Automated Bilingual Computerized Alcohol Screening & Intervention in Latinos

描述(申请人提供)：酒精给人类生活带来的疾病负担令人震惊。酒精滥用无处不在地侵蚀个人饮酒者的生活质量，并对社区产生负面和累积的后果。美国拉美裔美国人受到酒精滥用和依赖的影响不成比例，这一点尤其令人担忧，因为在过去十年里，拉美裔占美国人口增长的56%。与此同时，在家中说西班牙语的美国居民数量从1700万人增加到3500万人以上。语言障碍，以及繁忙的急诊科(ED)环境中的其他独特挑战，限制了ED酒精筛查、短暂干预和转诊治疗(SBIRT)的广泛采用。在ED中对拉丁裔饮酒者使用自动双语计算机化酒精筛查和干预(AB-CASI)拥有强有力的早期令人信服的证据，表明它可以克服障碍，增加易受ED人群的酒精治疗。目的：进行一项随机对照试验，招募讲英语和西班牙语的成年拉丁裔ED患者，比较AB-CASI和标准护理(SC)在减少酒精消耗方面的效果，以及从高风险到依赖的各种不健康饮酒的后果。目的：我们经验丰富的多学科团队将：(1)比较AB-CASI和SC在减少不健康饮酒者饮酒方面的有效性，(2)比较AB-CASI和SC在减少与酒精相关的负面健康行为和后果方面的有效性，(3)比较AB-CASI和SC在30天的治疗投入中的有效性，以及(4)探索AB-CASI在酒精消费、与酒精相关的负面健康行为和后果以及拉丁裔亚群和其他潜在修饰物的30天治疗参与度方面的变化。我们的假设是：(1)在12个月时，AB-CASI在减少酗酒次数和过去28天的每周平均饮酒量方面优于SC；(2)在12个月时，AB-CASI在减少与酒精相关的负面健康行为和后果(驾驶受损、与受损司机一起骑车、受伤、逮捕、迟到和缺课天数)方面优于SC；以及(3)AB-CASI在增加30天的治疗参与度方面优于SC。方法：成年拉丁裔、英语和西班牙语ED患者饮酒超过NIAAA低风险限度(有依赖风险)将被随机分为AB-CASI或SC。基线、30天、6个月和12个月的评估将用于评估AB-CASI的疗效。意义：美国拉美裔人口的快速增长和ED人口日益多样化对与酒精相关的健康差距研究和预防活动具有重大影响。独特之处：几乎所有的ED-SBIRT研究都排除了说西班牙语的人群。经验性测试AB-CASI将增加不可或缺的价值和独特的知识，推动酒精研究领域向前发展。预期结果：AB-CASI疗效将超越障碍，改善数百万不健康饮酒的脆弱美国人的健康。

DESCRIPTION (provided by applicant): The burden of disease on human life due to alcohol is staggering. Alcohol misuse pervasively erodes the quality of life for individual drinkers and has negative and cumulative consequences on communities. U.S. Latinos are disproportionately affected by alcohol misuse and dependence which is of particular concern given that Latinos comprise 56% of U.S. population growth in the past decade. Simultaneously, the number of U.S. residents that speak Spanish at home grew from 17 million to over 35 million. Language barriers, among other unique challenges in the busy emergency department (ED) setting, have limited wide adoption of ED alcohol screening, brief intervention and referral to treatment (SBIRT). Use of Automated Bilingual-Computerized Alcohol Screening and Intervention (AB-CASI) for Latino Drinkers in the ED holds strong early compelling evidence that it can surmount barriers and increase alcohol treatment in vulnerable ED populations. Objective: To conduct a randomized controlled trial that enrolls both English and Spanish speaking adult Latino ED patients to compare the efficacy of AB-CASI to Standard Care (SC) in reducing alcohol consumption and consequences for all levels of unhealthy drinking ranging from at-risk to dependence. Aims: Our seasoned multidisciplinary team will: (1) compare the efficacy of AB-CASI to SC in the reduction of alcohol consumption in unhealthy drinkers, (2) compare the efficacy of AB-CASI to SC in the reduction of alcohol-related negative health behaviors and consequences, (3) compare the efficacy of AB-CASI to SC in 30-day engagement in treatment, and (4) explore variation of AB-CASI on alcohol consumption, alcohol-related negative health behaviors and consequences and 30-day treatment engagement across Latino subpopulations and other potential modifiers. Our hypotheses are: (1) at 12 months, AB-CASI will be superior to SC in reducing the number of binge drinking episodes and the mean number of weekly drinks over the last 28-days, (2) at 12 months, AB-CASI will be superior to SC in reducing alcohol-related negative health behaviors and consequences (episodes of impaired driving, riding with an impaired driver, injuries, arrests, tardiness and days absent from work/school), and (3) AB-CASI will be superior to SC in increasing 30-day treatment engagement. Methods: Adult Latino English and Spanish speaking ED patients who drink over the NIAAA low-risk limits (at-risk to dependence) will be randomized to AB-CASI or SC. Baseline, 30-day, 6 and 12-month assessments will be used to evaluate efficacy of AB-CASI. Significance: The rapid U.S. Latino population growth and increasing diversity of ED populations has major implications for alcohol-related health disparities research and prevention activities. Unique features: Nearly all ED-SBIRT research has excluded Spanish speaking populations. Empirically testing AB-CASI will add indispensable value and unique knowledge to move the field of alcohol research forward. Expected results: AB-CASI efficacy will improve the health of millions of vulnerable Americans with unhealthy alcohol use by transcending barriers.