Pediatric Subspecialist Alcohol Screening Rates and Concerns About Alcohol and Cannabis Use Among Their Adolescent Patients.

PURPOSE: Pediatric specialty care provides an opportunity to screen for and address patient substance use; however, little is known about providers' screening rates, their opinions regarding substance use harms, or the potential marijuana to be used as a medication. METHODS: We surveyed national convenience samples of pediatric endocrinologists (N = 142) and rheumatologists (N = 83) and used descriptive statistics and multivariate logistic regression to examine alcohol screening rates, barriers, and for medical use of marijuana, differences between subspecialist concerns. RESULTS: In all, 36.4% of providers reported screening adolescent patients annually or more, and a majority expressed concerns about impacts on disease management (80.0%/80.0%) and symptom management (69.3%/53.3%) from alcohol and marijuana, respectively. Nearly equal proportions disagreed (30.2%), were neutral (34.7%), or agreed (35.1%) that some patients would benefit from medical marijuana, although majorities were not comfortable recommending marijuana (62.7%) and did not believe marijuana is standardized enough to be used as medication (57.8%). DISCUSSION: Fewer than half of the subspecialists in our study routinely screen their adolescent patients for substance use, although many have concerns regarding the impacts of alcohol and marijuana use on their patients. Education and training on best practice could help to increase screening rates. There is agreement that marijuana is not standardized enough to be used as a medication. There is also a broad range of opinions regarding the pharmaceutical potential of marijuana and concerns about the impact of marijuana on underlying chronic medical conditions, which should be considered as marijuana policy continues to evolve.

Association of Screening and Brief Intervention With Substance Use in Massachusetts Middle and High Schools.

Importance: Screening and brief intervention (SBI) programs in schools have the potential to provide substance use prevention messages to large numbers of adolescents. This study evaluated the association between exposure to a school-based SBI program and reductions in substance use among youths after enactment of a law that required Massachusetts schools to provide SBI to all students. Objective: To estimate the association between exposure to a school-based SBI program and changes in substance use among youths. Design, Setting, and Participants: In this mixed-method quality improvement study using an effectiveness-implementation hybrid design, stakeholder interviews were conducted to describe the operations, timing, and impressions of SBI implementation at 14 intervention schools in Massachusetts. Repeated cross-sectional surveys of youths in intervention and comparison groups were administered between December 19, 2017, and May 22, 2019, to assess substance use and associated measures of perceived risk, knowledge, and adult support before and approximately 3 months after SBI implementation among exposed groups. A difference-in-differences framework was used to estimate substance use outcomes associated with SBI exposure among students in middle school (grades 7 and 8) and high school (grades 9 and 10) using adjusted overlap-weighted generalized models to account for covariate imbalance between exposed and unexposed school grades. In addition, 14 school staff members were interviewed about implementation. Exposures: Exposure vs nonexposure to a school-based SBI program. Main Outcomes and Measures: Frequency of alcohol, cannabis, and e-cigarette use (measured in days) and any binge drinking in the past 3 months. Results: Between December 2017 and May 2019, 8771 survey responses were collected from 4587 students in grades 7 through 10 who were attending one of 23 participating school districts. The median (IQR) age was 13 (13-14) years (range, 12-17 years); 2226 students self-identified as female (48.5%), 2206 (48.1%) as male, and 155 (3.4%) as transgender or preferred not to answer. Overall, 163 students (3.6%) identified their race as Asian, 146 (3.2%) as Black or African American, 2952 (64.4%) as White, and 910 (19.8%) as mixed or other race (including American Indian or Alaska Native and Native Hawaiian or Pacific Islander); 416 students (9.1%) preferred not to answer or were missing data on race. A total of 625 students (13.6%) identified their ethnicity as Hispanic and 3962 (86.4%) as non-Hispanic. Cannabis use increased over time in both the SBI group (middle school: marginal estimated probability, 0.73 [95% CI, 0.21-2.51] at baseline vs 2.01 [95% CI, 0.60-6.70] at follow-up; high school: marginal estimated probability, 2.86 [95% CI, 0.56-14.56] at baseline vs 3.10 [95% CI, 0.57-16.96] at follow-up) and the control group (middle school: marginal estimated probability, 0.24 [95% CI, 0.05-1.03] at baseline vs 3.38 [95% CI, 0.81-14.18] at follow-up; high school: marginal estimated probability, 1.30 [95% CI, 0.27-6.29] at baseline vs 1.72 [95% CI, 0.34-8.66] at follow-up). e-cigarette use also increased over time in both the SBI group (middle school: marginal estimated probability, 0.81 [95% CI, 0.22-3.01] at baseline vs 1.94 [95% CI, 0.53-7.02] at follow-up; high school: marginal estimated probability, 3.82 [95% CI, 0.72-20.42] at baseline vs 3.51 [95% CI, 0.55-22.59] at follow-up) and the control group (middle school: marginal estimated probability, 0.51 [95% CI, 0.12-2.30] at baseline vs 3.40 [95% CI, 0.72-16.08] at follow-up; high school: marginal estimated probability, 2.29 [95% CI, 0.41-12.65] at baseline vs 3.53 [95% CI, 0.62-20.16] at follow-up). Exposure to SBI was associated with a significantly smaller increase in the rate of cannabis use among middle school students (adjusted rate ratio [aRR], 0.19; 95% CI, 0.04-0.86) and significantly smaller increases in the rates of cannabis and e-cigarette use among all female students (cannabis use: aRR, 0.17 [95% CI, 0.03-0.96]; e-cigarette use: aRR, 0.16 [95% CI, 0.03-0.82]) compared with nonexposure. No other significant differences were observed among students in grades 7 and 8, and no differences were found in any comparison between groups in grades 9 and 10. Conclusions and Relevance: In this quality improvement study, exposure to a school-based SBI program was associated with a significantly smaller increase in the rate of cannabis use among middle school students and significantly smaller increases in the rates of cannabis and e-cigarette use among all female students. These findings suggest that implementation of SBI programs in schools may help to reduce substance use among middle school and female students, and further study of these programs is warranted.

