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

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.

The Health Literacy of U.S. Immigrant Adolescents: A Neglected Research Priority in a Changing World.

Immigrant adolescents are the fastest-growing sector among U.S. youth, but they receive little attention in health literacy research. Immigrant adolescents are a diverse population tasked with mastering new literacies while also navigating new social systems. Many immigrant adolescents serve as important linguistic and cultural resources in their families and local communities, and yet their contributions (and struggles) as new navigators of our health care system remain invisible. In this commentary article, we argue that health literacy researchers need to devote more attention to immigrant adolescents and the pathways by which they learn new language and literacy skills while also developing their own health habits and behaviors. We contend that the study of immigrant adolescents provides a critical window into health literacy as a socially and historically situated practice, specifically how immigrant adolescents' transnational experiences shape their learning of new health literacy practices. With a coordinated interdisciplinary research agenda on immigrant adolescents, the health literacy field will expand its empirical base for what becoming "health literate" looks like in today's globalizing world.