Validity of brief screening instrument for adolescent tobacco, alcohol, and drug use

Pediatrics. 2014 May;133(5):819-26. doi: 10.1542/peds.2013-2346.


Background and objective: The National Institute on Alcohol Abuse and Alcoholism developed an alcohol screening instrument for youth based on epidemiologic data. This study examines the concurrent validity of this instrument, expanded to include tobacco and drugs, among pediatric patients, as well as the acceptability of its self-administration on an iPad.

Methods: Five hundred and twenty-five patients (54.5% female; 92.8% African American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) via interviewer-administration or self-administration using an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders (SUDs) were identified using a modified Composite International Diagnostic Interview-2 Substance Abuse Module. Receiver operating characteristic curves, sensitivities, and specificities were obtained to determine optimal cut points on the BSTAD in relation to SUDs.

Results: One hundred fifty-nine (30.3%) adolescents reported past-year use of ≥1 substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and 50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95; specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity = 0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93). iPad self-administration was preferred over interviewer administration (z = 5.8; P < .001).

Conclusions: The BSTAD is a promising screening tool for identifying problematic tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of substance use among adolescents may indicate need for intervention.

Keywords: DSM-5; adolescent; substance abuse screen; substance use; substance use disorder.

Publication types

  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Adolescent
  • Alcohol Drinking* / epidemiology
  • Alcohol Drinking* / psychology
  • Baltimore
  • Child
  • Female
  • Humans
  • Male
  • Mass Screening*
  • Psychometrics / statistics & numerical data*
  • Reproducibility of Results
  • Smoking* / epidemiology
  • Smoking* / psychology
  • Substance-Related Disorders / diagnosis*
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology
  • Surveys and Questionnaires*