9. Understanding Smokeless Tobacco Initiation and Use Among Rural Youth: An Unexplored Population

Abstract

screening practices, screening and intervention confidence (1 not at all confident, 10 so confident I could teach someone else), obstacles to SBIRT implementation (1 not an obstacle, 5 major obstacle), potential practice changes (1 strongly disagree, 5 strongly agree) and teaching modalities (1 not at all effective, 5 very effective) that would improve SBIRT adoption. Spearman correlations between percentage of adolescents seen by clinician and differences in responses between the two medical centers were calculated. Results: Twenty-one clinicians responded (32%). Eighty-one percent had heard of SBIRT and 60% knew of the AAP recommendation. Clinicians identified problematic marijuana use (24% of patients) as the most common problematic substance used by their adolescent patients followed by alcohol (19%), tobacco (15%) and prescription medications (6%). Seeing a higher percentage of adolescent patients correlated with clinicians feeling that the challenge of addressing two especially problematic areas, street (rs -.633, p .006) and club drugs (rs -.594, p .013) usagewas less difficult. Clinicians felt most confident in their ability to effectively screen adolescent patients for unhealthy substance use (mean 6.43, SD 2.25). Almost 90% reportedusingHEADSSS to screen for substance abuse 80%ormore of the time during primary care visits, although only 28% reported using a validated screener like CRAFFT more than 50% of the time. Seeing a higher percentage of teen patients was significantly correlated with higher confidence in the clinician’s ability to distinguish whether a patient has a substance abuse diagnosis (rs .608, p .003) and to treat a patient’s substance abuse disorder (rs .490,p .017). Barriers to SBIRT adoption identified included lack of available treatment resources (mean 4.21, SD 0.86), limited visit time (4.11, 0.88), and lack of non-English resources (3.94, 0.80). Clinicians identified that a lecture on validated substance use screening tools (4.28, 1.18), CME on motivational interviewing (4.29, 1.16) or SBIRT (4.21, 0.70), or online self-directed education (4.0, 1.20) would be most effective in developing SBIRT skills. Practice changesmost helpful in implementing SBIRT included having a behaviorist in clinic (4.75, 0.55), creating a referral tracking system (4.5, 0.51), making appropriate materials available (4.45, 0.69), specifically non-English materials (4.5, 0.51), and creating a “referral champion” within their practice (4.40, 0.68). Conclusions: Our needs assessment findings identify knowledge, skill and practice gaps that can be addressed to successfully implement SBIRT in pediatric practice. Specifically, focusing curriculum development on validated screening tools, motivational interviewing techniques, making and following up on referrals and addressing the needs of limited English proficiency patients may enhance the adoption of SBIRT. Sources of Support: SAMHSA 1R25AT006573-01; U79 TI020296.