Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2012

Open Access 01-12-2012 | Research

Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy

Authors: Stacy Sterling, Andrea H Kline-Simon, Charles Wibbelsman, Anna Wong, Constance Weisner

Published in: Addiction Science & Clinical Practice | Issue 1/2012

Login to get access

Abstract

Objective

This paper used data from a study of pediatric primary care provider (PCP) screening practices to examine barriers to and facilitators of adolescent alcohol and other drug (AOD) screening in pediatric primary care.

Methods

A web-based survey (N = 437) was used to examine the influence of PCP factors (attitudes and knowledge, training, self-efficacy, comfort with alcohol and drug issues); patient characteristics (age, gender, ethnicity, comorbidities and risk factors); and organizational factors (screening barriers, staffing resources, confidentiality issues) on AOD screening practices. Self-reported and electronic medical record (EMR)-recorded screening rates were also assessed.

Results

More PCPs felt unprepared to diagnose alcohol abuse (42%) and other drug abuse (56%) than depression (29%) (p < 0.001). Overall, PCPs were more likely to screen boys than girls, and male PCPs were even more likely than female PCPs to screen boys (23% versus 6%, p < 0.0001). Having more time and having other staff screen and review results were identified as potential screening facilitators. Self-reported screening rates were significantly higher than actual (EMR-recorded) rates for all substances. Feeling prepared to diagnose AOD problems predicted higher self-reported screening rates (OR = 1.02, p <0.001), and identifying time constraints as a barrier to screening predicted lower self-reported screening rates (OR = 0.91, p < 0.001). Higher average panel age was a significant predictor of increased EMR-recorded screening rates (OR = 1.11, p < 0.001).

