PROJECT SUMMARY Children’s first exposure to alcohol often occurs within their homes, under the supervision of their parents. Early onset alcohol use and permissive parental attitudes about adolescent alcohol use predict subsequent alcohol problems. Family-oriented preventive interventions are generally most effective, but most interventions are delivered in schools. Home-based family interventions are resource intensive and difficult to implement on a wide scale; thus, their reach and sustainability are limited. The long-term objective of this R34 Planning Grant is to develop and assess feasibility of an initial version of the Brief Intervention to Prevent Alcohol Socialization (BI-PAS), which will be delivered to parents of rising 6th graders by pediatric healthcare practitioners during the annual well-child visit. Messages contained within the brief encounter with providers will be bolstered by weekly text messages that contain tailored intervention content based on parents’ self-reported attitudes about adolescent alcohol use. As a primary care-based intervention, BI-PAS will have a wide reach because of the non-stigmatizing intervention context. Entry into middle school is the ideal time for a primary care-based intervention because the schedule of required booster immunizations ensures access to difficult-to-reach populations. Furthermore, this intervention may provide a way to meet American Academy of Pediatrics standards regarding anticipatory guidance for parents about adolescent alcohol use. We have two specific aims. First, we will develop and optimize the BI-PAS intervention message content and delivery through semi- structured qualitative interviews with parents and pediatric providers. Our second aim is to conduct a pilot study to assess feasibility, implementation, and parental engagement over time. In our design, we will recruit providers in two large pediatric clinics (one treatment clinic and one comparison clinic). We will train all providers from the treatment clinic to implement BI-PAS with 50 parents of rising 6th graders. The 50 parents in the comparison group will follow the same study protocol as the treatment parents but will not receive the provider intervention or tailored text messages. All 100 parents in the study will complete repeated assessments of alcohol-related attitudes and behaviors at baseline and monthly for 6 months after baseline. Treatment families will receive weekly intervention messages that are tailored based on their most recent assessments. Providers will use implementation checklists to track implementation quality. They will also participate in a follow-up interview at the conclusion of the study to assess feasibility and barriers to implementation. Primary analyses will assess implementation of intervention components, parental engagement with intervention material over time, BI-PAS implementation quality, and change in permissive parental attitudes over time in the treatment group compared to t...