Episodic alcohol use and risk of nonfatal injury

Sober up: Time from last drink to a road traffic injury

PURPOSE

There is no intervention that quickly reduces a person's blood alcohol content (BAC). "Sober up before you drive" may prevent road traffic injury (RTI) caused by alcohol consumption. The aim of this study was to analyze the risk of RTI on an hourly basis (1-6 h) after the last drink and the determinants of this risk.

METHODS

This was a case-crossover study of alcohol consumption among 430 patients who suffered an RTI and arrived at an emergency department in a large hospital in Mexico City from January to April 2022.

RESULTS

Of the 430 patients studied, 46 reported drinking within 1 h before the RTI, for a risk ratio (RR) of 7.7 (95% CI [5.6, 10.4]). This RR decreased to 2.2 (95% CI [1.3, 3.7]) for the 12 patients drinking in the second hour before the RTI and was null for those drinking earlier (p ≤ 0.001 for the trend). The induction time was 3 h among those with higher BAC and intoxication levels. The RR for an RTI decreases 71% from the first to second hour from the last drink and 32% from the second to third hour. This decrease was similar among those intoxicated and those with increased BACs. In multiple regression models, higher levels of intoxication and higher BACs remained associated with higher RRs.

DISCUSSION

People should avoid driving after drinking. Waiting to drive, walking, or riding after drinking reduces the risk of an RTI, especially for people with higher BAC and intoxication levels.

Alcohol and cannabis use in traffic-related injuries in Mexico City

BACTERKGROUND

There is debate on whether cannabis affects road traffic injuries (RTIs) separately from the effects of alcohol. Our goals are to report the possible increase in risk of an RTI among alcohol and cannabis users by type of exposure (biological, self-reported and combined) and the possible interaction of alcohol and cannabis in patients with an RTI in an emergency department in Mexico City.

METHODS

A case-crossover study with 433 cases of RTI (as a pedestrian, driver or passenger) during the period January-April 2022. A breath sample, an oral sample for cannabis detection and self-reported alcohol and cannabis use 6 hours prior to the RTI and in two control periods were used. We report ORs and 95% CIs from conditional logistic regressions for the case-crossover estimates.

RESULTS

Alcohol alone increased the risk of an RTI (OR=6.02, 95% CI 3.29 to 10.99) for most RTIs, regardless of whether we used information from self-reports or a breath sample in the hazard period. Conversely, cannabis only increased the RTI when we added information in the hazard period from self-reports or oral samples. Nevertheless, this increase in risk disappeared (OR=2.06, 95% CI 0.90 to 4.70) among those who only used cannabis. We also found no evidence of interaction between alcohol and cannabis in the risk of an RTI.

CONCLUSIONS

Alcohol is the most commonly used substance in Mexico and a high-risk factor for RTI in Mexico City. Although cannabis alone was not associated with an RTI, continuous monitoring of its effects is required.

Dose-Response Relationship of Alcohol and Injury Cause: Effects of Country-Level Drinking Pattern and Alcohol Policy

BACKGROUND

The dose-response relationship of alcohol and injury and the effects of country-level detrimental drinking pattern (DDP) and alcohol control policy on this relationship are examined for specific causes of injury.

METHODS

The dose-response risk of injury is analyzed on 18,627 injured patients in 22 countries included in the International Collaborative Alcohol and Injury Study, using case-crossover analysis by cause of injury (traffic, violence, falls, other), DDP, and the International Alcohol Policy and Injury Index.

RESULTS

Risk of all injury was higher at all volume levels in higher DDP countries compared to lower DDP countries and for each cause of injury. Risk of injury from traffic was significantly greater in higher DDP than lower DDP countries at 3.1 to 6 drinks (odds ratio (OR) = 2.64, confidence interval (CI) = 1.17 to 5.97) and at ≤3 drinks for falls (OR = 2.51, CI = 1.52 to 4.16) and injuries from other causes (OR = 1.72, CI = 1.10 to 2.69). Countries with higher restrictive alcohol policy were at a lower risk of injury at lower levels of consumption (≤3 drinks) for all injuries (OR = 0.72, CI = 0.56 to 0.92) and for injuries from other causes (OR = 0.46, CI = 0.29 to 0.73) and at a lower risk of traffic injuries at higher levels of consumption (≥10 drinks). At higher levels of consumption (≥10 drinks), countries with higher alcohol policy restrictiveness were at greater risk of all injuries (OR = 2.03, CI = 1.29 to 3.20) and those from violence (OR = 9.02, CI = 3.00 to 27.13) and falls (OR = 4.29, CI = 1.86 to 9.91).

CONCLUSIONS

Countries with high DDP are at higher risk of injury from most causes at a given level of consumption, while countries with low restrictiveness of alcohol policy are at higher risk of injury at lower levels of consumption and at higher risk of traffic injuries at high levels of consumption. These findings underscore the importance of aggregate-level factors which need to be considered in developing effective intervention and prevention strategies for reducing alcohol-related injury.

A multi-level analysis of emergency department data on drinking patterns, alcohol policy and cause of injury in 28 countries

BACKGROUND

While individual-level drinking pattern is an important risk factor for alcohol-related injury, societal-level pattern and alcohol policy are also important, and no research exists on the relationship of these variables with specific causes of injury.

METHODS

A probability sample of 14,142 emergency department (ED) patients from 32 ED studies in 28 countries included in the International Collaborative Alcohol and Injury Study (ICAIS) is analyzed using multilevel modeling of individual-level volume and pattern of drinking, country-level detrimental drinking pattern (DDP), and alcohol policy using the International Alcohol Policy and Injury Index (IAPII) on self-reported drinking prior to the injury event, categorized as traffic, violence, fall or other cause. The IAPII includes four domains: availability, vehicular, advertising, and drinking context.

RESULTS

Frequent heavy drinking was a strong predictor (p < .0.001) of injuries related to violence (OR = 2.57), falls (OR = 2.86), and other causes (OR = 1.71), while episodic heavy drinking was a significant predictor of injuries related to violence and falls. DDP was a significant predictor (p < 0.05) of traffic (OR = 1.54) and violence-related injuries (OR = 1.38) but lost significance when the IAPII was included. The IAPII was a significant predictor only for traffic injury (OR = 0.97, p < 0.001), and each domain with the exception of context were also significant.

CONCLUSIONS

Findings here clearly point to the importance of targeted policies for specific causes of injury as well as the importance of individual and societal drinking patterns, the latter of which may be difficult to influence by preventive measures aimed to reduce alcohol-related injury.

