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Objective: Alcohol- and drug-related car crashes are a leading cause of death for adolescents in the United States. This analysis tested the effects of a computer-facilitated Screening and Brief Advice (cSBA) system for primary care on adolescents' reports of driving after drinking or drug use (driving) and riding with substance-using drivers (riding)., Method: Twelve- to 18-year-old patients (N = 2,096) at nine New England pediatric offices completed assessments only during the initial 18-month treatment-as-usual (TAU) phase. Subsequently, the 18-month cSBA intervention phase began with a 1-hour provider training and implementation of the cSBA system at all sites. cSBA included a notebook-computer with self-administered screener, immediate scoring and feedback, and 10 pages of scientific information and true-life stories illustrating substance-related harms. Providers received screening results, "talking points" for 2 to 3 minutes of counseling, and a Contract for Life handout. Logistic regression with generalized estimating equations generated adjusted relative risk ratios (aRRR) for past-90-day driving and riding risk at 3- and 12-month follow-ups, controlling for significant covariates., Results: We found no significant effects on driving outcomes. At 3 months, cSBA youth were less likely than TAU to report riding with a drinking driver (aRRR = 0.70, 95% CI [0.49, 1.00]), and less likely to report riding with a driver who had used cannabis or other drugs (aRRR = 0.46, 95% CI [0.29, 0.74]). The effect was even greater (aRRR = 0.34, 95% CI [0.16, 0.71]) for riding with drinking drivers who were adult family members. All effects dissipated by 12-month follow-up., Conclusions: Screening and pediatrician brief advice shows promise for reducing adolescents' risk of riding with substance-using drivers.

Objective: Alcohol-related car crashes are a leading cause of adolescent death, and one in five U.S. adolescents reports recent riding in a car with a drinking driver. How often the driver is an adult in the home (e.g., parent) is unknown. Pediatric visits offer an opportunity to counsel families to reduce this risk. Our study aim was to determine the prevalence of recent riding with a drinking driver (RWDD) who was an adult in the home among adolescent primary care patients and to identify the demographic and environmental (substance use among family members) profiles of those at increased risk., Method: We recruited 12- to 18-year-olds arriving for routine medical care between 11/2005 and 10/2008 from nine practices in New England. Computer self-administered questionnaires assessed demographics, past-3-month RWDD, driver characteristics, and parent/sibling substance use. We computed adjusted relative risk ratios using multiple logistic regression modeling., Results: Among 2,096 adolescents (86% participation rate; mean age = 15.8 years, SD = 2.0; 58% girls; 65% White non-Hispanic), 8.2% reported past-3-month RWDD who was an adult in the home (36.6% of those reporting any past-3-month RWDD). Risk was higher for girls, younger adolescents (<17 year olds), White non-Hispanic and Hispanic versus Black youth, those with non-college-graduate parents, and those with substance-involved parents., Conclusions: For a substantial proportion of adolescent primary care patients RWDD, the driver is a parent or other household adult, suggesting an important target for screening and counseling.

Purpose: To determine if peer risk (having friends who drink or approve of drinking) modifies the effects of a computer-facilitated screening and provider brief advice (cSBA) intervention on adolescent alcohol use., Methods: We assessed the intervention effect using logistic regression modeling with generalized estimating equations on a sample of 2,092 adolescents. Effect modification by peer risk was analyzed separately for alcohol initiation (drinking at follow-up in baseline nondrinkers) and cessation (no drinking at follow-up in baseline drinkers) by testing an interaction term (treatment condition by peer risk). Interpretation of the interaction effect was further clarified by subsequent stratification by peer risk., Results: The intervention effect on alcohol cessation was significantly greater among those with peer risk (adjusted relative risk ratios; risk 1.44, 1.18-1.76 vs. no risk .98, .41-2.36) at 3 months' follow-up. There was no such finding for alcohol initiation., Conclusions: Alcohol screening and brief provider counseling may differentially benefit adolescent drinkers with drinking friends., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Opioid dependence is a significant problem for adolescents in the United States. Psychosocial treatment for adolescents with opioid use disorders may be effective, although it has not been well studied., Methods: This paper describes a 13-week psychoeducational group therapy program with parallel tracks for adolescents with opioid use disorders and their parents attending an outpatient substance use program in a children's hospital. In addition to group therapy, participating adolescents received medical care, including medication-assisted treatment for opioid dependence, drug testing, medical follow-up, psychopharmacology, individual counseling, and parent guidance. Data were collected as part of a quality improvement project for the program. Forty-two adolescents and 72 parents attended the group program between 2006 and 2009. Frequencies were computed and a weighted kappa was used to assess agreement between adolescent and parent reports of use and driving risk., Results: Of the 42 adolescents participating in the 13-week group program, 36 (86%) completed 3 or more group sessions, and 24 (57%) completed 10 or more sessions. Twenty-two (52%) adolescent participants reported abstinence from all substances on each of their weekly evaluations. Adolescent-parent agreement for substance use was good to very good: weighted kappa (95% confidence interval) .76 (.60, .87), but poor for driving risk, weighted kappa .11 (-.20, .40)., Conclusions: Completion rates and self-report of outcomes from this group program indicate promise and warrant further testing.

