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1 Computer-Facilitated Screening and Clinician Brief Advice: Effects on Heavy Episodic Drinking Among Adolescents in the USA and Czech Republic 1 Center for Adolescent Substance Abuse Research Boston Childrens Hospital Department of Pediatrics Harvard Medical School Center for the Evaluation, Prevention and Research of Substance Abuse Kateryna Kuzubova, MA, PC-CR; John R Knight, MD; Ladislav Csmy, PhD; Lon Sherritt, MPH; Sion K Harris, PhD Slide 2 2 Financial Support This study supported by Grant R01 DA018848 from the National Institute on Drug Abuse Other support provided by: Grant K07 AA013280 from the National Institute on Alcohol Abuse and Alcoholism (JK) Grants T20MC07462 (JK, SVH) and #T71NC0009 (SKH) from the Maternal and Child Health Bureau The Davis Family Charitable Foundation, The Carl Novotny & Judith Swahnberg Fund, The Ryan Whitney Memorial Fund, J.F Maddox Foundation and the John F. Brooke Foundation 2 Slide 3 Disclosure Neither I nor any member of my immediate family have a financial relationship or interest with any proprietary entity producing health care goods or services related to the content of this CME activity My content does not include discussion or reference to commercial products or services I will not discuss an unapproved or investigative use of commercial products or devices Slide 4 Background & Significance Heavy Episodic Drinking (Binge) 5+ drinks/occasion for boys; 4+ for girls 1 Common among adolescents worldwide Adverse effects on brain development, health, psychosocial outcomes 2 1.Wechsler H. et al. JAMA 272:1672-1677, 1994 2.Kuntsche E. et al. Alcoholism: Clinical & Experimental Research. February 2013; 37(22): 308-314 Slide 5 Previous Study Computer-facilitated Screening and clinician Brief Advice (cSBA) on alcohol use Reduced past-12-month any drinking among adolescents in USA, but not in Czech Republic (CZR) 1 CZR teen drinking is normative and twice prevalent as in USA 1. Harris et al., Pediatrics. June 2012;129(6):1072-1082. Slide 6 Study Objective To assess cSBA effects on binge drinking among 12- to 18-year-old primary care patients in USA and CZR The Method has been previously published 1. Harris et al., Pediatrics. June 2012;129(6):1072-1082. Slide 7 7 Milton Family Practice, Milton, VT Concord Family Practice, Concord, NH Department of Pediatrics Reliant Medical Group, Worcester, MA Adolescent Clinic, Tufts Medical Center, Boston, MA Cambridge Rindge and Latin High School, Cambridge, MA Center for Adolescent Substance Abuse Research (CeASAR), Boston Childrens Hospital, Boston, MA (Study Coordinating Center) The New England Partnership for Substance Abuse Research (NEPSAR) 7 Colchester Family Practice, Colchester, VT Dartmouth-Hitchcock Pediatrics, Concord, NH Pediatric Clinic, Cambridge Hospital, Cambridge, MA Somerville High School, Somerville, MA Slide 8 8 Offices of Study Pediatricians in Prague MUDr. Ruzkova MUDr. Jedlickova MUDr. Holub MUDr. Mottlova MUDr. Schwarzova MUDr. Chaloupkova MUDr. Kolarova MUDr. Belorova MUDr. Tylingrova MUDr. Vlkova Center for Evaluation, Prevention, and Research of Substance Abuse Slide 9 9 Study Design (2005-2009) Quasi-Experimental Comparative Effectiveness Trial 1 18 36 Months Recruit/assess TAU Recruit/assess cSBA Clinicians instructed to Do what you usually do. 1-hr Clinician training; Computer system initiated at all sites 9 Slide 10 10 Intervention: cSBA Computer-facilitated system included: CRAFFT screen* Immediate feedback: patients score and risk level 10 pages of scientific information and true-life stories showing harmful effects of substance use Clinician Report sheet with screen results and talking points to prompt 2- to 3-minutes discussion with teen 10 * Knight JR, et al,., Arch Pediatr Adolesc Med, 2002(Jun);156(6):607-614. Slide 11 Slide 12 Slide 13 Slide 14 Treatment as Usual (TAU) Could already include substance use screening and advice Some sites in the USA already used paper/electronic templates with CRAFFT Slide 15 Sample Sizes Baseline 589 (100%) 2096 (87%) 1516 (72%) 516 (91%) 3-Mo. Post 1523 (74%) 532 (90%) 12-Mo. Post USA CZR 589 2409 Invited Slide 16 16 Results: Percent Binge Drinking at 3 Months Follow-up aRRR = 0.68 (95%CI 0.45-1.03; p