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Renny MH, Love JS, Walton MA, Levy S, Merchant RC. Emergency Department Screening and Interventions for Adolescents With Substance Use: A Narrative Review. J Emerg Med 2024; 67:e414-e424. [PMID: 39242345 DOI: 10.1016/j.jemermed.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Adolescent substance use is a growing public health concern, particularly given rising mortality rates from drug overdose deaths. The emergency department (ED) provides a unique opportunity to screen adolescents for substance use and provide brief interventions and linkage to care. OBJECTIVE OF THE REVIEW This article provides a narrative review of the current evidence for ED screening and brief interventions for adolescents with substance use and identifies important opportunities, challenges, and areas for future research. DISCUSSION There are several validated substance use screening and assessment tools for use with adolescents that can be implemented into ED screening programs. Brief motivational interviewing interventions may reduce alcohol use, but evidence for reductions of other substances is limited due to insufficient research. Both screening and interventions are feasible and acceptable in the ED setting with the appropriate resources. Increased training and the use of emerging technology can provide emergency physicians with opportunities to incorporate these tools into practice to when treating adolescents. Linkage to outpatient care for adolescents with substance use is understudied. The research on adult patient ED interventions and linkage to care is more robust and can provide insights for future ED studies among adolescents. CONCLUSION ED-based adolescent substance use screening and interventions are necessary, feasible, and acceptable, but understudied. Future studies, focusing on optimizing ED interventions and linkage to care, are important next steps in determining the best care for adolescents with substance use who present to the ED.
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Affiliation(s)
- Madeline H Renny
- Departments of Emergency Medicine, Pediatrics, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jennifer S Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maureen A Walton
- Department of Psychiatry and Addiction Center, University of Michigan, Ann Arbor, Michigan
| | - Sharon Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Roland C Merchant
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Lowik A, Mniszak C, Pang M, Ziafat K, Karamouzian M, Knight R. A sex- and gender-based analysis of alcohol treatment intervention research involving youth: A methodological systematic review. PLoS Med 2024; 21:e1004413. [PMID: 38829916 PMCID: PMC11182506 DOI: 10.1371/journal.pmed.1004413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 06/17/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND While there is widespread consensus that sex- and gender-related factors are important for how interventions are designed, implemented, and evaluated, it is not currently known how alcohol treatment research accounts for sex characteristics and/or gender identities and modalities. This methodological systematic review documents and assesses how sex characteristics, gender identities, and gender modalities are operationalized in alcohol treatment intervention research involving youth. METHODS AND FINDINGS We searched MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, PsycINFO, CINAHL, LGBT Life, Google Scholar, Web of Science, and grey literature from 2008 to 2023. We included articles that reported genders and/or sexes of participants 30 years of age and under and screened participants using AUDIT, AUDIT-C, or a structured interview using DSM-IV criteria. We limited the inclusion to studies that enrolled participants in alcohol treatment interventions and used a quantitative study design. We provide a narrative overview of the findings. Of 8,019 studies screened for inclusion, 86 articles were included in the review. None of the studies defined, measured, and reported both sex and gender variables accurately. Only 2 studies reported including trans participants. Most of the studies used gender or sex measures as a covariate to control for the effects of sex or gender on the intervention but did not discuss the rationale for or implications of this procedure. CONCLUSIONS Our findings identify that the majority of alcohol treatment intervention research with youth conflate sex and gender factors, including terminologically, conceptually, and methodologically. Based on these findings, we recommend future research in this area define and account for a spectrum of gender modalities, identities, and/or sex characteristics throughout the research life cycle, including during study design, data collection, data analysis, and reporting. It is also imperative that sex and gender variables are used expansively to ensure that intersex and trans youth are meaningfully integrated. TRIAL REGISTRATION Registration: PROSPERO, registration number: CRD42019119408.
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Affiliation(s)
- A.J. Lowik
- British Columbia Centre on Substance Use, Vancouver, Canada
- Institute for Gender, Race, Sexuality and Social Justice, University of British Columbia, Vancouver, Canada
| | - Caroline Mniszak
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Michelle Pang
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kimia Ziafat
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada
- Université de Montréal, École de santé publique, Montréal, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Canada
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Bonar EE, Goldstick JE, Tan CY, Bourque C, Carter PM, Duval ER, McAfee J, Walton MA. A remote brief intervention plus social media messaging for cannabis use among emerging adults: A pilot randomized controlled trial in emergency department patients. Addict Behav 2023; 147:107829. [PMID: 37598642 DOI: 10.1016/j.addbeh.2023.107829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Interventions addressing cannabis use among emerging adults (ages 18-25) are currently needed to prevent negative outcomes. Emergency Department (ED) visits provide an opportunity to initiate interventions. In this pilot study, we created a brief intervention (BI), extended with private social media messaging for emerging adult ED patients who use cannabis regularly. Study aims were to examine intervention feasibility, acceptability, and descriptive outcomes. METHODS We recruited and randomized N = 58 emerging adults (M age 21.5 years, 65.5% female) who used cannabis from an ED in-person and remotely after their ED visit (given COVID-19 restrictions). Participants randomized to the intervention (N = 30) received a Motivational Interviewing-based BI and 4 weeks of health coaching via private social media; control participants received a resource brochure and entertaining social media messaging. Follow-ups occurred at 1-month and 3-months. RESULTS Most intervention participants liked the BI (95.8%), found it helpful to discuss cannabis use in the BI (91.7%), and liked interacting with coaches on social media (86.3%). Social media content (e.g., video clips, images/still pictures/memes) were highly rated. Descriptively, the intervention group showed theory-consistent changes in importance of and intentions to change cannabis (increases vs. decrease/stability in control group), whereas findings for cannabis consumption/consequences were mixed. CONCLUSIONS This BI paired with social media messaging was acceptable in a sample of emerging adults from an ED who used cannabis regularly. Despite feasibility challenges due to COVID-19, this intervention warrants future investigation with a larger sample and longer follow-up period, with attention to the changing cannabis landscape when measuring outcomes.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA.
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Burlington Building, 325 E. Eisenhower Parkway, Ann Arbor, MI 48108, USA.
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
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Monarque M, Sabetti J, Ferrari M. Digital interventions for substance use disorders in young people: rapid review. Subst Abuse Treat Prev Policy 2023; 18:13. [PMID: 36805783 PMCID: PMC9937742 DOI: 10.1186/s13011-023-00518-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/26/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed. METHODS Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance. RESULTS In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions. CONCLUSIONS While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.
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Affiliation(s)
- Marika Monarque
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Manuela Ferrari
- Douglas Mental Health University Institute, Montreal, QC, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 Boulevard LaSalle, Perry C3 E-3102, QC H4H 1R3, Montreal, Canada.
