Adolescent Substance Use, Sexual Assault, and Sexual Risk Behaviors in Primary Care Settings

Introduction: Substance use, sexual assault (SA), and sexual risk behaviors (SRBs) among adolescents are common. Substance use is associated with increased risk for both SA and SRBs. Therefore, targeting substance use, SA, and SRBs in an integrated manner is ideal. Primary care is an ideal setting to screen and intervene with these behaviors because it is the most likely setting for adolescents to seek preventative healthcare. In this study, we aimed to explore the conversations adolescents have with primary care providers regarding these topics. We also aimed to determine content that adolescents would like to learn regarding substance use, SA, and SRBs within a tablet-based prevention program in a primary care setting.

Methods: A total of 24 adolescents aged 14-18 (M = 16.21; SD = 1.35) were recruited from a pediatric or community setting. The majority of participants were female (54.2%; 37.5% were male and 8.3% were transgender), Black/African American (50.0%; 33.3% were White, 8.3% Hispanic, and 8.3% other race), and heterosexual (62.5%, 37.5% identified as lesbian, gay, bisexual, or pansexual). Participants completed a questionnaire regarding their experiences talking to a primary care provider about substance use, SA, and SRBs. Participants also completed an interview to provide feedback on initial prevention content for the first phase of a NIDA-funded study.

Results: The majority of participants indicated that they have not talked to their primary care provider about substance use (70.8%), alcohol use (66.7%), SA (66.7%), or smoking (58.3%). Half of the participants reported that they have talked to their primary care provider about contraception choices, 54.2% indicated that they have talked to their primary care provider about sexual activity, and 54.2% indicated they have talked to their primary care provider about sexually transmitted infections. Qualitative data from the interviews will be coded using a thematic analysis and overall themes will be presented.

Conclusion: The current study found that the majority of adolescents do not discuss substance use or SA with their primary care provider. Further, approximately half of adolescents do not discuss sexual behaviors with their providers. These findings, combined with the qualitative themes, will be used to develop a tablet-based intervention for adolescents to prevent substance use, SA, and SRBs in a pediatric setting. They also have implications for prevention within primary care settings, and suggest that more work is needed to ensure that adolescents and primary care providers discuss these important issues.