Standardized Screening for Substance Use Disorder
The most appropriate USPSTF-recommended preventive service for this 14-year-old male is a standardized screening tool for substance use disorder. 1
Why Substance Use Screening is Recommended
The American Academy of Pediatrics recommends screening annually for substance use (tobacco, alcohol, marijuana, other drugs) in adolescents, as substance abuse is a leading cause of adolescent morbidity and mortality. 1 While the USPSTF has an "I" statement (insufficient evidence) regarding behavioral interventions to prevent illicit drug use, screening itself is still recommended to identify adolescents who may already be using substances or who meet criteria for a substance use disorder requiring treatment. 2
Key implementation points:
- The CRAFFT screening tool is specifically recommended by the American Academy of Pediatrics for adolescents, taking less than 2 minutes to administer with good sensitivity and specificity. 2
- Screening can be delivered as an interview or paper/computer-based self-report. 2
- Screening allows identification of adolescents experiencing consequences of drug use who require appropriate treatment. 2
- Mandatory private time alone with the adolescent is essential to address sensitive topics including substance use. 1
Why Other Options Are NOT Appropriate
Skin cancer prevention counseling: The USPSTF concludes that evidence is insufficient to recommend visual skin examination screening for skin cancer in asymptomatic adolescents and adults. 2 There is no USPSTF recommendation supporting routine counseling on skin cancer prevention for this age group.
Scoliosis screening: The USPSTF does not have a current recommendation supporting routine scoliosis screening in adolescents. This is not among the evidence-based preventive services for this patient.
Fasting lipid panel: Lipid screening is only recommended between ages 9-11 years if there is a family history of hyperlipidemia or cardiovascular disease, or if not previously screened. 1 At age 14 without these risk factors mentioned, this is not indicated.
Chlamydia testing: This patient explicitly reports not engaging in sexual activity. 1 Chlamydia screening is only recommended for sexually active adolescents. 1
Critical Caveat
While substance use screening is recommended, clinicians should understand that the USPSTF found insufficient evidence for effective behavioral interventions to prevent or reduce drug use in adolescents who do not have a substance use disorder. 2 However, screening remains valuable because it identifies adolescents who already meet criteria for a substance use disorder and require treatment, which is outside the scope of prevention but is clinically necessary. 2