Alcohol and non-fatal injury in the U.S. general population: a risk function analysis

Racial/Ethnic and Gender Differences in Risk of Injury and Life-Course Drinking Patterns: Data from US National Alcohol Surveys

AIMS

To estimate risk of injury associated with frequency of drinking and heavy drinking (5+ drinks on occasion) by gender and race/ethnicity in the US population.

METHODS

Data were from a merged sample of two National Alcohol Surveys (telephone and web-based) (2014-2015 and 2019-2020) on 16,639 respondents, and analyzed using Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking was determined by age of onset and questions on any drinking and heavy drinking by decade of life. The outcome measure was having had an injury from a serious accident at a certainage.

RESULTS

Frequent heavy drinking (5+ daily, weekly and monthly) was significantly predictive of injury with hazard ratios (HRs) of 2.40, 1.81 and 1.50, respectively, while frequent light drinking (alcohol at least weekly and 5+ yearly or less) was also significant for women (HR = 1.73). For White respondents, 5+ at least weekly was significant for both men (HR = 1.74) and women (HR = 2.42). Among Hispanic respondents, 5+ at least weekly and 5+ monthly were both significant for men (HR = 2.81 and 2.49, respectively) and women (HR = 2.81 and 3.48, respectively). Among Black women, risk was significant for 5+ monthly (HR = 2.90) and for any alcohol ≥ weekly (HR = 2.72), but neither frequency of any drinking or 5+ was significant for Blackmen.

CONCLUSIONS

Data suggest a greater risk of injury from a serious accident for frequent heavy drinkers among all White and Hispanic respondents, and Black women, but not for Blackmen.

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.

The Moderate Alcohol and Cardiovascular Health Trial (MACH15): Design and methods for a randomized trial of moderate alcohol consumption and cardiometabolic risk

BACKGROUND

Observational studies have documented lower risks of coronary heart disease and diabetes among moderate alcohol consumers relative to abstainers, but only a randomized clinical trial can provide conclusive evidence for or against these associations.

AIM

The purpose of this study was to describe the rationale and design of the Moderate Alcohol and Cardiovascular Health Trial, aimed to assess the cardiometabolic effects of one alcoholic drink daily over an average of six years among adults 50 years or older.

METHODS

This multicenter, parallel-arm randomized trial was designed to compare the effects of one standard serving (∼11-15 g) daily of a preferred alcoholic beverage to abstention. The trial aimed to enroll 7800 people at high risk of cardiovascular disease. The primary composite endpoint comprised time to the first occurrence of non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalized angina, coronary/carotid revascularization, or total mortality. The trial was designed to provide >80% power to detect a 15% reduction in the risk of the primary outcome. Secondary outcomes included diabetes. Adverse effects of special interest included injuries, congestive heart failure, alcohol use disorders, and cancer.

RESULTS

We describe the design, governance, masking issues, and data handling. In three months of field center activity until termination by the funder, the trial randomized 32 participants, successfully screened another 70, and identified ∼400 additional interested individuals.

CONCLUSIONS

We describe a feasible design for a long-term randomized trial of moderate alcohol consumption. Such a study will provide the highest level of evidence for the effects of moderate alcohol consumption on cardiovascular disease and diabetes, and will directly inform clinical and public health guidelines.

Predictors and burden of injury mortality in the Thai cohort study 2005-2015

BACKGROUND

Thailand is a high injury burden setting. In 2015 it had the world's second highest rate of road traffic fatalities. In order to develop strategies to reduce this burden an accurate understanding of the development of injury risk over the life course is essential.

METHODS

A national cohort of adult Thais was recruited in 2005 (n = 87,151). Participants completed a health questionnaire covering geodemographic, behavioural, health and injury data. Citizen ID numbers were matched with death registration records, identifying deaths from any injury. Adjusted logistic regression models were used to measure associations between baseline exposures and injury deaths between 2005 and 2015.

RESULTS

Injury mortality comprised 363 individuals, the majority (36%) from traffic injuries. Predictors of all-injury mortality were being male (AOR 3.55, 95% CI 2.57-4.89), Southern Thai (AOR 1.52, 95% CI 1.07-2.16), smoking (AOR 1.55, 95% CI 1.16-2.17), depression (AOR 1.78, 95% CI 1.07-2.96), previous injury (AOR 1.37, 95% CI 1.03-1.81) and drink driving history (AOR 1.37, 95%CI 1.02-1.85). Age and region of residence were stronger predictors for men, while anxiety/depression was a stronger predictor for women. Among males in the far south, assault caused the largest proportion of injury mortality, elsewhere traffic injury was most common.

CONCLUSIONS

This study identifies that a history of drink driving, but not regular alcohol consumption, increased injury risk. The associations between smoking and depression, and injury mortality also need further consideration.

Screening for alcohol use disorders in college student drinkers with the AUDIT and the USAUDIT: a receiver operating characteristic curve analysis

Background: The Alcohol Use Disorders Identification Test (AUDIT) and its consumption subscale (AUDIT-C) are international gold standard screeners for identifying at-risk drinkers. Items have been modified to reflect United States low-risk drinking guidelines in the USAUDIT and USAUDIT-C, which also perform well in identifying at-risk drinkers. The USAUDIT may also be used to screen for potential AUD, an important first step to identify individuals needing diagnostic testing and treatment referrals. Objectives: The present study sought to evaluate the sensitivity and specificity of each measure in predicting potential AUDs via diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition in a college sample. Methods: Participants were 382 college student drinkers (Mage = 20.2, SD = 1.5; 68.7% female) who completed online surveys assessing alcohol use, at-risk drinking, and AUD symptom endorsement. Receiver operating curves provide optimal cutoff scores for each measure in overall, male, and female samples. Results: Results indicated the AUDIT and USAUDIT are equally superior in detecting potential AUD in the current sample. Recommended cutoff scores for detecting likely AUD with the USAUDIT are 12 for males (sensitivity = 62.0%, specificity = 86.6%) and 8 for females (sensitivity = 65.3%, specificity = 87.7%). Conclusions: Whereas prior work supports the USAUDIT-C in detecting at-risk drinking, the current study supports the AUDIT and USAUDIT in detecting potential AUD. Based on prior work, and in an effort to be consistent with standard US drinking guidelines, we recommend using the USAUDIT in screening and brief interventions across college campuses.

Identification of alcohol problem among long route bus drivers and staffs of Dharan, eastern Nepal: Assessing from the CAGE and DSM-IV tools

BACKGROUND

Alcohol use remains a major cause of preventable death worldwide occurring prematurely. Despite its global burden, alcohol still is a legal drug. Various studies have also shown that factors like education, occupation, influence from films and family, for stress relief, pleasure during alcohol use, better self-esteem, and occupational boredom are associated with alcohol use. The consumption of alcohol, even in relatively small amounts, increases the risk of being involved in a crash for motorists and pedestrians. It is also associated with impaired judgments and so is often linked to road traffic accident.

