Screening and Brief Intervention in the ED among Mexican-origin Young Adults The aims of this application """"""""Screening and Brief Alcohol Intervention in Underage and Young Adult Populations"""""""" are to: 1) examine the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) among Mexican-origin young adults (age 18-25), using a motivational intervention delivered by a Health Promotion Advocate (promotore), relative to standard care with and without assessment, on a reduction in heavy drinking (drinking days per week, number of drinks per day, maximum number of drinks on an occasion) and alcohol-related problems (RAPS4 and SIPS +6) in the emergency department (ED) at the U.S.- Mexico border;and, 2) identify variables that are related to effectiveness of the intervention and that predict successful treatment outcome. We plan to translate motivational interventions that have been successful in primary care and which were recently implemented in the U.S. 14 Academic Emergency Medicine Collaborative (AEMC) SBIRT study to a population of young adult Mexican-origin ED patients on the Texas border in El Paso;a population which has evidenced a high prevalence of hazardous drinking and alcohol- related problems, in part due to the greater availability of alcohol and at low cost in Mexico border cities. The SBIRT study, funded by NIAAA and SAAMHSA, was the first multi-site, collaborative study of screening, brief intervention and referral for at-risk and dependent drinking in the ED. We will conduct a blinded randomized control brief motivational intervention trial in which both injured and non-injured patients will be screened for at- risk or dependent (using the RAPS4) drinking. Patients screening positive who consent to participate in the study will be randomized into one of three groups: screened only, assessed, and assessed plus brief intervention, with n=312 in each group. Intervention and assessment groups will be followed-up at 3 months and all three groups at 12 months. Modifying variables include drinking in the event, risk-taking disposition, readiness and stage of change, country of birth (U.S. vs. Mexico) and language in which the assessment and intervention were conducted (English vs. Spanish). Outcome data will be analyzed using ANOVA, logistic regression and Generalized Estimating Equations. The interaction of modifying variables on outcomes will also be analyzed. Additionally, the study will examine data relevant to key issues related to the potential translatability and public health impact of the intervention and next steps. Given the paucity of published studies of brief intervention in the ED among young adults in general, or among Mexican-origin adults, and none among Mexican-origin young adults, who may be most vulnerable to alcohol use problems and disorders, especially at the border, work to be undertaken in this application is especially important in determining the effectiveness of AEMC SBIRT protocols (which may serve as a prototype for screening, brief intervention and referral for at-risk and dependent drinking in the ED) in this context of Mexican-origin young adults.
This work is especially relevant to public health in relation to reducing subsequent alcohol-related ED visits and associated costs and increase quality of life among young adults. The project will inform the development and spread of more effective techniques and protocols for addressing at-risk and dependent drinking in the ED in this age group, and provide a better understanding of those factors that influence effectiveness of brief intervention and predict successful patient outcomes across ethnic and cultural groups in the U.S. Additionally, this will be the first randomized controlled clinical trial compared to standard care of brief intervention using promotores in the Mexican-origin community, which may provide a better chance of ongoing implementation of SBIRT in the ED than using ED staff providers.
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