The relationship between self-reported drinking and BAC level in emergency room injury cases: is it a straight line?

Clinician assessment of blood alcohol levels among emergency department patients

INTRODUCTION

Alcohol intoxication is a significant public health concern and is commonly seen among emergency department (ED) patients. This study was undertaken to identify the accuracy of clinician assessment of blood alcohol levels among emergency department patients.

METHODS

This prospective survey study was conducted at a Level 1 Trauma Center. Eligible study participants included physicians, nurses, and medical students involved in the care of patients who had BAC. Clinicians estimated the BAC prior to results availability.

RESULTS

Among 243 clinicians, the mean difference between the estimated BAC and actual BAC was 17.4 (95% CI: 4.7 to 30.1). Providers tended to overestimate the actual BAC level. The accuracy between roles (attendings, residents, RNs, students) was not significant (ANOVA p-value 0.90). Accuracy was not correlated with age of the patient (Pearson correlation 0.04, p-value 0.54). Accuracy was not associated with the patient's gender (Student's t-test two-tailed p-value 0.90), ethnicity (White versus all others, t-test p-value 0.31), nor insurance (government versus not government, t-test p-value 0.81). The average accuracy value was associated with mode of arrival (t-test p-value 0.003). The average accuracy for walk-in subjects was -14.9 (CI: -32.8 to 3.1) compared to ambulance arrivals 28.3 (CI: 12.7 to 44.0). Providers underestimated BAC for walk-ins and overestimated BAC for ambulance arrivals. Among 107 patients with a BAC of 0, clinician estimates ranged from 0 to 350. Clinicians estimated non-zero BAC levels in 17% of patients with BAC of 0 (N = 18).

CONCLUSIONS

Clinicians' estimates of BAC were often inaccurate, and often overestimated the BAC.

Racial/Ethnic Disparities in the Relationship of Alcohol-Related Injury and Perceived Driving Under the Influence from Hours of Exposure to High Blood Alcohol Concentration: Data From Four US National Alcohol Surveys (2000-2015)

AIMS

To analyze racial/ethnic disparities in risk of two alcohol-related events, alcohol-related injury and self-reported perceived driving under the influence (DUI) from hours of exposure to an elevated blood alcohol concentration (BAC).

METHODS

Risk curves for the predicted probability of these two outcomes from the number of hours of exposure to a BAC ≥ 0.08 mg% in the past year were analyzed separately for whites, blacks and Hispanics in a merged sample of respondents from four US National Alcohol Surveys (2000-2015).

RESULTS

Hours of exposure to a BAC ≥ 0.08 showed a stronger association with perceived DUI than with alcohol-related injury for all racial/ethnic groups. Greater risk was found for whites than blacks or Hispanics for outcomes at nearly all BAC exposure levels, and most marked at the highest level of exposure. Risk of both outcomes was significant for whites at all exposure levels, but small for alcohol-related injury. Little association was found for alcohol-related injury for blacks or Hispanics. For perceived DUI, risk for blacks was significantly elevated at lower levels of exposure, while risk for Hispanics was significantly elevated beginning at 30 h of exposure.

CONCLUSIONS

Findings showed racial/ethnic differences in risk of alcohol-related injury and perceived DUI from hours of exposure to elevated BAC. Risk increased at relatively low levels of exposure to a BAC ≥ 0.08, especially for whites, highlighting the importance of preventive efforts to reduce harmful outcomes for moderate drinkers.

