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Prevalence of positive substance abuse screen results among adolescent primary care patients / J. R. KNIGHT ; S. K. HARRIS ; L. SHERRITT ; S. VAN HOOK ; N. LAWRENCE ; T. BROOKS ; P. CAREY ; R. KOSSACK ; J. KULIG in Archives of Pediatrics and Adolescent Medicine, Vol.161, n°11 (November 2007)
in Archives of Pediatrics and Adolescent Medicine > Vol.161, n°11 (November 2007) . - 1035-1041
Titre : Prevalence of positive substance abuse screen results among adolescent primary care patients Type de document : Périodique Auteurs : J. R. KNIGHT ; S. K. HARRIS ; L. SHERRITT ; S. VAN HOOK ; N. LAWRENCE ; T. BROOKS ; P. CAREY ; R. KOSSACK ; J. KULIG Année de publication : 2007 Article en page(s) : 1035-1041 Langues : Anglais Mots-clés : Thésaurus Géographique
ADOLESCENT ; DEPISTAGE ; CRAFFT ; ETUDE TRANSVERSALE ; TEST
Domaine : Plusieurs produits / Several products Résumé : OBJECTIVES: To measure the prevalence of positive substance use screen results among adolescent primary care patients and to estimate the prevalence of substance-related problems and disorders.
DESIGN: Cross-sectional survey.
SETTING: A network of primary care practices in New England.
PARTICIPANTS: A consecutive sample of 12- to 18-year-old patients (N = 2133), with a study participation rate of 92.7%. Main Exposure The CRAFFT substance abuse screening test (a full description of this screen is given in the "Introduction").
OUTCOME MEASURES: Frequencies of positive screen results were computed for the entire sample, each practice, visit type (well-child care, sick visit, follow-up, or other), and patient status (new vs established). Generalized estimating equation modeling was used to test for difference in proportions. CRAFFT scores, demographic data, and Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic data from a previous study were used to estimate the prevalence of problematic substance use, abuse, and dependence.
RESULTS: Overall, 14.8% of adolescents had positive results on the CRAFFT screen. Prevalence rates differed significantly across practices (P < .001) after adjusting for demographic factors. The highest positive rates on the CRAFFT screen were at school-based health centers (29.5%) and the rural family practice (24.2%), the middle rate was at the adolescent clinic (16.6%), and the lowest rates were at the health maintenance organization (14.1%) and pediatric clinic (8.0%). Sick visits had the highest rate (23.2%). Well-child care visits had a significantly lower rate (11.4%, P < .001). Statistical modeling estimated that 11.3% of all patients had problematic use, 7.1% had abuse, and 3.2% had dependence.
CONCLUSION: Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only.
Refs biblio. : 46 Affiliation : Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, MA 02115, USA Lien : http://archpedi.jamanetwork.com/article.aspx?articleid=571433 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=70136[article]Primary care follow-up plans for adolescents with substance use problems / A. HASSAN ; S. K. HARRIS ; L. SHERRITT ; S. VAN HOOK ; T. BROOKS ; P. CAREY ; R. KOSSACK ; J. KULIG ; J. R. KNIGHT in Pediatrics, Vol.124, n°1 (July 2009)
in Pediatrics > Vol.124, n°1 (July 2009) . - 144-150
Titre : Primary care follow-up plans for adolescents with substance use problems Type de document : Périodique Auteurs : A. HASSAN ; S. K. HARRIS ; L. SHERRITT ; S. VAN HOOK ; T. BROOKS ; P. CAREY ; R. KOSSACK ; J. KULIG ; J. R. KNIGHT Année de publication : 2009 Article en page(s) : 144-150 Langues : Anglais Mots-clés : Thésaurus TOXIBASE
ADOLESCENT ; PRISE EN CHARGE ; ETUDE PROSPECTIVE ; CRAFFT ; RECOMMANDATION ; TRAITEMENT ; DIAGNOSTIC ; PROFIL SOCIO-DEMOGRAPHIQUE ; INTERVENTION ; SUIVI DU PATIENT
Discipline : TRA Traitement et prise en charge / Treatment and care Résumé : OBJECTIVE: Primary care visits provide an opportunity to screen adolescents for substance use and offer early intervention, but little is known about follow-up plans. The objective of this study was to determine recommendations by PCPs* and assess the relationship between their diagnostic impressions of substance use severity and plans for intervention.
METHODS: Data were collected through a prospective observational study conducted at 7 primary care practices in New England. Patients aged 12 to 18 years completed an interview, which included sociodemographic characteristics and the CRAFFT substance abuse screen. PCPs received screen results, noted their diagnostic impression of participants' substance use severity, and recorded follow-up plans. Follow-up plans other than "periodic screening" alone were defined as "active intervention." We examined the relationship of provider impressions with follow-up recommendations by using the chi² test.
