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Mintz CM, Knox J, Hartz SM, Hasin DS, Martins SS, Kranzler HR, Greene E, Geng EH, Grucza RA, Bierut LJ. Demographic differences in the cascade of care for unhealthy alcohol use: A cross-sectional analysis of data from the 2015-2019 National Survey on Drug Use and Health. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1890-1903. [PMID: 37864538 PMCID: PMC10590988 DOI: 10.1111/acer.15176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The screening, brief intervention, and referral to treatment (SBIRT) model is recommended by the U.S. Preventive Services Task Force to improve recognition of and intervention for unhealthy alcohol use. How SBIRT implementation differs by demographic characteristics is poorly understood. METHODS We analyzed data from the 2015-2019 National Survey on Drug Use and Health from respondents ≥18 years old who used an outpatient clinic and had at least one alcoholic drink within the past year. Respondents were grouped into one of three mutually exclusive groups: "no binge drinking or alcohol use disorder (AUD)," "binge drinking without AUD," or "AUD." Outcome variables were likelihood of screening, brief intervention (BI), referral to treatment (RT), and AUD treatment. The demographic predictors on which outcomes were regressed included gender, age, race and ethnicity, sexual orientation, insurance status, and history of military involvement. Consistent with SBIRT guidelines, the entire sample was included in the screening model; screened persons with either binge drinking without AUD or with AUD were included in the BI model; screened persons with AUD were included in the RT model, and persons referred to treatment with AUD were included in the AUD treatment model. RESULTS Analyses included 120,804 respondents. Women were more likely than men to be screened, but less likely to receive BI or RT. When referred to treatment, women were more likely than men to receive it. Persons aged ≥50 were least likely to be screened about alcohol, but most likely to receive BI, while persons aged 18-25 were least likely to receive BI or AUD treatment. Racial and ethnic minorities were less likely than White persons to be screened; Asians were less likely to receive RT, and Black persons were less likely to receive treatment than White persons. Persons identifying as gay, lesbian, or bisexual were equally as likely or more likely to receive SBIRT or AUD treatment as those identifying as heterosexual. Persons without insurance were less likely to be screened than those with insurance. Persons with a history of military involvement were more likely to be screened and receive BI and RT than persons who had not served in the military. CONCLUSIONS Demographic disparities in SBIRT implementation exist. Addressing the sources of these disparities and minimizing attrition from care could improve outcomes for persons with unhealthy alcohol use.
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Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah M. Hartz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Emily Greene
- Physician Assistant Program, The City College of New York School of Medicine, New York, New York, USA
| | - Elvin H. Geng
- Department of Medicine, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Richard A. Grucza
- Department of Family Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
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Köchling J, Geis B, Chao CM, Dieks JK, Wirth S, Hensel KO. The hazardous (mis)perception of Self-estimated Alcohol intoxication and Fitness to drivE-an avoidable health risk: the SAFE randomised trial. Harm Reduct J 2021; 18:122. [PMID: 34872586 PMCID: PMC8650558 DOI: 10.1186/s12954-021-00567-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide, alcohol-related road traffic accidents represent a major avoidable health risk. The aim of this study was to evaluate the accuracy of self-estimating the degree of acute alcohol intoxication regarding the legal driving limit, and to identify risk factors for misjudgement. METHODS In this prospective randomised controlled crossover trial, 90 social drinkers (mean age 23.9 ± 3.5 years, 50% female) consumed either beer or wine. Study group subjects were made aware when exceeding the legal driving limit (BrAC = 0.05%). Controls received no information about their BrAC. For crossover, beer or wine were consumed in the opposite order. RESULTS 39-53% of all participants exceeded the legal driving limit whilst under the impression to be still permitted to drive. Self-estimation was significantly more accurate on study day 2 (p = 0.009). Increasing BrAC positively correlated with self-estimation inaccuracy, which was reproducible during crossover. Multiple regression analysis revealed fast drinking and higher alcohol levels as independent risk factors for inaccurate self-estimation. CONCLUSIONS Social drinkers are commonly unaware of exceeding the legal driving limit when consuming alcohol. Self-estimating alcohol intoxication can be improved through awareness. Dedicated awareness programs, social media campaigns and government advice communications should be utilised to address this avoidable hazard. Trial registration The trial was registered prospectively at the Witten/Herdecke University Ethics Committee (trial registration number 140/2016 on 04/11/2016) and at the DRKS-German Clinical Trials Register (trial registration number DRKS00015285 on 08/22/2018-Retrospectively registered). Trial protocol can be accessed online.
