For a healthy 14-year-old male with no chronic conditions, no tobacco or sexual activity, and a negative depression screen, which USPSTF-recommended preventive service is most appropriate: skin‑cancer counseling, standardized substance‑use disorder screening, scoliosis screening, fasting lipid panel, or chlamydia testing?

Standardized Substance Use Disorder Screening

For this healthy 14-year-old male, a standardized screening tool for substance use disorder (option b) is the most appropriate USPSTF-aligned preventive service, as the American Academy of Pediatrics strongly recommends annual screening for all adolescents using validated tools like CRAFFT, given that substance abuse is a leading cause of adolescent morbidity and mortality. 1

Why Substance Use Screening is Most Appropriate

• The American Academy of Pediatrics recommends that all adolescents be screened annually for tobacco, alcohol, marijuana, and other drugs to identify early morbidity and mortality risks, as substance abuse represents one of the primary causes of death and disability in this age group 2, 1

• The CRAFFT questionnaire is the preferred screening instrument, requiring under 2 minutes to complete with high sensitivity and specificity for detecting substance use disorders 1, 3

• Screening must be conducted in a private setting with the adolescent alone to ensure honest disclosure, as approximately 58% of high school students report health concerns they wish to keep private from parents 4

• Even in adolescents without current substance use, screening serves a preventive function by opening dialogue about risks and may have therapeutic effects in itself 3

Why Other Options Are Not Indicated

Skin Cancer Prevention Counseling (option a)

• The USPSTF finds insufficient evidence to recommend routine visual skin cancer examinations or preventive counseling for skin cancer in asymptomatic adolescents 1

Scoliosis Screening (option c)

• No current USPSTF recommendation supports routine scoliosis screening in adolescents, indicating a lack of sufficient evidence for its preventive benefit 1

Fasting Lipid Panel (option d)

• Lipid screening is recommended between ages 9-11 years if there is a family history of hyperlipidemia or cardiovascular disease, but this 14-year-old is outside that window and has no mentioned risk factors 1, 4

Chlamydia Testing (option e)

• STI screening is only indicated for sexually active adolescents, and this patient explicitly does not engage in sexual activity 1, 4

Critical Implementation Points

• Mandatory private time alone with the adolescent is essential for addressing sensitive topics including substance use, as fear of disclosure causes adolescents to delay or avoid needed care 1, 4

• Positive CRAFFT screens identify youth experiencing adverse consequences who should be referred for appropriate treatment services 1

• The screening can be administered face-to-face, on paper, or via computer without loss of validity, taking an average of 49-74 seconds 1, 3

• While the USPSTF assigns an "I" (insufficient evidence) rating to behavioral interventions for preventing drug use in adolescents without diagnosed disorders, this does not negate the strong recommendation for universal screening itself, which serves to identify those needing treatment 2, 1