Patients, Clinics, and Systems: Screening for Alcohol Use

描述（由申请人提供）：正在提交这份修订后的以患者为导向的研究中期职业研究者奖的竞争性更新，以使我能够巩固和扩展第一个奖项所取得的成就。应审查委员会的要求，我的指导理念和学员的更多信息包括在内。更新将支持我的目标，为以患者为导向的酒精研究做出重大贡献，特别关注女性健康，并继续作为下一代临床研究人员的教师。在指导，我想继续我的，否则没有资金的个人辅导活动，同时也导致了整个医院的发展，跨学科的指导计划作为临床研究中心（CCI）的核心组成部分，在那里我是教育主任。在以病人为导向的研究，我提出的项目，“识别和修改酒精和物质使用的怀孕青少年，”将不仅综合了几个富有成效的线以前的临床研究，在识别和减少风险饮酒怀孕，并在减少青少年物质使用的动机干预，但也解决了一个特别脆弱的群体的需要。试点研究和最终临床试验的发展将为初级研究者提供充分的参与机会。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。大多数青少年怀孕都是计划外的，往往比成年怀孕晚被发现。青少年健康风险行为，如物质使用和性活动聚集在一起，构成了年轻母亲年龄固有的生物风险和青少年怀孕的不良社会后果。该研究的目的是双重的：1）评估CRAFFT酒精和药物使用筛查工具在怀孕的青少年，和2）测试的假设，这些受试者接受动机干预将显示更大的减少酒精和物质的使用比那些随机注意力控制条件，包括产前营养教育。拟议的研究地点是青少年生殖健康服务，由布里格姆妇女医院与儿童医院在过去二十年中共同经营，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.