title: Computer-facilitated substance use screening and brief advice for teens in primary care: an international trial.
abstract: OBJECTIVE
  Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system.
  
  
  METHODS
  We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and "talking points" designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up.
  
  
  RESULTS
  Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38-0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57-0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17-0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32-0.71).
  
  
  CONCLUSIONS
  Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA. sion.harris@childrens.harvard.edu
authors.forename: Sion Kim
authors.initials: SK
authors.lastname: Harris
authors.forename: Ladislav
authors.initials: L
authors.lastname: Csémy
authors.forename: Lon
authors.initials: L
authors.lastname: Sherritt
authors.forename: Olga
authors.initials: O
authors.lastname: Starostova
authors.forename: Shari
authors.initials: S
authors.lastname: Van Hook
authors.forename: Julie
authors.initials: J
authors.lastname: Johnson
authors.forename: Suzanne
authors.initials: S
authors.lastname: Boulter
authors.forename: Traci
authors.initials: T
authors.lastname: Brooks
authors.forename: Peggy
authors.initials: P
authors.lastname: Carey
authors.forename: Robert
authors.initials: R
authors.lastname: Kossack
authors.forename: John W
authors.initials: JW
authors.lastname: Kulig
authors.forename: Nancy
authors.initials: N
authors.lastname: Van Vranken
authors.forename: John R
authors.initials: JR
authors.lastname: Knight
mesh_terms: D000293:Adolescent; D002648:Child; D018153:Czech Republic / Q000453:epidemiology; D003936:Diagnosis, Computer-Assisted / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D009511:New England / Q000453:epidemiology; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D057566:Self Report / Q000592:standards; D015813:Substance Abuse Detection / Q000379:methods / Q000592:standards*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*