Need: Unhealthy alcohol use ranges from risky drinking to alcohol use disorder. In Texas, 19% of the population reported heavy drinking and in some Central Texas counties, this is close to 23%. Alcohol is a risk factor for head and neck, breast, liver, esophageal, and colorectal cancer. Approximately 4% of cancer cases worldwide are attributed to alcohol. Rural counties in Central Texas have higher incidence of and more late-stage diagnoses of alcohol-attributable cancers. The US Preventive Services Task Force recommends screening for unhealthy alcohol use in adults ages 18 and older. Screening, brief interventions, referral to treatment such as pharmacotherapy within a primary care setting ...

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Need: Unhealthy alcohol use ranges from risky drinking to alcohol use disorder. In Texas, 19% of the population reported heavy drinking and in some Central Texas counties, this is close to 23%. Alcohol is a risk factor for head and neck, breast, liver, esophageal, and colorectal cancer. Approximately 4% of cancer cases worldwide are attributed to alcohol. Rural counties in Central Texas have higher incidence of and more late-stage diagnoses of alcohol-attributable cancers. The US Preventive Services Task Force recommends screening for unhealthy alcohol use in adults ages 18 and older. Screening, brief interventions, referral to treatment such as pharmacotherapy within a primary care setting to address unhealthy alcohol use have been found to be effective. Unfortunately, due to lack of resources and understaffed clinic systems, competing health priorities, lack of specialty staff to conduct interventions, and lack of culturally appropriate interventions, implementation of screening and brief interventions has been limited. These barriers are especially prevalent among underserved and rural populations. The first grant cycle of our program integrated interventionists into two federally qualified health centers (FQHCs) in Central Texas to screen 6500 patients, complete a more thorough assessment using the full AUDIT with 637 patients who screened positive, and deliver a brief intervention to 625 individuals who screened positive. We propose to expand our program into five Central Texas counties by including an additional clinic location within CommUnityCare Health Centers (CUC) in Travis County and include all primary care clinic locations within Lone Star Circle of Care (LSCC) with a focus on their rural locations in Bastrop, Bell, and Burnet counties. Overall Project Strategy: Primary care patients of the two CUC clinic sites and all LSCC sites who are 18 years and older and have screened positive on the Alcohol Use Disorder Identification Test - Concise (AUDIT-C) will be referred to our program. Our program interventionists will administer the full 10-item AUDIT. If the patient screens positive, our interventionist will provide a BI incorporating motivational interview techniques and tailored to the needs of the patient. Patients who are willing to reduce their alcohol consumption will be guided in establishing 1-2 short-term goals with the interventionist and be sent a 1-page leaflet with basic information on the link between alcohol and cancer. The interventionist will also assess patients for current tobacco use and need for cancer screening. The patient will be referred to existing CPRIT-funded prevention programs that can provide smoking cessation resources, breast, and colorectal cancer screenings. The interventionist will then call the patient in 2 weeks to assess progress on short term goals. At 3-6 months post-intervention, the interventionist will administer the full AUDIT to assess change in score. Specific Goals: The first goal of our program is to sustain high rates of engagement for patients who screen positive on the AUDIT-C among underserved populations at two large Central Texas FQHCs. We will achieve this by administering the full AUDIT to at least 70% of patients who screen positive on the AUDIT-C and delivering the brief intervention to at least 98% of patients who screen positive on the AUDIT. The second goal is to successfully refer patients who have a high likelihood of alcohol use disorder to additional counseling or treatment by ensuring that at least 60% of patients with a score on the AUDIT indicating moderate-severe alcohol use disorder attend the referral appointment. The third goal is to reduce risky drinking behavior among patients who screen positive on the full AUDIT by having at least 70% of patients who complete the initial full AUDIT complete a 3-6 month follow-up AUDIT. We anticipate a decrease in scores for all patients. Significance and Impact: We have the the only outpatient unhealthy alcohol use screening and intervention program in Central Texas that is necessary to address the burden of alcohol-related cancers. The first grant cycle has proven to be effective at reducing unhealthy alcohol use and this expansion will allow the program to grow to other underserved and rural communities. Through use of evidence-based strategies, including screening, brief interventions, referral, and treatment, we can reduce the incidence of colorectal, breast, esophageal, head and neck, and liver cancer (a CPRIT priority area) throughout Central Texas.

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