Risk of violence-related injury from alcohol consumption and its burden to society in Latin America and the Caribbean

OBJECTIVES

The risk for violence-related injury from drinking and attributable burden in the Latin American and Caribbean region was explored.

METHODS

A probability sample of 1024 emergency department patients reporting a violence-related injury was analyzed from 11 countries, using case-crossover fractional polynomial analysis of the number of drinks consumed prior to the event.

RESULTS

A dose-response relationship was observed with a six-fold increase in risk (RR=5.6) for less than two drinks prior to injury. Risk was higher for females than males at 10 or more drinks, and higher for those aged 30 and older compared to those younger at all volume levels. Overall, 32.7% of the violence-related injuries were attributable to alcohol. Alcohol attributable fraction (AAF) was nearly three times larger for males (38%) than for females (12.3%).

CONCLUSIONS

A dose-response relationship was found between the volume of alcohol consumed prior to the event and risk of violence-related injury. Risk was not uniform across gender or age. At higher volumes, females compared to males were at greater risk of injury but had a lower AAF due to their lower prevalence of drinking at higher levels.

A dose-response estimate for acute alcohol use and risk of suicide attempt

This study reports dose-response estimates for the relative risk and population attributable risk (PAR) between acute alcohol use and serious suicide attempt. Data were analyzed on 272 suicide attempters arriving at 38 emergency departments within 6 hours of the event in 17 countries. Case-crossover analysis, pair-matching the number of standard drinks consumed within the 6 hours prior to the suicide attempt with that consumed during the same 6-hour period of the previous week, was performed using fractional polynomial analysis for dose-response. Every drink increased the risk of a suicide attempt by 30 percent; even one-two drinks was associated with a sizable increase in the risk of a serious suicide attempt, and a dose-response was found for the relationship between drinking 6 hours prior and the risk of a suicide attempt up to 20 drinks. Acute use of alcohol was responsible for 35 percent PAR of all suicide attempts. While very high levels of drinking were associated with larger relative risk s of suicide attempt, the control and reduction of smaller quantities of acute alcohol use also had an impact on population levels of suicide attempt, as showed here for the first time with our PAR estimates. Interventions to stop drinking or at least decrease levels of consumption could reduce the risk of suicide attempt. Screening people more at risk to suffer these acute effects of ethanol and offering interventions that work to these high-risk groups are a matter of urgent new research in the area.

Alcohol and Road Traffic Injuries in Latin America and the Caribbean: A Case-Crossover Study

BACKGROUND

This study reports dose-response estimates for the odds ratio (OR) and population attributable risk of acute alcohol use and road traffic injury (RTI).

METHODS

Data were analyzed on 1,119 RTI patients arriving at 16 emergency departments (EDs) in Argentina, Brazil, Costa Rica, Dominican Republic, Guatemala, Guyana, Mexico, Nicaragua, Panama, and Trinidad and Tobago. Case-crossover analysis, pair-matching the number of standard drinks consumed within the 6 hours prior to the RTI with 2 control periods (prior d/wk), was performed using fractional polynomial analysis for dose-response.

RESULTS

About 1 in 6 RTI patients in EDs were positive for self-reported alcohol 6 hours prior to the injury (country range 8.6 to 24.1%). The likelihood of an RTI with any drinking prior (compared to not drinking) was 5 times higher (country range OR 2.50 to 15.00) and the more a person drinks the higher the risk. Every drink (12.8 g alcohol) increased the risk of an RTI by 13%, even 1 to 2 drinks were associated with a sizable increase in risk of an RTI and a dose-response was found. Differences in ORs for drivers (OR = 3.51; 95% CI = 2.25 to 5.45), passengers (OR = 8.12; 95% CI = 4.22 to 15.61), and pedestrians (OR = 6.30; 95% CI = 3.14 to 12.64) and attributable fractions were noted. Acute use of alcohol was attributable to 14% of all RTIs, varying from 7% for females to 19% for being injured as a passenger.

CONCLUSIONS

The finding that the presence of alcohol increases risk among drivers and nondrivers alike may further help to urge interventions targeting passengers and pedestrians. Routine screening and brief interventions in all health services could also have a beneficial impact in decreasing rates of RTIs. Higher priority should be given to alcohol as a risk factor for RTIs, particularly in Latin America and the Caribbean.

Recall bias across 7 days in self-reported alcohol consumption prior to injury among emergency department patients

INTRODUCTION AND AIMS

Recall bias is a concern in self-reported alcohol consumption, potentially accounting for varying risk estimates for injury in emergency department (ED) studies. The likelihood of reporting drinking for the same 6-h period each day of the week for a full week preceding the injury event is analysed among injured ED patients.

DESIGN AND METHODS

Probability samples of patients 18 years old and older were interviewed in two ED sites in Vancouver and one in Victoria, BC (n = 1191). Generalized estimating equation modelling was used to predict the likelihood of reporting drinking for the same 6-h period prior to the injury event for each day of the week, compared to day 7 as the reference recall day, for a full week preceding the event. Recall by frequency of drinking and frequency of heavy drinking was analysed.

RESULTS

Drinking was significantly more likely to be reported for each of the first 3 days of recall compared to 7-day recall and highest for 1-day recall (odds ration 1.55; = 0.002). Patients who reported ≥ weekly drinking and 5+ drinking < monthly were significantly more likely to report drinking for each of the first 3 days of recall (compared to 7-day recall).

DISCUSSION

Findings suggest the first 3 days prior to injury may be a less biased multiple-matched control period than longer periods of recall in case-crossover studies.

CONCLUSION

Length of accurate recall may be important to consider in case-crossover analysis and other study designs that rely on patient self-report such as the Timeline Followback. [Cherpitel CJ, Ye Y, Stockwell T, Vallance K, Chow C. Recall bias across 7 days in self-reported alcohol consumption prior to injury among emergency department patients.

Risk of injury from alcohol, marijuana and other drug use among emergency department patients

BACKGROUND

Alcohol is known to be associated with injury, but little is known of combined use of alcohol and other drugs on injury; especially important for marijuana, given increasing legalization of use in the U.S. and Canada.

METHODS

Probability samples of patients 18 and older were interviewed in the emergency department at two sites in Vancouver and one in Victoria, BC (n=1191 injured and 1613 non-injured patients). Case-control and case-crossover analyses were used to analyze risk of injury, based on self-reported alcohol and drug use (marijuana, stimulants, depressants) prior to injury.

