Adolescent Behavior
Conditions
Brief summary
Adolescents have some of the highest rates of risk behaviors of all age groups and health behaviors developed in adolescence can persist into adulthood. These behaviors carry significant risks for subsequent disease, disability, and healthcare burden. Despite these risks, health risk screening in primary care is infrequently performed and results are rarely followed by targeted intervention. In response to the need for screening-linked interventions, our study team has developed a web-based, electronic Personalized Motivational Feedback tool which we refer to as Check Yourself. Based on motivational interviewing, a technique to mobilize personal change, Check Yourself is designed to promote healthy choices for the multiple behaviors relevant to adolescents as well as to provide information to providers to promote discussions around health behaviors between providers and adolescents. Building on electronic health interventions, primary care providers can play an essential role in helping adolescents to make healthy behavior choices. Emerging evidence suggests that the consistency of preventive counseling can be increased through provider training and the provision of screening tools; yet, we know very little about the quality of such counseling, and if it impacts outcomes that are important to adolescent patients themselves. This study is a stepped-wedge, controlled trial comparing the effectiveness of an interactive adolescent-centered training for primary care providers (I-ACT) and Check Yourself to usual care. This study will take place in six pediatric practices. The purpose of this study is to determine whether this system of interventions (i.e., I-ACT, Check Yourself, and the summary report) is more effective than usual care in reducing health risk behaviors, improving adolescent motivation for health, and improving quality of care among adolescents receiving primary health care services.
Interventions
BEHAVIORALI-ACT with Check Yourself
Sponsors
Patient-Centered Outcomes Research Institute
Seattle Children's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
13 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
* Eligible adolescent participants will be 13-18 years of age and caregiver participants will be 18 years of age or older and able to understand English. Eligible participants will have an appointment (or have a child with an appointment) with a participating medical practice.
Exclusion criteria
* Adolescents will be excluded from the study if they do not meet age requirements, do not have an appointment with a participating provider at a PSPRN clinic, lack the means to complete follow-up interviews (i.e., have neither telephone nor internet access), have a sibling who has been/is being enrolled in the study or have previously participated in our previous trial comparing Check Yourself to usual care, and/or are not able to understand English. * Caregivers will be excluded from the study if they do not speak English; or if their child is not eligible or declines to participate in the study .
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tobacco Use | 3 months | Adolescent self-reported tobacco use in the past 3 months. The tobacco use scale includes 2 values: 0=no (min) or 1=yes (max). Higher scores mean a worse outcome. |
| Number of Health Risk Behaviors | 3 month | The risk behavior scale includes 22 values: 0 (min) to 21 (max). Higher scores indicate a worse outcome. Endorsement of any of the following counts as 1 (moderate risk) or 2 (high risk) on the scale depending on response and participant: ≥2 sugar-sweetened beverages consumed during typical day; ≤3 servings fruits/vegetables consumed during typical day; ≤3 days with 60+ minutes exercise during typical week; texting while driving in past 3 months; ≤7 hrs of sleep during typical night; not always using seatbelt; not always using helmet when bicycling; having driven under the influence of substances; tobacco use; days alcohol consumption in last 30 days (risk based on age) and/or number of drinks per drinking episode (risk based on age & sex); days marijuana consumption in last 30 days (risk based on age) and/or other drug use in past 3 months; not using birth control during last sexual intercourse and/or not always using a condom; & score of ≥10 on PHQ-9 depression. |
| Sweetened Beverage Consumption | 3 month | Adolescent self-reported number of sweetened beverages consumed in a typical day in the past 3 months. The sweetened beverages scale includes 4 values: 0 (min), 1, 2, or 3+ (max) sweetened beverages per day. Higher scores mean a worse outcome. |
| Fruit and Vegetable Consumption | 3 month | Adolescent self-reported number of fruits and vegetables consumed in a typical day in the past 3 months. The fruits and vegetables scale includes 6 values: 0 (min), 1, 2, 3, 4, or 5+ (max). Higher scores mean a better outcome. |
