Technology-Based Prevention for Adolescents in Primary Care
Phase: NA
Conditions: Substance Use
Sponsor: Georgia State University

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Georgia State University Research Protocol 
1. Title  
 
Full Title: Technology-Based Prevention for Adolescents in Primary Care: Pilot Randomized-
Controlled Trial 
 
Short Title: Teen Well Check Pilot RCT 
 
Principal Investigator: Amanda K. Gilmore, PhD, School of Public Health, Georgia State 
University 
 
Sponsor: National Institutes of Health (NIH); National Institute on Drug Abuse (NIDA) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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2. External Collaborators: N/A 
 
 
3. Background & Significance 
A. Substance use, sexual assault (SA), and sexual risk behaviors (SRBs) are common 
among adolescents. Substance use is common among adolescents aged 14-18, with past 
year substance use being common in 201515: 39.9% used alcohol, 23.7% used cannabis, 
and 10.5% used other illicit drugs. Substance use and sexual behavior often co-occur, with 
22.4% of sexually active adolescents aged 14-18 using substances before their most recent 
sexual encounter15. Substance use before sexual activity impairs sexual decision-making26. 
Impairments in sexual decision-making can lead to a range of problematic behaviors from 
consensual SRBs to nonconsensual SA. SA and SRBs can result in mental health 
problems, sexually transmitted infections (STIs), unwanted pregnancies, and legal 
consequences. Adolescents are disproportionally affected. They are more likely to contract 
STIs27, be sexually victimized18, and experience hardship as a result of unwanted 
pregnancy28. Out of first SA victimization experiences, 42.2% occur before age 1818 and 
50% involve substance use by the perpetrator, victim, or both32. Estimated annual costs are 
$700 billion for substance use33, $16 billion for the most prevalent STIs34, $9.4 billion in 
taxes for teen pregnancy35, and each rape costs $95,00036. Integrated prevention of these 
three major public health concerns would result in significant cost reductions to our nation. 
The nation has prioritized reducing SA in colleges29 and military settings30. Improvements in 
adolescent health, safety, and healthcare costs would likely extend through adulthood and 
prevention needs to move earlier in the lifespan during the window of adolescents when 
sexual debut and substance use initiation occurs when rates of SA and SRBs soar. 
 
B. Integrated prevention for substance use, SA, and SRBs is needed. An approach that 
aims to prevent/reduce substance misuse and use, SA victimization, SA perpetration, and 
SRBs in an integrated manner is more likely to work than targeting these interrelated 
problems separately or in partial combinations (i.e., integrated prevention of substance use 
and SRBs only). The scientific premise for integrating prevention draws from previous work 
outlining the interrelated nature of these health risk behaviors (e.g., substance use 
increases risk for SA and SRBs37-39; SA results in more SRBs40-41 and substance use42 
yielding higher risk for sexual re-victimization41) combined with the multitude of theories 
linking substance use and sexual decision making (see Table 1). Integrated prevention of 
substance use, SA, and SRBs is needed due to the interrelated nature of these health risk 
behaviors. Integrated prevention approaches are more effective than targeting one health 
risk behavior by itself51. No preventative work has been done to date targeting these four co-
occurring risk behaviors among adolescents in an integrated manner. Adolescence is a 
crucial time to target these specific health risk behaviors because it is when substance use 
initiation and sexual debut typically occurs and this period can be formative in the 
development of sex-related cognitions and behavior. If targeted early, it may be possible to 
prevent sexual behaviors driven by substance use and/or trauma symptoms. An integrated 
approach would not only be more likely to be effective, it reduces burden to adolescents by 
providing them with one brief prevention program targeting multiple pertinent concerns.  
 
C. Primary care is an ideal setting to screen and intervene with substance-involved 
SA and SRBs. The most likely setting for adolescents to seek preventative healthcare is 
primary care because they are routine visits associated with preventative health in this 
setting. Recent health reforms have led to increased access to primary care services20, 
suggesting that primary care settings will have an even wide reach to adolescents each 

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year. Health reforms also bring an increased priority for primary care to address a wide 
variety of issues. The American Academy of Pediatrics recommends that pediatricians 
complete screening for substance use, brief intervention, and referral to treatment (SBIRT) 
with all adolescent patients using developmentally appropriate tools43. SBIRT is effective 
and easy to disseminate. However, SBIRT is not universally integrated into primary care 
despite these recommendations. Further, a major weakness of SBIRT is that substance-
involved SA victimization, SA bystander intervention, and SRBs are not assessed and 
integrated prevention programs for these problems are not provided. It is possible that 
routine assessment of SA and SRBs do not occur in primary care because they are 
sensitive topics. When assessed in research studies, only 4% of primary care physicians 
were aware of their adolescent patients’ SA histories44, and when referred for SA-related 
treatment, 93% of adolescents were interested in referrals and 81% went to their 
appointment45. Further, substance-involved SRBs have not yet been directly prioritized in 
this setting. It is imperative to provide this integrated SBIRT to adolescents where 
preventative health screening is routinely conducted. 
 
D. Technology-based brief prevention programs are effective and preferred. 
Technology-based, brief prevention can be easily personalized, disseminated, and 
implemented without taking time away from physicians. Technology-based substance use 
assessments take half the time of provider-led assessments46 with equal 
sensitivity/specificity within primary care settings among adolescents47. Existing technology-
based prevention programs targeting substance-involved SA and SRBs separately1,31 
indicate this prevention delivery mode is feasible and effective. Further, adolescents prefer 
self-report screening48. 
 
E. The association between drug use and sexual health is understudied. Considerable 
research has found that alcohol use is clearly linked to increased risk of SA victimization39, 
SA bystander intervention49,50, and certain SRBs26. Considerably less attention focuses on 
the effect of drugs on SA and SRBs among adolescents. The effect of drug use on sexual 
decision-making is similar to that of alcohol use, with similar underlying mechanisms 
including cognitive impairments52, substance use expectancies53, and social normative 
beliefs54. Further, simultaneous use of alcohol and marijuana or alcohol and prescription 
drug use can exacerbate consequences associated with alcohol use alone55. Prevention 
programs targeting multiple substances and related SA and SRBs are needed for 
adolescents.  
 
F. Scientific Premise: As described above, findings from basic research have consistently 
indicated that substance use, SA, SRBs are related in several ways37-42. Previous research 
has included rigorous experimental studies and prospective examinations. These consistent 
findings indicate a need for integrated prevention. National studies using rigorous sampling 
methodologies have yielded high rates of substance use among adolescents15, high risk of 
SA18, high risk of STIs27 resulting from SRBs, and high rates of sexual activity after 
substance use15. The research base for the need of integrated prevention aimed at reducing 
substance use, SA, and SRBs for adolescents is strong. However, it has not yet been done. 
Further, it has not been done in primary care settings, where adolescents regularly seek 
preventative health care services and services are growing. An alternate consideration could 
be to implement such prevention in schools. However, given the direct health 
consequences, it is better served within a healthcare system where health consequences 
can be easily and efficiently addressed. Further, prevention programs that have targeted 
multiple health behaviors (i.e., alcohol use and SA or alcohol use and SRBs) tend to do so 
among adults and prevention is needed earlier in the lifespan. The proposed project draws 

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from the strengths of previous work and addresses the weaknesses by integrating evidence-
based prevention and adapting it to adolescents within primary care settings in a 
technology-based delivery mode. 
 
