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A Survey of Suburban Parent-Adolescent Dyads

Richard H. Schwartz, MD; Tomas J. Silber, MD; Richard B. Heyman, MD; Michael J. Sheridan, ScD; Dawn M. Estabrook, MD

Arch Pediatr Adolesc Med. 2003;157:158-161.

Background  The American Academy of Pediatrics is opposed to involuntary diagnostic testing for drugs of abuse.

Objective  To gather data about attitudes of parents and their teenagers about involuntary drug testing on parental request.

Design  Adolescents and their accompanying parents separately answered a printed survey in the offices of their private pediatrician. The survey posed 2 hypothetical questions about urine testing: (1) Do parents have the right to ask a teenager's physician to order a urine test for drugs of abuse without the teenager's knowledge—if the teenager has falling school grades, an uncooperative attitude, and major untruthfulness? (2) In such a case, should the teenager's physician obtain a urine test for drugs on parental request only, without the teenager's consent?

Results  A total of 393 paired evaluable surveys were collected: 77.6% from Virginia and 22.4% from Ohio. There were no significant differences in answers between the 2 study sites. Of the students, 85.8% had either an A or a B grade point average. Current marijuana use was unusually low in our teenaged respondents. Of the parents surveyed, 81.7% would want a physician to be able to perform a urine test for drugs of abuse for a problematic teenager without the young person's consent. The answers to the 2 questions about urine drug tests had poor coefficients of agreement between teenagers and parents (0.04 and 0.09, respectively). Reanalysis, using the variables of age, grade point average, and frequency of marijuana smoking, showed little difference in agreement scores.

Conclusions  In the 2 suburban pediatric practices surveyed, parental opinions and expectations were at variance with the American Academy of Pediatrics policy statement on nonconsensual urine drug testing in the presence of clinical problems. Pediatricians need to be conscious of this clinical-ethical dilemma, become familiar with the American Academy of Pediatrics policy on drug testing, and develop their own position and expertise in this area. The dyad method (parent-teenager survey) is novel and improved the methodology of our study. We surveyed middle-class suburban adolescents while previous studies of adolescents surveyed inner-city populations.

From the Departments of Pediatrics (Drs Schwartz and Estabrook) and Medicine (Dr Sheridan), Inova Fairfax Hospital for Children, Falls Church, Va; the Department of Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, DC (Dr Silber); and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Heyman). Dr Schwartz is now with Vienna Pediatrics Associates, Vienna, Virginia.

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