Optimizing Brief Alcohol Intervention for Underage Drinkers in the ER

描述（由申请人提供）：酒精滥用筛查为医疗机构中青少年和年轻成人患者早期发现和提供适合发展的干预措施提供了机会。虽然筛查和简短干预在急诊科（ED）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了有希望的筛查和简短干预/治疗/转诊组成部分，这可能是由于在这种情况下采用的后勤和实际障碍。因此，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5700名患者），并将在二因子设计（3x2）中测试适合发展的量身定制的干预策略。具体而言，900名14-20岁的ED患者在过去3个月内筛查出问题酒精使用阳性（审计评分>=2，年龄14-17岁，>=3，年龄18-20岁），将被随机分配到三种基于ED的条件（计算机简短干预- cbi；干预者提供简短干预- ibi；强化常规护理- euc），以及两种随访条件（适应性动机增强治疗- amet；强化常规护理- euc），将在ED后3个月进行。干预措施将量身定制，以解决跨越关键发展转型（例如，获得驾驶执照、独立生活等）的个体差异（例如，酒精使用模式、变化阶段、变化的障碍/好处）。所有参与者将收到有关社区资源的书面信息；符合AUD标准的个人将额外接受药物使用治疗转诊。分层随机分配[按性别、年龄（14-17岁；18- 20岁）和AUD标准]将在基线对所有ed和随访条件进行。认识到简短的干预措施对于改变所有滥用酒精的青少年和年轻人是重要的，但不一定是充分的，拟议研究的主要具体目标将确定立即“现场”基于ed的简短干预条件、3个月随访的简短治疗条件和各种条件的组合在减少酒精使用和改善与健康相关的结果（包括伤害、心理健康）方面的独立有效性。以及其他危险行为)在6个月和12个月的随访中。使用最先进的计算机技术进行筛查和简短干预，有可能达到更多的未成年饮酒者到急诊科就诊，而不是通过个人提供的筛查和简短干预。开发方法来有效和有效地优化筛查和简短的干预成分具有广泛和强大的公共卫生影响，可以修改风险轨迹，以减少酒精滥用，并防止未成年饮酒者中AUD的发展。公共卫生相关性：急诊科（ED）设置是一个独特的点接触未成年饮酒者（14-20岁）。在计算机技术的帮助下，本研究将筛查ED中的青少年和年轻人，并充分测试有希望的基于ED的酒精滥用简短干预和3个月的随访简短治疗方法。开发有效优化这些方法的方法对改善未成年饮酒者的结果具有强大的公共卫生意义。

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.