Project Summary

Description of problem
Adolescents who use alcohol and cannabis regularly may suffer lifelong consequences, such as social, health, financial and emotional problems. These problems could be addressed during primary care (PC) visits, assuming providers can identify teens who may use alcohol and cannabis and discuss these issues with them. However, this does not always happen as providers may not have time or expertise to discuss these issues. Some teens are even less likely to receive such care, especially teens with diverse racial, ethnic, and sexual and gender minority identities. Because there is not enough scientific information on how to best address alcohol and cannabis use with these diverse teens (ages 12-17) in PC, this study will evaluate a brief intervention for these young people, called CHAT, that has been shown to help teens decrease their alcohol and cannabis use. 

This intervention uses a communication style that empowers teens to change their behavior if they are ready, also known as motivational interviewing. In this study, researchers will work with teens, parents and providers to see how to ensure CHAT addresses issues that teens with diverse identities may face. The study seeks to understand what benefits CHAT brings compared to usual care. In working with stakeholders, researchers also want to understand individual values, preferences and other factors to be aware of when implementing this intervention. The study team will examine how results compare for those who receive CHAT and those who receive usual care. 

Methods 
This study will recruit 500 youth across two PC organizations in Los Angeles and Pittsburgh. Researchers will recruit patients ages 12-17 based on how they answer a questionnaire to identify who may be at risk for alcohol and/or cannabis use. Half of the teens will receive CHAT, which will address the pros and cons of alcohol and cannabis use and how their peers may influence their behavior. Half will receive usual care, which will involve a brochure about alcohol and cannabis use. Young people will complete surveys at the start of the study and then at three, six and 12 months. The team will also interview teens, parents and providers throughout the study.   

Outcomes 
The study will follow teens for one year to evaluate effects of both CHAT and usual care on various results. Primary outcomes are alcohol use, cannabis use, alcohol consequences, cannabis consequences, and time spent around peers who use alcohol or cannabis. Secondary outcomes include motivation to change, resistance self-efficacy, and healthcare service use. Researchers will also examine for which patient subgroups CHAT or usual care are most effective and will work closely with teens, parents, providers and other stakeholders to determine how to make CHAT available should it be successful.   

Importance to patients 
This study is important to teens who are diverse in their race, ethnicity, and sexual orientation and gender who are at risk of using alcohol and cannabis because there are very few successful interventions tailored to these populations. CHAT focuses on empowering youth and increasing their motivation to change if they are ready to change. Regular substance use has lifelong consequences for teens and their families. The outcomes of this study are important to these teens as they will provide an understanding of how a brief intervention could increase individual motivation to change to improve individual outcomes.

Stakeholder Engagement
The study team has demonstrated a long-term commitment to patient-centered participatory research with many historically marginalized communities to eliminate health disparities and find solutions to public health problems. The team has assembled a patient and stakeholder advisory board to guide researchers in planning and conducting the study and disseminating study results. Researchers also include extensive qualitative data collection before, during and after the study with teens, parents and providers. For example, this patient-centered approach will help researchers be respectful of cultural and linguistic norms and carefully consider what they should measure and how. Patients and stakeholders will also assist with recruitment and retention and understanding what the research means for teens and their parents.

This study is set up to facilitate mutual learning and support across researchers and stakeholders to ensure that the work is meaningful and sustainable for these PC settings and the communities where the teens live.

Project Information

Elizabeth D'Amico, Ph.D.
Alina Palimaru, Ph.D.
RAND Corporation
$6,699,517 *

Key Dates

60 months *
November 2023
2023

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: January 24, 2024