RESULTS

Risk of injury was significantly elevated (p<0.001) for alcohol use alone in both case-control (OR=2.72) and case-crossover analyses (OR=2.80) but not for any of the three drug classes. The interaction of alcohol with each class of drug was tested, and marginally significant only for marijuana in case-control analysis (OR=4.42; p=0.088). The interaction of alcohol and two or more drugs was also significant in case-control analysis (OR=03; p=0.035). The volume of alcohol consumed prior to injury was greater for those also using drugs during this time and positively associated with the number of drugs reported.

CONCLUSION

Given the potential issues involved with both case-control and case-crossover study designs, the inconsistent findings suggest caution in reaching any definite conclusion regarding whether there is extra risk related to combined use of alcohol and marijuana, and is an important area for future research.

Relative risk of injury from acute alcohol consumption: modeling the dose-response relationship in emergency department data from 18 countries

AIMS

To update and extend analysis of the dose-response relationship of injury and drinking by demographic and injury subgroups and country-level drinking pattern, and examine the validity and efficiency of the fractional polynomial approach to modeling this relationship.

DESIGN

Pair-matched case-cross-over analysis of drinking prior to injury, using categorical step-function and fractional polynomial analysis.

SETTING

Thirty-seven emergency departments (EDs) across 18 countries.

PARTICIPANTS

A total of 13 119 injured drinkers arriving at the ED within 6 hours of the event.

MEASUREMENTS

The dose-response relationship was analyzed by gender, age, cause of injury (traffic, violence, fall, other) and country detrimental drinking pattern (DDP).

FINDINGS

Estimated risks were similar between the two analytical methods, with injury risk doubling at one drink [odds ratio (OR) = 2.3-2.7] and peaking at about 30 drinks. Although risk was similar for males and females up to three drinks (OR = 4.6), it appeared to increase more rapidly for females and was significantly higher starting from 20 drinks [female OR = 28.6; confidence interval (CI) = 16.8, 48.9; male OR = 12.8; CI = 10.1, 16.3]. No significant differences were found across age groups. Risk was significantly higher for violence-related injury than for other causes across the volume range. Risk was also higher at all volumes for DDP-3 compared with DDP-2 countries.

CONCLUSIONS

There is an increasing risk relationship between alcohol and injury but risk is not uniform across gender, cause of injury or country drinking pattern. The fractional polynomial approach is a valid and efficient approach for modeling the alcohol injury risk relationship.

The rate ratio of injury and aggressive incident for alcohol alone, cocaine alone and simultaneous use before the event: a case-crossover study

OBJECTIVES

(i) To estimate the rate ratio (RR) of use of alcohol alone, cocaine alone, and both substances simultaneously on acute injury or an aggressive incident, (ii) to compare the RRs for simultaneous use within 3 or 6h of the event; and (iii) to compare the RRs of two measures of exposure, "hours of feeling effects" vs estimates based on self-reported quantity and frequency of use.

METHODS

The study employed a case-crossover design with the frequency approach. Clients (N=616) in substance abuse treatment for alcohol or cocaine issues from 2009 to 2012 completed a self-administered questionnaire on their substance use within 3 and 6h before a recent injury or physically aggressive incident. Clients also reported detailed quantity and frequency information in relation to their typical substance use, as well as information on "feeling effects". The RR of acute harms due to substance use was estimated using the Mantel-Haenszel estimator.

RESULTS

In the 6-h window before the event, use of cocaine alone, alcohol alone and simultaneous alcohol and cocaine use were each significantly (P<0.05) related to a recent injury and aggressive incident. Simultaneous use was not significantly greater than use of either drug alone. Estimates of RR based on simultaneous use for a 3-h window before the event were consistently larger than those based on a 6-h window, and comparisons were significant (P<0.05) for an aggressive incident but not an injury. With reference to the two measures of exposure, three of eight comparisons of RRs were significantly larger for feeling the effects of the substance in comparison to quantity and frequency of substance use.

CONCLUSION

These findings are consistent with increased likelihood of harms related to the acute effects of alcohol alone, cocaine alone or simultaneous use. The results are suggestive that the acute effects of these drugs may be better measured within a 3-h time window than a 6-h window. Finally, we found that "hours of feeling effects" yielded higher estimates of RR than the quantity-frequency approach; however both measures support the overall findings.

Risk of injury from drinking: the difference which study design makes

BACKGROUND

The magnitude of risk of injury from drinking, based on emergency department (ED) studies, has been found to vary considerably across studies, and the impact of study design on this variation is unknown.

METHODS

Patients were interviewed regarding drinking within 6 hours prior to the injury or illness event, drinking during the same time the previous week, and usual drinking during the last 30 days. Risk estimates were derived from case-control analysis and from both pair-matched and usual frequency case-crossover analysis.

RESULTS

The odds ratio (OR) based on case-control (2.7; 1.9 to 3.8) was larger than that based on pair-matched case-crossover analysis (1.6; 1.0 to 2.6). The control-crossover estimate suggested the case-crossover estimate was an underestimate of risk, and when this adjustment was applied to the case-crossover estimate, risk of injury increased (OR = 3.2; 1.7 to 6.0). Adjusted case-crossover estimates compared with unadjusted showed the largest proportional increase at 7 or more drinks prior to injury (OR = 7.1; 2.2 to 22.9). The case-crossover estimate based on usual frequency of drinking was substantially larger (OR = 10.7; 8.0 to 14.3) than that based on case-control or pair-matched case-crossover analysis, but less than either when adjusted based on control-crossover usual frequency analysis (OR = 2.2; 1.5 to 3.3).

CONCLUSIONS

The data suggest that while risk of injury based on case-control analysis may be biased, control data are important in providing adjustments derived from control-crossover analysis to case-crossover estimates, and are most important at higher levels of consumption prior to the event.

A population-based study on road traffic injuries in Pune City, India

OBJECTIVE

The annual mortality of road traffic injuries (RTIs) is estimated to be over 80,000 in India; however, there is not enough information about the magnitude, pattern, and factors associated with RTIs in a population-based scenario, where the police and hospital records suffer from severe underreporting. This study was conducted with the aim of identifying the burden, pattern, and risk factors of RTIs in the population of Pune City.

METHOD

A population-based cross-sectional study was conducted among 9014 individuals in a randomly selected and representative sample of the population from 14 administrative wards of the city from March 2008 to April 2009.