OBJECTIVES

To assess the prevalence, type of alcohol use, and the associated factors for the initiation of alcohol use among bus drivers and staffs of long route bus of Dharan. To assess the knowledge, attitude, and practice regarding alcohol use for their willingness to quit it with medical help.

MATERIALS AND METHODS

The cross-sectional survey was conducted in 250 long route drivers and staffs in Dharan Bus Park in 2016 with the help of a self-designed questionnaire in Nepali language. The sample size was preliminarily estimated on the basis of the prevalence of alcohol use. The "Alcohol consumer" refers to drivers who used alcohol at least once in the previous year.

RESULTS

Alcohol dependency among Hindu was found to be significantly more than other religious group. The prevalence of alcohol consumption was found to be 78%. About 51% drivers are likely to have alcohol problems, 39% are alcohol abuser, and 45% are alcohol dependent.

CONCLUSION

Drinking and driving increase the vulnerability to injury and death on the road. The study creates awareness among drivers about the harmful use of alcohol and psychosocial consequences.

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.

Association between job stress and occupational injuries among Korean firefighters: a nationwide cross-sectional study

OBJECTIVE

We aimed to assess the nature of association between job stress and occupational injuries among firefighters in Korea.

DESIGN

Cross-sectional study.

SETTING

We conducted a nationwide survey using self-reported questionnaires in South Korea.

PARTICIPANTS

A survey was conducted among 30 630 firefighters; 25 616 (83.6%) responded. Our study included firefighters who were 20-59 years old. Individuals with <12 months of current job experience and those with missing data were excluded; ultimately, 14 991 firefighters were analysed.

RESULTS

Among fire suppression personnel, high job demands (OR=1.49, 95% CI 1.25 to 1.77), high interpersonal conflicts (OR=1.18, 95% CI 1.02 to 1.37), a poor organisational system (OR=1.33, 95% CI 1.14 to 1.55), and a negative workplace environment (OR=1.41, 95% CI 1.21 to 1.64) were associated with the occurrence of occupational injury; high job demands (OR=1.22, 95% CI 1.01 to 1.47) were also associated with the frequency of injuries. Among emergency medical services personnel, high job demands (OR=1.26, 95% CI 1.03 to 1.54), high interpersonal conflicts (OR=1.40, 95% CI 1.19 to 1.66), a poor organisational system (OR=1.55, 95% CI 1.30 to 1.85), lack of reward (OR=1.43, 95% CI 1.21 to 1.69) and a negative workplace environment (OR=1.30, 95% CI 1.10 to 1.54) were associated with the occurrence of occupational injury; low job control (OR=1.20, 95% CI 1.04 to 1.38), high interpersonal conflicts (OR=1.18, 95% CI 1.03 to 1.36), lack of reward (OR=1.17, 95% CI 1.02 to 1.35) and a negative workplace climate (OR=1.16, 95% CI 1.01 to 1.34) were also associated with a greater number of injuries. Among officers, high job demands (OR=1.96, 95% CI 1.35 to 2.85) and a negative workplace environment (OR=1.54, 95% CI 1.13 to 2.10) were associated with the occurrence of occupational injuries; however, there was no significant correlation between job stress and the number of injuries.

CONCLUSIONS

High job stress among firefighters was associated with both the occurrence of occupational injury, and also with an increased frequency of injuries. Therefore, job stress should be addressed to prevent occupational injuries among firefighters.

Moderate Alcohol Consumption and Chronic Disease: The Case for a Long-Term Trial

Drinking within recommended limits is highly prevalent in much of the world, and strong epidemiological associations exist between moderate alcohol consumption and risk of several major chronic diseases, including coronary heart disease, diabetes, and breast cancer. In many cases, plausible biological mediators for these associations have been identified in randomized trials, but gold standard evidence that moderate drinking causes or prevents any chronic disease remains elusive and important concerns about available evidence have been raised. Although long-term randomized trials to test the observed associations have been termed impossible, clinical investigators have now successfully completed randomized trials of complex nutritional interventions in a variety of settings, along with trials of alcohol consumption itself of up to 2 years duration. The successful completion of these trials suggests that objections to the execution of a full-scale, long-term clinical trial of moderate drinking on chronic disease are increasingly untenable. We present potential lessons learned for such a trial and discuss key features to maximize its feasibility and value.

Patterns of Drinking and Mortality from Different Diseases—An Overview

Alcohol has been linked to a considerable burden of disease worldwide. Recent epidemiological research has shown that dimensions of alcohol exposure other than average volume are causal in the etiology of disease. Based on a systematic, computer-assisted search, this article attempts a qualitative review of this literature. Results show that cardiovascular disease, especially ischaemic heart disease, is linked to patterns of drinking: regular and light to moderate drinking, and drinking with meals are cardioprotective; heavy drinking occasions have been associated with detrimental outcomes and increases in disease risk. For cancers, consumption of spirits is linked to higher risk of cancers of the upper digestive tract. Spirits also may play a particular role in causing liver cirrhosis in addition to heavy drinking occasions. Finally, injuries are especially related to high blood alcohol concentration and to the frequency of heavy drinking occasions. Overall, these findings strongly indicate that alcohol epidemiology should include adequate pattern measures into future research.

No Protective Effect of Alcohol Consumption on Coronary Heart Disease (CHD) in African Americans: Average Volume of Drinking over the Life Course and CHD Morbidity and Mortality in a U.S. National Cohort

The association between average volume of drinking and coronary heart disease (CHD) morbidity and mortality in African Americans compared with whites was explored, based on a representative US sample. A prospective cohort study with interview follow-up after 10 years and outcome follow-up over about 15 years was used. The sample consisted of 1,158 African Americans and 6,607 whites, all 40 years of age and older with no history of heart disease at baseline. Alcohol intake was measured with a quantity-frequency measure. Incidence of CHD was the sum of non-fatal and fatal events as determined from hospital records and death certificates. The event with the earliest date was defined as the incident event. With respect to CHD, African Americans showed markedly higher risks and significantly fewer protective effects compared with whites. Thus the cardioprotective effects of alcohol were not present in a representative sample of African Americans. On the contrary: Moderate to high average volume of alcohol was associated with increased risk of CHD in African Americans. Patterns of drinking as a potential cause for this finding are discussed.

Racial/Ethnic Disparities in the Risk of Injury Related to the Frequency of Heavy Drinking Occasions

AIMS

To estimate the risk of injury associated with the frequency of heavy drinking days overall and for black, white and Hispanic drinkers in a US sample.

METHODS

Data are from the 2010 National Alcohol Survey and included 6506 respondents comprising the landline sample. Analyses utilize Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking is determined by age of onset and questions on heavy drinking by decade of life. The outcome measure is having had a serious injury at a certain age. Models estimate the risk of injury in relation to heavy drinking in each year controlling for demographics, risk taking and time varying measures of smoking and chronic disease.

