The overall mission of this proposed program is to develop a research infrastructure in primary health care settings in rural Iowa so that interventions can be evaluated to address underage drinking. Our infrastructure will include a central research office at the University of Iowa (Center for Addictions Research), a primary care setting for youth only (Adolescent Health & Resource Center or AHRC) and several cooperating primary health care clinics that are members of the University of Iowa Community Medical Services (UICMS) system. In Phase 1, we will begin with 5 UICMS clinics and the AHRC, and then, as our infrastructure becomes more efficient, we will add the remaining UICMS clinics for Phase 2. Additionally, we will develop an innovative Video Doctor computer application, which will consist of two main components: (1) the GAPS (Guidelines for ? Adolescent Preventive Services) screening system and (2) the Video Doctor - a computerized video clips of physicians giving age-appropriate motivational feedback about alcohol consumption - based on responses to screening items. The GAPS program was developed by the American Medical Association and used in many Adolescent Medicine clinics. The Video Doctor will be developed in the first 6 months of our project and then subjected to extensive and sequential review by youth in three age categories (10-12 years; 13 - 15 years; and 16 - 18 years) participating in Positive Youth Development groups. Finally, after the beta version has been developed, this intervention will be pilot tested in our primary health care clinics with each age group. Based on the results from Phase 1, we will then develop an application for a Phase 2 study that includes a more rigorous design and additional sites. To accomplish the goals of this develop project, we have developed interdisciplinary support for our infrastructure improvement plan and for our proposed pilot study. In summary, we propose to develop a research infrastructure by (1) partnering with primary health care clinics in the UICMS system, (2) providing training for the clinic staff about alcohol abuse issues and health services research skills, and (3) developing an age appropriate Video Doctor computer application which can be used easily in primary health care settings. This project focuses on a significant public health problem - underage drinking in rural Iowa. In many of our rural communities, many adolescents describe a culture of binge drinking - especially on the weekends. However, these episodes of alcohol consumption often lead to fairly negative consequences ranging from school absence, conflict with parents, physical violence, unprotected sexual activity and use of other illegal substances. We argue that our primary care clinics can have a positive impact on this culture of alcohol consumption by underage drinkers through a combination of primary prevention and early intervention. ? ? ?
