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Background: Alcohol and cannabis use frequently co-occur, which can result in problems from social and academic impairment to dependence (i.e., alcohol use disorder [AUD] and/or cannabis use disorder [CUD]). The Emergency Department (ED) is an excellent site to identify adolescents with alcohol misuse, conduct a brief intervention, and refer to treatment; however, given time constraints, alcohol use may be the only substance assessed due to its common role in unintentional injury. The current study, a secondary data analysis, assessed the relationship between adolescent alcohol and cannabis use by examining the National Institute of Alcohol Abuse and Alcoholism (NIAAA) two question screen's (2QS) ability to predict future CUD at one, two, and three years post-ED visit. Methods: At baseline, data was collected via tablet self-report surveys from medically and behaviorally stable adolescents 12-17 years old (n = 1,689) treated in 16 pediatric EDs for non-life-threatening injury, illness, or mental health condition. Follow-up surveys were completed via telephone or web-based survey. Logistic regression compared CUD diagnosis odds at one, two, or three-year follow-up between levels constituting a single-level change in baseline risk categorization on the NIAAA 2QS (nondrinker versus low-risk, low- versus moderate-risk, moderate- versus high-risk). Receiver operating characteristic curve methods examined the predictive ability of the baseline NIAAA 2QS cut points for CUD at one, two, or three-year follow-up. Results: Adolescents with low alcohol risk had significantly higher rates of CUD versus nondrinkers (OR range: 1.94-2.76, p < .0001). For low and moderate alcohol risk, there was no difference in CUD rates (OR range: 1.00-1.08). CUD rates were higher in adolescents with high alcohol risk versus moderate risk (OR range: 2.39-4.81, p < .05). Conclusions: Even low levels of baseline alcohol use are associated with risk for a later CUD. The NIAAA 2QS is an appropriate assessment measure to gauge risk for future cannabis use.

ObjectivesTo determine the test-retest reliability, concurrent, convergent, and discriminant validity of a recently devised screen (the Newton screen) for alcohol and cannabis use/misuse, and its predictive validity at follow-up.Study designAdolescents, 12-17 years old (n = 4898), treated in 1 of 16 participating pediatric emergency departments across the US were enrolled in a study as part of a larger study within the Pediatric Emergency Care Applied Research Network. Concurrent and predictive validity (at 1, 2, and 3 years of follow-up) were assessed in a random subsample with a structured Diagnostic and Statistical Manual of Mental Disorders-based interview. Convergent validity was assessed with the Alcohol Use Disorders Identification, a widely used alcohol screening measure.ResultsThe sensitivity of the Newton screen for alcohol use disorder at baseline was 78.3% with a specificity of 93.0%. The cannabis use question had a baseline sensitivity of 93.1% and specificity of 93.5% for cannabis use disorder. Predictive validity analyses at 1, 2, and 3 years revealed high specificity but low sensitivity for alcohol and high specificity and moderate sensitivity for cannabis.ConclusionsThe Newton screening instrument may be an appropriate brief screening tool for use in the busy clinical environment. Specificity was high for both alcohol and cannabis, but sensitivity was higher for cannabis than alcohol. Like other brief screens, more detailed follow-up questions may be necessary to definitively assess substance misuse risk and the need for referral to treatment.

BackgroundThe pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse.ObjectiveA multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs.MethodsParticipants included 12-17-year olds (n = 4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer.ResultsA diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question screen is a valid adolescent alcohol screening tool. No studies have examined if this tool predicts future alcohol problems. We conducted a study at 16 pediatric emergency departments to determine the tool's predictive validity for alcohol misuse and alcohol use disorders (AUDs). Participants (N = 4834) completed a baseline assessment battery. A subsample of participants completed the battery at 1, 2, and 3 years follow up. Of the 2209 participants assigned to follow-up, 1611 (73%) completed a 1-year follow-up, 1591 (72%) completed a 2-year follow-up, and 1377 (62%) completed a 3-year follow-up. The differences in AUDs between baseline NIAAA screen nondrinkers and lower-risk drinkers were statistically significant at 1 year (P = .0002), 2 years (P

