Project Overview +

Project START uses a personal digital assistant-based screening instrument and tailored print materials and tests their effectiveness in reducing alcohol use and alcohol-related problems among injured hazardous drinkers treated in the Emergency Department.

Aims +

Aim 1. Assess outcomes in alcohol use, health status, and psychosocial factors for subjects participating in an Emergency Department tailored message study.

Aim 2. Determine if tailored messages are significantly more effective than generic messages in changing alcohol use, health status, and psychosocial factors among injured ED patients.

Aim 3. Determine if brief advice, in conjunction with tailored messages is more effective in changing alcohol use, health status, and psychosocial factors among injured ED patients than are tailored messages alone.

Participants +

575 injured adult patients presenting to a university hospital ED between August 1999 and February 2002.

Intervention +

This study uses a randomized controlled trial to test the effectiveness of tailored versus generic messages, given with or without brief advice, at reducing alcohol consumption and consequences among injured adult patients in an ED setting.

All at-risk drinkers are randomly assigned to one of four intervention conditions:

  • tailored message booklet with brief advice
  • tailored message booklet only
  • generic message booklet with brief advice
  • generic message booklet only

A 12-page color, similarly formatted, tailored or generic booklet is automatically printed for each participant, depending on group assignment. Interventions occur during the participants' ED visit and are preceded by a saliva alcohol test to assess patient competency. The intervention proceeds once the patient's blood alcohol concentration reaches 100 mg/dL or less.

For the brief advice conditions, the research social worker conducts a brief advice session before participant leaves the ED. During the advice session, the booklet, either tailored or generic, is reviewed with the participant. Research social workers are trained in principles of motivational interviewing. Participants receive telephone follow-up interviews at 3 months and 12 months.

Findings +

Each of the intervention groups significantly decreased their alcohol consumption from baseline to 12-month follow-up; subjects in the tailored message booklet with brief advice group significantly decreased their average weekly alcohol consumption by 48.5% (p < .0001).

Those in the brief advice conditions (tailored or generic) significantly decreased their average consumption during the 12 months of the study compared with the no brief advice conditions.

Younger adult women (ages 19-22) who received some brief advice were the most likely to decrease their heavy episodic drinking.

Conclusion +

This was the first large-scale, brief intervention trial that included development and testing of computerized, highly tailored interventions with injured drinkers in the ED. ED-based interventions for alcohol problems would benefit from computerized screening, brief advice, and booklets to positively impact risky drinking practices.