“You Almost Feel Out of Touch [For Saying] … ‘Oh, and by the way, Stop Smoking.’” A Qualitative Exploration of Provider Perspectives About Discussing Tobacco and Cannabis Use With 18-24-Year-Old Young Adults With HIV

Abstract Background: Youth with HIV (YWH) aged 18–24 are overburdened by tobacco, with half also using cannabis recreationally. Increasing tobacco cessation necessitates exploring providers’ approaches to cessation. Methods: Grounded in social cognitive theory, we explored cognitive, socioenvironmental, and behavioral factors impacting providers’ approaches to tobacco use among recreational cannabis users. Virtual interviews were conducted among healthcare providers caring for YWH in Washington (legalized cannabis), Massachusetts (legalized cannabis), and Alabama (cannabis not legal). Interviews were transcribed and analyzed via deductive and