Optimizing Brief Alcohol Intervention for Underage Drinkers in the ER

酒精滥用筛查为早期发现和分娩发育迟缓提供了机会 在医疗环境中对青少年和青壮年患者进行适当的干预。虽然 筛查和简短的干预措施在青少年和年轻人中显示出了希望 急诊科(ED)，很少有研究完全测试有希望的筛查和简要 干预/治疗/转诊部分，可能是由于后勤和实际障碍 在这种情况下的领养。因此，拟议的研究将使用使用触摸的计算机筛选- 筛选带有音频的计算机平板电脑(约5,700名患者)，并将测试适合发育的、量身定做的 干预策略采用双因素设计(3x2)。具体地说，急诊科有900名年龄在14-20岁的患者 世卫组织对有问题的饮酒行为进行了阳性筛查(14-17岁审核分数=2分，18-20岁审核分数=3分) 过去3个月将随机分为三种基于ED的情况的组合(计算机简报 干预-CBI；干预者提供短暂干预-IBI；增强型日常护理-EUC)，以及 后续情况(适应动机增强疗法-AMET；加强日常护理-EUC) 这将在ED后3个月进行。干预措施将量身定做，以解决个体差异 (例如，酒精使用模式、改变的阶段、改变的障碍/好处) 过渡(例如，获得驾照、独立生活等)所有参与者都将收到 有关社区资源的书面信息；符合AUD标准的个人将另外 接受药物使用治疗转诊。分层随机分配[按性别、年龄(14-17岁；18- 20)，AUD的标准]将在所有以ED为基础和后续情况的基线上进行。 认识到短暂的干预对所有方面的改变都很重要，但不一定是充分的 对于滥用酒精的青少年和年轻人，拟议研究的主要具体目标将是 即刻“现场”ED短时干预的独立有效性判定 条件，3个月随访的简短治疗条件，以及条件的组合，用于减少 饮酒和改善与健康相关的结果(包括伤害、精神健康和其他风险 行为)在6个月和12个月的随访期。使用最先进的计算机技术 筛查和简短的干预有可能接触到更多的未成年饮酒者 向急诊室提交的报告比亲自进行筛查和简短干预更有可能。 开发高效和有效地优化筛查和简短干预组件的方法 对修改风险轨迹以降低风险具有广泛和强大的公共卫生影响 酒精滥用，并防止未成年饮酒者发展为AUD。

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.