Youth tobacco use is a public health concern in the United States (U.S.) with about 2.8 million middle and high school youth reporting current tobacco use in 2023. Healthcare providers (HCPs) can play a crucial role in addressing youth tobacco use through screening and counseling, yet rates of these interventions are suboptimal. Tennessee has a high prevalence of youth tobacco use and not much is known about these interventions in Northeast Tennessee. This study has several objectives: 1) conduct a scoping review of available evidence on screening and counseling for youth tobacco use and identify related gaps; 2) assess youth self-reported rates of HCPs’ screening and counseling for tobacco use among U.S. youth, and identify associated factors; 3) explore HCPs’ experiences and identify barriers and facilitators in implementing screening and counseling interventions for youth tobacco use in Northeast Tennessee; and 4) provide recommendations for policy and practice based on identified gaps. This multi-method study employed 1) a scoping review, adhering to the Johanna Briggs Institute methodology; 2) a cross-sectional analysis of data from the 2022 National Youth Tobacco Survey using logistic regression models; 3) a qualitative study using a blended-inductive coding of semi-structured interviews and thematic analysis, and 4) a research brief highlighting the policy and practice implications of study findings. The scoping review analyzed 22 articles and revealed disparities in HCPs’ tobacco screening and counseling interventions. The quantitative study showed tobacco screening and counseling rates of 43.7% and 3 45.6%, respectively. Younger youth (9–12 years) and non-Hispanic (NH) Black, Hispanic, and NH Asian youth were less likely to receive screening and counseling compared to NH White youth. In-depth interviews with 12 primary care providers (PCPs) revealed varying levels of confidence in screening and counseling for tobacco use. PCPs primarily conduct formal screening for older youth (12–18 years), and barriers such as time constraints, lack of confidentiality, and resistance from youth were frequently mentioned. Efforts should be made to improve screening and counseling interventions for youth tobacco use by implementing policies to reduce barriers and increase HCPs’ awareness regarding early intervention for all age groups, races, and ethnicities.