Manwell L B, Fleming M F, Mundt M P, Stauffacher E A, Barry K L
Departmetn of Family Medicine, Center for Addiction Research and Education, University of Wisconsin-Madison Medical School, 53715, USA.
Alcohol Clin Exp Res. 2000 Oct;24(10):1517-24.
Studies suggest that 14% of women age 18 to 40 drink alcohol above recommended limits. Of special concern is the increasing use of alcohol by women during pregnancy. This article reports 48 month follow-up data from a subanalysis of a trial for early alcohol treatment (Project TrEAT) focused on women of childbearing age.
Project TrEAT was conducted in the offices of 64 primary care, community-based physicians from 10 Wisconsin counties. Of 5979 female patients ages 18 to 40 who were screened for problem drinking, 205 were randomized into an experimental group (n = 103) or control group (n = 102). The intervention consisted of two 15 min, physician-delivered counseling visits that included advice, education, and contracting by using a scripted workbook. A total of 174 subjects (85%) completed the 48 month follow-up procedures.
No significant differences were found between the experimental and control groups at baseline for alcohol use, age, socioeconomic status, smoking, depression or anxiety, conduct disorder, lifetime drug use, or health care utilization. The trial found a significant treatment effect in reducing both 7 day alcohol use (p = 0.0039) and binge drinking episodes (p = 0.0021) over the 48 month follow-up period. Women in the experimental group who became pregnant during the follow-up period had the most dramatic decreases in alcohol use. A logistic regression model based on a 20% or greater reduction in drinking found an odds ratio of 1.93 (confidence interval 1.07-3.46) in the sample exposed to physician intervention. Age, smoking, depression, conduct disorder, antisocial personality disorder, and illicit drug use did not reduce drinking significantly. No significant differences were found in health care utilization and health status between groups.
This trial provides the first direct evidence that brief intervention is associated with sustained reductions in alcohol consumption by women of childbearing age. The results have enormous implications for the U.S. health care system.
研究表明，18至40岁的女性中有14%饮酒量超过推荐限量。特别令人担忧的是，孕期女性饮酒的情况日益增多。本文报告了一项针对育龄女性的早期酒精治疗试验（TrEAT项目）子分析的48个月随访数据。
TrEAT项目在威斯康星州10个县的64名基层医疗、社区医生的办公室进行。在5979名接受问题饮酒筛查的18至40岁女性患者中，205人被随机分为实验组（n = 103）或对照组（n = 102）。干预措施包括两次由医生进行的15分钟咨询问诊，使用脚本式工作手册提供建议、教育和约定。共有174名受试者（85%）完成了48个月的随访程序。
在饮酒情况、年龄、社会经济地位、吸烟、抑郁或焦虑、品行障碍、终生药物使用或医疗保健利用方面，实验组和对照组在基线时未发现显著差异。该试验发现在48个月的随访期内，在减少7天饮酒量（p = 0.0039）和暴饮次数（p = 0.0021）方面有显著的治疗效果。随访期间怀孕的实验组女性饮酒量下降最为显著。基于饮酒量减少20%或更多的逻辑回归模型发现，接受医生干预的样本中的优势比为1.93（置信区间1.07 - 3.46）。年龄、吸烟、抑郁、品行障碍、反社会人格障碍和非法药物使用并未显著减少饮酒量。两组在医疗保健利用和健康状况方面未发现显著差异。
该试验提供了首个直接证据，即简短干预与育龄女性持续减少酒精消费有关。这些结果对美国医疗保健系统具有重大意义。
