A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking.
A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking.
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DOI：
10.1111/j.1553-2712.2010.00818.x
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发表时间：
2010-08
期刊：
影响因子：
--
通讯作者：
Bernstein E
中科院分区：
文献类型：
--
作者：
Bernstein J;Heeren T;Edward E;Dorfman D;Bliss C;Winter M;Bernstein E
在美国，十几岁和二十岁出头的青少年饮酒量最高;酗酒的高峰在21岁。未成年人饮酒与许多负面后果有关，包括学业问题以及故意和无意伤害的风险。这项研究测试了儿科急诊科（PED）筛查和简短干预对减少饮酒和相关风险的有效性。一项三组随机分配试验旨在测试干预组（I）和标准评估对照组（AC）从基线至12个月的饮酒量和酒精相关行为的差异，并将AC组与最低评估对照组（MAC）进行比较，以调整评估反应对对照组行为的影响。年龄在14 - 21岁之间的患者如果在酒精使用障碍识别测试（AUDIT）或酗酒或高风险行为中筛选出阳性，则符合资格。MAC小组收到了一份资源讲义，关于酒精相关风险的书面建议，以及12个月的随访预约。AC组患者除MAC方案外，还使用标准化仪器进行评估。干预组接受同伴指导的动机干预，向社区资源和治疗（如有指征）提供帮助，并在评估的基础上进行为期10天的强化治疗。测量包括30天饮酒量和酒精相关行为的自我报告，抑郁症和创伤后应激障碍的筛查，以及尝试戒烟，减少或改变使用条件的自我报告，所有这些都在随访时重复。还分析了机动车记录和医疗记录从基线到一年随访的变化。在筛选的7，807例PED患者中，1，202例合格; 853例入组（I n = 283; AC n = 284; MAC n = 286），12个月随访率为72%。在12个月时，超过一半的RAP（接触青少年预防）登记者试图减少饮酒，超过三分之一的人试图戒烟。与AC注册者相比，I组中有更大比例的人努力戒酒并在饮酒时小心，I组中努力减少饮酒的可能性在数字上更大，但并不显着（p = 0.065）。在三个月的时间里，I组试图削减开支的可能性几乎是AC组的三倍。对于戒烟的努力，这是两倍，并且在饮酒时要小心的情况下，I组的优势比增加了72%。三个月的尝试结果持续到12个月的戒烟尝试和努力小心。从基线到3个月到12个月，两组的饮酒量都有所下降，但在12个月时酒精相关后果或酒精相关风险行为方面，两组之间没有显著差异。我们发现，在12个月时，仅在一个变量中存在提示评估反应的模式：尝试减量（I组为73.3%，AC组为64.9%，MAC组为54.8%）。简短的动机干预导致了改变行为的重大努力（戒酒和饮酒时要小心），但没有改变组间消费或后果。
Adolescents in their late teens and early twenties have the highest alcohol consumption in the United States; binge drinking peaks at age 21 years. Underage drinking is associated with many negative consequences, including academic problems and risk of intentional and unintentional injuries. This study tested the effectiveness of pediatric emergency department (PED) screening and brief intervention to reduce alcohol consumption and associated risks. A three-group randomized assignment trial was structured to test differences between intervention (I) and standard assessed control (AC) groups in alcohol consumption and alcohol-related behaviors from baseline to 12 months, and to compare the AC group with a minimally assessed control group (MAC) to adjust for the effect of assessment reactivity on control group behavior. Patients aged 14–21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test (AUDIT), or for binge drinking or high-risk behaviors. The MAC group received a resource handout, written advice about alcohol-related risks, and a 12-month follow-up appointment. Patients in the AC group were assessed using standardized instruments in addition to the MAC protocol. The intervention group received a peer-conducted motivational intervention, erral to community resources and treatment if indicated, and a ten-day booster in addition to assessment. Measurements included 30 day self-report of alcohol consumption and alcohol-related behaviors, screens for depression and posttraumatic stress disorder, and self-report of attempts to quit, cut back, or change conditions of use, all repeated at follow-up. Motor vehicle records and medical records were also analyzed for changes from baseline to one year follow-up. Among 7,807 PED patients screened, 1,202 were eligible; 853 enrolled (I n = 283; AC n = 284; MAC n = 286), with a 12-month follow-up rate of 72%. At 12 months, more than half of enrollees in RAP (Reaching Adolescents for Prevention) attempted to cut back on drinking, and over a third tried to quit. A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees, and there was a numerically but not significantly greater likelihood (p = 0.065) among the I group for efforts to cut back on drinking. At three months, the likelihood of the I group making attempts to cut back was almost triple that of ACs. For efforts to quit, it was double, and for trying to be careful about situations when drinking, there was a 72% increase in the odds ratio for the I group. Three-month results for attempts were sustained at 12 months for quit attempts and efforts to be careful. Consumption declined in both groups from baseline to 3 months to 12 months, but there were no significant between-group differences in alcohol-related consequences at 12 months, or in alcohol-related risk behaviors. We found a pattern suggestive of assessment reactivity in only one variable at 12 months: the attempt to cut back (73.3% for the I group vs. 64.9% among the AC group, and 54.8% among the MAC group). Brief motivational intervention resulted in significant efforts to change behavior (quit drinking and be careful about situations while drinking) but did not alter between-group consumption or consequences.
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