 
4-1. Goals 
A. Using technology as a mode of prevention program delivery in primary care. 
Technology-based brief assessments and prevention programs can revolutionize healthcare 
by allowing for low-cost, easily accessible, low-burden, effective prevention in healthcare 
settings without taking away from routine healthcare provided by physicians. It is essential 
that interventions target multiple health behaviors. This intervention focuses on several high-
risk health behaviors among adolescents including substance use, SA, and SRBs, all of 
which are associated with both physical and mental health problems. This patient-oriented 
career development award would allow the candidate to pursue this line of research and 
ultimately develop, test, and disseminate effective technology-based prevention programs 
related to substance use, SA, and SRBs within primary care settings. 
 
B. Developing an intervention for use by real-world providers. Adolescents prefer to be 
asked questions regarding substance use using technology-based or pencil paper 
modalities compared to physician-led assessments48. Therefore, the development of a 
technology-based brief assessment and intervention would be an innovative method to 
provide services to patients with minimal added burden to providers. Further, this brief 
assessment and intervention will be informed by both providers and patients in community-
based primary care settings, allowing for the specific needs of real-world providers to be 
addressed in the development of the intervention, thereby increasing the likelihood of 
dissemination and implementation ease. 
 
C. Informing best practices for implementing assessment and prevention programs 
targeting SA and SRB in primary care settings. There is limited information in the 
assessment and prevention of SA and SRB among adolescents in primary care. The 
proposed research will not only provide feasibility and effect sizes for a future RCT to 
examine this intervention, it will also result in guidelines to implement substance-involved 
SA and SRBs within primary care settings guided by patient and provider preferences which 
could also inform other sensitive topics useful to assess in primary care settings. 
 
4-2. Research Aims 
A. Pilot Feasibility Trial 
Participants: A total of 250 adolescents aged 14-18 will be recruited for a pilot feasibility 
trial. Adolescents will be screened using a screening assessment to determine if they 
are eligible for the study based on inclusion and exclusion criteria described below.  
 
Method: After their Well Check Visit with their pediatrician, adolescents will be recruited 
virtually or in-person to complete a screening survey about substance use. Participants 
who are ineligible to complete the study because they did not use substances or have 
friends that use substances in the past year will receive the recommended reinforcing 
message for abstaining from substance use such as “You’ve made a smart decision not 
to use alcohol or drugs” to reinforce choice (adapted from the Alcohol Screening and 
Brief Intervention for Youth63). This “screening out” procedure will allow for adolescent 
substance non-use to be reinforced in the recommended manner to save time for 
providers by providing evidence-based care. Eligible participants (and their guardian) will 
be invited to meet with a research assistant either in person at the clinic, by phone, or in 

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a video conference meeting to discuss the research and obtain consent. While 
discussing informed consent, participants and their guardians will be informed of the 
sensitive nature of the prevention program and that the adolescent will complete the 
brief survey and then research procedures. Both the adolescent and guardian will be 
informed that if the adolescent discloses a SA history as a child that has not been 
previously reported to the appropriate officials (Department of Social Services or Law 
Enforcement depending on the perpetrator), a report will need to be made prior to the 
adolescent and guardian leaving the clinic. Both the adolescent and guardian will be 
informed that if the adolescent discloses imminent risk of suicide and the adolescent is 
not willing to agree to a safety plan, a mental health professional will need to conduct an 
exam to determine if hospitalization is needed.  
 
After consenting to the prevention program and completing the baseline survey, the 
adolescent will be randomized to receive the interactive online prevention program (15 
minutes) or no intervention. All participants will then be contacted to complete 1-, 3-, and 
6-month follow-up assessments. Participants will receive a $5 gift card for screening for 
the study, $30 gift card for completing the baseline survey up to the point of 
randomization (plus $10 for completing the intervention if randomized to that condition), 
$40 gift card for the 1-month follow-up, $45 gift card for the 3-month, and $50 gift card 
for the 6-month. Participants may also receive partial payment for the follow-up surveys 
based on the percentage of the survey they complete. They will also receive a $5 bonus 
for completing each survey within a week of the date it was sent, and a $10 bonus if they 
complete all the surveys. Additionally, participants randomized to the intervention group 
will receive an additional $10. 
 
The research team will observe restrictions imposed by Georgia State University and 
relevant government or public health authorities in the conduct of research activities. 
 
5. Study Design 
 
A. Organizational 
The Principal Investigator of the overall study is Amanda Gilmore and is housed 
at Georgia State University (GSU). This study is funded by a NIDA career 
development award to GSU and all funds will go through GSU.  
 
 
 
B. Setting and location: 
Study procedures will take place at GSU and recruitment will occur at two sites: in the 
Old Fourth Ward Pediatrics clinic in Atlanta, Georgia and at the Medical College of 
Georgia-Augusta University Children’s Hospital of Georgia in Augusta, Georgia. 
Adolescents will either complete the consent, baseline survey, and intervention at their 
primary care clinic or they will complete those study activities online in a private location 
of their choosing. All participants will complete the follow-up surveys at 1 month, 3 
months, and 6 months online in a private location of their choosing. When completing 
data surveys and/or the intervention remotely, we will ensure that they are in a private 
space in these ways: 
1) displaying a reminder screen at the beginning of all surveys and the intervention that 
this should be completed in a private location 
2) displaying a reminder screen to close the browser at the end 
3) language in the consent form for guardians that indicates they do not have access to 
the adolescent's study information. 
 

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C. Community participation (if applicable): N/A 
 
D. Virtual or In-Person Recruitment: 
See Figure 1 for a visual diagram of recruitment, informed consent, and data collection 
methods for this study. 
 
Adolescents aged 14-18 will be recruited to participate in the screening procedures—an 
online Screening Survey—if they are at a recruitment site for a primary care visit or if 
they have attended a recruitment site visit in the last month for primary care. We will use 
in-person recruitment strategies when possible, but we will also use virtual recruitment 
strategies: 
 
1) Research staff in-person at the recruitment site(s) speak with potential participants 
and invite them to take the online Screening Survey using a computer in the waiting 
room.  
1a) Researchers will use the "Adolescent Recruitment Script" if only the 
adolescent is in the waiting room. They will use the "Parent and Teen 
Recruitment Script" if the adolescent is waiting with their parent. 
 
2) Research staff hang and hand out flyers (see Flyer) with contact information and a 
QR code in the recruitment site(s) exam and waiting rooms 
 
3) Clinic staff obtain permission from patients for research staff to contact them about 
the study (see Clinic Staff Recruitment Script and Research Registry Form) 
3a) For patients who seem interested in the study but do not have time to 
consent on the day of their office visit, the clinic staff will ask them to complete a 
research registry form (see attached) with their contact information. 
 
4) Research staff recruit potential participants virtually using a computer and 
teleconferencing in the clinic waiting room 
4a) For patients and their guardians who are interested in the study and have 
time to consent on the day of their office visit, clinic staff will alert the research 
team who is available on the computer via Zoom. The research staff will then use 
the appropriate recruitment script (adolescent, guardian, or adolescent and 
guardian) to inform them about the study, screen for eligibility, and consent if 
appropriate. 
 
