordant negative self-report.•Biological measures of nicotine may be a useful add...

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Bibliographic Details
Published in:	Addictive behaviors Vol. 107; p. 106424
Main Authors:	Meadows, Amy L., Guenthner, Gregory, Broster, Lucas S., Luo, Alice Y., Martin, Catherine A.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-08-2020
Subjects:	Adolescent Carbon Monoxide Cotinine Electronic Cigarette Electronic Nicotine Delivery Systems Humans Nicotine Retrospective Studies Self Report Smoking Substance-Related Disorders - epidemiology Substance-Related Disorders - therapy Tobacco Tobacco Use - epidemiology Tobacco TLFB Carbon Monoxide Adolescent SBIRT CO Electronic Cigarette Cotinine Nicotine
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Summary:	•Adolescent visits to a SUD treatment clinic included multiple tobacco use screens.•22% of visits had discordance between self-reported tobacco and biological measures.•Fourteen of 52 (27%) patients had at least one discordant negative self-report.•Biological measures of nicotine may be a useful addition to self-report. Tobacco use in adolescents can alter their lifetime health outcomes. Despite the importance of early identification and treatment, adolescent tobacco use, including that of electronic vapor products (e.g., e-cigarettes), is often missed. In a state-funded substance use treatment program, we added biological measures, including urinary cotinine and exhaled carbon monoxide to self-report measures to assess recent and lifetime tobacco use. We conducted a retrospective review of the de-identified charts to examine the feasibility of screening for self-report and biological measures of tobacco use. Self-report, urinary cotinine, and exhaled carbon monoxide samples were obtained at every visit, including intake and follow-up. There were 52 adolescents with a total of 400 clinic visits to the program. Of those 400 visits, 258 included self-reported tobacco use and 142 included a denial of using any form of tobacco. However, of those 142 visits with a negative self-report of tobacco, 31 tested positive for cotinine and 6 had positive exhaled carbon monoxide. Although 111 of the 142 had negative cotinine, 5 had positive carbon monoxide, but all of those self-reported recent cannabis use. Despite using a sensitive measure of self-report of tobacco use, almost 22% of visits had a discordant self-report with a biological measure that indicated tobacco use. Considering the lifelong impact of adolescent tobacco use, clinicians should consider augmenting self-report with biological measures of tobacco use. Identification of tobacco use in adolescents with substance use can assist clinicians in providing education about tobacco use, such as electronic vapor products, and individualizing treatments.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0306-4603 1873-6327
DOI:	10.1016/j.addbeh.2020.106424