Screening and Counseling for Youth Tobacco Use: A Qualitative Study of Primary Care Providers in Northeast Tennessee

In 2021, Tennessee high school youth reported a cigarette smoking rate of 4.9% and an electronic cigarette (e-cigarette) use rate of 19%, surpassing national averages of 2.3% and 11.3%, respectively. In 2019, 15.5% of 8th- and 9th-grade youth in northeast Tennessee reported current e-cigarette use. Primary care providers (PCPs) can prevent youth tobacco initiation and promote cessation through screening and counseling, yet little is known about these services in Tennessee. This study explored the experiences of PCPs in northeast Tennessee regarding youth tobacco use screening and counseling and identified barriers and facilitators to these services.

Semistructured interviews with 12 PCPs were conducted via Zoom between November 2023 and March 2024 using an interview guide based on McLeroy's ecological health promotion model. Transcripts were analyzed using ATLAS.ti 23.4 software. Coding and analysis followed Braun and Clarke's thematic analysis using a blended deductive-inductive approach.

PCPs recognize the importance of youth tobacco use screening and counseling and employ tool-based screening, verbal questioning, motivational interviewing, and warm hand offs to behavioral health clinicians. Key barriers included knowledge gaps on e-cigarettes, balancing rapport and trust with screening and counseling, confidentiality and privacy issues, time constraints, negative social norms around tobacco use, limited community resources for youth tobacco cessation, and tobacco regulatory concerns. Facilitators included training and educational resources for PCPs, an integrated behavioral health model, and effective clinic policies and workflows.

Supportive policies and quality improvement measures are needed to strengthen youth tobacco prevention and cessation efforts in northeast Tennessee and statewide.