| Physical Activity | 3 month | Adolescent self-reported number of days with \>60 minutes of physical activity in an average week in the past 3 months. The physical activity scale includes 8 values: 0 (min) to 7 (max). Higher scores mean a better outcome. |
| Sleep | 3 month | Adolescent self-reported hours of sleep on a typical night in the past 3 months. The sleep scale includes 13 values: 0 (min) to 12+ (max) hours of sleep per night. Higher scores mean a better outcome. |
| Alcohol Consumption (Frequency) | 3 months | Adolescent self-reported number of days of alcohol consumption in the past month. Alcohol frequency scale includes 31 values: 0 (min) to 30 (max) days in the past month. Higher scores mean a worse outcome. |
| Alcohol Consumption (Quantity) | 3 months | Adolescent self-reported number of drinks during a typical drinking episode in the prior month. The alcohol quantity scale includes 16 values from 0 (min) to 15+ (max). Higher score means a worse outcome. |
| Marijuana Consumption | 3 months | Adolescent self-reported number of days using marijuana in the past month. The marijuana frequency scale includes 31 values: 0 (min) to 30 (max) days in the past month. Higher scores mean a worse outcome. |
| Other Drug Consumption | 3 months | Adolescent self-reported use of other drugs in the past 3 months. The other drug score includes 2 values: 0=no (min) and 1=yes (max). Higher scores mean a worse outcome. |
| Depression | 3 month | Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire (PHQ-9) in the past 2 weeks. The PHQ-9 depression scale includes 28 values: 0 (min) to 27 (max). Higher scores mean a worse outcome. |
| Seatbelt Use | 3 month | Adolescent self-reported frequency of seatbelt use in a car in the past 3 months. The seatbelt use scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a better outcome. |
| Helmet Use | 3 months | Adolescent self-reported frequency of helmet use while bicycling in the past 3 months. The helmet use scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a better outcome. |
| Texting While Driving | 3 months | Adolescent self-reported endorsement of texting while driving in the past 3 months. This question is only asked among adolescents who drive a car. The texting while driving scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a worse outcome. |
| Condom and/or Birth Control Use | 3 months | Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse. Two questions were used for this category. These questions were asked only to sexually active youth. The condom use scale includes 4 values: 1=always (min), 2=often, 3=sometimes, 4=never (max). Higher scores mean a worse outcome. The birth control scale includes 2 values: 0=no (min), 1=yes (max). Higher scores mean a better outcome. |
| Driving With Impairment | 3 month | Adolescent self-reported driving under the influence of a substance in the past 3 months. This question was asked only of adolescents who drive a car. The driving with impairment scale includes 2 values: 0=no (min) and 1=yes (max). Higher scores mean a worse outcome. |
| Adolescent Satisfaction With Care | 1-day | Adolescent satisfaction with care is assessed using one item adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure at 1-day follow-up. The CAHPS scale includes 10 values: 1 (min) to 10 (max). Higher scores mean a better outcome. |
| Caregiver Satisfaction With Care | 1-day | Caregiver satisfaction with care is assessed using the four items adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure at 1-day follow-up. Scores on this scale range from 3 (min) to 22 (max) with higher scores indicating higher satisfaction with care. |
| Adolescent Perception of Patient-Centeredness | 1 day | The total score on the Consultation and Relational Empathy measure (CARE) is used to assess adolescent self-report of perceived patient-centeredness from their primary care provider. Scores on the scale range from 10 (min) to 50 (max) with higher scores indicating a better outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Seatbelt Use | 6 month | Adolescent self-reported frequency of seatbelt use in a car in past 3 months |
| Helmet Use | 6 month | Adolescent self-reported frequency of helmet use while bicycling in past 3 months |
| Number of Health Risk Behaviors | 6 month | Adolescent total count health-risk behaviors at 6 month follow-up including: During typical day: ≥2 sugar-sweetened beverages consumed and ≤3 servings fruits/vegetables consumed; ≤3 days with 60+ minutes exercise during typical week; having texted while driving in past 3 months; ≤7 hours of sleep during typical night; not always using seatbelt; not always using helmet when bicycling; having driven under the influence of substances; tobacco use; days of alcohol consumption in last 30 days (risk based on age: ≥1 day/30 days (ages 13-15), ≥2 days/30 days (ages 16-17), or ≥3 days/30 days (age 18))and/or number of drinks per drinking episode (risk based on age and sex: ≥3 (Girls 13-17; Boys 13), ≥4 (Girls 18; Boys 14-15), or ≥5 (Boys 16-18)); days marijuana consumption in 30 day (risk based on age) and/or other drugs use in past 3 months; not using birth control during last sexual intercourse and/or not always using a condom; and score of ≥10 on PHQ-9. |
