BMC Public Health 2009, 9:101 http://www.biomedcentral.com/1471-2458/9/101 ent in English or Spanish, and had data available on 3 behavior change constructs of interest. Subjects were interviewed before, immediately after the visit and 6 months later. At each time point, subjects completed 3 visual analog scales (VASs), one for each of 3 behavior constructs ("how ready are you to change your drinking habits", "how important is it for you right now to change your drinking", "if you decide to change your drinking habits, how confident are you that you would succeed", with a score of 1 being "not ready/not important to change/not confident to succeed" and 10 "ready/very important to change/very confident to succeed") [17,28]. Subjects also completed the RTCQ, a validated instrument that assesses readiness that has satisfactory test-retest reli- ability and consists of 12 statements, each one evaluated by the participant on a 5 point Likert scale [29]. For the present study, we used a continuous RTCQ score (-24 to +24) that has good reliability (alpha = 0.85– 0.86)[30,31]. The readiness item was included in the screener (paper and pencil). Confidence and importance items and the RTCQ were included in the previsit inter- view (face to face interview). After the visit and 6 months later, subjects completed the 30-day Timeline Followback, a validated calendar method considered a reference stand- ard for assessing alcohol consumption,[32] and the Short Inventory of Problems (SIP) to assess alcohol-related problems [33]. Immediately after the visit, subjects were asked by research assistants if they had had any discussion with their physician about alcohol consumption as well as the content of such a discussion (i.e. "Did the doctor give you advice about your drinking habits," "Did the doctor talk about drinking?", "Did the doctor tell you how many drinks would be safe for you to drink?", "Did the doctor recommend that you cut down/quit drinking, go to Alco- holics Anonymous/treatment?"). Research assistants also assessed demographics, social support ("Do you currently have a partner?"), and illicit drug use over the past month ("In the last 30 days have you used marijuana/cocaine/ heroin/other illegal drug?"). The study was approved by the Boston University Medical Center Institutional Review Board and a Certificate of Confidentiality was obtained from the U.S. government. Analyses were performed using SAS software 9.1.3 (Cary, North Carolina). P values less than 0.05 were considered to be statistically significant. All analyses controlled for clustering of subjects within physician and physician ran- domization group, using Generalized Estimating Equa- tions (GEE) regression models with an exchangeable working correlation and empirical variance estimator. Of note, in the original trial, the intervention (i.e. randomi- zation group) was not associated with improvements in drinking risky amounts. We assessed the outcomes changes in readiness, impor- tance, and confidence between pre- and immediate post- visit assessments. Differences were computed by subtract- ing the pre-visit score from the immediate post-visit score. We used unadjusted models (but accounting for cluster- ing) and models that adjusted for predictors to assess the changes between pre- and immediate post-visit assess- ments in each of the behavior change constructs. Because a change in behavior could take place during the 6-month follow-up period after the pre-visit assessment, the state of readiness to change drinking at 6 months could become irrelevant (e.g. readiness to change in a sub- ject who no longer consumed alcohol). Therefore, to assess change outcomes, we created 3 dichotomous varia- bles representing "improvement," each defined as either no longer drinking risky amounts or, if still drinking risky amounts, having improvement (difference > 0) in readi- ness to change drinking (i.e. improvement in drinking or readiness), importance of changing drinking (i.e. improvement in drinking or importance), or confidence in ability to change drinking (i.e. improvement in drink- ing or confidence). Since readiness, importance and confi- dence are often considered intermediate outcomes, it is of clinical relevance to use an outcome taking into account increases in these readiness to change constructs [34,35]. We did not analyze these behavior change constructs in those who had already changed, and we did not have data on readiness/importance/confidence to sustain changes in drinking (e.g. not drinking risky amounts), and there- fore could not analyze these constructs as outcomes. Predictors of interest were: demographics (age, sex, race/ ethnicity), social support (currently having a partner), alcohol consumption at study entry (drinks per day), SIP score, illicit drug use (marijuana, heroin, cocaine, other), and discussion with the physician about alcohol con- sumption during the visit. All analyses were repeated with the RTCQ continuous score as the outcome, in order to corroborate the results obtained with the readiness VAS. Results Of 4143 patients approached, 182 did not complete the screener. Of 487 who reported drinking risky amounts in the past month, 235 refused participation in the study and 18 had no time before the visit to complete the pre-visit assessment. Of the 234 remaining enrolled patients, our analytic sample was restricted to the 173 subjects drinking risky amounts who had available data on "readiness to change" at all 3 assessments (Table 1); they saw one of 36 physicians. We tested potential differences between included subjects who completed and did not complete the follow up: There were no significant differences (p < Page 3 of 9 (page number not for citation purposes)