Transcriptional analysis of the response of C. elegans to ethanol exposure

Ethanol-induced transcriptional changes underlie important physiological responses to ethanol that are likely to contribute to the addictive properties of the drug. We examined the transcriptional responses of Caenorhabditis elegans across a timecourse of ethanol exposure, between 30 min and 8 h, to determine what genes and genetic pathways are regulated in response to ethanol in this model. We found that short exposures to ethanol (up to 2 h) induced expression of metabolic enzymes involved in metabolizing ethanol and retinol, while longer exposure (8 h) had much more profound effects on the transcriptome. Several genes that are known to be involved in the physiological response to ethanol, including direct ethanol targets, were regulated at 8 h of exposure. This longer exposure to ethanol also resulted in the regulation of genes involved in cilia function, which is consistent with an important role for the effects of ethanol on cilia in the deleterious effects of chronic ethanol consumption in humans. Finally, we found that food deprivation for an 8-h period induced gene expression changes that were somewhat ameliorated by the presence of ethanol, supporting previous observations that worms can use ethanol as a calorie source.

Gender differences in the consumption of alcohol mixed with caffeine and risk of injury

INTRODUCTION AND AIMS

There is increasing evidence suggesting the consumption of caffeinated alcoholic beverages is associated with risks over and above alcohol use on its own; however, research in this area remains limited. We examined whether gender differences existed in the relationship between the combined use of alcohol and caffeine (Alc + Caff) and risk for injury.

DESIGN AND METHODS

This emergency department study utilised case-control and case-crossover analyses to examine in situ session specific Alc + Caff use and injury risk for men and women, while controlling for socio-demographic variables, dose of alcohol and caffeine, other substance use, risk-taking propensity and context. The sample comprised 2804 individuals aged 18-years or older who presented to three hospital emergency departments in British Columbia.

RESULTS

A relationship between Alc + Caff use and increased risk of injury was confirmed. Further, gender differences were found in the risk relationship between Alc + Caff use and injury. Women were found to have a higher risk injury propensity following Alc + Caff use in both the case-control (OR = 3.10, 95% CI = 1.78, 5.84) and case-crossover analyses (OR = 3.21, 95% CI = 1.69, 6.12), relative to men (OR = 1.69, 95% CI = 1.30, 2.30; OR = 1.38, 95% CI = 1.08, 1.86). These results remained even after controlling for demographic factors, risk-taking, context and other substance use.

DISCUSSION AND CONCLUSIONS

Women may be at higher risk of injury than men following the consumption of alcohol mixed with caffeine. The findings offer support for differential low-risk drinking guidelines for men and women and the restriction and regulation of the sale and availability of caffeinated alcoholic beverages.

Validity of self-reports of drinking before injury by cause of injury and societal context among emergency department patients

INTRODUCTION AND AIMS

Validity of self-reported alcohol consumption is a topic of continued interest with mixed findings. Validity of self-reports prior to injury is analysed among emergency department (ED) patients by cause of injury, blood alcohol concentration (BAC) and societal context.

DESIGN AND METHODS

Data are on 16 196 injured patients from 23 countries in the International Collaborative Alcohol and Injury Project. The proportion of those reporting drinking within 6 h prior to injury among the 2658 BAC positive patients was analysed by injury cause (traffic, violence, falls, other), BAC level (0.01-0.079 mg%, ≥ 0.08 mg%), detrimental drinking pattern (DDP) and the International Alcohol Policy and Injury Index (IAPII).

RESULTS

Validity averaged 92%, ranging from 85% for drivers to 95% for violence-related injuries. Validity was significantly lower at lower BAC levels for all injuries (P < 0.01) and for violence and falls. Countries with a high DDP and those with lower IAPII scores (less restrictive alcohol policy) also appeared more likely to deny drinking which was significant for DDP for falls (P < 0.01) and for IAPII for passengers/pedestrians (P < 0.05) and violence (P < 0.05). Validity was highest for high IAPII countries, ranging from 92% to 99%.

DISCUSSION AND CONCLUSIONS

Validity of self-report compared to breathalyzer readings at the time of admission to the ED was high, but varied by cause of injury, BAC level, country-level detrimental drinking patterns and the restrictiveness of alcohol control policy. Findings may support the utility or self-reports as an alternative to a quantifiable measure of BAC in the ED setting.

