Teen Alcohol Screening in the Pediatric Emergency Care Applied Research Network

描述（由申请人提供）：饮酒是造成青少年发病和死亡以及其他健康风险（包括其他物质使用和危险行为）的主要原因。青少年饮酒还可能导致长期的认知、行为、解剖和神经化学变化。此外，在青春期开始饮酒会显著增加成人酒精使用障碍的风险。鉴于这一巨大的公共卫生负担，成功地确定目前或未来有问题饮酒风险的青少年是非常重要的，因为干预可能对青少年和成人酒精使用障碍产生重大影响。国家酒精滥用和酒精中毒研究所（NIAAA）开发了一种新的两问题筛选工具，用于早期发现酒精使用和问题。根据经验，筛查可能是当前和未来酒精使用负面影响的有力预测指标。我们建议通过在15个美国儿科急诊科（PED）的12-17岁儿童中验证NIAAA两题筛查来检验RFA- AA-12-008的目标，通过追求两个特定目标：主要目标1)确定两题筛查关于酒精滥用的并发、趋同、判别和预测效度；次要目标1)确定两题筛查关于其他物质使用和危险行为的并发和预测效度。PED设置的优势在于能够捕获高风险人群，如辍学者和没有初级保健或保险的人，他们经常使用PED进行医疗护理，而在其他研究设置中被遗漏。采用儿科急诊应用研究网络（PECARN），我们将采用多中心设计，在一个非常大的、不同的青少年样本中，使用已建立的、经过验证的测量工具，测试NIAAA两题筛选的并发、收敛和预测效度。参加PECARN PEDs的12-17岁青少年（N=8000）将在3.5年的时间内入组，并将完成两个问题的筛选以及酒精和其他药物（AOD）和行为（“标准”）评估。这些年轻人的回答将被用来评估NIAAA两题筛选的并发收敛效度和判别效度。将从初始样本中得到两个青年子样本。第一个子样本（N=300）将在首次急诊科访问一周后重新进行NIAAA两题筛查，以评估NIAAA两题筛查的测试-重测可靠性。第二个样本（N=2500）将在PED访问后的12个月和24个月用标准评估电池重新评估，以评估两问题屏幕的预测有效性。这个大样本将允许按性别、种族、民族和其他重要的人口统计学变量进行分层分析，这在单中心或小样本研究中是不可能的。这项研究具有重要意义，因为它严格评估了NIAAA双问题筛选预测当前和未来AOD风险以及其他行为问题的能力，并将产生非常可靠的、可推广的结果。

DESCRIPTION (provided by applicant): Alcohol use is a major contributor to the leading causes of adolescent morbidity and mortality and to other health risks, including other substance use and risky behaviors. Adolescent alcohol use may also result in long term cognitive, behavioral, anatomic and neurochemical changes. Additionally, initiating alcohol use in adolescence significantly increases a person's risk for adult alcohol use disorders. Given this considerable public health burden, successfully identifying adolescents at risk for current or future problematic alcohol use is of major importance, as intervention may significantly affect both adolescent and adult alcohol use disorders. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) has developed a novel two-question screening tool for the early detection of alcohol use and problems. Empirically based, the screen may be a powerful predictor of current and future negative consequences of alcohol use. We propose to test the goals of RFA- AA-12-008 by validating the NIAAA two-question screen with 12-17 year olds in 15 U.S. pediatric emergency departments (PED), by pursuing two specific aims: Primary Aim 1) To determine the concurrent, convergent, discriminant, and predictive validity of the two-question screen regarding alcohol misuse, and Secondary Aim 1) To determine the concurrent and predictive validity of the two-question screen regarding other substance use and risky behaviors. The advantage of the PED setting is the ability to capture high risk populations such as school dropouts and those without primary care or insurance, who often use PEDs for their medical care and are missed in other study settings. Employing the Pediatric Emergency Care Applied Research Network (PECARN), we will use a multi-center design to test the concurrent, convergent and predictive validity of the NIAAA two-question screen using established, validated measurement instruments in a very large, diverse sample of youths. Youths 12-17 years (N=8000) presenting to participating PECARN PEDs will be enrolled over a 3.5-year period and will complete the two-question screen and an alcohol and other drug (AOD) and behavior ("criterion") assessment battery. Responses from these youths will be used to assess the concurrent convergent, and discriminant validity of the NIAAA two-question screen. Two subsamples of youths will be derived from the initial sample. The first subsample (N=300) will be re-administered the NIAAA two-question screen, one week after their initial ED visit to assess the test-retest reliability of the NIAAA two-question screen. The second sample (N=2500), will be reassessed at 12 and 24 months after their PED visit with the criterion assessment battery to assess the predictive validity of the two-question screen. This large sample will permit stratified analyses by gender, race, ethnicity and other important demographic variables, which are not possible with single center or smaller sample studies. The proposed research is significant because it rigorously evaluates the ability of the NIAAA two-question screen to predict current and future AOD risks as well as other behavior problems, and will generate very robust, generalizable results.