Alcohol misuse and violent behavior are serious and prevalent problems among urban adolescents and have large impacts on morbidity and mortality. Research from a variety of disciplines and methodological approaches has demonstrated that temporal connections between alcohol misuse and violent behavior tend to increase throughout adolescence, likely due to shared risk factors. For example, national data suggest that 49% of adolescent drinkers also report violent behaviors (e.g., physical fighting, and weapon usage.) in the past year. The urban Emergency Department (ED) provides a unique setting for addressing alcohol misuse and violent behaviors among adolescents, and capitalizes on a """"""""teachable moment."""""""" This five-year study will refine promising intervention approaches to incorporate tailoring technology based on assessment of the adolescents' personal risk behaviors to address both alcohol misuse and violent behaviors. This randomized controlled trial will screen approximately 3200 adolescents in the ED (ages 14-18) over 30 months. Those who screen positive for both past year alcohol use and violent behaviors (approximately 30%) will be stratified by sex and then randomized to one of three conditions (n=250/group): Computer adapted motivational interviewing + skills training, Therapist adapted motivational interviewing + skills training, and an informational pamphlet control condition. Primary outcomes will be evaluated at 3- and 12-months and include alcohol use/misuse, violent behaviors, illicit drug use, unintentional injury, delinquency, and weapon carriage. A 1-week follow-up assessment will assess hypothesized mechanisms of change related to the interventions including stage of change, self-efficacy, intervention fidelity, and other intervention process measures. Additional covariates that will be examined include sex, race, and age. This study capitalizes upon the research team's prior experience delivering ED-based alcohol interventions, using both tailored computerized programs and brief motivational advice sessions to address common behaviors among at-risk inner-city youth. The proposed study integrates empirically-derived brief intervention strategies for alcohol misuse and violent behaviors using state-of-the-art technology to tailor the interventions to the specific risk factors of the adolescent in a high-risk urban ED setting; tailored computerized programs use available technology to augment and/or replace the need for clinical staff in the ED setting, where there is limited staff time to effect behavior change. This project will provide the critical first step toward the implementation of an integrated prevention program addressing overlapping risk factors that has the potential to be delivered to the millions of adolescents visiting urban EDs each year.
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