Conclusions

Organizational factors, lack of training, and discomfort with AOD screening may impact adolescent substance-abuse screening and intervention, but organizational approaches (e.g., EMR tools and workflow) may matter more than PCP or patient factors in determining screening.
Appendix
Available only for authorised users
Literature
1.
2.
Brindis C, Park MJ, Ozer EM, Irwin CE: Adolescents' access to health services and clinical preventive health care: crossing the great divide. Pediatr Ann. 2002, 31: 575-581.CrossRefPubMed
3.
Blum R: Physicians′ assessment of deficiencies and desire for training in adolescent care. J Med Educ. 1987, 62: 401-407.PubMed
4.
Shrier LA, Harris SK, Kurland M, Knight JR: Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics. 2003, 111: e699-e705.CrossRefPubMed
5.
Knight JR, Harris SK, Sherritt L, Van Hook S, Lawrence N, Brooks T, Carey P, Kossack R, Kulig J: Prevalence of positive substance abuse screen results among adolescent primary care patients. Arch Pediatr Adolesc Med. 2007, 161: 1035-1041.CrossRefPubMed
6.
Ammon L, Sterling S, Mertens J, Weisner C: Adolescents in private chemical dependency programs: Who are most at risk for HIV?. J Subst Abuse Treat. 2005, 29: 39-45.CrossRefPubMed
7.
8.
Windle M, Spear LP, Fuligni AJ, Angold A, Brown JD, Pine D, Smith GT, Giedd J, Dahl RE: Transitions into underage and problem drinking: developmental processes and mechanisms between 10 and 15 years of age. Pediatrics. 2008, 121 (Suppl 4): S273-S289.PubMedCentralCrossRefPubMed
9.
Brown SA, Tapert SF, Granholm E, Delis DC: Neurocognitive functioning of adolescents: effects of protracted alcohol use. Alcohol Clin Exp Res. 2000, 24: 164-171.CrossRefPubMed
10.
Merenstein D, Green L, Fryer GE, Dovey S: Shortchanging adolescents: room for improvement in preventive care by physicians. Fam Med. 2001, 33: 120-123.PubMed
11.
Levy S, Vaughan BL, Knight JR: Office-based intervention for adolescent substance abuse. Pediatr Clin North Am. 2002, 49: 329-343.CrossRefPubMed
12.
13.
Brown JD, Wissow LS: Discussion of sensitive health topics with youth during primary care visits: relationship to youth perceptions of care. J Adolesc Health. 2009, 44: 48-54.PubMedCentralCrossRefPubMed
14.
Freeborn DK, Polen MR, Mullooly JP: Adolescent drug misuse treatment and use of medical care services. Int J Addict. 1995, 30: 795-822. PMCID: PMC040599/itnPubMed
15.
Mertens JR, Flisher AJ, Fleming MF, Weisner CM: Medical conditions of adolescents in alcohol and drug treatment: comparison with matched controls. J Adolesc Health. 2007, 40: 173-179.PubMedCentralCrossRefPubMed
16.
Sterling S, Kohn CS, Lu Y, Weisner C: Pathways to chemical dependency treatment for adolescents in an HMO. J Psychoactive Drugs. 2004, 36: 439-453.CrossRefPubMed
17.
Levy SJ, Kokotailo PK: Substance use screening, brief intervention, and referral to treatment for pediatricians. Pediatrics. 2011, 128: e1330-e1340.CrossRefPubMed
18.
19.
Knight JR: The role of the primary care provider in preventing and treating alcohol problems in adolescents. Ambul Pediatr. 2001, 1: 150-161.CrossRefPubMed
20.
21.
American Academy of Pediatrics Committee on Substance Abuse: Tobacco, alcohol, and other drugs: The role of the pediatrician in prevention and management of substance abuse. Pediatrics. 1998, 101: 125-128.CrossRef
22.
American Medical Association: Guidelines for Adolescent Preventive Services (GAPS). 1997, Chicago: American Medical Association
23.
24.
25.
Bethell C, Klein J, Peck C: Assessing health system provision of adolescent preventive services: The Young Adult Health Care Survey. Med Care. 2001, 39: 478-490.CrossRefPubMed
26.
Friedman LS, Johnson B, Brett AS: Evaluation of substance-abusing adolescents by primary care physicians. J Adolesc Health Care. 1990, 11: 227-230.CrossRefPubMed
27.
Emans SJ, Bravender TD, Knight JR, Frazer C, Luoni M, Berkowitz C, Armstrong E, Goodman E: Adolescent medicine training in pediatric residency programs: Are we doing a good job?. Pediatrics. 1998, 102: 588-595.CrossRefPubMed
28.
Spandorfer JM, Israel Y, Turner BJ: Primary care physicians' views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract. 1999, 48: 899-902.PubMed
29.
Steiner BD, Gest KL: Do adolescents want to hear preventive counseling messages in outpatient settings?. J Fam Pract. 1996, 43: 375-381.PubMed
30.
Friedmann PD, McCullough D, Chin MH, Saitz R: Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000, 15: 84-91.PubMedCentralCrossRefPubMed
31.
Ozer EM, Adams SH, Gardner LR, Mailloux DE, Wibbelsman CJ, Irwin CE: Provider self-efficacy and the screening of adolescents for risky health behaviors. J Adolesc Health. 2004, 35: 101-107.CrossRefPubMed
32.
Gottlieb NH, Mullen PD, McAlister AL: Patients′ substance abuse and the primary care physician: patterns of practice. Addict Behav. 1987, 12: 23-32.CrossRefPubMed
33.
Wilson CR, Sherritt L, Gates E, Knight JR: Are clinical impressions of adolescent substance use accurate?. Pediatrics. 2004, 114: e536-e540.CrossRefPubMed
34.