| Sweetened Beverage Consumption | 6 month | Adolescent self-reported sweetened beverages consumed in a typical day in past 3 months |
| Fruit and Vegetable Consumption | 6 month | Adolescent self-reported fruits and vegetables consumed in a typical day in past 3 months |
| Physical Activity | 6 month | Adolescent self-reported days with \>60 minutes of physical activity in an average week in past 3 months |
| Sleep | 6 month | Adolescent self-reported hours of sleep on a typical night in past 3 months |
| Alcohol Consumption | 6 month | Adolescent self-reported number of days of alcohol consumption and drinks during typical drinking episode in the prior month |
| Marijuana and/or Other Drug Consumption | 6 month | Adolescent self-reported number of days using marijuana in the past month and/or other drugs used in past 3 months |
| Marijuana and/or Other Consumption | 12 month | Adolescent self-reported number of days using marijuana in the past month and/or other drugs used in past 3 months |
| Depression | 6 month | Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire in past 2 weeks |
| Texting While Driving | 6 month | Adolescent self-reported endorsement of texting while driving in past 3 months |
| Condom Use and/or Birth Control Use | 6 month | Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse |
| Driving With Alcohol Impairment | 6 month | Adolescent self-reported driving under the influence of a substance |
| Interval Receipt of Care Questionnaire | 3 month | Dichotomous variable indicating receipt of any follow-up care to address risk behaviors identified at baseline adjusted for baseline number of health risk behaviors. |
| Readiness to Change Ruler Questionnaire | 1 day | Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler. |
| Tobacco Use | 6 month | Adolescent self-reported tobacco use in past 3 months |
| Percent of Risk Behaviors Counseled on During Primary Care Appointment | 1 day | Percent of adolescent-reported health risk behaviors discussed with the healthcare provider during the primary care visit adjusted for the total number of health risk behaviors reported at baseline. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Experimental: I-ACT With Check Yourself Adolescents completed Check Yourself which delivered personalized, motivational feedback to them on their health behaviors prior to their primary care appointment. Primary care providers received training (I-ACT) and the Check Yourself summary report of health risk behaviors before the adolescent's appointment. I-ACT consisted of online, interactive training in adolescent-preferred communication methods and motivational interviewing, with booster sessions and feedback reports to reinforce new skills. | 167 |
| No Intervention: Usual Care In the usual care group, adolescents are asked to complete health risk screening on a computer. No personalized feedback is provided to adolescents and primary care providers do not receive I-ACT or the Check Yourself summary report of the adolescent's health risk behaviors. | 135 |
| Total | 302 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 17 | 13 |
Baseline characteristics
| Characteristic | No Intervention: Usual Care | Experimental: I-ACT With Check Yourself | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 135 Participants | 167 Participants | 302 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 14.70 years STANDARD_DEVIATION 1.44 | 14.79 years STANDARD_DEVIATION 1.41 | 14.75 years STANDARD_DEVIATION 1.42 |
| Race/Ethnicity, Customized African American | 4 Participants | 2 Participants | 6 Participants |
| Race/Ethnicity, Customized Asian | 17 Participants | 11 Participants | 28 Participants |
| Race/Ethnicity, Customized Caucasian | 90 Participants | 122 Participants | 212 Participants |
| Race/Ethnicity, Customized Hispanic | 6 Participants | 11 Participants | 17 Participants |
| Race/Ethnicity, Customized Native American | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Other/Multiple Races | 17 Participants | 21 Participants | 38 Participants |
| Region of Enrollment United States | 135 participants | 167 participants | 302 participants |
| Sex: Female, Male Female | 69 Participants | 88 Participants | 157 Participants |
| Sex: Female, Male Male | 66 Participants | 79 Participants | 145 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 167 | 0 / 135 |
| other Total, other adverse events | 0 / 167 | 0 / 135 |
| serious Total, serious adverse events | 0 / 167 | 0 / 135 |
Outcome results
Primary
Adolescent Perception of Patient-Centeredness
The total score on the Consultation and Relational Empathy measure (CARE) is used to assess adolescent self-report of perceived patient-centeredness from their primary care provider. Scores on the scale range from 10 (min) to 50 (max) with higher scores indicating a better outcome.
