Table 2.

Trials Comparing Physician to Non-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
Maio, Shope, Blow, Gregor, Zakrajsek, Weber, & Nypaver, 2005 [38]	Setting: Hospital emergency department Sample Frame: Non-intoxicated adolescents aged 14–18 with an acute minor injury whose parent/guardian was present to consent (843 eligibles). Location: Ann Arbor, Michigan and Flint, Michigan	Number Participants: 655 adolescent patients Participant Characteristics: Adolescents: Age range: 14–18 years; Mean age: 15.9 years (SD 1.5 years); 66% Male	Design: RCT with 3 and 12 month follow up Conditions: 1) Usual care 2) Usual care plus laptop-based interactive program addressing alcohol misuse	Interventionist: 1) Physician 2) Research assistant Format: 1) Individual 2) Individual Length: 1) Variable 2) Not reported	No data on physician fidelity was reported.	Knowledge/Attitudes: Behaviors: Those adolescents in the intervention group reported significantly less alcohol misuse and binge drinking at the 3 month follow up when compared to the control group. At the 12 month follow up, there were no significant differences among the two groups’ alcohol misuse and binge drinking.	Potential limitations included narrow recruitment time frame, reliance on self-report data, difference in data collection methods (computer at baseline and telephone at follow up), and difference of drop-out behaviors.
Spirito, Monti, Barnett, Colby, Sindelar, Rohsenow, Lewander, & Myers, 2004 [39]	Setting: Urban hospital emergency departments Sample Frame: English speaking, non-suicidal adolescents aged 13–17 with injury suffered while under influence of alcohol (287 eligibles) Location: Northeast United States	Number Participants: 152 adolescents Participant Characteristics: Adolescents: 64% Male; Mean age: 15.6 (SD of 1.2 years); 72% White; 17% Hispanic	Design: RCT with 3, 6, and 12 month follow up Conditions: 1) Standard care with a handout on avoiding drinking and driving. 2) Motivational interviewing with personalized education, counseling, assessments, and goal setting along with the handout to avoid drinking and driving.	Interventionist: 1) Physician 2) Research staff Format: 1) Individual 2) Individual Length: 1) 5 minutes 2) 35 to 45 minutes	Adherence to the study guidelines by research staff was measured by having interventionists and patients complete questionnaires to rate the delivery and utility of the protocol. Novice interventionists were also videotaped throughout the study.	Knowledge/Attitudes: Behaviors: Those adolescents in Group 2 with high alcohol involvement reported significantly less drinking days per month and significantly less high-volume drinking days when compared to those adolescents in Group 1 at each of the follow up periods.	Potential limitations included the high refusal rate, reliance on self-report data, and the difficulty in following up with school drop-outs.
Tait, Hulse, & Robertson, 2004 [40]	Setting: Hospital emergency departments Sample Frame: Adolescents aged 12–19 years with an alcohol or other drug health issue (184 eligibles) Location: Perth, Australia	Number Participants: 127 adolescents Participant Characteristics: Adolescents: Mean age: 16.7 (SD of 1.8 years); 55% Males	Design: RCT with 4 month follow up Conditions: 1) Usual care 2) Referral to external treatment agency, individualized sessions with interventionist to discuss treatment barriers, and vehicle and/or financial assistance to referral.	Interventionist: 1) Physician 2) Research staff Format: 1) Individual 2) Individual Length: 1) Variable 2) Variable	No data on fidelity was reported.	Knowledge/Attitudes: Behaviors: Significantly more adolescents in Group 2 sought treatment at a community treatment agency. Among those seeking treatment, there was a reduction in drug consumption. Those adolescents in Group 2 also showed significant improvements in psychological well-being at follow up when compared to those adolescents in Group 1.	Potential limitations included the lack of definitive diagnoses of substance dependence, the reliance of self- report data, inability to blind interviewers, limited recruitment time frame, and attrition at follow- up.
