Youth who begin using alcohol regularly during adolescence are at risk of experiencing severe consequences during adolescence and throughout adulthood. Thus, there is a critical need to screen youth to determine who is at-risk. The primary care (PC) setting presents a unique opportunity to screen adolescents, as 66% of 12-17 year old teens visit a PC provider at least once every six months. Recognizing this opportunity, AMA guidelines encourage providers to integrate preventive services into routine medical care for teens by screening for alcohol and drug use and providing brief counseling and referrals where appropriate. Unfortunately, most adolescents are not screened for alcohol use in this setting;therefore, significant numbers of at-risk youth are never identified and never receiv appropriate preventive or treatment services. Lack of screening in PC is often due to discomfort discussing alcohol use, insufficient training or lack of referral options among providers. Providers need a screener that is easy to administer, does not require extensive time or training, can be incorporated into a PC appointment, and that can simply and quickly determine an adolescent's risk level so that referral and/or treatment services can be provided. We are therefore responding to RFA AA-12-08, "Evaluation of NIAAA's Alcohol Screening Guide for Children and Adolescents," which focuses on screening and treatment referral specifically among adolescents. In the proposed study, we will train PC clinicians (e.g., nurses) in four clinics across two states to use the new two-question NIAAA screening guide (NIAAA SG) to determine the prevalence of at-risk alcohol use among an ethnically and racially diverse group of youth age 12- 18, and to test the feasibility and practicality of this brief screener for predicing subsequent alcohol use, alcohol risk and other behavioral health problems (e.g., marijuana use, sexual risk-taking behavior, delinquency and conduct disorder) among this population. We will compare the NIAAA SG to other highly-used screening measures, such as the PESQ-PS, AUDIT and CRAFFT against a gold standard of DSM diagnosis of abuse or dependence to determine each screener's utility, sensitivity and specificity as a predictor of alcohol risk, use, and problems at baseline and six month follow up. We will also compare the utility of these measures in predicting other behavioral health problems, including marijuana use, cigarette smoking, sexual risk-taking behavior, and conduct disorder at both baseline and at six month follow up. An alcohol screening program to identify at-risk youth is of little value if not paired ith treatment. Thus, we go one step further by providing a brief motivational interviewing (MI) intervention as recommended by the NIAAA SG for those youth who are at-risk. This MI intervention called CHAT (a stand-alone term) was specifically developed as a brief intervention (15-20 minutes) that can be integrated and used in PC, and has shown promise in reducing alcohol and marijuana use among youth aged 12-18. We will examine whether alcohol use and problems decrease over a one year period for at-risk youth who receive CHAT compared to at-risk youth who receive usual care. We will also explore whether there is differential effectiveness of the intervention depending upon risk level (i.e., moderate or high).
Screening youth in the primary care setting is one way to identify adolescents who may be at-risk for future alcohol problems. The current study tests the new NIAAA screening guide questions, which ask about friend and adolescent drinking, to see how well these questions work to predict subsequent alcohol use, problems, and involvement in other risk behaviors, such as sexual risk-taking and delinquency. In addition, we plan to provide a brief motivational intervention for some at-risk teens and see whether alcohol use differs for those teens who receive our intervention and those teens who receive enhanced usual care. The results of this study have the potential to significantly impact the standard of care for identifying and intervening with at-risk youth in primary care settings.
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