A computer-facilitated screening and practitioner-delivered brief intervention (CSBI) may be an effective tool for capturing and preventing substance use in youths, according to the results from a pilot study published in JAMA Network Open.
Investigators conducted an intent-to-treat randomized clinical trial of CSBI compared with usual care among youths (aged 12-18 years) at 5 pediatric primary care offices in the United States. Alcohol use, cannabis use, and heavy drinking were captured at baseline and at 3-, 6-, 9-, and 12-month follow-ups via Timeline Followback, a series of self-administered computer-based surveys. After baseline survey completion, patients were randomly assigned to receive either CSBI (n=628) or usual care (n=243) from their practitioner. During their pediatric visit, patients in the CSBI group completed a tablet-based screening questionnaire, after which they received a risk score and 10 interactive pages of information on the risks for substance use.
Practitioners were then able to access patient scores and initiate a conversation based on CSBI results. Patients in the usual care group completed a self-administered computer screening, but received no other CSBI components. Cox proportional hazard models were used to assess the effect of each intervention mode on time to first postvisit substance use, as ascertained with Timeline Followback. In addition, patients completed postbaseline visit reports, in which they were asked if they had received counseling about avoiding substance use and whether the counseling was effective.
Out of 871 participants, 869 youths completed the baseline assessment, in which they reported alcohol or cannabis use in the last 12 months (mean [SD] age, 16.4 [1.3] years; 114 [54.1%] girls; 105 [49.8%] non-Hispanic white). Of these 211 participants, 148 (70.1%) were assigned to the CSBI and 63 (29.9%) received usual care. In youths in the CSBI group, 105 (70.9%) reported receiving counseling about alcohol, 122 (82.4%) reported receiving counseling about cannabis, and 129 (87.2%) reported receiving counseling about not riding with an impaired driver. These positivist survey results suggest that CSBI was effectively received by the majority of participants. Compared with usual care, the CSBI condition was associated with longer time to first postvisit alcohol use (adjusted HR [aHR], 0.69; 95% CI, 0.47-1.02), heavy episodic drinking (aHR, 0.66; 95% CI, 0.40-1.10), and cannabis use (aHR, 0.62; 95% CI, 0.41-0.94). In youths who did not report past substance use in the baseline survey, time to first alcohol and cannabis use was nominally longer in the CSBI group compared with usual care.
The investigators noted that results may have been affected by having the same trained practitioners deliver both the CSBI and usual care interventions. They also relied on self-reported data that were unverified by parents or guardians.
These data suggest that the CSBI system was a feasible screening strategy for youth in pediatric primary care. CSBI also showed promising results in reducing substance use during the 12-month follow-up period. Further long-term research is necessary to assess the real-world validity and cost-effectiveness of CSBI.
Knight JR, Sherritt L, Gibson EB, et al. Effect of computer-based substance use screening and brief behavioral counseling vs usual care for youths in pediatric primary care: a pilot randomized clinical trial. JAMA Netw Open. 2019;2(6):e196258.