Brief Youth Substance Use Intervention for Primary Care

Over the past decade, many new programs intended to motivate adolescents to decrease
substance use have been developed and evaluated. There has been a recent shift towards
brief interventions for youth in school (Brown, 2001; D'Amico and Fromme, 2002) and health
care settings, such as emergency rooms and inpatient clinics (Barnett et al., 2001; Colby et
al., 1998; Monti et al., 1999). Many youth who use drugs and alcohol are at risk for
consequences (Johnston et al., 2003). The primary care setting presents a unique
opportunity to intervene with substance abusing adolescents as 70% of youth age 10-18 visit
a physician approximately 3 times a year (Gans and Newacheck, 1991; Monheit and Cunningham,
1992). However, many youth are not screened for use in this setting (Friedman et al., 1990;
Johnson and Millstein, 2003; Middleman et al., 1995) and preventive services are
significantly below recommended levels (Halpern-Felsher et al., 2000; Klein et al., 2001;
Ozer et al., 2001). This may be due to clinician time constraints and insufficient training
on substance abuse, adolescent fear that parents may see the record, and clinician
discomfort in asking questions about substance use (Blum, 1987; Blum et al., 1996; Lustig et
al., 2001; Marcell et al., 2002; Middleman et al., 1995).

The present proposal is designed to meet the objectives of the Exploratory/Developmental
Grants program (R21) for studies that will contribute to the development of future, more
intensive and larger research programs. The objectives of the proposed research are to: 1)
explore the feasibility of adapting a brief intervention from our previous work in schools
and emergency rooms for use in the primary care setting, and 2) assess the short-term
efficacy of the intervention in the primary care setting. This project serves as our first
step in an innovative line of research designed to examine the viability of utilizing brief
interventions targeting adolescent drug use in primary care settings. Our objectives will
be accomplished through the following aims:

1. Explore the feasibility of adapting a brief intervention for high-risk youth in a
primary care (PC) setting. We will determine barriers and facilitative factors
associated with implementing a brief intervention in a PC setting through focus groups
with high-risk youth (n=16), parents (n=8), and clinicians (n=8). Intervention content
will be established through modifications of our previous brief intervention work in
school and hospital settings and from focus group feedback from adolescents,
clinicians, and parents. We anticipate the intervention will take 15 minutes and will
be implemented by a clinician (e.g., nurse) in the PC setting. The intervention will
emphasize motivational techniques and will address a variety of substances, including
marijuana, inhalants, alcohol, and cigarettes. We will pilot test the intervention
with a small sample of high-risk youth (n=10) to obtain feedback to discern whether the
intervention was difficult to implement (e.g., time constraints, comfort level) and how
youth felt about receiving feedback from their clinicians on their substance use (e.g.,
was it helpful? What other topics would they have liked to discuss?). We will modify
content based on this feedback.

2. Implement and assess short-term efficacy of a brief intervention for high-risk youth in
a PC setting. We will implement the intervention in the PC setting with a small sample
of high-risk youth (n=30) and assess its potential impact on short-term outcomes (e.g.,
perceived prevalence of peer use, self-change efforts) at a 3-month follow up. These
youth will be compared to an assessment only control group (n=30).

This research will culminate with the development of a longer-term plan for implementing and
evaluating the intervention more intensively with a larger sample. Products will include:
1) intervention materials adapted for use with high-risk youth in primary care settings, 2)
pilot data on intervention feasibility and implementation, and 3) an R01 application to
examine the generalizability and long-term impact of the intervention.