Literature Collection

OBJECTIVES: In 2021, Tennessee high school youth reported a cigarette smoking rate of 4.9% and an electronic cigarette (e-cigarette) use rate of 19%, surpassing national averages of 2.3% and 11.3%, respectively. In 2019, 15.5% of 8th- and 9th-grade youth in northeast Tennessee reported current e-cigarette use. Primary care providers (PCPs) can prevent youth tobacco initiation and promote cessation through screening and counseling, yet little is known about these services in Tennessee. This study explored the experiences of PCPs in northeast Tennessee regarding youth tobacco use screening and counseling and identified barriers and facilitators to these services. METHODS: Semistructured interviews with 12 PCPs were conducted via Zoom between November 2023 and March 2024 using an interview guide based on McLeroy's ecological health promotion model. Transcripts were analyzed using ATLAS.ti 23.4 software. Coding and analysis followed Braun and Clarke's thematic analysis using a blended deductive-inductive approach. RESULTS: PCPs recognize the importance of youth tobacco use screening and counseling and employ tool-based screening, verbal questioning, motivational interviewing, and warm hand offs to behavioral health clinicians. Key barriers included knowledge gaps on e-cigarettes, balancing rapport and trust with screening and counseling, confidentiality and privacy issues, time constraints, negative social norms around tobacco use, limited community resources for youth tobacco cessation, and tobacco regulatory concerns. Facilitators included training and educational resources for PCPs, an integrated behavioral health model, and effective clinic policies and workflows. CONCLUSIONS: Supportive policies and quality improvement measures are needed to strengthen youth tobacco prevention and cessation efforts in northeast Tennessee and statewide.

Youth with epilepsy (YWE) are at elevated risk for anxiety, yet anxiety is often undetected and understudied in this population. Most research on anxiety in YWE is based on parent proxy-report and broad-band measures with limited sensitivity. The aim of the current study was to: 1) examine rates of anxiety symptoms in YWE using a diagnosis-specific, self-report measure of anxiety symptoms, 2) assess differences in anxiety symptoms by sociodemographic and medical variables, and 3) evaluate changes in anxiety symptoms following a brief behavioral health intervention delivered within an interdisciplinary epilepsy clinic visit. As part of routine clinical care, 317 YWE [M(age)=13.4+2.5 years (range 7-19 years); 54% female; 84% White: Non-Hispanic] completed the Multidimensional Anxiety Scale for Children, self-report (MASC-10), with a subset completing the MASC-10 at a second timepoint (n=139). A retrospective chart review was completed and sociodemographic, medical variables and behavioral health interventions were collected. Thirty percent of YWE endorsed elevated anxiety symptoms, with higher rates in those who were younger. YWE who received a behavioral health intervention for anxiety (n=21) demonstrated greater decreases in anxiety symptoms from Time 1 to Time 2 compared to those who did not receive a behavioral intervention (n=108). The integration of psychologists into pediatric epilepsy clinics may have allowed for early identification of anxiety symptoms, as well behavioral interventions to address these symptoms, which has the potential to decrease the need for more intensive services.

INTRODUCTION: Screening for depression in caregivers of children with developmental disabilities is not routine, representing missed opportunities for support. METHOD: A quality improvement project was initiated in our pediatric clinic. Root causes of limited screening included unclear guidelines for support, caregiver perception that help is unavailable, and lack of a quick screening tool. A clinical pathway was constructed and integrated into existing practice using quality improvement methodology. RESULTS: Baseline screening rate was 5%-10%. During the 12-week pilot, weekly rates ranged from 46.0% to 91.0% (mean 70.2%). Monthly rates subsequently averaged 55.0%. Approximately 20% had a positive screen; over half were caregivers of children with autism. About 5% had moderate depression, of whom 40% required referral to social workers. DISCUSSION: Structured depression screening of caregivers of children with developmental disabilities is feasible and sustainable in a busy clinic. Further research is needed to measure the impact on child and family outcomes.