5) Research staff recruit by sending messages to potential participants on their online 
patient portal (see Adolescent Recruitment Script) 
 
Follow-up survey links will be sent via email, text, or social media (ex: Instagram) as 
preferred by the adolescent participant. The email used for follow-up survey 
correspondence is attached (see Email Script). 
 
In addition to the survey links, research staff will encourage participation by sending 
brief, animated videos that relay the information in a more engaging format. These 
videos will contain information about survey length, study compensation, and what to 
expect for follow-up surveys.  
 
Inclusion/exclusion criteria will be determined by the screening survey. Inclusion criteria 
for the pilot feasibility trial:  

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1)  14-18 years old 
2)  Attended a primary care visit for a preventative healthcare visit within the past 
month  
3)  Endorse self or friend substance use in the past year.   
 
Exclusion criteria for the pilot feasibility trial: 
The proposed prevention program will be made in English for the feasibility trial 
and requires that adolescents appropriately read and understand the program 
content. Therefore, it would be inappropriate for adolescents who are not able to 
read English. This is the same rationale for excluding adolescents with an 
intellectual or cognitive disability. Further, adolescents with intellectual/cognitive 
disabilities may have unique risk factors concerning sexual consent that will not 
be addressed in the prevention program. This is not to say that adolescents who 
do not speak English or who have intellectual disabilities are not at risk for 
substance use, SA, and SRBs, however, addressing these populations within the 
proposed research would not possible. The screening questionnaire is written at 
less than a 6th grade reading level, so we believe people with 
intellectual/cognitive disability will be able to understand the question. 
 
E. Informed Consent Process: 
For adolescents under 18 who are eligible for the intervention, the guardian and 
adolescent will go through informed consent (guardian) and assent (adolescent under 
18) after taking the screening survey (see Parental Consent, 18 Year Old Consent, and 
Assent Forms). While discussing informed consent, participants and their guardian will 
be informed of the sensitive nature of the prevention program and that the adolescent 
will complete the prevention program online. Both the adolescent and guardian will be 
informed that if the adolescent discloses a SA history, a trained research staff will 
contact them to report the SA to the appropriate location (Department of Social Services 
or Law Enforcement depending on the perpetrator) and to provide any needed referrals 
for treatment. After guardian consents and adolescent assents to the prevention 
program, the adolescent will complete the study procedures in private. Although 
guardians will be informed that they might be contacted to help remind their child to 
complete the surveys. This will be discussed with the guardian during the consent 
process. 
 
For adolescents 18 years of age who are eligible for the intervention, they will go through 
informed consent after taking the screening survey (see 18 Year Old Consent Form). 
While discussing informed consent, participants will be informed of the sensitive nature 
of the prevention program and that they will complete the prevention program online. 
The adolescent will be informed that if they disclose a SA history, a trained research 
staff will contact them to report the SA to the appropriate location (Department of Social 
Services or Law Enforcement depending on the perpetrator) and to provide any needed 
referrals for treatment.   
 
If possible, the consent procedures will happen in-person at the doctor’s office 
immediately after the teen’s clinic visit. Otherwise, consent will happen virtually either 
through video conferencing (e.g., WebEx or Zoom) on the computer located at the clinic 

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or by phone after the patient has left the clinic. If consent occurs via video (e.g., Zoom or 
Webex) or by phone, the teen and their guardian will be directed to open the study 
website on an internet browser, where there will be online consent and assent forms. 
The research team will obtain an e-signature for consent through the online form. No 
teen under 18 will be allowed to participate in the study without their parent’s consent.  
 
All participants will receive referral information pertinent to treatment of substance use 
disorders, mental health and physical problems subsequent to SA victimization, 
treatment for SA perpetration, and STI testing recommendations. 
 
Figure 1. Virtual and In-Person Recruitment, Consent, and Data Collection Procedures for 
Teen Well Check 
 
 
F. Virtual or In-Person Field Methods: 
If eligible and consented/assented for research, adolescents will complete a Baseline 
Survey and (if randomized to experimental condition) the intervention in privacy. 
Throughout the online intervention, the adolescent will have access to a research 
assistant (virtually by phone/text or in-person) to answer any questions that arise.  
 

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Participants complete the prevention program, which includes intervention content 
provided online regarding substance use, sexual assault, and sexual risk behaviors. All 
informed consent, baseline assessment, and the intervention (if randomized to the 
program) procedures will take approximately 1 hour to complete. Adolescents will be 
paid $5 for screening for the study whether they are eligible or not. If they are eligible, 
adolescents will receive a $30 Walmart e-gift card for participating in the baseline portion 
of the study (plus $10 for completing the intervention if randomized to that condition). 
They will complete online follow-up surveys (see “1 Month Follow-up Survey,” “3-Month 
Follow up Survey,” and “6-Month Follow up Survey”) one-, three-, and six-months after 
participating in the baseline procedures. They will be paid a $40 Walmart e-gift card for 
the one-month follow-up survey, a $45 Walmart e-gift card for the three-month follow-up 
survey, and a $50 Walmart e-gift card for the six-month follow-up survey. Participants 
may also receive partial payment for the follow-up surveys based on the percentage of 
the survey they complete. All of the follow-up surveys will take approximately 30 minutes 
to complete. 
 
6. Potential Risks/Discomforts 
The two potential risks to participants that may be associated with involvement in the 
study include: 1) potential threats to confidentiality, particularly with regard to reporting 
sexual assault and reporting of imminent suicide risk without agreeing to a safety plan; 
and 2) potential embarrassment or distress from responding to questions or engaging in 
the prevention program targeting sensitive topics including substance use, sexual 
assault, and sexual risk behaviors. These risks are discussed in greater detail below. In 
addition, although not a risk specifically linked with participating in the study, the 
vulnerability of adolescents who have experienced sexual assault necessitate 
consideration of procedures in the cases of psychiatric emergencies (e.g., suicidal 
attempts). These considerations are noted here and in the following Protection Against 
Risk section.  
 
First, regarding potential threats to confidentiality, there may be emotional and/or legal 
consequences if personal information obtained during the assessment is released to 
outside parties. That is, mandatory reporting laws necessitate that new disclosures (i.e., 
previously unreported) of qualifying incidents of child abuse (including SA of someone 
under the age of 18 years old), be reported to the Department of Social Services/DSS 
(when perpetrator of abuse is in a caretaking position) or the local law enforcement 
agency (when perpetrator of abuse is in a non-caretaking position). Reports to such 
agencies may result in DSS involvement with the family, removal of family members or 
child from the home, or criminal charges/arrests. With regard to likelihood of this threat 
to confidentiality in relation to child abuse reporting, sexual assault history will be initially 
assessed through the assessment during the feasibility trial prior to beginning the 
prevention program. Participants will be informed of these risks of mandatory reporting 
laws prior to completing the assessments. A research assistant and licensed 
psychologist (e.g., P.I. Amanda Gilmore) will be immediately informed if an adolescent 
discloses a sexual assault victimization. 
 