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Affiliation(s)
- Jöran Köchling
- Department of Paediatrics, Faculty of Health, Centre for Clinical and Translational Research (CCTR), Helios University Medical Centre Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Berit Geis
- Institute of Medical Biometry and Epidemiology (IMBE), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Cho-Ming Chao
- University Medical Center Rostock, Department of Paediatrics, University of Rostock, Rostock, Germany.,University of Giessen and Marburg Lung Center, German Center of Lung Research (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Jana-K Dieks
- Department of Paediatric Cardiology and Intensive Care Medicine, University Medical Centre, Georg-August-University, Göttingen, Germany
| | - Stefan Wirth
- Department of Paediatrics, Faculty of Health, Centre for Clinical and Translational Research (CCTR), Helios University Medical Centre Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Kai O Hensel
- Department of Paediatrics, Faculty of Health, Centre for Clinical and Translational Research (CCTR), Helios University Medical Centre Wuppertal, Witten/Herdecke University, Witten, Germany. .,Department of Paediatric Cardiology and Intensive Care Medicine, University Medical Centre, Georg-August-University, Göttingen, Germany. .,Department of Paediatrics, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK.
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Grube JW, Krevor BS, DeJong W. A Group Randomized Trial of the Stop Service to Obviously-Impaired Patrons (S-STOP) Program to Prevent Overservice in Bars and Restaurants in College Communities. Subst Use Misuse 2021; 56:1216-1223. [PMID: 33960263 PMCID: PMC8159893 DOI: 10.1080/10826084.2021.1914107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND College student drinking in on-premises establishments has been associated with heavy alcohol consumption and a range of problems including assault, fighting, risky sex, and drinking and driving. Although more strictly enforcing overservice laws might reduce heavy drinking in on-premises establishments, law enforcement agencies have few resource-efficient tools for doing so, resulting in these laws seldom being enforced. OBJECTIVES In this paper, we report the results of an evaluation of the Stop Service to Obviously-impaired Patrons (S-STOP) program that was implemented in 303 bars and restaurants in 18 university communities in California using a randomized cross-over design (early vs. delayed implementation). The S-STOP program: (a) deployed pseudo-intoxicated patrons who attempted to purchase a drink when showing obvious signs of intoxication; (b) provided feedback to owners and managers on staff performance; and (c) offered free online refresher training for staff. RESULTS Overall, alcohol servers in bars and restaurants in these college communities were willing to serve a pseudo-intoxicated mystery shopper 90% of the time. The study found no evidence that S-STOP reduced the prevalence of alcohol sales to apparently impaired patrons during the two intervention stages of the study. CONCLUSIONS The findings highlight the need for developing effective interventions to prevent overservice and should prompt college and university leaders to take the lead in addressing the problem of alcohol overservice at on-premises establishments by working with community leaders, law enforcement, and retailers.
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Affiliation(s)
- Joel W. Grube
- Prevention Research Center, Pacific Institute for Research and Evaluation
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Boutrous ML, Tian Y, Brown D, Freeman CA, Smeds MR. Area Deprivation Index Score is Associated with Lower Rates of Long Term Follow-up after Upper Extremity Vascular Injuries. Ann Vasc Surg 2021; 75:102-108. [PMID: 33910047 DOI: 10.1016/j.avsg.2021.03.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
The Area Deprivation Index (ADI) has been shown to be a determinant of healthcare outcomes in both medical and surgical fields, and is a measure of the socioeconomic status of patients. We sought to analyze outcomes in patients with upper extremity vascular injuries that were admitted over a five-year period to a Level I trauma center sorted by ADI. All patients with upper extremity vascular injury presenting to a level one trauma center between January 2013 and January 2017 were retrospectively collected. The patients were divided into two groups based on their ADI with the first group representing the lowest quartile of patients and the second group the higher three quartiles. Patient's demographics were analyzed as well as modes of trauma, hospital transfer status prior to receiving care, type of intervention received, follow-up rates and outcomes including both complication and amputation rates. Over this time period, a total of 88 patients with traumatic upper extremity vascular injuries were identified. The majority of injuries were due to penetrating trauma (74/88, 84%) with 41% (10/24) of patients in the lower ADI being victims of gunshot wounds compared to 27% (17/64) of those in the higher ADI (P = 0.19). Patients in the lowest ADI quartile were more likely to be African Americans (P= 0.0001), and more likely to be transferred to our university hospital prior to receiving care (P= 0.007). Arrival Glasgow Coma Scale and Injury Severity Score were similar as was time spent in the emergency room. Length of stay trended longer in the lowest ADI quartile as compared to the higher ADI (7.5 vs. 11.8, P= 0.59). The rates of long term follow-up were significantly lower in patients with the lowest ADI scores as opposed to the higher ADI group (P= 0.0098), however, there was no statistically significant difference in outcomes between the two groups including both complication and amputation rates. The ADI is associated with lower rates of long term follow-up after upper extremity vascular injuries, despite patients in both the high and low ADI groups having similar outcomes in regards to complication and amputation rates. Further study is warranted to investigate the role of the socioeconomic status in outcomes following traumatic injury.