Cross-species molecular dissection across alcohol behavioral domains

This review summarizes the proceedings of a symposium presented at the "Alcoholism and Stress: A Framework for Future Treatment Strategies" conference held in Volterra, Italy on May 9-12, 2017. Psychiatric diseases, including alcohol-use disorders (AUDs), are influenced through complex interactions of genes, neurobiological pathways, and environmental influences. A better understanding of the common neurobiological mechanisms underlying an AUD necessitates an integrative approach, involving a systematic assessment of diverse species and phenotype measures. As part of the World Congress on Stress and Alcoholism, this symposium provided a detailed account of current strategies to identify mechanisms underlying the development and progression of AUDs. Dr. Sean Farris discussed the integration and organization of transcriptome and postmortem human brain data to identify brain regional- and cell type-specific differences related to excessive alcohol consumption that are conserved across species. Dr. Brien Riley presented the results of a genome-wide association study of DSM-IV alcohol dependence; although replication of genetic associations with alcohol phenotypes in humans remains challenging, model organism studies show that COL6A3, KLF12, and RYR3 affect behavioral responses to ethanol, and provide substantial evidence for their role in human alcohol-related traits. Dr. Rob Williams expanded upon the systematic characterization of extensive genetic-genomic resources for quantifying and clarifying phenotypes across species that are relevant to precision medicine in human disease. The symposium concluded with Dr. Robert Hitzemann's description of transcriptome studies in a mouse model selectively bred for high alcohol ("binge-like") consumption and a non-human primate model of long-term alcohol consumption. Together, the different components of this session provided an overview of systems-based approaches that are pioneering the experimental prioritization and validation of novel genes and gene networks linked with a range of behavioral phenotypes associated with stress and AUDs.

Risk of Past Year Injury Related to Hours of Exposure to an Elevated Blood Alcohol Concentration and Average Monthly Alcohol Volume: Data from 4 National Alcohol Surveys (2000 to 2015)

BACKGROUND

While a strong association exists between alcohol and injury in emergency department (ED) studies, these studies are not representative of the general population.

METHODS

The association of injury with the number of hours of exposure to a blood alcohol concentration (BAC) ≥ 0.05 and average monthly volume in drinks, both based on self-report of quantity and frequency of drinking in the last year, in a merged sample of respondents (n = 29,571) from 4 U.S. National Alcohol Surveys (2000 to 2015) are analyzed. Risk curves based on categorical step function and fractional polynomial modeling were analyzed separately by gender, and by age and race/ethnicity for males.

RESULTS

Risk of injury increased at 1 hour of a BAC exposure of ≥ 0.05 and at an average monthly volume of 1 drink. Risk of injury for spirits increased to an average daily volume of 1 drink, but no association was found for injury risk and average volume for either wine or beer. Risk of injury increased with both exposure hours and monthly volume among males, but little association was found for either consumption measure with risk of injury for females. Among males, increased risk of injury was greater for whites than for blacks or Hispanics for BAC exposure; Hispanics showed a continued elevated risk up to 8 hours of exposure. After peaking at a monthly volume of 1 drink, injury risk decreased substantially for blacks, but was more gradual for whites, while risk increased very slightly for Hispanics to about 4 drinks per day. Males aged 18 to 29 showed the largest increase in risk associated with the number of hours of exposure to a BAC of ≥0.05, with risk doubling at 1 hour of exposure, but subsequently falling.

CONCLUSIONS

While findings here are weaker than those from ED studies and likely due to the context of drinking, risk of injury appears to increase at relatively low levels of consumption, suggesting the importance of preventive efforts to reduce injury not only for heavier drinkers but also for more moderate drinkers.

Drinking context and cause of injury: Emergency department studies from 22 countries

Background

It is estimated that up to a third of injuries requiring emergency department admission are alcohol-related. While injuries that are alcohol-related are unsurprising to emergency department staff, less is understood about the precursors to the injury event.

