Screening and Brief Intervention in the ED among Mexican-origin Young Adults

墨西哥裔年轻人的急诊科筛查和短暂干预

• 批准号: 7783402
• 负责人: CHERYL J CHERPITEL
• 金额: $ 70.85万
• 依托单位: PUBLIC HEALTH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-20 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7783402
• 关键词: 19 year old; 20 year old; Accident and Emergency department; Acute; Address; Admission activity; Adolescent; Adult; Advocate; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcohols; American College of Surgeons; Applications Grants; Area; Attention; Birth; Blinded; Centers for Disease Control and Prevention (U.S.); Cities; Communities; Consent; Country; Coupled; Cultural Characteristics; Data; Development; Disease; Effectiveness; Effectiveness of Interventions; Emergency Medical Technicians; Emergency Medicine; Equation; Esthesia; Ethnic group; Event; Female; Funding; Future; Generations; Guidelines; Health Promotion; Heavy Drinking; High Prevalence; Hispanics; Immigrant; Impulsivity; Individual; Injury; International; Intervention; Intervention Studies; Intervention Trial; Knowledge; Language; Lead; Leadership; Life; Literature; Logistic Regressions; Medical; Mexican; Mexico; NIH Program Announcements; National Institute on Alcohol Abuse and Alcoholism; Nurse Practitioners; Nurses; Outcome; Outcome Assessment; Patient Self-Report; Patients; Physician Assistants; Physicians; Poland; Population; Predictive Value; Prevalence; Primary Health Care; Protocols documentation; Provider; Public Health; Publishing; Quality of life; Randomized; Randomized Controlled Clinical Trials; Readiness; Recommendation; Relative (related person); Reporting; Research; Research Personnel; Risk; Risk-Taking; Screening procedure; Site; Source; Staging; Subgroup; Surveys; Techniques; Telephone; Testing; Texas; Time; Training; Translating; Translations; Trauma; Treatment Protocols; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Visit; Work; World Health Organization; Youth; age group; alcohol abuse therapy; alcohol advertising; alcohol availability; alcohol related problem; alcohol risk; alcohol screening and brief intervention; alcohol use disorder; binge drinking; breath alcohol measurement; brief alcohol intervention; brief intervention; brief motivational intervention; care seeking; convict; cost; drinking; driving behavior; experience; follow-up; group intervention; hazardous drinking; high risk drinking; impaired driving performance; improved; injured; legal drinking age; male; marijuana user; motivational enhancement therapy; motivational intervention; prototype; public health relevance; recidivism; response; screening and brief intervention; screening, brief intervention, referral, and treatment; social; standard care; symposium; trauma centers; treatment trial; trial comparing; twelfth grade; young adult

DESCRIPTION (provided by applicant): Screening and Brief Intervention in the ED among Mexican-origin Young Adults The aims of this application "Screening and Brief Alcohol Intervention in Underage and Young Adult Populations" are to: 1) examine the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) among Mexican-origin young adults (age 18-25), using a motivational intervention delivered by a Health Promotion Advocate (promotore), relative to standard care with and without assessment, on a reduction in heavy drinking (drinking days per week, number of drinks per day, maximum number of drinks on an occasion) and alcohol-related problems (RAPS4 and SIPS +6) in the emergency department (ED) at the U.S.- Mexico border; and, 2) identify variables that are related to effectiveness of the intervention and that predict successful treatment outcome. We plan to translate motivational interventions that have been successful in primary care and which were recently implemented in the U.S. 14 Academic Emergency Medicine Collaborative (AEMC) SBIRT study to a population of young adult Mexican-origin ED patients on the Texas border in El Paso; a population which has evidenced a high prevalence of hazardous drinking and alcohol- related problems, in part due to the greater availability of alcohol and at low cost in Mexico border cities. The SBIRT study, funded by NIAAA and SAAMHSA, was the first multi-site, collaborative study of screening, brief intervention and referral for at-risk and dependent drinking in the ED. We will conduct a blinded randomized control brief motivational intervention trial in which both injured and non-injured patients will be screened for at- risk or dependent (using the RAPS4) drinking. Patients screening positive who consent to participate in the study will be randomized into one of three groups: screened only, assessed, and assessed plus brief intervention, with n=312 in each group. Intervention and assessment groups will be followed-up at 3 months and all three groups at 12 months. Modifying variables include drinking in the event, risk-taking disposition, readiness and stage of change, country of birth (U.S. vs. Mexico) and language in which the assessment and intervention were conducted (English vs. Spanish). Outcome data will be analyzed using ANOVA, logistic regression and Generalized Estimating Equations. The interaction of modifying variables on outcomes will also be analyzed. Additionally, the study will examine data relevant to key issues related to the potential translatability and public health impact of the intervention and next steps. Given the paucity of published studies of brief intervention in the ED among young adults in general, or among Mexican-origin adults, and none among Mexican-origin young adults, who may be most vulnerable to alcohol use problems and disorders, especially at the border, work to be undertaken in this application is especially important in determining the effectiveness of AEMC SBIRT protocols (which may serve as a prototype for screening, brief intervention and referral for at-risk and dependent drinking in the ED) in this context of Mexican-origin young adults. PUBLIC HEALTH RELEVANCE: This work is especially relevant to public health in relation to reducing subsequent alcohol-related ED visits and associated costs and increase quality of life among young adults. The project will inform the development and spread of more effective techniques and protocols for addressing at-risk and dependent drinking in the ED in this age group, and provide a better understanding of those factors that influence effectiveness of brief intervention and predict successful patient outcomes across ethnic and cultural groups in the U.S. Additionally, this will be the first randomized controlled clinical trial compared to standard care of brief intervention using promotores in the Mexican-origin community, which may provide a better chance of ongoing implementation of SBIRT in the ED than using ED staff providers.

