A Randomized Controlled Trial of an Emergency Department–Based Interactive Computer Program to Prevent Alcohol Misuse Among Injured Adolescents
Received 19 March 2004; received in revised form 13 September 2004 and 12 October 2004; accepted 13 October 2004. published online 15 February 2005.
Study objective
To determine whether an emergency department (ED)–based laptop computer intervention reduces the normative age-related increase in alcohol misuse compared with standard of care.
Methods
This was a randomized controlled trial conducted from October 11, 1999, to April 14, 2001, in a community teaching hospital and university medical center. Subjects were aged 14 to 18 years and with a minor injury. Controls and intervention participants completed a computer-based questionnaire. Intervention participants also completed a laptop-based interactive computer program to affect alcohol misuse. Main outcome measures were Alcohol Misuse Index (Amidx) and binge-drinking episodes. Follow-up occurred by telephone at 3 and 12 months. Analysis included repeated-measures analysis of variance (α=0.05; power 0.80; effect size 0.10).
Results
Three hundred twenty-nine participants were randomized to the intervention group, and 326 participants were randomized to the control group. Two hundred ninety-five (89.7%) intervention subjects and 285 (87.4%) control subjects completed 3- and 12-month follow-ups. For intervention and control groups, respectively, mean age was 16.0 and 15.9 years and men composed 66.8% and 66.3% of the groups; Amidx scores were 2.2 and 2.0; binge-drinking episodes were 1.2 and 1.0. Outcomes for intervention and control, respectively, were Amidx (3 months) 1.5 and 1.4; Amidx (12 months) 1.8 and 2.1; binge drinking (3 months) 0.9 and 0.8; and binge drinking (12 months) 1.4 and 1.2. Overall, there were no significant effects (effect size 0.04). No detrimental effects were noted. Subgroup analysis suggested that the intervention may have an effect among subjects with experience drinking and driving (5% of the sample).
Conclusion
The intervention was not effective in decreasing alcohol misuse among the study population. Further research will be required to determine effectiveness among the subgroup of adolescent minor injury patients who have experience drinking and driving.
SEE EDITORIAL, P. 430.
From the University of Michigan Injury Research Center (Maio, Shope, Blow, Gregor, Weber, Nypaver), the Department of Emergency Medicine (Maio, Gregor, Weber, Nypaver), the University of Michigan Transportation Research Institute (Shope, Zakrajsek), and the School of Public Health (Shope), University of Michigan, Ann Arbor, MI; and the Department of Psychiatry, Department of Veterans Affairs/Health Services Research and Development (Blow), Ann Arbor, MI
Address for reprints: Ronald F. Maio, DO, MS, University of Michigan Injury Research Center, Department of Emergency Medicine, 300 N. Ingalls, Room 2D06, Ann Arbor, MI 48109-0437; 734-936-1724, fax 734-936-2706
Author contributions: RFM, JTS, FCB, and MAG conceived the study, designed the trial, and obtained research funding. MAG, JEW, and MMN supervised the conduct of the trial and data collection. MAG managed the data, including quality control. JTS and JSZ headed the planning of and conducted the analysis. RFM drafted the manuscript. All authors contributed substantially to its revision. RFM takes responsibility for the paper as a whole.
Funding and support: Funded by the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, R49-CCR-515413.
Presented at the Society for Academic Emergency Medicine annual meeting, May 2003, Boston, MA.
ABSTRACT