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JAMA. 2010 Aug 4;304(5):527-35. doi: 10.1001/jama.2010.1066.

Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial.

Author information

1
Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA. waltonma@umich.edu

Abstract

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.

PMID:
20682932
PMCID:
PMC3560393
DOI:
10.1001/jama.2010.1066
[Indexed for MEDLINE]
Free PMC Article

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