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Awarded Grant - Acute Care

Emergency Department (ED) Intervention to Reduce Risky Behaviors

FOA Number: CE03-023 - Grants for Acute Care, Rehabilitation and Disability Research
Project Period: 09/01/03–08/31/06
Application/Grant Number: 1-R49-CE523225-01
Principal Investigator: Marilyn S. Sommers, RN, PhD, FAAN
University of Cincinnati
P.O. Box 210038
Cincinnati, OH 45521-0038
Phone: 513-558-5268
Fax: 513-558-5647


Disability and death from injury remain a persistent problem in the United States, and risk-taking behaviors are known to contribute to injury. Healthy People 2010 set goals to reduce deaths caused by injury, including motor vehicle crash-related injuries: "Motor vehicle crashes are often predictable and preventable. Increased use of seat belts and reductions in driving while impaired are two of the most effective means to reduce the risk of death and serious injury of occupants in motor vehicle crashes." One preventive strategy to reduce this risk is to establish screening and intervention procedures that can be administered in the emergency department (ED) to young adults who have risky driving practices and alcohol-use problems.

The specific aim of this prospective, randomized controlled trial is to test the effectiveness of administering brief intervention in the ED to limit risky driving behaviors (i.e., risky driving practices, lack of seat belt use) and problem drinking in drivers. In addition, the trial will result in a cost-benefit analysis from the perspectives of both society as a whole and hospitals in particular.

Young adults ages 18 to 44 will be screened during an ED visit for problem drinking and risky driving practices. Subjects who screen positive for problem drinking and risky driving will be randomized to one of three groups: No Contact Control Group (after informed consent, subjects receive no screening or intervention until 12 months after injury); Contact Control Group (subjects screened at baseline and every 3 months for 12 months, but receive no intervention); and a Brief Intervention Group (subjects receive screening and brief intervention with data collection points every 3 months for 12 months). In each group, 133 subjects will be enrolled (N=400). The intervention will consist of a 20-minute nurse visit in the ED and a booster intervention at 7 to 10 days after ED discharge. All subjects will be telephoned at 3, 6, 9 and 6 months by interviewers blinded to condition.

Outcomes of interest include reported alcohol use, risky driving behaviors, driving citations, adverse health outcomes, and costs (i.e., health care use, property damage, travel delays, lost work productivity, criminal justice expenses, and monetarized adverse health outcomes).

Power analysis suggests that 133 subjects in each arm of the trial will have sufficient power to detect a difference in the main outcome variables of interest. A variety of regression techniques, including individual growth curve modeling and event history analysis, will be used to test the hypotheses.