RESULTS

Results indicate that the risk of injury increases with the frequency of heavy drinking days to a hazard ratio of 2.14 (1.45-3.14) for daily heavy drinkers. Risks for white respondents were similar to the overall results but different risk relationships were found for black respondents among whom only daily heavy drinkers had increased risk of 4.09 (2.11-7.93), and for Hispanic respondents where elevated risk was seen among yearly heavy drinkers 2.71 (1.29-5.68), with a similar risk estimate for monthly heavy drinkers but lower and non-significant risks found for more frequent heavy drinking categories.

CONCLUSIONS

Different risk relationships were found across race/ethnicity groups suggesting elevated risk with less frequent heavy drinking among Hispanic respondents and very high risk from daily heavy drinking among black respondents.

Alcoholism risk reduction in France: a modernised approach related to alcohol misuse disorders

During many years in France, risk reduction strategies for substance abuse concerned prevention strategies in the general population or interventions near users of illicit substances. In this spirit, the reduction of consumption only concerned opiate addicts. With regard to alcohol, the prevention messages relative to controlled consumption were difficult to transmit because of the importance of this product in the culture of the country. In addition, methods of treatment of alcoholism rested on the dogma of abstinence. Several factors have recently led to an evolution in the treatment of alcohol use disorders integrating the reduction of consumption in strategies. Strategies for reducing consumption should aim for consumption below recommended thresholds (two drinks per day for women, three for the men) or, at least, in that direction. It must also be supported by pharmacotherapy and psychotherapy, which offer possibilities. Failure to manage reduction will allow the goals to be revisited and to reconsider abstinence. Finally this evolution or revolution is a new paradigm carried in particular by a pragmatic approach of the disease and new treatments. The aims of this article are to give elements of comprehension relating to the evolution of the practices in France in prevention and treatment of alcohol use disorders and in particular with regard to the reduction of consumption.

Complications associated with blood alcohol concentration following injury

Alcohol increases the risk of injuring oneself and others. However, following an injury there appears to be a benefit to alcohol in mediating the body's response to a traumatic injury and reducing mortality. The physiological mechanism underlying this reported association is poorly understood. One approach to explaining the pathways by which alcohol affects acute mortality following a traumatic injury is to identify differential prevalence of medical complications associated with increased mortality. The goal of this study was to evaluate the association between blood alcohol concentration and complications subsequent to a traumatic injury that are associated with increased in-hospital mortality. This study involved a retrospective analysis of traumatic injuries occurring between 2000 and 2009 as reported by all level I and II trauma units in the state of Illinois. The study includes all patients with blood alcohol toxicological examination levels ranging from zero to 500 mg/dL and meeting additional inclusion criteria (n = 84,974). A reduction in complications of cardiac and renal function by 23.5% and 30.0%, respectively, was attributable to blood alcohol concentration. In addition, blood alcohol concentration was associated with fewer cases of pneumothorax and convulsions. However, blood alcohol concentration continued to be positively associated with aspiration pneumonitis and acute pancreatitis in the final models. The net impact of alcohol following an injury is protective, largely attributable to a reduction in complications relating to cardiac and renal function. This study helps to explain the observed protective effect from blood alcohol concentrations in reducing in-hospital mortality after an injury, as reported in many studies.

Factors associated with geriatric syndromes in older homeless adults

Although older homeless adults have high rates of geriatric syndromes, risk factors for these syndromes are not known. We used multivariable regression models to estimate the association of subject characteristics with the total number of geriatric syndromes in 250 homeless adults aged 50 years and older. Geriatric syndromes included falls, cognitive impairment, frailty, major depression, sensory impairment, and urinary incontinence. A higher total number of geriatric syndromes was associated with having less than a high school education, medical comorbidities (diabetes and arthritis), alcohol and drug use problems, and difficulty performing one or more activities of daily living. Clinicians who care for older homeless patients with these characteristics should consider screening them for geriatric syndromes. Moreover, this study identifies potentially modifiable risk factors associated with the total number of geriatric syndromes in older homeless adults. This knowledge may provide targets for clinical interventions to improve the health of older homeless patients.

Risks of alcohol use disorders related to drinking patterns in the U.S. general population

OBJECTIVE

The purpose of this study was to examine the relations between drinking (mean quantity and heavy drinking patterns) and alcohol use disorders (AUDs) in the U.S. general population.

METHOD

Data from three telephone National Alcohol Surveys (in 2000, 2005, and 2010) were pooled, with separate analyses for men and women restricted to current drinkers (ns = 5,922 men, 6,270 women). Predictors were 12-month volume (mean drinks per day), rates of heavy drinking (5+/4+ drinks in a day for men/women), and very heavy drinking (8+, 12+, and 24+ drinks in a day). Outcomes were negative alcohol-related consequences constituting abuse (1+ of 4 DSM-IV-based domains assessed by 13 items) and alcohol dependence (symptoms in 3+ of 7 DSM-IV-based domains), together taken to indicate an AUD. Segmentation analyses were used to model risks of problem outcomes from drinking patterns separately by gender.

RESULTS

In the general population, men and women who consumed ≤1 drink/day on average with no heavy drinking days did not incur substantial risks of an AUD (<10%). Men who drank from 1 to 2 drinks/day on average but never 5+ incurred a 16% risk of reporting an AUD (3.5% alcohol dependence). At higher volumes, men and women who indicated higher rates of drinking larger amounts per day and/or involving 8+ and 12+ drinks/day (and even 24+ drinks/day for men) showed much higher risks of experiencing AUDs.

CONCLUSIONS

The findings provide quantitative guidance for primary care practitioners who wish to make population-based recommendations to patients who might benefit by reducing both overall intake and amounts per occasion in an effort to lower their risks of developing AUDs.

Using risk model judgements to better understand perceptions of synergistic risks

Numerous scientific studies show that risk factors can interact to synergistically increase the likelihood of certain adverse and life-threatening outcomes. Yet, the extent to which individuals know that specific risk factor combinations present 'synergistic risks' is unclear and little is known about the determinants of such knowledge. This is largely because epistemological progress concerning this topic has been frustrated by a reliance on metrics that have latterly been judged to be of questionable validity. To address this issue, this paper presents two studies that assess an alternative approach (i.e., risk model judgements) which requires respondents to judge the risk for a factor combination relative to, rather than in isolation from, the risk attributable to each constituent factor. Results from both studies indicate that risk model judgements overcome the drawbacks of traditional metrics. More importantly, the results provide epistemological insights into what can determine whether an individual understands that a factor combination presents a synergistic risk; these determinants include experiential and intuitive insights into the effects of combining specific risk factors, domain-specific judgemental experience and exposure to effective learning opportunities. These findings can be utilized in interventions aimed at helping individuals to make better decisions concerning multiple risk factors.