RESULTS: For 2034 adolescents, PCPs recommended no plan for 369 patients, periodic screening for 1557 patients, a return visit for 98 patients, and referral to counseling for 44 patients. PCPs' diagnostic impressions identified 97 (4.8%) patients with problem use and 19 (0.01%) patients with abuse or dependence. Recommendations for active intervention were more likely with patients' higher severity of use. However, 1 in 5 patients thought to have problem use did not receive a recommendation for an active intervention. Parent notification was planned for only 13 patients.
CONCLUSIONS: When concerned about substance use, PCPs recommend a return visit to their office more than twice as often as referral to counseling, and rarely planned to engage parents. PCPs need enhanced training and strategies for delivery of office-based interventions.
*PCP = primary care provider
Refs biblio. : 21 Affiliation : Division of Adolescent Medicine, Children's Hospital Boston, Boston, Massachusetts, USA Lien : http://dx.doi.org/10.1542/peds.2008-2979 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=71953[article]The design of medical marijuana laws and adolescent use and heavy use of marijuana: Analysis of 45 states from 1991 to 2011 / J. JOHNSON ; D. HODGKIN ; S. K. HARRIS in Drug and Alcohol Dependence, Vol.170 (January 2017)
in Drug and Alcohol Dependence > Vol.170 (January 2017) . - 1-8
Titre : The design of medical marijuana laws and adolescent use and heavy use of marijuana: Analysis of 45 states from 1991 to 2011 Type de document : Périodique Auteurs : J. JOHNSON ; D. HODGKIN ; S. K. HARRIS Année de publication : 2017 Article en page(s) : 1-8 Langues : Anglais Mots-clés : Thésaurus Géographique
CANNABIS ; LEGALISATION ; USAGE THERAPEUTIQUE ; ADOLESCENT ; EVOLUTION ; ABUS ; PREVALENCE
Discipline : EPI Epidémiologie / Epidemiology Domaine : Drogues illicites / Illicit drugs Résumé : Objectives: To assess the association between U.S. state medical marijuana laws (MML), the most liberal category of marijuana policies before legalization, their specific provisions, and adolescent past-30-day use and heavy marijuana use.
Methods: This quasi-experimental study used state Youth Risk Behavior Survey (YRBS) data collected during 1991-2011 from 45 states (N = 715,014) to examine MML effects, taking advantage of heterogeneity across states in MML status and design. Multiple logistic regression modeling was used to adjust for state and year effects, and youth demographics.
Results: Unadjusted analyses found that MMLs were associated with higher rates of adolescent past-30-day marijuana use (odds ratio [OR] = 1.08, 95% confidence interval, [(CI) = 1.03, 1.13]) and heavy marijuana use (OR = 1.12, [CI = 1.05, 1.21]). However, analyses adjusting for state/year effects found a 7% lower odds of use (OR = 0.99, [CI = 0.98, 0.999]) and no difference in heavy use. In the adjusted models, years since MML enactment (OR = 0.93, [CI = 0.86, 0.99]) and MML inclusion of more liberalized provisions (OR = 0.98, [CI = 0.96, 0.998]) were associated with slightly lowered odds of past-30-day marijuana use. Conversely, allowance for ?2.5 usable marijuana ounces was associated with higher past-30-day marijuana use odds (OR = 1.21, [CI = 1.09, 1.34]) and a voluntary vs. mandatory patient registration with higher odds of both past-30-day use (OR = 1.41, [CI = 1.28, 1.56]) and heavy use (OR = 1.23, [CI = 1.08, 1.40]).
Conclusions: MML enactment, years since enactment, and inclusion of more liberalized provisions were not associated with increased adolescent marijuana use in this dataset after adjusting for state and year effects; however, higher possession limits and a voluntary registration were. It is possible that state norms are the impetus for MML enactment.
Crude current marijuana and heavy marijuana use rates higher in medical marijuana law (MML) states.
Decreased odds of current marijuana use with MMLs with state fixed effects.
Decreased odds of current marijuana use with years since MML enactment.
Increased odds of current marijuana use with higher possession limits.
Increased odds of current marijuana use with a voluntary patient registration.
Affiliation : Institute for Behavioral Health, Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=78612[article]Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT / J. R. KNIGHT
Titre : Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT Type de document : Périodique Auteurs : J. R. KNIGHT ; L. SHERRITT ; S. K. HARRIS ; E. C. GATES ; G. CHANG Année de publication : 2003 Importance : 67-73 Présentation : tabl. Note générale : Alcoholism, Clinical and Experimental Research, 2003, 27, (1), 67-73 Langues : Anglais Mots-clés : Thésaurus TOXIBASE
ALCOOL ; ADOLESCENT ; JEUNE ; TEST ; QUESTIONNAIRE ; DIAGNOSTIC ; COMPARAISON ; EVALUATION ; VALIDITE
Discipline : PRE Prévention / Prevention Domaine : Alcool / Alcohol Résumé : BACKGROUND: Adolescents should be screened for alcohol misuse as part of routine care. The objective of this study was to compare the criterion validity of the Alcohol Use Disorders Identification Test (AUDIT), the Problem Oriented Screening Instrument for Teenagers substance use/abuse scale (POSIT), and the CAGE and CRAFFT questions among adolescents.
