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Screening Adolescents for Alcohol Use

Tracking Practice Trends of Massachusetts Pediatricians

Levy, Sharon MD, MPH; Ziemnik, Rosemary E. BS; Harris, Sion K. PhD, CPH; Rabinow, Lily MS; Breen, Louise BA; Fluet, Christina MPH; Strother, Heather MPH; Straus, John H. MD

doi: 10.1097/ADM.0000000000000340
Original Research

Objectives: Substance use screening is a recommended component of routine healthcare for adolescents. A 2008 survey of Massachusetts primary care physicians found high rates of screening, but low rates of validated tool use, leading to the concern that physicians may be missing substance use-related problems and disorders. In an effort to improve practice, a cross-disciplinary group developed and distributed an adolescent screening, brief intervention, and referral to treatment toolkit in 2009. A new survey of Massachusetts primary care physicians was conducted in 2014; this report describes its findings, and compares them to those from 2008.

Methods: A survey was mailed to a randomly selected sample of Massachusetts primary care physicians listed in the state Board of Registration in Medicine database. Item response frequencies were computed. Multiple logistic regression modeling was used to compare 2008 and 2014 responses, while controlling for any demographic differences between samples.

Results: Pediatrician respondents in 2014 (analysis N = 130) reported a high rate of annually screening patients for alcohol use (96.2%), but only 56.2% reported using a validated screening tool. Rates of screening and validated tool use were higher in 2014 than 2008. Insufficient knowledge as a reported barrier to screening decreased from 2008 to 2014. However, lack of time or staff resources remained key perceived barriers to screening.

Conclusions: Our findings suggest that adolescent alcohol use screening practices among Massachusetts pediatricians have improved in recent years, during a time of national and statewide efforts to educate physicians. However, opportunities for practice improvement remain.

Adolescent Substance Abuse Program, Division of Developmental Medicine, Boston Children's Hospital (SL, REZ, LR, LB), Department of Pediatrics, Harvard Medical School (SL, SKH), Center for Adolescent Substance Abuse Research, Division of Developmental Medicine (SKH), Division of Adolescent/Young Adult Medicine, Boston Children's Hospital (SKH), Division of Child, Youth, and Family Services, Massachusetts Department of Mental Health (CF, HS), Massachusetts Child Psychiatry Access Program, Massachusetts Behavioral Health Partnership, Beacon Health Options, Boston, MA (JHS).

Send correspondence to Sharon Levy, MD, MPH, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail:

Received 18 April, 2017

Accepted 2 July, 2017

The Massachusetts Department of Mental Health and Centers for Medicaid and Medicare Service, State Innovation Model grant to the Commonwealth of Massachusetts (CMS-1G1-12-001) provided support for the administration of the 2014 survey and the analysis of results. The Massachusetts Department of Public Health Bureau of Substance Abuse Services provided support for survey administration and the development of the screening, brief intervention, and referral to treatment toolkits. The authors acknowledge additional support from the National Institute on Alcohol Abuse and Alcoholism (1R01AA021904, 1R34AA023026, 1R01AA022493), the Substance Abuse and Mental Health Services Administration (#TI025389), and the Health Resources and Services Administration Maternal and Child Health Bureau's Leadership Education in Adolescent Health Training Program (#T71MC00009).

Ms Ziemnik and Dr Levy had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Levy supervised administration of the survey, data analysis, and preparation of the manuscript. Ms Ziemnik conducted data analyses and drafted the manuscript. Dr Harris advised data analysis, and assisted with manuscript revisions and editing. Ms Rabinow assisted data analysis and preparation of the manuscript. Ms Breen assisted with manuscript preparation and revisions. Ms Strother and Ms Fluet edited the draft article, 2014 survey, and 2015 SBIRT toolkit. Dr Straus edited the draft article, 2008 and 2014 surveys, 2009 and 2015 SBIRT toolkits and was responsible for administration of 2014 survey. The authors have no conflicts of interest to disclose.

© 2017 American Society of Addiction Medicine