High-risk Behavior Screening and Interventions in Hospitalized Adolescents

Risky behaviors are the main threats to adolescents' health. Consequently, guidelines recommend adolescents be screened annually for high-risk behaviors. Our objectives were to (1) determine rates of physician-documented risk behavior screening of hospitalized adolescents, (2) determine rates of positive screening results, and (3) evaluate associations between risk behavior screening and provision of risk behavior-related health care interventions.

We conducted a cross-sectional study of patients aged 12 to 24 years admitted to the pediatric hospital medicine service at an urban tertiary children's hospital from January to December 2018. Exclusion criteria were transfer to a different service, nonverbal status, or altered mental status. We reviewed 20 charts per month. Outcomes included (1) documentation of risk behavior screening (mood, sexual activity, substance use, abuse and/or violence, and suicidal ideation), and (2) risk behavior-related health care interventions (eg, testing for sexually transmitted infections). We determined associations between screening and risk behavior-related interventions using χ² tests.

We found that 38% (90 of 240) of adolescents had any documented risk behavior screening, 15% (37 of 240) had screening in 4 of 5 risk behavior domains, and 2% (5 of 240) had screening in all 5 domains. The majority of screened adolescents had a positive screening result (66%), and most with positive results received a risk behavior-related health care intervention (64%-100% across domains). Adolescents with documented screening were significantly more likely to receive a risk behavior-related health care intervention.

We found low rates of risk behavior screening documentation among hospitalized adolescents. There was a high rate of positive screen results, and those who were documented as screened were more likely to receive risk behavior-related interventions.