Dental and medical office iMET to reduce teen tobacco, alcohol, and drug use

牙科和医疗办公室 iMET 旨在减少青少年吸烟、饮酒和吸毒

• 批准号: 7834745
• 负责人: JOHN R KNIGHT
• 金额: $ 47.51万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-22 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7834745
• 关键词: 18 year old; 21 year old; Address; Adolescence; Adolescent; Adult; Age; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Area; Behavioral; Caring; Cause of Death; Clinic Visits; Clinical; Commit; Computers; Confidence Intervals; Counseling; Dental; Dental Care; Dental General Practice; Dental Offices; Dental Schools; Development; Drug Addiction; Drug Prescriptions; Drug usage; Early treatment; Effectiveness; Ethnic Origin; Feedback; Focus Groups; Future; Gender; Goals; Health; Health behavior; Healthcare; Home environment; Hour; Human; Internet; Intervention; Intranet; Journals; Life; Massachusetts; Medical; Medicine; Mentors; Odds Ratio; Office Visits; Oral health; Outpatients; Parenting Education; Parents; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Practice Guidelines; Preventive; Primary Health Care; Printing; Production; Protocols documentation; Provider; Public Health; Publishing; Race; Randomized; Randomized Clinical Trials; Reporting; Research; Risk; Risk Assessment; Sampling; Screening procedure; Self Administration; Self-Administered; Services; Site; Substance abuse problem; System; Technology; Teenagers; Testing; Text; Textbooks; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Training; Treatment Cost; Treatment Protocols; Universities; Validity and Reliability; Youth; alcohol and other drug; alcohol intervention; base; brief screening; career; comparative effectiveness; computer generated; computer program; computerized; design; drinking; effectiveness research; effectiveness trial; experience; improved; interest; mortality; motivational enhancement therapy; older patient; prevent; programs; routine care; screening, brief intervention, referral, and treatment; smoking cessation; technological innovation; tool; treatment as usual; treatment strategy

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research, and specific Topic (05-DE-102) Treatment of tobacco and drug dependence in dental settings. The goal of this project is to develop an Internet/Intranet-based Motivational Enhancement Therapy (iMET) program for adolescents that targets tobacco, alcohol, and drug use. These substances are associated with the leading causes of death during adolescence and serious health problems later in life. Our investigative team has previously developed screening, brief intervention, and referral to treatment (SBIRT) strategies for medical offices that target alcohol and drug use. We created a computer program (cSBIRT) based on the CRAFFT screen, which adolescent patients could self-administer in the waiting room before seeing the primary care provider (PCP). The program immediately shows the adolescent his/her score and level of risk, presents scientific information and true life stories about the harmful effects of substance use, and prints a Report sheet that prompts the PCP to advise the teen to stay away from alcohol and drugs. We found in a recent study that 40% of adolescent patients who received cSBIRT stopped using alcohol/drugs, which was significantly better than Treatment As Usual (TAU). However, 60% did not stop and need additional counseling, such as MET. We created our MET intervention to be specifically suited to the unique developmental needs of adolescents. We found in another recent study that MET was significantly better than TAU in reducing drug use among teens in an outpatient substance abuse treatment population. We will now adapt this proven MET intervention and test it in a primary care population of adolescents coming for routine medical and dental care, where we believe it will have an even greater effect. First, we must adapt MET so that it targets tobacco use in addition to other substances, and convert its tools to a computerized format. We will design the iMET program so that adolescents can self- administer nearly all of it, which makes it practical for use in busy PCP offices. We also will add a new feature, Technological Extenders (TEs), which are computer-generated personalized emails/text messages that PCPs send to teen patients during the months after the office visit to extend the effects of the iMET over time. We will hold focused group discussions with teens, parents, and PCPs during the first year of the project, and design the iMET system to respond to their opinions and needs. We will add dental practices to our research network of nine PCP offices, and then conduct a small pilot study comparing iMET/TE with TAU. The purpose of the pilot is to estimate the effect size of the new iMET/TE system in reducing tobacco, drug, and alcohol use. We will use these estimates and our pilot study experience to design a future study comparing iMET/TE to TAU in a much larger population of adolescents, which could prove with statistical certainty that the iMET/TE system is effective. The purpose of this project is to improve adolescent behavioral counseling services in healthcare settings with a new Internet/Intranet-based Motivational Enhancement Therapy (iMET) intervention that targets the use of tobacco, alcohol, and other drugs. If proven effective, we will disseminate iMET to primary care dental and medical offices across the U.S. Early intervention can substantially reduce teen substance use and its related mortality; prevent other serious consequences; and greatly decrease the associated later burdens of human suffering and high treatment costs.

描述（由申请人提供）：本申请涉及广泛的挑战领域（05）比较有效性研究，以及特定主题（05- de -102）牙科环境中烟草和药物依赖的治疗。这个项目的目标是为青少年开发一个基于互联网/内部网的动机增强疗法（iMET）项目，针对烟草、酒精和毒品的使用。这些物质与青春期死亡的主要原因以及以后生活中的严重健康问题有关。我们的调查小组先前为针对酒精和药物使用的医疗办公室制定了筛查、短暂干预和转诊治疗（SBIRT）策略。我们创建了一个基于craft屏幕的计算机程序（cSBIRT），青少年患者可以在等候室看到初级保健提供者（PCP）之前自行管理。该计划立即向青少年显示他/她的分数和风险水平，提供有关药物使用有害影响的科学信息和真实生活故事，并打印一份报告表，提示PCP建议青少年远离酒精和毒品。我们在最近的一项研究中发现，接受cSBIRT的青少年患者中有40%停止使用酒精/药物，这明显优于常规治疗（TAU）。然而，60%的人没有停止，需要额外的咨询，如MET。我们创造了MET干预来特别适应青少年独特的发展需求。我们在最近的另一项研究中发现，在门诊药物滥用治疗人群中，MET在减少青少年吸毒方面明显优于TAU。现在，我们将采用这种经过验证的MET干预措施，并在接受常规医疗和牙科护理的青少年初级保健人群中进行测试，我们相信它会产生更大的效果。首先，我们必须调整MET，使其除针对其他物质外还针对烟草使用，并将其工具转换为计算机格式。我们将设计iMET计划，使青少年可以自行管理几乎所有的内容，这使得它在繁忙的PCP办公室中实用。我们还将增加一个新功能，技术扩展器（te），这是电脑生成的个性化电子邮件/短信，pcp在办公室访问后的几个月内发送给青少年患者，以延长iMET的效果。在项目的第一年，我们将与青少年、家长和pcp进行重点小组讨论，并设计iMET系统来回应他们的意见和需求。我们将在我们的9个PCP办公室的研究网络中增加牙科诊所，然后进行一项比较iMET/TE与TAU的小型试点研究。该试点的目的是估计新的iMET/TE系统在减少烟草、毒品和酒精使用方面的效应大小。我们将利用这些估计和我们的试点研究经验来设计一项未来的研究，在更大的青少年人群中比较iMET/TE和TAU，这可以从统计上确定iMET/TE系统是有效的。该项目的目的是通过一种新的基于互联网/内部网的动机增强疗法（iMET）干预措施，以烟草、酒精和其他药物的使用为目标，改善医疗保健机构中的青少年行为咨询服务。如果证明有效，我们将把iMET推广到美国的初级保健牙科和医疗办公室。早期干预可以大大减少青少年药物使用及其相关死亡率；防止其他严重后果；并大大减少与之相关的人类痛苦的后期负担和高昂的治疗费用。