RESULTS

The annual incidence rate of RTIs was 93.2 (95% confidence interval [CI], 83.2-103.2) per 1000 individuals and after adjustment for age it was 76.4 per 1000 individuals. Injury occurrence was significantly more among the age group 15-30, males, and students and workers. Univariate analysis showed a significant association between RTIs and age, gender, occupation, mode of transport, driving a vehicle, and alcohol abuse. Multivariate analysis showed that only age, driving a vehicle, and alcohol abuse were the factors associated with RTIs.

CONCLUSION

The magnitude of RTIs in India is very high, which is not reflected in police registration reports.

Risk of injury due to alcohol: evaluating potential bias using the case-crossover usual-frequency method

BACKGROUND

The usual-frequency case-crossover method, comparing exposure before an event with typical exposure of the same person, is widely used to estimate the risk of injury related to acute alcohol use. Prior results suggest that risk estimates might be biased upward compared with other methods.

METHODS

Using data from 15 emergency room studies in seven countries, we compared the usual-frequency case-crossover method with case-control analysis, using noninjury patients as controls. Control-crossover analysis was performed to examine potential bias and to adjust risk estimates.

RESULTS

The cross-study pooled odds ratio (OR) of injury related to drinking was 4.7 (95% confidence interval = 2.6-8.5) in case-crossover analysis and 2.1 (1.6-2.7) in case-control analysis. A control-crossover analysis found an indication of bias (OR = 2.2 [1.8-2.8]), which was larger among less-frequent drinkers.

CONCLUSION

Findings suggest that the potential overestimation of injury risk based on the usual-frequency case-crossover method might be best explained by recall bias in usual-frequency estimates.

Alcohol as a trigger for medical emergencies

In this paper, our goal is to report relative risks of the impact of alcohol consumption 6 hours prior to medical emergencies presenting in the emergency department for 8,346 patients in seven countries using data from the Emergency Room Collaborative Alcohol Analysis Project. We found that alcohol increased the risk of a medical emergency by 2.17 times (confidence interval: 1.78-2.65), and those without a regular pattern of heavy drinking and those younger showed a greater risk. Acute alcohol is associated not only with injury but also with medical emergencies. More studies are needed on the acute role of alcohol in medical emergencies, preferably with data on the type of medical emergencies.

Evaluating recall bias in a case-crossover design estimating risk of injury related to alcohol: data from six countries

INTRODUCTION AND AIMS

Prior work suggests that recall bias may be a threat to the validity of relative risk estimation of injury due to alcohol consumption, when the case-crossover method is used based on drinking during the same six hours period the week prior to injury as the control period. This work explores the issue of alcohol recall bias used in the case-crossover design.

DESIGN AND METHODS

Data were collected on injury patients from emergency room studies across six countries (Dominican Republic, Guatemala, Guyana, Nicaragua, Panama and Canada), conducted in 2009-2011, each with n ≈ 500 except Canada (n = 249). Recall bias was evaluated comparing drinking during two control periods: the same six hours period the day before versus the week before injury.

RESULTS

A greater likelihood of drinking yesterday compared with last week was seen using data from the Dominican Republic, while lower likelihood of drinking yesterday was found in Guatemala and Nicaragua. When the data from all six countries were combined, no differential drinking between the two control periods was observed.

DISCUSSION AND CONCLUSIONS

These findings are in contrast to earlier studies showing a downward recall bias of drinking, and suggest that it may be premature to dismiss the last week case-crossover method as a valid approach to estimating risk of injury related to drinking. However, the heterogeneity across countries suggests that there may be some unexplained measurement error beyond random sampling error.

D, de Bradshaw AM. Risk of injury after alcohol consumption from case-crossover studies in five countries from the Americas

AIMS

This study aimed to: (i) provide relative risk (RR) estimates between acute alcohol use and injuries from emergency departments (EDs) in the Dominican Republic, Guatemala, Guyana, Nicaragua and Panama, and (ii) test whether the RR differs if two control periods for the estimates were used.

DESIGN

Case-crossover methodology was used to obtain estimates of the RR of having an injury within 6 hours after drinking alcohol, using a pair-matching design with control periods of the same time of day on the day prior to injury, and the same time of day and day of week during the week prior to injury.

SETTING

EDs.

PARTICIPANTS

A total of 2503 injured patients from EDs were interviewed between 2010 and 2011, with a response rate of 92.6%.

MEASUREMENTS

Number of drinks consumed within 6 hours prior to the injury and in the two control periods.

FINDINGS

The RR of injury after drinking alcohol was 4.38 [95% confidence interval (CI): 3.29-5.84] using the prior week as the control period, and 5.35 (CI: 3.50-8.17) using the prior day as a control period. The RR was 5.08 (CI: 4.15-6.23) in multiple matching. Those drinking one to two drinks had a RR of 4.85 (CI: 3.12-7.54); those drinking three to five drinks an RR of 5.00 (CI: 3.47-7.18); those drinking six to 15 drinks an RR of 4.54 (CI: 3.36-6.14); and those drinking 16 or more drinks an RR of 10.42 (CI: 4.38-24.79).

CONCLUSIONS

As in other countries, drinking alcohol is an important trigger for an injury in the Dominican Republic, Guatemala, Guyana, Nicaragua and Panama.

Buckle up: non-seat belt use and antisocial behavior in the United States

OBJECTIVE

To compare persons who report that they never wear a seat belt while driving or as a passenger with those who do in a nationally representative sample in the United States. Our guiding hypothesis is that failure to wear a seat belt is part of an antisocial behavior spectrum.

METHODS

Using public-use data from the 2010 National Survey on Drug Use and Health, this study employed binary logistic regression with adjustments for complex survey sampling to assess relationships between never wearing a seat belt and sociodemographic variables, antisocial behaviors, substance abuse and co-occurring problems, and criminal justice system contact.

RESULTS

Individuals who do not wear seat belts are younger, more likely to be male, less likely to be African American or Hispanic, have incomes of less than $75,000, and be a high school or college graduate. After controlling for the effects of age, gender, race, income, education, and population density, individuals reporting that they never wear a seat belt while driving or as a passenger are more likely to report using alcohol and drugs (adjusted odds, 1.61-2.56), committing antisocial behaviors including felony offenses (adjusted odds, 2.13-3.57), and possess a dual diagnosis (adjusted odds, 1.62-1.73).

