Screening and Brief Intervention in the ED among Mexican-origin Young Adults

墨西哥裔年轻人的急诊科筛查和短暂干预

• 批准号: 8074108
• 负责人: CHERYL J CHERPITEL
• 金额: $ 65.33万
• 依托单位: PUBLIC HEALTH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-20 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8074108
• 关键词: 19 year old; 20 year old; Accident and Emergency department; Acute; Address; Admission activity; Adolescent; Adult; Advocate; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcohols; American College of Surgeons; Applications Grants; Area; Attention; Birth; Blinded; Centers for Disease Control and Prevention (U.S.); Cities; Communities; Consent; Country; Coupled; Cultural Characteristics; Data; Development; Disease; Effectiveness; Effectiveness of Interventions; Emergency Medical Technicians; Emergency Medicine; Equation; Esthesia; Ethnic group; Event; Female; Funding; Generations; Guidelines; Health Promotion; Heavy Drinking; High Prevalence; Hispanics; Immigrant; Impulsivity; Individual; Injury; International; Intervention; Intervention Studies; Intervention Trial; Knowledge; Language; Lead; Leadership; Life; Literature; Logistic Regressions; Medical; Mexican; Mexico; NIH Program Announcements; National Institute on Alcohol Abuse and Alcoholism; Nurse Practitioners; Nurses; Outcome; Outcome Assessment; Patient Self-Report; Patients; Physician Assistants; Physicians; Poland; Population; Predictive Value; Prevalence; Primary Health Care; Protocols documentation; Provider; Public Health; Publishing; Quality of life; Randomized; Randomized Controlled Clinical Trials; Readiness; Recommendation; Relative (related person); Reporting; Research; Research Personnel; Risk; Risk-Taking; Screening procedure; Site; Social Characteristics; Source; Staging; Subgroup; Surveys; Techniques; Telephone; Testing; Texas; Time; Training; Translating; Translations; Trauma; Treatment Protocols; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Visit; Work; World Health Organization; Youth; age group; alcohol abuse therapy; alcohol advertising; alcohol availability; alcohol related problem; alcohol risk; alcohol screening and brief intervention; alcohol use disorder; binge drinking; breath alcohol measurement; brief alcohol intervention; brief intervention; brief motivational intervention; care seeking; convict; cost; disorder prevention; drinking; driving behavior; experience; follow-up; group intervention; hazardous drinking; high risk drinking; impaired driving performance; improved; injured; legal drinking age; male; marijuana user; motivational enhancement therapy; motivational intervention; prototype; public health relevance; recidivism; response; screening and brief intervention; screening, brief intervention, referral, and treatment; standard care; symposium; trauma centers; treatment trial; trial comparing; twelfth grade; young adult

DESCRIPTION (provided by applicant): Screening and Brief Intervention in the ED among Mexican-origin Young Adults The aims of this application "Screening and Brief Alcohol Intervention in Underage and Young Adult Populations" are to: 1) examine the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) among Mexican-origin young adults (age 18-25), using a motivational intervention delivered by a Health Promotion Advocate (promotore), relative to standard care with and without assessment, on a reduction in heavy drinking (drinking days per week, number of drinks per day, maximum number of drinks on an occasion) and alcohol-related problems (RAPS4 and SIPS +6) in the emergency department (ED) at the U.S.- Mexico border; and, 2) identify variables that are related to effectiveness of the intervention and that predict successful treatment outcome. We plan to translate motivational interventions that have been successful in primary care and which were recently implemented in the U.S. 14 Academic Emergency Medicine Collaborative (AEMC) SBIRT study to a population of young adult Mexican-origin ED patients on the Texas border in El Paso; a population which has evidenced a high prevalence of hazardous drinking and alcohol- related problems, in part due to the greater availability of alcohol and at low cost in Mexico border cities. The SBIRT study, funded by NIAAA and SAAMHSA, was the first multi-site, collaborative study of screening, brief intervention and referral for at-risk and dependent drinking in the ED. We will conduct a blinded randomized control brief motivational intervention trial in which both injured and non-injured patients will be screened for at- risk or dependent (using the RAPS4) drinking. Patients screening positive who consent to participate in the study will be randomized into one of three groups: screened only, assessed, and assessed plus brief intervention, with n=312 in each group. Intervention and assessment groups will be followed-up at 3 months and all three groups at 12 months. Modifying variables include drinking in the event, risk-taking disposition, readiness and stage of change, country of birth (U.S. vs. Mexico) and language in which the assessment and intervention were conducted (English vs. Spanish). Outcome data will be analyzed using ANOVA, logistic regression and Generalized Estimating Equations. The interaction of modifying variables on outcomes will also be analyzed. Additionally, the study will examine data relevant to key issues related to the potential translatability and public health impact of the intervention and next steps. Given the paucity of published studies of brief intervention in the ED among young adults in general, or among Mexican-origin adults, and none among Mexican-origin young adults, who may be most vulnerable to alcohol use problems and disorders, especially at the border, work to be undertaken in this application is especially important in determining the effectiveness of AEMC SBIRT protocols (which may serve as a prototype for screening, brief intervention and referral for at-risk and dependent drinking in the ED) in this context of Mexican-origin young adults. PUBLIC HEALTH RELEVANCE: This work is especially relevant to public health in relation to reducing subsequent alcohol-related ED visits and associated costs and increase quality of life among young adults. The project will inform the development and spread of more effective techniques and protocols for addressing at-risk and dependent drinking in the ED in this age group, and provide a better understanding of those factors that influence effectiveness of brief intervention and predict successful patient outcomes across ethnic and cultural groups in the U.S. Additionally, this will be the first randomized controlled clinical trial compared to standard care of brief intervention using promotores in the Mexican-origin community, which may provide a better chance of ongoing implementation of SBIRT in the ED than using ED staff providers.

