Forty-six percent of patients were due for the human papillomavirus (HPV) vaccine, and 19% of these received it during admission.25. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth, Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review, The role of motivational interviewing in children and adolescents in pediatric care. Of those who participated, 89.2% reported willingness to receive STI testing if it was recommended (regardless of reason for ED visit). Nineteen studies on sexual activity screening and/or intervention were included in our review: 5 in the hospital setting (Table 3) and 14 in the ED (Table 4). We conducted a literature search in June 2019. 1 HEADSS is an acronym for the topics that the physician wants to be sure to cover: home, education (ie, school), activities/employment, drugs, suicidality, and sex. Although poverty increases the risk for mental health conditions, studies show that the greatest increase in prevalence occurred among children living in households earning greater than 400% above the federal poverty line. Most adolescents support suicide risk screening in the ED. Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established. Dr Pfaff conceptualized and designed the study, conducted the literature search, screened literature for inclusion, extracted data from included studies, and drafted and edited the manuscript; Dr DaSilva helped in study design, conducted the literature search, screened literature for inclusion, extracted data, and helped with drafting the original manuscript; Dr Ozer helped in study design, editing and revising the manuscript, and critically appraising the manuscript content; Dr Kaiser supervised the conceptualization and design of the study, supervised the data extraction from the included literature, and helped in revising and editing the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. It is important to conduct adolescent substance use screening in the ED. However, lack of initial physician buy-in and administrative hurdles, such as funding for HPAs, training, and competition with other medical professionals (ie, social workers), made it difficult to transition this intervention into sustainable clinical practice.20 In 2 studies, researchers evaluated physician reminders to screen, including a home, education, activities, drugs, sexual activity, suicide and/or mood (HEADSS) stamp on paper medical charts and a distress response survey in the electronic health record (EHR). Barriers identified included time, concern about follow-up, and lack of knowledge. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). Parents were overall supportive of sexual activity screening and care provision in the ED and hospital setting. We report on a number of successful domain-specific screening tools validated in ED and hospital settings. In the full-text screen, both reviewers included 43 studies and excluded 25 studies; 7 studies were in conflict.