Patients, Clincs, and Systems: Screening for Alcohol Use

描述(由申请人提供)：现提交修订后的以患者为中心的职业生涯中期研究人员奖的竞争续展，以使我能够巩固和扩大第一个奖项所取得的成就。应审查委员会的要求，现附上更多关于我的指导理念和指导对象的信息。续约将支持我的目标，即为以患者为导向的酒精研究做出重大贡献，特别关注女性的健康，并继续担任下一代临床研究人员的教师。在指导方面，我希望继续我原本没有资金的个人指导活动，同时也领导医院范围内跨学科指导计划的发展，作为我担任教育主任的临床调查中心(CCI)的核心组成部分。在以患者为中心的研究中，我提出的项目“确定和修改怀孕青少年的酒精和物质使用情况”，不仅将综合先前在确定和减少怀孕期间饮酒风险方面的几项富有成效的临床研究，以及减少青少年物质使用的激励性干预措施，而且还将满足特别脆弱群体的需求。试点研究的开展和最终的临床试验将为初级研究人员提供充足的参与机会。美国的青少年怀孕率是发达国家中最高的，每年约有100万青少年怀孕。这些青少年怀孕大多是计划外的，而且往往比成年怀孕更晚被发现。青少年的健康危险行为，如药物使用和性行为，聚集在一起，构成了年轻产妇年龄固有的生物风险和青少年怀孕的不良社会后果。这项研究的目的有两个：1)评估CRAFFT在怀孕青少年中使用酒精和药物筛查工具，2)检验这样一种假设，即接受动机干预的受试者比随机接受注意控制条件的受试者在酒精和药物使用方面的减少幅度更大，包括产前营养教育。拟议的研究地点是青年生殖健康服务，由布里格姆妇女医院和儿童医院联合运营了20年，每年为200名新患者提供服务。

DESCRIPTION (provided by applicant): This revised Competitive Renewal for the Midcareer Investigator Award in Patient-Oriented Research is being submitted to allow me to consolidate and extend the achievements realized with the first award. As requested by the Review Committee, more information about my mentoring philosophy and mentees is included. A renewal would support my goals to make a significant contribution to patient-oriented alcohol research with a particular focus on women's health, and to continue as a teacher of the next generation of clinical researchers. In mentoring, I would like to continue my otherwise unfunded individual mentoring activities, while also leading the development of a hospital-wide, interdisciplinary mentoring program as a core component of the Center for Clinical Investigation (CCI), where I am Director of Education. In patient-oriented research, my proposed project, "Identification and Modification of Alcohol and Substance Use by Pregnant Adolescents," will not only synthesize several fruitful lines of previous clinical research in the identification and reduction of risk drinking in pregnancy, and motivational interventions in reducing adolescent substance use, but also address the needs of a particularly vulnerable group. The development of a pilot study and eventual clinical trial will provide ample opportunities for junior investigators to participate. The rate of adolescent pregnancy in America is the highest among developed nations, with approximately 1 million teenagers becoming pregnant every year. Most of these adolescent pregnancies are unplanned, and tend to be recognized later than adult pregnancies. Adolescent health risk behaviors such as substance use and sexual activity cluster together, componding the biologic risk inherent in young maternal age and the adverse social consequences of adolescent pregnancy. The study's purpose is twofold: 1) to evaluate the CRAFFT alcohol and drug use screening instrument in pregnant adolescents, and 2) to test the hypothesis that those subjects receiving the motivational intervention will demonstrate greater reductions in alcohol and substance use than those randomized to the attention control condition, consisting of prenatal nutrition education. The proposed study site is the Young Adult Reproductive Health Service, run by the Brigham and Women's Hospital in conjunction with Children's Hospital for the past two decades, and serves 200 new patients annually.