ED Intervention Modestly Alters Teens' Behaviors

Article excerpt

A brief intervention in the emergency department resulted in modest reductions in violence and alcohol use, according to a randomized, controlled trial involving 726 adolescents.

The teenagers, all of whom reported violence and alcohol abuse during the past year, were randomized to receive either a brochure (the control condition) or a 35-minute intervention delivered via computer or by a therapist. Both interventions were targeted at alcohol use and violence and were based on motivational interviewing techniques and skills training. The interventions included a review of goals, tailored feedback, a decisional balance exercise, role plays, and referrals, wrote Maureen A. Walton, Ph.D., of the University of Michigan, Ann Arbor, and her colleagues (JAMA 2010;304:527-35).

On every violence-related measure, all three groups, including the control group, showed substantial declines from baseline at 3 months and again at 6 months. For example, at baseline 83% of the therapist group, 76% of the computer group, and 78% of the control group reported severe peer aggression during the past year. At 3 months the percentages reporting aggression were 48%, 54%, and 62%, respectively, and at 6 months they were 45%, 49%, and 49%.

Similarly, all three groups showed substantial declines in every alcohol-related measure at 3 months and additional declines in most alcohol-related measures at 6 months. For example, at baseline 53% of the therapist group, 49% of the computer group, and 54% of the control group reported binge drinking. At 3 months the percentages declined to 34%, 29%, and 35%, respectively, and at 6 months they were 33%, 33%, and 34%.

Included in the study were adolescents aged 14-18 years who were being seen in a level I trauma center for a variety of reasons. Excluded were teens experiencing suicidal ideation, abnormal vital signs, insufficient cognitive orientation, and several other conditions. Of 3,764 patients approached for screening, 446 refused and 2,509 did not meet inclusion criteria, the most important of which was reported alcohol use and reported violence within the past year. More than 100 others refused participation, leaving 726 to be randomized. A total of 626 completed the 6-month assessment.

Several of the between-group differences were statistically significant. Compared with those in the control group, teenagers in the therapist group were significantly less likely to report severe peer aggression, an experience of peer violence, or consequences of violence at 3 months. None of those differences were statistically significant at 6 months. At 6 months, but not at 3 months, those in the therapist group reported significantly fewer alcohol consequences than controls.

The investigators reported several encouraging results from a number-need-ed-to-treat analysis. …