Rates and predictors of substance use in pediatric primary care clinics

Abstract

Background: Screening for substance use within pediatric primary care provides a unique opportunity to identify adolescents in need of intervention. Methods: This study analyzed screening data collected across 13 Federally Qualified Health Centers over the course of an 18-month project designed to implement Screening Brief Intervention Referral to Treatment (SBIRT) for adolescents aged 12–21. A mixed-effects modeling strategy was used to describe associations between demographic, procedural, and clinical factors and adolescent reports of substance use. Results: In total, 10,813 adolescents were screened between December 2017 and May 2019, with 17% reporting past year use, including 11% at lower risk and 6% at high risk of a substance use disorder. Females, Hispanic, Black/African American, heterosexual, non-primary English speakers, and patients who did not have a co-occurring mental health disorder were all less likely to report past year substance use. While rates of disclosing any past year substance use were equivalent between patients screened by a staff member and those who completed self-administered screens, patients who were screened by a staff member were associated with reporting overall greater frequencies of use. Patients who were screened by a staff member with a parent present were less likely to disclose any past year substance use. Conclusion: While overall rates of disclosure of any past year substance use (17.2%) were lower than reported in research settings, a substantial proportion (6.3%) had screen results indicating a high risk for substance use disorder.

Keywords:

• Adolescent
• primary health care
• screening

Author contributions

AS: lead author and lead data analyst. SL: lead content expert and assisted in writing manuscript. FC: assisted in writing manuscript. PP: content expert and assisted in writing manuscript. LD: oversaw evaluation design and assisted in writing manuscript. SG: assisted with data compiling, cleaning, and analysis. CL and CB: assisted in writing manuscript.

Disclosure statement

The authors have no conflicts of interest to report.

Additional information

Funding

This work was supported by Conrad N. Hilton Foundation. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.