Tailored Teen Alcohol and Violence Prevention in the ER

急诊室中量身定制的青少年酒精和暴力预防

• 批准号: 6869362
• 负责人: Maureen A Walton
• 金额: $ 62.57万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-03-01 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6869362
• 关键词: adolescence (12-20); age difference; alcoholism /alcohol abuse prevention; behavior therapy; behavioral /social science research tag; child behavior; clinical research; drug abuse; emergency health services; gender difference; high risk behavior /lifestyle; human subject; human therapy evaluation; injury prevention; interactive multimedia; juvenile delinquency; longitudinal human study; medically underserved population; mental health personnel; motivation; patient oriented research; racial /ethnic difference; substance abuse related behavior; urban area; violence; violence prevention

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：酗酒和暴力行为是城市青少年中严重而普遍的问题，对发病率和死亡率有很大影响。各种学科和方法论的研究表明，滥用酒精和暴力行为之间的时间联系往往在整个青春期增加，这可能是由于共同的风险因素。例如，国家数据表明，49% 的青少年饮酒者在过去一年中也有过暴力行为（例如肢体冲突和使用武器）。城市急诊室 (ED) 为解决青少年酗酒和暴力行为问题提供了独特的环境，并利用了“教育时刻”。这项为期五年的研究将完善有前途的干预方法，将基于青少年个人风险行为评估的定制技术纳入其中，以解决酗酒和暴力行为。这项随机对照试验将在 30 个月内对急诊科的约 3200 名青少年（14-18 岁）进行筛查。那些在过去一年中酗酒和暴力行为筛查呈阳性的人（约 30%）将按性别分层，然后随机分配到以下三个条件之一（n=250/组）：计算机改编的动机访谈 + 技能培训、治疗师改编的动机访谈面试+技能培训，以及控制条件信息小册子。主要结局将在 3 个月和 12 个月时进行评估，包括饮酒/滥用、暴力行为、非法药物使用、无意伤害、犯罪和携带武器。为期 1 周的随访评估将评估与干预相关的假设变化机制，包括变化阶段、自我效能、干预保真度和其他干预过程措施。将检查的其他协变量包括性别、种族和年龄。这项研究利用了研究团队之前提供基于 ED 的酒精干预措施的经验，使用量身定制的计算机化程序和简短的激励建议会议来解决高危内城青少年的常见行为。拟议的研究整合了根据经验得出的针对酒精滥用和暴力行为的简短干预策略，使用最先进的技术，根据高风险城市急诊室环境中青少年的特定风险因素制定干预措施；定制的计算机化程序使用现有技术来增加和/或取代急诊室对临床工作人员的需求，因为急诊室工作人员实现行为改变的时间有限。该项目将为实施解决重叠风险因素的综合预防计划迈出关键的第一步，该计划有可能为每年数百万到城市急诊科就诊的青少年提供服务。