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Thomas-Smith S, Klein EJ, Strelitz B, Jensen J, Parker E, Richardson L, McCarty CA, Shafii T. Electronic Screening for Adolescent Risk Behaviors in the Emergency Department: A Randomized Controlled Trial. West J Emerg Med 2022; 23:931-938. [PMID: 36409949 PMCID: PMC9683771 DOI: 10.5811/westjem.2022.7.55755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION In this study we aimed to assess the impact of an electronic health assessment with individualized feedback for risk behaviors in adolescents seeking care in a pediatric emergency department (ED). METHODS We conducted a randomized control trial using a tablet-based screening program with a study population of adolescents in a busy pediatric ED. The intervention group received the screening program with individualized feedback. The control group received the screening program without feedback. All participants received one-day and three-month follow-up surveys to assess behaviors and attitudes toward health behaviors. RESULTS A total of 296 subjects were enrolled and randomized. There was no difference in changes in risky behaviors between the control and experimental groups. A higher proportion of participants in the intervention groups reported that the screener changed the way they thought about their health at one-day follow-up (27.0%, 36/133) compared to the control group (15.5%, 20/129, P = .02). CONCLUSION This study successfully tested a multivariable electronic health screener in a real-world setting of a busy pediatric ED. The tool did not significantly change risky health behaviors in the adolescent population screened. However, our finding that the intervention changed adolescents' perceptions of their health opens a door to the continued development of electronic interventions to screen for and target risk behaviors in adolescents in the ED setting.
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Affiliation(s)
- Siobhan Thomas-Smith
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Eileen J Klein
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Jennifer Jensen
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Elizabeth Parker
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Laura Richardson
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Carolyn A McCarty
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Taraneh Shafii
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
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Patrick ME, Terry-McElrath YM, Bonar EE. Patterns and predictors of high-intensity drinking and implications for intervention. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2022; 36:581-594. [PMID: 36066869 PMCID: PMC9449141 DOI: 10.1037/adb0000758] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Efforts to intervene with subgroups at particularly high risk for alcohol use require information on factors that differentiate drinking intensity levels. This article summarizes existing research and provides new findings on sociodemographics and risk factors that differentiate high-intensity drinking (HID) to provide context for developing and delivering interventions for the highest-risk drinkers. Cross-sectional data were obtained in 2019 from participants who reported past 30-day alcohol use in 2018 as part of the nationally representative 12th grade Monitoring the Future study. Among past 2-week drinkers in 2019 (N = 601; modal age 19; 57.0% male; 67.4% non-Hispanic White), bivariate associations between drinking intensity (moderate drinking [1-4 drinks for women/1-5 drinks for men], binge-only drinking [4-7/5-9 drinks], and HID [8+/10+ drinks]) and a range of sociodemographic characteristics, risk factors, and alcohol-related consequences were examined. Results showed binge-drinking norms, social and enhancement drinking motives, nicotine vaping, and use of limiting/stopping drinking and manner of drinking protective behavioral strategies differentiated all drinking intensity levels, lending support to HID and binge-only drinking having an overlapping risk profile. However, there were also risk factors uniquely associated with HID, including sex, college attendance, employment, HID norms, use of serious harm reduction protective behavioral strategies, family history of drinking problems, any cigarette or drug use other than marijuana, and depression symptoms. Therefore, risk factors differentiate young adult drinking intensity. These results can inform efforts to adapt interventions for young adults who report HID. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Megan E. Patrick
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | - Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
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Bae SJ, Kim E, Lee JH. Validation of the screening test for at-risk drinking in an emergency department using a tablet computer. Drug Alcohol Depend 2022; 230:109181. [PMID: 34847505 DOI: 10.1016/j.drugalcdep.2021.109181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Alcohol Use Disorder Identification Test (AUDIT) is widely used and validated in primary care settings for alcohol screening, yet practical challenges in conducting it in crowded clinics exist. Recently, a new abbreviated version of the AUDIT, was presented: the Screening Test for At-risk Drinking (STAD). This study aimed to evaluate the performance of STAD compared to other abbreviated versions of AUDIT for patients visiting the emergency department (ED). METHODS This cross-sectional survey was conducted with 543 patients in the urban tertiary academic hospital ED in South Korea We diagnosed at-risk drinking using the entire AUDIT score. The optimal cut-off values, sensitivity, specificity, and the area under the receiver operating characteristics (AUROC) of the STAD were analyzed. We compared the AUROC with AUDIT-C and AUDIT-QF, which are previously abbreviated versions of AUDIT. RESULTS For males, the optimal cut-off value in the STAD test was 3 points with 83.1% sensitivity (95% CI: 75.3-89.2) and 95.9% specificity (95% CI: 91.2-98.5). For females, the optimal cut-off value was 2 points with 95.9% sensitivity (95% CI: 88.5-99.1) and 89.1% specificity (95% CI: 83.9-93.0). The AUROC curves for STAD were 0.964 (95% CI: 0.934-0.983) for males and 0.980 (95% CI: 0.965-0.993) for females. CONCLUSIONS The STAD is a simple and useful test to screen at-risk drinking in the ED, and its assisted applications will enable faster and more efficient screening and management of at-risk drinking.
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Affiliation(s)
- Sung Jin Bae
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Eun Kim
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jae Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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Bonar EE, Kidwell KM, Bohnert ASB, Bourque CA, Carter PM, Clark SJ, Glantz MD, King CA, Losman ED, McCabe SE, Philyaw-Kotov ML, Prosser LA, Voepel-Lewis T, Zheng K, Walton MA. Optimizing scalable, technology-supported behavioral interventions to prevent opioid misuse among adolescents and young adults in the emergency department: A randomized controlled trial protocol. Contemp Clin Trials 2021; 108:106523. [PMID: 34352386 PMCID: PMC8453131 DOI: 10.1016/j.cct.2021.106523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16-30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder. Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625 NCT Registration: NCT04550715.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Amy S B Bohnert
- Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA; Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carrie A Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Sarah J Clark
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Meyer D Glantz
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 3WFN BG 11601 RM 08C79 MSC 6020, 301 North Stonestreet Ave., Bethesda, MD 20892, USA
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Eve D Losman
- Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA
| | - Sean Esteban McCabe
- Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Meredith L Philyaw-Kotov
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lisa A Prosser
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Terri Voepel-Lewis
- Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Kai Zheng
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA; Department of Emergency Medicine, School of Medicine, University of California, Irvine, CA 92697, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Chung H, Lee JH. Clinical validation of screening test for at-risk drinking for young and middle-aged adults in an emergency department. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920933757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Emergency department has been shown to be suitable for conducting screening and interventions for at-risk drinking groups. Simple screening test is needed for crowded environments such as the emergency department. Objective: This study explores the validity of screening test for at-risk drinking, which was a newly developed abbreviated version of the alcohol use disorder identification test, among patients in the emergency department. Method: A survey was conducted at the emergency department of an academic tertiary hospital in South Korea during 4 months. All patients, who visited the emergency department and were between 19 and 65 years of age, answered the alcohol use disorder identification test questionnaire. In this study, at-risk drinking was identified using alcohol use disorder identification test. Results: The screening test was completed by 178 patients in this study. At-risk drinking group comprises 78 patients (43.8%). The cut-off values of screening test for at-risk drinking were 3 for males and 2 for females. As a result, the sensitivity/specificity was 98.0/93.5 and 96.4/79.6 for men and women, respectively. Area under the receiver operating characteristics of screening test for at-risk drinking was 0.9 and 0.9 in men and women, respectively. Conclusion: screening test for at-risk drinking is a useful test that easily identifies at-risk drinking. It is expected that this test can facilitate screening for at-risk drinking in emergency department setting.
