title: Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy.
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.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA. stacy.a.sterling@kp.org
authors.forename: Stacy
authors.initials: S
authors.lastname: Sterling
authors.forename: Andrea H
authors.initials: AH
authors.lastname: Kline-Simon
authors.forename: Charles
authors.initials: C
authors.lastname: Wibbelsman
authors.forename: Anna
authors.initials: A
authors.lastname: Wong
authors.forename: Constance
authors.initials: C
authors.lastname: Weisner
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010372:Pediatrics / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D011795:Surveys and Questionnaires