Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers

• Published in: Drug and alcohol dependence Vol. 218; p. 108423
• Main Authors: Gryczynski, Jan, Mitchell, Shannon Gwin, Schwartz, Robert P., Dusek, Kristi, O’Grady, Kevin E., Cowell, Alexander J., Barbosa, Carolina, Barnosky, Alan, DiClemente, Carlo C.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-01-2021; Elsevier Science Ltd
• Subjects: Adolescent; Adolescent sexuality; Adolescents; Alcohol; Alcohol Drinking - prevention & control; Alcohol Drinking - therapy; Alcohol use; Alcohol-Related Disorders; Alcoholic beverages; Alcohols; Binge drinking; Brief intervention; Brief interventions; Cannabis; Child & adolescent psychiatry; Computers; Cost analysis; Crisis Intervention; Drinking behavior; Evaluation; Female; Health behavior; Health care facilities; Health facilities; Health Risk Behaviors; Health risks; Health status; Humans; Male; Marijuana; Marijuana Smoking - therapy; Marijuana Use; Mass Screening; Medical screening; Nurse Practitioners; Quality of life; Quasi-experimental methods; Risk assessment; Risk behavior; Risk taking; Safe sexual practices; School Health Services; School-based health centers; Schools; Sex; Sexual Behavior; Sexual health; Substance abuse; Substance use; Substance-Related Disorders; Teenagers; Marijuana; Alcohol; Brief intervention; Sexual health; School-based health centers
• ISSN: 0376-8716; 1879-0046; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.108423

•Adolescent SBHC patients had similar risk behavior outcomes for CBI vs. NBI.•Adolescents reported higher satisfaction with NBI, but CBI had lower costs.•CBI and NBI had superior outcomes compared to an historical assessment-only cohort.
This study examined approaches to delivering brief interventions (BI) for risky substance use and sexual behaviors in school-based health centers (SBHCs).
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.
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).
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.