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ABSTRACT: The primary aim of this study was to identify distinct classes of trajectories of adolescent substance use following a brief motivational interviewing (MI) intervention in an Emergency Department (ED). The secondary aim was to identify predictors of class membership.
Latent growth mixture modeling was used with 177 adolescents who participated in two randomized clinical trials evaluating MI for an alcohol-related event.
Three classes were identified: (1) moderate use, decreasers consisting of 56.8% of participants; (2) heavy use, decreasers, consisting of 10.5% of participants, and (3) heavy use sustainers, consisting of 32.7% of participants. Hispanic ethnicity, parental monitoring, and days of high-volume drinking were significant predictors of class membership. Hispanic ethnic status and high levels of parental monitoring were associated with decreased likelihood of belonging to either of the two heavy use classes. More frequent high-volume drinking at baseline was associated with increased likelihood of belonging to the heavy use, sustainer class, and decreased likelihood of belonging to the heavy use, decreaser class. Across all three classes, being female and having frequent high-volume drinking at baseline were associated with worse response to the intervention.
These findings have important implications for identifying adolescents who may benefit from different or additional intervention, and for anticipating and informing families of adolescents' potential drinking course following treatment.
Drug and alcohol dependence 05/2012; 125(1-2):103-9. · 3.60 Impact Factor
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ABSTRACT: Motivational interviewing (MI) is widely used for adolescent smoking cessation but empirical support for this approach is mixed.
Adolescent cigarette smokers 14-18 years old (N=162) were recruited from medical, school, and community settings and randomly assigned to enhanced MI or brief advice (BA) for smoking cessation. MI comprised an in-person individual session, a telephone booster session one week later, and a brief telephone-based parent intervention. BA consisted of standardized brief advice to quit smoking. Assessments occurred at baseline, post-treatment and at 1-, 3-, and 6-month follow ups.
Biochemically-confirmed 7-day point prevalence abstinence rates were low (e.g., 4.5% for MI; 1.4% for BA at 1 month) and did not differ significantly by group at any follow up. Only those in MI reported significant decreases in cigarettes smoked per day (CPD) from baseline to 1 month. At 3 and 6 months, smokers in both groups reported significantly reduced CPD with no differences between groups. MI reduced perceived norms regarding peer and adult smoking rates, while BA had no effect on normative perceptions. No group differences emerged for self-reported motivation or self-efficacy to quit smoking.
Findings support the efficacy of MI for addressing normative misperceptions regarding peer and adult smoking and for modestly reducing CPD in the short-term; however, these effects did not translate to greater smoking abstinence. MI may have more promise as a prelude to more intensive smoking intervention with adolescents than as a stand-alone intervention.
Addictive behaviors 03/2012; 37(7):817-23. · 2.25 Impact Factor
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ABSTRACT: To determine whether a brief individual motivational interview (IMI) plus a family motivational interview (Family Check-Up [FCU]) would reduce alcohol use in adolescents treated in an emergency department after an alcohol-related event more effectively than would an IMI only.
Two-group randomized design with 3 follow-up time points.
An urban regional level I trauma center.
Adolescents aged 13 to 17 years (N = 125) with a positive blood alcohol concentration as tested using blood, breath, or saliva.
Either IMI or IMI plus FCU.
Drinking frequency (days per month), quantity (drinks per occasion), and frequency of high-volume drinking (≥5 drinks per occasion).
Both conditions resulted in a reduction in all drinking outcomes at all follow-up points (P < .001 for all), with the strongest effects at 3 and 6 months. Adding the FCU to the IMI resulted in a somewhat better outcome than did the IMI only on high-volume drinking days at 3-month follow-up (14.6% vs 32.1%, P = .048; odds ratio, 2.76; 95% confidence interval, 0.99-7.75).
Motivational interventions have a positive effect on drinking outcomes in the short term after an alcohol-related emergency department visit. Adding the FCU to an IMI resulted in somewhat better effects on high-volume drinking at short-term follow-up than did an IMI only. The cost of extra sessions necessary to complete the FCU should be weighed against the potential benefit of reducing high-volume drinking when considering adding the FCU to an IMI for this population.
Archives of pediatrics & adolescent medicine 03/2011; 165(3):269-74. · 3.73 Impact Factor
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ABSTRACT: The current study compared 3 groups of adolescents identified in an emergency department (ED) following an alcohol-related event: (1) alcohol-positive adolescents scoring at or above the clinical cutoff on a measure of problematic drinking, the Adolescent Drinking Inventory (ADI) (n = 45); (2) alcohol-positive adolescents scoring below the clinical cutoff on the ADI (n = 68), and (3) alcohol-negative adolescents (n = 64). We examined whether these 3 groups of adolescents differed on measures of substance use as well as psychosocial factors.
Participants were recruited as part of a larger clinical trial. Alcohol-positive adolescents were recruited from a level I regional trauma center for treatment related to an alcohol-related incident. Alcohol-negative adolescents were recruited from the ED and the community. The data reported here were from the baseline adolescent and parent assessments. Before completing assessments, adolescents were required to pass a brief mental status examination.
Adolescents in the alcohol-positive, high-ADI group reported significantly more substance use, peer substance use, and peer tolerance of substance use than adolescents in the alcohol-positive, low-ADI group followed by adolescents in the alcohol-negative group. Adolescents in the alcohol-positive, high-ADI group reported significantly less parental supervision than adolescents in the other 2 groups.
These findings underscore that alcohol-positive adolescents being treated in an ED are a heterogeneous group with respect to substance use as well as parent and peer risk factors. Physicians need to consider relevant background factors when making individualized discharge recommendations.
