Adolescent substance use screening in primary care: Validity of computer self-administered versus clinician-administered screening

ABSTRACT

Background: Computer self-administration may help busy pediatricians' offices increase adolescent substance use screening rates efficiently and effectively, if proven to yield valid responses. The CRAFFT screening protocol for adolescents has demonstrated validity as an interview, but a computer self-entry approach needs validity testing. The aim of this study was to evaluate the criterion validity and time efficiency of a computerized adolescent substance use screening protocol implemented by self-administration or clinician-administration. Methods: Twelve- to 17-year-old patients coming for routine care at 3 primary care clinics completed the computerized screen by both self-administration and clinician-administration during their visit. To account for order effects, we randomly assigned participants to self-administer the screen either before or after seeing their clinician. Both were conducted using a tablet computer and included identical items (any past-12-month use of tobacco, alcohol, drugs; past-3-month frequency of each; and 6 CRAFFT items). The criterion measure for substance use was the Timeline Follow-Back, and for alcohol/drug use disorder, the Adolescent Diagnostic Interview, both conducted by confidential research assistant interview after the visit. Tobacco dependence risk was assessed with the self-administered Hooked on Nicotine Checklist (HONC). Analyses accounted for the multisite cluster sampling design. Results: Among 136 participants, mean age was 15.0 ± 1.5 years, 54% were girls, 53% were black or Hispanic, and 67% had ≥3 prior visits with their clinician. Twenty-seven percent reported any substance use (including tobacco) in the past 12 months, 7% met criteria for an alcohol or cannabis use disorder, and 4% were HONC positive. Sensitivity/specificity of the screener were high for detecting past-12-month use or disorder and did not differ between computer and clinician. Mean completion time was 49 seconds (95% confidence interval [CI]: 44–54) for computer and 74 seconds (95% CI: 68–87) for clinician (paired comparison, P < .001). Conclusions: Substance use screening by computer self-entry is a valid and time-efficient alternative to clinician-administered screening.

KEYWORDS:

• Adolescents
• alcohol
• cannabis
• computers
• drugs
• primary care
• screening
• substance use
• tobacco
• validity (epidemiology)

Acknowledgments

The authors thank the physicians and staff at our 3 participating clinics for assistance with study implementation, including Julia Lee, PNP MPH, Department of Pediatrics, Tufts Medical Center–Floating Hospital for Children; Deborah Glotzer, MD, Ellen Sigman, MD, Margaret Coleman, MD, Paul Geltman, MD, and Jeanette Callahan, MD, at Cambridge Pediatrics, Cambridge Health Alliance; and José Alberto Betances, MD, Department of Pediatrics–Adolescent Center, Boston Medical Center. The authors also acknowledge research assistants Rebecca Adams, Tatyana Buynitsky, Kateryna Kuzubova, and Roman Pavlyuk for their invaluable help with data collection. Finally, the authors thank the adolescent patients who agreed to participate.

Author contributions

Drs. Harris and Knight had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Harris, Knight, and Saitz conceptualized and designed the study; obtained funding; oversaw study implementation; performed data analysis and interpretation; drafted the initial manuscript; revised the manuscript critically for important intellectual content; approved the final manuscript to be published; and agree to be accountable for all aspects of the work. Ms. Van Hook coordinated and supervised data collection across all sites; acquired study data; revised the manuscript critically for important intellectual content; approved the final manuscript to be published; and agrees to be accountable for all aspects of the work. Mr. Sherritt substantially contributed to the design of the study; developed the computerized screening and data collection programs; performed data analysis and interpretation; revised the manuscript critically for important intellectual content; approved the final manuscript to be published; and agrees to be accountable for all aspects of the work. Drs. Brooks, Kulig, and Nordt substantially contributed to the acquisition of study data; revised the manuscript critically for important intellectual content; approved the final manuscript to be published; and agree to be accountable for all aspects of the work.

Funding

This study was supported by grant 3R01DA025068-05S1 from the National Institute on Drug Abuse. The National Institute on Drug Abuse (NIDA) was involved in the review and approval of study design and conduct; review and approval of the manuscript for publication; and the decision to submit the manuscript for publication. NIDA was not involved in the collection, management, analysis, or interpretation of the data. Other support was provided by grant K07 AA013280 from the National Institute on Alcohol Abuse and Alcoholism (J.K.); grants T20MC07462 (J.K., S.V.H.) and T71NC0009 (S.K.H.) from the Maternal and Child Health Bureau. No author has any conflict of interest or financial relationship relevant to this article to disclose.