Screening and Brief Advice to Reduce Adolescents’ Risk of Riding With Substance-Using Drivers

Abstract

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