Further, if an adolescent indicates that they have suicidal ideation within the survey, this 
will prompt a full suicide risk assessment (see Safety Plan) to be completed by the 
research personnel supervised by a licensed mental health professional. If there is acute 
risk of suicide, the guardian will be informed. The safety plan—detailing what to do and 
whom to speak with if ideation should occur—will be discussed with all adolescents who 
screen positive for suicidality, including specifics on how to access 24-hour care for 

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suicidality via dialing 9-1-1 and/or going to the closest emergency department when a 
mental health professional is not available. 
 
If there is any disclosure requiring reporting, the research personnel (supervised by a 
licensed mental health professional) will contact both the adolescent and guardian (if 
under 18, or adolescent alone if 18) to discuss mandated reporting and to provide any 
needed referrals for treatment. A report will be made to the appropriate location (DSS or 
law enforcement agency) by the researcher under the supervision of a licensed mental 
health professional.   
 
Our proposed methodology was developed in order to balance the safety of human 
subjects with the ability to acquire accurate data. We have used similar procedures in 
both local and national studies. We ultimately chose a tablet-based intervention because 
individuals are more likely to disclose information about sensitive topics like sexual 
assault, alcohol use, and sexual risk behaviors in self-report measures than when asked 
by a person. Therefore, including the tablet-based intervention rather than an in-person 
intervention will increase the likelihood of disclosures. However, this is balanced with the 
human subjects concern and ethical concern of mandatory reporting laws. It is essential 
to ensure that children are safe from child abuse, and sexual assault is a form of sexual 
abuse. We have included mandatory reporting within these procedures to ensure that 
participants within this study are protected from future harm. However, it is notable that 
in the National Survey on Adolescents, which several of the mentors on the current 
project oversaw the Child in Danger protocol, out of the approximately 3600 youth 
confidentiality was broken in less than 5 cases total. Previous and current studies 
conducted by the research team have revealed that adolescents do in fact still disclose 
sexual assaults even with being informed that it is mandatory that we report the incident. 
However, it is possible that some adolescents will not disclose sexual assault if they are 
informed in will be reported to the authorities if disclosed. Because of this, we ensured 
that all participants will receive the same information and resources despite their 
reported histories to ensure that they receive the best care possible. It is a potential 
limitation that the sexual assault victimization experiences will likely be under 
representative of the actual rates in the population being observed. 
 
Similarly, if an adolescent is threatening to hurt her/himself or someone else, 
confidentiality may have to be broken to make a report to the guardian and/or necessary 
authorities. Given that suicidality is common among child sexual abuse victims, while not 
a direct risk of the study, it is an important issue to assess and monitor closely with 
participants. Procedures for assessing and addressing suicide attempts are addressed 
in the following Protection Against Risk section.  
 
The second potential risk of the proposed study is the possibility that some participants 
might experience distress when asked questions pertaining to sexual assault and sexual 
risk behaviors. Many people assume that asking such questions produces substantial 
distress, particularly in research settings. However, our prior clinical research 
experience, as well as the empirical literature, suggests that this risk is minimal, and that 
individuals with traumatic event histories actually report obtaining positive benefits from 
their participation in studies using assessment instruments similar to the ones proposed. 
Procedures to protect against this risk are described in more detail below. Nonetheless, 
protocols are in place in the unlikely event that participants become significantly 
distressed during the assessment or prevention program process (see Protection 
Against Risk below).  

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With regard to potential alternative treatments, no “standard of care” exists for the 
integrated prevention of substance use, SA, and SRBs among adolescents within 
primary care settings. Provision of parallel or sequential treatments for each presenting 
problem could be considered. However, depending on the pre- treatment symptom 
presentation of the youth, this would potentially require that control participants and their 
families attend numerous treatment programs (e.g., a research-based outpatient 
treatment for substance use, psychoeducation for healthy dating and sexual decision 
making), placing significant burden on these families. Nonetheless, when the study is 
being described to potential participants, it will be made very clear that the adolescents 
and caregivers have the right to choose not to participate in the study and to be provided 
with appropriate referrals if they so prefer.  
 
All participants will receive a Resource Sheet with information about referrals for 
additional support. This will be provided at the end of Teen Well Check program and at 
the end of each survey. 
 
Protection Against Risks: 
To protect against violations of confidentiality: (a) a federal certificate of confidentiality 
has been automatically granted because it is study funded by NIDA to render the data 
immune from subpoena (due to the sensitivity of some of the data that we are collecting 
- e.g., self-reports of drug use and SA - and the potential legal jeopardy faced by some 
of the participants); while aware of the ambiguities about the reach of the certificates, we 
are convinced that they are the best protection available for confidentiality of research 
data; (b) all staff will sign confidentiality agreements, and our training sessions will 
emphasize the critical importance of confidentiality; (c) all hard copies of data will be 
kept and locked within the research office; (d) the computer containing the data will be 
password-protected as a security precaution to eliminate unauthorized access; (e) all 
digital data including survey responses will be stored on the encrypted GSU Enterprise 
Dropbox account that requires dual-identity log-in and is only available to members of 
this study team.  
 
Regarding the risks of breaking confidentiality due to mandated reporting laws: a) 
adolescents and guardians (if under the age of 18) will be informed of the risks during 
the consent process, and continually reminded of the risks throughout the study (e.g., at 
each assessment time-point); and b) when a question arises about whether a situation 
falls under a mandated reporting law, the research personnel and/or a licensed 
psychologist will be alerted immediately by text message and email. The PI will make all 
final decisions about whether a mandated report must be made on behalf of a study 
participant. If a mandated report is required, guardians and/or adolescents will be 
encouraged to make the report themselves (e.g., from the office within the primary care 
clinic), such that confidentiality is not broken by the project staff. If the guardian or 
adolescent refuses to make the report, then the research personnel will be required to 
make the report. This leads to very limited instances where confidentiality is actually 
broken by staff. The proposed mentorship team has extensive experience in dealing with 
these issues with trauma- exposed child populations.  
 
Ongoing monitoring of SA victimization will be conducted throughout the duration of the 
study using self-report measures. As described above, any youth or caregiver reports of 
harm to the child will be made to the local division of the Department of Social Services 
and/or law enforcement agency, when necessary. In the event that there is evidence (by 

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child/guardian report or physical evidence) that the child would be in danger of physical 
harm upon returning to the home, the appropriate law enforcement agency will be called 
and the child will not be permitted to leave with the guardian (i.e., if the abuser lives in 
the home).  
 
Dr. Gilmore is well-versed in mandating reporting and will be available on an as needed 
on-call basis during the duration of the study to pediatricians who may have any 
questions regarding study policies. Mandatory reporting within the study, combined with 
discussion of other sensitive topics including substance use may bring up questions from 
pediatricians regarding best practices concerning adolescent substance use, SA, and 
SRBs. Therefore, Dr. Gilmore will be available on call.  
 
To minimize distress or discomfort associated with participation in the study (from either 
assessment or the prevention program): (a) research staff will be carefully chosen and 
highly trained by the P.I.; (b) participants will be informed that they can discontinue 
participation at any time; and (c) if other problems arise, the research personnel or a 
licensed psychologist will contact the family to address and resolve these issues. To 
ensure this is possible, the research personnel and/or a licensed psychologist will be 
available during recruitment procedures at all times virtually.  
 
