title: Using topic coding to understand the nature of change language in a motivational intervention to reduce alcohol and sex risk behaviors in emergency department patients.
abstract: To elucidate patient language that supports changing a health behavior (change talk) or sustaining the behavior (sustain talk).
  
  
  
  We developed a novel coding system to characterize topics of patient speech in a motivational intervention targeting alcohol and HIV/sexual risk in 90 Emergency Department patients. We further coded patient language as change or sustain talk.
  
  
  
  For both alcohol and sex, discussions focusing on benefits of behavior change or change planning were most likely to involve change talk, and these topics comprised a large portion of all change talk. Greater discussion of barriers and facilitators of change also was associated with more change talk. For alcohol use, benefits of drinking behavior was the most common topic of sustain talk. For sex risk, benefits of sexual behavior were rarely discussed, and sustain talk centered more on patterns and contexts, negations of drawbacks, and drawbacks of sexual risk behavior change.
  
  
  
  Topic coding provided unique insights into the content of patient change and sustain talk.
  
  
  
  Patients are most likely to voice change talk when conversation focuses on behavior change rather than ongoing behavior. Interventions addressing multiple health behaviors should address the unique motivations for maintaining specific risky behaviors.
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA. Electronic address: Christopher_Kahler@brown.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Kahler
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Caswell
authors.affiliation: Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA.
authors.forename: M Barton
authors.initials: MB
authors.lastname: Laws
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Walthers
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Magill
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Nadine R
authors.initials: NR
authors.lastname: Mastroleo
authors.affiliation: Center for Population Health and Clinical Epidemiology, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Chanelle J
authors.initials: CJ
authors.lastname: Howe
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Souza
authors.affiliation: Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Wilson
authors.affiliation: National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Bethesda, MD, USA.
authors.forename: Kendall
authors.initials: K
authors.lastname: Bryant
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Monti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy; D059019:Clinical Coding; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology; D015438:Health Behavior; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology; D055815:Young Adult
keywords: Alcohol; Dialogue coding; HIV; Motivational interviewing; Sex risk