Stevens J, Kelleher KJ, Gardner W, Chisolm D, McGeehan J, Pajer K, Buchanan L: Trial of computerized screening for adolescent behavioral concerns. Pediatrics. 2008, 121: 1099-1105.CrossRefPubMed
35.
Hassan A, Harris SK, Sherritt L, Van Hook S, Brooks T, Carey P, Kossack R, Kulig J, Knight JR: Primary care follow-up plans for adolescents with substance use problems. Pediatrics. 2009, 124: 144-150.PubMedCentralCrossRefPubMed
36.
Monti PM, Colby SM, Barnett NP, Spirito A, Rohsenow DJ, Myers M, Woolard R, Lewander W: Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. J Consult Clin Psychol. 1999, 67: 989-994.CrossRefPubMed
37.
Gates S, McCambridge J, Smith LA, Foxcroft DR: Interventions for prevention of drug use by young people delivered in non-school settings. Cochrane Database Syst Rev Issue 1. Art. No.: CD000353. 2004, 10.1002/14651858.CD000353.pub2.
38.
Spirito A, Monti PM, Barnett NP, Colby SM, Sindelar H, Rohsenow DJ, Lewander W, Myers M: A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. J Pediatr. 2004, 145: 396-402.CrossRefPubMed
39.
Winters KC, Leitten W, Wagner E, O’Leary Tevyaw T: Use of brief interventions for drug abusing teenagers within a middle and high school setting. J Sch Health. 2007, 77: 196-206.CrossRefPubMed
40.
Knight JR, Sherritt L, Van Hook S, Gates EC, Levy S, Chang G: Motivational interviewing for adolescent substance use: a pilot study. J Adolesc Health. 2005, 37: 167-169.CrossRefPubMed
41.
Leontieva L, Horn K, Haque A, Helmkamp J, Ehrlich P, Williams J, Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE, Borsari B, Carey KB, Freyer J, Tonigan JS, Keller S, Rumpf HJ, John U, Hapke U: Readiness to change problematic drinking assessed in the emergency department as a predictor of change. J Crit Care. 2005, 20: 251-256.CrossRefPubMed
42.
43.
Martin G, Copeland J, Swift W: The Adolescent Cannabis Check-Up: feasibility of a brief intervention for young cannabis users. J Subst Abuse Treat. 2005, 29: 207-213.CrossRefPubMed
44.
Marlatt GA, Baer JS, Kivlahan DR, Dimeff LA, Larimer ME, Quigley LA, Somers JM, Williams E: Screening and brief intervention for high-risk college student drinkers: results from a two-year follow-up assessment. J Consult Clin Psych. 1998, 66: 604-615.CrossRef
45.
Bernstein J, Heeren T, Edward E, Dorfman D, Bliss C, Winter M, Bernstein E: A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking. Acad Emerg Med. 2010, 17: 890-902.PubMedCentralCrossRefPubMed
46.
Walton MA, Chermack ST, Shope JT, Bingham CR, Zimmerman MA, Blow FC, Cunningham RM: Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. JAMA. 2010, 304: 527-535.PubMedCentralCrossRefPubMed
47.
Baer JS, Kivlahan DR, Blume AW, McKnight P, Marlatt GA: Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. Am J Public Health. 2001, 91: 1310-1316.PubMedCentralCrossRefPubMed
48.
Borsari B, Carey KB: Effects of a brief motivational intervention with college student drinkers. J Consult Clin Psychol. 2000, 68: 728-733.CrossRefPubMed
49.
Carey KB, Correia CJ: Drinking motives predict alcohol-related problems in college students. J Stud Alcohol. 1997, 58: 100-105.CrossRefPubMed
50.
Monti PM, Barnett NP, Colby SM, Gwaltney CJ, Spirito A, Rohsenow DJ, Woolard R: Motivational interviewing versus feedback only in emergency care for young adult problem drinking. Addiction. 2007, 102: 1234-1243.CrossRefPubMed
51.
Larimer ME, Turner AP, Anderson BK, Fader JS, Kilmer JR, Palmer RS, Cronce JM: Evaluating a brief alcohol intervention with fraternities. J Stud Alcohol. 2001, 62: 370-380.CrossRefPubMed
52.
Murphy JG, Duchnick JJ, Vuchinich RE, Davison JW, Karg RS, Olson AM, Smith AF, Coffey TT: Relative efficacy of a brief motivational intervention for college student drinkers. Psychol Addict Behav. 2001, 15: 373-379.CrossRefPubMed
53.
Tait RJ, Hulse GK, Robertson SI, Sprivulis PC: Emergency department-based intervention with adolescent substance users: 12-month outcomes. Drug Alcohol Depend. 2005, 79: 359-363.CrossRefPubMed
54.
Ozer E, Lustig JL, Adams S, Gee AGS, Wibblesman C, Bonar RW, Fuster D, Irwin J, Charles J: Integrating training into practice: Increasing the delivery of adolescent clinical preventive services. J Adolesc Health. 2003, 32: 130-131.CrossRef
55.
De Micheli D, Fisberg M, Formigoni ML: Study on the effectiveness of brief intervention for alcohol and other drug use directed to adolescents in a primary health care unit. Rev Assoc Med Bras. 2004, 50: 305-313.CrossRefPubMed
56.
D’Amico EJ, Miles JN, Stern SA, Meredith LS: Brief motivational interviewing for teens at risk of substance use consequences: a randomized pilot study in a primary care clinic. J Subst Abuse Treat. 2008, 35: 53-61.CrossRefPubMed
57.
Aira M, Kauhanen J, Larivaara P, Rautio P: Factors influencing inquiry about patients' alcohol consumption by primary health care physicians: qualitative semi-structured interview study. Fam Pract. 2003, 20: 270-275.CrossRefPubMed
58.
Rowland N, Maynard A, Beveridge A, Kennedy P, Wintersgill W: Doctors have no time for alcohol screening. Br Med J. 1987, 295: 95-96.CrossRef
