The long term objectives of this program are to develop effective intervention approaches for adolescent drinking and driving and for the behavior of riding with a drinking driver by evaluating promising treatments derived from cognitive behavioral social learning theory. Current approaches to behavior change in this area rely on driver education programs and secondary prevention programs that have shown rather modest results. While Emergency Departments are another potential locus for intervention, no studies have as yet intervened directly with adolescents following an alcohol-related motor vehicle crash. Studies of individual risk factors and the role of parents in preventing drinking and driving point to the importance of these considerations in designing effective interventions. Motivational interviewing (MI) has been selected as the intervention to be studied because of the likely state of readiness to change in this high risk population and because of the demonstrated effectiveness of this approach in reducing drinking among adults that had not sought treatment for drinking. Given their history, these motivation to change their behavior. The MI will intervene with both the adolescents and their parents, to maximize the effectiveness of the intervention. The proposed work will extend our group's track record of careful assessment and treatment interventions with adults and adolescents to an risk group of adolescent drinking drivers, their passengers, and parents. A three group (MI with multiple follow-up versus standard care with multiple follow-up versus standard care with a single follow-up) repeated measures analysis of covariance design will test the primary hypothesis that a MI will significantly reduce the incidence of drinking and driving or riding with drinking drivers. Since within-group factors may differentially influence outcome, alcohol use severity will be considered as a potential matching variable. The comparison of standard care with multiple versus single follow-ups allows investigation of any reactive effects of repeated assessment on alcohol use during motor vehicle use. As assessment instruments in this area are weak, instrument development is also a focus of the work to be accomplished. Outcome measures will assess changes in alcohol use during motor vehicle use plus changes in drinking behavior per se, risk-taking behavior, and injuries, as reported by both parent and adolescent 3,6 and 12 months after the intervention. The importance of this work is its potential for providing a cost- effective brief intervention to reduce deaths and injuries among adolescents due to alcohol use combined with motor vehicle use.
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