BACKGROUND: Children experiencing trauma are at risk of developing acute and chronic stress disorders. In 2022, the American College of Surgeons Committee on Trauma required verified pediatric trauma centers to screen at-risk patients and provide mental health provider referrals as needed. OBJECTIVE: The study objective is to assess the current readiness of pediatric trauma centers to meet the new American College of Surgeons requirements. METHODS: This study used an exploratory, electronic, cross-sectional survey design. The Pediatric Trauma Society distributed a survey on mental health screening practices to its members in February 2023. Results were summarized with descriptive statistics. Chi-square test was used to compare responses of Levels I and II pediatric trauma centers. RESULTS: There were 91 survey responses from the PTS membership of 1247 (response rate of 7.3%). Fifty-nine participants were from Level I and 27 from Level II pediatric trauma centers. 63.8% of Level I and 51.9% of Level II center respondents currently screened for acute stress (χ2(1) = 1.09, p =.30). Of these, 75.7% of Level I and 57.1% of Level II center respondents routinely screened all admitted trauma patients (χ2(1) = 1.68, p =.19). However, only 32.4% of Level I and 21.4% of Level II respondents reported having outpatient acute stress referral protocols. For pediatric trauma centers currently without screening, 65% of Level I and 46.2% of Level II pediatric trauma center respondents felt they needed more than six months to establish a program (χ2(1) = 1.15, p =.28). Most respondents (68.9%) reported staff shortages as a barrier to the delivery of acute stress services. CONCLUSIONS: Pediatric trauma center compliance with acute stress screening requirements for verification is variable. Pediatric trauma centers may benefit from technical assistance with acute stress screening. [ABSTRACT FROM AUTHOR]

OBJECTIVE:The aim of this study was to determine the psychometric properties of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within 16 Pediatric Emergency Care Applied Research Network pediatric emergency departments. This article describes the study methodology, sample characteristics, and baseline outcomes of the NIAAA 2-question screen. METHODS:Participants included 12- to 17-year-olds treated in one of the participating pediatric emergency departments across the United States. After enrollment, a criterion assessment battery including the NIAAA 2-question screen and other measures of alcohol, drug use, and risk behavior was self-administered by participants on a tablet computer. Two subsamples were derived from the sample. The first subsample was readministered the NIAAA 2-question screen 1 week after their initial visit to assess test-retest reliability. The second subsample is being reassessed at 12 and 24 months to examine predictive validity of the NIAAA 2-question screen. RESULTS:There were 4834 participants enrolled into the study who completed baseline assessments. Participants were equally distributed across sex and age. Forty-six percent of the participants identified as white, and 26% identified as black. Approximately one quarter identified as Hispanic. Using the NIAAA 2-question screen algorithm, approximately 8% were classified as low risk, 12% were classified as moderate risk, and 4% were classified as highest risk. Alcohol use was less likely to be reported by black participants, non-Hispanic participants, and those younger than 16 years. DISCUSSION:This study successfully recruited a large, demographically diverse sample to establish rates of the NIAAA screen risk categories across age, sex, ethnicity, and race within pediatric emergency departments.

The Covid‐19 pandemic resulted in unprecedented restrictions on many public, private, and workplace activities throughout the United States and elsewhere. When restrictions were imposed, we were conducting a type III hybrid effectiveness‐implementation trial in 10 pediatric trauma centers. In response to several pandemic‐based restrictions, we had to develop procedures for engaging with potential research participants while limiting nonclinical, in‐person interactions. This manuscript describes the procedures and challenges of obtaining electronic informed consent and assent in a multisite trauma center‐based research study. We developed, tested, and trained staff to implement three options for obtaining informed consent. Twenty‐five participants were enrolled in the effectiveness‐implementation multisite trial during the first six months of utilization of the consent options, with eleven of these individuals enrolled using hybrid or electronic consent procedures. The challenges we identified involving electronic consent procedures included confusion over who would complete the electronic consent process and difficulties reconnecting with families. Lessons learned can strengthen electronic consent and assent procedures for future studies. More research is needed to further strengthen this process and increase its utilization. [ABSTRACT FROM AUTHOR]

