Substance Use Screening and Prevention for Adolescents in Pediatric Primary Care

儿科初级保健中青少年的药物使用筛查和预防

• 批准号: 8611104
• 负责人: MAUREEN D REYNOLDS
• 金额: $ 64万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8611104
• 关键词: 13 year old; Academy; Address; Adolescence; Adolescent; Age; Alcohol consumption; Alcohol or Other Drugs use; American; Behavior; Cardiovascular Diseases; Caring; Characteristics; Child; Childhood; Chronic Obstructive Airway Disease; Clinic; Collaborations; Communities; Computers; Coupled; Development; Disease; Drug usage; Effectiveness; Emotional; Evidence based program; Family; Family Process; Funding; Gender; Health Services Research; Healthcare; Healthcare Systems; Home visitation; Incidence; Insurance; Intervention; Intervention Studies; Laws; Lead; Lifestyle-related condition; Low income; Malignant neoplasm of lung; Mediating; Mediator of activation protein; Medical; Medicare; Modeling; National Institute of Drug Abuse; Nurses; Outcome; Parenting behavior; Parents; Participant; Patient Monitoring; Patients; Pediatrics; Personal Satisfaction; Persons; Physicians; Policies; Population; Prevention; Prevention program; Prevention strategy; Preventive; Primary Health Care; Problem behavior; Procedures; Psychologist; Race; Recruitment Activity; Reporting; Research; Research Infrastructure; Risk; Risk Factors; Sampling; Schools; Services; Sex Behavior; Smoking; Specificity; Subgroup; Substance Use Disorder; Testing; Tobacco; Training; United States National Institutes of Health; United States Substance Abuse and Mental Health Services Administration; Youth; adolescent substance use; anti social; base; brief intervention; burden of illness; checkup examination; conduct problem; copayment; cost; design; disorder prevention; dosage; drug abuse prevention; effectiveness clinical trial; efficacy testing; evidence base; health care quality; high risk; high risk sexual behavior; high school; informant; innovation; meetings; motivational enhancement therapy; outcome forecast; payment; pediatrician; prevent; primary care setting; programs; psychosocial; public health relevance; response; screening; screening, brief intervention, referral, and treatment; stressor; substance use prevention; tool

Recent developments in healthcare law support primary care-based intervention to prevent substance use disorder (SUD) and related behavior problems. However, evidence-based programs designed specifically for healthcare settings are lacking. This proposal is to test the effectiveness of integrating and adapting two NIDA- funded procedures for use in primary care pediatric clinics serving low-income youth: 1) the Urgency Indicator (UI) - a nurse-administered screening tool for high risk of substance use (SU) prior to high school and thus also for SUD and 2) the Family Check-Up (FCU) - a brief, family-based program to prevent SU/SUD with replicated efficacy. Recent American Academy of Pediatrics policy calls for this type of approach for preventing SU/SUD and outlines six barriers that have precluded a screening and referral-to-treatment approach for SU prevention in primary care. The UI/FCU integrated program addresses all six barriers. The UI/FCU approach has been rated in preliminary research during well-child check-ups with enthusiasm by youth patients, their parents and their physicians. The UI and FCU are currently being used in ongoing, albeit parallel, studies with the pediatrician collaborators of this proposal, but they have yet to be integrated within the same project. The following three aims focus on evaluating and refining the adaptation of the UI/FCU program for primary-care use: 1) to replicate the effectiveness of the UI screening tool in terms of concurrent and predictive validity and the engagement rate in the FCU; 2) to identify and address challenges in implementing and integrating the UI/FCU prevention strategy within a primary care clinic serving urban, low-income youth; and 3) to test the effectiveness of the UI/FCU on emerging SU, sexual activity, and conduct problems, as well as the putative mediators of these outcomes including parenting and parental well-being. Based on prior FCU efficacy studies, 500 dyads of parents and their 10- to 13-year-old children from low-income, ethnically diverse families will be recruited from a large primary care clinic in an urban community. This sample affords statistical power for effectiveness testing even in subgroups (e.g., age, gender, race). The FCU will be delivered for two or three years to test impact of dosage. Participants will be followed-up one year after completing FCU to evaluate longitudinal outcomes of the integrated UI/FCU. In addition to traditional effectiveness estimates, analyses will test for mediators and moderators of UI/FCU outcomes as well as whether pre-intervention within-person variability in risk factors (in addition to baseline scores) forecast outcomes. This approach represents a critical step toward a transformational advance in SU/SUD prevention by delivering intervention from pediatric primary care which meets a need identified by that profession, offers fiscal self-sustainability, provides infrastructure for dissemination, ascertains multiple informants (child and parent) for yearly patient monitoring, and serves as a venue for individualized intervention.

医疗保健法的最新发展支持以初级保健为基础的干预，以防止物质使用 疾病（SUD）和相关行为问题。然而，基于证据的方案专门为 缺乏医疗保健设施。本建议旨在测试整合和调整两个NIDA的有效性- 资助的程序，用于初级保健儿科诊所服务低收入青年：1）紧迫性指标 (UI)- 由护士管理的高中前物质使用高风险筛查工具， 2）家庭检查（FCU）-一个简短的，以家庭为基础的计划，以防止SU/SUD与复制 功效最近美国儿科学会的政策呼吁这种方法来预防SU/SUD 并概述了六个障碍，阻碍了筛查和治疗方法的SU预防 在初级保健中。UI/FCU集成计划解决了所有六个障碍。UI/FCU方法已被 在儿童健康检查的初步研究中，年轻患者、他们的父母和 他们的医生。UI和FCU目前正在进行中，尽管是平行的研究， 儿科医生合作者的这一建议，但他们还没有被纳入同一个项目。的 以下三个目标侧重于评估和改进初级保健的UI/FCU计划 用途：1）在同时和预测有效性方面复制UI筛选工具的有效性， 2）确定和应对在执行和整合 在为城市低收入青年服务的初级保健诊所内实施UI/FCU预防战略;以及3）测试 UI/FCU对新出现的SU，性活动和行为问题的有效性，以及假定的 这些结果的调解人，包括养育和父母的福祉。基于之前的FCU功效 研究，500对父母和他们的10至13岁的孩子从低收入，种族多样化的家庭 将从城市社区的大型初级保健诊所招募。这个样本提供了统计学上的力量 对于甚至在子组中的有效性测试（例如，年龄、性别、种族）。FCU将提供两个或 三年来测试剂量的影响。参与者将在完成FCU后一年进行随访， 评价集成UI/FCU的纵向结局。除了传统的有效性估计之外， 分析将测试UI/FCU结局的中介者和调节者，以及干预前 风险因素（除了基线评分之外）的人内变异性可以预测结果。这种方法 通过提供干预措施，代表了向SU/SUD预防转型迈进的关键一步 从儿科初级保健，满足该专业确定的需求，提供财政自我维持， 为传播提供基础设施，为每年的病人提供多个信息提供者（儿童和父母） 监测，并作为个性化干预的场所。