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。美国儿科学会与包括NIAAA和美国外科医生在内的联邦卫生服务机构一起，建议在医疗机构中定期筛查青少年未成年饮酒，并在阳性筛查后采取简短的干预策略。尽管指南和手册的可用性，酒精筛查仍然是罕见的，在与青年的医疗保健访问进行，并筛选往往不与基于证据的干预措施的交付。 一个有希望的方法，以增加提供有效的，基于人口的青年酒精筛查和简短的干预是通过使用电子健康技术，连接病人和HP。与单独面谈相比，具有实时结果的电子健康筛查与HP更高水平的问题行为识别相关，并且年轻人更喜欢这些技术来提供敏感的健康相关主题的信息。电子保健工具已成功地用于促进行为改变，如增加青少年的体育活动和健康饮食。我们建议测试的有效性，我们已经开发了一个电子健康工具，以促进系统的筛选和指示干预策略，以减少青少年饮酒，基于Web的青少年动机增强（Web-AME）。Web-AME自动化筛选，直接向青少年提供动机增强反馈和酒精减少策略，并为HP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，包括激励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，以增加医疗保健访问中与酒精相关的讨论，并减少年轻人的酒精使用。我们的研究将筛选来自2个不同医疗保健网站的715名13-18岁的青少年，以获得200名支持至少中度风险饮酒的样本，使用基于使用频率的NIAAA年龄定义。青少年将随机接受Web-AME（n=100）或常规护理（仅筛选; 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，以及各组预约后2个月酒精消费的变化。我们还将测试感知饮酒规范和改变的准备，作为Web-AME对酒精使用影响的中介。这一面向青少年及其服务提供者的创新电子保健工具（Web-AME）可以提高酒精筛查和相关干预措施在青年中的普及率，从而减少青少年滥用酒精和酒精使用障碍的发生。

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.