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Substance Use Screening and Prevention for Adolescents in Pediatric Primary Care: A Randomized Clinical Trial using the Family Check-Up


This study evaluated acceptability, engagement in prevention, and efficacy of a primary care screening-and-referral-to-prevention program to reduce substance use in early adolescence. Screening tools were the Youth Risk Index and Transmissible Liability Index and prevention consisted of the Family Check-Up (FCU). Three hundred sixty-one 10- to 13-year-olds from low resource neighborhoods (85.9% African American; 52.4% female) screened “at risk” during primary care visits and were randomized to the FCU (n = 123) or usual care (n = 238). Screening was acceptable to parents and youths: nearly 95% of each rated it as important, about 90% of each were happy with or did not mind it, and only 2.4% of parents did not want their child to be screened at their next check-up. Of parents who had a chance to receive the FCU (or waitlist-control), 87.5% followed through with researchers while 93.5% who were offered FCU engaged in it. FCU efficacy primarily involved interactions such that youth with greater risk at baseline experienced larger benefits. At 12-month follow-up, FCU was associated with 11% reduced risk of initiating a new substance per substance that had been initiated before baseline; greater reductions in tolerance of deviance among those with higher tolerance of deviance at baseline; and a main effect of reduced anxiety, but no effect for conduct problems. Pediatric well-child check-up screening can identify high-risk youth before, or in the initial stages of, problematic SU; engage families in a preventive intervention; and reduce rates of substance use and related risk factors.

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This work was supported by the National Institute on Drug Abuse (NIDA), grant number DA036628-01, awarded to Drs. Ty Ridenour, Daniel S. Shaw, and Maureen Reynolds (MPIs).

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Authors and Affiliations



Conceptualization: Ty Ridenour, Daniel Shaw, Deborah Bogen; Methodology: Ty Ridenour, Daniel Shaw, Deborah Bogen, Maureen Reynolds, Flannery O’Rourke; Analysis: Ty Ridenour, Chardee Galan, Flannery O’Rourke; Writing: All coauthors; Funding acquisition: Ty Ridenour, Daniel Shaw, Maureen Reynolds, Deborah Bogen; Supervision: Daniel Shaw, Ty Ridenour, Flannery O’Rourke.

Corresponding author

Correspondence to Ty A. Ridenour.

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Informed Consent

Informed consent was obtained from all study participants.

Clinical Trial Registration

Registry Name: Substance Use Screening and Prevention for Adolescents in Pediatric Primary Care (SKY); Registration Number: NCT03074877.

Ethical Approval

All procedures performed in studies involving human subjects were in accordance with the ethical standards of the IRB at the University of Pittsburgh (Protocol number 13070072; approved 10/2/2013) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals.

Competing Interests

Lori Ridenour, spouse of Ty Ridenour (last author), is copyright owner of the Youth Risk Index and ALEXSA. All other authors have no relevant financial or non-financial interests to disclose.

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Galán, C.A., Shaw, D.S., O’Rourke, F. et al. Substance Use Screening and Prevention for Adolescents in Pediatric Primary Care: A Randomized Clinical Trial using the Family Check-Up. Res Child Adolesc Psychopathol 51, 151–163 (2023).

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  • Screening
  • Primary care
  • Family Check-up
  • Adolescence
  • Substance use
  • Indicated prevention