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Affiliation(s)
- Hosub Chung
- Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
- Department of Emergency medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jae Hee Lee
- Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
- Department of Emergency medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Bonar EE, Schneeberger DM, Bourque C, Bauermeister JA, Young SD, Blow FC, Cunningham RM, Bohnert AS, Zimmerman MA, Walton MA. Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16688. [PMID: 32401225 PMCID: PMC7254293 DOI: 10.2196/16688] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/30/2020] [Accepted: 02/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use. OBJECTIVE This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences. METHODS This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor's-level and master's-level therapist electronic coaches posting relevant content and responding to participants' posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups. RESULTS We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT. CONCLUSIONS The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking. TRIAL REGISTRATION ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16688.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Diane M Schneeberger
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Sean D Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, United States
- Department of Emergency Medicine, University of California Irvine, Irvine, CA, United States
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Center for Clinical Management Research, Veterans Health Administration, Ann Arbor, MI, United States
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Amy Sb Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Center for Clinical Management Research, Veterans Health Administration, Ann Arbor, MI, United States
| | - Marc A Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
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11
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Prescription opioid misuse among adolescents and emerging adults in the United States: A scoping review. Prev Med 2020; 132:105972. [PMID: 31904397 PMCID: PMC7024638 DOI: 10.1016/j.ypmed.2019.105972] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorders (OUD)]. This article describes the current state of research focusing on prescription opioid misuse (POM) among adolescents and emerging adults (A/EAs) in the U.S. Given the rapidly changing nature of the opioid epidemic, we applied PRISMA Scoping Review (PRISMA-ScR) guidelines to identify empirical articles published in the past 5 years (January 2013-September 2018) from nine databases examining POM among A/EAs (ages 10-25) in the U.S. Seventy-six articles met our inclusion criteria focusing on POM in the following areas: cross-sectional surveys (n = 60), longitudinal cohort studies (n = 5), objective, non-self-reported data sources (n = 9), and interventions (n = 2). Final charted data elements were organized by methodology and sample, with results tables describing design, sample, interventions (where applicable), outcomes, and limitations. Most studies focused on the epidemiology of POM and risk/protective factors, including demographic (e.g., sex, race), individual (e.g., substance use, mental health), and social (e.g., peer substance use) factors. Despite annual national surveys conducted, longitudinal studies examining markers of initiation and escalation of prescription opioid misuse (e.g., repeated overdoses, time to misuse) are lacking. Importantly, few evidence-based prevention or early intervention programs were identified. Future research should examine longitudinal trajectories of POM, as well as adaptation and implementation of promising prevention approaches.
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Ranney ML, Patena JV, Dunsiger S, Spirito A, Cunningham RM, Boyer E, Nugent NR. A technology-augmented intervention to prevent peer violence and depressive symptoms among at-risk emergency department adolescents: Protocol for a randomized control trial. Contemp Clin Trials 2019; 82:106-114. [PMID: 31129373 DOI: 10.1016/j.cct.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Peer violence and depressive symptoms are increasingly prevalent among adolescents, and for many, use the emergency department (ED) as their primary source of healthcare. Brief in-person interventions and longitudinal text-message-based interventions are feasible, acceptable, and may be effective in reducing peer violence and depressive symptoms when delivered in the ED setting. This paper presents the study design and protocol for an in-ED brief intervention (BI) and text messaging program (Text). METHODS This study will be conducted in a pediatric ED which serves over 50,000 pediatric patients per year. Recruitment of study participants began in August 2018 and anticipated to continue until October 2021. The study will enroll 800 adolescents (ages13-17) presenting to the ED for any reason who self-report past-year physical peer violence and past-two week mild-to-moderate depressive symptoms. The study will use a factorial randomized trial to test both overall intervention efficacy and determine the optimal combination of intervention components. A full 2 × 2 factorial design randomizes patients at baseline to 1) BI or no BI; and 2) Text or no Text. Peer violence and depressive symptoms improvements will be measured at 2, 4, and 8 months through self-report and medical record review. DISCUSSION This study has important implications for the progress of the greater field of mobile health interventions, as well as for adolescent violence and depression prevention in general. This proposal has high clinical and public health significance with high potential scalability, acceptability, and impact.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street 2nd Floor, Providence, RI 02903, United States; Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - John V Patena
- Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, Box G-5121-4, Providence, RI 02912, United States.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States.
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
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Biroscak BJ, Pantalon MV, Dziura JD, Hersey DP, Vaca FE. Use of non-face-to-face modalities for emergency department screening, brief intervention, and referral to treatment (ED-SBIRT) for high-risk alcohol use: A scoping review. Subst Abus 2019; 40:20-32. [PMID: 30829126 PMCID: PMC6579646 DOI: 10.1080/08897077.2018.1550465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The purpose of this review was to examine and chart the "scope" of strategies reported in ED-SBIRT (emergency department-based screening, brief intervention and referral to treatment) studies that employ non-face-to-face (nFtF) modalities for high-risk alcohol use (i.e., risk for alcohol-related injury, medical condition, use disorder) and to identify research gaps in the scientific literature. Methods: The scoping review population included study participants with high-risk alcohol use patterns as well as study participants targeted for primary public health prevention (e.g., adolescent ED patients). Core concepts included SBIRT components among intervention studies that incorporated some form of nFtF modality (e.g., computer-assisted brief intervention). The context encompassed ED-based studies or trauma center studies, regardless of geographic location. After screening a total of 1526 unique references, reviewers independently assessed 58 full-text articles for eligibility. Results: A total of 30 full-text articles were included. Articles covered a period of 14 years (2003-2016) and 19 journal titles. Authors reported the use of a wide range of nFtF modalities across all 3 ED-SBIRT components: "screening" (e.g., computer tablet screening), "brief intervention" (e.g., text message-based brief interventions), and "referral to treatment" (e.g., computer-generated feedback with information about alcohol treatment services). The most frequently used nFtF modality was computerized screening and/or baseline assessment. The main results were mixed with respect to showing evidence of ED-SBIRT intervention effects. Conclusions: There is an opportunity for substance use disorder researchers to explore the specific needs of several populations (e.g., ED patients with co-occurring problems such as substance use disorder and violence victimization) and on several methodological issues (e.g., ED-SBIRT theory of change). Substance use disorder researchers should take the lead on establishing guidelines for the reporting of ED-SBIRT studies-including categorization schemes for various nFtF modalities. This would facilitate both secondary research (e.g., meta-analyses) and primary research design.
