Computer-based screening and brief counseling reduced teen cannabis use and riding with impaired drivers | Research

The takeaway

A computer-facilitated screening system in pediatric primary care reduced youth cannabis use by 38% and riding with impaired drivers by 42% compared to usual care.

Pediatricians, school health professionals, parents, and public health planners.

38% cannabis use reduction

What the researchers found

At-risk youth receiving the computer-based screening and brief intervention (CSBI) showed significantly reduced cannabis use (HR 0.62) and reduced riding with impaired drivers (RR 0.58) compared to usual care over 12 months. Alcohol use and heavy drinking trended lower but did not reach statistical significance.

Why it matters

Annual pediatric checkups are a missed opportunity for substance use screening. A system that works within existing visit structure and meaningfully reduces cannabis use and dangerous driving behavior could be implemented widely.

The numbers in context

869 screened; 211 at-risk at baseline; HR for cannabis use 0.62 (95% CI 0.41-0.94); RR for riding with impaired driver 0.58 (95% CI 0.37-0.91); 82.4% received cannabis counseling in CSBI group.

How the study worked

Pilot randomized clinical trial with 965 youth ages 12-18 across 5 pediatric practices and 54 practitioners, with 12-month follow-up using Timeline Followback assessment. CSBI group (n=628) received computer screening plus practitioner counseling.

What this study cannot tell us

Pilot study with unequal randomization (628 vs 243). Self-reported outcomes. No significant prevention effect among youth without baseline use. Effect on heavy drinking did not reach significance.

How to read the evidence

Moderate: randomized trial with 12-month follow-up, but pilot-sized with unequal groups.

When this study was published

Published in 2019.

The bigger picture

Brief interventions for substance use work better when they reach people before problems escalate. Embedding screening into routine pediatric visits catches teens at a critical developmental window.

Questions still open

Would this system work in non-pediatric settings like school health clinics? Can the computer-facilitated component be updated to address vaping and newer cannabis products?

Common questions

How does the screening system work?

Teens complete a computer questionnaire before their annual checkup, then receive tailored information about substance use risks. Their doctor gets the results with talking points for a brief counseling conversation.

Did the system prevent teens from starting to use substances?

No prevention effect was observed among youth who reported no prior substance use at baseline. The benefits were seen among those already using substances.

Read the original research

Effect of Computer-Based Substance Use Screening and Brief Behavioral Counseling vs Usual Care for Youths in Pediatric Primary Care: A Pilot Randomized Clinical Trial.

JAMA network open, 2(6), e196258

View on PubMed ↗Publisher’s paper ↗

Citation

Knight, John R; Sherritt, Lon; Gibson, Erin Bray; Levinson, Jordan A; Grubb, Laura K; Samuels, Ronald C; Silva, Thomas; Vernacchio, Louis; Wornham, Wendy; Harris, Sion Kim. (2019). Effect of Computer-Based Substance Use Screening and Brief Behavioral Counseling vs Usual Care for Youths in Pediatric Primary Care: A Pilot Randomized Clinical Trial.. JAMA network open, 2(6), e196258. https://doi.org/10.1001/jamanetworkopen.2019.6258