Tailored Teen Alcohol and Violence Prevention in the ER

描述（由申请人提供）：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的影响。来自各种学科和方法的研究表明，酒精滥用和暴力行为之间的时间联系往往在整个青春期增加，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暴力行为（例如，（物理攻击和武器使用）。过去一年城市急诊科（艾德）为解决青少年酗酒和暴力行为提供了一个独特的环境，并利用了“可教的时刻”。“这项为期五年的研究将完善有前途的干预方法，根据对青少年个人风险行为的评估，结合定制技术，以解决酗酒和暴力行为。这项随机对照试验将在30个月内筛选约3200名艾德（14-18岁）青少年。那些过去一年饮酒和暴力行为筛查呈阳性的人（约30%）将按性别分层，然后随机分配到三种条件之一（n=250/组）：计算机改编的动机访谈+技能培训、治疗师改编的动机访谈+技能培训，以及控制条件的信息小册子。主要结局将在3个月和12个月时进行评价，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。1周随访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、干预保真度和其他干预过程措施。将检查的其他协变量包括性别、人种和年龄。这项研究利用了研究团队先前提供基于ED的酒精干预的经验，使用量身定制的计算机程序和简短的激励建议会议来解决处于危险中的内城青年的常见行为。拟议的研究整合了酒精滥用和暴力行为的简单干预策略，使用最先进的技术，以调整干预措施，以适应青少年在高风险的城市艾德设置的特定风险因素;量身定制的计算机化程序使用现有的技术，以增加和/或取代临床工作人员在艾德设置的需要，那里有有限的工作人员的时间来影响行为改变。该项目将为实施综合预防计划提供关键的第一步，该计划旨在解决每年有可能向数百万访问城市ED的青少年提供的重叠风险因素。

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.