BMC Public Health 2009, 9:101 http://www.biomedcentral.com/1471-2458/9/101 Table 4: Predictors of Improvement 6 Months After a Primary Care Physician Visit Improvement in drinking or... Readiness (1–10) Importance (1–10) Confidence (1–10) RTCQ (-24- +24) Female Age White No Partner Drinks per day Alcohol consequences (SIP score) Discussion with physician Illicit drug use OR 0.63 1.02 0.25 0.80 0.98 0.98 1.06 1.45 (95% CI) (0.30, 1.30) (0.99, 1.05) (0.09, 0.69) (0.41, 1.54) (0.90, 1.07) (0.95, 1.02) (0.58, 1.95) (0.65, 3.22) OR 0.60 1.00 0.66 0.42 0.99 1.00 0.56 0.71 (95% CI) (0.31, 1.18) (0.97, 1.03) (0.29, 1.47) (0.23, 0.79) (0.93, 1.06) (0.96, 1.04) (0.33, 0.95) (0.31, 1.63) OR 0.66 1.01 0.47 0.44 0.98 1.02 0.62 0.96 (95% CI) (0.32, 1.38) (0.98, 1.04) (0.21, 1.03) (0.25, 0.78) (0.91, 1.06) (0.98, 1.06) (0.27, 1.41) (0.42, 2.19) OR 0.91 1.00 0.85 0.30 0.96 0.99 0.85 1.61 (95% CI) (0.47, 1.73) (0.98, 1.03) (0.36, 1.99) (0.34, 1.99) (0.89, 1.03) (0.96, 1.03) (0.42, 1.73) (0.63, 4.09) OR = odds ratio SIP: Short Inventory of Problems RTCQ: Readiness To Change Questionnaire Bold entries have p-values < 0.05 ures of health states (e.g. blood pressure), "readiness to change" should be viewed as an instantaneous measure dependent on various internal and external influences. In addition to these short-term changes, we studied the course of risky drinking and "readiness to change" in pri- mary care patients. Six months after a physician visit, most subjects improved either their drinking or readiness. These improvements suggest that primary care physicians should be somewhat optimistic regarding the course of unhealthy alcohol use, with more than half of patients improving in a relatively short period of time. We identified few predictors of changes in "readiness to change" and none that were consistent across measures or time. Not having a partner was a positive predictor of immediate changes in readiness but a negative predictor of improvement in two measures 6 months later. Being white was associated with worse readiness immediately after a physician visit and less improvement 6 months later but the finding was not confirmed in analyses with the RTCQ or the other two behavior change construct measures. Speculation regarding the mechanism for these hypothesis generating and inconsistent findings would be premature. A discussion between the physician and the subject about alcohol predicted a positive change in readiness immedi- ately after the visit (confirmed by the RTCQ), but para- doxically, was associated with less improvement in drinking or importance (but no change in VAS- or RTCQ- measured readiness). The fact that no association was found between discussion with the physician and drink- ing 6 months later may have been due to the use of inef- fective counseling, but given the observed short-term effect, another explanation could be simply that this effect did not last. Neither alcohol consumption, alcohol problems, nor illicit drug use significantly affected behavior change con- structs or improvements. The fact that these markers of severity were not found to be negative predictors of improvement is of interest and should encourage physi- cians to address problems related to alcohol consumption even in the presence of concomitant illicit drug use, con- sidering that most of their patients will have some improvement, independent of the severity of the alcohol problem. A number of studies have assessed readiness to change and related constructs. In general, these studies have focused on characterizing specific populations [13,36-39] or on studying readiness as a predictor of behavior change [12,14]. Our study instead focused on how these con- structs change over time. Improvement over time in untreated adults with unhealthy alcohol use and alcohol use disorders (alcohol abuse and dependence) has been previously reported [22,40,41]. Alcohol abuse and alco- hol dependence seem to be (especially the latter) chronic conditions characterized by recurrent episodes of disease activity [42]. But the natural history of the spectrum of unhealthy alcohol use (risky drinking amounts through dependence) is not well described in the literature, nor is the natural history of readiness to change. In addition to the aforementioned studies of the natural history of alcohol use disorders, studies of brief interven- tion for nondependent unhealthy alcohol use in primary care consistently report improvement over time in both treated and untreated individuals [43]. For example, male heavy drinkers in primary care decreased drinking over 3 years by 25 to 53% (depending on the outcome measure) in both intervention and control groups [44]. The improvement in drinking observed in our sample is in this range. Improvements such as these could be attributed to Page 6 of 9 (page number not for citation purposes)