A Randomized Controlled Trial
JAMA. 2010;304(5):527-535. doi:10.1001/jama.2010.1066
Context Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury.
Objective To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED.
Design, Setting, and Participants Between September 2006 and September 2009, 3338 patients aged 14 to 18 years presenting to a level I ED in Flint, Michigan, between 12 PM and 11 PM 7 days a week completed a computerized survey (43.5% male; 55.9% African American). Adolescents reporting past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens).
Intervention All patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n = 235) or a 35-minute brief intervention delivered by either a computer (n = 237) or therapist (n = 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included review of goals, tailored feedback, decisional balance exercise, role plays, and referrals.
Main Outcome Measures Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences.
Results About 25% (n = 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, –34.3%; control, –16.4%; relative risk [RR], 0.74; 95% confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, –10.4%; control, +4.7%; RR, 0.70; 95% CI, 0.52-0.95), and violence consequences (therapist, –30.4%; control, –13.0%; RR, 0.76; 95% CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, –32.2%; control, –17.7%; odds ratio, 0.56; 95% CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, –29.1%; control, –17.7%; odds ratio, 0.57; 95% CI, 0.34-0.95).
Conclusion Among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences.
Trial Registration clinicaltrials.gov Identifier: NCT00251212
Author Affiliations: Department of Psychiatry (Drs Walton, Chermack, and Blow), School of Public Health (Drs Shope, Bingham, Zimmerman, and Cunningham), Transportation Research Institute (Drs Shope and Bingham), and Injury Prevention Center, Department of Emergency Medicine (Dr Cunningham), University of Michigan, and Health Services Research and Development, Department of Veterans Affairs (Drs Chermack and Blow), Ann Arbor; and Hurley Medical Center, Flint, Michigan (Dr Cunningham).
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