For participants enrolled in the study, in any circumstances where a research assistant 
or a licensed psychologist is concerned regarding suicidal ideation or attempt, the P.I. 
will be contacted immediately. All research staff will have a cell phone number where the 
P.I. will be available 24 hours 7 days a week. In rare instances where she cannot be 
reached, a licensed psychologist will serve as a back-up. Dr. Gilmore will ensure 
research assistants are well-trained in assessing distress and suicidality (intent, plan, 
etc) using a Safety Plan that includes the Linehan risk assessment and management 
protocol (LRAMP) (see “TWC Suicide Safety Plan Revised 041321”). In circumstances 
where adolescents in either condition express suicidal ideation and are sincerely willing 
to contract for safety (i.e., will agree to keep her/himself safe), the guardian will not be 
informed. The safety plan—detailing what to do and whom to speak with if ideation 
should occur—will be discussed with all participating adolescents who screen positive 
for suicidality, including specifics on how to access 24-hour care for suicidality via dialing 
9- 1-1 and/or going to the closest emergency department (research staff will help 
families determine this location) when a licensed psychologist and/or supervisor is not 
available. Thus, a 24-hour safety plan is in place, including access to medical care 24 
hours per day. Further, any participant in which it is deemed that medication is 
warranted will be referred to a hospital or community-based psychiatrist for such 
services and monitoring. Suicidal risk factors - including suicidal ideation, intent, plan, 
and means - will continue to be assessed on an ongoing basis throughout the 
adolescents’ participation in the study via the baseline and follow-up surveys.  
 
If a participant is deemed at risk for suicide and the adolescent will not contract for 
safety, or has made any indication of acute suicidal risk, the guardian will be informed 
immediately and the adolescent will be assessed by local emergency department for 
possible inpatient hospitalization.  
 
In all surveys, if a teen reports a sexual assault or suicidal ideation while completing the 
online survey, a notification will be made to Dr. Gilmore automatically. No matter the 
teen's responses, all teens will receive information for the suicide hotline and information 
about how to report a sexual assault if they have experienced one as a child. However, 

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to ensure the safety of the child, a member of the research team supervised by a mental 
health professional will contact the participant within 24 hours to follow-up 
 
Finally, all participating families enrolled in the study will be given Dr. Gilmore’s contact 
information on the consent/assent forms. 
 
All participant data will be collected via Qualtrics, which meets GSU standards for 
encryption. GSU has extensive experience safeguarding the security and integrity of 
sensitive materials, including protected health information and sensitive financial 
information. Respondent confidentiality will be masked in all data files by the use of 
project identification numbers rather than personal information. All other electronic 
records, including digital recordings of sessions, are de-identified in collection and will be 
maintained in password-protected locations on the secure server. All paper records will 
be de-identified and maintained in a locked file cabinet on a secure floor. The only 
document linking participants with identification numbers will be retained in a password-
protected encrypted file on the secure server. That linking document will be destroyed at 
the end of the study. Data presented at professional meetings or published in journals or 
books will not allow identification of individual participants. These procedures are 
expected to minimize any potential adverse effects from participating in this study. 
 
 
7. Benefits 
Potential benefits to participants who receive the prevention program are substantial, 
including decreased likelihood of substance misuse, sexual assault victimization, sexual 
assault perpetration, and engagement in sexual risk behaviors, thereby decreasing the 
risk of subsequent development of substance use disorders and sexual revictimization, 
though these cannot be guaranteed. In addition, the successful demonstration of 
feasibility for a clinically useful and cost-effective technology-based approach to improve 
the efficiency, effectiveness, and reach of prevention programs to primary care would be 
of significant benefit to society. Further, this technology could be adapted to other 
populations if effective. 
 
 

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8. Compensation 
Participants in the pilot feasibility trial will receive: 
• 
A $5 Walmart e-gift card for completing the screening survey even if they are not 
eligible or do not finish the study. 
• 
A $30 Walmart e-gift card for completing the baseline survey 
• 
A $10 Walmart e-gift card for completing the online prevention program (if 
randomized to the intervention) 
• 
A $40 Walmart e-gift card for completing the 1-month follow-up 
• 
A $45 Walmart e-gift card for completing the 3-month follow-up 
• 
A $50 Walmart e-gift card for completing the 6-month follow-up 
• 
In addition, participants who complete each survey within a week of the date they 
were sent the survey will receive an additional $5 per survey. 
• 
Participants will also receive a $10 bonus for completing all surveys 
• 
Participants may also receive partial payment for the follow-up surveys based on 
the percentage of the survey they complete. 
 
9. Data Analysis: Data Management & Monitoring 
To address electronic data security, Qualtrics at GSU will be used for data collection. 
Questionnaire data will be collected via software that meets GSU standards for 
encryption. GSU has extensive experience safeguarding the security and integrity of 
sensitive materials, including protected health information and sensitive financial 
information. Respondent confidentiality will be masked in all data files by the use of 
project identification numbers rather than personal information. All other electronic 
records, including digital recordings of sessions, are de-identified in collection and will be 
maintained in password-protected locations on the secure server. All paper records will 
be de-identified and maintained in a locked file cabinet on a secure floor. The only 
document linking participants with identification numbers will be retained in an encrypted 
file on the secure server with access limited to Dr. Gilmore and the research personnel. 
This linking document will be destroyed at the end of the study. Data presented at 
professional meetings or published in journals or books will not allow identification of 
individual participants. These procedures are expected to minimize any potential 
adverse effects from participating in this study. All final data will be stored on GSU 
secure servers, on GSU password-protected computers. 
 
 
10. Plans for Analysis, Statistical and/or Otherwise 
Feasibility will be determined based on recruitment, retention, execution of study 
protocols, and satisfaction of adolescents and providers. Feasibility is the primary goal of 
this aim. Recruitment will be considered successful if 250 adolescents are screened and 
70 meet criteria for the study. Study retention will be considered successful if 80% of 
participants are retained for 1-, 3-, and 6-month follow-up assessments. Satisfaction will 
be considered adequate if participants report at least average satisfaction with the 
prevention program. Feasibility will be used to inform a larger randomized clinical trial. 
Preliminary effects: Preliminary effects will be examined as a secondary goal to 
determine preliminary evidence of effects on substance use, SA victimization, SA 
perpetration, and SRBs. The small sample size prevents any conclusions regarding 
prevention program efficacy to be determined, however, ANOVAs (gender X treatment 

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condition) will be conducted to determine if there are any preliminary effects on 
substance use, SA victimization, SA perpetration, and SRBs. Given that the primary aim 
is to determine feasibility and not to determine effects on outcomes, this will be 
preliminarily examined. 
 
 
11. Training of Study Team 
All study staff will be approved by all involved IRBs and will receive extensive training 
from the grant PI (Dr. Gilmore) on study procedures and risk protocols. Specifically, 
study staff will receive training on suicide risk assessment and suicide risk management 
as well as on assessing for child safety in relation to sexual assault histories. All 
investigators and study staff will complete the required CITI training and study staff with 
direct contact with participants will have weekly supervision meetings as well as 24-7 
access to Dr. Gilmore, a licensed clinical psychologist, for any study-related concerns. 
 