59.
60.
Horwitz SM, Kelleher KJ, Stein RE, Storfer-Isser A, Youngstrom EA, Park ER, Heneghan AM, Jensen PS, O'Connor KG, Hoagwood KE: Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics. 2007, 119: e208-e218.CrossRefPubMed
61.
Van Hook S, Harris SK, Brooks T, Carey P, Kossack R, Kulig J, Knight JR: The “Six T′s”: barriers to screening teens for substance abuse in primary care. J Adolesc Health. 2007, 40: 456-461.CrossRefPubMed
62.
Meadows T, Valleley R, Haack MK, Thorson R, Evans J: Physician “costs” in providing behavioral health in primary care. Clin Pediatr (Phila). 2011, 50: 447-455.CrossRef
63.
Stein RE, Horwitz SM, Storfer-Isser A, Heneghan A, Olson L, Hoagwood KE: Do pediatricians think they are responsible for identification and management of child mental health problems? Results of the AAP periodic survey. Ambul Pediatr. 2008, 8: 11-17.CrossRefPubMed
64.
Friedmann PD, McCullough D, Saitz R: Screening and intervention for illicit drug abuse: a national survey of primary care physicians and psychiatrists. Arch Intern Med. 2001, 161: 248-251.CrossRefPubMed
65.
Ewing GB, Selassie AW, Lopez CH, McCutcheon EP: Self-report of delivery of clinical preventive services by U.S. physicians. Comparing specialty, gender, age, setting of practice, and area of practice. Am J Prev Med. 1999, 17: 62-72.CrossRefPubMed
66.
Klein JD, Wilson KM: Delivering quality care: adolescents' discussion of health risks with their providers. J Adolesc Health. 2002, 30: 190-195.CrossRefPubMed
67.
68.
Gardner W, Pajer KA, Kelleher KJ, Scholle SH, Wasserman RC: Child sex differences in primary care clinicians' mental health care of children and adolescents. Arch Pediatr Adolesc Med. 2002, 156: 454-459.CrossRefPubMed
69.
Gardner W, Kelleher KJ, Pajer KA, Campo JV: Primary care clinicians’ use of standardized tools to assess child psychosocial problems. Ambul Pediatr. 2003, 3: 191-195.CrossRefPubMed
70.
Weisner C, Matzger H: Missed opportunities in screening for alcohol problems in medical and mental health services. Alcohol Clin Exp Res. 2003, 27: 1132-1141.CrossRefPubMed
71.
Volk RJ, Steinbauer JR, Cantor SB: Patient factors influencing variation in the use of preventive interventions for alcohol abuse by primary care physicians. J Stud Alcohol. 1996, 57: 203-209.CrossRefPubMed
72.
McCrady BS, Richter SS, Morgan TJ, Slade J, Pfeifer C: Involving health care workers in screening for alcohol problems. J Addict Dis. 1996, 15: 45-58.CrossRefPubMed
73.
Franzgrote M, Ellen JM, Millstein SG, Irwin CE: Screening for adolescent smoking among primary care physicians in California. Am J Public Health. 1997, 87: 1341-1345.PubMedCentralCrossRefPubMed
74.
Ellen JM, Franzgrote M, Irwin CE, Millstein SG: Primary care physicians’ screening of adolescent patients: a survey of California physicians. J Adolesc Health. 1998, 22: 433-438.CrossRefPubMed
75.
Friedmann PD, Saitz R, Gogineni A, Zhang JX, Stein MD: Validation of the screening strategy in the NIAAA “Physicians’ Guide to Helping Patients with Alcohol Problems. J Stud Alcohol. 2001, 62: 234-238.CrossRefPubMed
76.
Institute of Medicine: Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. 2006, Washington, DC: National Academies Press
77.
78.
Mignone J, Washington R, Ramesh BM, Blanchard JF, Rajaretnam T, Moses S: Discrepancies between the self-reporting of STI preventive care and the actual care provided by male doctors to male patients in Karnataka, India. Sex Transm Infect. 2010, 86: 391-392.CrossRefPubMed
79.
Parthasarathy S, Weisner C: Health care services use by adolescents with intakes into an outpatient alcohol and drug treatment program. Am J Addict. 2006, 15 (Suppl): 113-121.CrossRefPubMed
80.
Sisko AM, Truffer CJ, Keehan SP, Poisal JA, Clemens MK, Madison AJ: National health spending projections: the estimated impact of reform through 2019. Health Aff (Millwood). 2010, 29: 1933-1941.CrossRef
Metadata
Title
Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy
Authors
Stacy Sterling
Andrea H Kline-Simon
Charles Wibbelsman
Anna Wong
Constance Weisner
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2012
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/1940-0640-7-13

Other articles of this Issue 1/2012

Addiction Science & Clinical Practice 1/2012 Go to the issue

Research

Brief alcohol intervention in a psychiatric outpatient setting: a randomized controlled study

Meeting Report

Performance measures for substance use disorders – what research is needed?

Research

Self-reported alcohol and drug use six months after brief intervention: do changes in reported use vary by mental-health status?

Research

Risk of future trauma based on alcohol screening scores: A two-year prospective cohort study among US veterans

Letter to the Editor

Comment on the case for considering quality of life in addiction research and clinical practice

Research

Testing for amphetamine-type stimulant (ATS) use to ascertain validity of self-reported ATS use among young female sex workers in Cambodia