CONCLUSIONS

Findings indicate that non-seat belt use is convergent with a spectrum of serious antisocial behavior and comorbid psychological distress. Importantly, results suggest that standard seat belt use policies and campaigns may not be effective for non-seat belt using individuals and a targeted approach may be needed.

Contribution of alcohol in accident related mortality in Belarus: a time series approach

BACKGROUND

High accidental death rates in the former Soviet republics (FSR) and its profound fluctuation over the past decades have attracted considerable interest. The research evidences emphasize binge drinking pattern as a potentially important contributor to accident mortality crisis in FSR. In line with this evidence we assume that higher level of alcohol consumption in conjunction with binge drinking pattern results in close aggregate-level association between alcohol psychoses and accidental death rates in the former Soviet Slavic republic Belarus.

METHODS

Trends in alcohol psychoses rate (as a proxy for alcohol consumption) from 1979 to 2007 were analyzed employing a distributed lag analysis in order to asses bivariate relationship between the two time series.

RESULTS

According to the Bureau of Forensic Medicine autopsy reports the number of deaths due to accidents and injuries increased by 52.5% (from 62.3 to 95.0 per 100.000 of residents), and fatal alcohol poisoning rate increased by 108.6% (from 12.8 to 26.7 per 100.000 of residents) in Belarus between 1979 and 2007. Alcohol in blood was found in 50.1% victims of deaths from accidents and injuries for the whole period, with the minimum figure 40% in 1986 and maximum 58.2% in 2005. The outcome of distributed lags analysis indicated statistically significant association between the number of alcohol psychoses cases and the number BAC-positive deaths from accidents at zero lag.

CONCLUSIONS

The outcome of this study supports previous findings suggesting that alcohol and deaths from accidents are closely connected in a culture with prevailing intoxication-oriented drinking pattern, and add to growing body of evidence that a substantial proportion of accidental deaths in Belarus are due to effects of binge drinking.

Correlates of alcohol use in adults with ADHD and comorbid alcohol use disorders: exploratory analysis of a placebo-controlled trial of atomoxetine

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder are often comorbid in adults. The effects of ADHD treatment on comorbid alcohol use disorder have not been extensively studied.

OBJECTIVE

To assess correlates of ADHD and alcohol use outcomes in ADHD with comorbid alcohol use disorders, via a post-hoc exploratory subgroup analysis of a previously conducted, randomized, double-blind, placebo-controlled study of recently abstinent adults.

METHODS

Adults who had ADHD and alcohol use disorders and were abstinent for 4-30 days were randomized to daily atomoxetine 25-100 mg (mean final dose = 89.9 mg) or placebo for 12 weeks. Changes in ADHD symptoms from baseline to endpoint were assessed using the ADHD Investigator Symptom Rating Scale (AISRS) total score, alcohol use by the timeline followback method, and alcohol cravings by the Obsessive Compulsive Drinking Scale.

RESULTS

Of 147 subjects receiving atomoxetine (n = 72) or placebo (n = 75) in the primary study, 80 (54%) completed 12 weeks (n = 32 atomoxetine; n = 48 placebo). Improvements in ADHD symptoms on the AISRS correlated significantly with decreases in alcohol cravings (Pearson's r = 0.28; 95% confidence interval [CI] = 0.11-0.43; p = 0.002), and the correlation was most notable with atomoxetine (r = 0.29; CI [0.04 - 0.51]; p = 0.023) rather than with placebo (r = 0.24; CI [0.00-0.46]; p = 0.055). On-treatment drinking levels correlated with AISRS scores (r = 0.12; CI [0.05 -0.19]; p = 0.001). Relapse to alcohol abuse significantly correlated with worse ADHD symptoms on 15 of 18 items of the AISRS in the placebo group (p < 0.05 for each).

CONCLUSIONS

No baseline predictor (other than degree of sobriety) of alcohol use or ADHD outcomes emerged. ADHD symptom improvements correlated significantly with reductions in alcohol cravings, and relapse to alcohol abuse correlated significantly with worsening of most ADHD symptoms in the placebo group, but not in the atomoxetine group. This post-hoc subgroup analysis is of a hypothesis-generating nature, and the generalizability of the findings may be limited by exclusion of adults with common ADHD comorbidities from the base study. Further, prospective clinical trials in larger and more heterogeneous patient populations are warranted to confirm or reject these preliminary associations. TRIAL REGISTRATION (BASE STUDY): ClinicalTrials.gov identifier: NCT00190957.

Alcohol and risk of admission to hospital for unintentional cutting or piercing injuries at home: a population-based case-crossover study

Background

Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home.

Methods

A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts.

Results

Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers.

Conclusions

Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.

Risk of injury from alcohol and drug use in the emergency department: a case-crossover study

INTRODUCTION AND AIMS

A substantial literature exists demonstrating the risk of injury from alcohol, but less is known about the association of alcohol in combination with other drugs and injury. This study examined the risk of injury associated with alcohol and drug use prior to the event.

DESIGN AND METHODS

Case-crossover analysis was used to estimate the relative risk (RR) of injury due to alcohol use alone, compared with alcohol in combination with other drug use in a sample of emergency department injured patients from two sites in Vancouver, British Columbia (n = 443). Alcohol and drug use in the 6 h prior to injury was compared with the patient's use of these substances during the same 6 h period the day prior and the week prior to injury.

RESULTS

Using multiple matching for the two control time periods, RR of injury was significantly related to both alcohol use (RR = 3.3) and to alcohol combined with drug use (RR = 3.0), but not to drug use alone. Effect modification was found only for age for alcohol combined with drug use, with a significant increase in injury risk (P = 0.087) for those over 30.

DISCUSSION AND CONCLUSION

While a similar elevated risk of injury was found for alcohol use alone and alcohol used with other drugs, the literature suggests that alcohol in combination with some drugs may be potentially more risky for injury occurrence. Findings suggest the need for future research on risk of injury for specific alcohol and drug combinations.

Sociodemographic, behavioral, and substance use correlates of reckless driving in the United States: findings from a national Sample

This study examined the sociodemographic, behavioral, psychiatric, and substance use correlates of three forms of reckless driving using a nationally representative sample of U.S. adults. Participants were 43,093 adults from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule--DSM-IV version (AUDADIS-IV). This measure provides extensive sociodemographic data as well as diagnoses for mood, anxiety, personality, and substance use disorders. Reckless driving was significantly associated with male gender, lower levels of income, being born in the U.S., and numerous forms of antisocial behaviors. Fully adjusted models revealed significant effects with respect to substance use disorders across categories of reckless drivers with those having their licenses revoked or suspended being particularly more likely to be diagnosed with antisocial (AOR = 3.35, 95% CI = 2.54, 4.42) and paranoid personality disorder (AOR = 1.56, 95% CI = 1.07, 2.29). All three reckless driving groups were more likely to have a family history of antisocial behavior than non-reckless drivers. Study findings provide information from which targeted behavioral interventions can be applied.

