Youth use of electronic nicotine delivery systems (ENDS) has increased over the last several years, necessitating proactive steps by primary care providers (PCP) including discussing ENDS health effects with youth and providing cessation counseling. The CDC recommends that people under age 25 should not use ENDS. Brief counseling about use of tobacco products is cost-effective and beneficial to patients’ health. PCPs need current, accurate information about ENDS to deliver comprehensive preventive services and cessation counseling to a vulnerable adolescent population. The purposes of this practice improvement project were to increase PCPs’ knowledge, patient discussions, and cessation referrals related to ENDS use. Key informant interviews with two PCPs were conducted with five identified themes combined with best practice recommendations into an educational session for PCPs and nurses. Surveys assessed PCPs for increased knowledge, motivation, confidence, and comfort in discussing ENDS use with their patients and for increased tobacco cessation activities. A retrospective chart review evaluated the education’s impact on the rates of PCP-patient discussions about ENDS use and cessation referrals by PCPs. The education resulted in increased knowledge, motivation, confidence, and comfort in discussing ENDS use, cessation medications, cessation treatment within PCP practices and referral for treatment outside of PCP practices. Although not confirmed by the chart review, PCPs reported the likelihood to change their practices in relation to ENDS counseling and referral. PCPS also reported at three-months post-education increased activity in treating patients within PCP practice as well as referring to ENDS treatment outside of PCP practice. Recommendations include that all PCPs should receive more education about how to talk to their youth and young adult patients about ENDS use and about the resources available to help them quit using ENDS. Clear and readily available clinical guidelines are needed to support PCPs’ efforts and modifications of the chart review software is needed for improved assessment of PCP practices. Youth should also receive education about ENDS use so that they are able to make informed decisions about behaviors that may negatively impact their health.