Advertisement

Perceived Risk of Harm Mediates the Effects of Primary Care Alcohol Use Screening and Brief Advice in Adolescents

      Abstract

      Purpose

      A previous trial found lower alcohol use risk during follow-up among adolescent primary care patients receiving computer-facilitated Screening and provider Brief Advice (cSBA) compared to treatment-as-usual (TAU). We tested whether the effect was mediated by alcohol-related perceived risk of harm (PRoH).

      Methods

      We analyzed data from the cSBA trial on 12- to 18-year-old patients at 9 New England practices (n = 2,096, 58% females). The trial used a quasi-experimental pre–post design with practices being their own controls (TAU followed by cSBA). Because prior alcohol experience could modify effects, we stratified analyses by baseline past 12-month drinking. Among baseline nondrinkers, we tested baseline to 3-month trajectories in PRoH of “trying alcohol” as an effect mediator for drinking at 3- and 12-month follow-up. Similarly, among those with prior drinking, we examined baseline to 3-month trajectories in PRoH of “weekly binge drinking” as an effect mediator for drinking and binge drinking. We used the Hayes product of coefficients mediation approach.

      Results

      Among baseline nondrinkers (n = 1,449), cSBA had higher PRoH compared to TAU for “trying alcohol,” and higher PRoH in turn was associated with lower follow-up drinking risk. PRoH mediated their cSBA effect at 12 months, but not 3 months. Among adolescents with prior drinking (n = 647), cSBA had higher PRoH for “weekly binge drinking,” which was associated with lower drinking risk at both follow-ups, and lower binge drinking risk at 3 months. PRoH mediated their cSBA effect on drinking at both follow-ups, and binge drinking at 3 months.

