Optimizing Brief Alcohol Intervention for Underage Drinkers in the ER

描述(由申请人提供)：酒精滥用筛查为在医疗环境中的青少年和年轻成人患者提供早期发现和提供适合发育的干预措施的机会。虽然筛查和简单干预在急诊科的青少年和年轻人中显示出了希望，但很少有研究充分测试有希望的筛查和简短干预/治疗/转诊部分，这可能是因为在这种情况下收养存在后勤和实际障碍。因此，这项拟议的研究将使用带有音频的触摸屏电脑平板电脑进行计算机筛查(约5,700名患者)，并将以双因素设计(3x2)测试适合发育的、量身定制的干预策略。具体地说，在过去3个月中，ED中900名年龄14-20岁的患者筛查出有问题的饮酒行为(审计分数=2名14-17岁和3名18-20岁)，他们将被随机分为三种基于ED的条件(计算机简短干预-CBI；干预者提供短暂干预-IBI；增强型日常护理-EUC)和两种将在ED后3个月进行的随访条件(适应性动机增强疗法-AMET；增强型日常护理-EUC)。干预措施将量身定做，以解决关键发展转型(例如，获得驾照、独立生活等)中的个体差异(例如，酒精使用模式、变化阶段、变化的障碍/好处)。所有参与者将收到关于社区资源的书面信息；符合AUD标准的个人将额外获得药物使用治疗转介。分层随机分配[按性别、年龄(14-17岁；18-20岁)和AUD标准]将在所有基于ED和后续情况的基线上进行。鉴于简短的干预措施对于改变所有滥用酒精的青少年和青壮年的行为很重要，但并不充分，因此拟议研究的主要具体目标将确定在6个月和12个月的随访中，即时“现场”简短干预条件、3个月随访的简短治疗条件和多种条件的组合对于减少饮酒和改善健康相关结果(包括伤害、心理健康和其他危险行为)的独立有效性。使用最先进的电脑技术进行筛查和简短干预，有可能接触到更多未成年饮酒者，而不是亲自进行筛查和简短干预。开发高效和有效地优化筛查和简短干预组件的方法，对于改变风险轨迹，减少酒精滥用，防止未成年饮酒者发生AUD，具有广泛和强大的公共卫生影响。公共卫生相关性：急诊科(ED)设置是接触到未成年饮酒者(14-20岁)的独特途径。在计算机技术的帮助下，这项研究将对勃起功能障碍中的青少年和年轻人进行筛查，并全面测试基于勃起功能障碍的短期干预和为期3个月的酒精滥用短期跟踪治疗方法。开发高效和有效地优化这些方法的方法对于改善未成年饮酒者的结果具有强大的公共健康影响。

DESCRIPTION (provided by applicant): Screening for alcohol misuse offers opportunities for early detection and delivery of developmentally appropriate interventions among adolescent and young adult patients in medical settings. Although screening and brief interventions have shown promise among adolescents and young adults in the Emergency Department (ED), few studies have fully tested promising screening and brief intervention/treatment/referral components, perhaps due to logistical and practical impediments for the adoption in this setting. Therefore, the proposed study will use computerized screening using touch- screen computer tablets with audio (~5,700 patients) and will test developmentally appropriate, tailored intervention strategies in a two-factorial design (3x2). Specifically, 900 patients aged 14-20 in the ED who screen positive for problematic alcohol use (AUDIT score >=2 ages 14-17 and >=3 ages 18-20) in the past 3 months will be randomized to the combinations of three ED-based conditions (computer brief intervention-CBI; intervener delivered brief intervention-IBI ; enhanced usual care-EUC), and two follow-up conditions (adapted motivational enhancement therapy-AMET; enhanced usual care-EUC) that will take place 3 months post-ED. Interventions will be tailored to address individual differences (e.g., alcohol use patterns, stage of change, barriers/benefits of change) across key developmental transitions (e.g., acquiring a driver's license, living independently, etc.) All participants will receive written information regarding community resources; individuals who meet AUD criteria will additionally receive substance use treatment referrals. Stratified random assignment [by gender, age (14-17; 18- 20), and criteria for AUD] will take place at baseline for all ED-based and follow-up conditions. Recognizing that brief interventions are important, but not necessarily sufficient, for change in all adolescents and young adults who misuse alcohol, the primary specific aims of the proposed study will determine the independent effectiveness of immediate "on-the-spot" ED-based brief intervention conditions, 3-month follow-up brief treatment conditions, and combinations of conditions, for decreasing alcohol use and improving health-related outcomes (including injury, mental health, and other risk behaviors) at 6- and 12-months follow-up. The use of state-of-the-art computer technology for screening and brief interventions has the potential to reach greater numbers of underage drinkers presenting to the ED than is possible with person-delivered screening and brief intervention. Developing methods to efficiently and effectively optimize screening and brief intervention components has wide-ranging and powerful public health implications for modifying risk trajectories to reduce alcohol misuse and to prevent the development of AUD's among underage drinkers. PUBLIC HEALTH RELEVANCE: The Emergency Department (ED) setting is a unique point of access for reaching underage drinkers (age 14-20). With the aid of computer technology, this study will screen adolescents and young adults in the ED and fully test promising ED-based brief intervention and 3-month follow-up brief treatment approaches for alcohol misuse. Developing methods to efficiently and effectively optimize these approaches has powerful public health implications for improving outcomes for underage drinkers.