When we see your child for the annual checkup, there is a lot of ground to cover. We evaluate the number of fruits and vegetables he or she consumes daily, how their grades are in school, the amount of screen time they are exposed to, if they wear a bike helmet when riding, their teeth brushing habits and more.

At all visits we also inquire about tobacco, drug and alcohol use and exposure.

If your child is an adolescent, we also ask for the opportunity to talk with him or her without a parent present.

Substance abuse is a major cause of illness and injury for older children and adolescents. It is linked to automobile accidents, homicide, suicide and mental health problems. The National Institute on Drug Abuse indicates that marijuana use, which had previously declined from the late 1990s to mid-2000s, is on the rise again, with 6.5 percent of eighthgraders, 17 percent of 10thgraders and 22.9 percent of 12thgraders reporting use in the last month.

As the use of conventional and synthetic marijuana rises, the perception that these substances are harmful has decreased substantially. Many experts speculate this is related to the debate over the legalization of marijuana. Marijuana has often been regarded as a “gateway drug” and, in fact, these surveys show that more than half of illicit-drug users began with marijuana.

Nonmedical use of prescription drugs and over-the-counter medication remains a problem as well, with Adderall and Vicodin as the two most commonly abused by teenagers. In 2012, 14.8 percent of 12th-graders had used a prescription medication nonmedically in the past year. Education about the harms these medications cause is critical as their use becomes more commonplace.

Alcohol is one of the most commonly used substances we discuss. While alcohol use among teens is declining, teens are more likely to engage in heavy drinking, defined as five or more drinks per episode. In 2012, 3.6 percent of eighthgraders, 14.5 percent of 10thgraders and 28.1 percent of 12thgraders reported getting drunk within the previous month. These statistics underscore that teens are not just dabbling in alcohol use, but are drinking to become intoxicated.

There are indicators that can predict the likelihood of substance abuse later in life. If a child displays problems with aggression, lack of self-control, poor classroom performance, social issues or has a caregiver or associates with friends who use drugs, the risk of substance abuse increases significantly. Appropriate behavioral, social work and mental health referrals early in a child’s life can have a significant impact.

We also look for factors we know are protective and tend to decrease a child’s risk for substance abuse. These include a strong parent-child bond, mastery of a skill by the child, and strong community attachment. Having an actively involved caregiver who gives clear rules, sets clear expectations and fairly enforces discipline is also protective.

We pay attention to subtle clues throughout the visit that will help us to provide the best care and advice to families. We are here to provide accurate information to help keep kids safe as they navigate one of the bumpiest times in their lives.

Realistically, our impact is minute. A child may only spend 15 to 20 minutes in front of a physician each year. Parents have the most important influence in their childrens’ lives.

A caregiver’s attitude toward substance use can profoundly guide a child’s decision to experiment with drugs. Establishing clear expectations and nurturing an environment of trust and respect are of utmost importance to your child.

For more information, Communities Against Substance Abuse offers several resources including safe monitoring tips, communication about awareness issues and intervention classes. Find out more at www.midcoastcasa.org.

DEBORAH HAGLER, MD is a certified pediatrician and KATIE SWAN, RN, MSN is a certified Family Nurse Practitioner with Martin’s Point Health Care Center in Brunswick.