Background: Laboratory drug testing programs may be effective in reducing substance use by adolescents, but developmentally appropriate programs have not been described, and it is unknown if adolescents would be willing to participate in drug testing., Objective: To describe a drug testing protocol for adolescents and report on acceptance rate by patients participating in an outpatient adolescent substance abuse program., Methods: Eligible adolescents participating in an outpatient substance abuse treatment program were offered a random laboratory drug testing program that is described in detail in this manuscript. We recorded whether they accepted and, if not, the reason for refusal., Results: Of the first 114 eligible patients, 67 (59%) agreed to participate in a drug testing program (PDT)., Conclusions: A majority of adolescents participating in an outpatient drug treatment program agreed to participate in a drug testing program that requires frequent urine specimens and reports results to parents. Future studies should determine how this program affects treatment outcomes and whether this program is feasible in primary care., (Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Developed for use in health research, the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) consists of brief measures of a broad range of religiousness and spirituality (R/S) dimensions. It has established psychometric properties among adults, but little is known about its appropriateness for use with adolescents., Purpose: We assessed the psychometric properties of the BMMRS among adolescents., Method: We recruited a racially diverse (85% non-White) sample of 305 adolescents aged 12-18 years (median 16 yrs, IQR 14-17) from 3 urban medical clinics; 93 completed a retest 1 week later. We assessed internal consistency and test-retest reliability. We assessed construct validity by examining how well the measures discriminated groups expected to differ based on self-reported religious preference, and how they related to a hypothesized correlate, depressive symptoms. Religious preference was categorized into "No religion/Atheist" (11%), "Don't know/Confused" (9%), or "Named a religion" (80%)., Results: Responses to multi-item measures were generally internally consistent (alpha > or = 0.70 for 12/16 measures) and stable over 1 week (intraclass correlation coefficients > or = 0.70 for 14/16). Forgiveness, Negative R/S Coping, and Commitment items showed lower internal cohesiveness. Scores on most measures were higher (p < 0.05) among those who "Named a religion" compared to the "No religion/Atheist" group. Forgiveness, Commitment, and Anticipated Support from members of one's congregation were inversely correlated with depressive symptoms, while BMMRS measures assessing negative R/S experiences (Negative R/S Coping, Negative Interactions with others in congregation, Loss in Faith) were positively correlated with depressive symptoms., Conclusions: These findings suggest that most BMMRS measures are reliable and valid for use among adolescents.

Objective: To assess adolescents' preferences for substance abuse screening in primary medical care settings., Design/methods: Twelve- to 18-year-old patients (N = 2133) arriving for routine care at a network of primary care sites completed an interview that included demographic items, the CRAFFT screen, and a questionnaire assessing preferences for screening method (paper questionnaire, computer, oral interview by nurse or doctor). A subgroup (n = 222) completed the CRAFFT directly on the computer., Results: Across the entire sample, paper was the screening administration method most preferred (mean rank (MR) = 2.92, 95%CI 2.87-2.96) vs. computer (MR = 2.38, 2.33-2.43), nurse (MR = 2.43, 2.39-2.47), and doctor (MR = 2.30, 2.25-2.35). Among the participants who received the screening on the computer, however, computer (MR = 3.08, 95%CI 2.42-2.52) was statistically tied with paper (MR = 2.88, 2.75-3.02) and both were ranked significantly higher than nurse (MR = 2.06, 1.94-2.17) and doctor (MR = 1.98, 1.82-2.14). The findings were similar for participants' reports of being "very likely" to be honest when answering substance abuse screening questions., Conclusions: Adolescents should ideally be screened for substance abuse using paper or computer questionnaires.

Background: Adolescent substance abuse is a serious problem for which effective interventions are needed. To conduct trials of new therapies, investigators need reliable means of identifying potential participants and of measuring outcomes. The objective of this study was to determine the 1-week test-retest reliability of the CRAFFT screening test and of the timeline follow-back (TLFB) calendar method for measuring alcohol, cannabis, and other drug use., Methods: Ninety-three 12- to 18-year-old patients presenting for routine medical care to three urban adolescent clinics were administered the CRAFFT screen in both lifetime and past-year versions and a 90-day TLFB. Both measures were completed on the day of the clinic visit and again 1 week later. We computed kappa coefficients and the intraclass correlation coefficient (ICC) for the CRAFFT and computed the ICC separately for TLFB self-reports of alcohol and cannabis., Results: For the CRAFFT, kappa for individual items ranged from 0.31 to 0.86, and the ICC was 0.93 (95% confidence interval, 0.90-0.95). However, the total score of the lifetime CRAFFT at time 2 was significantly lower than at time 1; there was no difference in time 1 and time 2 total scores for the past-year version. The ICCs for past-90-days TLFB variables were as follows: drinking days, 0.92; drinks per occasion, 0.87; cannabis days, 0.83; and joints per occasion, 0.76. Past-30-day and past-60-day intervals compared favorably to past-90-day intervals., Conclusions: The CRAFFT screen is a reliable means of screening adolescents for substance abuse, although we recommend using the past-year version. The TLFB is a reliable method of quantifying adolescents' alcohol and cannabis use at intervals of 30, 60, or 90 days., (Copyright 2004 Research Society on Alcoholism)