Web-Supported Adolescent Motivational Enhancement to Reduce Alcohol Use

描述（由申请人提供）：如果没有早期识别和干预，青少年酒精使用可能会升级并导致酒精使用障碍的发展。美国儿科学会（American Academy of Pediatrics）与包括NIAAA和美国外科医生在内的联邦卫生服务机构建议，在医疗机构中定期对青少年进行未成年人饮酒筛查，并在筛查呈阳性后采取简短的干预策略。尽管有指导方针和手册，但在青年保健访问中仍然很少进行酒精筛查，而且筛查往往与提供循证干预措施无关。增加提供高效率、以人群为基础的青少年酒精筛查和简短干预的一种有希望的方法是使用连接患者和健康服务提供者的电子卫生技术。与单独的面谈相比，具有实时结果的电子健康筛查与健康服务提供者对问题行为的识别水平更高有关，年轻人更喜欢这些技术来提供与健康相关的敏感话题的信息。电子健康工具已经成功地用于促进青少年的行为改变，如增加身体活动和健康饮食。我们建议测试我们开发的电子健康工具的有效性，以促进系统筛查和指示干预策略，以减少青少年饮酒，基于网络的青少年动机增强（Web-AME）。Web-AME使筛查自动化，直接向青少年提供动机增强反馈和酒精减少策略，并为健康服务提供者提供有针对性的决策支持工具，以促进动机访谈技术的使用。Web-AME为更系统地提供基于证据的干预措施提供了一个平台，包括动机性访谈策略和个性化反馈。拟议的研究将为提供者和诊所工作人员制定实施和培训流程，以准备在医疗保健环境中使用Web-AME。然后，我们将测试Web-AME作为一种手段，在医疗保健访问中增加与酒精相关的讨论，并减少青少年的酒精使用。我们的研究将筛选715名年龄在13-18岁之间的青少年，他们来自两个不同的医疗保健站点，使用NIAAA基于年龄的基于使用频率的定义，选出200名认可至少中度饮酒风险的样本。青少年将随机接受网络ame （n=100）或常规护理（仅筛查；n=100）之前，他们的医疗保健预约。我们将检查提供者对酒精使用的咨询频率，青少年对医疗保健访问的满意度，以及他们预约后2个月酒精消费量的变化。我们还将测试感知到的饮酒规范和改变的意愿，作为Web-AME对酒精使用影响的中介。这一面向青少年及其提供者的创新电子卫生工具（Web-AME）可以提高青少年中酒精筛查和相关干预措施的普及率，从而减少青少年酒精滥用和酒精使用障碍的发展。

DESCRIPTION (provided by applicant): Without early identification and intervention, adolescent alcohol use can escalate and lead to the development of alcohol use disorders. The American Academy of Pediatrics, together with federal health services agencies, including NIAAA and the US Surgeon General, recommends regular screening for underage drinking among adolescents in healthcare settings with brief intervention strategies following positive screens. Despite the availability of guidelines and manuals, alcohol screening is still infrequentl performed at healthcare visits with youth, and screening is often not linked to the delivery of evidence-based interventions. One promising approach to increasing the delivery of efficient, population-based youth alcohol screening and brief intervention is through the use of eHealth technologies that connect patients and HPs. eHealth screening with real-time results is associated with higher levels of problem behavior recognition by HPs than interview alone, and youth prefer these technologies to provide information on sensitive health-related topics. EHealth tools have already been successfully used to promote behavior changes such as increasing physical activity and healthy eating among adolescents. We propose to test the effectiveness of an eHealth tool we have developed to promote systematic screening and indicated intervention strategies to reduce adolescent alcohol use, Web-based Adolescent Motivational Enhancement (Web-AME). Web-AME automates screening, delivers motivational enhancement feedback and alcohol reduction strategies directly to adolescents, and provides HPs with targeted decision support tools to facilitate the use of motivational interviewing techniques. Web-AME provides a platform for more systematic delivery of evidence-based interventions, including motivational interviewing strategies and personalized feedback. The proposed study will develop implementation and training processes for providers and clinic staff to prepare Web-AME for use in healthcare settings. We will then test Web-AME as a means to increase alcohol- related discussions at healthcare visits and to reduce alcohol use among youth. Our study will screen 715 youth ages 13-18 drawn from 2 different healthcare sites to yield a sample of 200 who endorse at least moderate risk drinking, using NIAAA age-based definitions based on frequency of use. Youth will be randomized to receive Web-AME (n=100) or usual care (screening only; n=100) prior to their healthcare appointment. We will examine frequency of provider counseling on alcohol use, youth satisfaction with the healthcare visit, and changes in alcohol consumption 2 months following their appointment across groups. We will also test perceived drinking norms and readiness to change as a mediators of the effects of Web-AME on alcohol use. This innovative eHealth tool (Web-AME) geared to adolescents and their providers could improve the penetration of alcohol screening and linked intervention among youth, thus reducing adolescent alcohol misuse and the development of alcohol use disorders.