Most adolescent morbidity and mortality result from participation in health-risk behaviors,
such as alcohol and other drug use, smoking, sexual activity without use of protection against pregnancy or sexually transmitted diseases, and poor nutrition and physical inactivity.1 These behaviors frequently begin during adolescence and then persist into adulthood. Primary care visits present a key opportunity for improving the health of adolescents through early intervention to reduce risk behaviors. In recognition of this, professional practice guidelines from multiple organizations recommend screening and counseling to reduce risk;3,4 yet, health risk screening is infrequently performed and results are rarely followed by targeted risk reduction interventions.
To address this gap in preventive care, our study team proposes to test personalized feedback as a strategy to impact adolescent risk and improve clinical care. We have developed an electronic Personalized Motivational Feedback tool (ePMF) that uses adolescent health screen responses, treatment guidelines, and national data on health risk behaviors to: 1) provide direct feedback to adolescents aimed at increasing motivation to reduce risk behaviors; 2) summarize youth-reported risk behaviors, goals, and consequences for Primary Care Providers (PCPs) in order to stimulate patient-provider discussions around risk reduction; and 3) provide decision support for PCPs in
determining the next steps in care. Risk behaviors covered include substance and tobacco use, depression, physical inactivity, poor nutrition, pregnancy and sexually transmitted infections, seatbelt and helmet use.
In this proposal, we aim to develop implementation strategies for use of ePMF in primary care settings with adolescents, and to evaluate the efficacy of this tool among a sample of adolescents aged 13-18 drawn from six primary care clinics. We will use an experimental design (randomized, controlled trial) with 300 adolescent patients who are followed with web-based surveys at 4 assessment points over 6 months. Primary outcomes of the study are provision of PCP risk reduction counseling at the healthcare visit, and improved behavioral health (decreased alcohol use, marijuana use, tobacco use, unprotected sexual activity, and depression; increased physical activity, fruit and vegetable consumption, seatbelt and helmet use). Outcomes of this study will contribute to the Healthy People 2020 goals by the following health risk behaviors among adolescents: substance use (SA-4, SA-13-1, SA-13-2, SA-14, TU-2, TU-3, TU-7), unprotected intercourse leading to teen pregnancy and sexually transmitted diseases (FP-8, FP- 10, FP-11), unhealthy eating patterns (NWS-6, NWS-14, NWS-15), low physical activity (PA-3, PA-8), and unrestrained driving (IVP-15). Additionally, this study aims to improve mental health outcomes, specifically for depression (MHMD-4.,1 MHMD-6, MHMD-11). Study outcomes will also contribute to MCHB’s Strategic Research Plan by studying how motivational interventions involving both youth and providers affects the consistency of preventive and risk reduction counseling delivered to adolescents (Strategic Research Issue (SRI) #3), promoting the healthy development of adolescents
through the study of the effectiveness of health promotion and prevention strategies (ePMF) for adolescents (SRI #4), and examining practice-based barriers to implementation of risk reduction counseling in order to develop systems based solutions to increase uptake at the primary care level (SRI #1).
Risk Behaviors, Clinical Practice , Primary Care, Nutrition & Diet, Prevention, Physical Activity, Safety, Substance Use