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.

• MeSH
• Adolescent Behavior psychology   MeSH
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Alcohol Drinking prevention & control   psychology   trends   MeSH
• Counseling methods   trends   MeSH
• Substance-Related Disorders epidemiology   prevention & control   psychology   MeSH
• Primary Health Care methods   trends   MeSH
• Automobile Driving psychology   MeSH
• Driving Under the Influence prevention & control   psychology   trends   MeSH
• Physician's Role psychology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, N.I.H., Extramural MeSH
• Geographicals
• New England epidemiology   MeSH

PURPOSE: A computer-facilitated screening and brief advice (cSBA) intervention was previously shown to reduce drinking among U.S. adolescents but not among Czech youth. The purpose of this study was to assess cSBA effect on heavy episodic drinking (HED). METHODS: Participants were 12- to 18-year-olds at nine U.S. primary care offices (N = 2,096) and 10 Czech pediatrician-generalist offices (N = 589) who completed measurements only during an 18-month treatment-as-usual (TAU) phase. We then initiated the cSBA protocol for all participants and recruited the 18-month cSBA phase. Generalized Estimating Equations logistic regression compared past-90-day HED for cSBA versus TAU at 3- and 12-months, controlling for baseline HED and other covariates. RESULTS: Baseline past-90-day HED rates were 11% for U.S. and 28% for Czech youth. At 3 months, among Czech baseline non-HED, the adjusted relative risk ratio for cSBA versus TAU was .52 (95% confidence interval .29, .92). The effect dissipated by 12 months. CONCLUSIONS: cSBA shows promise for short-term prevention of adolescent HED.

• Keywords
• Adolescents, Heavy episodic drinking, Technology-assisted prevention,
• MeSH
• Diagnosis, Computer-Assisted methods   MeSH
• Humans MeSH
• Adolescent MeSH
• Binge Drinking diagnosis   therapy   MeSH
• Underage Drinking statistics & numerical data   MeSH
• Mass Screening * MeSH
• Substance-Related Disorders diagnosis   MeSH
• Cross-Cultural Comparison * MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, N.I.H., Extramural MeSH
• Research Support, U.S. Gov't, P.H.S. MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• United States MeSH