Associations between heavy episodic drinking and alcohol related injuries: a case control study

BACKGROUND

Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries.

METHODS

We applied a case - control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately.

RESULTS

An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox.

CONCLUSION

There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.

Missed and inconsistent classification of current drinkers: results from the 2005 US National Alcohol Survey

AIMS

This study compares current 12-month drinkers who do not report drinking in the last 30 days with current drinkers who drank in the last 30 days and assesses possible misclassification errors from use of a 30-day consumption measure.

DESIGN

Data are from the 2005 US National Alcohol Survey (n = 6919), a national household probability survey.

SETTING

Telephone interviews were used to measure alcohol use and alcohol-related problems.

PARTICIPANTS

This study compared 1300 current drinkers who did not drink in the last 30 days with 2956 current drinkers who drank in the last 30 days.

MEASUREMENTS

Volume was measured by quantity/frequency scales (12-month and 30-day) and a graduated frequency scale (12-month). Both groups were compared by demographic, alcohol volume, days of five or more drinks, social consequences and dependence measures.

FINDINGS

Results indicate a significantly lower prevalence rate of current drinking for 30-day measures-47.3% (45.8%, 48.8%) versus 67.3% (66.0%, 68.7%) with 12-month measures. Further, 385 non-30-day drinkers reported 12-month drinking frequencies of once a month or more often, suggesting possible inconsistent reporting of their alcohol use. When this group of 'inconsistent' respondents is compared with the 915 non-30-day current drinkers who reported less than monthly drinking, they reported significantly higher yearly volume, days of five or more drinks, mean social consequences and proportion reporting alcohol dependence.

CONCLUSIONS

In population surveys assessing alcohol use, asking about the previous 12 months rather than the past 30 days provides higher estimates of current use, including more days of heavy episodic use.

Dose-response relationship between in-hospital mortality and alcohol following acute injury

Although the relationship between alcohol and injury incidence is well researched, there continues to be dispute about the relationship between alcohol and mortality following an injury. Findings from past studies have varied primarily because of methodological issues and have failed to characterize the dose-response relationship. The main objective of this study was to evaluate the dose response relationship of in-hospital mortality and blood alcohol concentration (BAC). This study was a retrospective analysis of traumatic injuries occurring between 1995 and 2009 as reported by all level 1 and 2 trauma units in the State of Illinois. The study includes all patients with blood alcohol toxicological examination levels ranging from zero to 500 mg/dl (N = 190,612). The Illinois trauma registry includes all patients sustaining traumatic injuries and admitted to a trauma center for ≥12 h. A total of 6733 patients meeting the inclusion criteria died following admission. Patients that were dead on arrival and those that died during the initial assessment within the emergency room were excluded. In the adjusted multivariable model, a decrease in in-hospital mortality was strongly associated with an increase in blood alcohol concentration (adjusted OR = 0.83 per 100 mg/dl units change in BAC; CI 95%: 0.80, 0.85; p < 0.001). The direction of the dose response relationship was consistent across the stratified models, with the exception of patients suffering burns. The largest reduction of in-hospital case fatality rates by blood alcohol concentration was observed among patients suffering penetrating or severe injuries (Injury Severity Score ≥ 16). In the clinical setting, it is important to understand not only how to recognize intoxicated patients, but also how alcohol may affect the course of treatment. The consistency of the findings across the multivariable models indicates that blood alcohol concentration is strongly associated with lower in-hospital mortality among those that survive long enough to receive treatment in specialized trauma units.

Risk of future trauma based on alcohol screening scores: a two-year prospective cohort study among US veterans

BACKGROUND

Severe alcohol misuse as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is associated with increased risk of future fractures and trauma-related hospitalizations. This study examined the association between AUDIT-C scores and two-year risk of any type of trauma among US Veterans Health Administration (VHA) patients and assessed whether risk varied by age or gender.

METHODS

Outpatients (215, 924 male and 9168 female) who returned mailed AUDIT-C questionnaires were followed for 24 months in the medical record for any International Statistical Classification of Diseases and Related Health Problems (ICD-9) code related to trauma. The two-year prevalence of trauma was examined as a function of AUDIT-C scores, with low-level drinking (AUDIT-C 1-4) as the reference group. Men and women were examined separately, and age-stratified analyses were performed.

RESULTS

Having an AUDIT-C score of 9-12 (indicating severe alcohol misuse) was associated with increased risk for trauma. Mean (SD) ages for men and women were 68.2 (11.5) and 57.2 (15.8), respectively. Age-stratified analyses showed that, for men≤50 years, those with AUDIT-C scores≥9 had an increased risk for trauma compared with those with AUDIT-C scores in the 1-4 range (adjusted prevalence, 25.7% versus 20.8%, respectively; OR=1.24; 95% confidence interval [CI], 1.03-1.50). For men≥65 years with average comorbidity and education, those with AUDIT-C scores of 5-8 (adjusted prevalence, 7.9% versus 7.4%; OR=1.16; 95% CI, 1.02-1.31) and 9-12 (adjusted prevalence 11.1% versus 7.4%; OR=1.68; 95% CI, 1.30-2.17) were at significantly increased risk for trauma compared with men≥65 years in the reference group. Higher AUDIT-C scores were not associated with increased risk of trauma among women.

CONCLUSIONS

Men with severe alcohol misuse (AUDIT-C 9-12) demonstrate an increased risk of trauma. Men≥65 showed an increased risk for trauma at all levels of alcohol misuse (AUDIT-C 5-8 and 9-12). These findings may be used as part of an evidence-based brief intervention for alcohol use disorders. More research is needed to understand the relationship between AUDIT-C scores and risk of trauma in women.

Alcohol-related injury and driving while intoxicated: a risk function analysis of two alcohol-related events in the 2000 and 2005 National Alcohol Surveys

BACKGROUND

National population data on risk of alcohol-related injury or driving while intoxicated (DWI) are scarce.

OBJECTIVE

The association of alcohol-related injury and perceived DWI (PDWI) with both volume and pattern of consumption are examined in a merged sample of respondents from the 2000 and 2005 National Alcohol Surveys using risk function analysis.

METHODS

Self-reported consumption patterns on 8,736 respondents who consumed at least one drink in the last 12 months were assessed as the average daily volume and frequency of consuming 5 or more (5+), 8 or more (8+), and 12 or more (12+) drinks in a day. Risks were defined using CHAID segmentation analysis implemented with SPSS Answer Tree.

RESULTS

For alcohol-related injury (n = 110), those most at risk drank at lower volumes with some high maximum occasions, or at higher volumes, where high maximum occasions had little added effect. Risk was highest for those reporting more than 6 drinks per day (9.7%). For PDWI (n = 696), those most at risk drank at higher volumes and with a greater number of high maximum occasions. Risk was highest for those reporting more than 6 drinks per day and more than one 8+ occasion during the last year (39%).