 
12. Plans for Monitoring the Study for Safety 
Dr. Gilmore will be responsible for monitoring the safety and efficacy of this trial, 
executing the NIDA- approved Data and Safety Monitoring (DSM) plan, and complying 
with the reporting requirements. Dr. Gilmore will provide a summary of the DSM report to 
NIDA on an annual basis as part of the progress report. The DSM report will include the 
participants’ socio-demographic characteristics, expected versus actual recruitment 
rates, any quality assurance or regulatory issues that occurred during the past year, 
summary of adverse events, and any actions or changes with respect to the protocol. 
The DSM report to NIDA will also include, when available, the results of any data 
analyses.  
 
A. Participant Safety  
Diligent safety monitoring will be conducted by the candidate throughout this study in 
compliance with the following required elements of the GSU IRB and continuing review 
process: 
1. tracking of subject accrual (enrollment, drop-outs, demographics) 
2. timely and appropriate reporting of informed consent process deficiencies, protocol 
deviations, privacy breaches, conflicts of interest, and/or changes in personnel 
3. ongoing monitoring and appropriate reporting of adverse event activity: a. Internal: i) 
frequency of unexpected, related or possibly related, and serious or more prevalent 
than expected adverse events; ii) frequency of internal deaths occurring during the 
study or within 30 days of study termination, even if expected or unrelated b. 
External: frequency of unexpected, related or possibly related, and serious adverse 
events  
4. interim assessment of risk/benefit relationship in reference to adverse event 
occurrences, preliminary observations, and emerging information  
5. timely and appropriate IRB submission of safety-related documents such as audit 
reports, sponsor progress reports, and other materials or communications that might 
impact the safe conduct of this study 
6. active cooperation with the IRB and other applicable entities in the event of a random 
or for-cause internal or external audit  
 
Participant Safety Relevant to Specific Application. Regarding the risk of harm to self 
or others, the nature of the population (adolescents at risk for using substances, SA, and 
SRBs) entail that specific adverse events, such as suicidal and homicidal ideation and 

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attempts, are possible given the high-risk nature of the population under study. 
Regardless, both expected adverse events and unexpected adverse events will be 
monitored and addressed continuously throughout the course of the project. Risk of 
harm to self and others will be directly assessed through self-report questionnaires. 
Participants in the study who indicate any risk of harm will immediately be assessed and 
referred for treatment, if needed. Dr. Gilmore and her mentorship team have extensive 
training in crisis management. Dr. Gilmore was directly clinically trained by Dr. Marsha 
Linehan, the developer of Dialectical Behavior Therapy which is effective at reducing 
suicidal behavior. Therefore, she is well versed and very experienced in the assessment 
and management of acutely suicidal individuals. Both expected and unanticipated 
adverse events will also be continuously monitored by the candidate and mentorship 
team. All study staff will be closely supervised by the candidate, who will hold weekly 
meetings with the staff to address clinical barriers, prevention program and enrollment 
progress, and safety issues throughout the feasibility trial. Dr. Gilmore will also be 
available 24/7 to study staff by phone if any additional support is needed. Participant 
safety is assessed routinely as part of the research context through assessments given 
at each time point to evaluate substance use, SA, SRBs, and risk of harm.  
 
For participants enrolled in the study, in any circumstances where the study staff is 
concerned regarding suicidal or homicidal ideation or attempt, or SA perpetration against 
a minor, s/he will immediately contact Dr. Gilmore, who is a licensed psychologist in 
South Carolina (License No. PSY.1417). Dr. Gilmore will assess safety and provide 
instructions to the study staff to address any risks. Dr. Gilmore will ensure that the study 
staff are well-trained in assessing distress and suicidality (ideation, intent, plan, etc). In 
circumstances where participants express suicidal ideation and are sincerely willing to 
contract for safety (i.e., will agree to keep her/himself safe), a plan will be made and 
carefully monitored. If a participant is deemed at-risk for suicide and will not contract for 
safety or has made a suicidal behavior or attempt, the participant will be assessed by a 
local emergency department for possible inpatient hospitalization. Dr. Gilmore or trained 
research staff will also ensure that participants who present with risk for suicidal or 
homicidal ideation are well educated on how to access 24-hour emergency care 
(through 9-1-1 or going to the local Emergency Department). Dr. Gilmore will be on-call 
for study therapists, 24 hours per day, 7 days per week.  
 
B. Procedures for Monitoring Safety of Data  
Regarding data management and storage, all data will be collected using computerized 
self-report questionnaires. Only participants’ study identification codes will be inputted 
computer-based databases. The codes that link the name of the participant and the 
study ID will be kept confidential by Dr. Gilmore in a secured cabinet. The data will be 
imported directly into a password-protected SPSS data file stored on the GSU server. 
The server is protected by the GSU network, and a secured log-in is required from all 
users. All research personnel collecting and manipulating data will have completed a 
Human Subjects Research Training and will meet weekly with Dr. Gilmore or a 
postdoctoral fellow in the lab to ensure strict compliance with the DSM plan. Only study 
personnel (candidate, research staff, and mentorship team) will have access to data. No 
data will be released to other agencies unless participants consent to release.  
 

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Adverse Events  
The candidate, with consultation from the mentoring team—which includes a licensed 
clinical psychologist (Gilmore)—will be responsible for monitoring data and participant 
safety. Adverse events will be one of the standard agenda items during weekly research 
meetings. Any adverse event that occurs will be reported by Dr. Gilmore to the GSU 
IRB, as well as NIDA. In keeping with the IRB requirements, events that are not 
considered severe are reported to the IRB in writing no later than 10 working days after 
the Investigator learns of the event, whereas those that are severe will be reported 
immediately and no longer than 48 hours after learning of the event. If instances arise 
where the severity of the event is questionable to the candidate, the IRB official assigned 
to the protocol will be contacted for guidance. In addition to reporting the adverse event 
to the IRB, those events that involve maltreatment of a child or risk of harm will be 
reported to appropriate child protection and law enforcement agencies. All reported 
events and any action taken by the IRB will be reported to the NIH.  
 
Adverse Identification, Detection, Grading, Attribution, and Reporting  
1. Identification. Potential risks identified for participants will be listed in the IRB-approved 
informed consent document. Additional unknown risks might occur and, if so, will be 
identified through diligent investigator monitoring throughout the conduct of this study.  
2. Detection. During the informed consent process, participants will be advised of the 
potential risks of participation as identified in the IRB-approved informed consent 
document. Participants will be advised during the informed consent process that they 
should promptly inform the investigators of any concerns regarding adverse events 
related to participation in the study. Participants will be advised to notify Dr. Gilmore of 
any suspected adverse events in a timely fashion. Safety parameters will be followed by 
the candidate as outlined above.  
3. Grading. Adverse events will be assessed and graded as follows: 
1. Expected/Anticipated Adverse Event: Identified in nature, severity, or frequency 
in the current protocol, informed consent, investigator brochure, or with other 
current risk information.  
2. Unexpected/Unanticipated Adverse Event: Not identified in nature, severity, or 
frequency in the current protocol, informed consent, investigator brochure, or with 
other current risk information.  
3. More Prevalent: Occurs more frequently than anticipated or at a higher 
prevalence than expected.  
4. Attribution. Adverse events will be attributed to study participation according to these 
parameters: 
1. Unrelated: There is not a reasonable possibility that the adverse event may have 
been caused by participation in the study.  
2. Possibly Related: The adverse event may have been caused by participation in 
the study; however, there is insufficient information to determine the likelihood of 
this possibility.  
3. Related: There is a reasonable possibility that the adverse event may have been 
caused by participation in the study.  
4. Seriousness: Results in death, is life threatening, requires inpatient 
hospitalization or prolongs existing hospitalization, results in persistent or 
significant disability/incapacity, or any other event that may jeopardize the 
participant’s health and may require medical or surgical intervention to prevent 
one of the other outcomes listed in this definition.  
5. Reporting. Adverse events experienced by participants will be reported using the GSU 
IRB's password protected on-line adverse event reporting system, as follows:  