      Conclusion

      A computer-facilitated primary care intervention enhanced adolescents’ perceived alcohol risks which in turn was associated with lower drinking risk.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Underage drinking | CDC.
        (Available at:)
        • National Institute of Alcohol Abuse and Alcoholism
        Underage Drinking | National Institute on Alcohol Abuse and Alcoholism (NIAAA).
        (Available at:)
        • National Institute on Alcohol Abuse and Alcoholism
        Alcohol Screening and Brief Intervention for Youth: Practitioner’s Guide.
        National Institutes of Health, Department of Health and Human Services, Washington, D.C.2011
        • Donovan J.E.
        Estimated blood alcohol concentrations for child and adolescent drinking and their implications for screening instruments.
        Pediatrics. 2009; 123: e975-e981
        • Hingson R.W.
        • Heeren T.
        • Winter M.R.
        • et al.
        Age at drinking onset and alcohol dependence.
        Arch Pediatr Adolesc Med. 2006; 160: 739-746
        • Substance Abuse and Mental Health Services Administration
        Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.
        (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55), Washington, D.C.2020
        • Adams S.H.
        • Park M.J.
        • Irwin C.E.
        • et al.
        Adolescent and young adult preventive care: comparing national survey rates.
        Am J Prev Med. 2015; 49: 238-247
        • Adams S.H.
        • Park M.J.
        • Twietmeyer L.
        • et al.
        Association between adolescent preventive care and the role of the affordable care act.
        JAMA Pediatr. 2018; 172: 43
        • Harris S.K.
        • Woods E.R.
        • Sherritt L.
        • et al.
        A youth-provider connectedness measure for use in clinical intervention studies.
        J Adolesc Heal. 2009; 44: S35-S36
        • D’Amico E.J.
        • Parast L.
        • Shadel W.G.
        • et al.
        Brief motivational interviewing intervention to reduce alcohol and marijuana use for at-risk adolescents in primary care.
        J Consult Clin Psychol. 2018; 86: 775-786
        • Tanner-Smith E.E.
        • Lipsey M.W.
        Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis.
        J Subst Abuse Treat. 2015; 51: 1-18
        • Harris S.K.
        • Csémy L.
        • Sherritt L.
        • et al.
        Computer-facilitated substance use screening and brief advice for teens in primary care: an international trial.
        Pediatrics. 2012; 129: 1072-1082
        • Rosenstock I.M.
        • Strecher V.J.
        • Becker M.H.
        Social learning theory and the health belief model.
        Heal Educ Behav. 1988; 15: 175-183
        • Jones C.J.
        • Smith H.
        • Llewellyn C.
        Evaluating the effectiveness of health belief model interventions in improving adherence: a systematic review.
        Health Psychol Rev. 2014; 8: 253-269
      2. Substance Abuse and Mental Health Services Administration C for BHS and Q.
        The NSDUH Report: Trends in Adolescent Substance Use and Perception of Risk from Substance Use, Rockville, MD2013
        • Giovacchini C.X.
        • Pacek L.
        • McClernon F.J.
        • et al.
        Use and perceived risk of electronic cigarettes among north carolina middle and high school students.
        N C Med J. 2017; 78: 7-13
        • Carter P.M.
        • Bingham C.R.
        • Zakrajsek J.S.
        • et al.
        Social norms and risk perception: predictors of distracted driving behavior among novice adolescent drivers hhs public access.
        J Adolesc Heal. 2014; 54: 32-41
        • Louis-Jacques J.
        • Knight J.R.
        • Sherritt L.
        • et al.
        Do risky friends change the efficacy of a primary care brief intervention for adolescent alcohol use?.
        J Adolesc Health. 2014; 54: 449-453
        • Harris S.K.
        • Johnson J.K.
        • Sherritt L.
        • et al.
        Putting adolescents at risk: riding with drinking drivers who are adults in the home.
        J Stud Alcohol Drugs. 2017; 78: 146-151
        • Knight J.R.
        • Kuzubova K.
        • Csemy L.
        • et al.
        Computer-facilitated screening and brief advice to reduce adolescents’ heavy episodic drinking: a study in two countries.
        J Adolesc Heal. 2018; 62: 118-120
        • Winters K.C.
        • Henley G.A.
        Personal Experience Inventory (PEI) Test and Manual.
        Western Psychological Services, Los Angeles, CA1989
        • Sobell L.C.
        • Sobell M.B.
        Timeline Follow-Back.
        in: Litten R.Z. Allen J.P. Measuring Alcohol Consumption. Humana Press, Totowa, NJ1992: 41-72
        • Bachman J.G.
        • Johnston L.D.
        • O’Malley P.M.
        The Monitoring the Future Project After 27 Years: Design and Procedures.
        Institute for Social Research, Ann Arbor, MI2001
      3. PROCESS macro. The PROCESS macro for SPSS, SAS, and R-PROCESS macro for SPSS and SAS.
        (Available at:)
        https://processmacro.org/index.html
        Date accessed: January 12, 2021
        • Cable N.
        • Roman M.M.F.
        • Kelly Y.
        What could keep young people away from alcohol and cigarettes? findings from the UK household longitudinal study.
        BMC Public Health. 2017; 17: 371
        • Kelly Y.
        • Goisis A.
        • Sacker A.
        • et al.
        What influences 11-year-olds to drink? Findings from the Millennium Cohort Study..
        BMC Public Health. 2016; 16: 169
        • Grevenstein D.
        • Nagy E.
        • Kroeninger-Jungaberle H.
        Development of risk perception and substance use of tobacco, alcohol and cannabis among adolescents and emerging adults: evidence of directional influences.
        Subst Use Misuse. 2015; 50: 376-386
        • Prince M.A.
        • Swaim R.C.
        • Stanley L.R.
        • et al.
        Perceived harm as a mediator of the relationship between social norms and marijuana use and related consequences among American Indian youth.
        Drug Alcohol Depend. 2017; 181: 102-107
        • Hanauer M.
        • Walker M.R.
        • Machledt K.
        • et al.
        Association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking in young adults.
        J Am Coll Heal. 2021; 69: 345-352
        • Johnston L.D.
        • Miech R.A.
        • O’malley P.M.
        • et al.
        Monitoring the Future: National Survey Results on Drug Use 1975-2019. 2019 Overview; Key Findings on Adolescent Drug Use. National Institute on Drug Abuse, Ann Arbor, MI2020
        • Volcarelli L.B.
        • Bagley S.M.
        • Hadland S.
        • et al.
        Healthcare providers’ role in adolescents’ perceived risk of alcohol use.
        Assoc. Med. Educ. Res. Subst. Abus., Washington, D.C.2017
        • Naar-King S.
        • Suarez M.
        Motivational Interviewing with Adolescents and Young Adults. Guilford Press, New York, NY2011