Need: Excess alcohol use is an important but under-recognized risk factor for cancer. In 2014, alcohol intake was the third most important risk factor for cancer incidence and mortality in the US, leading to increased incidence of multiple types of cancer, including breast, head and neck, esophageal, colorectal, and liver cancer, a key CPRIT priority area. Excess alcohol use is a particularly important risk factor in Central Texas. Screening for unhealthy alcohol use and offering brief counseling to reduce risky drinking and more extensive treatment (behavioral or pharmacological or both) to patients with alcohol use disorders can reduce unhealthy alcohol use. Lower levels of unhealthy alcoh...

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Need: Excess alcohol use is an important but under-recognized risk factor for cancer. In 2014, alcohol intake was the third most important risk factor for cancer incidence and mortality in the US, leading to increased incidence of multiple types of cancer, including breast, head and neck, esophageal, colorectal, and liver cancer, a key CPRIT priority area. Excess alcohol use is a particularly important risk factor in Central Texas. Screening for unhealthy alcohol use and offering brief counseling to reduce risky drinking and more extensive treatment (behavioral or pharmacological or both) to patients with alcohol use disorders can reduce unhealthy alcohol use. Lower levels of unhealthy alcohol use are associated with lower rates of cancer, as well as a host of other health benefits, including reduced stroke and liver disease; fewer unintentional injuries; and reduced risk for suicide and other intentional injuries. The US Preventive Services Task Force recommends screening for unhealthy alcohol use in adults ages 18 and older. Moreover, recent analyses have found unhealthy alcohol use screening to be among the most beneficial preventive services in terms of burden of disease and potential for improvement. Despite the potential benefits of screening, implementation has been limited. Few providers routinely screen for unhealthy alcohol use in clinical practice with evidence-based tools, and those who screen often do not address unhealthy use when identified. There are many reasons for this sub-optimal implementation, including competing priorities, lack of awareness of the prevalence of unhealthy alcohol use and its connection to health outcomes, lack of knowledge about the effectiveness of treatment, absence of experience or skills for initiating treatment or referrals from primary care, and lack of access to treatment. These barriers are especially prevalent in underserved and rural communities, including the community health center patients included in our proposed program. Developing novel programs to identify patients with unhealthy alcohol use and provide effective interventions has the potential to have major health benefits, and should be a key part of cancer prevention initiatives. Overall Project Strategy: In this proposal, we seek to develop and implement an evidence-based program for the recognition and treatment of unhealthy alcohol use in Federally-Qualified Health Centers (FQHCs) in Central Texas. Our proposed program builds on the extensive experience of team members in development of novel programs to implement effective preventive care services in primary care, especially in underserved patients, including prior work in developing systems to identify patients with unhealthy alcohol use in primary care. Specific goals: Educate and train 500 staff and providers in Central Texas FQHCs on the importance and feasibility of identifying patients with unhealthy alcohol use and its role in cancer prevention. Implement routine screening for unhealthy alcohol use of 2000 total patients across two FQHC systems in Central Texas, including concurrent assessment for other modifiable risk factors (smoking, viral hepatitis) in patients who screen positive for unhealthy drinking. Provide brief intervention to 300 patients with risky drinking but low likelihood of alcohol use disorder, with the goal of reducing risky drinking behaviors. Refer 100 patients with high likelihood of alcohol use disorder for additional evaluation and treatment, with the support of patient navigation. Among those who engage in intervention, reduce the proportion with unhealthy drinking levels by 25%. Innovation: Our proposal is innovative in several respects. To our knowledge, it would be the first CPRIT-funded program to address the 3rd most important risk factor for cancer, unhealthy alcohol use. It would also represent one of the largest quality improvement initiatives to date for implementing screening for unhealthy alcohol use in primary care. Third, it would bring together a novel, multidisciplinary team with the opportunity to provide cross-disciplinary learning and advance implementation methods. Finally, it has the opportunity to identify and treat co-morbid risk factors, including smoking and viral hepatitis, other key risk factors that increase cancer risk multiplicatively. Few or no current programs address these risk factors together, despite their frequent co-occurrence. Significance and impact: Our proposed program has the opportunity to significantly reduce a key risk factor for cancer, unhealthy alcohol use, and thus reduce the incidence of several types of cancer, including breast, colorectal, esophageal, head and neck, and liver cancer. By identifying and treating concurrent tobacco use and viral hepatitis, the program will enable us to make a significant dent in the incidence of liver cancer (a CPRIT priority area) and of head and neck cancers, where few other evidence-based strategies are available.

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