Drinking and driving: drinking patterns and drinking problems

Two perspectives guide examinations of alcohol-related injury; studies of drinking behaviors which characterize the activities in which drinkers participate, and studies of drinking patterns which characterize individuals' likelihoods of intoxication. This paper presents a study of self-reported drinking and driving using both perspectives. A theoretical model of the relationships of drinking patterns and drinking behaviors to drinking and driving is derived. This model is used as the basis for analyses of self-reports of driving after drinking and driving while intoxicated. Using cross-sectional data from a study of alcohol-related injury in the United States, these self-reports were related to measures of respondent socio-demographics, drinking patterns, beverage preferences and routine activities. The results showed: (1) that the drinking pattern measures were significantly related to likelihoods of drinking and driving; (2) these measures were superior to alternate measures of drinking patterns in their ability to explain drinking and driving; (3) the measures of beverage preferences were unrelated to either measure of drinking and driving; and (4) that the utilization of certain venues for drinking (bars and restaurants) was significantly related to both measures of drinking and driving. It is concluded that observed socio-demographic differences in drinking and driving (e.g. related to ethnicity and marital status) are due to related differences in drinking patterns and drinking behaviors.     

Human babesiosis in New York State: an epidemiological description of 136 cases.

Epidemiological data on 136 cases of human babesiosis reported from laboratories and clinicians in the state of New York from 1982 to 1991 were reviewed. All but two patients, who had traveled to Nantucket Island in Massachusetts, acquired disease in Suffolk County, Long Island. The highest average age-group-specific annual incidence rates occurred among men > or = 80 years of age (7.72 per 100,000) and among women 70-79 years of age (3.61 per 100,000). Seven patients (5%) had previously undergone splenectomy, and 31 (23%) had evidence of concurrent Lyme disease. One hundred three patients (76%) were hospitalized, and seven (5%) died. Although the geographic distribution of this disease has remained constant, the recent introduction of babesiosis in mainland Connecticut and the spread of Lyme disease in New York suggest that the geographic distribution of babesiosis could also spread in New York.     

Reliability of self-reported age of first drug use: analysis of New York City narcotics register data.

New York City Narcotics Register data were analyzed to determine the consistency of self-reported age of first drug use among multiple reports on a single individual. There were 15,263 individuals with two or more reports between January 1973 and April 1974 which specified age of first drug use. Discrepancies were noted in 68% of cases; in 31% the responses differed by 3 or more years. Even among reports from a single agency, there were discrepancies in 45% of cases. The degree of consistency was only slightly better when the analysis was restricted to subjects 20 years of age and younger. No comparable inconsistency was observed with respect to self-reported year of birth.     

Surveillance of Work-Related Asthma in New York State

Objective. The objective of this paper is to determine the percent of adults with asthma attributable to work and describe characteristics of the work-related asthma population in New York State. Sociodemographic and control characteristics of those with and without work-related asthma are compared. Methods. Data from three population-based surveys and one case-based surveillance system were analyzed. Work-relatedness of asthma was determined by self-report for the population-based surveys and by physician report for the case-based system. Self-reported sociodemographic and control characteristics were analyzed for the population-based surveys by work-relatedness. Results. The percent of work-relatedness among adults with current asthma in New York State ranged from 10.6% to 44.5%. Significantly more adults with work-related asthma had poorly controlled asthma than those without work-related asthma. More adults with work-related asthma also tended to be employed in the manufacturing, educational services, and public administration industries than the general population. The most frequently reported exposure was dust. Conclusions. Adults with work-related asthma have decreased control and adverse socioeconomic impacts compared to those with asthma that is not work-related. Increased recognition and physician reporting is necessary to further prevent the impact of work-related exposures.     

Silo filler's disease in New York State.

Twenty new cases of Silo filler's disease (SFD) have been collected, documenting the incidence and clinical features of exposure to nitrogen oxides present in freshly filled silos. Cases of SFD were identified using a statewide computerized discharge diagnosis system. Fifteen of these were identified in the index period, allowing us to calculate an approximate annual incidence of 5.0 cases/100,000 silo-associated farm workers/yr in New York State. All cases occurred during harvest periods, with 80% in September and October. Corn silage was the gas source in 18 (90%). All cases involved young white men (mean age, 31.5 yr). The most common presenting feature was dyspnea. All victims entered a silo during the peak danger period, and only one used recommended ventilation techniques. Four cases ended in death (20% mortality). Silo filler's disease, although rare, is a potentially devastating disease involving otherwise young, healthy farm workers. It is readily prevented.     