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Affiliation(s)
- Brian J Biroscak
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Michael V Pantalon
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - James D Dziura
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Denise P Hersey
- b Department of Clinical Information Services, Cushing/Whitney Medical Library , Yale University , New Haven , Connecticut , USA
| | - Federico E Vaca
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
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14
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Falvo F, Schmid A. Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients. J Emerg Nurs 2018; 44:325-330. [DOI: 10.1016/j.jen.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
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15
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Ngo QM, Eisman AB, Walton MA, Kusunoki Y, Chermack ST, Singh V, Cunningham R. Emergency Department Alcohol Intervention: Effects on Dating Violence and Depression. Pediatrics 2018; 142:peds.2017-3525. [PMID: 29871891 PMCID: PMC6317550 DOI: 10.1542/peds.2017-3525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES With this study, we examined secondary outcomes of an emergency department (ED)-based brief intervention (BI) on dating violence perpetration and victimization and depression symptoms over 3, 6, and 12 months. METHODS ED patients (14-20 years) were screened for risk drinking. Patients who received positive screen results were randomly assigned to a computer BI (n = 277), therapist BI (n = 278), or control condition (n = 281). After the 3-month assessment, participants were randomly assigned to receive the post-ED BI or control condition. BIs were used to address alcohol consumption and consequences (eg, dating violence and depression symptoms) by using motivational interviewing. RESULTS A total of 836 patients were enrolled in the randomized controlled trial of 4389 patients screened and 1054 who reported risky drinking. Regression models were used to examine longitudinal effects of the alcohol BI on dating violence perpetration, dating violence victimization, and depression symptoms. The therapist BI resulted in a significant reduction of dating violence perpetration up to 12 months (incidence rate ratio [IRR] = 0.53; 95% confidence interval [CI]: 0.37-0.77) and depression symptoms up to 3 months (IRR = 0.85; 95% CI: 0.72-1.00) after the intervention. Computer BI resulted in a reduction of dating violence perpetration (IRR = 0.52; 95% CI: 0.35-0.76) and depression symptoms (IRR = 0.78; 95% CI: 0.66-0.94) 6 months postintervention. Post-ED BIs were associated with lower perpetration at 12 months and lower victimization at 6 and 12 months, irrespective of BI intervention randomization at baseline; however, they did not affect depression symptoms. CONCLUSIONS A single-session ED BI revealed previously to show promise in reducing underage drinking also demonstrates promise in preventing dating violence perpetration and depression symptoms. These technology-enhanced BIs could be particularly helpful given the potential for more efficient resource usage and ease of future implementation.
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Affiliation(s)
- Quyen M. Ngo
- Department of Emergency Medicine,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan;,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Andria B. Eisman
- Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maureen A. Walton
- Department of Psychiatry, Addiction Research Center,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Yasamin Kusunoki
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan;,Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Stephen T. Chermack
- Department of Psychiatry, Addiction Research Center,,Department of Veterans Affairs, Veterans Affairs Healthcare System, Ann Arbor, Michigan; and
| | - Vijay Singh
- Departments of Family Medicine and Internal Medicine, Division of Hospital Medicine,,Department of Emergency Medicine,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rebecca Cunningham
- Department of Emergency Medicine,,Injury Prevention Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan;,Hurley Medical Center, Flint, Michigan
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16
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Davis AK, Arterberry BJ, Bonar EE, Chermack ST, Blow FC, Cunningham RM, Walton MA. Predictors of positive drinking outcomes among youth receiving an alcohol brief intervention in the emergency department. Drug Alcohol Depend 2018; 188:102-108. [PMID: 29758380 PMCID: PMC6261455 DOI: 10.1016/j.drugalcdep.2018.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential "teachable moment" to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline markers of BI response in order to inform future interventions. METHOD We conducted secondary analyses of data from a randomized controlled trial of an alcohol BI delivered to youth in an ED. Among 475 participants (Mage = 18.6, SD = 1.4; 48.7% Female, 78.6% White/Caucasian) receiving a computer or therapist BI, we examined baseline characteristics (i.e., demographic, substance use, mood, risk/protective factors, and readiness to change) that predicted positive intervention response (i.e., BI responder) at 3-month follow-up using AUDIT-C scores (cut offs: <3 for ages 14-17; <4 for ages 18-20). RESULTS Mediated logistic regression analysis (controlling for demographics) showed that greater readiness to change at baseline was positively related to BI response and baseline alcohol consumption was negatively related to BI response. Having a mentor was indirectly related to BI response via baseline alcohol consumption. Baseline readiness to change and alcohol consumption mediated the association between positive peer influences and BI response, whereas readiness to change mediated the relation between depression and BI response. CONCLUSION Findings suggest that BI response is influenced by protective social factors, such as positive peers and mentors, and depression, via baseline alcohol severity indicators (i.e., readiness to change, consumption), thus providing clues for enhancing the content and dose of early interventions.
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Affiliation(s)
- Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA
| | - Stephen T Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI, 48109-2800, USA
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
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Lee JH, Kong KA, Lee DH, Choi YH, Jung KY. Validation and proposal for cut-off values of an abbreviated version of the Alcohol Use Disorder Identification Test using the Korean National Health and Nutrition Examination Survey. Clin Exp Emerg Med 2018; 5:113-119. [PMID: 29973036 PMCID: PMC6039362 DOI: 10.15441/ceem.17.228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022] Open
Abstract
Objective Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and are widely used in clinical settings. In this study, we provide evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining cut-off values for the population of South Korea. Methods Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, we applied the cut-off value of at-risk drinking proposed by the World Health Organization and divided the study sample into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and optimal cut-off values were obtained for each group. Results A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions increased from one to four. The differences in AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. Conclusion As the number of items analyzed increased from one to four items, the AUROC increased to a statistically significant level. Cut-off values for abbreviated versions of AUDIT are similar in South Korea to other countries.
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Affiliation(s)
- Jae Hee Lee
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyoung Ae Kong
- Department of Preventive Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Koo Young Jung
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Lee KW, Choi YH, Lee JH. Cut-off points for screening at-risk drinking by AUDIT-C Korean version at emergency department. Turk J Emerg Med 2018; 18:57-61. [PMID: 29922731 PMCID: PMC6005919 DOI: 10.1016/j.tjem.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose To reduce problems caused by alcohol drinking, it is necessary to identify those with 'at-risk drinking' behavior to maximize therapeutic access or intervention. To this end, we sought to determine the cut-off point for screening of at-risk drinking by the Korean version of the AUDIT-C (Alcohol Use Disorder Identification Test-Consumption). Materials and methods We obtained data from the scientific research project of "the supervision of the Korea Center for Disease Control and Prevention (KCDCP)" in 2010. Injured patients over an 18-year-of age who visited an emergency department of an academic tertiary hospital from May to September 2010 were recruited to perform the AUDIT. The total number of patients who underwent the screening test was 640, 12.7% of the entire patients studied. Among them, 375 patients (58.4%) were men, and 265 patients (41.4%) were women. At-risk drinking was diagnosed based on the AUDIT total score and the cut-off points of the AUDIT-C were determined. Results Cut-off points were 5 for men [Area Under the Receiver Operation Characteristic (AUROC) 0.956], 4 for women (AUROC 0.966), and 4 in elders >65-year-of age (AUROC 0.972). Conclusion This study is the first research about the cut-off points of Korean version of AUDIT-C for patients including women and elders to screen for at-risk drinking in South Korea. AUDIT-C is a useful and accurate tool to screen patients for at-risk drinking.
