Adolescent Primary Care Adoption of Substance Use SBI

描述(由申请人提供)： 对于青少年(12-24岁)来说，大麻和其他药物、酒精和烟草的使用在美国很普遍，并与负面结果的风险有关。尽管许多倡议鼓励在初级保健环境中提供药物使用筛查和适当的预见性指导或简短干预，但现有研究表明，对这些建议的遵守充其量是不一致的。采用具体的组织政策、程序来支持和监测履行机构的规定，是遵守的主要决定因素之一。目前，建议的履行机构议定书在其资源使用和初级保健环境的其他要求方面有所不同。在其他卫生保健背景下引入的新技术之间的平行差异已显示出影响组织采用和从业者遵守的两个方面。这项研究将从创新扩散的新兴模型中得出一组假设，用于青少年初级保健环境中的SBI采用。这些假设将在对60个市场地区(n=300)的社区卫生中心和学校卫生中心的临床主任进行的全国电话调查中得到验证。我们的具体研究目的是：1.描述支持和监测为公共部门初级保健环境中的青少年提供大麻和其他药物、酒精和烟草而采用的规范的不同；2.模拟与采取政策和程序以支持和监测这些环境中物质使用的供应相关的组织和背景因素；3.检验公共部门初级保健环境中支持和监测提供物质使用的SBI规范的特点和传播策略，以增加临床主任对公共部门初级保健环境中的青少年采用大麻和其他药物的意向。假设将使用多元回归技术进行检验。预计履行机构更有可能采用具有更大相对优势、兼容性、复杂性和“可观察性”的方法，组织和外部对这些创新提供更多支持的环境将显示出更高的采用水平。根据我们对先前采用情况的决定因素的建模和对履行机构替代办法的评估，随着物质使用情况履行机构循证准则的进一步制定，将有可能确定最有可能取得成功的传播战略。

DESCRIPTION (provided by applicant): For adolescents (ages 12-24), use of marijuana and other drugs, alcohol, and tobacco is prevalent in the United States and associated with risks for negative outcomes. Although numerous initiatives have encouraged provision of screening for substance use and appropriate anticipatory guidance or brief interventions (SBI) in primary care settings, available research indicates adherence to these recommendations is inconsistent at best. Adoption of specific organizational policies procedures to support and monitor provision of SBI is among the major determinants of adherence. Currently, recommended SBI protocols differ in terms of their resource-use and other requirements for primary care settings. Parallel differences among new technologies introduced in other health care context have been shown to both influence organizational adoption and practitioner adherence. This study will apply a set of hypotheses derived from emerging models of diffusion of innovation to SBI adoption in primary care settings for adolescents. These hypotheses will be tested in a national telephone survey of the clinical directors of Community Health Centers and School Based Health Centers in 60 market areas (n=300). Our specific study aims are to: 1.Describe variations in adoption of protocols to support and monitor provision of SBI for marijuana and other drugs, alcohol, and tobacco to adolescents in public sector primary care settings; 2. Model the organizational and contextual factors associated with adoption of policies and procedures to support and monitor provision of substance use SBI in these settings; 3.Examine the characteristics of SBI protocols and dissemination strategies that increase clinical directors intentions to adopt marijuana and other drugs SBI protocols for adolescents in public sector primary care settings. Hypotheses will be tested using multivariate regression techniques. It is anticipated that SBI approaches with greater relative advantage, compatibility, complexity, and "observability" are more likely to be adopted, and that settings with more organizational and external supports for these innovations will show greater levels of adoption. Based on our modeling of prior adoption determinants and assessments of alternative SBI approaches, it will be possible to identify dissemination strategies that are most likely to be successful as substance use SBI evidence-based guidelines are further developed.