Purpose

A previous trial found lower alcohol use risk during follow-up among adolescent primary care patients receiving computer-facilitated Screening and provider Brief Advice (cSBA) compared to treatment-as-usual (TAU). We tested whether the effect was mediated by alcohol-related perceived risk of harm (PRoH).

Methods

We analyzed data from the cSBA trial on 12- to 18-year-old patients at 9 New England practices (n = 2,096, 58% females). The trial used a quasi-experimental pre–post design with practices being their own controls (TAU followed by cSBA). Because prior alcohol experience could modify effects, we stratified analyses by baseline past 12-month drinking. Among baseline nondrinkers, we tested baseline to 3-month trajectories in PRoH of “trying alcohol” as an effect mediator for drinking at 3- and 12-month follow-up. Similarly, among those with prior drinking, we examined baseline to 3-month trajectories in PRoH of “weekly binge drinking” as an effect mediator for drinking and binge drinking. We used the Hayes product of coefficients mediation approach.

Results

Among baseline nondrinkers (n = 1,449), cSBA had higher PRoH compared to TAU for “trying alcohol,” and higher PRoH in turn was associated with lower follow-up drinking risk. PRoH mediated their cSBA effect at 12 months, but not 3 months. Among adolescents with prior drinking (n = 647), cSBA had higher PRoH for “weekly binge drinking,” which was associated with lower drinking risk at both follow-ups, and lower binge drinking risk at 3 months. PRoH mediated their cSBA effect on drinking at both follow-ups, and binge drinking at 3 months.

Conclusion

A computer-facilitated primary care intervention enhanced adolescents’ perceived alcohol risks which in turn was associated with lower drinking risk.

中文翻译：

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感知伤害风险介导青少年初级保健酒精使用筛查和简短建议的影响

目的

之前的一项试验发现，与常规治疗 (TAU) 相比，接受计算机辅助筛查和提供者简要建议 (cSBA) 的青少年初级保健患者在随访期间饮酒的风险较低。我们测试了这种影响是否是由酒精相关的感知伤害风险 (PRoH) 介导的。

方法

我们分析了 cSBA 试验的数据，这些患者来自 9 家新英格兰诊所（n = 2,096，58% 为女性）的 12 至 18 岁患者。该试验使用了准实验性前后设计，实践是他们自己的控制（TAU 之后是 cSBA）。因为之前的饮酒经历可能会改变影响，所以我们根据过去 12 个月饮酒的基线进行分层分析。在基线非饮酒者中，我们在 3 个月和 12 个月的随访中测试了 PRoH 中基线到 3 个月的轨迹，将“尝试饮酒”作为饮酒的影响中介。同样，在那些有饮酒史的人中，我们检查了 PRoH 中“每周酗酒”的基线到 3 个月的轨迹，作为饮酒和酗酒的影响中介。我们使用了 Hayes 乘积系数调解方法。

结果

在基线非饮酒者 (n = 1,449) 中，与 TAU 相比，cSBA 在“试酒”方面的 PRoH 更高，而更高的 PRoH 又与更低的后续饮酒风险相关。PRoH 在 12 个月而不是 3 个月时介导了它们的 cSBA 效应。在有饮酒史的青少年中 (n = 647)，cSBA 在“每周酗酒”方面具有较高的 PRoH，这与两次随访时较低的饮酒风险以及 3 个月时较低的酗酒风险相关。PRoH 介导了他们的 cSBA 对两次随访饮酒和 3 个月时酗酒的影响。

结论

计算机辅助的初级保健干预增强了青少年对酒精风险的认知，而这反过来又与较低的饮酒风险相关。