This revised Competitive Renewal for the Midcareer Investigator Award in Patient-Oriented Research isbeing submitted to allow me to consolidate and extend the achievements realized with the first award. Asrequested by the Review Committee, more information about my mentoring philosophy and mentees isincluded. A renewal would support my goals to make a significant contribution to patient-oriented alcoholresearch with a particular focus on women's health, and to continue as a teacher of the next generation ofclinical researchers. In mentoring, I would like to continue my otherwise unfunded individual mentoringactivities, while also leading the development of a hospital-wide, interdisciplinary mentoring program as acore 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 byPregnant Adolescents,' will not only synthesize several fruitful lines of previous clinical research in theidentification and reduction of risk drinking in pregnancy, and motivational interventions in reducingadolescent substance use, but also address the needs of a particularly vulnerable group. The developmentof a pilot study and eventual clinical trial will provide ample opportunities for junior investigators toparticipate. The rate of adolescent pregnancy in America is the highest among developed nations, withapproximately 1 million teenagers becoming pregnant every year. Most of these adolescent pregnancies areunplanned, and tend to be recognized later than adult pregnancies. Adolescent health risk behaviors suchas substance use and sexual activity cluster together, componding the biologic risk inherent in youngmaternal age and the adverse social consequences of adolescent pregnancy. The study's purpose istwofold: 1) to evaluate the CRAFFT alcohol and drug use screening instrument in pregnant adolescents, and2) to test the hypothesis that those subjects receiving the motivational intervention will demonstrate greaterreductions in alcohol and substance use than those randomized to the attention control condition, consistingof prenatal nutrition education. The proposed study site is the Young Adult Reproductive Health Service, runby the Brigham and Women's Hospital in conjunction with Children's Hospital for the past two decades, andserves 200 new patients annually.
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