CONCLUSIONS

Overall risk appears to increase with increasing volume, but at a given volume level, risk also increases with frequency of high maximum occasions. These data lend relatively weak support for previous findings suggesting that less frequent drinkers who only occasionally consume larger quantities may be at greater risk, and any alcohol consumption appears to carry some risk of these harms.

Drinking patterns and problems and drinking in the injury event: an analysis of emergency room patients by ethnicity

While a substantial literature exists on the association of alcohol consumption and injury, less is known about the context in which drinking occurs within specific ethnic groups in the United States. This paper analyzes drinking patterns, alcohol-related problems and drinking-in-the-event variables among a probability sample of 359 black, 528 Hispanic and 458 white patients who were breathalyzed and interviewed after admission to the emergency room. Injured patients among both Hispanics and whites were more likely to be positive on the breathalyzer and to report heavy drinking and more frequent drunkenness during the preceding year than their non-injured counterparts. Blacks were less likely than either Hispanics or whites to report a larger number of drinks prior to injury, feeling drunk at the time, or a causal association of alcohol and the injury event. These data suggest a differential role of alcohol in injury occurrence within ethnic groups, with alcohol possibly playing less of a role in the injury event for blacks than for Hispanics or whites.

The cost of alcohol in California

BACKGROUND

California is the largest alcohol market in the United States. In 2005 alone, Californians consumed almost 14 billion alcoholic drinks, which contributed to many severe and potentially fatal alcohol-related illnesses and conditions. Alcohol use also causes violent and nonviolent crimes, as well as injuries and traffic collisions. While several studies have estimated the magnitude and cost of these problems nationally and others have analyzed underage drinking costs, no overall cost estimate at the state level currently exists for California. We present the first comprehensive estimate of the cost of alcohol consumption in California.

METHODS

For each category of alcohol-related problems, we estimated fatal and nonfatal cases attributable to alcohol use. We multiplied alcohol-attributable cases by estimated costs per case to obtain total costs for each problem. Our estimates are presented in 2 sections, the economic costs, estimated using a human capital approach, and quality-of-life costs estimated using a quality adjusted life year framework.

RESULTS

Alcohol consumption in California led to an estimated 9,439 deaths and 921,929 alcohol-related problems, such as crime and injury in 2005. The economic cost of these problems is estimated at between $35.4 billion and $42.2 billion. Our main estimate is $38.5 billion, of which $5.4 billion was for medical and mental health spending, $25.3 billion in work losses, and $7.8 billion in criminal justice spending, property damage and public program costs. In addition, alcohol is responsible for severe reductions in individuals' quality of life in California. We estimate that the disability caused by injury, the personal anguish of violent crime victims, and the life years lost to fatality are the largest costs imposed by alcohol. The total value for this reduced quality of life in California is between $30.3 billion and $60.0 billion. Our main estimate for quality-of-life costs is $48.8 billion.

CONCLUSIONS

In light of the associated substantial illness, injuries, death, and high cost to society, alcohol consumption in California needs serious attention. In addition, the methods developed in this paper can be expanded to estimate the cost of alcohol in other states.

Patterns of alcohol consumption and related behaviour in Great Britain: a latent class analysis of the alcohol use disorder identification test (AUDIT)

AIMS

Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples.

METHODS

Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes.

RESULTS

Six classes best described responses in the sample data. Three were heavy consumption groups, one with multiple negative consequences, one experiencing alcohol-related injury and social pressures to cut down and an additional class with memory loss. There was one moderate class with few negative consequences, and finally two mild consumption groups, one with alcohol-related injury and social pressure to cut down and one with no associated problems.

CONCLUSIONS

Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not. Differences between alcohol use classes are apparent with reduced risk of depressive episode in moderate classes and an increased risk of anxiety disorders for the highest consumers of alcohol.

A prospective study of risk drinking: at risk for what?

Data from two waves of a nationally representative U.S. population sample were used to link frequency of risk drinking in the year preceding the Wave 1 interview with the incidence or occurrence of various adverse outcomes in the approximately 3-year-period between the two interviews (n=22,122 Wave 1 drinkers who were reinterviewed at Wave 2). Risk drinking was defined as consuming the equivalent of 5+ standard drinks in a day for men and the equivalent of 4+ standard drinks in a day for women. Controls included sociodemographic and health characteristics, mean quantity of drinks consumed on risk drinking days and average volume of intake on non-risk drinking days. The odds of nonhierarchical alcohol abuse and dependence, initiation of smoking and incidence of nicotine dependence were increased at all frequencies of risk drinking and showed a fairly continuous increase in magnitude with increasing frequency, reaching OR of 3.03-7.23 for daily/near daily risk drinking. The incidence of liver disease was strongly increased among weekly or more frequent risk drinkers (OR=2.78-4.76). The odds of social harm and drug use were increased among daily/near daily risk drinkers (OR=1.61-2.54), and the likelihood of drivers license revocation showed near-significant increases at all frequencies of risk drinking. Frequency of risk drinking interacted with volume of intake on non-risk drinking days in predicting alcohol abuse and illicit drug use and with duration of drinking in predicting alcohol dependence. Risk drinking poses a threat of many types of harm, both directly and indirectly through its association with smoking initiation and nicotine dependence. These findings have illustrative value for prevention programs, and they indicate that frequent risk drinking is a strong marker for alcoholism.

The joint association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes

BACKGROUND

Previous studies on alcohol-related road safety have not assessed the joint impact of average volume of alcohol and binge drinking.

AIM

To examine the joint and separate association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes.

METHODS

Data were drawn from telephone interviews conducted in the period 2000-2005, with 12 037 individuals representative of the population aged 18-64 years in the Madrid region, Spain. The threshold between average moderate and heavy volumes was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of >or= 80 g of alcohol in men and >or= 60 g in women, during any drinking occasion in the preceding 30 days. Individuals were classified into the following categories: (i) non-drinkers; (ii) moderate drinkers with no binge drinking (MDNB); (iii) moderate drinkers with binge drinking (MDB); (iv) heavy drinkers with no binge drinking (HDNB); and (v) heavy drinkers with binge drinking (HDB). Analyses were performed using logistic regression, with adjustment for sex, age and educational level.

FINDINGS

Frequency of inadequate seat-belt use increased progressively across categories of alcohol consumption, with odds ratio (OR) 1 in non-drinkers, 1.19 [95% confidence interval (CI) 1.06-1.33] in MDNB, 1.69 (1.41-2.03) in MDB, 1.68 (1.24-2.29) in HDNB and 2.41 (1.83-3.18) in HDB (P for trend <0.001). Compared with MDNB, alcohol-impaired driving was also more frequent in MDB (OR 7.43; 95% CI: 5.52-10.00), HDNB (OR 7.31; 95% CI: 4.37-12.25) and in HDB (OR 15.50; 95% CI: 10.62-22.61). Lastly, compared with non-drinkers, frequency of traffic crashes increased progressively across categories of alcohol consumption (P for trend=0.028), although it only reached statistical significance in HDB (OR 2.01; 95% CI: 1.00-4.09).