Smith, Hodgson, Bridgeman, & Shepherd, 2003 [43]	Setting: Oral and maxillofacial outpatient clinics Sample Frame: Males aged 16–35 attending a clinic with a facial injury (219 eligibles). Location: Cardiff, United Kingdom	Number Participants: 2 senior general nurses; 151 male patients Participant Characteristics: Patients: Mean age: 24	Design: RCT with 3 and 12 month follow up Conditions: 1) Usual care 2) Motivational interviewing consisting of topics such as alcohol consumption, agenda-setting, motivation to change, information provision, and assistance with decision making.	Interventionist: 1) Physician 2) Nurse Format: 1) Individual 2) Individual Length: 1) variable 2) variable	It was reported that both nurse therapists adhered to the intervention protocol as determined by tape-recorded sessions.	Knowledge/Attitudes: Behaviors: At 3 and 12 month follow ups, those males in the intervention group reported significantly less consumption of alcohol in a typical week. Also at 12 months, the percentage of hazardous drinkers as determined by AUDIT decreased from 95% to 58% in the intervention group and only 96% to 81% for the control group.	Potential limitations included the use of self-report data, reliance on standardized questionnaire assessments, and a potential motivational bias in the nurses.
Walker, Townsend, Oakley, Donovan, Smith, Hurst, Bell, & Marshall, 2002 [44]	Setting: General practice registers Sample Frame: Adolescents aged 14 or 15 who were patients of the clinics (1516 eligibles). Location: Hertfordshire, England	Number Participants: 1488 adolescents Participant Characteristics: Adolescents: Mean age: 14.8 (range 14–16); 51% Female; 89% White	Design: RCT with 3 and 12 month follow up Conditions: 1) Usual care 2) Adolescents received an appointment to meet with a practice nurse to discuss any health related topic.	Interventionist: 1) Physician 2) Nurses Format: 1) Individual 2) Individual Length: 1) Variable 2) 20 minutes	No data on physician fidelity was reported.	Knowledge/Attitudes: Behaviors: Only 8% wanted to discuss alcohol related health issues. There were no significant changes in adolescent drinking at 3 or 12 month follow-up.	Potential limitations included limited external validity, reliance on self report data, the brief nature of the study, and the ability of adolescents to choose their primary health concern.
Johnston, Rivara, Droesch, Dunn, & Copass, 2002 [42]	Setting: Urban emergency department Sample Frame: Sober, English speaking, coherent adolescents between the ages of 12 and 20 with an injury. Location Pacific Northwest, United States	Number Participants: 631 adolescent patients Participant Characteristics: Adolescents: Mean age: 16.4; 65.2% male	Design: RCT with 3 and 6 month follow up Conditions 1) Usual care 2) Adolescents received a 20-minute behavior change counseling session based on a risk behavior they self- reported in their baseline analysis.	Interventionist: 1) Physician 2) Master’s level social workers Format: 1) Individual 2) Individual Length: 1) Variable 2) 20 minutes	No data on physician fidelity was reported.	Knowledge/Attitudes: Behaviors: No significant behavior changes were reported for adolescents regarding driving after drinking, riding with an impaired driver, or binge drinking.	The limitations of this study included the inclusion of adolescents without an injury-related risk behavior resulting in difficulty detecting change, timing of the recruitment period (nights only), reliance on self report data, and the inclusion of older adolescents.
Monti, Spirito, Myers, Colby, Barnett, Rohsenow, Woolard, & Lewander, 1999 [41]	Setting: Hospital Emergency rooms Sample Frame: English speaking, non-suicidal adolescents with injury suffered while under influence of alcohol (184 eligibles) Location: Northeast United States.	Number Participants: 94 adolescent patients Participant Characteristics: Adolescents: Mean age: 18.4 (SD of .5 years); 64% male; 80% White; 13% African American	Design: RCT with 3 and 6 month follow up Conditions: 1) Usual care with a handout on avoiding drinking and driving and a list of local treatment agencies 2) Motivational interviewing with personalized and computerized assessment feedback and goal setting activities and handouts.	Interventionist: 1) Physician 2) Research staff Format: 1) Individual 2) Individual Length: 1) Variable 2) Variable	Adherence to the study guidelines by research staff was measured by having interventionists and patients complete questionnaires to rate the delivery and utility of the protocol. Novice interventionists were also videotaped throughout the study. It was reported from both the patients and providers that the essential elements of the intervention were utilized at least 88% of the time. Both parties also agreed that rapport, empathy, and self-efficacy enhancement were all high.	Knowledge/Attitudes: Behaviors: Those adolescents in Group 2 were less likely to have had a moving violation (20% difference), 4 times less likely to drink and drive, and suffer from alcohol-related injuries and other problems (29% difference) when compared to those in Group 1 at 3 and 6 month follow up.	Potential limitations included the specific population used, the high refusal rate, use of self reported data, and the use of a proactive recruitment strategy.