Caregiver Acceptability of Hospital-based Household Substance Use Screening during Pediatric Hospital Admissions

Exposure to household substance use (SU) is an adverse childhood experience linked to poor long-term health outcomes. Despite guidelines, pediatricians infrequently screen for household SU, often citing concerns about offending parents. Prior outpatient studies suggest caregivers support universal outpatient screening, but acceptability in inpatient settings remains unclear. This study assessed caregiver acceptance of household SU screening during pediatric hospitalizations, differences by reported household SU, and the association between screening acceptability and caregiver trust in inpatient pediatricians.

English-speaking adult caregivers of pediatric patients admitted to a community hospital's newborn or pediatric floor (October 2023-June 2024) completed an anonymous computer-based survey. Measures included items on screening acceptability, provider trust, demographics, and household SU. Chi-squared tests and multivariable logistic regression were used to assess associations.

Of 278 respondents, 58% were mothers, 44% were Black, and 42% were insured with Medicaid. Forty percent reported current household SU, most commonly alcohol (70%), marijuana (43%), and tobacco (28%). Most caregivers supported screening for household SU (89% to 96%), with no differences by SU in the home. Caregivers with education beyond high school (aOR 4.15) and those on the newborn floor (aOR 2.45) were more likely to find screening acceptable. Trust in inpatient pediatricians was strongly associated with acceptability (aOR 14.19, p=0.001) CONCLUSIONS: Caregivers broadly support inpatient screening for household SU, even when SU is present. Trust in providers significantly influences acceptance, highlighting the importance of building trusting relationships to support families and address intergenerational SU risk.