Physician Advice to Adolescents About Smoking: Who Gets Advised and Who Benefits Most?

Differences in tobacco use prevalence, behaviors, and cessation services by race/ethnicity: A survey of persons in addiction treatment

BACKGROUND

Disparities in tobacco use prevalence, behaviors, and services have been identified among people of different racial and ethnic groups in the United States general population. Persons in addiction treatment have among the highest smoking prevalence of any population. However, little is known about racial and ethnic disparities in tobacco use prevalence, behaviors, and services among persons in addiction treatment.

METHODS

Survey data were used from 1840 clients from 24 addiction treatment programs from the NIDA Clinical Trials Network. Multivariate regression analyses were conducted to assess associations between race/ethnicity (White, African American, Hispanic) and patterns of tobacco and other tobacco product use, as well as quitting behaviors and receipt of tobacco cessation services among current smokers (n = 1425) while in treatment.

RESULTS

There was no difference in cigarette smoking prevalence across racial/ethnic groups. In the multivariate models, Hispanics and African Americans, compared to Whites, were less likely to be daily smokers, use smokeless tobacco, or use e-cigarettes. African Americans and Hispanics reported more past-year quit attempts and higher use of menthol compared to Whites. Hispanics were more interested in quitting while in treatment than Whites. Contrary to expectations, African Americans reported receiving more tobacco cessation advice and services while in treatment than Whites.

CONCLUSIONS

Some findings reflected broader population patterns (e.g., tobacco use behaviors, other tobacco product use), while others did not (e.g., no difference in tobacco use prevalence by race/ethnicity). The reasons for greater receipt of cessation services among African Americans are unclear. Findings indicate the need for continued engagement of African Americans and Hispanics in cessation services while in addiction treatment, and for addressing heavier tobacco use and lack of interest in cessation during treatment among White clients.

Adolescent Experiences of Clinician-Patient HIV/STI Communication in Primary Care

Effective clinician-patient communication is linked to positive patient health outcomes in adults, yet the research on adolescent populations remains limited. We describe adolescent experiences of clinician-patient HIV/STI communication through qualitative interviews with predominantly African-American adolescent women from a youth-centered primary care clinic. Participants described acknowledging clinicians are professionals, the importance of confidentiality to foster clinician-adolescent communication, and calling for clinician-initiated HIV/STI communication. Adolescents expressed the necessity for clinicians to engage youth in these challenging conversations through an open and understanding approach. Additionally, adolescents described experiences of perceived judgment and uncomfortableness from clinicians, and non-disclosure of HIV/STI risk behaviors to their clinician. Findings underscore the adolescents' desire to engage in HIV/STI communication with healthcare providers, while highlighting important strategies for clinicians. Results can inform health communication research and practice, and the development of interventions aimed at increasing clinician-adolescent HIV/STI communication.

Trends in Healthcare Provider Advice on Youth Tobacco Use, 2011-2015

INTRODUCTION

The American Academy of Pediatrics issued a policy statement to recommend screening all adolescents for tobacco and other drug use in 2011. This study sought to evaluate the trends of health professional screening and advice on youth tobacco use since then.

METHODS

Data from the 2011, 2013, and 2015 National Youth Tobacco Survey were analyzed to report the changes in tobacco screening and advice among 46,554 U.S. middle and high school students. Logistic regressions were used to assess trends and factors associated with screening or advice on tobacco use and to examine whether screening or advice on tobacco use was associated with quit behaviors. Analyses were conducted in 2017.

RESULTS

Overall, the prevalence of tobacco screening significantly increased from 32.0% in 2011 to 37.9% in 2013 but had no significant change after that. The increase was largest among females and blacks, but there was no significant increase among e-cigarette users. By contrast, the prevalence of being advised not to use tobacco significantly decreased from 31.4% in 2011 to 26.9% in 2015. The decrease was largest among females, younger students, and e-cigarette users. Current cigarette smokers were more likely than nonsmokers to be advised on tobacco use, but no significant difference was found between e-cigarette only users and noncurrent users. Being advised not to use tobacco was associated with higher odds of planning to quit tobacco use among current tobacco users and current e-cigarette users, respectively.

CONCLUSIONS

Continued efforts to increase tobacco use interventions by healthcare providers are needed.