Pediatric emergency care 06/2010; 26(6):417-23. · 0.92 Impact Factor
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ABSTRACT: To compare the characteristics of adolescents with and without a history of problematic alcohol use, who are treated in the emergency department (ED) for an alcohol-related problem.
Three hundred seventeen adolescents presenting to the ED after an alcohol-related incident were divided into 2 groups based on whether their score on the Adolescent Drinking Inventory reached the clinical cutoff on problematic drinking, and compared regarding current drinking, depression, and risk-taking behaviors.
Adolescents who reached the clinical cutoff on the Adolescent Drinking Inventory were older and reported more frequent drinking, greater depressed mood, and more risk-taking behaviors.
Of the adolescents presenting to the ED with an alcohol-related incident, those with a positive history of problematic drinking represent a particularly high-risk subgroup.
Pediatric emergency care 08/2008; 24(7):457-61. · 0.92 Impact Factor
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ABSTRACT: This study evaluated the efficacy of using a brief motivational intervention to reduce smoking among adolescent patients treated in a hospital outpatient clinic or Emergency Department. Patients aged 14-19 years (N=85) were randomly assigned to receive either one session of motivational interviewing (MI) or standardized brief advice (BA) to quit smoking. The assessment and intervention were conducted in the medical setting proximal to the patient's medical treatment. Patients were proactively screened and recruited, and were not seeking treatment for smoking. Follow-up assessments were conducted at 1, 3, and 6 months post-intervention. Self-report data indicated that 7-day abstinence rates at 6-month follow-up were significantly higher in the MI group than in the BA group, but this difference was not confirmed biochemically. Self-reported smoking rate (average cigarettes per day) was significantly lower at 1, 3, and 6 months follow-up than it was at baseline. Cotinine levels indicated reduced smoking for both groups at 6 months, but not at 1 month. At 3-month follow-up, only those in MI showed cotinine levels that were significantly reduced compared to baseline. Findings offer some support for MI for smoking reduction among non-treatment-seeking adolescents, but overall changes in smoking were small.
Addictive Behaviors 07/2005; 30(5):865-74. · 2.09 Impact Factor
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Current problems in pediatric and adolescent health care 11/2004; 34(9):322-39.
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ABSTRACT: We tested whether a brief motivational interview (MI) would reduce alcohol-related consequences and use among adolescents treated in an emergency department (ED) after an alcohol-related event. Patients aged 13 to 17 years (N = 152) with a positive blood alcohol concentration (BAC) by lab test or self-report were recruited in the ED and randomly assigned to receive either MI or standard care (SC). Both conditions resulted in reduced quantity of drinking during the 12-month follow-up, whereas alcohol-related negative consequences were relatively low and stayed low at follow-up. Adolescents who screened positive for problematic alcohol use at baseline reported significantly more improvement on 2 of 3 alcohol use outcomes (average number of drinking days per month and frequency of high-volume drinking) if they received MI compared with SC. We conclude that brief interventions are recommended for adolescents who present to an ED with an alcohol-related event and report preexisting problematic alcohol use.
Journal of Pediatrics 10/2004; 145(3):396-402. · 4.11 Impact Factor
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ABSTRACT: To determine the factors associated with physician decisions to test for alcohol involvement in adolescents treated in an emergency department (ED) and to examine patient and event characteristics associated with being identified as alcohol positive, either by testing or by clinical examination.
Medical chart reviews were conducted for all adolescent patients (n = 9,660; age range, 13-19 y) treated over a 1-year period in a Level I regional trauma center/ED.
Among all 9,660 patients in the ED, 298 (3.1%) were identified as alcohol positive by test or clinical examination. Of the 9,660 patients, 464 (4.8%) were tested for alcohol, and 49% of these had alcohol-positive test results. Physicians were more likely to order alcohol tests when patients were male, older, injured, and treated during the overnight shift or on weekends. Testing was most common for suicide attempts, motor vehicle crashes, assaults, and intoxication. Patients being treated for an illness or for occupational or athletic injuries were rarely tested. A large proportion of alcohol-related treatment was for intoxicated, uninjured patients, whose profile was different (ie, younger, more often female, with higher blood alcohol concentrations, and admission distributed more evenly across ED shifts).
Case detection rates for alcohol involvement may be biased and inflated when based on physician decisions to test for alcohol use. Rates based on comprehensive chart reviews and clinical examination may be better estimates but are also subject to methodologic limitations. Universal screening would yield the most accurate estimates of alcohol prevalence and would provide more accurate guidance to physicians regarding when to test for alcohol use. Universal screening as a clinical standard would help to identify more adolescents who might benefit from additional alcohol use intervention.
Pediatric Emergency Care 11/2002; 18(5):350-4. · 0.78 Impact Factor
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ABSTRACT: To determine whether a problem-solving intervention would increase adherence to outpatient treatment for adolescents after a suicide attempt.
Sixty-three adolescents who had attempted suicide and were evaluated in an emergency department between 1997 and 2000 were randomly assigned to undergo standard disposition planning or a compliance enhancement intervention using a problem-solving format. At 3 months after the intervention, all evaluable adolescents, guardians, and outpatient therapists were contacted to determine adherence to outpatient treatment.
At 3-month follow-up, the compliance enhancement group attended an average of 7.7 sessions compared with 6.4 sessions for the standard disposition group, but this difference was not statistically significant. However, after covarying barriers to receiving services in the community (such as being placed on a waiting list and insurance coverage difficulties), the compliance enhancement group attended significantly more treatment sessions than the standard disposition-planning group (mean = 8.4 versus 5.8 sessions).
Interventions designed to improve treatment attendance must address not only individual and family factors but also service barriers encountered in the community that can impede access to services.
Journal of the American Academy of Child & Adolescent Psychiatry 05/2002; 41(4):435-42. · 6.44 Impact Factor