CONCLUSIONS

Self-reported average volume of alcohol and binge drinking are both associated with self-reported hazardous driving behaviour and traffic crashes. The strength of the association is greater when average heavy consumption and binge drinking occur jointly.

Legislative and regulatory measures for preventing alcohol-related drownings and near-drownings

OBJECTIVE

Alcohol contributes to about 30% of drowning fatalities associated with recreational aquatic activity and to 35% of drownings associated with boating. We consider regulatory and legislative strategies for preventing such deaths.

METHODS

We contacted water police in each Australian State and Territory to identify legislation creating alcohol-related offences for operators of recreational boats in their jurisdiction and to determine whether they conducted random breath testing (RBT). We also sought information from all 152 (81 urban and 71 rural) local government councils in NSW regarding restrictions on consumption of alcohol in public places within their shires.

RESULTS

Four Australian States (New South Wales, Queensland, Victoria and South Australia) have legislation prescribing maximum blood alcohol concentrations (BACs) for operators of recreational boats; all support this with RBT. Western Australia, Tasmania and the Australian Capital Territory define more general offences for operating vessels while under the influence of alcohol. Prohibitions or restrictions on consumption of alcohol in public places exist in 78 of the 86 shires in NSW that responded: 69 councils had alcohol-free zones, 53 restricted consumption of alcohol in public parks and reserves, and 33 had prohibitions or restrictions in some aquatic environments.

CONCLUSIONS/IMPLICATIONS

Legislation restricting BACs for recreational boat operators should be adopted in all Australian States and Territories. Optimal legislation would require that all occupants of recreational boats are required to comply with prescribed BAC levels, including when vessels are at anchor. Extension of by-laws prohibiting or restricting the consumption of alcohol specifically in aquatic environments warrants consideration.

Prevalence and patterns of alcohol use in the Australian workforce: findings from the 2001 National Drug Strategy Household Survey

AIMS

To describe Australian workers' prevalence and patterns of alcohol use.

DESIGN

A secondary analysis of the 2001 National Drug Strategy Household Survey.

PARTICIPANTS

A total of 13 582 workers > or = 14 years old.

MEASUREMENTS

Alcohol consumption levels associated with National Health and Medical Research Council (NHMRC) guidelines for short- and long-term harm were stratified by occupation and industry.

FINDINGS

Approximately 8% of the workforce drank at least weekly at short-term risky or high risk levels, 17% drank at least monthly, 18% drank at least yearly and 11% drank at long-term risky or high risk levels. The prevalence of risky or high risk drinking was higher for younger than for older workers. Controlling for socio-demographic factors, the risk of workers frequently drinking at levels associated with short-term harm was lowest in the education industry and significantly higher in the hospitality, agriculture, manufacturing and construction industries. Drinking patterns associated with long-term harm were more prevalent in the agriculture, retail and manufacturing industries, compared to the education industry. Drinking patterns associated with both short- and long-term harm were more prevalent for blue-collar workers than professionals.

CONCLUSIONS

Risky and high risk drinking occurred at least occasionally in 44% of Australian workers. Workers in the hospitality, agriculture, manufacturing, construction and retail industries, workers in blue-collar occupations and young workers were identified as at-risk subgroups. These data provide evidence that patterns of consumption differ between occupational and industry groups, and highlight the pressing need to develop policies, prevention and intervention strategies to reduce harmful alcohol use in Australia, particularly among young adults.

Frequency of heavy episodic drinking among nonfatal injury patients attending an emergency room

This study investigated the relationship between frequency of heavy episodic drinking and nonfatal injury in four categories: environment, external cause, diagnosis, and activity at the time of injury. Data were collected over 18 months at the emergency room facility of a Swedish hospital. Injury patients aged 18-70 years answered an alcohol screening questionnaire. Heavy episodic drinking was measured as drinking six glasses (72 g alcohol) or more per occasion, for both males and females. A total of 2211 patients were enrolled in the study (79.5% completion rate). Demographic and drinking characteristics for the patients were compared to those of the general population, data for which were derived from a population-based survey. The proportion of people who reported heavy episodic drinking once a month or more was nearly twice as large among the injury patients as in the general population. However, age and sex outweighed heavy episodic drinking as risk factors for most injury types. There were 11 significant associations between frequency of heavy episodic drinking and injury types in the four injury categories, yet no linear trends of increased likelihood of injury with increased frequency of heavy episodic drinking could be discerned.

Reduction in heavy drinking as a treatment outcome in alcohol dependence

In the field of clinical alcohol disorders treatment in North America, abstinence continues to be largely viewed as the optimal treatment goal; however, there is a growing awareness of limitations when abstinence is considered the only successful outcome. Although this issue has been discussed in research settings, new studies on the public health significance of heavy drinking (defined as five or more standard drinks per drinking day in men, and four or more standard drinks per drinking day in women) in the past 10 years suggest that clinical providers should consider the value of alternative outcomes besides abstinence. A focus on abstinence as the primary outcome fails to capture the impact of treatment on reduction in the pattern and in the frequency of alcohol consumption. In addition, evaluating reduction in drinking as "positive" has value for patients as an indicator of clinical progress. Measurement of continuous variables, such as the quantity and the frequency of alcohol consumption, has provided a clearer understanding of the scope of alcohol-related morbidity and mortality at the societal level, and of the relationship between individual patient characteristics and the naturalistic course of alcohol use, abuse, and dependence. A review of these characteristics suggests that there are clinical benefits associated with reducing heavy drinking in alcohol-dependent patients. Given the significant public health consequences associated with heavy drinking and the benefits associated with its reduction, it is proposed that researchers, public health professionals, and clinicians consider using reduction in heavy drinking as a meaningful clinical indicator of treatment response, and that outcomes be individualized to patients' goals and readiness to change.

The role of alcohol consumption in future classifications of alcohol use disorders

BACKGROUND

Item response theory (IRT) was used to determine whether DSM-IV alcohol abuse and dependence and consumption criteria were arrayed along a continuum of severity.

METHODS

Data came from a large, nationally representative sample of the U.S. adult population.

RESULTS

DSM-IV alcohol abuse and dependence criteria formed a continuum of alcohol use disorder severity along with the drinking 5+/4+ at least once a week in the past year criterion. Criteria were invariant across sex, race-ethnicity, and age subgroups.

