Computerized Alcohol Screening for Children and Adolescents (cASCA) in Primary Care

The primary goal of this project is to develop a computerized screening program for primary
care offices that is based on the NIAAA's new Alcohol Screening Guide for Children and
Adolescents and assess its psychometric properties among nine- to 18-yr-old primary care
patients. There is substantial evidence supporting the effectiveness of screening and brief
intervention among adult primary care patients, primarily in the reduction of harmful
drinking. However, there have been few studies of alcohol screening and brief intervention
conducted among adolescents seen in busy primary care settings. This project will develop and
validate a new computerized Alcohol Screening for Children and Adolescents (cASCA) program
which incorporates the age-specific screening questions of the NIAAA Guide and includes the
CRAFFT and AUDIT as secondary risk/problem assessments. We will add tobacco screening because
tobacco use is the leading cause of cancer-related mortality in the US as well as screening
for marijuana and other drug use so as to create a comprehensive screening instrument that
includes all major substances that adolescents use.

Additionally, the NIAAA guide recommends that providers deliver a brief intervention in
response to the screening results. Therefore, a secondary aim of this project will be to
pilot-test a computer-facilitated Brief Intervention component using a randomized design
comparing three groups: 1) screening with treatment as usual [cASCA/TAU]; 2) screening with
the computer-facilitated brief intervention [cASCA/BI]. The BI component consists of patients
viewing on the computer, immediately after the screening, their score and level of risk for a
substance use problem, as well as several interactive pages of science and true-life stories
about the health risks of substance use. Clinicians are then given the screen results and
suggested talking points for a few minutes of brief counseling during the visit.

Hypothesis: Among 9- to 18-year-old primary care patients, those receiving cASCA/BI will have
lower rates of any alcohol use, days of alcohol use, drinks per drinking day, and days of
heavy episodic drinking, at 3, 6, 9 and 12-months follow-up than those receiving treatment as
usual.

Inclusion Criteria:

- access to computer and email address

- available and willing to complete all follow ups by email or phone

- medically and emotionally stable

- can read and understand English

Exclusion Criteria:

- Patient has already participated in this study