Effect of patient priming and primary care provider prompting on adolescent-provider communication about alcohol.

OBJECTIVE To determine whether priming adolescent patients to discuss alcohol with their primary care providers and prompting providers to discuss alcohol increases adolescent-provider communication about alcohol. DESIGN Randomized controlled trial. SETTING Five managed care group practices in Washington, DC. PARTICIPANTS Consecutive patients aged 12 to 17 years who were seeing primary care providers (n = 26) for health checkups. Of 892 eligible adolescents, 444 (50%) were randomized and completed data collection. Most adolescents (80%) were African American, 55% were male, and 17% currently drank alcohol. INTERVENTION Usual care (group 1) vs adolescent priming with alcohol self-assessment and education just before their health checkups (group 2) vs adolescent priming and provider prompting with the adolescent's self-assessment and a patient education brochure (group 3). MAIN OUTCOME MEASURES This exploratory substudy of a longitudinal study on adolescent alcohol behaviors examined adolescent-provider communication by adolescent exit survey, researcher observation, and audiotapes of a subsample of visits. RESULTS More adolescents in group 3 (96%) than group 1 (87%) reported that their provider talked about alcohol (adjusted odds ratio [OR], 1.10; 95% confidence interval [CI], 1.04-1.17). More adolescents in group 3 (18%) than group 1 (10%) reported asking about alcohol (adjusted OR, 1.08; 95% CI, 1.00-1.16). The mean +/- SD number of minutes adolescents were with their providers without parents being present was greater for group 3 (10.8 +/- 7.6) than group 1 (8.8 +/- 8.0). Adolescents in group 2 spent more time with their provider and reported initiating more discussion not specific to alcohol than did group 1 adolescents. CONCLUSION Adolescent priming and provider prompting increases adolescent-provider communication about alcohol.