Differences in health care provider screening for tobacco use among youth in the United States: The National Youth Tobacco Survey, 2021

Prev Med. 2023 Oct:175:107718. doi: 10.1016/j.ypmed.2023.107718. Epub 2023 Oct 2.


Objective: Health care providers (HCP) are encouraged to screen youth for tobacco product use as a key step in preventing such use and associated health outcomes. However, recent data examining differences in HCP tobacco screening by sociodemographic characteristics and tobacco use is scant.

Methods: Data from the 2021 National Youth Tobacco Survey (N = 14,685) were analyzed. Three types of HCP screening were examined: no screening, any e-cigarette use (e-cigarette only, e-cigarette and other tobacco), and non-e-cigarette tobacco product use. Differences by HCP screening were examined using multinomial logistic regression adjusted for age, sex, gender identity, sexual orientation, race/ethnicity, and tobacco use (non-current, sole, dual/poly).

Results: Among the sample, 42.8% were screened for any tobacco use, with 30.6% screened for any e-cigarette use and 12.2% for non-e-cigarette tobacco product use only. Youth who were older (vs. younger) (OR = 5.98, 95% CI: 4.78-7.49) and gay/lesbian (vs. heterosexual) (OR = 1.47, 95% CI: 1.02-2.12) were more likely to be screened for e-cigarette use. Youth who were non-Hispanic Black (vs. non-Hispanic White) were less likely to be screened for e-cigarette use (OR = 0.53, 95% CI: 0.42-0.67) and more likely to be screened for non-e-cigarette tobacco use (OR = 1.34, 95% CI: 1.10-1.63). Current sole tobacco use (vs. non-current use) and dual/poly tobacco use (vs. non-current use) increased the likelihood for HCP screening for e-cigarette use.

Conclusions: The majority of U.S. youth continue to not be screened for tobacco use by their HCP. Evidence of disparities in tobacco use screening suggest the need for policies and training that promote equity in screening.

Keywords: E-cigarettes; Health care provider screening; Sociodemographics; Tobacco; Youth.

MeSH terms

  • Adolescent
  • Electronic Nicotine Delivery Systems*
  • Female
  • Gender Identity
  • Humans
  • Male
  • Tobacco Products*
  • Tobacco Use / epidemiology
  • Tobacco Use Disorder*
  • United States / epidemiology