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Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers
Gryczynski, J., Mitchell, S. G., Schwartz, R. P., Dusek, K., O'Grady, K. E., Cowell, A. J., Barbosa, C., Barnosky, A., & DiClemente, C. C. (2021). Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers. Drug and Alcohol Dependence, 218, Article 108423. https://doi.org/10.1016/j.drugalcdep.2020.108423
Background: This study examined approaches to delivering brief interventions (BI) for risky substance use and sexual behaviors in school-based health centers (SBHCs).Methods: 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 30day 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.Results: 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).Conclusions: 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.
