Tailored Teen Alcohol and Violence Prevention in the ER

描述(申请人提供)：酒精滥用和暴力行为是城市青少年中严重和普遍的问题，对发病率和死亡率有很大影响。来自各种学科和方法的研究表明，在整个青春期，酗酒和暴力行为之间的时间联系往往会增加，这可能是由于共同的风险因素。例如，国家数据显示，49%的青少年饮酒者也报告了暴力行为(例如，肢体打斗和使用武器)。在过去的一年。城市急诊部(ED)为解决青少年中的酒精滥用和暴力行为提供了一个独特的环境，并利用了一个“可教的时刻”。这项为期五年的研究将完善有希望的干预方法，纳入基于对青少年个人危险行为的评估的定制技术，以解决酒精滥用和暴力行为。这项随机对照试验将在30个月内对ED中约3200名青少年(14-18岁)进行筛查。那些在过去一年中酒精使用和暴力行为都呈阳性的人(约30%)将按性别分层，然后随机分为三种情况之一(n=250/组)：计算机适应的动机访谈+技能培训，治疗师适应的动机访谈+技能培训，以及信息性小册子控制条件。主要结果将在3个月和12个月时进行评估，包括酒精使用/滥用、暴力行为、非法药物使用、意外伤害、犯罪和携带武器。为期一周的跟踪评估将评估与干预相关的假设变化机制，包括变化阶段、自我效能、干预忠诚度和其他干预过程措施。其他的协变量包括性别、种族和年龄。这项研究利用了研究团队提供基于ED的酒精干预的先前经验，使用定制的计算机化程序和简短的激励建议会议来解决市中心高危青年的常见行为。拟议的研究整合了针对酒精滥用和暴力行为的经验得出的简短干预策略，使用最先进的技术针对高风险城市ED环境中青少年的特定风险因素量身定做干预措施；量身定制的计算机化计划使用现有技术来增加和/或取代ED环境中对临床工作人员的需求，在ED环境中，工作人员的时间有限来影响行为改变。该项目将为实施综合预防计划迈出关键的第一步，以解决重叠的风险因素，这些因素有可能传递给每年到城市急诊室就诊的数百万青少年。

DESCRIPTION (provided by applicant): Alcohol misuse and violent behavior are serious and prevalent problems among urban adolescents and have large impacts on morbidity and mortality. Research from a variety of disciplines and methodological approaches has demonstrated that temporal connections between alcohol misuse and violent behavior tend to increase throughout adolescence, likely due to shared risk factors. For example, national data suggest that 49% of adolescent drinkers also report violent behaviors (e.g., physical fighting, and weapon usage.) in the past year. The urban Emergency Department (ED) provides a unique setting for addressing alcohol misuse and violent behaviors among adolescents, and capitalizes on a "teachable moment." This five-year study will refine promising intervention approaches to incorporate tailoring technology based on assessment of the adolescents' personal risk behaviors to address both alcohol misuse and violent behaviors. This randomized controlled trial will screen approximately 3200 adolescents in the ED (ages 14-18) over 30 months. Those who screen positive for both past year alcohol use and violent behaviors (approximately 30%) will be stratified by sex and then randomized to one of three conditions (n=250/group): Computer adapted motivational interviewing + skills training, Therapist adapted motivational interviewing + skills training, and an informational pamphlet control condition. Primary outcomes will be evaluated at 3- and 12-months and include alcohol use/misuse, violent behaviors, illicit drug use, unintentional injury, delinquency, and weapon carriage. A 1-week follow-up assessment will assess hypothesized mechanisms of change related to the interventions including stage of change, self-efficacy, intervention fidelity, and other intervention process measures. Additional covariates that will be examined include sex, race, and age. This study capitalizes upon the research team's prior experience delivering ED-based alcohol interventions, using both tailored computerized programs and brief motivational advice sessions to address common behaviors among at-risk inner-city youth. The proposed study integrates empirically-derived brief intervention strategies for alcohol misuse and violent behaviors using state-of-the-art technology to tailor the interventions to the specific risk factors of the adolescent in a high-risk urban ED setting; tailored computerized programs use available technology to augment and/or replace the need for clinical staff in the ED setting, where there is limited staff time to effect behavior change. This project will provide the critical first step toward the implementation of an integrated prevention program addressing overlapping risk factors that has the potential to be delivered to the millions of adolescents visiting urban EDs each year.