CONCLUSION

The drinking 5+/4+ high-risk drinking pattern was identified as a suitable criterion for future classifications of DSM-IV alcohol use disorder. Some dependence criteria were among the least severe criteria, and some abuse criteria were among the most severe, findings that question the validity of DSM-IV abuse and dependence categories as distinct entities and that do not support the assumption of abuse as prodromal to dependence. Physical dependence and addiction were identified as defining elements of the continuum. Further research examining their dimensional properties and relationships to high-risk drinking patterns appears warranted. An approach highlighting a more important role of consumption in future classifications of alcohol use disorder defined broadly to encompass all alcohol-related harm, including addiction and physical dependence, is discussed.

Health effects from drinking: type, severity, and associated drinking patterns based on qualitative and quantitative questions in a methodological survey

The specific content of reported health harms are explored in relation to heavy episodic drinking and alcohol dependence symptoms. A national telephone computer-assisted interview of U.S. adults (N = 635), was conducted in 1994. A modified National Alcohol Survey instrument assessed self-reported health harms and related economic costs and work missed. Among the 579 lifetime drinkers, 26% reported health harms from drinking. In multivariate logistic regression harms relating to intoxication, injuries or internal organs were associated with monthly heavy drinking (5+ drinks) and past dependence symptoms. Study limitations are noted. Dependence symptoms should be assessed in screening for those most at risk for alcohol-related health harms.

Maximum quantity consumed and alcohol-related problems: assessing the most alcohol drunk with two measures

PURPOSES

The maximum amount of alcohol consumed on any day is an important indicator of problem drinking. This study examined the ability of 2 maximum measures, taken individually and in combination, to predict alcohol-related consequences and dependence symptoms.

METHOD

We analyzed data from 4,296 current drinkers who participated in the 2000 National Alcohol Survey (N10) and provided complete data on several alcohol measures. Items included the most they drank in any day in the past 12 months assessed by 2 questions: a standard question with a 6-level categorical response format and an open-ended (continuous) question referencing the occasion that you had the most to drink that followed items on drinking contexts.

RESULTS

In a within-subjects analysis, more than two-thirds of the respondents provided consistent responses on both questions (69.9%), 12.4% respondents reported higher maximum quantities on the open-ended question partitioned into equivalent categories, and 17.7% reported a higher maximum on the initial categorical question. In multiple logistic regression analyses predicting alcohol-related consequences, the continuous open-ended maximum or the mean of the 2 maximum items were the strongest predictors, whereas for predicting alcohol dependence symptoms, the maximum of the open-ended and closed-ended maximum items was a better predictor than each measure alone.

CONCLUSION

Although categorical response formats generally capture high-quantity drinking better than open-ended formats, use of a second, alternatively formatted "most drunk" question may modestly improve ability to predict survey indicators of alcohol use disorders.

Understanding the Use of Weights in the Analysis of Data From Multistage Surveys

Understanding the use of weights in the analysis of data from multistage surveys. Large national surveys are powerful tools with which to examine a variety of important rehabilitation-related issues and are currently the only feasible method to study disability trends over time. Because it is impractical to draw simple random samples from the entire United States, national surveys, such as the Medicare Current Beneficiary Survey (MCBS), select random samples of subgroups of a population. Thus, respondents may have unequal probabilities of being included in the survey, and weighting must be used in the analysis before the results may be generalized to the entire United States. Surveys such as the MCBS are rich sources of data for rehabilitation medicine, and it can be expected that more research will be conducted using these data sources. Statistical analysis of these data should account for the sampling scheme used in data collection. We review the principles involved in the design of multistage samples, the calculation of weights, and their use in the data analysis, focusing on their importance in the estimation of population values. Our objective is to help readers to understand and interpret results of research articles using this methodology. Examples using the MCBS data are provided to clarify the concepts presented in the article.

Alcohol and injury: a risk function analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)

While emergency room (ER) studies have documented a strong association of alcohol and injury, less is known about the level of risk at which various quantities of alcohol or particular patterns of drinking place the individual for injury. Comparative risk function analyses are carried out in ER samples in seven countries that cover sites in 14 studies included in the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP). Risk of injury is analyzed for the mean number of drinks consumed per day and the number of occasions in which 5 or more drinks were consumed at one time (5+) during the last year. All countries showed similar increases in injury risk to an average volume of about 2 drinks per day, with a leveling off of risk at higher average daily volumes, with the exception of Italy. Risk of injury increased to 12 or more 5+ days for the USA, Canada and Mexico, but leveled off after only 3 5+ days for Argentina and Spain. Poland showed increased risk to 30 5+ days. Similar risk curves were found for both males and females, although females were at lower risk of injury in all countries expect Spain and Poland. In low detrimental drinking pattern societies, risk curves showed higher risk for any drinking and any frequency of 5+ but at higher levels of each, risk levels decreased nearly to levels found for abstainers. Risk functions were also consistent across gender and age groups in low detrimental drinking pattern societies, with higher risk for males and those <30. For those countries with high detrimental drinking patterns, injury risk increased with volume and 5+ drinking primarily among males. This ER-based risk function analysis suggests that risk of injury increases proportionally with increased alcohol consumption at lower consumption levels, but a threshold effect is achieved at relatively low levels of mean daily consumption and higher consumption times. Risk may be culturally specific, dependent, in part, on the manner in which alcohol is used in the culture.

Psychotropic medication use and accidents, injuries and cognitive failures

BACKGROUND

Psychotropic medication has the potential to impair psychomotor and cognitive function, and several medications have well documented links to increased accident and injury susceptibility. Those developed more recently have many fewer side effects. However, there is little work examining any association between psychotropic medication use and safety within the context of other demographic, health and lifestyle factors.

AIMS

To examine and compare any associations between psychotropic medication use (including benzodiazepines, tricyclics and SSRIs) and accidents, injuries and cognitive failures in a community sample.

METHODS

A postal questionnaire survey was conducted among people selected at random from the electoral registers of Cardiff and Merthyr Tydfil.

RESULTS

Psychotropic medication use was associated with accidents, injuries and cognitive failures, particularly among those who already had higher levels of other risk factors and/or continuing mental health problems.

CONCLUSIONS

The well established associations between accidents and injuries and older psychotropic medications were replicated. SSRIs, however, were relatively safer. The study also highlighted the need to consider any effect of psychotropic medication within the context of both mental health status and other factors.

The association between stress and drinking: modifying effects of gender and vulnerability

AIMS

To assess the relationship between number and type of past-year stressful experiences and alcohol consumption, with a focus on how gender, poverty, and psychological vulnerability moderate this association.

METHODS

Data from 26 946 US past-year drinkers 18 years of age and over, interviewed in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), were used to construct multivariate linear regression models predicting six measures of drinking pattern and volume.

