PURPOSE: To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables. DESIGN: We conducted a mixed-methods study with an online survey and qualitative interviews. SETTING: Study setting was student health clinics on college campuses. SUBJECTS: Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews). MEASURES: 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. ANALYSIS: Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis. RESULTS: 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. CONCLUSION: This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.
PURPOSE: To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables. DESIGN: We conducted a mixed-methods study with an online survey and qualitative interviews. SETTING: Study setting was student health clinics on college campuses. SUBJECTS: Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews). MEASURES: 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. ANALYSIS: Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis. RESULTS: 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. CONCLUSION: This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.
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Keywords:
College Tobacco; Health focus: smoking control; Manuscript format: research; Outcome measure: behavioral; Prevention Research; Research purpose: descriptive; Setting: clinical/health care; Strategy: policy change; Student Health; Study design: mixed-method; Target population age: college students and adults; Target population circumstances: education; Tobacco Cessation Counseling; Tobacco Cessation Screening
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