Black, Hispanic and Native American adolescents face more drug and alcohol testing than their white peers at trauma centers

By Enrique Rivero

(Newswise) – Injured adolescents from marginalized groups treated at pediatric trauma centers are more likely to be tested for drugs and alcohol than white adolescents, even when controlling for severity of injuries, study suggests conducted by researchers at UCLA and Children’s Hospital Los Angeles.

The findings, to be published Oct. 4 in the peer-reviewed JAMA Network Open, suggest that clinician biases may influence the selection of adolescents for screening for biochemical use in pediatric trauma centers, a said Dr. Jordan Rook, general surgery resident at the David Geffen School of Medicine at UCLA and lead author of the study. These unfair testing models can lead to stigma and possibly even legal implications for some injured adolescents.

“While screening can have a positive effect on patients if followed by counseling and treatment, it can also have negative consequences,” Rook said. “We believe that existing substance use screening guidelines may be inadequate to achieve high-quality, equitable screening in adolescent trauma care. Stricter guidance and monitoring and/or implementation of universal screening protocols and equitable use of support services may be necessary.

Researchers used data from the 2017-2021 ACS Trauma Quality Programs for 85,400 adolescent trauma patients ages 12 to 17 from 121 pediatric trauma centers. Of these teens, 67 percent were white, 82 percent were non-Hispanic, 72 percent were male, and 51 percent had private insurance.

Of the total number of adolescents, 25 percent were tested for alcohol and 22 percent for drugs. Overall, Native American, black, Hispanic, female, Medicaid-insured and uninsured adolescents were more likely to be screened for alcohol and drugs, the researchers found.

Among the findings:

For black adolescents, the odds of being tested for alcohol and drugs were 8% and 13% higher, respectively, than for white adolescents.

For Native American adolescents, the odds of being tested for alcohol and drugs were 117 percent and 75 percent higher, respectively, than for white adolescents.

For Hispanic adolescents, the odds of being tested for alcohol and drugs were 20 percent and 12 percent higher, respectively, than for white adolescents.

For adolescent girls, the odds of being tested for alcohol and drugs were 32 percent and 28 percent higher, respectively, than for men.

For adolescents with Medicaid insurance, the odds of being tested for alcohol and drugs were 15 percent and 28 percent higher, respectively, than for adolescents with private insurance.

The authors note that there are some limitations to the study. The data used by the authors does not describe whether the tests resulted in treatment or intervention. It is therefore unclear whether the benefits of screenings outweigh the potential harms. Additionally, the data include only biochemical screening tests and not interview-based screenings, thus underestimating overall screening rates.

Researchers are conducting more studies based on these findings to identify potential solutions to inequality, Rook said. Using national data, they are studying whether individual hospital practices reduce screening disparities, and they will also examine the accuracy and effectiveness of interview-based screening compared to biochemical screening.

“These efforts are all aimed at equitably increasing substance use screening and support services for all adolescents,” Rook said.

The study’s lead author is Dr. Lorraine Kelley-Quon of Children’s Hospital Los Angeles and the University of Southern California. Other co-authors are Dr. Catherine Juillard of UCLA, Dr. Ryan Spurrier, Dr. Cathy Shin of Children’s Hospital Los Angeles and the University of Southern California, Dr. Christopher Russell of Stanford University and Dr. Steven Lee of Seattle Children’s Hospital. .

The study was funded by the VA Office of Academic Affiliations through the National Clinician Scholars Program grant, the Association for Academic Surgery Clinical Outcomes and Health Services Research Award, and a grant from the National Center for Advancing Translational Sciences UCLA CTSI (UL1TR001881).