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Affiliation(s)
- Kyung Wan Lee
- Department of Emergency Medicine, Nowon Eulji Medical Center, Seoul, South Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jae Hee Lee
- Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
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Lee JH, Jung KY, Choi YH. Screening Test for At-Risk Drinking: Development of New Abbreviated Version of Alcohol Use Disorder Identification Test for Young and Middle-Aged Adults. Emerg Med Int 2018; 2018:2306587. [PMID: 29888006 PMCID: PMC5985078 DOI: 10.1155/2018/2306587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 11/17/2022] Open
Abstract
Several abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) have been developed for use in high-volume clinical situations such as emergency departments. In this study, we developed a new abbreviated version of AUDIT called the Screening Tool for At-risk Drinking (STAD) for young and middle-aged adults, consisting of two questions that reflect the structure of the AUDIT questionnaire using data from the Korea National Health and Nutrition Examination Survey (KNHANES). To derive the abbreviated test considering AUDIT item structure, we performed confirmatory factor analysis on the 10 AUDIT questions in the Korea National Health and Nutrition Examination Survey (KNHANES) IV. To validate the new abbreviated test, we analyzed the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) on the KNHANES V-VI except for the KNHANES VI-2. Based on the two-factor structure of AUDIT, question (Q) 3 and Q7 were finally selected for STAD. In validation, AUROC was significantly wider for STAD than for AUDIT-QF, which has the same number of questions. There was no significant difference between AUDIT-C, consisting of three questions, and STAD. It can be used as a simple and reliable screening test in clinical settings.
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Affiliation(s)
- Jae Hee Lee
- Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Koo Young Jung
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Stephenson R, Bonar EE, Carrico A, Hunter A, Connochie D, Himmelstein R, Bauermeister J. Intervention to Increase HIV Testing Among Substance-Using Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e114. [PMID: 29712625 PMCID: PMC5952122 DOI: 10.2196/resprot.9414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) and transgender people in the Detroit Metro Area are the only risk group for whom the incidence of HIV and sexually transmitted infections (STI) has increased since 2000, with HIV incidence nearly doubling among youth. Substance use (including alcohol), which is relatively frequent among YMSM and transgender people, creates barriers to the optimal delivery of HIV prevention and care services. Standard HIV counseling, testing, and referral (CTR) is limited in providing strategies to identify and address substance use. Hence, in its current form, CTR may not be serving the prevention needs of substance-using YMSM and transgender people. Brief counseling interventions, grounded in principles of motivational interviewing, may offer a mechanism to meet the HIV prevention and care needs of substance-using YMSM and transgender people. OBJECTIVE This prospective, 4-arm, factorial randomized controlled trial aims to examine the efficacy of an motivational interviewing-based substance use brief intervention (SUBI) on participants' substance use and engagement in HIV prevention. METHODS The research implements a prospective randomized controlled trial (Project Swerve) of 600 YMSM and transgender people recruited both online and in person. Eligibility criteria include participants who (1) are between the ages of 15 to 29 years, (2) live in the Detroit Metro Area, (3) self-identify as a man or transgender man or woman, (4) have had sexual contact with a man in the 6 months before enrollment, (5) self-report binge drinking or any substance use in the 3 months before enrollment, and (6) self-report an unknown or negative HIV status upon enrollment. Participants are randomized to receive, 3-months apart starting at baseline, 2 individual sessions. Sessions are CTR-only, SUBI-only, CTR followed by SUBI, or SUBI followed by CTR. RESULTS Project Swerve was launched in April 2017 and enrollment is ongoing. CONCLUSIONS Incorporating a SUBI that utilizes the principles of motivational interviewing into HIV CTR provides an opportunity to tailor counseling services for YMSM and transgender people to address additional client barriers to HIV and STI testing. TRIAL REGISTRATION ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 (Archived by WebCite at http://www.webcitation.org/6yFyOK57w).
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Affiliation(s)
- Rob Stephenson
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Adam Carrico
- School of Public Health, University of Miami, Miami, FL, United States
| | - Alexis Hunter
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Connochie
- Program on Sexuality, Technology & Action Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Himmelstein
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Jose Bauermeister
- Program on Sexuality, Technology & Action Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
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21
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Walton MA, Ngo QM, Chermack ST, Blow FC, Ehrlich PF, Bonar EE, Cunningham RM. Understanding Mechanisms of Change for Brief Alcohol Interventions Among Youth: Examination of Within-Session Interactions. J Stud Alcohol Drugs 2018; 78:725-734. [PMID: 28930060 DOI: 10.15288/jsad.2017.78.725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol brief interventions (BIs) for youth are efficacious, but effect sizes found have been modest. This article presents secondary data analyses from a randomized controlled trial of motivational interviewing-based (MI) alcohol BIs among youth in an emergency department, examining within-session predictors of alcohol outcomes at 3 months among those receiving BIs. METHOD Risky drinkers (ages 14-20) received either a computer BI (n = 277) or therapist BI (n = 278). Within-session measures were obtained via computer metrics (therapist and computer BIs) and coding of audiotapes (therapist BI only). Parallel structural equation models examined direct and indirect effects of BI components on 3-month alcohol consumption and consequences, with posttest precursors of behavior change (e.g., importance, readiness, and intentions) as potential mediators. Components examined included reasons to avoid or reduce drinking, strengths, strategies for change, benefits of change, and leisure activities (computer BI only), and MI global ratings and MI-adherent behaviors (therapist BI only). RESULTS For both BIs, greater number of strategies directly predicted greater posttest scores, with posttest scores mediating the relationship between strategies and alcohol consumption at 3 months. Greater number of strengths directly predicted fewer alcohol-related consequences at 3 months for both BIs; however, strengths also indirectly predicted greater consumption, mediated by posttest scores. Greater number of reasons to avoid or reduce drinking directly predicted greater alcohol consumption for the therapist BI only. CONCLUSIONS These findings suggest ways to optimize the content and efficacy of alcohol BIs. Reviews of strategies such as refusal skills, protective behavioral strategies, and coping with negative affect may be particularly salient for reducing alcohol misuse.
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Affiliation(s)
- Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Injury Center, University of Michigan, Ann Arbor, Michigan
| | - Quyen M Ngo
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,Institute on Women and Gender Studies, University of Michigan, Ann Arbor, Michigan
| | - Stephen T Chermack
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Mental Health Innovation, Services, and Outcomes Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Peter F Ehrlich
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,School of Public Health, University of Michigan, Ann Arbor, Michigan
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22
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Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2:CD004148. [PMID: 29476653 PMCID: PMC6491186 DOI: 10.1002/14651858.cd004148.pub4] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.