描述(由申请人提供)：在墨西哥裔年轻人中进行ED的筛查和短暂干预这项申请的目的是：1)检查墨西哥裔年轻人(18-25岁)中筛查、简短干预和转诊治疗(SBIRT)的有效性，使用健康促进倡导者(促进者)提供的关于减少酗酒(每周饮酒天数，每天饮酒量，美国-墨西哥边境急诊科(ED)的酒精相关问题(RAPS4和SIPS+6)；以及，2)确定与干预效果相关并预测成功治疗结果的变量。我们计划将在初级保健方面取得成功且最近在美国14学术急救医学合作(AEMC)SBIRT研究中实施的激励性干预措施转化为埃尔帕索得克萨斯州边境的墨西哥裔年轻ED患者；这一人群已经证明危险饮酒和与酒精相关的问题非常普遍，部分原因是墨西哥边境城市酒精的供应更容易且成本更低。SBIRT研究由NIAAA和SAAMHSA资助，是ED中第一项关于高危和依赖饮酒的筛查、简短干预和转介的多地点合作研究。我们将进行一项盲法、随机对照、简明动机干预试验，在该试验中，受伤和未受伤的患者都将接受危险饮酒或依赖饮酒(使用RAPS4)的筛查。同意参与这项研究的筛查阳性患者将被随机分成三组之一：仅筛查、评估、评估和短暂干预，每组312人。干预组和评估组将在3个月时进行随访，所有三组在12个月时进行随访。修改变量包括事件中的饮酒情况、冒险倾向、准备程度和变化阶段、出生国家(美国和墨西哥)以及进行评估和干预的语言(英语和西班牙语)。结果数据将使用方差分析、Logistic回归和广义估计方程进行分析。还将分析修改变量对结果的交互作用。此外，这项研究将审查与干预和下一步行动的潜在可译性和公共健康影响相关的关键问题的相关数据。鉴于已发表的在一般年轻人或墨西哥裔成年人中对勃起功能障碍进行短暂干预的研究很少，而在墨西哥裔年轻人中没有发表研究，墨西哥裔年轻人可能最容易受到酒精使用问题和障碍的影响，特别是在边境地区，因此，在这一应用中开展的工作对于确定AEMC SBIRT方案在墨西哥裔年轻人中的有效性尤其重要(该方案可作为筛查、短暂干预和转介墨西哥裔青年饮酒高危和依赖性饮酒的原型)。 公共卫生相关性：这项工作与公共卫生尤其相关，因为它有助于减少随后因酒精引起的急症就诊和相关费用，并提高年轻人的生活质量。该项目将为更有效的技术和方案的开发和传播提供信息，以解决该年龄段的ED高危和依赖饮酒问题，并更好地了解那些影响短期干预有效性的因素，并预测美国不同种族和文化群体的成功患者结局。此外，这将是第一次随机对照临床试验，与墨西哥裔社区使用促进剂进行短暂干预的标准护理相比，这可能提供比使用ED工作人员提供者更好的机会在ED实施SBIRT。