Standardized Screenings Improve Detection, Reduce Bias in Teen Substance Use

Research By: Sarah Beal, PhD

Post Date: June 3, 2025 | Publish Date: Feb. 14, 2025

Cincinnati Children’s researchers have found that standardized screening for substance use, using a consistent set of questions, not only increases the number of completed screenings but also reduces bias and improves detection.

Their findings, published in Pediatrics Open Science, highlight how consistent processes can help clinicians respond more effectively to screening results.

The work started a few years ago when Sarah Beal, PhD, a developmental psychologist in the Division of Behavioral Medicine and Clinical Psychology, Mary Greiner, MD, medical director of the CHECK Foster Care Center in the Division of General and Community Pediatrics, and a team of fellow clinicians and researchers decided to evaluate how substance use screenings were conducted in clinical settings.

“We found that the process was highly unstandardized—clinicians asked questions in different ways and documented results inconsistently,” Beal says.

That insight led the team to pilot a more consistent, tablet-based screening approach. As they implemented the new process, lead author Mariam Ranginwala, a University of Cincinnati student, raised a critical question: Would standardized screening actually change outcomes?

To find out, the researchers compared data they’d collected from earlier, unstandardized screenings with results from the new approach—and what they found was striking.

“We expected to find some changes, such as more patients being screened,” Beal says, “but we were surprised to find racial disparities. Clinicians were more likely to screen a Black adolescent than a non-Hispanic white adolescent. Even if unintentional, the variation in screening and documentation appeared to be influenced by the adolescent’s race.”

The study also revealed that standardized screenings were more effective at identifying substance use. “Before standardization, there may have been times when maybe a pediatrician forgot to ask the question, or got distracted, and then we missed valuable information,” Beal says.

Building on those findings, the Beal and Greiner used a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to introduce brief interventions during CHECK Center clinic visits and study their impact on outcomes. One key benefit they immediately noticed: when screenings were consistently documented in a patient’s chart using the tablet-based system, clinicians could act on the results more quickly and confidently.

“This becomes even more important in the context of growing issues like the youth mental health crisis and the legalization of medical cannabis,” Beal says. “If we’re not screening for it, we can’t intervene.”

Although the team has not yet published their latest results, Beal shares that early data show promising impact: adolescents who received a brief intervention after a positive screen reported, on average, five fewer days of substance use in the following six months—particularly among those just starting to experiment, not those with a diagnosed substance use disorder.

“We believe early interventions like this could have a meaningful impact on preventing more serious substance use disorders later in life,” Beal says.

Don’t Miss a Post:

Subscribe to the Research Horizons Newsletter
Follow Cincinnati Children’s Research Foundation on Bluesky, X and LinkedIn

Publication Information

Original title:	Reducing Bias in Substance Use Detection in Adolescents Via Standardized Substance Use Screening
Published in:	Pediatrics Open Science
Publish date:	Feb. 14, 2025

Read the Findings