According to the 2019 Youth Risk Behavior Survey, 29% of high school students drank alcohol during the past 30 days; 14% reported binge drinking, and 17% rode with a driver who had been drinking alcohol. The use of alcohol in young people is associated with many negative outcomes, including increased risk for motor vehicle accidents, unwanted pregnancy, violence, disengagement from school, psychiatric illness, and addiction.
However, the progression of alcohol use is preventable and risk for negative outcomes can be reduced when interventions targeting alcohol use are introduced early. Last month, Randi Schuster, PhD, Director of School-Based Research and Program Development at the Center for Addiction Medicine at Mass General, was awarded a grant from the Patient-Centered Outcomes Research Institute or PCORI to study interventions targeting alcohol use in youth. With this funding, Dr. Schuster and her team will conduct a study exploring school-based interventions for alcohol use.
Many schools have leveraged lessons learned from medical settings and have implemented the Screening, Brief Interventions, and Referral for Treatment (SBIRT) framework within schools as a means of improving early detection and intervention. SBIRT includes administering a validated screening instrument to all students and then, based on responses on the screen, delivering a brief intervention (BI) to increase motivation to reduce alcohol use.
While SBIRT is an important step forward in harnessing the power of schools to promote youth health and well-being, questions on how best to use SBIRT in this setting remain. One concern is that brief interventions are typically only delivered to youth who have already begun drinking at risky levels. The proposed study will assess outcomes in youth with and without risky drinking at baseline.
In addition, most schools rely on nursing and/or clinical staff to deliver brief interventions; however, this workforce is already strained and may not be able to provide care to all who would benefit from intervention. Other studies have demonstrated that expanding traditional SBIRT workforces to include paraprofessionals, such as peers, mentors, and other nonclinical service providers, may help to reduce this burden and to reach a greater number of individuals. Finally, minoritized youth are at greater risk for negative alcohol-
related outcomes, yet there has been little work to date to ensure that brief interventions are as effective in these populations.
The Proposed Study
The research team will collaborate with 40 public high schools across Massachusetts, with an overrepresentation of high-need schools. The study will enroll 1,500 youth participants from grades 9 to 11 who have reported past-year alcohol use on the SBIRT screening survey. In this study, schools will be randomized to one of four conditions which differ in how interventions will be delivered as part of SBIRT:
1. Brief interventions will be delivered to youth with risky drinking by nursing/clinical staff. This is the current standard practice in schools.
2. Brief interventions will be delivered to youth with risky drinking by an expanded SBIRT workforce involving nursing/clinical staff and trained, supervised paraprofessionals.
3. Brief interventions will be delivered to youth with and without risky drinking by nursing/clinical staff.
4. Brief interventions will be delivered to youth with and without risky drinking by an expanded SBIRT workforce involving nursing/clinical staff and trained, supervised paraprofessionals.
Participants will be assessed at the time of the SBIRT screening survey and every three months over a 12-month period and will monitor use of alcohol and other substances, impact of substance use, and depressive symptoms and anxiety.
The research team will also conduct focus group interviews with a subset of minoritized participants, including those who are from racial or ethnic minority populations, LGBTQ+, and/or learning English. Interviews will be conducted at the time of the SBIRT screening survey and after 12 months to identify factors that may contribute to different responses to interventions for alcohol use.
Ultimately the information derived from this study will help school administrators and policy makers to implement SBIRT in a way that is most effective in preventing and reducing alcohol use in youth, scalable given infrastructure limitations, and equitable. These findings will help us to learn about ways to best support youth and to improve access to substance use prevention in schools. These studies will be critical in reducing disparities in the effectiveness of school-based interventions.
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Randi M. Schuster, PhD is the Director of School-Based Research and Program Development and Director of Neuropsychology in the Center for Addiction Medicine at MGH, and an Assistant Professor in Psychology in the Department of Psychiatry at Harvard Medical School. Her research focuses on defining the biological and environmental determinants of adolescent nicotine, cannabis, and alcohol use and the mechanisms underlying development of problem substance use particularly in the context of co-morbid psychopathology. She uses this information to develop and evaluate novel targeted, school-based prevention programs for adolescents at risk for progression to problematic substance use. Dr. Schuster currently oversees one of the largest school-based research consortia in the world, involving nearly 150 schools across the Commonwealth.
