Building the evidence for adolescent substance use preventive care at well-visits from mid-adolescence to young adulthood using the longitudinal NEXT study

摘要 物质使用(SU)是可预防的死亡、伤害和残疾的最常见原因之一，但我们 目前对于SU预防保健有益于青少年的初级保健存在证据空白。给定 尝试药物的中位发病年龄在15岁以下，临床医生需要询问并建议青少年 苏贯穿整个青春期。我们对青少年吸毒的程度知之甚少 随着时间的推移，青少年每年被问及并建议关于SU的比例 随着时间的推移，在井下访问，以及在青春期被询问和建议关于苏的程度是 与未来SU启动随着时间的推移而预防或减少有关。这项拟议的研究的目标是检查 青春期中期以来青少年SU预防保健与SU行为的纵向关联 青春期与青少年背景、社会决定因素和SU预防保健的差异 其他健康需求因素。我们假设，被询问和建议的青少年吸烟、酗酒、 以及在探井时使用其他药物将与随后预防非吸毒者开始使用SU有关，并 SU减少了以前的用户。我们将通过使用以下工具进行纵向数据分析来解决这一研究差距 NIH的下一项研究收集了2010-2017年(15-23岁)。这项建议是对我们先前工作的扩展， 显示大多数青少年在5-9岁(儿童期中期)到10-17岁(中期)进行良好访问 青春期)。在这些发现的基础上，我们的具体目标是：1)记录实质内容的程度 利用青少年随着时间的推移进行良好访问，2)描述青少年被定期询问的频率 并随着时间的推移对每一种和所有三种SU类型提供建议，以及3)检查被询问和 关于SU的建议与随后的SU启动预防或减少有关，并跨 旨在因青少年的背景、社会决定因素和其他健康需求因素而存在差异。创新： 我们提议的项目将是第一个研究青少年预防保健与纵向联系的研究 从青春期到青春期关于苏和苏行为的接收，臭名昭著的苏起病时代 和良好访问下降，使用尚未在青少年健康领域使用的分析方法 服务研究。我们将使用现有的基于非临床的国家纵向数据集，该数据集已经测量 不同发育期的井访、SU行为和SU预防护理接受情况的纵向数据。 这种类型的丰富数据以前从未用于向实践提供信息。公共卫生意义： 我们的研究将确定易受伤害的青少年，这些青少年一直没有参与或成为 没有参与井下探访的人，以及那些错过了SU预防护理机会的人。 调查结果将确定在多大程度上在探井时被询问和建议关于SU的情况 从青春期到青壮年，并展示SU筛查和建议的纵向好处 青春期关于青春期的苏，贡献了目前缺乏的证据质量。

ABSTRACT Substance use (SU) is one of the most common causes of preventable death, injury, and disability, yet we currently have evidence gaps for the benefit of SU preventive care for adolescents in primary care. Given the median onset age for trying substances is under age 15, clinicians need to ask and advise adolescents about SU throughout adolescence. We know little about the extent to which substance using adolescents are engaged in well-visits over time, the proportion of adolescents who are asked and advised annually about SU at well-visits over time, and the extent to which being asked and advised about SU during adolescence is related to future SU initiation prevention or reduction over time. The proposed study’s goals are to examine longitudinal associations of adolescents’ SU preventive care and SU behaviors from mid-adolescence through young adulthood and disparities in SU preventive care by adolescents’ background, social determinant, and other health need factors. We hypothesize that adolescents being asked and advised about smoking, alcohol, and other drug use at well-visits will be associated with subsequent prevention of SU initiation in non-users and SU reduction in prior users. We will address this research gap by conducting longitudinal data analyses using the NIH NEXT Study collected from 2010-2017 (ages 15-23). This proposal expands on our prior work which showed most adolescents were engaged in well-visits from ages 5-9 (mid-childhood) through 10-17 (mid- adolescence). Building on these findings, our specific aims are to: 1) document the extent to which substance using adolescents are engaged in well-visits over time, 2) describe how often adolescents are regularly asked and advised about each and all three SU types over time, and 3) examine the extent to which being asked and advised about SU is related to subsequent SU initiation prevention or reduction over time, and describe across aims disparities by adolescents’ background, social determinant, and other health need factors. INNOVATION: Our proposed project will be the first study to examine longitudinal associations of adolescents’ preventive care receipt about SU and SU behaviors from adolescence through young adulthood, notorious times for SU onset and well-visit decline, using analytic approaches that have not been used in the field of adolescent health services research. We will use an existing non-clinical based national longitudinal dataset that has measured longitudinal data on well-visits, SU behaviors, and SU preventive care receipt across developmental periods. This type of rich data has never been previously used to inform practice. PUBLIC HEALTH SIGNIFICANCE: Our study will identify vulnerable adolescents for outreach who are persistently not engaged or become disengaged from well-visits and among those engaged who have missed SU preventive care opportunities. Findings will identify the extent to which being asked and advised about SU at well-visits occurs from adolescence to young adulthood and demonstrate the longitudinal benefit of SU screening and advising during adolescence on young adulthood SU, contributing to quality of evidence that is currently lacking.