title: Patient and Provider Factors Associated With American Indian and Alaska Native Adolescent Tobacco Use Screening.
abstract: BACKGROUND
  Tobacco use is the leading behavioral cause of death among adults 25 years or older. American Indian (AI) and Alaska Native (AN) communities confront some of the highest rates of tobacco use and of its sequelae. Primary care-based screening of adolescents is an integral step in the reduction of tobacco use, yet remains virtually unstudied. We examined whether delivery of tobacco screening in primary care visits is associated with patient and provider characteristics among AI/AN adolescents.
  
  
  METHODS
  We used a cross-sectional analysis to examine tobacco screening among 4757 adolescent AI/AN patients served by 56 primary care providers at a large tribally managed health system between October 1, 2011 and May 31, 2014. Screening prevalence was examined in association with categorical patient characteristics (gender, age, clinic visited, insurance coverage) and provider characteristics (gender, age, tenure) using multilevel logistic regressions with individual provider identity as the nesting variable.
  
  
  RESULTS
  Thirty-seven percent of eligible patients were screened. Gender of both providers and patients was associated with screening. Male providers delivered screening more often than female providers (odds ratio [OR] 1.6, 95% confidence interval [CI] 0.7-3.9). Male patients had 20% lower odds of screening receipt (OR 0.8, 95% CI 0.7-0.9) than female patients, independent of patient age and provider characteristics. Individual provider identity significantly contributed to variability in the mixed-effects model (variance component 2.2; 95% CI 1.4-3.4), suggesting individual provider effect.
  
  
  CONCLUSIONS
  Low tobacco screening delivery by female providers and the low receipt of screening among younger, male patients may identify targets for screening interventions.
authors: Southcentral Foundation, Anchorage, AK, USA vhiratsuka@scf.cc.
authors: Vanessa Y
authors: VY
authors: Hiratsuka
authors: University of Washington, Seattle, WA, USA.
authors: Astrid M
authors: AM
authors: Suchy-Dicey
authors: Boston College, Chestnut Hill, MA, USA.
authors: Eva M
authors: EM
authors: Garroutte
authors: University of Washington, Seattle, WA, USA.
authors: Cathryn
authors: C
authors: Booth-LaForce
mesh_terms: D000293:Adolescent; D000328:Adult; D000413:Alaska / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D064424:Tobacco Use / Q000453:epidemiology*; D055815:Young Adult
keywords: children; community health; primary care; quality improvement; smoking