Without early identification and intervention, adolescent alcohol use can escalate and lead to the development of alcohol use disorders. The American Academy of Pediatrics, together with federal health services agencies, including NIAAA and the US Surgeon General, recommends regular screening for underage drinking among adolescents in healthcare settings with brief intervention strategies following positive screens. Despite the availability of guidelines and manuals, alcohol screening is still infrequentl performed at healthcare visits with youth, and screening is often not linked to the delivery of evidence-based interventions. One promising approach to increasing the delivery of efficient, population-based youth alcohol screening and brief intervention is through the use of eHealth technologies that connect patients and HPs. eHealth screening with real-time results is associated with higher levels of problem behavior recognition by HPs than interview alone, and youth prefer these technologies to provide information on sensitive health-related topics. EHealth tools have already been successfully used to promote behavior changes such as increasing physical activity and healthy eating among adolescents. We propose to test the effectiveness of an eHealth tool we have developed to promote systematic screening and indicated intervention strategies to reduce adolescent alcohol use, Web-based Adolescent Motivational Enhancement (Web-AME). Web-AME automates screening, delivers motivational enhancement feedback and alcohol reduction strategies directly to adolescents, and provides HPs with targeted decision support tools to facilitate the use of motivational interviewing techniques. Web-AME provides a platform for more systematic delivery of evidence-based interventions, including motivational interviewing strategies and personalized feedback. The proposed study will develop implementation and training processes for providers and clinic staff to prepare Web-AME for use in healthcare settings. We will then test Web-AME as a means to increase alcohol- related discussions at healthcare visits and to reduce alcohol use among youth. Our study will screen 715 youth ages 13-18 drawn from 2 different healthcare sites to yield a sample of 200 who endorse at least moderate risk drinking, using NIAAA age-based definitions based on frequency of use. Youth will be randomized to receive Web-AME (n=100) or usual care (screening only; n=100) prior to their healthcare appointment. We will examine frequency of provider counseling on alcohol use, youth satisfaction with the healthcare visit, and changes in alcohol consumption 2 months following their appointment across groups. We will also test perceived drinking norms and readiness to change as a mediators of the effects of Web-AME on alcohol use. This innovative eHealth tool (Web-AME) geared to adolescents and their providers could improve the penetration of alcohol screening and linked intervention among youth, thus reducing adolescent alcohol misuse and the development of alcohol use disorders.
We propose to test the effectiveness of an eHealth tool we have designed to promote systematic screening and indicated intervention strategies to reduce adolescent alcohol use, Web-based Adolescent Motivational Enhancement (Web-AME). Web-AME will automate screening, deliver motivational enhancement feedback and alcohol reduction strategies directly to adolescents, and provide healthcare providers with targeted decision support tools to facilitate the use of motivational interviewing techniques. Such a population-based approach to intervention has significant potential to prevent and reduce adolescent alcohol misuse and the development of alcohol use disorders.