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Affiliation(s)
- Mina L Boutrous
- Division of Vascular and Endovascular Surgery, University of Connecticut, Farmington, CT, USA.
| | - Yuqian Tian
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
| | - Daniel Brown
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
| | - Carl A Freeman
- Trauma and Surgical Critical Care Division, St. Louis University, St. Louis, MO, USA
| | - Matthew R Smeds
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
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Bountress KE, Gilmore AK, Metzger IW, Aggen SH, Tomko RL, Danielson CK, Williamson V, Vladmirov V, Ruggiero K, Amstadter AB. Impact of disaster exposure severity: Cascading effects across parental distress, adolescent PTSD symptoms, as well as parent-child conflict and communication. Soc Sci Med 2020; 264:113293. [PMID: 32858492 PMCID: PMC7689632 DOI: 10.1016/j.socscimed.2020.113293] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE Natural disasters are common and have potentially deleterious impacts on individuals, as well as on the relationships among family members (Adams et al., 2015; Paul, 2015). Additionally, caregiver-, offspring-, and family-level outcomes are often correlated following disaster. OBJECTIVE Thus, longitudinal work is needed to clarify the prospective associations among such constructs following severe disasters. METHOD The current study included 1,271 adolescents and investigated whether disaster exposure impacted adolescent posttraumatic stress disorder (PTSD) symptoms, parent distress, and family parent-child conflict and communication, as well as whether/how these factors influenced one another over time. This study used a dynamic cascade model and included adolescents (ages 12-17) and caregivers present for tornadoes in Missouri and Alabama in 2011. These participants were part of a larger study involving a web-based intervention. RESULTS Over and above covariates (i.e., adolescent age, gender, race, treatment, prior trauma, adolescent alcohol use and depressive symptoms, and household income), families who experienced greater severity of disaster exposure had adolescents who reported more baseline PTSD symptoms and caregivers who reported more distress at baseline. CONCLUSIONS Providing tangible resources (e.g., housing, food, transportation, essential possessions) to families post-disaster may reduce parent distress and adolescent PTSD symptoms. Additionally, reducing adolescent PTSD symptoms may prospectively improve relationships between parents and adolescents.
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Affiliation(s)
- Kaitlin E Bountress
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, United States.
| | - Amanda K Gilmore
- Mark Chaffin Center for Healthy Development and Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, United States
| | - Isha W Metzger
- University of Georgia, Department of Psychology, United States
| | - Steven H Aggen
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, United States
| | - Rachel L Tomko
- Addiction Sciences Division, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Carla Kmett Danielson
- National Crime Victim Research & Treatment Center (NCVC), Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States
| | - Vernell Williamson
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, United States
| | - Vladimir Vladmirov
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, United States
| | - Kenneth Ruggiero
- College of Nursing, Medical University of South Carolina, United States
| | - Ananda B Amstadter
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, United States
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Courchesne NS, Muth CM, Barker M, Woodruff SI. Correlates of Breath Alcohol Concentration Among Driving Under the Influence Program Clients in Southern California. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618815688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding factors correlated with breath alcohol concentration (BrAC) at time of arrest for driving under the influence (DUI) may lead to informed rehabilitation programs. This study describes correlations between BrAC at time of arrest and sociodemographic, mental, and physical health, and alcohol-related characteristics among clients in a large California DUI Program. Client reported data ( n = 17,282) were collected at an intake from 2009 to 2014. BrACs ranged from 0.083% to 0.390%, with an average of 0.159% ( SD = 0.051), almost twice the legal limit in the state. Approximately 10.6% of the variance in BrAC was explained by 11 significant correlates. Two sociodemographic factors (age and race/ethnicity) as well as several alcohol-related characteristics were related to higher BrAC levels, whereas comorbid mental and physical health factors played less of a role. Factors associated with BrAC are complex and warrant further investigation to identify causality and inform future interventions.
