U.S. Pediatricians' Attitudes and Practices Around Screening for Substance Use in Adolescents

To examine primary care pediatricians' attitudes and practices around substance use screening, including barriers to screening.

The 2021 American Academy of Pediatrics Periodic Survey was completed by a national, random sample of 1,683 nonretired US American Academy of Pediatrics members (residents excluded; response rate 43%). Pediatricians who reported providing health supervision to adolescents (n = 455) completed survey items assessing substance use screening practices and attitudes, including barriers to screening and access to treatment resources. Multivariable logistic regression identified associations between physician- and practice-level characteristics and (1) using a standardized substance use screening instrument and (2) barriers to substance use screening.

Nine of 10 primary care pediatricians (404/455) reported always/often screening adolescent patients for substance use during health supervision visits, with 41% usually using a standardized instrument. Compared to those in the Northeast, pediatricians in the South (adjusted odds ratio 0.56; 95% confidence interval [CI] 0.32-0.97), Midwest (adjusted odds ratio 0.26; 95% CI 0.13-0.49), or West (0.46; 95% CI 0.25-0.85) were half as likely to report use of a standardized screening instrument. The most common barriers to screening were a lack of treatment options for adolescents with a positive screen (69%), a lack of on-site substance use counseling providers (67%), and needing more information on counseling (50%). Most pediatricians reported it was difficult/very difficult to find outpatient behavioral interventions (76%), inpatient treatment (79%), or medication management services (73%) for adolescent substance use.

These data highlight variability in substance use screening practices by US region. Systems-level interventions that strengthen workforce training on screening and the availability of referral resources may help overcome barriers to screening.