Detecting initiation or risk for initiation of substance use before high school during pediatric well-child check-ups

Abstract

Background Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index© (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups. Design A high-risk longitudinal design with two cross-sectional replication samples, ages 9–13 was used. Analyses included receiver operating characteristics and regression analyses. Participants A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool. Results YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratio=7.44 CI=4.3–13.0) and conduct problems (odds ratios=7.33 CI=3.9–13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service. Conclusions Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI’s association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders.

Substance Use Patterns Through Early Adulthood

“…Policy reforms hold promise for improving the health of adolescents and young adults and may provide a context for integrating screening and brief intervention into practice, to address the alarmingly high rates of substance use among medically vulnerable youth. 34,50 Life course outcomes for chronically ill youth are imperiled without effective disease management, 51–53 and substance use may adversely affect self-care and interrupt disease management habits. Early identification and response to ameliorate substance use among YCMC, using a model that appropriately considers this group’s heightened risk for health harm, are critical for protecting health and preventing complications and exacerbations.…”

Addressing Barriers to Primary Care Screening and Referral to Prevention for Youth Risky Health Behaviors: Evidence Regarding Potential Cost-Savings and Provider Concerns

“…Additional recent SRP innovations may address physician concerns such as availability of brief, psychometrically strong screening tools; behavioral specialists embedded into primary care; evidence-based healthcare prevention programs; and evidence that parents and patients support SRP (Galan et al, 2021;Ozechowski et al, 2016;Prado et al, 2019;Ridenour et al, 2015;Sterling et al, 2015). Evidence is accumulating regarding efficacy and effectiveness of healthcarebased screening and referral related to risky behaviors (Moyer & USPSTF, 2013;Tanner-Smith & Lipsey, 2015).…”

“…First, we estimated the burden of hospital charges to healthcare payors for services arising from risky behaviors (toward building a business case for healthcare-based SRP). Second, we evaluated providers' perceptions of SRP barriers and facilitators, based on a recently developed SRP for well-child visits that uses a preteen self-report screening tool of propensity for risky health behaviors (not asking about the behaviors per se) given by behavior specialists who interpret scores, make "referrals," and provide family-based prevention (Galan et al, 2021;Ridenour et al, 2015).…”

“…Likewise, no estimates exist regarding the initial investment that would be required of healthcare payors to fund SRP. Thus, we estimated cost-savings needed to yield a return on investment in a specific SRP that uses the Youth Risk Index screening tool and the Family Check-Up intervention (see its description in Study 2 Supplemental Materials; Galan et al, 2021;Ridenour et al, 2015). Costs were based on 2019 Medicaid fee schedules for services of SBIRT and family therapy, which resemble this SRP.…”

Neurodevelopmental Precursors and Consequences of Substance Use during Adolescence: Promises and Pitfalls of Longitudinal Neuroimaging Strategies

“…Combined with other recruitment sources (e.g., Craigslist, in-person), we identified a total of 971 families that were identified as potentially eligible cases for the web survey. Additional strategies described below supplemented these listings based on successful efforts in large-scale longitudinal studies of high-risk adolescents (Trotman et al, 2014 ; Ridenour et al, 2015 ).…”