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Behavior Change Counseling in the Emergency Department to Reduce Injury Risk: A Randomized, Controlled Trial

Brian D. Johnston, MD, MPH^*,, Frederick P. Rivara, MD, MPH^*,,, RoseAnne M. Droesch, MSW^,||, Chris Dunn, PhD^|| and Michael K. Copass, MD^¶

^* Division of General Pediatrics, Department of Pediatrics
Harborview Injury Prevention and Research Center
Department of Epidemiology
^|| Department of Psychiatry and Behavioral Science
^¶ Departments of Medicine and Neurology, University of Washington, Seattle, Washington

Objective. To determine whether a brief session of behavior change counseling (BCC), offered to injured adolescents in the emergency department (ED) as a therapeutic intervention, could be used to change injury-related risk behaviors and the risk of reinjury.

Study Design. A randomized, controlled trial.

Participants. Adolescents between 12 and 20 years old who were undergoing treatment for an injury in the ED and who were cognitively able to participate in the intervention.

Setting. An urban ED at a level 1 pediatric trauma center.

Intervention. Study participants completed a baseline risk behavior prevalence assessment. Participants were then randomly assigned to receive BCC or routine ED care. Those in the treatment group underwent a brief session of BCC with a study social worker focused on changing an identified injury-related risk behavior (seatbelt use, bicycle helmet use, driving after drinking, riding with an impaired driver, binge drinking, or carrying a weapon). Participants were recontacted 3 months and 6 months after enrollment to assess the prevalence of positive behavior change and the interim occurrence of medically treated injuries.

Results. We enrolled 631 participants (78% of those eligible) and obtained follow-up for 76% at 3 months and 75% at 6 months. The relative risk of a positive behavior change with respect to seatbelt use was 1.34 (95% confidence interval [CI]: 1.00, 1.79) at 3 months, favoring the intervention group. The relative risk for the same outcome was 1.47 (95% CI: 1.09, 1.96) at 6 months. A positive change in bicycle helmet use was 1.81 (95% CI: 1.02, 3.18) times more likely at 3 months and 2.00 (95% CI: 1.00, 4.00) times more likely at 6 months in the intervention group. There was no effect of the intervention on changes in other target behaviors. Over the 6-month follow-up period, the risk of reinjury requiring medical attention did not differ between treatment groups.

Conclusions. Brief BCC can be delivered to adolescents undergoing treatment for injury in the ED and can be used to address injury-related risk behaviors. The intervention was associated with a greater likelihood of positive behavior change in seatbelt and bicycle helmet use. This effect lasted over 6 months of follow-up. BCC was not associated with changes in other risk behaviors and could not be shown to significantly reduce the risk of reinjury.

Key Words: behavior change counseling • emergency department • adolescents • risk behaviors

Abbreviations: BCC, behavioral change counseling • ED, emergency department • CI, confidence interval

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