title: Examining the Impact of Separate Components of a Multicomponent Intervention Designed to Reduce At-Risk Drinking Among Older Adults: The Project SHARE Study.
abstract: BACKGROUND
  Health promotion interventions often include multiple components and several patient contacts. The objective of this study was to examine how participation within a multicomponent intervention (Project SHARE) is associated with changes in at-risk drinking among older adults.
  
  
  METHODS
  We analyzed observational data from a cluster-randomized trial of 31 primary care physicians and their patients aged ≥60 years, at a community-based practice with 7 clinics. Recruitment occurred between 2005 and 2007. At-risk drinkers in a particular physician's practice were randomly assigned as a group to usual care (n = 640 patients) versus intervention (n = 546 patients). The intervention included personalized reports, educational materials, drinking diaries, in-person physician advice, and telephone counseling by health educators (HEs). The primary outcome was at-risk drinking at follow-up, defined by scores on the Comorbidity Alcohol Risk Evaluation Tool (CARET). Predictors included whether a physician-patient alcohol risk discussion occurred, HE call occurred, drinking agreement with the HE was made, and patients self-reported keeping a drinking diary as suggested by the HE.
  
  
  RESULTS
  At 6 months, there was no association of at-risk drinking with having had a physician-patient discussion. Compared to having had no HE call, the odds of at-risk drinking at 6 months were lower if an agreement was made or patients reported keeping a diary (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37 to 0.90), or if an agreement was made and patients reported keeping a diary (OR 0.52, CI 0.28 to 0.97). At 12 months, a physician-patient discussion (OR 0.61, CI 0.38 to 0.98) or an agreement and reported use of a diary (OR 0.45, CI 0.25) were associated with lower odds of at-risk drinking.
  
  
  CONCLUSIONS
  Within the Project SHARE intervention, discussing alcohol risk with a physician, making a drinking agreement, and/or self-reporting the use of a drinking diary were associated with lower odds of at-risk drinking at follow-up. Future studies targeting at-risk drinking among older adults should consider incorporating both intervention components.
authors.affiliation: Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Obidiugwu K
authors.initials: OK
authors.lastname: Duru
authors.affiliation: Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Haiyong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Moore
authors.affiliation: Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: Mirkin
authors.affiliation: Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ang
authors.affiliation: Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.|Ahava Center for Spiritual Living, Lexington, Kentucky.
authors.forename: Louise
authors.initials: L
authors.lastname: Tallen
authors.affiliation: Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.affiliation: Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.|Fielding School of Public Health, University of California, Los Angeles, California.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000517:prevention & control*; D000068237:Distance Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D057566:Self Report
keywords: Alcohol Use; Drinking Agreement; Drinking Diary; Older Adults; Physician-Patient Discussion