According to the Department of Health and Human Services, nearly 20% of high school students report smoking within the past month. About the same percentage reported what amounts to binge drinking within the same time period.

Use of tobacco, alcohol, and illicit substances is clearly a problem among kids and adolescents. One of the biggest challenges for programs which aim to counter these risk-laden behaviors is identifying kids who need the help. You certainly don’t need a medical degree to know that getting a teenager to admit any of these activities to an adult is, at best, challenging.

A group of researchers based in Baltimore, MD explored whether a self-administered screening tool administered via an iPad would help overcome some of those barriers. This evaluation was embedded within a study that aimed to validate a brief screening tool for pediatric alcohol abuse developed by the National Institute on Alcohol Abuse and Alcoholism.

In this study, they found that kids strongly preferred the use of the tablet for self-administration of the screening tool.


A total of 525 patients were recruited from pediatric clinics in Baltimore. The first half were administered the brief screening tool by an interviewer and the second via an iPad app. A gold standard screening tool, the modified composite international diagnostic interview, was also used for comparison.


There were no significant differences when the brief screening tool was administered via an interviewer or iPad in the patient’s ability to understand or respond accurately (based on self-assessment) to the questions. There was however a significant preference for the iPad administration option (z = 5.8).

Intuitively, that should make sense as one would imagine that kids would be less comfortable disclosing substance use to an adult, particularly a stranger. However, it would be interesting to compare what they report to their pediatrician to what they self-report on the iPad administered tool – one could imagine that so long as there is a strong patient-physician relationship, kids may be more apt to disclose substance use to a trusted pediatrician who asks.

Oddly, the researchers do not specifically report the prevalence of substance use for each approach; rather this data is only presented in aggregate. That raises the question of whether there were statistically significant differences in what patients reported – a confounder that could really go either way as far as accurate or under-reporting of substance use.

This study highlights an opportunity to expand screening tools, particularly for health issues that are more challenging to identify, using mobile technology. Particularly when it comes to an issue like pediatric substance abuse, the bar may not be set all that high given to low costs and flexibility with this type of screening. Even if an app-based brief screening tool only identified a small percentage of kids previously unknown to have issues with substance use, even that incremental gain would be worth it.

Kelly SM et al. Validity of a Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use. Pediatrics. 2014 Apr 21.