Optimizing Brief Alcohol Intervention for Underage Drinkers in the ER

优化急诊室中未成年饮酒者的短暂酒精干预

• 批准号: 7631535
• 负责人: REBECCA M. CUNNINGHAM
• 金额: $ 73.18万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-15 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7631535
• 关键词: Accident and Emergency department; Address; Adolescent; Adoption; Adult; Age; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Arts; Barrier Contraception; Caring; Communities; Computer Assisted; Computers; Data; Dependence; Development; Driving While Intoxicated; Drunk driving; Early Diagnosis; Early identification; Effectiveness; Effectiveness of Interventions; Emergency Situation; Environment; Epidemic; Gender; Health; Health Personnel; Health behavior; Healthcare; Heterogeneity; Hospitals; Individual; Individual Differences; Individuation; Injury; Inpatients; Intervention; Intervention Studies; Licensing; Life; Mediation; Mediator of activation protein; Medical; Medical Staff; Mental Health; Methods; Modeling; Motivation; Nature; Outcome; Participant; Patient Discharge; Patient Recruitments; Patients; Pattern; Persons; Population; Prevention; Process; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Relative (related person); Research; Research Design; Resources; Risk; Risk Behaviors; Sampling; Screening procedure; Self Efficacy; Spottings; Staging; Subgroup; Tablets; Technology; Testing; Time; Training; Visit; Work; Writing; Youth; aged; alcohol misuse; alcohol related consequences; alcohol related problem; alcohol screening; alcohol use disorder; base; binge drinking; brief alcohol intervention; brief intervention; computerized; design; drinking; follow-up; improved; injured; innovation; intervention effect; laptop; longitudinal design; meetings; motivational enhancement therapy; prevent; public health relevance; reduced alcohol use; research study; screening and brief intervention; screening, brief intervention, referral, and treatment; sex; technological innovation; touchscreen; treatment as usual; treatment strategy; tv watching; underage drinker; underage drinking; young adult

DESCRIPTION (provided by applicant): Screening for alcohol misuse offers opportunities for early detection and delivery of developmentally appropriate interventions among adolescent and young adult patients in medical settings. Although screening and brief interventions have shown promise among adolescents and young adults in the Emergency Department (ED), few studies have fully tested promising screening and brief intervention/treatment/referral components, perhaps due to logistical and practical impediments for the adoption in this setting. Therefore, the proposed study will use computerized screening using touch- screen computer tablets with audio (~5,700 patients) and will test developmentally appropriate, tailored intervention strategies in a two-factorial design (3x2). Specifically, 900 patients aged 14-20 in the ED who screen positive for problematic alcohol use (AUDIT score >=2 ages 14-17 and >=3 ages 18-20) in the past 3 months will be randomized to the combinations of three ED-based conditions (computer brief intervention-CBI; intervener delivered brief intervention-IBI ; enhanced usual care-EUC), and two follow-up conditions (adapted motivational enhancement therapy-AMET; enhanced usual care-EUC) that will take place 3 months post-ED. Interventions will be tailored to address individual differences (e.g., alcohol use patterns, stage of change, barriers/benefits of change) across key developmental transitions (e.g., acquiring a driver's license, living independently, etc.) All participants will receive written information regarding community resources; individuals who meet AUD criteria will additionally receive substance use treatment referrals. Stratified random assignment [by gender, age (14-17; 18- 20), and criteria for AUD] will take place at baseline for all ED-based and follow-up conditions. Recognizing that brief interventions are important, but not necessarily sufficient, for change in all adolescents and young adults who misuse alcohol, the primary specific aims of the proposed study will determine the independent effectiveness of immediate "on-the-spot" ED-based brief intervention conditions, 3-month follow-up brief treatment conditions, and combinations of conditions, for decreasing alcohol use and improving health-related outcomes (including injury, mental health, and other risk behaviors) at 6- and 12-months follow-up. The use of state-of-the-art computer technology for screening and brief interventions has the potential to reach greater numbers of underage drinkers presenting to the ED than is possible with person-delivered screening and brief intervention. Developing methods to efficiently and effectively optimize screening and brief intervention components has wide-ranging and powerful public health implications for modifying risk trajectories to reduce alcohol misuse and to prevent the development of AUD's among underage drinkers. PUBLIC HEALTH RELEVANCE: The Emergency Department (ED) setting is a unique point of access for reaching underage drinkers (age 14-20). With the aid of computer technology, this study will screen adolescents and young adults in the ED and fully test promising ED-based brief intervention and 3-month follow-up brief treatment approaches for alcohol misuse. Developing methods to efficiently and effectively optimize these approaches has powerful public health implications for improving outcomes for underage drinkers.

描述（由申请人提供）：酒精滥用筛查为医疗环境中的青少年和年轻成年患者提供了早期发现和提供适合发育的干预措施的机会。尽管筛查和简短干预措施在急诊科 (ED) 的青少年和年轻人中显示出希望，但很少有研究充分测试有希望的筛查和简短干预/治疗/转诊组成部分，这可能是由于在这种情况下采用的后勤和实际障碍。因此，拟议的研究将使用带音频的触摸屏电脑平板电脑进行计算机化筛查（约 5,700 名患者），并将在双因素设计 (3x2) 中测试适合发育的定制干预策略。具体来说，在过去 3 个月内，急诊室中 900 名年龄为 14-20 岁、酒精使用问题筛查呈阳性（审核评分≥2 名 14-17 岁和≥3 名 18-20 岁）的患者将被随机分配到三种基于 ED 的条件（计算机简短干预 -CBI；干预者提供简短干预 -IBI；强化常规护理 -EUC）和两种后续条件（适应性动机增强治疗 -AMET；增强型常规护理 -EUC）的组合。平常 care-EUC）将在 ED 后 3 个月进行。干预措施将量身定制，以解决关键发展转变（例如，获得驾驶执照、独立生活等）中的个体差异（例如，饮酒模式、变化阶段、变化的障碍/好处）。所有参与者都将收到有关社区资源的书面信息；符合 AUD 标准的个人还将额外接受药物滥用治疗转介。分层随机分配[按性别、年龄（14-17；18-20）和 AUD 标准]将在所有基于 ED 的情况和随访情况的基线时进行。认识到短暂干预对于改变所有滥用酒精的青少年和年轻人来说很重要，但不一定足够，拟议研究的主要具体目标将确定立即“现场”基于 ED 的简短干预条件、3 个月的后续简短治疗条件以及条件组合的独立有效性，以减少饮酒并改善 6 岁和 12个月的随访。与亲自进行筛查和简短干预相比，使用最先进的计算机技术进行筛查和简短干预有可能接触到更多到急诊室就诊的未成年饮酒者。开发有效优化筛查和简短干预措施的方法对于改变风险轨迹、减少酒精滥用并防止未成年饮酒者发生 AUD 具有广泛而强大的公共卫生影响。公共卫生相关性：急诊科 (ED) 是接触未成年饮酒者（14-20 岁）的独特途径。借助计算机技术，这项研究将对急诊科的青少年和年轻人进行筛查，并全面测试基于急诊科的短期干预和为期 3 个月的短期后续治疗方法。开发有效优化这些方法的方法对于改善未成年饮酒者的结果具有强大的公共卫生意义。