I agree pretty much with the previous answers and considerations from my colleagues.
I would suggest that vaping a liquid with variable knowledge about the constituent chemicals warrants its’ own assertion, well separated from tobacco smoking. Consider ‘current vaper’, ‘never vaped’, and ‘previous vaper’ as a starting point for proper risk assessment/screening, rather than munging it in with tobacco smoking. Then the issue becomes how to identify the substance and/or active constituents - some might be quite benign, others much more harmful and contain nicotine, and others totally unknown. Nicotine consumption may be a more important consideration for this model - either as part of the summary, as a separate OBSERVATION or both.
When designing the ‘Tobacco smoking summary’ the scope was very carefully selected. Not any smoking, not all tobacco use, and the underlying premise was to support the identification of patterns of behaviour/use that might be targetted with behaviour change intervention towards quitting, related to the prevention of high-risk cardiovascular and respiratory disease. The archetype reflected that clinicians prioritise recording types of tobacco smoked and overall exposure, ahead of specific episodes. Recording nicotine consumption has not seemed to be a significant factor in recording tobacco smoking to date, and we always wondered if one day we might need to record nicotine consumption/use as a separate archetype. Maybe the time is now, for both vaping and recording other forms of consumption.
The alcohol consumption summary was heavily based on the prior published tobacco summary, although there were some significant adjustments to the tobacco smoking pattern to reflect the way clinicians prioritise episodes ahead of the type of alcohol.
‘Substance use summary’ is another separate archetype currently out for review and has a same same, but slightly different pattern again, but it is still focused on identifying patterns of use for different forms and routes of administration of each substance/drug.
When this tobacco smoking archetype was designed, vaping was a relatively new phenomenon. It was not well understood, especially the mechanisms by which it causes harm, yet it was quite apparent that the focus would not be on the tobacco smoking patterns. It is probably timely for vaping to be investigated and modelled. Does anyone know of an expert on vaping who could guide this modelling?
And in the meantime, we should add a change request for Vaping/e-cigarettes to be added the ‘Tobacco smoking summary’ as an example of Misuse - it will help others who have the same query.
Lots of thoughts, not very specific guidance, sorry.