Time frame: 1 day
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Adolescent Perception of Patient-Centeredness | 45.63 score on a scale | Standard Deviation 5.6 |
| No Intervention: Usual Care | Adolescent Perception of Patient-Centeredness | 45.63 score on a scale | Standard Deviation 6.26 |
Primary
Adolescent Satisfaction With Care
Adolescent satisfaction with care is assessed using one item adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure at 1-day follow-up. The CAHPS scale includes 10 values: 1 (min) to 10 (max). Higher scores mean a better outcome.
Time frame: 1-day
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Adolescent Satisfaction With Care | 9.18 score on a scale | Standard Deviation 1.11 |
| No Intervention: Usual Care | Adolescent Satisfaction With Care | 9.23 score on a scale | Standard Deviation 0.95 |
Primary
Alcohol Consumption (Frequency)
Adolescent self-reported number of days of alcohol consumption in the past month. Alcohol frequency scale includes 31 values: 0 (min) to 30 (max) days in the past month. Higher scores mean a worse outcome.
Time frame: 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Alcohol Consumption (Frequency) | 0.25 score on a scale | Standard Deviation 1.09 |
| No Intervention: Usual Care | Alcohol Consumption (Frequency) | 0.25 score on a scale | Standard Deviation 1.28 |
Primary
Alcohol Consumption (Quantity)
Adolescent self-reported number of drinks during a typical drinking episode in the prior month. The alcohol quantity scale includes 16 values from 0 (min) to 15+ (max). Higher score means a worse outcome.
Time frame: 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Alcohol Consumption (Quantity) | 0.20 score on a scale | Standard Deviation 0.79 |
| No Intervention: Usual Care | Alcohol Consumption (Quantity) | 0.10 score on a scale | Standard Deviation 0.53 |
Primary
Caregiver Satisfaction With Care
Caregiver satisfaction with care is assessed using the four items adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure at 1-day follow-up. Scores on this scale range from 3 (min) to 22 (max) with higher scores indicating higher satisfaction with care.
Time frame: 1-day
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Caregiver Satisfaction With Care | 21.54 score on a scale | Standard Deviation 0.76 |
| No Intervention: Usual Care | Caregiver Satisfaction With Care | 21.47 score on a scale | Standard Deviation 1.13 |
Primary
Condom and/or Birth Control Use
Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse. Two questions were used for this category. These questions were asked only to sexually active youth. The condom use scale includes 4 values: 1=always (min), 2=often, 3=sometimes, 4=never (max). Higher scores mean a worse outcome. The birth control scale includes 2 values: 0=no (min), 1=yes (max). Higher scores mean a better outcome.
Time frame: 3 months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Condom and/or Birth Control Use | Condom Use | 1.89 score on a scale | Standard Deviation 1.36 |
| Experimental: I-ACT With Check Yourself | Condom and/or Birth Control Use | Birth Control Use | 1.0 score on a scale | Standard Deviation 0 |
| No Intervention: Usual Care | Condom and/or Birth Control Use | Condom Use | 2.00 score on a scale | Standard Deviation 1 |
| No Intervention: Usual Care | Condom and/or Birth Control Use | Birth Control Use | 1.0 score on a scale | Standard Deviation 0 |
Primary
Depression
Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire (PHQ-9) in the past 2 weeks. The PHQ-9 depression scale includes 28 values: 0 (min) to 27 (max). Higher scores mean a worse outcome.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Depression | 3.02 score on a scale | Standard Deviation 4.14 |
| No Intervention: Usual Care | Depression | 3.41 score on a scale | Standard Deviation 4.16 |
Primary
Driving With Impairment
Adolescent self-reported driving under the influence of a substance in the past 3 months. This question was asked only of adolescents who drive a car. The driving with impairment scale includes 2 values: 0=no (min) and 1=yes (max). Higher scores mean a worse outcome.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Driving With Impairment | 0.01 score on a scale | Standard Deviation 0.08 |
| No Intervention: Usual Care | Driving With Impairment | 0.02 score on a scale | Standard Deviation 0.13 |
Primary
Fruit and Vegetable Consumption
Adolescent self-reported number of fruits and vegetables consumed in a typical day in the past 3 months. The fruits and vegetables scale includes 6 values: 0 (min), 1, 2, 3, 4, or 5+ (max). Higher scores mean a better outcome.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Fruit and Vegetable Consumption | 2.84 score on a scale | Standard Deviation 1.29 |
| No Intervention: Usual Care | Fruit and Vegetable Consumption | 2.53 score on a scale | Standard Deviation 1.17 |
Primary
Helmet Use
Adolescent self-reported frequency of helmet use while bicycling in the past 3 months. The helmet use scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a better outcome.