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Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona Campbell
- The University of SheffieldSchool of Health and Related ResearchRegent StreetSheffieldUKS1 4DA
| | - Elizabeth D Pienaar
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - Nicolas Bertholet
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - Jean B Daeppen
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - John B Saunders
- Royal Brisbane and Women's HospitalDepartment of PsychiatryCentre for Drug & Alcohol StudiesSchool of MedicineUniversity of Queensland/Royal Brisbane HospitalQueenslandAustralia4029
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneVaudSwitzerlandCH‐1010
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Schinke S, Schwinn TM. Computer-Based Prevention and Intervention to Reduce Substance Use in Youth. CURRENT ADDICTION REPORTS 2017; 4:410-421. [PMID: 29354389 DOI: 10.1007/s40429-017-0171-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose of Review Computer-based programs for substance use prevention and intervention among youth are on the ascendancy. Whether delivered by computer per se or by electronic tablet or smartphone, technology-driven programs are harmonious with how young people access information and interact with their worlds. This review examines recent evidence on computer-based programs aimed at substance use among youth, with particular attention to results from randomized trials. Recent Findings Outcome studies of computer-based, substance use-related programs published over the past 5 years reveal mixed results amidst diverse intervention approaches and delivery settings. Many studies are marred by high attrition. Notable in the recent literature is the international nature of technology-driven substance use prevention and intervention programs. With some exceptions, most programs appear to not have been customized for their recipient populations. Though few in number, the highest-quality studies of computer-based programs show positive outcomes in reduced substance use rates. Summary Based on recent findings, considerable work needs to happen before computer-delivered approaches are a proven means for reducing substance use among youth. Original programs, expressly developed for subgroups of youth, are in short supply. Though controlled designs are becoming commonplace, too many studies of computer-based programs suffer from flaws-including high rates of attrition-that limit the discovery of positive outcomes.
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Affiliation(s)
- Steven Schinke
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027
| | - Traci Marie Schwinn
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027
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24
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Buckley L, Bonar EE, Walton MA, Carter PM, Voloshyna D, Ehrlich PF, Cunningham RM. Marijuana and other substance use among male and female underage drinkers who drive after drinking and ride with those who drive after drinking. Addict Behav 2017; 71:7-11. [PMID: 28231494 DOI: 10.1016/j.addbeh.2017.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Abstract
The study sought to describe the occurrence of adolescent driving after drinking (DD) and riding with a driver who had been drinking (RWDD) and associations with substance use for both males and females. As part of screening for a randomized controlled trial, we surveyed 16-20year olds (N=3418) recruited from an emergency department (ED) and analyzed data from those reporting past-year alcohol consumption (n=2150, 58% females). DD was reported by 22% of females and 28% of males and RWDD was reported by 39% of females and 38% of males, also in the past year. In regression models, risky alcohol use and past-year marijuana use were associated with increased odds of DD and RWDD for females and males. Marijuana use was a strong predictor, with odds increased by 2.3 and 1.7 times for DD among females and males respectively and 1.4 times for RWDD for females and males. Prescription drug misuse was also associated with RWDD for females and for both males' and females' reported DD. The findings highlight the alarming rate of DD and RWDD among both males and females and suggest ED-based injury prevention efforts consider such risky road behavior as well as consider their substance use. Future research might also further examine the effects of driving under influence of substances, particularly marijuana, and the negative synergistic effects of co-ingestion prior to driving.
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Affiliation(s)
- Lisa Buckley
- University of Michigan Transportation Research Institute, Ann Arbor, MI, United States; University of Michigan Injury Center, Ann Arbor, MI, United States.
| | - Erin E Bonar
- University of Michigan, Department of Psychiatry, Addiction Center, Ann Arbor, MI, United States
| | - Maureen A Walton
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan, Department of Psychiatry, Addiction Center, Ann Arbor, MI, United States
| | - Patrick M Carter
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Diana Voloshyna
- V.N. Karazin Kharkiv National University, Department of Psychiatry, Narcology, Neurology and Medical Psychology, Kharkiv, Ukraine
| | - Peter F Ehrlich
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan Health System, C.S. Mott Children's Hospital, Department of Surgery, Section of Pediatric Medicine, Ann Arbor, MI, United States
| | - Rebecca M Cunningham
- University of Michigan Injury Center, Ann Arbor, MI, United States; University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States; Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
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25
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Cortés-Tomás MT, Giménez-Costa JA, Motos-Sellés P, Sancerni-Beitia MD. Revision of AUDIT Consumption Items to Improve the Screening of Youth Binge Drinking. Front Psychol 2017. [PMID: 28642722 PMCID: PMC5463274 DOI: 10.3389/fpsyg.2017.00910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study analyzes the appropriateness of an improved version of one of the most frequently used instruments for the screening of high-risk alcohol consumption. This adaptation was created in accordance with certain limitations recognized by other researchers and in an attempt to adjust the content and scales of some items to a more consensual definition of binge drinking. After revising items 2 and 3, the areas under the ROC curves of the AUDIT and of different abbreviated versions were calculated. A total of 906 minors (468 females) between the ages of 15 and 17 were evaluated. Stratified sampling was conducted on a population of high school students in the city of Valencia (Spain). One school was randomly chosen from each of the city’s 16 school districts. Information was collected on sociodemographic aspects, consumption patterns and the AUDIT containing the improved items. The percentage of underage BD reached 36%, regardless of gender or age. BD groups have been differentiated by different intensity levels, both in males and females. Upon comparing the effectiveness of the distinct versions of the AUDIT, it is recommended that researchers and clinics use the combination of the revised items 2 and 3 to ensure a more precise identification of underage BD. A cut-off point of 5 for this test would permit identification of 94% of the underage BD and would notably reduce false positives.
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Affiliation(s)
| | | | - Patricia Motos-Sellés
- Department of Basic Psychology, Faculty of Psychology, University of ValenciaValencia, Spain
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26
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Kazemi DM, Jacobs DG, Portwood SG, Veach L, Zhou W, Hurley MJ. Trauma Center Youth Violence Screening and Brief Interventions: A Multisite Pilot Feasibility Study. VIOLENCE AND VICTIMS 2017; 32:251-264. [PMID: 28130901 DOI: 10.1891/0886-6708.vv-d-15-00141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Every day, 16 American youths between the ages of 10 and 24 years are murdered; 84% of these fatalities involve a firearm. Nearly half of traumatic youth deaths result from violence-related injuries. In 2013, 580,250 youth suffered nonfatal, assault-related injuries, necessitating emergency department treatment. The aim of this multisite pilot study was to examine the process, feasibility, and challenges of violence brief interventions (VBIs). The participants were youth between 15 and 25 years of age, at 2 major Level 1 trauma centers (TCs; TC1, TC2) in the Southeastern United States. Eligible participants (N = 38; TC1: n = 20, TC2: n = 18) received at least 1 VBI during their hospital stay, which provided information about individual screening results and elicited patients' perspectives on violent and risky behaviors. More participants at TC2 than at TC1 completed 2 VBI sessions. Barriers to and support of implementation were identified at both sites, and factors for improving implementation were identified, including the need for staff support through clinical guidelines and coordinated prevention and outreach programs. Further research is needed to identify factors for successful implementation of VBIs in TCs.