Methods

Using data from representative emergency department injury patients in 22 countries, we examined associations between context of injury (private or public), cause of injury (fall or trip, being stuck/cut/ or burned and violence) and alcohol use. Alcohol-related policy data were also obtained from each study locale.

Results

Injuries were similarly reported in private (54%) and public settings (46%) while cause of injury was most often due to falls (39%) or being struck/cut or burned (38%). Violence-related injuries were reported by approximately 1 in 5 patients (23%). Increased odds of drinking prior to the injury event was associated with injury due to violence in private settings but not public venues. Similarly, patients from regions with fewer restrictive alcohol policies were more likely to report drinking prior to an injury event and have elevated violence-related injuries in private settings.

Conclusion

Understanding the cause and context of injury and alcohol use are important components to evaluation and development of alcohol policies.

Genomewide Association Study of Alcohol Dependence Identifies Risk Loci Altering Ethanol-Response Behaviors in Model Organisms

BACKGROUND

Alcohol dependence (AD) shows evidence for genetic liability, but genes influencing risk remain largely unidentified.

METHODS

We conducted a genomewide association study in 706 related AD cases and 1,748 unscreened population controls from Ireland. We sought replication in 15,496 samples of European descent. We used model organisms (MOs) to assess the role of orthologous genes in ethanol (EtOH)-response behaviors. We tested 1 primate-specific gene for expression differences in case/control postmortem brain tissue.

RESULTS

We detected significant association in COL6A3 and suggestive association in 2 previously implicated loci, KLF12 and RYR3. None of these signals are significant in replication. A suggestive signal in the long noncoding RNA LOC339975 is significant in case:control meta-analysis, but not in a population sample. Knockdown of a COL6A3 ortholog in Caenorhabditis elegans reduced EtOH sensitivity. Col6a3 expression correlated with handling-induced convulsions in mice. Loss of function of the KLF12 ortholog in C. elegans impaired development of acute functional tolerance (AFT). Klf12 expression correlated with locomotor activation following EtOH injection in mice. Loss of function of the RYR3 ortholog reduced EtOH sensitivity in C. elegans and rapid tolerance in Drosophila. The ryanodine receptor antagonist dantrolene reduced motivation to self-administer EtOH in rats. Expression of LOC339975 does not differ between cases and controls but is reduced in carriers of the associated rs11726136 allele in nucleus accumbens (NAc).

CONCLUSIONS

We detect association between AD and COL6A3, KLF12, RYR3, and LOC339975. Despite nonreplication of COL6A3, KLF12, and RYR3 signals, orthologs of these genes influence behavioral response to EtOH in MOs, suggesting potential involvement in human EtOH response and AD liability. The associated LOC339975 allele may influence gene expression in human NAc. Although the functions of long noncoding RNAs are poorly understood, there is mounting evidence implicating these genes in multiple brain functions and disorders.

Violence and non-violence-related injuries and alcohol in women from developed and developing countries: a multi-site emergency room study

This study sought to analyze the association between alcohol consumption and the occurrence of injuries in women attending the emergency room (ER) from developing and developed countries. The sample consisted of ER data from women in 15 countries that were collected as part of two multi-site studies using similar methodologies: the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), and World Health Organization Collaborative Study on Alcohol and Injuries (WHO Study). Women ranged in age from 18 to 98years. Those from developed countries had higher levels of education (43% completed high-school) than women from developing countries (37%). Over half of the women from developing countries reported they had not consumed alcohol in the last 12months (abstentious), while 2% reported drinking every day. In addition, current drinking women from developing countries reported more binge drinking episodes (33% reported 5 to 11 drinks and 15% reported 12 or more drinks on an occasion) compared to those from developed countries (28% and 11%, respectively). Violence-related injury was more prevalent in developing countries (18%) compared to developed countries (9%). An association between injury and the frequency of alcohol consumption in the last 12months was observed in both developing and developed countries. Although women from developing countries who suffered violence-related injuries were more likely to demonstrate alcohol abstinence or have lower rates of daily alcohol consumption, these women drank in a more dangerous way, and violence-related injuries were more likely to occur in these women than in those living in developed countries.