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IRB Reporting Requirements for Adverse Events  
Internal Adverse Events. An internal adverse event is reportable if the occurrence meets all 
three of these conditions: 1) is unexpected, 2) is related or possibly related to participation in 
the research, and 3) is serious or places participants or others at greater risk of 
physical/psychological harm than was previously known or recognized. Internal adverse 
events are not reportable under these conditions: 1) expected and not more prevalent than 
expected, whether related or unrelated, and 2) unexpected and unrelated, regardless of 
seriousness, aside from death.  
 
Internal Deaths. All internal deaths occurring during the conduct of the study or 30 days 
post-termination from protocol are required to be reported as adverse events even if they 
are expected or unrelated.  
 
IRB Reporting Schedule for Adverse Events 
For any unexpected and related or possibly related, serious or more prevalent event 
occurring during a research study, a report must be made through GSU’s online reporting 
system as soon as possible but no later than 10 working days after the investigator first 
learns of the event. All other (expected adverse events) are reported as aggregate data at 
the time of IRB continuing review.  
 
Report of Changes or Amendments to the Protocol  
The annual DSM report will describe any minor actions or changes with respect to the 
protocol. In the unlikely event that major changes are required, Dr. Gilmore will discuss the 
needed changes with the NIDA Program Official first, reach a consensus agreement on the 
changes with the Program Official, and then provide a written description of the changes to 
NIDA.  
 
A Data Safety and Monitoring Board (DSMB) will be led by Dr. Kathleen Baggett, the 
Director of the Mark Chaffin Center for Health Development at GSU. Dr. Baggett will serve 
as the Security Officer and will convene the DSMB quarterly to review and ensure the on-
going safety of the participants. With the help of Dr. Baggett, Dr. Gilmore will appoint other 
members of the DSMB who are not involved on the project prior to beginning the 
randomized pilot trial.  
 
 
13. Confidentiality 
Regarding data management and storage, all data will be collected using computerized self-
report questionnaires. Only participants’ study identification codes will be inputted computer-
based databases. The codes that link the name of the participant and the study ID will be 
kept confidential in a secured cabinet or in a password-protected file on the encrypted GSU 
Enterprise Dropbox account, and then destroyed at the end of the study. The data will be 
imported directly into a password-protected SPSS data file stored on the GSU server. The 
server is protected by the GSU network, and a secured log-in is required from all users. In 
addition to these precautions, all personnel will have earned at least a bachelor’s degree 
and have experience in conducting research. All research personnel collecting and 
manipulating data will have completed a Human Subjects Research Training and will meet 
weekly with the candidate to ensure strict compliance with the DSM plan. Only study 
personnel (Dr. Gilmore, research staff, and mentorship team) will have access to data. No 
data will be released to other agencies unless participants consent to release. Audio 
recordings of therapy and data collection sessions will be used solely for research purposes. 

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Audio files will be stored on an encrypted hard drive at the research office, digital recordings 
will only be identified by numeric codes, and recordings will be destroyed at the end of the 
study. Only the candidate, project staff, and mentorship team will hear the content of the 
audio recordings.  
 
 
14. References 
1. Gilmore, A. K., Lewis, M. A., & George, W. H. (2015). A randomized controlled trial 
targeting alcohol use and sexual assault risk among college women at high risk for 
victimization. Behaviour Research and Therapy. Advance online publication. doi: 
10.1016/j.brat.2015.08.007 
2. Gilmore, A. K., Maples-Keller, J. L., Pinsky, H. T., Shepard, M. E., Lewis, M. A., George, 
W. H. (in press). Is the use of protective behavioral strategies associated with college 
sexual assault victimization? A prospective examination. Journal of Interpersonal 
Violence. 
3. Bird, E. R., Gilmore, A. K., George, W. H., & Lewis, M. A. (2015). The role of social 
drinking factors in the relationship between incapacitated sexual assault and drinking 
before sexual activity. Addictive Behaviors. Advance online publication.doi: 
10.1016/j.addbeh.2015.08.001 
4. Neilson, E. C., Gilmore, A. K., Pinsky, H. T., Shepard, M. E., Lewis, M. A., & George, W. 
H. (2015). The use of drinking and sexual assault protective behavioral strategies: 
Associations with sexual victimization and revictimization among college women. Journal 
of Interpersonal Violence. Advance online publication. doi: 10.1177/0886260515603977 
5. Gilmore, A. K., Granato, H. F., Wilson, S., & George, W. H. (2016). Sexual assault and 
heavy episodic drinking in college women: Differences between Asian/Pacific Islander 
ancestry and European ancestry. Psychology of Women Quarterly. Manuscript accepted 
for publication. 
6. Bountress, K. E., Metzger, I. W., & Gilmore, A. K. (under review). Reducing sexual risk 
behaviors: A web-based alcohol intervention for underage, heavy episodic drinking 
college women. Manuscript under review for publication. 
7. Gilmore, A. K., & Bountress, K. E. (under review). Reducing drinking to cope among 
heavy episodic drinking college women: A web-based combined alcohol use and sexual 
assault risk reduction intervention. Manuscript under review for publication. 
8. Gilmore, A. K., Bird, E. R., Neilson, E., George, W. H., & Norris, J. (under review). 
Understanding sexual assault risk perception in college: Relations among sexual assault 
history, drinking to cope, and trauma symptoms. Manuscript under review for publication. 
9. Walsh, K., Resnick, H. S., Danielson, C. K., McCauley, J. L., Saunders, B. E., & 
Kilpatrick, D. G. (2014). Patterns of drug and alcohol use associated with lifetime sexual 
revictimization and current posttraumatic stress disorder among three national samples 
of adolescent, college, and household-residing women. Addictive Behaviors, 39, 684-
489. doi: 10.1016/j.addbeh.2013.12.006 
10. Danielson, C. K., McCart, M. R., Walsh, K., de Arellano, M. A., White, D., & Resnick, H. 
S. (2012). Reducing substance use risk and mental health problems among sexually 
assaulted adolescents: A pilot randomized controlled trial. Journal of Family Psychology, 
26, 628-635. doi: 10.1037/a0028862 
11. Walsh, K., Danielson, C. K., McCauley, J., Hanson, R. F., Smith, D. W., Resnick. H. S, 
Saunders, B. E., & Kilpatrick, D. G. (2012). Longitudinal trajectories of posttraumatic 
stress disorder symptoms and binge drinking among adolescent girls: The role of sexual 
victimization. Journal of Adolescent Health, 50, 54-59. doi: 
10.1016/j.adolhealth.2011.05.017 
12. Danielson, C. K., McCart, M. R., de Arellano, M. A., Macdonald, A., Doherty, L. S., & 