描述（由申请人提供）：墨西哥裔年轻人在急诊室的筛查和短暂干预 本申请“未成年人和年轻人群体中的筛查和短暂酒精干预”的目的是： 1) 检查筛查、简短干预的有效性相对于标准护理，墨西哥裔年轻人（18-25 岁）使用由健康促进倡导者 (promotore) 提供的激励干预措施进行干预和转介治疗 (SBIRT)未经评估，在急诊科 (ED) 减少大量饮酒（每周饮酒天数、每天饮酒次数、一次最大饮酒次数）和酒精相关问题（RAPS4 和 SIPS +6）美国-墨西哥边境； 2) 确定与干预有效性相关并预测成功治疗结果的变量。我们计划将在初级保健中取得成功以及最近在美国 14 学术急诊医学合作组织 (AEMC) SBIRT 研究中实施的激励干预措施转化为德克萨斯州边境埃尔帕索的墨西哥裔年轻 ED 患者群体；事实证明，危险饮酒和酒精相关问题普遍存在，部分原因是墨西哥边境城市酒精供应较多且价格低廉。 SBIRT 研究由 NIAAA 和 SAAMHSA 资助，是第一个针对急诊室高危饮酒者和依赖饮酒者的筛查、简短干预和转诊的多地点协作研究。我们将进行一项盲法随机对照简短动机干预试验，对受伤和未受伤患者进行饮酒风险或依赖性（使用 RAPS4）筛查。同意参加该研究的筛查呈阳性的患者将被随机分为三组之一：仅筛查组、评估组、评估加简短干预组，每组 n=312。干预组和评估组将在 3 个月时进行随访，所有三组将在 12 个月时进行随访。修改变量包括事件中的饮酒情况、冒险倾向、准备情况和变化阶段、出生国（美国与墨西哥）以及进行评估和干预时使用的语言（英语与西班牙语）。结果数据将使用方差分析、逻辑回归和广义估计方程进行分析。还将分析修改变量对结果的相互作用。此外，该研究还将检查与干预措施和后续步骤的潜在可转化性和公共卫生影响相关的关键问题相关的数据。鉴于已发表的对一般年轻人或墨西哥裔成年人进行急诊室短暂干预的研究很少，而且没有针对墨西哥裔年轻人的研究，因为他们可能最容易受到酒精使用问题和疾病的影响，尤其是在边境，本申请中要开展的工作对于确定 AEMC SBIRT 方案的有效性尤其重要（该方案可作为在 ED 中筛查、简短干预和转诊高危饮酒者和依赖性饮酒者的原型）。出身青壮年。 公共卫生相关性：这项工作与公共健康尤其相关，可以减少随后因酒精相关的急诊就诊和相关费用，并提高年轻人的生活质量。该项目将为更有效的技术和方案的开发和传播提供信息，以解决该年龄段急诊室的高危饮酒和依赖饮酒问题，并更好地了解影响短期干预效果的因素，并预测整个患者的成功结果。此外，这将是第一个随机对照临床试验，与墨西哥裔社区中使用 promotores 进行短暂干预的标准护理相比，这可能为在急诊室持续实施 SBIRT 提供更好的机会。急诊科工作人员提供者。