Cultural Considerations: Alcohol Screening & Brief Interventions in a southern U.S. Level I Trauma Center

Laura Veach, PhD, Regina Moro, MS, Jennifer Rogers, MA, Preston Miller, MD, Beth Reboussin, PhD, and Mary Claire O’Brien, MD

Departments of Emergency Medicine & General Surgery, Wake Forest Baptist Health

BackgroundAlcohol is known to be a significant contributor to trauma, with 40-50% of admitted patients having alcohol present at the time of injury (D’Onfrio & Degutis, 2002). Providing brief interventions and referrals to treatment has been shown to decrease trauma recidivism with patients by up to 50% (Gentilello, 1999). The following preliminary data is from the Teachable Moment research study, a randomized clinical trial comparing two different interventions. Minimal research exists concerning the role cultural factors has on screening and brief intervention programs.

Methods (n=100, subset participants)A review of 100 cases where Screening and Brief Intervention or Referral for Treatment (SBIRT) counselor characteristics were examined. Finding indicate:• 100% of brief interventions conducted by White counselors• 92% of brief interventions conducted by Female counselors• The mean age difference between counselor and participant was 3.7 years. The participant was on average 3.7 years older than the participant.

ResultsIn light of age, gender, and ethnic differences SBIRT counselors continually focused on essential elements of rapport building. 76% of participants were of a different gender, 25% were of a different ethnicity, and on average the participant was 3.7 years older than the counselor. Both age (p=.1203) and gender (p=.9863) were not significant factors in enrollment rates, further analysis will indicate whether ethnicity was a contributing factor. In order to successfully enroll patients, SBIRT counselors were required to utilize a wide-range of rapport building techniques. Supervision of the SBIRT counselors continually focused on rapport building skills. As of April 2011, the decline rate for the entire study has been 25%, which appears to be lower than averages reported across trauma research. Decline rates in the screening and brief intervention literature range from 14-76% (Désy, Howard, Perhats, & Li, 2010; Ehrlich, Maio, Drongowski, et al., 2010).

ConclusionsBased on our experience we see that with skilled rapport building successful enrollment is possible especially considering cultural differences between participants and SBIRT counselors. Training for conducting SBIRT appears to indicate a need for cultural sensitivity training, with ongoing supervision focusing on cultural sensitivity. Further analysis will explore the following questions:• Do cultural factors predict the engagement scores of study participants and counselors?• Are there outcome differences for the two types of interventions related to cultural factors?• Are there cultural factors correlated with study decline rates?

  ReferencesDesy, P.M., Howard, P.K., Perhats, C., & Li, S. (2011). Alcohol screening, brief intervention, and referral to treatment conducted by emergency nurses: An impact evaluation. Journal of Emergency Nursing, 36(6), 538-545. D’Onofrio, G., & Degutis, L.C. (2002). Preventive care in the emergency department: Screening and brief intervention for alcohol problems in the emergency department: A systematic review. Academy Emergency Medicine, 9, 627-638. Ehrlich, P.F., Maio, R., Drongowski, R., et al. (2010). Alcohol interventions for trauma patients are not just for adults: Justification for brief interventions for the injured adolescent at a pediatric trauma center. The Journal of Trauma, Injury, Infection, and Critical Care, 69(1), 202- 210.Gentilello, L., Rivara, F., Donovan, D., et al. (1999). Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals of Surgery, 230(4), 473-483. Rich, J.A., & Grey, C.M. (2005). Pathways to recurrent trauma among young black men: Traumatic Stress, Substance Use, and the “Code of the Street.” American Journal of Public Health, 95(5), 816-824.

Characteristics Mean or % (sd, min-max)

N

Age 36.9 (12.6, 18-71) 332Gender Male Female

81.0 19.0

26963

Race White AA Latino Other Missing

72.320.8 5.11.20.6

240691742

BAC 0.124 (0.113, 0.0-0.45) 333AUDIT 15.2 (8.2, 1-37) 273Audit # 9 No (0) Not Last Year (2) Last year (4)

49.8 5.544.7

136 15122

Injury Severity Score

15.3 (9.4, 1-54) 241

Trauma Score 11.3 (1.6, 4-12) 244Type of Injury Blunt Penetrating

82.817.2

21144

Department of Counseling, University of North Carolina at Charlotte

Characteristics BAC AUDIT Injury Severity Trauma Score

Race White Non-White p-value

0.124 (0.115)0.123 (0.108)

0.5102

15.2 (8.8)15.3 (8.0)

0.9031

15.6 (9.2)14.3 (9.2)

0.3372

11.4 (1.5)11.3 (1.8)

0.771

Gender Male Female p-value

0.130 (0.115)0.098 (0.099)

0.041

15.6 (8.05)13.4 (8.8)

0.075

15.4 (9.6)14.6 (8.7)

0.606

11.3 (1.6)11.5 (1.5)

0.432

AimsCultural considerations and sensitivities particularly relevant to the southern U.S. when providing alcohol screening and brief interventions to individuals demonstrating risky drinking behavior.

75%

20%2% 3%

Ethnicity

White African-AmericanLatino Other

76%

24%

Gender

Male Female

Preliminary Data of Total (N=332) Study Participants

Support for this study was provided by a grant from the Robert Wood Johnson (RWJ) Foundation Substance Abuse Policy Research Program (SAPRP). PI: O’Brien; Co-PI’s: Miller, Reboussin, Veach.

Arm Assigned Interventions

1:  Experimental Arm number 1 focuses on the traditional quantity frequency model.

The quantitative intervention involves emphasis on tracking and measuring the number of drinks on a weekly basis.

2:  Experimental Arm number 2 targets subjective drunkenness.

Explores factors leading to drunkenness and alternative coping strategies for healthier function.

CODE OF THE STREETS (Rich & Grey, 2005)Need for respect REACT Lack of faith in authority VULNERABILITY PROTECTTraumatic Stress RETALIATESubstance Use