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27
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Voloshyna DM, Bonar EE, Cunningham RM, Ilgen MA, Blow FC, Walton MA. Blackouts among male and female youth seeking emergency department care. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 44:129-139. [PMID: 28032801 PMCID: PMC6186526 DOI: 10.1080/00952990.2016.1265975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alcohol-related blackouts are a common consequence of heavy drinking, and these blackouts pose risk for injury and other adverse health outcomes. OBJECTIVE To examine the prevalence and correlates of blackouts among underage drinkers. METHODS Youth (ages 14-20) presenting to a suburban Emergency Department (ED) completed screening surveys. Among those reporting past-year alcohol consumption, we examined past 3-month blackouts in relation to: background characteristics (e.g., demographics, fraternity/sorority involvement), substance use, sexual risk behaviors and incapacitated sexual assault (unaware/unable to consent due to alcohol/drugs), forced sexual assault, positive depression screening, and reason for ED visit (injury vs. medical). RESULTS In total, 2,300 past-year drinkers participated: 58% female, 75% Caucasian, and mean age = 18.4. Regarding past 3-month blackouts, 72.7% reported none, 19.3% reported monthly or less, and 8% reported monthly or more. Multivariate cumulative logit regression indicated that blackout frequency was positively associated with: college involvement in Greek life, alcohol use severity, prescription drug misuse, marijuana, screening positive for depression, incapacitated sexual assault, and a gender by alcohol use severity interaction. CONCLUSION With one-quarter of this clinical sample reporting recent blackouts, as well as the association between blackout frequency and health risk behaviors and other outcomes, findings underscore the need for programs focusing on substance use, depression, and preventing sexual assault. Interventions should also address poly-substance use and drinking motives. Although findings highlight how college students in Greek life may be at high risk for blackouts, many participants not in college also reported blackouts, suggesting that interventions in other settings are also needed.
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Affiliation(s)
- Diana M. Voloshyna
- Department of Psychiatry, Narcology, Neurology and Medical Psychology, V.N. Karazin Kharkiv National University, Svobody Sq. 6 r. №694а, Kharkiv, Ukraine, 61077
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Erin E. Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
| | - Mark A. Ilgen
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Frederic C. Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Maureen A. Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
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Corradi-Webster CM, Gherardi-Donato ECDS. Factors associated with problematic drug use among psychiatric outpatients. Rev Lat Am Enfermagem 2016; 24:e2815. [PMID: 27901217 PMCID: PMC5172613 DOI: 10.1590/1518-8345.1444.2815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/21/2016] [Indexed: 11/21/2022] Open
Abstract
Objective to examine the factors associated with problematic drug use among psychiatric outpatients. Method a cross-sectional study was carried out in two mental health services. Eligible individuals were patients of these mental health services, who used them within the data collection period. Instruments: standardized questionnaire with sociodemographic, social network, social harm, and clinical information; Alcohol, Smoking and Substance Involvement Screening Test; Barratt Impulsiveness Scale; Holmes and Rahe Stress Scale. Statistical analysis was performed using parametric statistics considering a significance level of p ≤ 0.05. Study participants were 243 patients, with 53.9% of these presenting problematic drug use. Results the most important independent predictors of problematic drug use were marital status (OR = 0.491), religious practice (OR = 0.449), satisfaction with financial situation (OR = 0.469), having suffered discrimination (OR = 3.821) and practicing sports activities in previous 12 months (OR = 2.25). Conclusion the variables found to be predictors were those related to the social context of the patient, there, it is recommended that mental health services valorize psychosocial actions, seeking to know the social support network of patients, their modes of socialization, their financial needs, and their experiences of life and suffering.
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Affiliation(s)
| | - Edilaine Cristina da Silva Gherardi-Donato
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Abstract
Preventing or mitigating substance use among youth generally involves 3 different intervention frameworks: universal prevention, selective prevention, and treatment. Each of these levels of intervention poses unique therapeutic and implementation challenges. Technology-based interventions provide solutions to many of these problems by delivering evidence-based interventions in a consistent and cost-effective manner. This article summarizes the current state of the science of technology-based interventions for preventing substance use initiation and mitigating substance use and associated consequences among youth.
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Ehrlich PF, Roche JS, Cunningham RM, Chermack ST, Carter PM, Booth BM, Blow F, Barry K, Walton MA. Underage drinking, brief interventions, and trauma patients: Are they really special? J Trauma Acute Care Surg 2016; 81:149-55. [PMID: 27120317 PMCID: PMC4915985 DOI: 10.1097/ta.0000000000001093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the relationship between underage drinking and injury has been well established, few studies have examined whether presenting for an acute injury moderates the efficacy of a brief intervention (BI) on alcohol misuse. METHODS Patients (aged 14-20 years) in the emergency department screening positive for risky drinking (Alcohol Use Disorders Identification Test-Consumption score) completed a baseline assessment, were randomized to conditions (a standalone computer-delivered BI [n = 277], a therapist-delivered BI [n = 278], or a control condition [n = 281]), and completed a 3-month follow-up. This secondary analysis of Project U-Connect examined regression models (controlling for baseline values) to examine the main effects of injury and the interaction effects of injury by BI condition on alcohol consumption and consequences. RESULTS Among 836 youth enrolled in the randomized controlled trial (mean age, 18.6 years; 51.6% were male; 79.4% were white), 303 (36.2%) had a primary complaint of intentional or unintentional injury. At baseline, injured patients were more likely to be male (p < 0.001) and have higher alcohol consumption (p < 0.01), but were less likely to misuse prescription drugs (p = 0.02) than those presenting for medical reasons. Regression models (controlling for baseline values) demonstrated that injury presentation predicted greater alcohol consumption prior to a BI. The computer BI was more effective at reducing alcohol consequences among those presenting with injury than those presenting for other reasons. Injury did not affect the efficacy of the computer BI on alcohol consumption, and injury did not affect the efficacy of the therapist BI on alcohol outcomes. CONCLUSIONS A therapist or computer BI reduced alcohol consumption and consequences among risky drinkers regardless of reason for emergency department presentation highlighting the opportunity to reach a broad array of youth. Although the therapist BI was not moderated by injury presentation, the computer BI was particularly effective at reducing alcohol consequences among those presenting with injury at 3-month follow-up. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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Affiliation(s)
- Peter F Ehrlich
- From the Injury Center (P.F.E., J.S.R., R.M.C., P.M.C., B.M.B., F.B., M.A.W.), University of Michigan Medical School, Ann Arbor, Michigan; Department of Emergency Medicine (J.S.R., R.M.C., P.M.C.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center (J.S.R., R.M.C., P.M.C., M.A.W.), University of Michigan School of Public Health, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry (S.T.C., F.B., K.B., M.A.W.), University of Michigan School of Medicine, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs (S.T.C., F.B., M.A.W.), Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Psychiatry College of Medicine, University of Arkansas for Medical Sciences, (B.M.B.), Little Rock, Arkansas; Section of Pediatric Surgery (P.F.E.), CS Mott Children's Hospital, Department of Surgery, University of Michigan School of Medicine, Ann Arbor Michigan; and Institute for Healthcare Policy and Innovation (R.M.C., F.B.), University of Michigan, Ann Arbor, Michigan
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Patton R, Lau CH(J, Blow FC, Ranney M, Cunningham R, Walton M. Prevalence and Correlates of Depression and Drinking Behaviors Among Adolescents and Emerging Adults in a Suburban Emergency Department. Subst Use Misuse 2016; 51:34-40. [PMID: 26669633 PMCID: PMC5137633 DOI: 10.3109/10826084.2015.1074692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both alcohol use and depression are concerning health issues among youth. The Emergency Department (ED) is a critical location to access youth with depressive symptoms and alcohol misuse. OBJECTIVES To inform future interventions in the ED, this study examined the relationship between drinking behaviors and depressive symptoms among youth seeking ED care. METHODS Youth ages 14-20 were recruited from a level-1 trauma ED located in the Midwest as part of a larger ongoing study. Participants completed an electronic screening survey, which included assessment of alcohol use, depressive symptoms, and demographic variables. Two logistic regression models were conducted to assess the relationship between depressive symptoms with alcohol consumption and specific alcohol-related consequences. RESULTS Among 3,659 participants, bivariate analysis indicated that individuals screening positive for depression were more likely to be female, nonwhite, receive public assistance, and report higher scores on both alcohol consumption and alcohol-related consequences. Regression analyses indicated alcohol consumption, inability to stop drinking once starting, and feelings of guilt or remorse after drinking were significantly positively related to screening positive for depression. CONCLUSIONS/IMPORTANCE Current findings support use of the ED as a location for identifying youth who are experiencing co-morbid alcohol use and depressive symptoms. Future research should focus on the effectiveness of brief intervention in the ED that focuses on the co-occurrence of alcohol misuse and depressive symptoms among youth.