Moderate to vigorous physical activity (MVPA), sports, and reduced screen time are associated with favorable youth risk profiles. We evaluated the association of MVPA, sports, and screen time with adolescent behaviors among pediatric emergency department youth. Adolescents were assessed for alcohol/drug use, risky behavior, conduct disorder, and depressive mood. MVPA was activity for ≥5 days/week and ≥60 minutes/day. Increased screen time was ≥3 hours/day computer/TV use for non-schoolwork. Multivariable regression studied association between MVPA, sports, and increased screen time and outcomes adjusting for demographics and academic achievement. Older age and lower academic achievement were significantly associated with risky behaviors, conduct disorder, and depression. Youth who endorsed MVPA and sports participation had less depression (odds ratio [OR] = 0.76; confidence interval [CI] = 0.66-0.87). Increased screen time was associated with conduct disorder (OR = 1.6; CI = 1.3-2.1), depression (OR = 1.2; CI = 1.0-1.4), and drug use (OR = 1.8; CI = 1.1-2.8). In pediatric emergency department youth, MVPA and sports participation is associated with less depression. Increased screen time is associated with conduct disorders, depression, and drug use. [ABSTRACT FROM AUTHOR]

Objectives: In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single‐center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives. Methods: Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females. Results: In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette‐smoking males, as well as depressed females. Conclusions: Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at‐risk adolescent patients, address risky behaviors, and intervene to improve adolescent health. [ABSTRACT FROM AUTHOR]

Background: Identifying problem drinkers and providing brief intervention (BI) for those who screen positive are required within all level I trauma centers. While parent–adolescent relationships impact adolescent alcohol use, parenting skills are rarely included in adolescent alcohol BIs within pediatric trauma centers. Introduction: The primary objective of this study was to examine the feasibility and acceptability of an electronic parenting skills intervention for parents of injured adolescents who report alcohol or drug use. Materials and Methods: Across three pediatric level I trauma centers, admitted trauma patients 12–17 years of age, screening positive for alcohol or drug use, were consented along with one parent. Adolescent–parent dyads were enrolled and assigned to the intervention (Parenting Wisely web-based modules coupled with text messaging) or standard care conditions using a 2:1 allocation ratio. Teens completed 3- and 6-month follow-up surveys; parents completed 3-month follow-up surveys. Results: Thirty-seven dyads were enrolled into the study. Only one-third of parents accessed the web-based Parenting Wisely after baseline. All parents completed the text message program. At 3-month follow-up, 78% of parents endorsed that they would recommend the program to others. There were no significant differences in adolescent substance use or parenting behaviors between groups at follow-up. Discussion: A texting component is well received, but web-based components may be underutilized. Larger studies are necessary to determine if an electronic skills intervention has an effect on parenting skills and adolescent substance use. Conclusions: This study demonstrated accessibility and feasibility of an e-parenting intervention with more utilization of text components than web-based. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To understand the epidemiology and clinical outcomes of older adult pedestrian injury in Rhode Island. METHODS: Descriptive univariate analysis of data from Rhode Island Hospital's trauma registry on patients admitted for pedestrian-related injuries between 2017-2020. RESULTS: The rate of pedestrian injury in older adults was 1.5 times the rate in adults age 18-49. Injured older adult pedestrians experienced a higher rate of serious adverse events during hospitalization (18.0%) than their younger counterparts (10.3%) and had almost twice the mortality rate (14.9% versus 7.6%). Across ages, pedestrian injury rates are higher in densely populated areas, and those injured disproportionately are male and have comorbid alcohol and substance use disorders. CONCLUSIONS: The increased risk of pedestrian injury in older adults is evident and necessitates intervention. Further research is warranted on the root causes of higher pedestrian injury and mortality rates among older adults. [ABSTRACT FROM AUTHOR]

