Substance use screening more common among marginalized adolescents

TOP LINE:

Injured adolescents who present to trauma centers and are black, Native American, or Hispanic are more likely to be screened for alcohol or biochemical drugs than their white peers. Adolescents insured by Medicaid also have higher screening rates.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using the Trauma Quality Programs data set from 2017 to 2021 to examine sociodemographic disparities in screening for substance use among injured adolescents.
• They included 85,362 adolescent trauma patients aged 12 to 17 years (66.7% white; 81.8% non-Hispanic; 28% female; 51.3% privately insured) from 121 pediatric trauma centers.
• Overall, 24.5% and 21.8% of participants underwent biochemical screening for alcohol and drugs, respectively.

TAKE AWAY:

• The odds of being tested for alcohol and drugs were 8% (P. = 0.02) and 13% (P. P.
• Hispanic adolescents were 20% and 12% more likely to be tested for alcohol (P. P = 0.001), respectively, than non-Hispanic adolescents.
• Compared to boys, girls had a 32% higher risk of alcohol testing and a 28% higher risk of drug testing (P.
• Medicaid-insured and uninsured adolescents were more likely to be screened than adolescents with private insurance.

IN PRACTICE:

“Our findings indicate potential disparities in screening for biochemical substance use in pediatric trauma centers. With drug overdoses and poisonings being the third leading cause of childhood death, high-quality screening is essential for both injury prevention and for public health,” the study authors wrote. .

Differences in screening rates “may reflect clinician bias, as inequalities persisted despite adjusting for clinical characteristics and after grouping patients across trauma centers to account for institutional screening practices,” they wrote the researchers.

SOURCE:

This study was led by Jordan M. Rook, MD, VA Greater Los Angeles Healthcare System, Los Angeles, and was published online October 4, 2024 in Open JAMA Network.

BOUNDARIES:

The dataset used in the analysis did not indicate whether a positive test was followed by intervention or treatment, making it unclear whether the benefits of screening outweighed the potential harms. It also did not monitor interview-based substance use screening, which limited the assessment to biochemical screening only. Additionally, it remained unclear whether disparities in testing rates differed by hospital case mix, which could have affected the generalizability of the results.

DISCLOSURES:

Some authors have received research support or funding from the VA Office of Academic Affiliations through the National Clinician Scholars Program Fellowship, the Association for Academic Surgery Clinical Outcomes and Health Services Research Award, and other sources. One author disclosed receipt of grant funding from the National Institutes of Health, outside of the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.