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. 2022 Nov 22;12(11):e059019.
doi: 10.1136/bmjopen-2021-059019.

Cross-sectional online survey of clinicians' knowledge, attitudes and challenges to screening and counselling adolescents and young adults for substance use

Anu L Gorukanti  1 , Kim S Kimminau  2 , Hilary A Tindle  3   4 , Jonathan D Klein  5 , Julie Gorzkowski  6 , Kristen Kaseeska  6 , Raabiah Ali  7 , Lavisha Singh  8 , Sean P David  9   10 , Bonnie Halpern-Felsher  1
Affiliations

Cross-sectional online survey of clinicians' knowledge, attitudes and challenges to screening and counselling adolescents and young adults for substance use

Anu L Gorukanti et al. BMJ Open. .

Abstract

Objective: To examine adolescent healthcare clinicians' self-reported screening practices as well as their knowledge, attitudes, comfort level and challenges with screening and counselling adolescents and young adults (AYA) for cigarette, e-cigarette, alcohol, marijuana, hookah and blunt use.

Design: A 2016 cross-sectional survey.

Setting: Academic departments and community-based internal medicine, family medicine and paediatrics practices.

Participants: Adolescent healthcare clinicians (N=771) from 12 US medical schools and respondents to national surveys. Of the participants, 36% indicated male, 64% female, mean age was 44 years (SD=12.3); 12.3% of participants identified as Asian, 73.7% as white, 4.8% as black, 4.2% as Hispanic and 3.8% as other.

Primary and secondary outcome measures: Survey items queried clinicians about knowledge, attitudes, comfort level, self-efficacy and challenges with screening and counselling AYA patients about marijuana, blunts, cigarettes, e-cigarettes, hookah and alcohol.

Results: Participants were asked what percentage of their 10-17 years old patients they screened for substance use. The median number of physicians reported screening 100% of their patients for cigarette (1st, 3rd quartiles; 80, 100) and alcohol use (75, 100) and 99.5% for marijuana use (50,100); for e-cigarettes, participants reported screening half of their patients and 0.0% (0, 50), (0, 75)) reported screening for hookah and blunts, respectively. On average (median), clinicians estimated that 15.0% of all 10-17 years old patients smoked cigarettes, 10.0% used e-cigarettes, 20.0% used marijuana, 25.0% drank alcohol and 5.0% used hookah or blunts, respectively; yet they estimated lower than national rates of use of each product for their own patients. Clinicians reported greater comfort discussing cigarettes and alcohol with patients and less comfort discussing e-cigarettes, hookah, marijuana and blunts.

Conclusions: This study identified low rates of screening and counselling AYA patients for use of e-cigarettes, hookahs and blunts by adolescent healthcare clinicians and points to potential missed opportunities to improve prevention efforts.

Keywords: Child & adolescent psychiatry; PAEDIATRICS; PRIMARY CARE; PUBLIC HEALTH.

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Conflict of interest statement

Competing interests: BH-F is a paid expert scientist in some litigation against e-cigarette companies and is an unpaid scientific advisor and expert witness regarding some tobacco-related policies. None of the other authors have any conflicting interests.

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