OBJECTIVE: 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). METHOD: 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. RESULTS: 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. CONCLUSIONS: Screening and pediatrician brief advice shows promise for reducing adolescents' risk of riding with substance-using drivers.

Center for Evidence Synthesis in Health School of Public Health Brown University Providence Rhode Island

Centre for Evaluation Prevention and Research of Substance Abuse Prague Czech Republic

Colchester Family Practice Road Colchester Vermont

Department of Medicine Boston Children's Hospital Boston Massachusetts

Department of Pediatrics Cambridge Health Alliance Cambridge Massachusetts

Department of Pediatrics Harvard Medical School Boston Massachusetts

Department of Pediatrics Reliant Medical Group Worcester Massachusetts

Department of Pediatrics Tufts Medical Center Floating Hospital for Children Boston Massachusetts

Division of Adolescent Young Adult Medicine Boston Children's Hospital Boston Massachusetts

Milton Family Practice Milton Vermont

National Institute of Mental Health Topolová 748 250 67 Klecany Czech Republic

Teen Health Center Cambridge Rindge and Latin High School Cambridge Massachusetts

Teen Health Center Somerville High School Somerville Massachusetts

The Faculty of Humanities Charles University U Kříže 8158 00 Prague 5 Jinonice Czech Republic

Vermont Child Health Improvement Project University of Vermont College of Medicine Burlington Vermont

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