Validation of a single question for the assessment of past three-month alcohol consumption among adolescents.

BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use is increasingly used in clinical care. Despite its endorsement by several professional societies, the U.S. Preventive Services Task Force has found the evidence base for adolescent SBIRT to be insufficient. A measure of substance use that is brief enough to embed in the electronic medical record could be used in pragmatic trials that enroll large numbers of primary care patients, facilitating research in this area. METHODS: Participants aged 14-18 years (N = 492) completed an electronic survey that included a 90-day Timeline Follow Back (TLFB) Calendar, considered the criterion standard, along with three survey questions about the frequency of their alcohol use: days of use in the past three months, average days of use per week in the past three months, and average days of use per month in the past year. We calculated the correlation between the number of days reported on each of the three questions and the total number of days of use reported on the TLFB. RESULTS: The question on number of days of use in the past three months was highly correlated with alcohol consumption frequency on the 90-day TLFB assessment (rho = 0.903). Other items displayed lower but satisfactory correlation with the TLFB (rho = 0.719-0.830). CONCLUSIONS: A single question about past 3-month frequency of alcohol use was highly correlated with alcohol use frequency on the criterion standard TLFB among adolescents presenting for routine primary care.

Screening and Counseling for Alcohol Use in Adolescents With Chronic Medical Conditions in the Ambulatory Setting.

PURPOSE: We seek to determine how youth with chronic medical conditions experience alcohol screening and counseling. METHODS: Adolescents with type I diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention deficit hyperactivity disorder, or inflammatory bowel disease were surveyed. Descriptive statistics and regression analysis quantified rates of asking and counseling about alcohol. RESULTS: Of 390 participants (75.1% white/non-Hispanic, 51.8% female, average age 16.4 years), 70% reported being asked about their alcohol use by a healthcare provider, and 76% reported receiving at least one message regarding alcohol and health. Of past year drinkers, 54% disclosed use to their provider. Only 2.0% of youth reported receiving the message "I should not drink." CONCLUSIONS: Most youth with chronic medical conditions were asked and counseled about alcohol use although few heard unambiguous recommendations to avoid alcohol consumption.