Diagnostic accuracy study of three alcohol breathalysers marketed for sale to the public

OBJECTIVES

To assess the diagnostic accuracy of three personal breathalyser devices available for sale to the public marketed to test safety to drive after drinking alcohol.

DESIGN

Prospective comparative diagnostic accuracy study comparing two single-use breathalysers and one digital multiuse breathalyser (index tests) to a police breathalyser (reference test).

SETTING

Establishments licensed to serve alcohol in a UK city.

PARTICIPANTS

Of 222 participants recruited, 208 were included in the main analysis. Participants were eligible if they were 18 years old or over, had consumed alcohol and were not intending to drive within the following 6 h.

OUTCOME MEASURES

Sensitivity and specificity of the breathalysers for the detection of being at or over the UK legal driving limit (35 µg/100 mL breath alcohol concentration).

RESULTS

18% of participants (38/208) were at or over the UK driving limit according to the police breathalyser. The digital multiuse breathalyser had a sensitivity of 89.5% (95% CI 75.9% to 95.8%) and a specificity of 64.1% (95% CI 56.6% to 71.0%). The single-use breathalysers had a sensitivity of 94.7% (95% CI 75.4% to 99.1%) and 26.3% (95% CI 11.8% to 48.8%), and a specificity of 50.6% (95% CI 40.4% to 60.7%) and 97.5% (95% CI 91.4% to 99.3%), respectively. Self-reported alcohol consumption threshold of 5 UK units or fewer had a higher sensitivity than all personal breathalysers.

CONCLUSIONS

One alcohol breathalyser had sensitivity of 26%, corresponding to false reassurance for approximately three people in four who are over the limit by the reference standard, at least on the evening of drinking alcohol. The other devices tested had 90% sensitivity or higher. All estimates were subject to uncertainty. There is no clearly defined minimum sensitivity for this safety-critical application. We conclude that current regulatory frameworks do not ensure high sensitivity for these devices marketed to consumers for a decision with potentially catastrophic consequences.

Alcohol consumption as an incremental factor in health care costs for traffic accident victims: evidence in a medium sized Colombian city

OBJECTIVES

Identify the possibility that alcohol consumption represents an incremental factor in healthcare costs of patients involved in traffic accidents.

METHODS

Data of people admitted into three major health institutions from an intermediate city in Colombia was collected. Socio-demographic characteristics, health care costs and alcohol consumption levels by breath alcohol concentration (BrAC) methodology were identified. Generalized linear models were applied to investigate whether alcohol consumption acts as an incremental factor for healthcare costs.

RESULTS

The average cost of healthcare was 878 USD. In general, there are differences between health care costs for patients with positive blood alcohol level compared with those who had negative levels. Univariate analysis shows that the average cost of care can be 2.26 times higher (95% CI: 1.20-4.23), and after controlling for patient characteristics, alcohol consumption represents an incremental factor of almost 1.66 times (95% CI: 1.05-2.62).

CONCLUSIONS

Alcohol is identified as a possible factor associated with the increased use of direct health care resources. The estimates show the need to implement and enhance prevention programs against alcohol consumption among citizens, in order to mitigate the impact that traffic accidents have on their health status. The law enforcement to help reduce driving under the influence of alcoholic beverages could help to diminish the economic and social impacts of this problem.

Does beverage type and drinking context matter in an alcohol-related injury? Evidence from emergency department patients in Latin America

BACKGROUND

Previous studies have already substantiated alcohol's causal role in injuries. Yet the role that alcoholic beverage preferences and the drinking context play in the risk for injury is still under-investigated. In this study, a cross-national comparison of the association between alcohol and injury focusing on beverage type preference and the drinking context is reported.

