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Primary Care Behavioral Interventions to Prevent or Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents

A Systematic Evidence Review for the U.S. Preventive Services Task Force

Evidence Syntheses, No. 106

Investigators: Carrie D Patnode, PhD, MPH, Elizabeth O'Connor, PhD, Maya Rowland, MPH, Brittany U Burda, MPH, Leslie A Perdue, MPH, and Evelyn P Whitlock, MD, MPH.

Kaiser Permanente Research Affiliates Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Mar.
Report No.: 13-05177-EF-1
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Structured Abstract

Background:

Drug use in youth is associated with multiple negative health and social consequences. Even infrequent use increases one's risk of serious adverse events due to an increase in risk-taking behaviors while intoxicated or impaired. Primary care could play a role in helping to prevent and reduce drug use in children and adolescents.

Purpose:

To systematically review the evidence on the benefits and harms of primary care–relevant interventions designed to reduce illicit drug use or the nonmedical use of prescription drugs in children and adolescents.

Methods:

We searched PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials to identify relevant literature published between January 1992 and June 4, 2013 and MEDLINE through August 31, 2013. We also examined the references from other relevant reviews and included studies. Two investigators independently reviewed all titles/abstracts and full-text articles against a set of predetermined inclusion and quality criteria. One reviewer abstracted data into a standard evidence table and a second reviewer checked the data for completeness and accuracy. We qualitatively synthesized the results for the three Key Questions and grouped the included studies by intervention type (primary care–based vs. primary care–relevant computer-based interventions conducted outside of primary care).

Results:

We included six studies reported in seven publications. Four of the six trials examined the effect of the intervention on a health outcome. One study found no effects of either a therapist-led or computer-based brief intervention on marijuana use consequences or driving under the influence of marijuana. Only one of the three computer-based interventions that reported depression outcomes found greater improvement in the intervention group compared with the control group at 6 months only. All six trials reported a drug use outcome. Four of the five studies assessing self-reported marijuana use found statistically significant differences in favor of the intervention group compared with the control group. All three computer-based trials also reported differences in nonmedical prescription drug use occasions. Individual studies reported additional substance use outcomes with mixed results.

Conclusions:

There is inadequate evidence on the benefits of primary care–relevant behavioral interventions in reducing self-reported illicit and pharmaceutical drug use in adolescents.

Contents

Acknowledgments: The authors gratefully acknowledge the following individuals for their contributions to this project: Aileen G. Buckler, MD, MPH, and David Meyers, MD, at AHRQ; Adelita Cantu, PhD, RN, Sue Curry, PhD, Mark Ebell, MD, MS, and Albert Siu, MD, (Chair Liaison) of the U.S. Preventive Services Task Force; Sara Becker, PhD, Richard Brown, MD, MPH, Sharon Levy, MD, MPH, Matthew Young, PhD, Stephen W. Banspach, PhD, and Dale Slavin, PhD, who provided expert or federal partner review of the report; and Jillian T. Henderson, PhD, Daphne A. Plaut, MLS, Kevin Lutz, MFA, and Keshia Bigler at the Kaiser Permanente Center for Health Research.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHS-290-2007-10057-I. Prepared by: Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Portland, OR

Suggested citation:

Patnode CD, O'Connor E, Rowland M, Burda BU, Perdue LA, Whitlock EP. Primary Care Behavioral Interventions to Prevent or Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 106. AHRQ Publication No. 13-05177-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHS-290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

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