Alcohol exposure and outcomes in trauma patients

Objective

To determine the injury patterns, complications, and mortality after alcohol consumption in trauma patients.

Methods

The Trauma Registry at an American College of Surgeons (ACS) level I center was queried for all patients with a toxicology screen admitted between 1st January 2002 and 31st December 2005. Alcohol-positive (AP) patients were matched to control patients who had a completely negative screen (AN) using age, gender, mechanism, Injury Severity Score (ISS), head Abbreviated Injury Scale (AIS), chest AIS, abdominal AIS, and extremity AIS. Injuries and outcomes were compared between the groups.

Results

As many as 5,317 patients had toxicology data, of which 471 (8.9%) had a positive alcohol screen (AP). A total of 386 AP patients were then matched to 386 control (AN) patients. The AP group had a significantly higher mortality than the AN group overall (23 vs. 13%; p < 0.001), and by ISS stratification: ISS < 16 (6 vs. 0.4%; p < 0.001), ISS 16–25 (53 vs. 28%; p = 0.01), and ISS > 25 (90 vs. 67%; p = 0.01). AP patients had a higher incidence of admission systolic blood pressure < 90 (18 vs. 10%; p < 0.001) and Glasgow Coma Scale (GCS) score ≤ 8 (25 vs. 17%; p = 0.002). AN patients had a significantly higher incidence of hemopneumothorax (11 vs. 7%; p = 0.03), while AP patients had a higher incidence of cardiac arrest (8 vs. 3%; p = 0.004). There was no difference in intensive care unit (ICU) and hospital length of stay.

Conclusion

In a mixed population of trauma patients, an AP screen is associated with an increased incidence of admission hypotension and depressed GCS score. In this case-matched study, alcohol exposure appeared to increase mortality after injury.

ALCOHOL AND VIOLENCE-RELATED INJURIES AMONG EMERGENCY ROOM PATIENTS IN AN INTERNATIONAL PERSPECTIVE

While alcohol has been found to be more closely associated with violence-related injury than with injury from other causes, little data is available which documents heterogeneity in this association across countries or cultures, taking into consideration usual drinking patterns and other socio-cultural variables. Data are reported from 15 countries comprising the Emergency Room Collaborative Alcohol Analysis Project and the WHO Collaborative Study on Alcohol and Injury. Case-crossover analysis was used to analyze the risk of injury (among current drinkers) from drinking six hours prior to the event, based on frequency of usual drinking, for violence-related injuries and separately for non-violence related injuries. Relative risk (RR) for a violence-related injury was significantly greater than for injuries from other causes across all countries (pooled RR=22.22 vs. 4.33), but the magnitude of risk varied considerably (ranging from 4.68 in Spain to 942 in Canada). Pooled effect size was found to be heterogeneous across countries, and was explained, in part, by the level of detrimental drinking pattern in a country. Risk for a violence-related injury was not significantly different by age (<30 and 30+), reporting 5 or more drinks on at least one occasion during the last year, or reporting symptoms of alcohol dependence. A number of methodological concerns suggest that risk of a violence-related injury compared to injuries from other causes may be inflated, and such variables as context of drinking should be taken into consideration in establishing relative risk and alcohol attributable fraction of violence-related injury across countries and cultures.

Alcohol and injuries: a review of international emergency room studies since 1995

This paper provides a review of emergency room (ER) studies on alcohol and injury, using representative probability samples of adult injury patients, and focuses on the scope and burden of the problem as measured by estimated blood alcohol concentration (BAC) at the time of the ER visit, self-report drinking prior to injury, violence-related injury and alcohol use disorders. A computerized search of the English-language literature on MEDLINE, PsychINFO and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol and Alcohol Problems Science Database (ETOH) was conducted for articles published between 1995 and 2005, using the following key descriptors: (1) emergency room/emergency department/accident and emergency, (2) alcohol/drinking and (3) injuries (intentional and unintentional). Findings support prior reviews, with injured patients more likely to be positive for BAC and report drinking prior to injury than non-injured, and with the magnitude of the association substantially increased for violence-related injuries compared to non-violence-related injuries. Indicators of alcohol use disorders did not show a strong association with injury. Findings were not homogeneous across studies, however, and contextual variables, including study-level detrimental drinking pattern, explained some of the variation. This review represents a broader range of ER studies than that reported previously, across both developed and developing countries, and has added to our knowledge base in relation to the influence of contextual variables on the alcohol-injury relationship. Future research on alcohol and injury should focus on obtaining representative samples of ER patients, with special attention to both acute and chronic alcohol use, and to organisational and socio-cultural variables that may influence findings across studies. In-depth patient interviews may also be useful for a better understanding of drinking in the injury event and associated circumstances.

Culturally Specific Youth Substance Abuse Resistance Skills: Applicability across the U.S.-Mexico Border

This study tests the applicability among adolescents in Mexico of the keepin' it REAL (refuse, explain, avoid, and leave) strategies that are common and effective ways that U.S. youth resist substance use. Following a social learning, communication competence and ecological theory integrated approach, the study draws on self-reported questionnaire data from a non-probability sample of 327 adolescents attending two public high schools in Monterrey, Nuevo León. Multivariate regressions were used to test whether the respondents' use of the REAL strategies by the participants could be predicted by key demographic variables. Separate models were estimated for the frequency of use of each strategy and for different substances. Findings indicate that most adolescents in this sample utilized each of the REAL strategies as well as other strategies to respond to offers of alcohol, cigarettes, or marijuana. Mexican and U.S. youth residing close to the US border appear to use similar drug resistance strategies. Use of the strategies varied considerably by the level of exposure to offers, but only minimally by gender and age. There were no notable differences by socioeconomic status or academic performance. Implications for prevention science, social work practice and social work research are discussed in the context of the bi-national border region and the applicability and prospect for dissemination of U.S. evidence based youth substance use prevention interventions.