Objectives: To determine the test-retest reliability, concurrent, convergent, and discriminant validity of a recently devised screen (the Newton screen) for alcohol and cannabis use/misuse, and its predictive validity at follow-up.Study Design: Adolescents, 12-17 years old (n = 4898), treated in 1 of 16 participating pediatric emergency departments across the US were enrolled in a study as part of a larger study within the Pediatric Emergency Care Applied Research Network. Concurrent and predictive validity (at 1, 2, and 3 years of follow-up) were assessed in a random subsample with a structured Diagnostic and Statistical Manual of Mental Disorders-based interview. Convergent validity was assessed with the Alcohol Use Disorders Identification, a widely used alcohol screening measure.Results: The sensitivity of the Newton screen for alcohol use disorder at baseline was 78.3% with a specificity of 93.0%. The cannabis use question had a baseline sensitivity of 93.1% and specificity of 93.5% for cannabis use disorder. Predictive validity analyses at 1, 2, and 3 years revealed high specificity but low sensitivity for alcohol and high specificity and moderate sensitivity for cannabis.Conclusions: The Newton screening instrument may be an appropriate brief screening tool for use in the busy clinical environment. Specificity was high for both alcohol and cannabis, but sensitivity was higher for cannabis than alcohol. Like other brief screens, more detailed follow-up questions may be necessary to definitively assess substance misuse risk and the need for referral to treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: A multisite study was conducted to determine the psychometric properties of the National Institute of Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within pediatric emergency departments (PEDs). METHODS: Participants (N = 4838) included 12- to 17-year-old subjects treated in 1 of the 16 participating PEDs across the United States. A criterion assessment battery (including the NIAAA 2-question alcohol screen and other measures of alcohol, drug use, and risk behaviors) was self-administered on a tablet computer. A subsample (n = 186) was re-administered the NIAAA 2-question screen 1 week later to assess test-retest reliability. RESULTS: Moderate to good test-retest reliability was demonstrated. A classification of moderate risk or higher on the screen had the best combined sensitivity and specificity for determining a diagnosis of alcohol use disorder (AUD) for all students. Any past year drinking among middle school students increased the odds of a diagnosis of an AUD according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, whereas the optimal cutoff for high school ages was ≥3 drinking days in the past year. The optimal cutoff for drinking days determining a positive Alcohol Use Disorders Identification Test score among middle school subjects was ≥1 drinking day, whereas the optimal cutoff for high school subjects was ≥2 drinking days. CONCLUSIONS: The NIAAA 2-question screen is a brief, valid approach for alcohol screening in PEDs. A positive screen suggests that referral for further evaluation is indicated to determine if an adolescent has an AUD. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective of this study was to examine opioid prescription frequency and identify differences across a national cohort of pediatric trauma centers in rates of prescribing opioids to injured adolescents at discharge., Methods: This was a retrospective observational study using electronic health records of injured adolescents (12-17 years) admitted to one of 10 pediatric trauma centers., Results: Of the 1345 electronic health records abstracted, 720 (53.5%, 95% CI 50.8 to 56.2) patients received opioid prescriptions at discharge with variability across sites (28.6%-72%). There was no association between patient factors and frequency of prescribing opioids. Center's trauma volume was significantly positively correlated with a higher rate of opioid prescribing at discharge (r=0.92, p=0.001). There was no significant difference between the frequency of opioid prescriptions at discharge among alcohol and other drugs (AOD)-positive patients (53.8%) compared with AOD-negative patients (53.5%)., Conclusions: Across a sample of 10 pediatric trauma centers, just over half of adolescent trauma patients received an opioid prescription at discharge. Prescribing rates were similar for adolescent patients screening positive for AOD use and those screening negative. The only factor associated with a higher frequency of prescribing was trauma center volume. Consensus and dissemination of outpatient pain management best practices for adolescent trauma patients is warranted., Level of Evidence: III-prognostic., Trial Registration Number: NCT03297060., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Alcohol screening, brief intervention and referral to treatment is mandated within the level 1 pediatric trauma center. However, data on the prevalence of alcohol and drug use among admitted pediatric trauma patients is limited. Our study objective was to describe substance use and related negative consequences in admitted adolescent trauma patients across three pediatric level 1 trauma centers., Methods: This surveillance study was nested within a study on electronically delivered parenting skills education to parents of admitted adolescents (12-17 years) screening positive for alcohol or drug use. Enrolled adolescents completed baseline assessments to examine demographics, substance use and related negative consequences. Thirty-seven parent-adolescent dyads enrolled in the intervention study., Results: Participants were eligible if they received a positive CRAFFT score or a positive biological screen for alcohol or drug use at time of the hospital admission. Of those enrolled into the study, 9 (24%) reported no substance use in the prior 12 months in our assessment battery. Of the remaining 28 patients, 6 (16%) reported using only alcohol, 10 (27%) only marijuana, 9 (24%) both alcohol and marijuana, and 3 (8%) alcohol and marijuana with other drugs in the past 12 months. Negative consequences reported varied between those who reported alcohol use only and those who reported marijuana use only with physical consequences of use most often being reported by those using alcohol (hangover, vomiting), and psychosocial consequences (getting into trouble with parents, doing something later regret) by those who used only marijuana., Conclusion: These findings support the use of laboratory screening and screening questionnaires for all adolescent trauma admissions to capture a complete picture of alcohol and drug use.