Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Psychology, Lakehead University, and Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
J Pediatr. 2018 Jun;197:221-232.e2. doi: 10.1016/j.jpeds.2018.02.002. Epub 2018 Apr 12.
To systematically describe when and how brief alcohol interventions delivered to adolescents in primary care settings reduce alcohol use and alcohol-related consequences among adolescents, using realist review methodology.
Eleven electronic databases, gray literature, and reference screening were searched up to June 2016; 11 brief interventions published in 13 studies met inclusion criteria. Intervention design components (delivery context and intervention mechanisms) underlying brief alcohol interventions for adolescents were extracted and linked to alcohol use and related consequences.
Brief interventions had either an indicated context of delivery (provided to adolescent patients with low-to-moderate risk for alcohol problems) or universal context of delivery (provided to general adolescent patient population). Interventions that used motivational interviewing in an indicated delivery context had 2 potential mechanisms-eliciting and strengthening motivation to change and providing direction through interpretation. These interventions resulted in clinically significant reductions in alcohol use and associated consequences. Peer risk also was identified among universal and indicated brief interventions as a potential mechanism for changing alcohol-related outcomes among adolescents who received the intervention. None of the studies tested the processes by which interventions were expected to work.
The current evidence base suggests that both indicated and universal delivery of brief alcohol interventions to adolescents in primary care settings can result in clinically important changes in alcohol-related outcomes. Studies that test brief intervention processes are now necessary to better understand how brief interventions work with adolescents in primary care settings.
采用现实主义综述方法，系统描述在初级保健环境中对青少年实施简短酒精干预的时间和方式，以减少青少年的饮酒行为和与酒精相关的后果。
截至 2016 年 6 月，共检索了 11 个电子数据库、灰色文献和参考文献筛选；13 项研究中发表的 11 项简短干预措施符合纳入标准。提取青少年简短酒精干预措施的干预设计组成部分（传递背景和干预机制），并将其与饮酒和相关后果联系起来。
简短干预措施具有明确的传递背景（提供给有低至中度酒精问题风险的青少年患者）或普遍的传递背景（提供给一般青少年患者群体）。在明确的传递背景下使用动机性访谈的干预措施有 2 种潜在机制——激发和加强改变的动机，并通过解释提供方向。这些干预措施导致饮酒量和相关后果的临床显著减少。同伴风险也被确定为普遍和明确的简短干预措施的潜在机制，以改变接受干预的青少年的酒精相关结果。没有一项研究测试过干预措施预期发挥作用的过程。
目前的证据基础表明，在初级保健环境中对青少年实施明确和普遍的简短酒精干预措施，可以导致与酒精相关的结果发生临床重要变化。现在有必要测试简短干预措施的过程，以更好地了解简短干预措施如何在初级保健环境中对青少年发挥作用。
