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

The purpose of this study is to assess the psychometric properties of a brief screening questionnaire for alcohol problems among 9- to 18-year-old patients in pediatricians' offices, and to pilot test a personalized, computer-facilitated brief intervention delivered on a tablet computer and by the provider based on screening results.

Study Overview

• Status: Completed
• Conditions: Prevention Harmful Effects
• Intervention / Treatment: Behavioral: computer-facilitated brief intervention

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 871
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02111
      • Tufts Medical Center
    • Boston, Massachusetts, United States, 02115
      • Longwood Pediatrics
    • Boston, Massachusetts, United States, 02115
      • Boston Childrens Primary Care Center
    • East Boston, Massachusetts, United States, 02128
      • East Boston Neighborhood Health Center
    • Lexington, Massachusetts, United States, 02421
      • Lexington Pediatrics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 9 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: screening w/ computer brief intervention; screening with computer-facilitated brief intervention	Behavioral: computer-facilitated brief intervention; Immediate feedback to patient of screening results and risk for substance use problem, followed by 11 pages of science and true-life stories about health risks of adolescent substance use. Screening results then go to provider who reviews them with patient and gives brief counseling, and refers to an online motivational enhancement therapy intervention for patients at moderate/high risk for substance use problems.
No Intervention: Screening with Treatment as Usual

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First Post-visit Drinking Day	Median (and interquartile range) for times to first use for the cSBI and Treatment As Usual (TAU) groups	12-months follow-up
Time to First Post-visit Heavy Episodic Drinking Day	The number of days post-visit to first reported heavy episodic drinking day	12-months follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First Post-visit Cannabis Use Day	The number of days post-visit to first reported cannabis use day.	12-months follow-up
Past-3-month Riding Risk	Self-reported riding in the past 3 months with a driver who had been drinking or using other drugs, stratified by reported riding risk in the past 3 months at baseline	12 months follow-up

Collaborators and Investigators

• Sponsor: Boston Children's Hospital
• Collaborators: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
• Investigators: Principal Investigator: John R Knight, MD, Boston Children's Hospital

Publications and helpful links

General Publications

• Harris SK, Csemy L, Sherritt L, Starostova O, Van Hook S, Johnson J, Boulter S, Brooks T, Carey P, Kossack R, Kulig JW, Van Vranken N, Knight JR. Computer-facilitated substance use screening and brief advice for teens in primary care: an international trial. Pediatrics. 2012 Jun;129(6):1072-82. doi: 10.1542/peds.2011-1624. Epub 2012 May 7.

Helpful Links

• Center for Adolescent Substance Abuse Research

Study record dates

Study Major Dates

• Study Start: January 1, 2015
• Primary Completion (Actual): May 31, 2018
• Study Completion (Actual): May 31, 2018

Study Registration Dates

• First Submitted: August 19, 2014
• First Submitted That Met QC Criteria: September 4, 2014
• First Posted (Estimate): September 9, 2014

Study Record Updates

• Last Update Posted (Actual): March 11, 2021
• Last Update Submitted That Met QC Criteria: February 18, 2021
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Keywords: Prevention; Alcohol; Substance Abuse; Youth; Drugs
• Other Study ID Numbers: P00004862; 1R01AA021904-01 (U.S. NIH Grant/Contract)