METHODS: Fourteen- to 18-year-old patients arriving for routine healthcare at a large, hospital-based adolescent clinic completed the four screens and the criterion standard Adolescent Diagnostic Interview, which yields DSM-IV diagnoses of alcohol abuse and dependence. Receiver operating characteristic (ROC) curves were plotted to determine optimal cut-points. Areas under the ROC curves of the four screens were compared, and sensitivities and specificities were calculated.
RESULTS: Participants' past 12-month alcohol diagnostic classifications were as follows: no use (58.6%), nonproblem use (13.0%), problem use (20.8%), abuse (5.4%), and dependence (2.2%). Optimal cut-points associated with problem use or higher were 2 for AUDIT, 1 for POSIT, 1 for CAGE, and 1 for CRAFFT. ROC curve area of the CAGE was significantly lower compared with areas of all other screens. Sensitivities (95% confidence intervals) were AUDIT 0.88 (0.83-0.93), POSIT 0.84 (0.79-0.90), CAGE 0.37 (0.29-0.44), and CRAFFT 0.92 (0.88-0.96); specificities were AUDIT 0.81 (0.77-0.85), POSIT 0.89 (0.86-0.92), CAGE 0.96 (0.94-0.98), and CRAFFT 0.64 (0.59-0.69).
CONCLUSIONS: The AUDIT, POSIT, and CRAFFT have acceptable sensitivity for identifying alcohol problems or disorders in this age group. The CAGE is not recommended for use among adolescents.
Refs biblio. : 48 Affiliation : Cter for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, MA, USA Centre Emetteur : 13 OFDT Cote : A01207 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=58452Validity of the CRAFFT substance abuse screening test among adolescent clinic patients / J. R. KNIGHT in Archives of Pediatrics and Adolescent Medicine, Vol.156, n°6 (June 2002)
in Archives of Pediatrics and Adolescent Medicine > Vol.156, n°6 (June 2002) . - 607-614
Titre : Validity of the CRAFFT substance abuse screening test among adolescent clinic patients Titre traduit : (Validité du test de dépistage d'abus de substances CRAFFT parmi des patients adolescents reçus en clinique) Type de document : Périodique Auteurs : J. R. KNIGHT ; L. SHERRITT ; L. A. SHRIER ; S. K. HARRIS ; G. CHANG Année de publication : 2002 Article en page(s) : 607-614 Présentation : tabl. Langues : Anglais Mots-clés : Thésaurus TOXIBASE
ADOLESCENT ; JEUNE ; TEST ; QUESTIONNAIRE ; EVALUATION ; EFFICACITE ; CRAFFT ; VALIDITE ; ETUDE CLINIQUE
Discipline : PRO Produits, mode d'action, méthode de dépistage / Substances, action mode, screening methods Domaine : Plusieurs produits / Several products Résumé : OBJECTIVE: To determine the accuracy of the CRAFFT substance abuse screening test.
DESIGN: Criterion standard validation study comparing the score on the 6-item CRAFFT test with screening categories determined by a concurrently administered substance-use problem scale and a structured psychiatric diagnostic interview. Screening categories were "any problem" (ie, problem use, abuse, or dependence), "any disorder" (ie, abuse or dependence), and "dependence."
SETTING: A large, hospital-based adolescent clinic.
PARTICIPANTS: Patients aged 14 to 18 years arriving for routine health care.
MAIN OUTCOME MEASURES: The CRAFFT receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value.
RESULTS: Of the 538 participants, 68.4% were female, and 75.8% were from racial and ethnic minority groups. Diagnostic classifications for substance use during the past 12 months were no use (49.6%), occasional use (23.6%), problem use (10.6%), abuse (9.5%), and dependence (6.7%). Classifications were strongly correlated with the CRAFFT score (Spearman rho, 0.72; P<.001). A CRAFFT score of 2 or higher was optimal for identifying any problem (sensitivity, 0.76; specificity, 0.94; positive predictive value, 0.83; and negative predictive value, 0.91), any disorder (sensitivity, 0.80; specificity, 0.86; positive predictive value, 0.53; and negative predictive value, 0.96) and dependence (sensitivity, 0.92; specificity, 0.80; positive predictive value, 0.25; and negative predictive value 0.99). Approximately one fourth of participants had a CRAFFT score of 2 or higher. Validity was not significantly affected by age, sex, or race.
CONCLUSION: The CRAFFT test is a valid means of screening adolescents for substance-related problems and disorders, which may be common in some general clinic populations.
Refs biblio. : 42 Affiliation : Department of Pediatrics, Harvard Medical School, Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, MA, USA Numéro Toxibase : 1300497 Centre Emetteur : 13 OFDT Cote : A01239 Lien : http://archpedi.jamanetwork.com/article.aspx?articleid=203511 Permalink : http://bdoc.ofdt.fr/index.php?lvl=notice_display&id=58385[article]