Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
J Stud Alcohol Drugs. 2018 Jul;79(4):611-616. doi: 10.15288/jsad.2018.79.611.
Alcohol- and drug-related car crashes are a leading cause of death for adolescents in the United States. This analysis tested the effects of a computer-facilitated Screening and Brief Advice (cSBA) system for primary care on adolescents' reports of driving after drinking or drug use (driving) and riding with substance-using drivers (riding).
Twelve- to 18-year-old patients (N = 2,096) at nine New England pediatric offices completed assessments only during the initial 18-month treatment-as-usual (TAU) phase. Subsequently, the 18-month cSBA intervention phase began with a 1-hour provider training and implementation of the cSBA system at all sites. cSBA included a notebook-computer with self-administered screener, immediate scoring and feedback, and 10 pages of scientific information and true-life stories illustrating substance-related harms. Providers received screening results, "talking points" for 2 to 3 minutes of counseling, and a Contract for Life handout. Logistic regression with generalized estimating equations generated adjusted relative risk ratios (aRRR) for past-90-day driving and riding risk at 3- and 12-month follow-ups, controlling for significant covariates.
We found no significant effects on driving outcomes. At 3 months, cSBA youth were less likely than TAU to report riding with a drinking driver (aRRR = 0.70, 95% CI [0.49, 1.00]), and less likely to report riding with a driver who had used cannabis or other drugs (aRRR = 0.46, 95% CI [0.29, 0.74]). The effect was even greater (aRRR = 0.34, 95% CI [0.16, 0.71]) for riding with drinking drivers who were adult family members. All effects dissipated by 12-month follow-up.
Screening and pediatrician brief advice shows promise for reducing adolescents' risk of riding with substance-using drivers.
在美国，酒精和药物相关的车祸是青少年死亡的主要原因。本分析测试了计算机辅助筛查和简短咨询（cSBA）系统对初级保健中青少年酒后驾车或药物使用后驾车（驾车）和与使用药物的司机一起乘车（乘车）报告的影响。
9 家新英格兰儿科诊所的 12 至 18 岁患者（N=2096）仅在最初的 18 个月治疗即常规（TAU）阶段完成评估。随后，在所有地点进行了为期 18 个月的 cSBA 干预阶段，包括 1 小时的提供者培训和 cSBA 系统的实施。cSBA 包括一个带有自我管理筛查器的笔记本电脑，即时评分和反馈，以及 10 页的科学信息和真实生活故事，说明与物质相关的危害。提供者收到筛查结果、2 到 3 分钟咨询的“谈话要点”以及一份“生命合同”传单。使用广义估计方程的逻辑回归生成了过去 90 天驾驶和骑行风险的调整相对风险比（aRRR），在 3 个月和 12 个月的随访中进行了控制，以控制重要的协变量。
我们没有发现对驾驶结果有任何显著影响。在 3 个月时，与 TAU 相比，cSBA 青少年报告与饮酒司机一起骑行的可能性较低（aRRR=0.70，95%CI[0.49,1.00]），报告与使用大麻或其他药物的司机一起骑行的可能性较低（aRRR=0.46，95%CI[0.29,0.74]）。对于与饮酒的成年家庭成员一起骑行的司机，效果甚至更大（aRRR=0.34，95%CI[0.16,0.71]）。所有影响在 12 个月的随访中都消失了。
筛查和儿科医生简短建议为降低青少年与使用药物的司机一起乘车的风险提供了希望。
