Table 1.

Trials to Improve Physician Provision of Alcohol Use Prevention Services with Adolescent Outpatients

Citation	Setting and Target Population	Study Sample	Study Design and Conditions	Experimental Intervention	Clinician Behavior Change or Fidelity	Adolescent Outcomes	Authors’ Observed Limitations
Boekeloo, Jerry, Lee- Ougo, Worrell, Hamburger, Russek- Cohen, & Snyder, 2004 [35]	Setting: Managed care organization primary care group practices Sample Frame: English speaking, adolescents receiving a general health examination (892 eligibles) Location: Washington, DC & Maryland metro area	Number Participants: 26 physicians; 409 adolescent patients Participant Characteristics: Physicians: 77% Female; 50% White; 35% African American Adolescents: 56% Female; 79% African American Age range: 12–17 years	Design: Randomized Controlled Trial (RCT) with 6 and 12 month follow up Conditions: 1)Usual care plus 15 minutes of listening to radio of choice 2) 15 minute audio program with self- assessment and general health examination 3) Same as Group 2 and researchers placed study brochure, adolescent self- assessment answer sheet, and self- assessment template in bag on examination room door for physicians’ use.	Interventionist: 1) Physician 2) Physician 3) Physician Format: 1) Individual 2) Individual 3) Individual Length: >15 minutes >15 minutes >15 minutes	It was reported that 86.7% of adolescents in Group 3 saw their physicians look at their alcohol risk assessments. 41.5% of adolescents in Group 3 reported that their physician had discussed the brochure information with them, and 66% of the same adolescents reported that their physician had given them information about alcohol.	Knowledge/Attitudes: Behaviors: Group 3 adolescents were significantly more likely (odds ratio 2.08) to refuse alcohol at 6 month follow up. However, Groups 2 and 3 were also at least 3 times as likely to have binged within the previous 3 months at the 6 month follow up. At 12 month follow up, Groups 2 and 3 were again at least 3 times as likely to have binged in the previous 3 months.	Potential limitations included reliance on self-report data, dissimilarity of the study groups, and potential for more honest reporting by intervention adolescents.
Grossberg, Brown, & Fleming, 2004 [36]	Setting: 17 primary care clinics Sample Frame: Patients were approached by a receptionist and asked to complete the Health Screening Survey. Male patients who drank more than 14 drinks per week and female patients who drank more than 11 drinks per week were then contacted by research staff and invited to participate in the study (850 eligibles). Location: southern Wisconsin	Number Participants: 226 patients Participant Characteristics: Physicians: 64 full-time family physicians and internists Adolescents: 51% female; 86% White, 5% African American; 53% aged 18–25, 47% aged 26–30;	Design: RCT with 6, 12, 24, 36, and 48 month follow up. Conditions: Patients randomized to: 1) Usual care 2) Brief intervention in which physician used a scripted workbook to review alcohol-related health effects, frequency of at-risk drinkers, methods to cut down on drinking, a treatment contract, and cognitive behavioral exercises.	Interventionist: 1) Physician 2) Physician Format: 1) Individual 2) Individual Length: 1) variable 2) 10–15 minutes per session	No data on physician fidelity was reported.	Knowledge/Attitudes: Behaviors: At the 6 month follow up, patients in the experimental condition significantly decreased their weekly alcohol consumption (42%). Weekly consumption between the 2 groups remained significantly different at 12, 24, and 36 month follow up periods as well. The patients in the experimental condition also experienced significantly less binge drinking episodes at 6, 12, and 48 month follow up periods when compared to the patients in the usual care condition (resulting in a difference of at least 15%). Those patients in the experimental condition also experienced significantly less emergency department visits, nonfatal motor vehicle accidents, and liquor violations than those in the usual care condition.	Potential limitations included the use of a brief intervention and the reliance on self-report data.
Stevens, Olson, Gaffney, Tosteson, Mott, & Starr, 2002 [37]	Setting: 12 pediatric primary care practices Sample Frame: Families with 5th or 6th grade students attending scheduled health supervision visits (3496 eligibles). Location: Massachusetts, Vermont, and New Hampshire	Number Participants: 92 physicians and nurse practitioners; 3145 families Participant Characteristics: Adolescents: Mean age: 11 years; 48% female; 57.6% had a family income of at least $50,000	Design: RCT with 12, 24, and 36 month follow up Conditions: 1) Alcohol and tobacco use counseling and education. 2) Gun safety, bicycle helmet use, and seatbelt use counseling and education. In both groups, all participants signed contracts to discuss the health issues and received a physician- signed agreement, a refrigerator magnet, and periodical newsletters.	Interventionist 1) Physician 2) Physician Format: 1) Family 2) Family Length: 1) variable 2) variable	Physician fidelity was determined by chart audit, calls, and routine visits from research coordinators. It was reported that the intervention was implemented as planned.	Knowledge/Attitudes Behaviors: A moderate increase in alcohol consumption was reported for adolescents in group 1 at 24 and 36 months (odds ratio of 1.27 and 1.30 respectively).	Potential limitations included the focus on many health behaviors, no true control group, and reliance on self- report data.