METHODS

Emergency department (ED) injured patients were interviewed in eight countries from the Latin American and Caribbean (LAC) region. Data on the type of alcoholic beverage, total alcohol volume, and the place where the injury occurred were obtained from patients who reported any alcohol consumption within 6h prior to being injured. Patients who did not drink prior to injury were also asked about their typical drinking pattern and the injury place. Differences within- and between-groups were evaluated regarding patients' typical drinking and drinking before injury.

RESULTS

Beer was the most prevalent beverage type usually consumed among injured patients across countries, however, patients who drank before injury had a higher typical consumption of spirits than those not drinking prior to injury. The total alcohol volume typically consumed and drinking in public settings were also found to be positively associated with alcohol-related injury.

CONCLUSIONS

A similar beverage-specific association with alcohol-related injury was found across LAC countries, mainly attributed to beer consumption, and spirits drinkers seem to have a greater chance of becoming involved in injury events. Future prevention strategies should inform the public about harms from drinking associated with the context in which drinking takes place.

Alcohol-medical drug interactions

Concomitant use of alcohol and medications may lead to potentially serious medical conditions. Increasing prescription medication abuse in today's society necessitates a deeper understanding of the mechanisms involved in alcohol-medication interactions in order to help prevent adverse events. Interactions of medications with alcohol result in altered bioavailability of the medication or alcohol (pharmacokinetic interactions) or modification of the effects at receptor or ion channel sites to alter behavioral or physical outcome (pharmacodynamic interactions). The nature of pharmacokinetic or pharmacodynamic interactions involved in alcohol-medication interactions may differ between acute and chronic alcohol use and be influenced by race, gender, or environmental or genetic factors. This review focuses on the mechanisms underlying pharmacokinetic and pharmacodynamic interactions between alcohol and medications and provides examples for such interactions from replicated research studies. In conclusion, further translational research is needed to address several gaps in our current knowledge of alcohol-medication interactions, including those under various pathologic conditions.

Alcohol intake and risk of injury

Injuries constitute a leading cause of morbidity and mortality in the world, with intentional injuries and those related to traffic most important, due to their social impact and high prevalence. Although alcohol consumption has been identified as a risk factor for injuries, few studies have assessed risk separately for intentional injuries and unintentional injuries caused by traffic, and by other causes. The objective of this paper was to estimate the risk of injuries after acute alcohol consumption for intentional injuries and unintentional traffic and non-traffic injuries, using, alternatively, two exposure measures: self-reported drinking prior to the event and blood alcohol concentration. A probability sample was collected of 540 patients from the emergency department of a hospital in Argentina. Logistic regressions were performed, with and without adjusting for gender, age and drinking pattern. Higher risks were found when blood alcohol concentration was used as a measure of consumption, compared to self-report. The highest risk estimates were obtained for intentional injuries, followed by unintentional traffic and, lastly, by unintentional non-traffic injuries. After controlling for confounders, risks for intentional and unintentional traffic injuries appeared similar for those above and below the legal limit. Results point to a significant involvement of alcohol in the regional context.

Studying psychoactive substance use in injured patients: does exclusion of late arriving patients bias the results?

BACKGROUND

Most studies of the prevalence of psychoactive substances in injured emergency department patients have excluded those who arrive more than 6h after injury. This may cause a selection bias. The aim of this study was: (1) to describe the characteristics of patients who arrive more than 6h after injury, compared to patients who arrive sooner (2) to examine whether self-report can add to the assessment of alcohol use when the patient is assessed more than 6h after injury.

METHODS

Blood sample analysis and self-report data were used to assess the prevalence of psychoactive substances in injured patients admitted to an emergency department within 48 h of injury (n=1611). Discriminant function analysis was used to assess group differences.

RESULTS

The patients who arrived more than 6h after injury differed significantly from those who arrived earlier in several respects. They more often screened positive for hypnotics; they were older, they were more likely to have had a fall and they were more often injured at home and at night. Self reported use of alcohol showed good consistency with blood sample screening within 6h of injury and could therefore be used to assess alcohol use more than 6h after injury.