Time frame: 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Helmet Use | 3.78 score on a scale | Standard Deviation 0.69 |
| No Intervention: Usual Care | Helmet Use | 3.52 score on a scale | Standard Deviation 1 |
Primary
Marijuana Consumption
Adolescent self-reported number of days using marijuana in the past month. The marijuana frequency scale includes 31 values: 0 (min) to 30 (max) days in the past month. Higher scores mean a worse outcome.
Time frame: 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Marijuana Consumption | 0.53 score on a scale | Standard Deviation 3.05 |
| No Intervention: Usual Care | Marijuana Consumption | 0.14 score on a scale | Standard Deviation 0.97 |
Primary
Number of Health Risk Behaviors
The risk behavior scale includes 22 values: 0 (min) to 21 (max). Higher scores indicate a worse outcome. Endorsement of any of the following counts as 1 (moderate risk) or 2 (high risk) on the scale depending on response and participant: ≥2 sugar-sweetened beverages consumed during typical day; ≤3 servings fruits/vegetables consumed during typical day; ≤3 days with 60+ minutes exercise during typical week; texting while driving in past 3 months; ≤7 hrs of sleep during typical night; not always using seatbelt; not always using helmet when bicycling; having driven under the influence of substances; tobacco use; days alcohol consumption in last 30 days (risk based on age) and/or number of drinks per drinking episode (risk based on age & sex); days marijuana consumption in last 30 days (risk based on age) and/or other drug use in past 3 months; not using birth control during last sexual intercourse and/or not always using a condom; & score of ≥10 on PHQ-9 depression.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Number of Health Risk Behaviors | 2.23 score on a scale | Standard Deviation 1.98 |
| No Intervention: Usual Care | Number of Health Risk Behaviors | 2.62 score on a scale | Standard Deviation 2.02 |
Primary
Other Drug Consumption
Adolescent self-reported use of other drugs in the past 3 months. The other drug score includes 2 values: 0=no (min) and 1=yes (max). Higher scores mean a worse outcome.
Time frame: 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Other Drug Consumption | 0.02 score on a scale | Standard Deviation 0.14 |
| No Intervention: Usual Care | Other Drug Consumption | 0.00 score on a scale | Standard Deviation 0 |
Primary
Physical Activity
Adolescent self-reported number of days with \>60 minutes of physical activity in an average week in the past 3 months. The physical activity scale includes 8 values: 0 (min) to 7 (max). Higher scores mean a better outcome.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Physical Activity | 4.81 score on a scale | Standard Deviation 1.72 |
| No Intervention: Usual Care | Physical Activity | 4.26 score on a scale | Standard Deviation 1.66 |
Primary
Seatbelt Use
Adolescent self-reported frequency of seatbelt use in a car in the past 3 months. The seatbelt use scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a better outcome.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Seatbelt Use | 3.97 score on a scale | Standard Deviation 0.18 |
| No Intervention: Usual Care | Seatbelt Use | 3.94 score on a scale | Standard Deviation 0.24 |
Primary
Sleep
Adolescent self-reported hours of sleep on a typical night in the past 3 months. The sleep scale includes 13 values: 0 (min) to 12+ (max) hours of sleep per night. Higher scores mean a better outcome.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Sleep | 7.75 score on a scale | Standard Deviation 1.26 |
| No Intervention: Usual Care | Sleep | 7.73 score on a scale | Standard Deviation 1.39 |
Primary
Sweetened Beverage Consumption
Adolescent self-reported number of sweetened beverages consumed in a typical day in the past 3 months. The sweetened beverages scale includes 4 values: 0 (min), 1, 2, or 3+ (max) sweetened beverages per day. Higher scores mean a worse outcome.
