计算机辅助 vs. 护士从业者提供的青少年在学校健康中心中涉及大麻、酒精和性行为风险行为的简短干预。
Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers.
机构信息
Friends Research Institute, 1040 Park Ave., Ste 103, Baltimore, MD 21201, United States.
Friends Research Institute, 1040 Park Ave., Ste 103, Baltimore, MD 21201, United States.
出版信息
Drug Alcohol Depend. 2021 Jan 1;218:108423. doi: 10.1016/j.drugalcdep.2020.108423. Epub 2020 Nov 23.
BACKGROUND
This study examined approaches to delivering brief interventions (BI) for risky substance use and sexual behaviors in school-based health centers (SBHCs).
METHODS
300 Adolescents (ages 14-18; 54 % female) with risky marijuana and/or alcohol use identified via CRAFFT screening (scores >1) were recruited from two SBHCs and randomized to computer-delivered BI (CBI) or nurse practitioner-delivered BI (NBI). Both BIs included motivational and didactic content targeting marijuana, alcohol, and risky sexual behaviors. Assessments at baseline, 3-month, and 6-month follow-up included past 30-day frequency of marijuana use, alcohol use, binge drinking, unprotected sex, and sex while intoxicated; marijuana and alcohol problems; and health-related quality-of-life (HRQoL). A focused cost-effectiveness analysis was conducted. An historical 'assessment-only' cohort (N=50) formed a supplementary quasi-experimental comparison group.
RESULTS
There were no significant differences between NBI and CBI on any outcomes considered (e.g., days of marijuana use; p=.26). From a cost-effectiveness perspective, CBI was 'dominant' for HRQoL and marijuana use. Participants' satisfaction with BI was significantly higher for NBI than CBI. Compared to the assessment-only cohort, participants who received a BI had lower frequency of marijuana (3-months: Incidence Rate Ratio [IRR] = .74 [.57, .97], p=.03), alcohol (3-months: IRR = .43 [.29, .64], p<.001; 6-months: IRR = .58 [.34, .98], p = .04), alcohol-specific problems (3-months: IRR = .63 [.45, .89], p=.008; 6-months: IRR = .63 [.41, .97], p = .04), and sex while intoxicated (6-months: IRR = .42 [.21, .83], p = .013).
CONCLUSIONS
CBI and NBI did not yield different risk behavior outcomes in this randomized trial. Supplementary quasi-experimental comparisons suggested potential superiority over assessment-only. Both NBI and CBI could be useful in SBHCs.
背景
本研究旨在探讨在学校健康中心（SBHC）中提供简短干预（BI）以减少危险物质使用和性行为风险的方法。
方法
通过 CRAFFT 筛查（得分>1）从两所 SBHC 招募了 300 名年龄在 14-18 岁之间的青少年（54%为女性），他们存在危险的大麻和/或酒精使用情况，将其随机分配到计算机提供的 BI（CBI）或护士从业者提供的 BI（NBI）。两种 BI 均包括针对大麻、酒精和危险性行为的动机和教学内容。在基线、3 个月和 6 个月的随访中，评估了过去 30 天的大麻使用频率、酒精使用频率、狂饮、无保护性行为和醉酒性行为；大麻和酒精问题；以及健康相关生活质量（HRQoL）。进行了一项重点成本效益分析。一个历史上的“仅评估”队列（N=50）构成了补充的准实验比较组。
结果
在任何考虑的结果方面，NBI 和 CBI 之间均无显著差异（例如，大麻使用天数；p=.26）。从成本效益的角度来看，CBI 在 HRQoL 和大麻使用方面具有“优势”。与仅评估队列相比，参与者对 NBI 的 BI 满意度明显更高。与仅评估队列相比，接受 BI 的参与者的大麻使用频率较低（3 个月：发病率比[IRR] =.74 [.57，.97]，p=.03），酒精（3 个月：IRR =.43 [.29，.64]，p<.001；6 个月：IRR =.58 [.34，.98]，p =.04），酒精特异性问题（3 个月：IRR =.63 [.45，.89]，p =.008；6 个月：IRR =.63 [.41，.97]，p =.04），以及醉酒性行为（6 个月：IRR =.42 [.21，.83]，p =.013）。
结论
在这项随机试验中，CBI 和 NBI 并未在风险行为结果上产生差异。补充的准实验比较表明，与仅评估相比，BI 可能具有潜在优势。NBI 和 CBI 都可以在 SBHC 中使用。
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