Federally Qualified Health Center (FQHC) Case Study: 15 year old sports physical

Background

Patient Information

15 y/o African-American male, seen in clinic for a routine annual visit and sports physical.
Initial Vitals:RR =14; BP=110/70 mm Hg, Temp= 98.

Meds:

• None

ROS (pertinent positives):

• Unable to make it through football practice without becoming short of breath, and his running has slowed down
• Self admits to increased irritability and nausea.
• His parents are unaware of any tobacco product use.

Other Info:

• Heterosexual; pronouns: he/him
• He lives with both parents and both are present for this appointment.
• He has one younger sibling who is also in high school.

Ask

Screen for Tobacco Use With Every Youth Age 11+ at Every Clinical Encounter

* Products used may vary between communities. Visit the Considerations for Clinicians page to view illustrations of common products.

Create a Space for Confidentiality & Trust

Sample Dialogue Part 1 of 3

Clinician: Do any of your friends or family use dip or any other tobacco products?

Patient: They all use dip.

Clinician: I appreciate you being honest and sharing that with me. Do you use any tobacco or vaping products, like cigarettes, e-cigarettes, pod, vapes, or dip?

Patient: Yes, but only when stressed about games or practice.

Clinician: Thank you for sharing. Which products do you use when stressed?

Patient: Dip mostly, but I also vape.

Counsel

Counsel All Patients Who Use Tobacco About Quitting, Regardless of Amount or Frequency of Use

Sample Dialogue Part 2 of 3

Clinician: As your doctor, I care about you and I want to help you stay as healthy as possible. Tell me which sports you are playing this year.

Patient: I’m playing football and basketball this year.

Clinician: That’s amazing! That also means it’s a good time to think about quitting. If you stop vaping, it can help your lung capacity, which could help you run farther and faster. While you’re doing that, you could also try quitting dip–this will help prevent gum disease, tooth decay, and tooth loss.

Patient: Yeah

Clinician: On a scale of 1-10, how important is it for you to quit dip and vaping?

Patient: 8.

Clinician: What made you choose 8 rather than 10 or 4?

Patient: I want to be a better athlete and make varsity team, but I know I may still have stress.

Clinician: It sounds like you’re using smoking/vaping to deal with stress. May I offer some suggestions about other ways to cope with stress?

Patient: Yes, I would like that.

Treat

Link Youth to Appropriate Behavioral Supports

Sample Dialogue Part 3 of 3

Clinician: I’m so glad you’re interested in quitting. Would you like to quit both at the same time or one at a time?

Patient: I would like to try to quit both.

Clinician: Let’s set a quit date in the next 2 weeks. What day would you like to start?

Patient: Can I start Monday?

Clinician: Monday is a great day to start. I’m very proud of you for making that decision.

Patient: Thanks.

Clinician: I would like to connect you with some resources to help make it easier to quit. Would you rather get support by text, online, or phone?

Patient: Text would be best.

Clinician: If you take out your phone I can show you the DITCHVAPE program. If you text DITCHVAPE to 88709 you will receive daily texts that will help you make a quit plan and deal with cravings and triggers that make you want to vape. I or someone from the clinic will check in with you 2 weeks from now to see how you’re doing.

Patient: Okay thank you.

* Additional behavioral support options can be found at www.aap.org/help2quit

Cessation Support & Additional Follow Up

* Case Study 2 explores the use of cessation medication users > 18 years old.

**AAP Recommendations for NRT Prescription can be found at aap.org/NRT

Download Full Case Study View Full Youth Clinical Considerations

Additional case studies were developed to show the variations in clinical settings, common products, screening techniques, motivational interviewing, patient response, and clinician considerations. Please return to the home page to see additional case studies.