Study uncovers racial disparities in substance use screenings for adolescents with traumatic injuries.
A recent study conducted by researchers at UCLA and Children’s Hospital Los Angeles has drawn attention to a concerning disparity in how marginalized teens are screened for substance use following traumatic injuries. Published in JAMA Network Open, the study highlights clinician bias in determining which teens are tested for drugs and alcohol in pediatric trauma centers.
The study team, led by Dr. Jordan Rook, a general surgery resident at the David Geffen School of Medicine at UCLA, reviewed data from 85,400 trauma patients ages 12 to 17 who were treated between 2017 and 2021 across 121 pediatric trauma centers. They examined whether adolescents from different racial, ethnic, and socio-economic backgrounds were subjected to substance use screening at the same rate, regardless of the severity of their injuries.
This was not the case. Marginalized teens, including American Indian, Black, and Hispanic youths, were much more likely to be tested for alcohol and drugs than their white counterparts. For example, Black adolescents were 8% more likely to be screened for alcohol and 13% more likely to be tested for drugs compared to white adolescents. The odds were even higher for American Indian adolescents, who were 117% more likely to be screened for alcohol and 75% more likely to be tested for drugs than their white peers. Similarly, Hispanic adolescents were found to be 20% more likely to be screened for alcohol and 12% more likely to be tested for drugs. The study also found that female adolescents were more likely to be tested than males, and those with Medicaid or uninsured adolescents were more likely to receive screenings than patients with private insurance plans.
The study’s findings are concerning because they suggest that implicit biases among healthcare providers may be influencing clinical decisions in pediatric trauma care, unfairly targeting marginalized teens. Implicit bias refers to the unconscious attitudes or stereotypes that influence a person’s thoughts, actions, and decisions without them realizing it. This unequal use of substance screenings not only has the potential to stigmatize adolescent patients from certain racial and socio-economic backgrounds, but it can also bring legal issues to healthcare systems and patients alike. From the patient’s perspective, a positive test result for alcohol or drugs could lead to legal consequences or increased scrutiny from social services.
While substance use screenings can, of course, be beneficial in determining treatment decisions when uses appropriately, there should be protocols in place to ensure the same procedures are followed across the board. According to Dr. Rook, current guidelines may be insufficient in ensuring that substance use screenings are conducted fairly and equitably.
The study’s authors suggest in their conclusions that stricter guidelines or universal screening measures might help address these disparities. By ensuring that all adolescents receive the same level of care and access to support services, healthcare providers can work towards minimizing the potential for biased decision-making in trauma care settings. Many healthcare professionals are already required by licensing boards to receive implicit bias training, but this requirement varies state to state. Rolling out a more inclusive guidelines for this could also help minimize the potential for unconscious biases to influence care decisions.
The research team is planning to conduct further studies to better understand the factors contributing to these disparities and to identify potential solutions. Dr. Rook and his colleagues are interested in investigating whether hospital-level practices can reduce screening disparities and whether interview-based screenings are as effective as biochemical tests in identifying substance use among trauma patients. By addressing these questions, they hope to develop strategies that will promote more equitable care for all.
Sources:
Study reveals bias in substance use screening for injured adolescents
Disparities in Screening for Substance Use Among Injured Adolescents
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