The contribution of alcohol to falls at home among working-aged adults

The role of alcohol in the occurrence and burden of fall related injury at home is unclear. We examined the contribution of alcohol to fatal and hospitalized injuries due to unintentional falls at home among working-aged adults. We conducted a population-based case-control study in Auckland, New Zealand between July 2005 and July 2006. Cases were 335 people aged 25-60 years who were admitted to hospital or died as a result of unintentional falls at home. Control subjects were 352 people randomly selected from the electoral roll from the same age band as the cases. The participants or next-of-kin completed a structured interview that ascertained data on sociodemographic, personal, and lifestyle factors including alcohol consumption. After controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding 6h relative to none was associated with a significantly increased risk of fall related injury (for two standard drinks: odds ratio: 3.7, 95% confidence interval: 1.2-10.9; for three or more drinks: odds ratio: 12.9, 95% confidence interval: 5.2-31.9). Approximately 20% of unintentional falls at home in this population may be attributable to the consumption of two or more alcoholic drinks in the preceding 6h. Drinking is strongly associated with unintentional falls at home that result in admission to hospital or death. Moreover, a substantial proportion of falls at home among working-age people can be attributed to alcohol consumption. This largely unrecognized problem should be addressed in falls prevention programs.

Alcohol consumption, bone density, and hip fracture among older adults: the cardiovascular health study

INTRODUCTION

Previous studies have found inconsistent relationships of alcohol consumption with risk of hip fracture, and the importance of bone mineral density and risk of falls in mediating such a relationship has not been determined.

METHODS

As part of the Cardiovascular Health Study, a population-based cohort study of adults aged 65 years and older from four U.S. communities, 5,865 participants reported their use of beer, wine, and liquor yearly. We identified cases of hip fracture unrelated to malignancy or motor vehicle accidents using hospitalization discharge diagnoses. A subgroup of 1,567 participants in two communities underwent dual-energy x-ray absorptiometry scans to assess bone mineral density.

RESULTS

A total of 412 cases of hip fracture occurred during an average of 12 years of follow-up. There was a significant U-shaped relationship between alcohol intake and risk of hip fracture (p quadratic 0.02). Compared with long-term abstainers, the adjusted hazard ratios for hip fracture were 0.78 (95% confidence interval [CI], 0.61-1.00) among consumers of up to 14 drinks per week and 1.18 (95% CI, 0.77-1.81) among consumers of 14 or more drinks per week. Alcohol intake was associated with bone mineral density of the total hip and femoral neck in a stepwise manner, with approximately 5% (95% CI, 1%-9%) higher bone density among consumers of 14 or more drinks per week than among abstainers. These relationships were all similar among men and women.

CONCLUSIONS

Among older adults, moderate alcohol consumption has a U-shaped relationship with risk of hip fracture, but a graded positive relationship with bone mineral density at the hip.

Acute alcohol use and the risk of non-fatal injury in sixteen countries

AIMS

To determine the relative risk (RR) of non-fatal injury associated with alcohol consumption in a series of emergency departments (EDs), possible effect modifiers and the impact of contextual variables on differences across sites.

DESIGN

The case-crossover method was used to obtain RR estimates of the effect of alcohol on non-fatal injuries. Meta-analysis was used to evaluate the consistency and magnitude of RR across sites, and the extent to which contextual variables explain differences in effect sizes.

PARTICIPANTS

Probability samples of 11,536 injured patients attending 28 EDs studies in 16 countries (1984-2002). The majority of the sample was male (65%) and > 30 years old (53%).

MEASUREMENTS

Exposed cases where those that consumed alcohol 6 hours prior to the injury. Usual alcohol consumption served as the control period.

FINDINGS

Drinking within 6 hours prior to the injury was reported by 21% of the sample. The estimated (random) pooled relative risk for patients who reported alcohol use within 6 hours prior to injury was 5.69 (95% confidence interval = 4.04-8.00), ranging from 1.05 in Canada to 35.00 in South Africa. Effect size was not homogeneous across studies, as societies with riskier consumption patterns had a higher relative risk for injury. Heavier drinkers also showed lower RR.

CONCLUSIONS

Acute alcohol was a risk factor for non-fatal injuries in most sites. Policy measures addressed to the general population are recommended, especially in societies with riskier consumption patterns.

Alcohol consumption and self-reported sunburn: a cross-sectional, population-based survey

BACKGROUND

Heavy drinking has been associated with several cancers, including melanoma and basal cell carcinoma.

OBJECTIVE

The purpose of this study was to determine whether excessive drinking is associated with sunburn, a risk factor for skin cancer.

METHODS

As part of the 2004 Behavioral Risk Factor Surveillance System, a population-based telephone survey, 299,658 adults reported their use of alcohol in the preceding month and a history of sunburn in the preceding year.

RESULTS

Approximately 33.5% of respondents reported a sunburn within the past year. Heavier average alcohol use and binge drinking were both positively associated with prevalence and number of sunburns within the past year. The adjusted odds ratios for prevalence and number of sunburns among binge drinkers were 1.39 (95% confidence interval 1.31-1.48) and 1.29 (95% confidence interval, 1.20-1.38), respectively. Associations tended to be of similar magnitude for average alcohol use and in all subgroups evaluated.

LIMITATIONS

This study was cross-sectional and relied upon participant self-report.

CONCLUSION

Excessive drinking is associated with higher rates of sunburn among American adults. The observed relationship typifies the high-risk behavior associated with excessive drinking and suggests one pathway linking alcohol use with skin cancer.

Risk of injury: a case-crossover analysis of injured emergency service patients in poland

BACKGROUND

Over the last 15 years large changes in both alcohol consumption and the health care system have occurred in Poland. Substantial fluctuations in alcohol-related mortality followed and burden on health services increased, but data on risk of injury from alcohol consumption are relatively scarce

METHODS

Estimates for risk of injury from drinking within six hours prior to the event are reported in samples of emergency services patients from Warsaw (n=508) and Sosnowiec (n=432), using case-crossover analysis based on usual frequency of drinking

RESULTS

A four-fold risk of injury was found for those reporting drinking prior to injury compared to those not drinking, and this was significantly greater for those positive for alcohol use disorders compared to those negative. Relative risk of injury was marginally greater in Sosnowiec (5.2) compared to Warsaw (3.4) (p=0.06), and was significantly greater for those under 30. A 17-fold increase in risk for violence-related injury was found, and was significantly greater for females than males. Risk was substantially greater in Sosnowiec compared to Warsaw across all subgroups, but differences were not significant, possibly due to the small numbers of those sustaining injuries from violence in Warsaw.

