Patients, Clincs, and Systems: Screening for Alcohol Use

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This revised Competitive Renewal for the Midcareer Investigator Award in Patient-Oriented Research is being submitted to allow me to consolidate and extend the achievements realized with the first award. As requested by the Review Committee, more information about my mentoring philosophy and mentees is included. A renewal would support my goals to make a significant contribution to patient-oriented alcohol research with a particular focus on women's health, and to continue as a teacher of the next generation of clinical researchers. In mentoring, I would like to continue my otherwise unfunded individual mentoring activities, while also leading the development of a hospital-wide, interdisciplinary mentoring program as a core component of the Center for Clinical Investigation (CCI), where I am Director of Education. In patient- oriented research, my proposed project, "Identification and Modification of Alcohol and Substance Use by Pregnant Adolescents," will not only synthesize several fruitful lines of previous clinical research in the identification and reduction of risk drinking in pregnancy, and motivational interventions in reducing adolescent substance use, but also address the needs of a particularly vulnerable group. The development of a pilot study and eventual clinical trial will provide ample opportunities for junior investigators to participate. The rate of adolescent pregnancy in America is the highest among developed nations, with approximately 1 million teenagers becoming pregnant every year. Most of these adolescent pregnancies are unplanned, and tend to be recognized later than adult pregnancies. Adolescent health risk behaviors such as substance use and sexual activity cluster together, componding the biologic risk inherent in young maternal age and the adverse social consequences of adolescent pregnancy. The study's purpose is twofold: 1) to evaluate the CRAFFT alcohol and drug use screening instrument in pregnant adolescents, and 2) to test the hypothesis that those subjects receiving the motivational intervention will demonstrate greater reductions in alcohol and substance use than those randomized to the attention control condition, consisting of prenatal nutrition education. The proposed study site is the Young Adult Reproductive Health Service, run by the Brigham and Women's Hospital in conjunction with Children's Hospital for the past two decades, and serves 200 new patients annually.