Substance Use Screening Practices among Primary Care Pediatricians in the US: Results from the 2021 AAP Periodic Survey

Camenga D, Hadland S, Zoucha K, Somberg C, Burr W

Presented at the 2023 Pediatric Academic Societies Annual Meeting

Background: The American Academy of Pediatrics (AAP) recommends universal screening for substance use during annual health supervision visits with adolescents. Current screening rates and practices among US primary care pediatricians are unknown.

Objective: Examine primary care pediatricians’ substance use screening practices and reported barriers to screening. Determine which practice characteristics are associated with a) always screening for substance use, and b) using a standardized instrument (e.g. S2BI, BSTAD, CRAFFT etc.) to screen.

Methods: The 2021 AAP Periodic Survey was completed by a national, random sample of 1,683 non-retired US AAP members (residents excluded; response rate-43%). Survey measures assessed screening practices (e.g. frequency, screening method), perceived barriers to screening, and practice characteristics. The analytic sample included n=471 pediatricians who reported providing health supervision to adolescents. Data were weighted for non-response bias by age. Separate multivariable logistic regression models examined associations between practice characteristics and a) screening frequency (Always vs Often/Occasionally/Rarely/Never) and b) using a standardized instrument (Yes vs No). Covariates included practice area, US region, and setting, and % of patients seen who were adolescents or experiencing financial hardship.

Results: Sixty percent of primary care pediatricians (284/471) reported always screening adolescent patients for substance use during health supervision visits; 42% used a standardized instrument. Among those who screened, 52% administered paper-based screeners, and 77% screened without a parent present. Pediatricians endorsed agreement (agree/strongly agree) with the following barriers: lack of treatment options for adolescents with a positive screen (70%) and perceptions that patients are reluctant to discuss substance use (49%). Fewer agreed/strongly agreed that inadequate payment for screening (38%), competing priorities (39%), or lack of time (30%) were barriers to screening [Figure]. Compared to those in the Northeast, pediatricians in the South, Midwest, or West had half the odds of reporting that they always screened or used a standardized screening instrument [Table 1].

Conclusion: These data highlight variability in substance use screening practices by US region. Pediatricians may benefit from electronic health-record embedded tools to support adoption and use of confidential and standardized screening instruments. Systems-level interventions that improve treatment access may help overcome barriers related to substance use screening in pediatric primary care.

Figure 1. Primary care pediatricians’ reported barriers to adolescent substance use screening

Table 1. Association between Substance Use Screening and Primary Care Pediatrician Practice Characteristics