Automated Bilingual Computerized Alcohol Screening & Intervention in Latinos

描述（由申请人提供）：酒精给人类生活带来的疾病负担是惊人的。酒精滥用普遍侵蚀个人饮酒者的生活质量，并对社区产生消极和累积的后果。美国拉丁美洲人受到酒精滥用和依赖的影响不成比例，鉴于拉丁美洲人在过去十年中占美国人口增长的56%，这一点尤其令人担忧。与此同时，在家说西班牙语的美国居民从1700万增加到3500多万。在繁忙的急诊科（ED）环境中，语言障碍以及其他独特的挑战限制了急诊科酒精筛查、短暂干预和转诊治疗（SBIRT）的广泛采用。在ED中的拉丁裔饮酒者中使用自动双语计算机酒精筛查和干预（AB-CASI）提供了强有力的早期令人信服的证据，表明它可以克服障碍并增加弱势ED人群的酒精治疗。目的：开展一项随机对照试验，纳入说英语和西班牙语的成年拉丁裔ED患者，比较AB-CASI与标准护理（SC）在减少饮酒量和从危险到依赖的所有水平的不健康饮酒的后果方面的疗效。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饮酒量方面的疗效，(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疗效，(3)比较AB-CASI与SC在治疗30天内的疗效，(4)探讨AB-CASI对饮酒量的影响。酒精相关的负面健康行为和后果以及拉丁裔亚人群和其他潜在调节因素的30天治疗参与情况。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天内每周平均饮酒次数方面优于SC；(2)在12个月时，AB-CASI在减少酒精相关的负面健康行为和后果（不良驾驶、与不良驾驶员同行、受伤、逮捕、迟到和缺勤天数）方面优于SC； (3) AB-CASI在增加30天治疗参与方面优于SC。方法：饮酒超过NIAAA低风险限值（有依赖风险）的成年拉丁美洲英语和西班牙语ED患者将被随机分为AB-CASI或SC。基线、30天、6和12个月的评估将用于评估AB-CASI的疗效。意义：美国拉丁裔人口的快速增长和ED人群多样性的增加对酒精相关健康差异的研究和预防活动具有重要意义。独特特点：几乎所有ED-SBIRT研究都排除了说西班牙语的人群。对AB-CASI进行实证检验将为酒精研究领域的发展增添不可或缺的价值和独特的知识。预期结果：AB-CASI的功效将超越障碍，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.