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Resnick, H. S. (2010). Risk reduction for substance use and trauma-related 
psychopathology in adolescent sexual assault victims: Findings from an open trial. Child 
Maltreatment, 15, 261-268. doi: 10.1177/1077559510367939 
13. Livingston, J. A., Testa, M., Windle, M., & Bay-Cheng, L. Y. (2015). Sexual risk at first 
coitus: Does alcohol make a difference? Journal of Adolescence, 43, 148-158. doi: 
10.1016/j.adolescence.2015.05.108 
14. Testa, M., Hoffman, J. H., Livingston, J. A., & Turrisi, R. (2010). Preventing college 
women’s sexual victimization through parent based intervention: A randomized 
controlled trial. Prevention Science, 11, 308-318. doi: 10.1007/s11121-010-0168-3. 
15. Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. 
(2016). Monitoring the future national survey results on drug use: 2015 overview key 
findings on adolescent drug use. Ann Arbor, MI: Institute for Social Research, The 
University of Michigan. 
16. Liu, G., Hariri, S., Bradley, H., Gottlieb, S. L., Leichliter, J. S., & Markowitz, L. E. (2015). 
Trends and patterns of sexual behaviors among adolescents aged 14 to 59 years, 
United States. Sexually Transmitted Diseases, 42, 20-26. doi: 
10.1097/OLQ.0000000000000231 
17. Bureau of Justice Statistics. (2006). Criminal victimization in the United States, 2005 
statistical tables: National Crime Victimization Survey. US Department of Justice 
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18. Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., 
Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence 
Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury 
Prevention and Control, Centers for Disease Control and Prevention. 
19. Schram, P., Harris, S. K., Van Hook, S., Forman, S., Mezzacappa, E., Pavlyuk, R., & 
Levy, S. (2015). Implementing adolescent screening, brief intervention, and referral to 
treatment (SBIRT) education in a pediatric residency curriculum. Substance Abuse, 36, 
332-338. doi: 10.1080/08897077.2014.936576 
20. Hofer, A. N., Abraham, J. M. & Moscovice, I. (2011). Expansion of coverage under the 
Patient Protection and Affordable Care Act and primary care utilization. The Milbank 
Quarterly, 89, 69-89. doi: 10.1111/j.1468-0009.2011.00620.x 
21. Danielson, C. K., McCauley, J. L., Jones, A. M., Borkman, A. L., Miller, S., & Ruggiero, 
K. J. (2013). Feasibility of delivering evidence-based HIV/STI prevention programming to 
a community sample of African American teen girls via the internet. AIDS Education and 
Prevention, 25, 394-404. doi: 10.1521/aeap.2013.25.5.394 
22. Bountress, K. E., Adams, Z. W., Gilmore, A. K., Amstadter, A. B., Thomas, S., & 
Danielson, C. K. (under review). Alcohol use based on trauma exposure and 
posttraumatic stress disorder: Differences in impulsivity. Manuscript under review. 
23. Danielson, C. K., Bountress, K. E., Gilmore, A. K., Amstadter, A. B., Thomas, S., & 
Adams, Z. W. (under review). Depressive symptoms, avoidant coping, and alcohol use: 
Differences based on race, gender, and posttraumatic stress disorder. Manuscript under 
review. 
24. Gilmore, A. K., Davis, M. T., Grubaugh, A., Resnick, H. Birks, A., Denier, C., Muzzy, W., 
Tuerk, P., & Acierno, R. (under review). “Do you expect me to receive PTSD care in a 
setting where most of the other patients remind me of the perpetrator?”: Home-based 
clinical videoconferencing to address barriers to care unique to military sexual trauma 
and Veterans Affairs hospitals. Manuscript under review. 
25. Gilmore, A. K., Walsh, K., Badour, C. L., Ruggiero, K. J., Kilpatrick, D. G., & Resnick, H. 
S. (under review). Forcible and drug- or alcohol-facilitated/incapacitated rape histories in 
a national study of women: Differences in suicidal ideation, posttraumatic stress 
disorder, and substance abuse. Manuscript under review. 

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26. Scott-Sheldon, L. A., Carey, K. B., Cunningham, K., Johnson, B. T., Carey, M. P., & 
MASH Research Team. (2016). Alcohol use predicts sexual decision-making: A 
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27. Satterwhite, C. L., Torrone, E., Meites, E., Dunne, E. F., Mahajan, R. , Ocfemia, M. C., 
Su, J., Xu, F., & Weinstock, H. (2013). Sexually transmitted infections among US women 
and men: prevalence and incidence estimates, 2008. Sex Transmitted Diseases. 40, 
187-93. doi: 10.1097/OLQ.0b013e3192868bb53 
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public costs of teen child-bearing — key data. (2013). Retrieved from: 
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it-up-key-data- 2013-update.pdf 
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military service academies, academic program year 2014-2015. Retrieved from: 
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31. Lewis, M. A., Patrick, M. E., Lee, D. M., Atkins, D. C., Kim, T., Blayney, J. A., Norris, J., 
George, W. H., & Larimer, M. E. (2014). Randomized controlled trial of a web-delivered 
personalized normative feedback intervention to reduce alcohol-related risky sexual 
behavior among college students. Journal of Consulting and Clinical Psychology, 82, 
429-440. doi: 10.1037/a0035550 
32. Abbey, A., Zawacki, T., Buck, P. O., Clinton, A. M., & McAuslan, P. (2004). Sexual 
assault and alcohol consumption: What do we know about their relationship and what 
types of research are still needed? Aggression and Violent Behavior, 9, 271-303. 
33. National Institute on Drug Abuse (2016). Trends & statistics. Retrieved from 
http://www.drugabuse.gov/related-topics/trends-statistics#costs 
34. CDC (2013). Incidence, prevalence, and cost of sexually transmitted infections in the 
United States. Retrieved from: http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-
2013.pdf 
35. National Campaign to Prevent Teen and Unplanned Pregnancy. Counting It Up: The 
Public Costs of Teen Childbearing 2013. Retrieved from: 
http://thenationalcampaign.org/why-it-matters/public-cost 
36. DeLisi, M., Kosloski, A., Sween, M., Hachmeister, E., Moore, M., & Drury, A. (2010). 
Murder by number: Monetary costs imposed by a sample of homicide offenders. The 
Journal of Forensic Psychiatry & Psychology, 21, 501-513. 
37. George, W. H., & Stoner, S. A. (2000). Understanding acute alcohol effects on sexual 
behavior. Annual Review of Sex Research, 11, 92-124. 
38. Hendershot, C. S., & George, W. H. (2007). Alcohol and sexuality research in the AIDS 
era: Trends in publication activity, target populations and research design. AIDS and 
Behavior, 11, 217–226. 
39. Testa, M., & Livingston, J. A. (2009). Alcohol consumption and women's vulnerability to 
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