CLINICAL SCREENING AND PEER INTERVENTIONS TO PREVENT SUBSTANCE USE IN AT-RISK ADOLESCENTS: A Longitudinal Single-Arm Trial Protocol

Mental health conditions and substance use disorders commonly co-occur and adolescence is a period of increased risk for both. Adolescents with mental health conditions often begin using substances earlier than those without. Early initiation increases the risk of later substance use disorder. We propose to measure the impact of a peer-developed, primary care-based intervention to prevent substance use initiation among adolescents with mental health diagnoses and to evaluate responses to the intervention. This is a single-arm 12-month longitudinal unblinded pilot observational study. Adolescents aged 11-14 receiving pediatric primary care for diagnoses of depression, anxiety, or ADHD who have not yet initiated substance use will be eligible. The intervention involves quarterly assessments of substance use in the primary care office followed by viewing one of four 90-second videos targeting prevention topics like peer pressure for those who remain substance-free. The primary outcome is time to substance initiation, measured using the validated CRAFFT 2.1+N screener. Secondary outcomes include participant acceptance of the intervention, assessed by surveys, and tertiary outcomes will describe characteristics of participants who initiate substance use during the study. We will use Kaplan-Meier survival estimates and descriptive statistics. Subgroup analyses will include age, sex, and diagnosis. This trial targets a vulnerable population with increased risk for future substance use disorder. The intervention seeks to harness the protective effects of positive peer influence within the context of ongoing patient-provider relationships to promote delayed onset of substance use and inform feasibility and design of a future multi-site trial. • Local youth will help design brief prevention videos for at-risk adolescents • Videos include 4 brief relevant and engaging animations reviewed at pediatric visits • Positive peer influence + engaged doctor relationship may delay onset of substance use • Validated CRAFFT 2.1+N will evaluate substance use initiation at quarterly visits • Findings will inform feasibility and design of a larger, multisite trial