Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care.

PURPOSE OF REVIEW: Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use. RECENT FINDINGS: There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use. SUMMARY: Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.

Parent Guidance on Alcohol Use for Youth With Chronic Medical Conditions.

PURPOSE: Youth with chronic medical conditions are vulnerable to unique alcohol-related health consequences, yet there are few prevention strategies targeting this group. Youth with chronic medical conditions parents' beliefs and provision of alcohol-related guidance have not yet been explored, which limits the development of effective family-based interventions. METHODS: We evaluated baseline surveys of youth with chronic medical conditions and their parents (n = 268 dyads) enrolled in a randomized controlled trial of a psychoeducational intervention to reduce alcohol use by youth with chronic medical conditions. Surveys evaluated youth alcohol use, parent beliefs about their child's alcohol use, and parental provision of alcohol guidance, including disease-related and disease-independent (ie, "drinking and driving") topics. Paired bivariate tests (χ 2 , Fisher exact) were used to measure associations between youth with chronic medical conditions alcohol use and parent alcohol-related beliefs and provision of alcohol-related guidance. RESULTS: In this study of 268 parent-youth dyads, many parents did not provide guidance on disease-specific topics, such as mixing alcohol with medications (47.8%) or risk of flares (37.6%). Furthermore, youth with chronic medical conditions whose parents had expectant beliefs about alcohol use (ie, alcohol use is "inevitable" or "OK with supervision") were more likely to report alcohol use (all P values <0.05). DISCUSSION: These findings suggest parent beliefs may influence youth with chronic medical conditions alcohol use. Proactive, disease-specific education from medical providers to parents of youth with chronic medical conditions may help to reduce adverse consequences of alcohol use in these vulnerable youth.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics.

Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics.

Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.

Coronavirus disease pandemic and adolescent substance use.

PURPOSE OF REVIEW: Substance use is common in adolescence and has distinct developmental, cognitive, and health consequences. Over the last 2 years, the coronavirus disease 2019 pandemic has isolated adolescents, disrupted typical developmental milestones, and caused pervasive stress and anxiety. Healthcare providers can help by recognizing and addressing these effects on adolescent mental health and substance use. This update reviews the immediate effects of the pandemic on adolescent substance use, potential future implications, and opportunities to use new strategies to improve care for adolescents with problematic use. RECENT FINDINGS: Initial findings suggest that fewer teens started using substances during the pandemic. This was likely influenced by stay at home orders that reduced opportunities for social use. However, increased time at home was not beneficial for all adolescents. Furthermore, adolescents who used substances prepandemic, experienced material hardship, or reported higher pandemic-related stress tended to intensify substance use during this time. SUMMARY: The adverse effects of pandemic isolation, anxiety, and developmental disruption will likely have consequences for adolescent substance use for many years to come. To comprehensively address adolescent health, healthcare providers can be sensitive to these realities and use existing screening and brief intervention strategies to address use. Innovative telehealth strategies that allow for the expansion of substance use treatment offer promising opportunities to improve care for adolescents with substance use disorder.

Using Reproductive Health as a Strategy to Engage Youth in Preventive Care.

PURPOSE: This research examined differences in receipt of recommended preventive services by contraceptive use in adolescent and young adult (AYA) women. METHODS: Data are from a retrospective chart review of 408 AYA women who received sexual health risk reduction counseling in an urban academic AYA clinic. Descriptive, bivariate, and logistic regression analyses were used to examine relationships between contraception use and receipt of care. RESULTS: AYA women aged 12-24 years using hormonal contraception were more likely to receive recommended preventive care, including an annual preventive visit and sexually transmitted infection screening, compared with those using condoms or no contraception. Women using medium-acting reversible contraception were more likely to have an annual visit compared with those not using hormonal contraception. CONCLUSIONS: AYA women using contraception are more likely to receive recommended preventive health services, suggesting reproductive health visits may be used to promote engagement around preventive care.