title: Adolescent substance use screening in primary care: Validity of computer self-administered versus clinician-administered screening.
abstract: BACKGROUND
  Computer self-administration may help busy pediatricians' offices increase adolescent substance use screening rates efficiently and effectively, if proven to yield valid responses. The CRAFFT screening protocol for adolescents has demonstrated validity as an interview, but a computer self-entry approach needs validity testing. The aim of this study was to evaluate the criterion validity and time efficiency of a computerized adolescent substance use screening protocol implemented by self-administration or clinician-administration.
  
  
  METHODS
  Twelve- to 17-year-old patients coming for routine care at 3 primary care clinics completed the computerized screen by both self-administration and clinician-administration during their visit. To account for order effects, we randomly assigned participants to self-administer the screen either before or after seeing their clinician. Both were conducted using a tablet computer and included identical items (any past-12-month use of tobacco, alcohol, drugs; past-3-month frequency of each; and 6 CRAFFT items). The criterion measure for substance use was the Timeline Follow-Back, and for alcohol/drug use disorder, the Adolescent Diagnostic Interview, both conducted by confidential research assistant interview after the visit. Tobacco dependence risk was assessed with the self-administered Hooked on Nicotine Checklist (HONC). Analyses accounted for the multisite cluster sampling design.
  
  
  RESULTS
  Among 136 participants, mean age was 15.0 ± 1.5 years, 54% were girls, 53% were black or Hispanic, and 67% had ≥3 prior visits with their clinician. Twenty-seven percent reported any substance use (including tobacco) in the past 12 months, 7% met criteria for an alcohol or cannabis use disorder, and 4% were HONC positive. Sensitivity/specificity of the screener were high for detecting past-12-month use or disorder and did not differ between computer and clinician. Mean completion time was 49 seconds (95% confidence interval [CI]: 44-54) for computer and 74 seconds (95% CI: 68-87) for clinician (paired comparison, P < .001).
  
  
  CONCLUSIONS
  Substance use screening by computer self-entry is a valid and time-efficient alternative to clinician-administered screening.
authors.affiliation: a Department of Pediatrics , Harvard Medical School , Boston , Massachusetts , USA.|b Division of Developmental Medicine , Boston Children's Hospital , Boston , Massachusetts , USA.|c Division of Adolescent/Young Adult Medicine , Boston Children's Hospital , Boston , Massachusetts , USA.|d The Center for Adolescent Substance Abuse Research (CeASAR) , Boston Children's Hospital , Boston , Massachusetts , USA.
authors.forename: Sion Kim
authors.initials: SK
authors.lastname: Harris
authors.affiliation: a Department of Pediatrics , Harvard Medical School , Boston , Massachusetts , USA.|b Division of Developmental Medicine , Boston Children's Hospital , Boston , Massachusetts , USA.|c Division of Adolescent/Young Adult Medicine , Boston Children's Hospital , Boston , Massachusetts , USA.|d The Center for Adolescent Substance Abuse Research (CeASAR) , Boston Children's Hospital , Boston , Massachusetts , USA.
authors.forename: John Rogers
authors.initials: JR
authors.lastname: Knight
authors.affiliation: e Inova Health Care Services , Falls Church , Virginia , USA.
authors.forename: Shari
authors.initials: S
authors.lastname: Van Hook
authors.affiliation: a Department of Pediatrics , Harvard Medical School , Boston , Massachusetts , USA.|b Division of Developmental Medicine , Boston Children's Hospital , Boston , Massachusetts , USA.|d The Center for Adolescent Substance Abuse Research (CeASAR) , Boston Children's Hospital , Boston , Massachusetts , USA.
authors.forename: Lon
authors.initials: L
authors.lastname: Sherritt
authors.affiliation: f Department of Pediatrics , Cambridge Health Alliance , Cambridge , Massachusetts , USA.
authors.forename: Traci L
authors.initials: TL
authors.lastname: Brooks
authors.affiliation: g Department of Pediatrics , Tufts Medical Center-Floating Hospital for Children , Boston , Massachusetts , USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Kulig
authors.affiliation: h Department of Pediatrics , Boston Medical Center , Boston , Massachusetts , USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Nordt
authors.affiliation: i Departments of Community Health Sciences and Medicine , Boston University Schools of Medicine and Public Health , Boston , Massachusetts , USA.|j Clinical Addiction Research and Education (CARE) Unit , Section of General Internal Medicine , Boston Medical Center , Boston , Massachusetts , USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000293:Adolescent; D002648:Child; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D010820:Physicians; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D057566:Self Report; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis*
keywords: Adolescents; alcohol; cannabis; computers; drugs; primary care; screening; substance use; tobacco; validity (epidemiology)