Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review

Abstract

CONTEXT: Risky behaviors are the main threats to adolescents’ health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. OBJECTIVE: To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. DATA SOURCES: Our data sources included PubMed (1965–2019) and Embase (1947–2019). STUDY SELECTION: Studies were included on the basis of population (adolescents aged 10–25 years), topic (risk behavior screening or intervention), and setting (urgent care, ED, or hospital). Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. DATA EXTRACTION: Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. RESULTS: Forty-six studies were included; most (38 of 46) took place in the ED, and a single risk behavior domain was examined (sexual health [19 of 46], mood and suicidal ideation [12 of 46], substance use [7 of 46], and violence [2 of 46]). In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (∼10%) but significant increases with clinician reminder implementation. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. Reported barriers were time constraints and limited resources. LIMITATIONS: Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. CONCLUSIONS: Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Our findings outline promising tools for improving screening and intervention, highlighting the critical need for continued development and testing of interventions in these settings to improve adolescent care.