Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers.

Abstract

To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables. We conducted a mixed-methods study with an online survey and qualitative interviews. Study setting was student health clinics on college campuses. Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews). Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices. Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis. A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports. This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.