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7
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Martin RJ, Cox MJ, Chaney BH, Knowlden AP. Examination of associations between risky driving behaviors and hazardous drinking among a sample of college students. TRAFFIC INJURY PREVENTION 2018; 19:563-568. [PMID: 29927681 DOI: 10.1080/15389588.2018.1476690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Hazardous drinking is associated with other risky behaviors and negative health-related outcomes. This study examined covariation between hazardous drinking scores and the following risky driving behaviors: Falling asleep while driving, texting (receiving and sending) while driving, and driving after consuming alcohol. METHODS The participants in this study were a sample of undergraduate students (N = 1,298) who were enrolled in an introductory health course at a large Southeastern university in spring 2016 and completed an online health survey that assessed hazardous drinking, falling asleep while driving, texting while driving, and driving after consuming alcohol. We conducted a series of 2-step regression analyses to examine covariation between hazardous drinking scores (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and the risky driving behaviors of interest. RESULTS We found that the majority of participants did not drink and drive (91.8%), nor did they fall asleep while driving (80.4%); however, the majority did read a text while driving (81.7%) and sent a text while driving (75.3%). In the full multivariable model, hazardous drinking score was positively associated with drinking and driving (step 2 odds ratio [OR] = 1.28, 95% confidence interval [CI], 1.18, 1.38) and sending a text message while driving (step 2 b = 0.19, P = .01). Hazardous drinking score was also positively associated with reading a text while driving (step 1 b = 0.14, P < .001) and falling asleep while driving (step 1 b = 0.02, P = .02) in the model only controlling for demographic characteristics. The analyses also indicated covariability between the following risky driving behaviors: (1) drinking and driving/reading a text message while driving, (2) drinking and driving/falling asleep and driving, (3) reading a text while driving/sending a text while driving, and (4) sending a text while driving/sleeping and driving. CONCLUSION The findings of this study indicate a need for interventions discouraging both hazardous drinking and risky driving behaviors in college student populations; recommendations to reduce risky driving and hazardous drinking are discussed.
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Affiliation(s)
- Ryan J Martin
- a Department of Health Education and Promotion , East Carolina University , Greenville , North Carolina
| | - Melissa J Cox
- a Department of Health Education and Promotion , East Carolina University , Greenville , North Carolina
| | - Beth H Chaney
- a Department of Health Education and Promotion , East Carolina University , Greenville , North Carolina
| | - Adam P Knowlden
- b Department of Health Science , The University of Alabama , Tuscaloosa , Alabama
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Coomber K, Mayshak R, Hyder S, Droste N, Curtis A, Pennay A, Gilmore W, Lam T, Chikritzhs T, Miller PG. Demographic and Substance Use Factors Associated with Non-Violent Alcohol-Related Injuries among Patrons of Australian Night-Time Entertainment Districts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010075. [PMID: 28085105 PMCID: PMC5295326 DOI: 10.3390/ijerph14010075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 12/02/2022]
Abstract
This study examined the relationship between patron demographics, substance use, and experience of recent alcohol-related accidents and injuries that were not due to interpersonal violence in night-time entertainment districts. Cross-sectional interviews (n = 4016) were conducted around licensed venues in entertainment districts of five Australian cities. Demographic factors associated with non-violent alcohol-related injuries were examined, including gender, age, and occupation. The association between substance use on the night of interview; blood alcohol concentration (BAC), pre-drinking, energy drink consumption, and illicit drug use; and experience of injury was also explored. Thirteen percent of participants reported an alcohol-related injury within the past three months. Respondents aged younger than 25 years were significantly more likely to report an alcohol-related injury. Further, a significant occupation effect was found indicating the rate of alcohol-related injury was lower in managers/professionals compared to non-office workers. The likelihood of prior alcohol-related injury significantly increased with BAC, and self-reported pre-drinking, energy drink, or illicit drug consumption on the night of interview. These findings provide an indication of the demographic and substance use-related associations with alcohol-related injuries and, therefore, potential avenues of population-level policy intervention. Policy responses to alcohol-related harm must also account for an assessment and costing of non-violent injuries.
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Affiliation(s)
- Kerri Coomber
- School of Psychology, Faculty of Health, Deakin University, Geelong VIC 3220, Australia.
| | - Richelle Mayshak
- School of Psychology, Faculty of Health, Deakin University, Geelong VIC 3220, Australia.
| | - Shannon Hyder
- School of Psychology, Faculty of Health, Deakin University, Geelong VIC 3220, Australia.
| | - Nicolas Droste
- School of Psychology, Faculty of Health, Deakin University, Geelong VIC 3220, Australia.
| | - Ashlee Curtis
- School of Psychology, Faculty of Health, Deakin University, Geelong VIC 3220, Australia.
| | - Amy Pennay
- School of Psychology, Faculty of Health, Deakin University, Geelong VIC 3220, Australia.
- Centre for Alcohol Policy Research, Department of Psychology and Public Health, La Trobe University, Melbourne VIC 3000, Australia.
| | - William Gilmore
- National Drug Research Institute, Curtin University, Perth WA 6845, Australia.
| | - Tina Lam
- National Drug Research Institute, Curtin University, Perth WA 6845, Australia.
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth WA 6845, Australia.
| | - Peter G Miller
- School of Psychology, Faculty of Health, Deakin University, Geelong VIC 3220, Australia.
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