E-cigarette use is prevalent among young adults, including college students. Factors contributing to this include increased product awareness, other substance use, perceptions of social acceptance, and positive affective associations. While healthcare provider discussions about e-cigarettes can influence patient perceptions and use, evidence suggests that some providers hold misperceptions about nicotine and its role in cessation. There's a recognized need for increased provider awareness and comfort in discussing vaping with college students. However, existing data on college health providers' approaches to addressing vaping is limited. This study aimed to assess college health providers' knowledge, confidence, and attitudes regarding nicotine/cannabis vaping, their training needs, and their preferred training approaches. The study also explored providers' perceptions of vaping products and the information they share with patients. The increasing prevalence of cannabis vaping, along with the co-use of nicotine and cannabis, further complicates the issue. The 2019 EVALI outbreak added another layer of complexity, creating uncertainty surrounding the safety of vaping both nicotine and cannabis. This study, therefore, provides a timely assessment of how college healthcare providers are addressing this evolving landscape.

The literature review extensively cites studies on e-cigarette use among young adults, highlighting its increasing prevalence and associated risk factors. It reviews studies on patient-provider interactions regarding e-cigarettes and tobacco use, indicating that provider knowledge and communication significantly impact patient perceptions. The review also touches upon the misperceptions held by some health care providers about nicotine and the limited guidance on addressing vaping among college students. Existing guidelines from organizations like the American College Health Association are mentioned, along with a position paper from the Society for Adolescent Health and Medicine emphasizing the need for vaping-related training for health providers. The review also acknowledges the changing landscape of vaping products, with the rise in cannabis vaping and the 2019 EVALI outbreak.

This mixed-methods study employed a sequential-explanatory design, starting with a cross-sectional online survey followed by qualitative interviews. Fifty college healthcare providers from 26 SUNY campuses were recruited via postcards and email. The survey, adapted from a similar study on veterans' health, assessed providers' knowledge, confidence, attitudes, professional practices, training experiences, and future training needs related to vaping. A 5-point Likert scale was used to measure knowledge and confidence. Eleven providers who completed the survey also participated in targeted semi-structured telephone interviews. These interviews aimed to explore providers' perceptions and experiences in more detail. Survey data were analyzed using Stata, while qualitative interview data were analyzed using thematic content analysis. The interviews focused on explaining the meaning of the survey results. The study obtained IRB approval from SUNY Buffalo State College.

Despite high self-reported knowledge (76%) and confidence (86%) levels among survey participants, a significant portion (64%) reported not knowing what product (nicotine or cannabis) students most often vape on their campuses. There was evidence of misinformation among some providers. While most providers (85%) felt knowing a patient's tobacco product use status improves care, there was uncertainty regarding the role of nicotine replacement therapies in e-cigarette cessation. A significant difference (p<0.01) was observed in the percentage of providers wanting to learn more about the potential harms (43) compared to the benefits (33) of e-cigarettes. Most providers (68%) believed e-cigarettes are as harmful as traditional cigarettes. Only 44% of providers had participated in e-cigarette-related training, and almost 20% hadn’t heard of the Tobacco 21 law. Most providers (82%) indicated they had time to learn more and considered it a priority (74%). Preferred training formats included webinars and materials for dissemination to students (e.g., handouts, posters, social media campaigns). Interviews underscored the importance of distinguishing between nicotine and cannabis vaping, understanding usage amounts, and acknowledging the need for updated training.

The study's findings reveal a potential gap between providers' perceived knowledge and their actual understanding of student vaping behaviors and product usage. The high self-reported knowledge and confidence, despite limited training, suggest that providers may be relying on less reliable sources of information. The lack of clarity regarding the type of product students use and nicotine levels in vape devices underscores the need for targeted educational interventions. The significant difference in interest in learning about harms versus benefits of e-cigarettes points to a potentially unbalanced approach to addressing this issue. The study's findings highlight the need for improved training on various aspects of vaping, including the differentiation between nicotine and cannabis vaping, the understanding of varying nicotine concentrations, and responsible harm reduction strategies. The study suggests that a more nuanced approach, potentially incorporating harm reduction principles where appropriate, is necessary.

This pilot study provides valuable insights into college health providers' knowledge, confidence, and attitudes regarding vaping. The high self-reported knowledge and confidence levels contrasted with limited training and evidence of misinformation highlight the need for improved training programs and educational resources. Future research should explore providers' information sources and assess the effectiveness of different training formats in bridging the gap between perceived and actual knowledge. Furthermore, incorporating students' perspectives on effective educational materials is crucial. The study emphasizes the need for college health providers to adopt a more comprehensive and nuanced approach to addressing vaping, taking into account the evolving landscape of vaping products and the importance of harm reduction strategies.

The study's sample, while including campuses spanning metro and non-metro areas and various college types, might not be fully generalizable to all New York State or U.S. colleges. The small sample sizes limited advanced statistical analyses. The data collection period coincided with the EVALI outbreak and the COVID-19 pandemic, potentially influencing responses. The lack of a response rate calculation is a limitation. The pandemic's impact on provider practices and responses also necessitates further consideration.