Screening and counseling for adolescent alcohol use among primary care physicians in the United States.

OBJECTIVE: To examine the prevalence and quality of alcohol prevention services delivered to adolescents in the United States.
METHODS: A national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Association Masterfile. The response rate was 63%, and the final sample size was 1842 physicians. Quality of services delivered was assessed by 2 scales: quality of screening (percentage of patients screened and depth of screening questions used) and quality of education (level of effectiveness of educational methods used and frequency of use).
RESULTS: Although most physicians reported providing some degree of alcohol prevention services, their efforts were typically inconsistent, not in enough depth, and they failed to incorporate the most effective educational methods. Reported rates of universal screening and counseling were low, and younger adolescents were less likely to receive services. Physicians' beliefs about their alcohol management skills and perceptions of resource availability were the most consistent correlates of higher quality service.
CONCLUSIONS: Prospective studies that elucidate the conditions under which individual physicians do and do not screen, as well as future efforts to educate physicians about the most effective brief intervention approaches, seem warranted.