RESULTS

There was a consistent positive relationship between number of past-year stressors experienced and all measures of heavy drinking. Frequency of heavy (5+ drinks for men; 4+ drinks for women) drinking increased by 24% with each additional stressor reported by men and by 13% with each additional stressor reported by women. In contrast, the frequency of moderate drinking (<5 drinks for men; <4 drinks for women) decreased as stress levels increased. Job-related and legal sources of stress were more strongly associated with alcohol consumption than were social and health-related stress. Men showed a stronger association than women between the number of stressors and the most consumption measures; they also responded more strongly to the presence of any legal and job-related stress. Having an income below the poverty level intensified the effects of job-related stress, but having a mood or anxiety disorder did not affect any of the associations between stress and consumption.

CONCLUSIONS

Stress does not so much lead individuals to drink more often as to substitute larger quantities of alcohol on the days when they do drink. Treatment and brief interventions aimed at problem drinkers might benefit from addressing the issue of tension alleviation and the development of alternative coping mechanisms.

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.

Alcohol consumption: an overview of benefits and risks

Published health benefits of regular light-to-moderate alcohol consumption include lower myocardial infarction rates, reduced heart failure rates, reduced risk of ischemic stroke, lower risk for dementia, decreased risk of diabetes and reduced risk of osteoporosis. Numerous complimentary biochemical changes have been identified that explain the beneficial effects of moderate alcohol consumption. Heavy alcohol consumption, however, can negatively affect neurologic, cardiac, gastrointestinal, hematologic, immune, psychiatric and musculoskeletal organ systems. Binge drinking is a significant problem even among moderate drinkers and is associated with particularly high social and economic costs. A cautious approach should be emphasized for those individuals who drink even small amounts of alcohol. Physicians can apply the research evidence describing the known risks and benefits of alcohol consumption when counseling their patients regarding alcohol consumption.

The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

AIMS

As part of a larger study to estimate the global burden of disease attributable to alcohol: to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and to combine exposure and risk estimates to determine regional and global alcohol-attributable fractions (AAFs) for major disease and injury categories. DESIGN, METHODS, SETTING: Systematic literature reviews were used to select diseases related to alcohol consumption. Meta-analyses of the relationship between alcohol consumption and disease and multi-level analyses of aggregate data to fill alcohol-disease relationships not currently covered by individual-level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi-level analyses with prevalence data.

FINDINGS

Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed.

CONCLUSIONS

Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.

Outcomes of alcohol treatment for adolescents

The use by adolescents and young adults of alcohol and other drugs continues to be a tremendous problem for this nation. Over 30% of all high school students nationwide report episodes of hazardous drinking (five or more drinks on one occasion), when both moderate and heavy alcohol consumption are associated with a higher risk of alcohol-related medical consequences and accidental injuries for youth. Increased awareness and concern related to adolescent substance use has led to the outgrowth of additional treatment facilities and programs for this age group. The current chapter discusses how developmental factors may impact the assessment process and subsequent treatment for adolescent alcohol use disorders. In addition, outcome research, intervention studies, relapse, and factors that may influence the recovery process are discussed.

Saliva alcohol concentrations in accident and emergency attendances

OBJECTIVES

Although alcohol is known to play a key part in accidents, no UK study has assessed alcohol concentrations in a comprehensive sample of accident and emergency (A&E) attenders. This study set out to do this, and examine the relation between alcohol concentrations and the severity, type and circumstances of presentation, and the sociodemographic characteristics of patients.

METHODS

A survey was conducted of all new A&E attenders (aged 10 years or over). Two 24 hour periods for each day of the week were covered in 6, 7 or 11 hour sessions over a two month period. Alcohol concentrations were assessed from saliva samples using a disposable device. Data were collected from 638 attenders, of whom 544 provided saliva samples; the remainder refused or were unable to participate.

RESULTS

Positive saliva alcohol readings were obtained in 22% of attenders (95%CI 19% to 26%); this increased to 25% if others were included (for example, those who refused to participate but were judged to be intoxicated). Alcohol was associated with 94% of incidents of self harm, 54% of non-specific/multiple complaints, 47% of collapses, 50% of assaults, and 50% of patients admitted to hospital. Higher concentrations of alcohol were found from Friday to Sunday, between midnight and 0900, and in patients aged 41 to 60. Among people with positive alcohol results, those attending with a companion had higher concentrations than those attending alone. There were no significant differences between men and women in alcohol concentrations.

DISCUSSION

These findings show that alcohol use is an important factor in A&E attendance, but it should not be assumed that there is a causal relation between alcohol use and injury. Several accident related and sociodemographic variables were predictive of alcohol use before attending. The overall level of prediction was too weak to permit accurate identification of drinkers for screening purposes, but routine alcohol concentration assessments may be justified in the high risk groups identified in this study. A&E departments may be convenient and fruitful settings for brief interventions with early problem drinkers.

Intimate partner violence and drinking patterns among white, black, and Hispanic couples in the U.S

PURPOSE

Using reports from both partners, this study estimated prevalence rates of intimate partner violence (IPV) among white, black, and Hispanic couples in the U.S., and assessed the contribution of drinking patterns, psychosocial, and other sociodemographic factors to the risk of partner violence.

METHODS

A multistage area probability sample consisting of 555 white, 358 black, and 527 Hispanic couples in the U.S. household population was interviewed in 1995. Logistic regression analyses revealed that predictors of IPV vary by ethnicity.

RESULTS

Rates of male-to-female (MFPV) and female-to-male partner violence (FMPV) were highest among black couples (23% and 30%), followed by Hispanic (17% and 21%), and white couples (12% and 16%). Between 27 percent and 41 percent of the men, and 4 percent and 24 percent of the women were drinking at the time of the violent incident.

IMPLICATIONS

Black and Hispanic couples are at higher risk for IPV than white couples and should be targeted for prevention intervention. The interrelationships among IPV, alcohol consumption, and ethnicity are complex. These findings suggest that future attempts at modeling IPV should be ethnically sensitive and, ideally, include separate analyses of each ethnic group.

Average volume of alcohol consumption, patterns of drinking, and all-cause mortality: results from the US National Alcohol Survey

The objective of this study was to investigate the effects of an average volume of alcohol consumption and drinking patterns on all-cause mortality. The sample (n = 5,072) was drawn from the 1984 National Alcohol Survey, representative of the US population living in households. Follow-up time was until the end of 1995, with 532 people deceased during this period. The authors found a significant influence of drinking alcohol on mortality with a J-shaped association for males and an insignificant relation of the same shape for females. When the largest categories of equivalent average volume of consumption were divided into people with and without heavy drinking occasions, serving as an indicator of drinking pattern, this differentiation proved important in predicting mortality. Light to moderate drinkers had higher mortality risks when they reported heavy drinking occasions (defined by either eight drinks per occasion or getting drunk at least monthly). Similarly, when the category of exdrinkers was divided into people who did or did not report heavy drinking occasions in the past, people with heavy drinking occasions had a higher mortality risk. Finally, indicating alcohol problems in the past was related to higher mortality risk. Results emphasized the importance of routinely including measures of drinking patterns into future epidemiologic studies on alcohol-related mortality.