DISCUSSION

Injury risk related to drinking was expected to be significantly greater in Sosnowiec, due to more traditional drinking styles of infrequent intake of large quantities of spirits, than in Warsaw, but this was only partially borne out by these data. Risk estimates for all injuries were similar to those found in other case-crossover studies in emergency departments. Given the high relative risk estimates for injury related to drinking prior to the event, among both problem and non-problem drinkers, hospital-based emergency services in Poland may be an important site for identification of those who could benefit from a brief intervention or referral for a reduction in alcohol-related injuries.

The role of alcohol and drugs in triggering criminal violence: a case-crossover study*

AIMS

To investigate the triggering effects of alcohol, illegal substances and major classes of prescribed psychotropic drugs on criminal violence.

DESIGN

A case-crossover design, using each subject as its own control.

SETTING AND PARTICIPANTS

A consecutive sample of 133 violent offenders was recruited from a forensic psychiatric evaluation unit and a national prison evaluation unit in Sweden during 2002-03. Measurements Offenders were assessed with structured interviews. Risk estimates were based on hazard periods of 24 hours. We used standard Mantel-Haenszel methods for statistical analyses.

FINDINGS

A 13.2-fold increase of risk of violence [95% confidence interval (CI): 8.2-21.2] was found within 24 hours of alcohol consumption. This increase in violence risk was similar among individuals combining alcohol with benzodiazepines [Relative risk (RR) = 13.2, 95% CI: 4.9-35.3]. Use of benzodiazepines alone in regular doses (RR = 0.4, 95% CI: 0.2-0.5) or antidepressants [selective serotonin reuptake inhibitors (SSRIs) or tricyclics] (RR = 0.4, 95% CI: 0.3-0.8) was associated with a lowered risk for violence.

CONCLUSIONS

This study confirmed that alcohol is a strong trigger of criminal violence. Benzodiazepines in combination with alcohol caused no further increase of violence risk. Benzodiazepines in regular doses and antidepressants may inhibit violence, but further studies are needed to verify causality. The case-crossover method can contribute to research on the proximal causes of criminal violence.

SSRIs and cognitive performance in a working sample

BACKGROUND

Studies of the impact of antidepressant use on cognitive performance have frequently been carried out among the elderly or on healthy volunteers. Comparatively little research has considered their impact on a relatively young, working population, particularly within the context of everyday life.

AIMS

To examine any association between SSRI use and cognitive performance, mood and human error at work.

METHODS

SSRI users and controls completed a battery of laboratory based computer tasks measuring mood and cognitive function pre- and post-work at the start and end of a working week. They also completed daily diaries reporting their work performance.

RESULTS

SSRI use was associated with memory impairment: specifically poorer episodic, though not working or semantic memory. Effects of SSRI use on recognition memory seemed to vary according to the underlying psychopathology, while effects on delayed recall were most pronounced among those whose symptoms had not (yet) resolved. There were no detrimental effects on psychomotor speed, attention, mood or perceived human error at work.

CONCLUSIONS

The findings lend support to the SSRIs comparative safety, even among workers, particularly as the symptoms of the underlying psychopathology are successfully addressed. Possible memory impairments may, however, be found in those taking SSRIs.

ALCOHOL INTAKE AND THE PATTERN OF TRAUMA IN YOUNG ADULTS AND WORKING AGED PEOPLE ADMITTED AFTER TRAUMA

AIMS

To investigate the relationship of different patterns of alcohol intake to various types of trauma.

METHODS

We examined the associations of alcohol consumption in a series of 385 consecutive trauma admissions (278 men, 107 women, age range 16-49 years). Patients underwent clinical examinations, structured interviews on the amount and pattern of alcohol intake, and measurements of blood alcohol concentration (BAC).

RESULTS

On admission, 51% of the patients had alcohol in their blood. Binge drinking was the predominant (78%) drinking pattern of alcohol intake. Assaults, falls and biking accidents were the most frequent causes of trauma. Dependent alcohol drinking and binge drinking were found to be significantly more common among patients with head trauma than in those with other types of trauma (77% vs 59%, OR=2.38; 95% CI 1.50 to 3.77). The OR for sustaining head injury increased sharply with increasing BAC: 1-99 mg/dl (1.24; 95% CI 0.55-2.01), 100-149 mg/dl 1.64; 95% CI 0.71-3.77), 150-199 mg/dl (3.20; 95% CI 1.57-6.53) and >199 mg/dl (9.23; 95% CI 4.79-17.79).

CONCLUSIONS

Binge drinking is a major risk factor for head trauma among trauma patients. Assaults, falls and biking accidents are the commonest causes for such injuries. The relative risk for head injury markedly increases with increasing blood alcohol levels. Alcohol control measures should feature in policies aiming at the prevention of trauma-related morbidity and mortality.

A CASE-CONTROL STUDY OF ALCOHOL AND SUBSTANCE USE DISORDERS AS RISK FACTORS FOR NON-FATAL INJURY

AIMS

While alcohol use is thought to be a major risk factor for both fatal and non-fatal injuries, the association of substance use disorders (alcohol use disorders, AUD and substance use disorders, SUD) with occurrence of injury has not received the same attention. To report the association of AUD and SUD, according to diagnostic and statistics manual of mental disorders-IV (DSM-IV) and international classification of diseases 10 (ICD-10) criteria, and the risk of non-fatal injuries.

METHODS

A case-control study: Cases included 653 injured patients, 18-65-years-old, who attended one emergency department (ED). Controls included 1131 subjects from a representative sample of residents of Mexico City, of the same age group. Information on drug and alcohol use was obtained by interview using the world mental health version of the composite international diagnostic interview (WMH-CIDI).

RESULTS

Among injured patients, the prevalence of substance abuse or dependence within the last 12 months was 12.3% for alcohol and 2.5% for other substances (marijuana, cocaine, tranquilizers, amphetamines, others). Among residents of Mexico City, these prevalences were 1.8 and 0.3%, respectively. Adjusted odds ratios (OR) of injury according to alcohol and substance use were 4.95 (95% confidence interval (CI): 2.87-8.52) for alcohol and 2.58 (0.73-9.17) for other substances. An important level of comorbid alcohol and substance use disorders was also found.

CONCLUSIONS

Efforts in the ED should be carried out to treat and/or refer patients with alcohol and substance use disorders, and special care should be taken to address comorbid cases.