Who talks to adolescents about e-cigarettes? Attitudinal profiles among Italian pediatricians

ABSTRACT

E-cigarette use among adolescents is rising rapidly, yet heterogeneity in pediatricians’ knowledge, risk perception, and counselling practices remains poorly characterized. This study aimed to identify distinct attitudinal profiles among Italian pediatricians and to determine the variables that most strongly discriminate between them. A cross-sectional anonymous online survey was distributed between April and October 2025 via the Italian Pediatric Respiratory Society (IPRS/SIMRI) national newsletter. The questionnaire covered demographic characteristics, smoking habits, knowledge of e-cigarettes, risk perception, clinical practices, and counselling behaviors. Latent class analysis (LCA) with an expectation-maximization algorithm was applied to 250 completed responses. Models with two to six classes were compared using AIC, BIC, entropy, and the Lo-Mendell-Rubin likelihood ratio test. The three-class solution provided the best balance between fit and parsimony (lowest BIC); however, entropy values were uniformly low (<0.05), indicating limited separation between classes, so the resulting profiles should be interpreted as broad, partially overlapping tendencies rather than sharply distinct groups. Class 1 (≈25%) tended to include senior pediatricians (mean age >60 years), with a pattern of more conservative attitudes and lower engagement in e-cigarette counselling. Class 2 (≈39%) showed tendencies toward mid-career practitioners reporting greater confidence and openness in discussing e-cigarettes with patients. Class 3 (≈36%) was more frequently composed of early-career pediatricians who tended to underestimate e-cigarette risks and reported lower counselling self-efficacy. Years of practice (importance = 1.00) and age (0.86) were the strongest class discriminators, followed by communication behaviors and risk perception variables. Italian pediatricians appear to cluster along three career-stage-related attitudinal tendencies regarding e-cigarettes, though the low entropy indicates these groupings are partially overlapping rather than rigid categories. These findings support the development of differentiated, career-stage-tailored educational interventions to strengthen counselling capacity across the pediatric workforce.

HIGHLIGHTS BOX

What is already known about this topic? E-cigarette use among adolescents is rising rapidly; pediatricians are expected to counsel on this issue, but their knowledge and attitudes vary substantially by professional setting and career stage. What does this article add to our knowledge? Applying latent class analysis to a national survey of 250 Italian pediatricians, this study identifies three career-stage-defined attitudinal profiles; professional experience and age are the strongest discriminators of e-cigarette knowledge and counselling behavior. How does this study impact current management guidelines? The three-class structure suggests a single educational intervention is insufficient; differentiated, career-stage-tailored training is needed to align all pediatricians with AAP, EAP, and SIMRI counselling recommendations on e-cigarettes.

KEY WORDS

Adolescents; e-cigarettes; pediatricians; latent class analysis; risk perception.