Dental and medical office iMET to reduce teen tobacco, alcohol, and drug use

牙科和医疗办公室 iMET 旨在减少青少年吸烟、饮酒和吸毒

基本信息

批准号：
7936133
负责人：
JOHN R KNIGHT
金额：
$ 47.62万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-22 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7936133
关键词：
18 year old 21 year old Address Adolescence Adolescent Adult Age Alcohol consumption Alcohol or Other Drugs use Alcohols Area Behavioral Caring Cause of Death Clinic Visits Clinical Commit Computers Confidence Intervals Counseling Dental Dental Care Dental General Practice Dental Offices Dental Schools Development Drug Addiction Drug Prescriptions Drug usage Early treatment Effectiveness Ethnic Origin Feedback Focus Groups Future Gender Goals Health Health behavior Healthcare Home environment Hour Human Internet Intervention Intranet Journals Life Massachusetts Medical Medicine Mentors Odds Ratio Office Visits Oral health Outpatients Parenting Education Parents Patients Pharmaceutical Preparations Pilot Projects Population Practice Guidelines Preventive Primary Health Care Printing Production Protocols documentation Provider Public Health Publishing Race Randomized Randomized Clinical Trials Reporting Research Risk Risk Assessment Sampling Screening procedure Self Administration Self-Administered Services Site System Technology Teenagers Testing Text Textbooks Time Tobacco Tobacco Use Cessation Tobacco use Training Treatment Cost Treatment Protocols Universities Validity and Reliability Youth alcohol and other drug alcohol intervention base brief screening career comparative effectiveness computer generated computer program computerized design drinking effectiveness research effectiveness trial experience improved interest mortality motivational enhancement therapy older patient prevent programs routine care screening, brief intervention, referral, and treatment smoking cessation substance abuse treatment technological innovation tool treatment as usual treatment strategy

项目摘要

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research, and specific Topic (05-DE-102) Treatment of tobacco and drug dependence in dental settings. The goal of this project is to develop an Internet/Intranet-based Motivational Enhancement Therapy (iMET) program for adolescents that targets tobacco, alcohol, and drug use. These substances are associated with the leading causes of death during adolescence and serious health problems later in life. Our investigative team has previously developed screening, brief intervention, and referral to treatment (SBIRT) strategies for medical offices that target alcohol and drug use. We created a computer program (cSBIRT) based on the CRAFFT screen, which adolescent patients could self-administer in the waiting room before seeing the primary care provider (PCP). The program immediately shows the adolescent his/her score and level of risk, presents scientific information and true life stories about the harmful effects of substance use, and prints a Report sheet that prompts the PCP to advise the teen to stay away from alcohol and drugs. We found in a recent study that 40% of adolescent patients who received cSBIRT stopped using alcohol/drugs, which was significantly better than Treatment As Usual (TAU). However, 60% did not stop and need additional counseling, such as MET. We created our MET intervention to be specifically suited to the unique developmental needs of adolescents. We found in another recent study that MET was significantly better than TAU in reducing drug use among teens in an outpatient substance abuse treatment population. We will now adapt this proven MET intervention and test it in a primary care population of adolescents coming for routine medical and dental care, where we believe it will have an even greater effect. First, we must adapt MET so that it targets tobacco use in addition to other substances, and convert its tools to a computerized format. We will design the iMET program so that adolescents can self- administer nearly all of it, which makes it practical for use in busy PCP offices. We also will add a new feature, Technological Extenders (TEs), which are computer-generated personalized emails/text messages that PCPs send to teen patients during the months after the office visit to extend the effects of the iMET over time. We will hold focused group discussions with teens, parents, and PCPs during the first year of the project, and design the iMET system to respond to their opinions and needs. We will add dental practices to our research network of nine PCP offices, and then conduct a small pilot study comparing iMET/TE with TAU. The purpose of the pilot is to estimate the effect size of the new iMET/TE system in reducing tobacco, drug, and alcohol use. We will use these estimates and our pilot study experience to design a future study comparing iMET/TE to TAU in a much larger population of adolescents, which could prove with statistical certainty that the iMET/TE system is effective. The purpose of this project is to improve adolescent behavioral counseling services in healthcare settings with a new Internet/Intranet-based Motivational Enhancement Therapy (iMET) intervention that targets the use of tobacco, alcohol, and other drugs. If proven effective, we will disseminate iMET to primary care dental and medical offices across the U.S. Early intervention can substantially reduce teen substance use and its related mortality; prevent other serious consequences; and greatly decrease the associated later burdens of human suffering and high treatment costs.

描述（由申请人提供）：本申请涉及广泛的挑战领域 (05) 比较有效性研究，以及具体主题 (05-DE-102) 牙科环境中烟草和药物依赖的治疗。该项目的目标是为青少年开发一个基于互联网/内联网的动机增强治疗（iMET）计划，针对烟草、酒精和毒品的使用。这些物质与青春期死亡和晚年严重健康问题的主要原因有关。我们的调查团队此前曾为针对酒精和毒品使用的医疗机构制定了筛查、简短干预和转诊治疗 (SBIRT) 策略。我们创建了一个基于 CRAFFT 屏幕的计算机程序 (cSBIRT)，青少年患者可以在看初级保健提供者 (PCP) 之前在候诊室自行管理。该计划立即向青少年显示他/她的分数和风险水平，提供有关药物使用有害影响的科学信息和真实生活故事，并打印一份报告表，提示 PCP 建议青少年远离酒精和毒品。我们在最近的一项研究中发现，接受 cSBIRT 的青少年患者中有 40% 停止饮酒/吸毒，这明显优于常规治疗 (TAU)。然而，60% 的人并没有停下来，需要额外的咨询，例如 MET。我们制定了 MET 干预措施，专门适合青少年的独特发展需求。我们在最近的另一项研究中发现，在门诊药物滥用治疗人群中，MET 在减少青少年药物使用方面明显优于 TAU。我们现在将采用这种经过验证的 MET 干预措施，并在接受常规医疗和牙科护理的青少年初级保健人群中进行测试，我们相信它将产生更大的效果。首先，我们必须调整 MET，使其除了其他物质之外还针对烟草使用，并将其工具转换为计算机化格式。我们将设计 iMET 计划，以便青少年几乎可以自行管理所有计划，这使其适合在繁忙的 PCP 办公室使用。我们还将添加一项新功能，即技术扩展器 (TE)，这是由计算机生成的个性化电子邮件/短信，PCP 在就诊后的几个月内发送给青少年患者，以随着时间的推移延长 iMET 的效果。我们将在项目的第一年与青少年、家长和 PCP 进行重点小组讨论，并设计 iMET 系统来回应他们的意见和需求。我们将把牙科诊所添加到由九个 PCP 办公室组成的研究网络中，然后进行一项小型试点研究，比较 iMET/TE 与 TAU。该试点的目的是评估新的 iMET/TE 系统在减少烟草、毒品和酒精使用方面的效果大小。我们将利用这些估计和我们的试点研究经验来设计一项未来的研究，在更大的青少年群体中比较 iMET/TE 和 TAU，这可以通过统计确定性证明 iMET/TE 系统是有效的。该项目的目的是通过针对烟草、酒精和其他药物使用的新的基于互联网/内联网的动机增强疗法 (iMET) 干预措施来改善医疗机构中的青少年行为咨询服务。如果证明有效，我们将向美国各地的初级保健牙科和医疗办公室传播 iMET。早期干预可以大大减少青少年药物使用及其相关死亡率；防止其他严重后果；并大大减少随后带来的人类痛苦负担和高昂的治疗费用。