Public Health Problem to be Studied

Alcohol and other drug (AOD) use by adolescents is a persistent public health problem. The proportion of youth reporting past month alcohol use nationally is 10 percent among 8th graders, rising to 35 percent among 12th graders. Teenage AOD use can have grave consequences. Youth who report starting to drink before the legal age are more likely than their peers to injure themselves or others. Adolescent AOD use is linked to the three leading causes of death among teens: accidents, homicides, and suicides. When not addressed or not well treated, risky AOD use during adolescence often continues into adulthood, leading to long-term substance use disorders and a host of related health problems. Preventing youth AOD use, and intervening early with those who use, are keys to reducing the many consequences of risky use.

Importance of the Proposed Study

Given that most teens in the United States visit pediatric primary care (PC) clinics at least once per year, PC settings provide rich opportunities to intervene with teens at risk for AOD problems. One approach to intervene in adolescent AOD use in PC settings is the Screening and Brief Intervention (SBI) approach. SBI procedures involve (1) using a research-proven clinical assessment tool to screen for AOD use and related problems (i.e., AOD risk) and then (2) delivering research-proven interventions to address AOD risk when it is detected.

In current PC practice, SBI procedures focus almost exclusively on adolescents by themselves; that is, the adolescent is assessed in private, and then if needed, the doctor or other clinic staff (i.e., provider) delivers a brief intervention to the adolescent alone. However, research shows that adolescent-only SBI procedures are not as effective as they could be. Research also shows that in general, involving caregivers in adolescent AOD interventions can be very effective. For these reasons, this study will examine whether SBI procedures that involve caregivers in a thorough way are more effective than SBI procedures that focus on adolescents alone.

Main Study Objectives and Study Interventions

This study will compare the effectiveness of SBI for adolescent AOD use in PC when implemented in its standard version as an adolescent-only model (SBI-Standard) versus as a family-based model that systematically includes a primary caregiver in all activities (SBI-Family).

Basic Study Design

This study will take place in pediatric PC clinics within three large urban hospitals. In each site, teen patients and a primary caregiver will be randomly assigned to receive either the SBI-Standard model or the SBI-Family model. All providers working in each clinic site will be trained to deliver both SBI models.

How This Study Will Be Helpful

Study results will inform the important decision of whether and how to involve caregivers in SBI procedures for adolescent AOD use in routine PC settings. Guidelines for delivering SBI procedures based on study results will directly inform PC clinical practices nationwide and directly benefit adolescents who are at risk for AOD problems.

Who Will Be Included in the Study

The study will enroll adolescents aged 12-17 years and their caregivers attending PC visits. Based on existing information collected from participating clinics, the research team expects the study sample will be:

• Male: 49.5 percent
• Female: 49.5 percent
• Nonbinary: 1 percent
• White Non-Hispanic: 34 percent
• Hispanic: 29 percent
• Black: 31 percent
• Other: 6 percent
• Ages 12-14: 55 percent
• Ages 15-17: 45 percent

Study Outcomes and Timeframe

The study will examine the following patient outcomes:

• Alcohol use
• Other drug use (nicotine, cannabis)
• AOD risk factors (e.g., impulsivity, anger coping)
• Emotional and behavior problems
• Quality of life
• Positive parenting
• Use of behavioral counseling/supports.

Outcomes will be collected via remote digital assessment at baseline (as soon as possible after the PC visit ends) and at 3, 6, 9, and 12 months after the PC visit.

Stakeholders in the Study

The study will be guided by a panel of stakeholders who will meet twice per year to provide input on research, practice, patient, and policy aspects of the study. Stakeholders will include pediatricians with experience treating diverse patient populations, persons with lived experience with AOD and as caregivers of adolescents with AOD problems, experts in family-based adolescent AOD interventions, and youth and family community advocates.