Screening and Brief Advice to Reduce Teen Substance Use

描述(由申请人提供)： 本申请是根据RFA-DA-04-006《初级保健环境中对青少年的筛查和干预》提交给NIDA的，并提议对初级保健办公室对青少年药物滥用的干预进行对照试验，其中包括计算机化筛查、简要的提供者建议以及父母和青少年教育。药物的使用与各种保健问题有关，这使得青少年接受常规医疗护理的环境成为实施常规筛查和早期干预的理想选择。然而，医疗机构目前在这方面利用不足，需要新的循证战略来改进实践模式，包括筛查、评估、短暂干预和转介治疗的标准化方法。我们以前曾进行研究，旨在评估为青少年服务的初级保健环境中药物滥用筛查测试的可靠性。然后，我们开发了一种新的简短屏幕，CRAFFT，它既适合青少年的发育，也适用于繁忙的诊所环境。我们目前正在新英格兰的一个初级保健站点网络中进行CRAFFT测试筛查实施情况的研究，该网络包括青少年诊所、儿科诊所、家庭诊所和以学校为基础的健康中心。作为这项研究的一部分，我们开发并试行了一个计算机化的CRAFFT筛查程序，它将提供青少年反馈和提供者提示，这些反馈和提示是根据青少年的药物使用参与程度量身定做的。我们研究的下一个合乎逻辑的步骤是开发一个示范视频和提供者培训方案，补充父母和青少年教育材料，然后在我们以实践为基础的研究网络中对全面筛查和简要建议方法进行有效性试验。拟议研究的第一年将用于“淘汰”我们目前的筛选研究，制作适用于繁忙办公室的演示视频和提供者培训方案，以及与家长和青少年开展焦点小组。在2-4年中，我们将使用前测后测对照实验设计来测试该方法的有效性。实验和对照队列将在所有参与地点按顺序招募。将在每年的井下护理访问时进行预测试，并在进入研究后的3个月和12个月获得测试后观察。我们将通过测量使用者之间的药物使用停用率的组间差异和非使用者之间的物质使用开始的差异来评估结果。我们还将跟踪初级保健提供者的管理策略和青少年对后续预约的遵守情况。有效的短期干预措施可以在为青少年服务的初级保健实践中广泛实施，并将在全美范围内具有巨大的公共卫生意义。

DESCRIPTION (provided by applicant): This application is submitted to NIDA in response to RFA-DA-04-006, Screening and Intervention for Youth in Primary Care Settings, and proposes a controlled trial of an primary care office intervention for adolescent substance abuse that includes computerized screening, brief provider advice, and parent and adolescent education. Use of drugs is associated with a variety of health care problems, making settings where adolescents receive routine medical care ideal for implementation of routine screening and early intervention. However, medical settings are currently underutilized in this regard and new evidence-based strategies are needed to improve practice patterns, including standardized methods of screening, assessment, brief intervention, and referral to treatment. We have previously conducted studies aimed at assessing the reliability of substance abuse screening tests in primary care settings that serve adolescents. We then developed a new brief screen, the CRAFFT, which is both developmentally appropriate for adolescents and practical for use in busy clinic settings. We are currently conducting a study of screening implementation with the CRAFFT test in a network of primary care sites in New England that includes an adolescent clinic, pediatric practices, family practices, and school-based health centers. As part of this study we have developed and pilot tested a computerized CRAFFT screening program, which will deliver adolescent feedback and provider prompts that are tailored to the adolescent's level of substance use involvement. The next logical steps in our research are to develop a demonstration video and provider training protocol, supplementary parent and adolescent education materials, and then to conduct an efficacy trial of the comprehensive screening and brief advice approach within our practice-based research network. Year one of the proposed study will be used for "wash out" of our current screening study, production of a demonstration video and provider training protocol that are practical for busy offices, and conducting focus groups with parents and adolescents. During years 2-4 we will test the efficacy of the approach using a pretest posttest controlled experimental design. The experimental and control cohorts will be recruited sequentially at all participating sites. Pretests will be given at the time of the annual well care visit, and posttest observations will be obtained at 3-months and 12-months following study entry. We will assess outcome by measuring between-groups differences in rates of substance use cessation among users, and differences in substance use initiation among non-users. We will also track primary care provider's management strategies and adolescents' adherence with follow-up appointments. An effective brief intervention could be widely implemented in primary care practices that serve adolescents, and would be of enormous public health significance across the U.S.