title: Provider, patient, and family perspectives of adolescent alcohol use and treatment in rural settings.
abstract: OBJECTIVE
  We examined rural primary care providers' (PCPs) self-reported practices of screening, brief interventions, and referral to treatment (SBIRT) on adolescent alcohol use and examined PCPs', adolescents', and parents' attitudes regarding SBIRT on adolescent alcohol use in rural clinic settings.
  
  
  METHODS
  In 2007, we mailed surveys that inquired about alcohol-related knowledge, attitudes, and treatment practices of adolescent alcohol use to all PCPs in 8 counties in rural Pennsylvania who may have treated adolescents. We then conducted 7 focus groups of PCPs and their staffs (n = 3), adolescents (n = 2), and parents (n = 2) and analyzed the narratives using structured grounded theory, evaluating for consistent or discordant themes.
  
  
  RESULTS
  Twenty-seven PCPs from 7 counties returned the survey. While 92% of PCPs felt that routine screening for alcohol use should begin by age 14, 84% reportedly screened for alcohol use occasionally, and reportedly 32% screened all adolescent patients. The provider focus groups (n = 20 PCPs/staff) related that SBIRT for alcohol use for adolescents was not currently effective. Poor provider training, lack of alcohol screening tools, and lack of referral treatment options were identified barriers. Adolescents (n = 12) worried that physicians would not maintain confidentiality. Parents (n = 12) acknowledged a parental contribution to adolescent alcohol use. All groups indicated computer-based methods to screen for alcohol use among adolescents may facilitate PCP engagement.
  
  
  CONCLUSIONS
  Despite awareness that rural adolescent alcohol use is a significant problem, PCPs, adolescents, and parents recognize that SBIRT for adolescent alcohol use in rural PCP settings is ineffective, but it may improve with computer-based screening and intervention techniques.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. adam.gordon@va.gov
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.forename: Lorraine
authors.initials: L
authors.lastname: Ettaro
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: John
authors.initials: J
authors.lastname: Mocik
authors.forename: Duncan B
authors.initials: DB
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000175:diagnosis* / Q000628:therapy*; D003219:Confidentiality; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D010465:Perception; D012424:Rural Population