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Affiliation(s)
- Rikki Patton
- University of Akron, Counseling, 114 Chima, 27 S. Forge St, Akron, 44325 United States
| | | | - Frederic C Blow
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, 48109 United States
| | - Megan Ranney
- Brown University, Emergency Medicine, Providence, United States
| | | | - Maureen Walton
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, 48109 United States
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Cunningham RM, Chermack ST, Ehrlich PF, Carter PM, Booth BM, Blow FC, Barry KL, Walton MA. Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial. Pediatrics 2015; 136:e783-93. [PMID: 26347440 PMCID: PMC4586730 DOI: 10.1542/peds.2015-1260] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months. METHODS Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program. RESULTS Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition × post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED. CONCLUSIONS A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation.
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Affiliation(s)
- Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Department of Health Behavior and Health Education and,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Stephen T. Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Peter F. Ehrlich
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Surgery, Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Brenda M. Booth
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Frederic C. Blow
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Kristen L. Barry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Maureen A. Walton
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
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Singh V, Epstein-Ngo Q, Cunningham RM, Stoddard SA, Chermack ST, Walton MA. Physical dating violence among adolescents and young adults with alcohol misuse. Drug Alcohol Depend 2015; 153:364-8. [PMID: 26088699 PMCID: PMC4509806 DOI: 10.1016/j.drugalcdep.2015.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 05/03/2015] [Accepted: 05/04/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study determined prevalence and correlates of physical dating violence (victimization or aggression) among male and female youth with alcohol misuse and seeking emergency department (ED) care. METHODS Patients age 14-20 seeking care at a single large university-based ED completed a computerized, self-administered, cross-sectional survey. Measures included demographics, alcohol and substance use, mental health problems, health service use, peer influences, parent support, and community involvement. Bivariate and multivariate regression assessed physical dating violence correlates. RESULTS Among 842 male and female youth seeking ED care who screened positive for alcohol misuse, 22.3% (n=188) reported dating violence in the past year. Multivariate analyses showed variables associated with dating violence were female gender (AOR 2.17, CI 1.46-3.22), Caucasian race (AOR 0.59, CI 0.37-0.93), receipt of public assistance (AOR 1.82, CI 1.16-2.87), AUDIT Score (AOR 1.06, CI 1.02-1.10), older age of drinking onset (AOR 0.86, CI 0.77-0.96), suicidal ideation or attempt (AOR 1.95, CI 1.13-3.37), frequency of ED visits (AOR 1.22, CI 1.05-1.46), negative peer influences (AOR 1.05, CI 1.01-1.10), and positive peer influences (AOR 0.86, CI 0.80-0.93). CONCLUSIONS Nearly 1 in 4 youth with alcohol misuse seeking ED care report dating violence. Key correlates of dating violence included alcohol use severity, suicidal ideation, ED services, and peer influences. Evidence-based dating violence interventions addressing these correlates are needed for youth with alcohol misuse seeking ED care.
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Affiliation(s)
- Vijay Singh
- University of Michigan, Department of Emergency Medicine and Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48105, United States; University of Michigan, Department of Family Medicine, Ann Arbor, MI 48105, United States; University of Michigan Injury Center, Ann Arbor, MI 48105, United States.
| | - Quyen Epstein-Ngo
- University of Michigan Injury Center, Ann Arbor, MI 48105, United States; University of Michigan, Department of Psychiatry and Addiction Research Center, Ann Arbor, MI 48109, United States
| | - Rebecca M Cunningham
- University of Michigan, Department of Emergency Medicine and Institute for Healthcare Policy and Innovation, Ann Arbor, MI 48105, United States; University of Michigan Injury Center, Ann Arbor, MI 48105, United States
| | - Sarah A Stoddard
- University of Michigan Injury Center, Ann Arbor, MI 48105, United States; University of Michigan, Department of Health Behavior and Health Education, School of Public Health, Ann Arbor, MI 48105, United States; University of Michigan School of Nursing, Ann Arbor, MI 48105, United States
| | - Stephen T Chermack
- University of Michigan, Department of Psychiatry and Addiction Research Center, Ann Arbor, MI 48109, United States
| | - Maureen A Walton
- University of Michigan Injury Center, Ann Arbor, MI 48105, United States; University of Michigan, Department of Psychiatry and Addiction Research Center, Ann Arbor, MI 48109, United States
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Harris SK, Knight JR. Putting the Screen in Screening: Technology-Based Alcohol Screening and Brief Interventions in Medical Settings. Alcohol Res 2014; 36:63-79. [PMID: 26259001 PMCID: PMC4432859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Alcohol is strongly linked to the leading causes of adolescent and adult mortality and health problems, making medical settings such as primary care and emergency departments important venues for addressing alcohol use. Extensive research evidence supports the effectiveness of alcohol screening and brief interventions (SBIs) in medical settings, but this valuable strategy remains underused, with medical staff citing lack of time and training as major implementation barriers. Technology-based tools may offer a way to improve efficiency and quality of SBI delivery in such settings. This review describes the latest research examining the feasibility and efficacy of computer- or other technology-based alcohol SBI tools in medical settings, as they relate to the following three patient populations: adults (18 years or older); pregnant women; and adolescents (17 years or younger).The small but growing evidence base generally shows strong feasibility and acceptability of technology-based SBI in medical settings. However, evidence for effectiveness in changing alcohol use is limited in this young field.
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