Building the evidence for adolescent substance use preventive care at well-visits from mid-adolescence to young adulthood using the longitudinal NEXT study

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ABSTRACT Substance use (SU) is one of the most common causes of preventable death, injury, and disability, yet we currently have evidence gaps for the benefit of SU preventive care for adolescents in primary care. Given the median onset age for trying substances is under age 15, clinicians need to ask and advise adolescents about SU throughout adolescence. We know little about the extent to which substance using adolescents are engaged in well-visits over time, the proportion of adolescents who are asked and advised annually about SU at well-visits over time, and the extent to which being asked and advised about SU during adolescence is related to future SU initiation prevention or reduction over time. The proposed study’s goals are to examine longitudinal associations of adolescents’ SU preventive care and SU behaviors from mid-adolescence through young adulthood and disparities in SU preventive care by adolescents’ background, social determinant, and other health need factors. We hypothesize that adolescents being asked and advised about smoking, alcohol, and other drug use at well-visits will be associated with subsequent prevention of SU initiation in non-users and SU reduction in prior users. We will address this research gap by conducting longitudinal data analyses using the NIH NEXT Study collected from 2010-2017 (ages 15-23). This proposal expands on our prior work which showed most adolescents were engaged in well-visits from ages 5-9 (mid-childhood) through 10-17 (mid- adolescence). Building on these findings, our specific aims are to: 1) document the extent to which substance using adolescents are engaged in well-visits over time, 2) describe how often adolescents are regularly asked and advised about each and all three SU types over time, and 3) examine the extent to which being asked and advised about SU is related to subsequent SU initiation prevention or reduction over time, and describe across aims disparities by adolescents’ background, social determinant, and other health need factors. INNOVATION: Our proposed project will be the first study to examine longitudinal associations of adolescents’ preventive care receipt about SU and SU behaviors from adolescence through young adulthood, notorious times for SU onset and well-visit decline, using analytic approaches that have not been used in the field of adolescent health services research. We will use an existing non-clinical based national longitudinal dataset that has measured longitudinal data on well-visits, SU behaviors, and SU preventive care receipt across developmental periods. This type of rich data has never been previously used to inform practice. PUBLIC HEALTH SIGNIFICANCE: Our study will identify vulnerable adolescents for outreach who are persistently not engaged or become disengaged from well-visits and among those engaged who have missed SU preventive care opportunities. Findings will identify the extent to which being asked and advised about SU at well-visits occurs from adolescence to young adulthood and demonstrate the longitudinal benefit of SU screening and advising during adolescence on young adulthood SU, contributing to quality of evidence that is currently lacking.