Time frame: 3 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Sweetened Beverage Consumption | 0.80 score on a scale | Standard Deviation 0.8 |
| No Intervention: Usual Care | Sweetened Beverage Consumption | 0.95 score on a scale | Standard Deviation 1.05 |
Primary
Texting While Driving
Adolescent self-reported endorsement of texting while driving in the past 3 months. This question is only asked among adolescents who drive a car. The texting while driving scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a worse outcome.
Time frame: 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Texting While Driving | 1.06 score on a scale | Standard Deviation 0.24 |
| No Intervention: Usual Care | Texting While Driving | 1.07 score on a scale | Standard Deviation 0.26 |
Primary
Tobacco Use
Adolescent self-reported tobacco use in the past 3 months. The tobacco use scale includes 2 values: 0=no (min) or 1=yes (max). Higher scores mean a worse outcome.
Time frame: 3 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Tobacco Use | 0.03 score on a scale | Standard Deviation 0.16 |
| No Intervention: Usual Care | Tobacco Use | 0.02 score on a scale | Standard Deviation 0.13 |
Secondary
Alcohol Consumption
Adolescent self-reported number of days of alcohol consumption and drinks during typical drinking episode in the prior month
Time frame: 12 month
Secondary
Alcohol Consumption
Adolescent self-reported number of days of alcohol consumption and drinks during typical drinking episode in the prior month
Time frame: 6 month
Secondary
Condom Use and/or Birth Control Use
Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse
Time frame: 12 month
Secondary
Condom Use and/or Birth Control Use
Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse
Time frame: 6 month
Secondary
Depression
Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire in past 2 weeks
Time frame: 12 month
Secondary
Depression
Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire in past 2 weeks
Time frame: 6 month
Secondary
Driving With Alcohol Impairment
Adolescent self-reported driving under the influence of a substance
Time frame: 6 month
Secondary
Driving With Alcohol Impairment
Adolescent self-reported driving under the influence of a substance
Time frame: 12 month
Secondary
Fruit and Vegetable Consumption
Adolescent self-reported fruits and vegetables consumed in a typical day in past 3 months
Time frame: 6 month
Secondary
Fruit and Vegetable Consumption
Adolescent self-reported fruits and vegetables consumed in a typical day in past 3 months
Time frame: 12 month
Secondary
Helmet Use
Adolescent self-reported frequency of helmet use while bicycling in past 3 months
Time frame: 6 month
Secondary
Helmet Use
Adolescent self-reported frequency of helmet use while bicycling in past 3 months
Time frame: 12 month
Secondary
Interval Receipt of Care Questionnaire
Dichotomous variable indicating receipt of any follow-up care to address risk
Time frame: 12 month
Secondary
Interval Receipt of Care Questionnaire
Dichotomous variable indicating receipt of any follow-up care to address risk
Time frame: 6 month
Secondary
Interval Receipt of Care Questionnaire
Dichotomous variable indicating receipt of any follow-up care to address risk behaviors identified at baseline adjusted for baseline number of health risk behaviors.
Time frame: 3 month
Secondary
Marijuana and/or Other Consumption
Adolescent self-reported number of days using marijuana in the past month and/or other drugs used in past 3 months
Time frame: 12 month
Secondary
Marijuana and/or Other Drug Consumption
Adolescent self-reported number of days using marijuana in the past month and/or other drugs used in past 3 months
Time frame: 6 month
Secondary
Number of Health Risk Behaviors
Adolescent total count health-risk behaviors at 6 month follow-up including: During typical day: ≥2 sugar-sweetened beverages consumed and ≤3 servings fruits/vegetables consumed; ≤3 days with 60+ minutes exercise during typical week; having texted while driving in past 3 months; ≤7 hours of sleep during typical night; not always using seatbelt; not always using helmet when bicycling; having driven under the influence of substances; tobacco use; days of alcohol consumption in last 30 days (risk based on age: ≥1 day/30 days (ages 13-15), ≥2 days/30 days (ages 16-17), or ≥3 days/30 days (age 18))and/or number of drinks per drinking episode (risk based on age and sex: ≥3 (Girls 13-17; Boys 13), ≥4 (Girls 18; Boys 14-15), or ≥5 (Boys 16-18)); days marijuana consumption in 30 day (risk based on age) and/or other drugs use in past 3 months; not using birth control during last sexual intercourse and/or not always using a condom; and score of ≥10 on PHQ-9.
