A Survey of Adolescent and Caregiver Perceptions of Substance Use Screening in Pediatric Emergency Departments

Objectives: Substance use among adolescents poses significant health risks; early identification is crucial. Understanding adolescents' and caregivers' perceptions toward substance use screening in emergency departments (EDs) is needed to develop acceptable and effective screening programs. Methods: A national online survey recruited adolescents aged 13-17 years and caregivers of adolescents via a Qualtrics research panel. The survey included 34 questions for adolescents and 28 for caregivers, assessing attitudes, perceived barriers, and facilitators of ED-based substance use screening through Likert-scale, multiple-choice, and open-ended qualitative responses. Data were analyzed using descriptive statistics, chi-square tests for group comparisons, and thematic analysis for qualitative responses. Results: Among the 548 adolescent and 544 caregiver respondents, 43.8% of adolescents and 42.6% of caregivers supported universal substance use screening in the ED, whereas 50.4% of adolescents and 38.0% of caregivers rated screening as “very” or “extremely” important. Privacy concerns were identified as a barrier for the majority of adolescents (75.5%) and caregivers (67.8%). Supportive health care staff and clear communication were key facilitators for adolescents (70.0%) and caregivers (74.0%). Adolescents preferred follow-up in the form of digital tools. Thematic analysis of qualitative responses revealed shared concerns among adolescents and caregivers, including privacy, judgment, and test accuracy, whereas adolescents emphasized autonomy and comfort, and caregivers prioritizing transparency, involvement, and legal implications. Conclusion: Most adolescents and caregivers did not definitely support substance use screening in EDs and identified distinct barriers and facilitators. Addressing concerns about privacy, legal consequences, and trust while leveraging digital tools and other follow-up resources may enhance screening acceptability and reach. Future clinical trials can leverage this information to design and evaluate interventions for optimal substance use screening among adolescents in EDs.