CONCLUSIONS

Patients who arrive more than 6h after injury differ significantly from those who arrive earlier. Future studies on the prevalence of psychoactive substances in emergency departments could expand the inclusion window.

A review of emergency room studies on alcohol and injuries conducted in Latin America and the Caribbean region

ISSUES

Alcohol-attributable burden of injury is one of the most serious public health problems in Latin America and the Caribbean region (LAC). Although knowledge on alcohol's involvement in injuries has progressed along with the implementation of evidenced-based alcohol policies in developed countries, this was not true for the most part of LAC countries for which reducing alcohol-related injuries is an urgent necessity.

APPROACH

A systematic review was performed in order to identify the most up-to-date information on alcohol and injuries derived from emergency room (ER) studies conducted in LAC.

KEY FINDINGS

Findings corroborate that alcohol has a high prevalence among injured patients in the ER setting in LAC, with violence-related injuries showing an increased association with alcohol use compared to unintentional injuries. However, a large number of studies did not include all types of injury and the measurement of injury risk associated with alcohol consumption. The amount of alcohol consumed in the event and hazardous drinking patterns seem to be strongly associated with injury occurrence, as well as drinking in public spaces, but a paucity of data relating to social-contextual factors limits the interpretation of the heterogeneity in the magnitude of the association of alcohol and injuries found across studies.

CONCLUSIONS

There is a lack of ER studies able to support strategies to reduce alcohol-related injuries in a region where effective alcohol policies are scant. Future research should focus on understanding how drinking influenced by local contexts and drinking behaviours may affect the risk of injury within each LAC country.

Multi-level analysis of alcohol-related injury and drinking pattern: emergency department data from 19 countries

Aim  While drinking in the event is an important factor in injury occurrence, the pattern of usual drinking may also be important in risk of injury. Explored here is the relationship of an alcohol-related injury with an individual usual drinking pattern. Design  Alcohol-related injury is examined using hierarchical linear models, taking into account individual usual volume of consumption over the past 12 months, as well as aggregate-level detrimental drinking pattern (DDP) and alcohol policy measures. Setting  Data analyzed are from emergency departments (EDs) in 19 countries, comprising three collaborative studies on alcohol and injury, all of which used a similar methodology. Participants  The sample comprised 14 132 injured drinkers across 46 emergency room (ER) studies. Measurements  Alcohol-related injury was measured, separately, by any self-reported drinking prior to injury, a blood alcohol concentration (BAC) ≥ 0.08 and self-reported causal attribution of injury to drinking. Findings  While individual usual volume strongly predicted an alcohol-related injury for all three measures, usual drinking pattern also predicted an alcohol-related injury (controlling for volume), with episodic heavy and frequent heavy drinking both more predictive of alcohol-related injury than other drinking patterns. When individual usual volume and drinking pattern were controlled, DDP was no longer a significant predictor of alcohol-related injury. Alcohol policy measures were predictive of both BAC and causal attribution (the stronger the policy the lower the rates of alcohol-related injury). Conclusions  Volume of alcohol typically consumed and occurrence of heavy drinking episodes are associated independently with incidence of alcohol-related injury. The stronger the anti-alcohol policies in a country, the lower the rates of alcohol-related injury.

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.

Last Call: decreasing drunk driving among 21-34-year-old bar patrons

Any effort to decrease the toll of drunk driving must include efforts directed at people who drink in bars, particularly young adults who use motor vehicles after drinking. We designed a multifaceted social marketing campaign, Last Call, to increase the use of designated drivers and safe rides homes among 21-34-year olds. There were three components to the intervention: (1) use of taxi stands to promote taxi use; (2) point-of-sale information to patrons at partner bars and (3) a mass media campaign to support the designated driver/safe ride home message. Among the heaviest drinkers, the programme significantly increased the use of designated drivers and increased the use of taxis by 63%.