Time frame: 6 month
Secondary
Number of Health Risk Behaviors
Adolescent total count health-risk behaviors at 12 month follow-up including: During typical day: ≥2 sugar-sweetened beverages consumed and ≤3 servings fruits/vegetables consumed; ≤3 days with 60+ minutes exercise during typical week; having texted while driving in past 3 months; ≤7 hours of sleep during typical night; not always using seatbelt; not always using helmet when bicycling; having driven under the influence of substances; tobacco use; days of alcohol consumption in last 30 days (risk based on age: ≥1 day/30 days (ages 13-15), ≥2 days/30 days (ages 16-17), or ≥3 days/30 days (age 18))and/or number of drinks per drinking episode (risk based on age and sex: ≥3 (Girls 13-17; Boys 13), ≥4 (Girls 18; Boys 14-15), or ≥5 (Boys 16-18)); days marijuana consumption in 30 day (risk based on age) and/or other drugs use in past 3 months; not using birth control during last sexual intercourse and/or not always using a condom; and score of ≥10 on PHQ-9.
Time frame: 12 month
Secondary
Percent of Risk Behaviors Counseled on During Primary Care Appointment
Percent of adolescent-reported health risk behaviors discussed with the healthcare provider during the primary care visit adjusted for the total number of health risk behaviors reported at baseline.
Time frame: 1 day
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Experimental: I-ACT With Check Yourself | Percent of Risk Behaviors Counseled on During Primary Care Appointment | Moderate risk behaviors | 43 percentage of risk behaviors counselled |
| Experimental: I-ACT With Check Yourself | Percent of Risk Behaviors Counseled on During Primary Care Appointment | High risk behaviors | 36 percentage of risk behaviors counselled |
| No Intervention: Usual Care | Percent of Risk Behaviors Counseled on During Primary Care Appointment | Moderate risk behaviors | 35 percentage of risk behaviors counselled |
| No Intervention: Usual Care | Percent of Risk Behaviors Counseled on During Primary Care Appointment | High risk behaviors | 23 percentage of risk behaviors counselled |
Secondary
Physical Activity
Adolescent self-reported days with \>60 minutes of physical activity in an average week in past 3 months
Time frame: 12 month
Secondary
Physical Activity
Adolescent self-reported days with \>60 minutes of physical activity in an average week in past 3 months
Time frame: 6 month
Secondary
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 12 month
Secondary
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 1 day
Secondary
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 3 month
Secondary
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 6 month
Secondary
Seatbelt Use
Adolescent self-reported frequency of seatbelt use in a car in past 3 months
Time frame: 6 month
Secondary
Seatbelt Use
Adolescent self-reported frequency of seatbelt use in a car in past 3 months
Time frame: 12 month
Secondary
Sleep
Adolescent self-reported hours of sleep on a typical night in past 3 months
Time frame: 12 month
Secondary
Sleep
Adolescent self-reported hours of sleep on a typical night in past 3 months
Time frame: 6 month
Secondary
Sweetened Beverage Consumption
Adolescent self-reported sweetened beverages consumed in a typical day in past 3 months
Time frame: 6 month
Secondary
Sweetened Beverage Consumption
Adolescent self-reported sweetened beverages consumed in a typical day in past 3 months
Time frame: 12 month
Secondary
Texting While Driving
Adolescent self-reported endorsement of texting while driving in past 3 months
Time frame: 12 month
Secondary
Texting While Driving
Adolescent self-reported endorsement of texting while driving in past 3 months
Time frame: 6 month
Secondary
Tobacco Use
Adolescent self-reported tobacco use in past 3 months
Time frame: 12 month
Secondary
Tobacco Use
Adolescent self-reported tobacco use in past 3 months
Time frame: 6 month