The proposed study extends data from our precursor studies showing that orofacial injury disproportionately affects vulnerable populations with great personal and health care consequences. Although the injury commonly derives from antecedent behaviors, particularly substance use, little screening or intervention is attempted as part of conventional trauma care. By weaving antecedent behavior-specific interventions into the fabric of orofacial injury care, we may be able to decrease adverse consequences, reduce the high rates of repeat injury, and preserve limited health care resources. We propose to conduct a two-arm randomized controlled study to test the effectiveness of an innovative personalized motivational intervention aimed at reducing substance use, improving treatment outcomes, and decreasing recurrent injury. The intervention will be tailored to the service needs of each patient and will employ motivational intervention techniques to effect behavioral change. In addition, it will be culturally appropriate and feasible to implement in a trauma center context. Approximately 720 orofacial injury patients evidencing substance use and other risky behaviors will be assigned to either a Personalized Motivational Intervention (PMI) Treatment group or a Health Information (HI) """"""""attention control"""""""" group.
Specific aims are as follows: 1) test the effectiveness of a personalized motivational intervention (PMI) in promoting recovery from the initial injury, reducing antecedent behavioral problems, and reducing psychological distress; 2) test the effectiveness of the PMI in decreasing occurrence and severity of re-injury and increasing time to any re-injury; 3) determine whether the PMI's effects on re-injury are mediated by recovery from the initial injury, reduced behavioral problems, and reduced psychological distress; 4) perform a cost-offset analysis of the PMI and, in the absence of cost-neutrality, perform a cost-effectiveness analysis. We hypothesize that by integrating into trauma care a personalized assessment of alcohol drug, psychological, and other service needs, plus active service referrals in a motivational intervention approach, we will significantly reduce the adverse consequences of orofacial injury, improve treatment outcomes, and decrease rates of re-injury, thus off-setting-intervention costs.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA016850-04
Application #
7100951
Study Section
Special Emphasis Panel (ZDA1-MXG-S (12))
Program Officer
Comolli, Jean C
Project Start
2003-09-30
Project End
2008-06-30
Budget Start
2006-07-01
Budget End
2007-06-30
Support Year
4
Fiscal Year
2006
Total Cost
$672,632
Indirect Cost
Name
University of California Los Angeles
Department
Dentistry
Type
Schools of Dentistry
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Shetty, Vivek; Murphy, Debra A; Zigler, Corwin et al. (2011) Randomized controlled trial of personalized motivational interventions in substance using patients with facial injuries. J Oral Maxillofac Surg 69:2396-411
Zigler, Corwin M; Belin, Thomas R (2011) THE POTENTIAL FOR BIAS IN PRINCIPAL CAUSAL EFFECT ESTIMATION WHEN TREATMENT RECEIVED DEPENDS ON A KEY COVARIATE. Ann Appl Stat 5:1876-1892
Shetty, Vivek; Yamaguchi, Masaki (2010) Salivary biosensors for screening trauma-related psychopathology. Oral Maxillofac Surg Clin North Am 22:269-78
Shetty, Vivek; Marshall, Grant N (2010) Preface: collaborative care of the facial injury patient. Oral Maxillofac Surg Clin North Am 22:ix-xii
Murphy, Debra A (2010) Substance use and facial injury. Oral Maxillofac Surg Clin North Am 22:231-8
Murphy, Debra A; Shetty, Vivek; Zigler, Corwin et al. (2010) Willingness of facial injury patients to change causal substance using behaviors. Subst Abus 31:35-42
Wong, Eunice C; Marshall, Grant N (2010) Barriers to the collaborative care of patients with orofacial injury. Oral Maxillofac Surg Clin North Am 22:247-50
Belin, Thomas R (2009) Missing data: what a little can do, and what researchers can do in response. Am J Ophthalmol 148:820-2
Murphy, Debra A; Shetty, Vivek; Resell, Judith et al. (2009) Substance use in vulnerable patients with orofacial injury: prevalence, correlates, and unmet service needs. J Trauma 66:477-84
Gironda, Melanie W; Der-Martirosian, Claudia; Belin, Thomas R et al. (2009) Predictors of depressive symptoms following mandibular fracture repair. J Oral Maxillofac Surg 67:328-34

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