Automated Bilingual Computerized Alcohol Screening & Intervention in Latinos

描述（由申请人提供）：由于酒精对人类生命造成的疾病负担是惊人的。酒精滥用普遍侵蚀饮酒者个人的生活质量，并对社区产生负面和累积性后果。美国拉丁美洲人受酒精滥用和依赖的影响不成比例，这一点尤其令人担忧，因为拉丁美洲人占过去十年美国人口增长的56%。与此同时，在家中讲西班牙语的美国居民人数从1700万增加到3500万。在忙碌的急诊科（艾德）环境中，语言障碍以及其他独特的挑战限制了艾德酒精筛查、简短干预和转诊治疗（SBIRT）的广泛采用。在艾德中对拉丁裔饮酒者使用自动双语计算机酒精筛查和干预（AB-CASI）具有强有力的早期令人信服的证据，表明它可以克服障碍，增加对弱势艾德人群的酒精治疗。目标：进行一项随机对照试验，招募讲英语和西班牙语的拉丁美洲艾德成年患者，比较AB-CASI与标准治疗（SC）在减少酒精摄入量方面的疗效以及从风险到依赖的所有不健康饮酒水平的后果。目的：我们经验丰富的多学科团队将：（1）比较AB-CASI与SC在减少不健康饮酒者的酒精消耗方面的功效，（2）比较AB-CASI与SC在减少酒精相关的负面健康行为和后果方面的功效，（3）比较AB-CASI与SC在30天参与治疗中的功效，以及（4）探索AB-CASI对酒精消耗的变化，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剂的30天治疗参与。我们的假设是：（1）在12个月时，AB-CASI在减少酗酒事件次数和过去28天内每周平均饮酒次数方面上级SC，（2）在12个月时，AB-CASI在减少酒精相关的不良健康行为和后果方面上级SC（驾驶受损、与受损司机一起乘车、受伤、被捕、迟到和缺勤/缺课天数），（3）AB-CASI在增加30天治疗参与方面将优于SC上级。研究方法：饮酒超过NIAAA低风险限值（存在依赖风险）的拉丁裔英语和西班牙语成人艾德ED患者将随机分配至AB-CASI或SC组。基线、30天、6个月和12个月评估将用于评价AB-CASI的疗效。重要性：美国拉丁裔人口的快速增长和艾德人群的多样性增加对酒精相关的健康差异研究和预防活动具有重大影响。独特之处：几乎所有的ED-SBIRT研究都排除了讲西班牙语的人群。AB-CASI的实证测试将增加不可或缺的价值和独特的知识，推动酒精研究领域的发展。预期结果：AB-CASI疗效将通过超越障碍来改善数百万不健康饮酒的弱势美国人的健康。

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.