Alcoholic beverage choice, risk perception and self-reported drunk driving: effects of measurement on risk analysis

Aims. The present study examined effects of measurement on risk curve analysis in an application involving prediction of frequency and indicator measures of drunk driving with beverage-specific alcohol consumption and risk perception measures. Design and participants. From a 1995 in-person survey of the US adult household population (response rate = 77%) the responses of 1260 adult drivers who reported any drinking in the prior year were selected for analysis. Regression and graphical techniques were used to investigate relationships between drinking pattern, beverage choice, perception of risks of drinking before driving, and frequency of drunk driving. Measurements. Self-reported drunk driving (occurrence) was measured by a question assessing driving after drinking enough to be in trouble if stopped by the police within the prior 12 months; those affirming this (n = 191) were asked how many times they did so (frequency). Alcohol consumption was assessed by beverage and in combination. Risk perception was assessed as a factor score from three correlated measures. Demographic variables included age, ethnicity, education and income. Findings. Controlling for demographics, heavy beer consumption (p < 0.01) more than heavy wine (NS) or liquor/spirits (p < 0.05) intake was strongly predictive of risk perception. A regression analysis showed a significant interaction between heavy beer consumption and perceived risk (p < 0.001) in predicting reported frequency of drunk driving, after controlling for heavy beer consumption (p < 0.05), total alcohol consumption and risk perception (both ps < 0.001). No interactions were important in equivalent models predicting dichotomous occurrence. Graphic analysis showed the shape of the risk curve is altered when frequency of drunk driving is taken into account rather than simple occurrence. Conclusions. Individuals' underestimation of beer's intoxicating effects, compared to other alcoholic beverage types, helps explain beer's over-representation in drinking driving violation reports. There is a need for creative public health campaigns designed to inform young men of beer's alcohol content and associated risks.     

Staphylococcus aureus colonization and infection in New York State prisons

Methicillin-resistant Staphylococcus aureus is increasingly responsible for staphylococcal outbreaks in prison. There is limited information on the source of the outbreak strains, risk factors for infection, and transmission of these strains within a prison. We conducted a survey to determine the prevalence of nasal colonization with S. aureus in 2 New York State prisons. S. aureus isolates from clinical cultures collected from all New York State prisons during a 6-month period were compared with the colonizing strains. Analyses were conducted to determine whether prison-level characteristics were associated with colonization or infection with S. aureus. The colonization rate was 25.5% (124/487); 10.5% of the isolates were methicillin resistant, all were staphylococcal chromosomal cassette (SCC)mec type IV, and 61.5% were Panton Valentine leukocidin (PVL) positive. Surprisingly, 21.6% of the methicillin-susceptible isolates were also PVL positive. Of the clinical isolates, 48.3% were methicillin resistant, with 93.1% of the latter being SCCmec type IV and 48.3% being PVL positive. The predominant clone was USA 300. Prison-level risk factors for infection included the proportion of inmates with drug offenses, the length of inmate stay, and the jail from which inmates originated. This study suggests that both new and long-term inmates act as sources of S. aureus strains, with the more virulent of the latter preferentially being selected as pathogens.     

Efficacy of an OspA vaccine preparation for prevention of lyme disease in New York State

Summary  A multicenter, double-blinded, placebo-controlled study was done comparing a 30-μg dose of a single protein recombinant OspA vaccine preparation with a saline placebo for efficacy in prevention of Lyme disease in humans. The OspA vaccine (30-μg dose) or saline placebo was given intramuscularly at day 0,1 month later, and 12 months later. Cases of possible Lyme disease were evaluated clinically and using culture, polymerase chain reaction and immunoblot assays. Safety data are being analyzed separately. 1,634 adult volunteers were enrolled at a single center in New York State. Vaccine efficacy during the first year was 40% and during the second 37%. Compared with placebo, the OspA vaccine significantly reduced the frequency of Lyme disease during the 2-year study period (P<0.04, one-tailed Fisher’s exact test). Vaccine efficacy was restricted to volunteers under 60 years old (50% vs 9%, P<0.03, two-tailed Fisher’s exact test). A recombinant OspA vaccine preparation was found to have moderate activity in preventing Lyme disease in adults under 60 years old from New York State. Reasons for vaccine failure need to be addressed and a risk benefit ratio calculated.     

Feline and Canine Rabies in New York State,USA

In New York State, domestic animals are no longer considered rabies vector species, but given their ubiquity with humans, rabies cases in dogs and cats often result in multiple individuals requiring post-exposure prophylaxis. For over a decade, the New York State rabies laboratory has variant-typed these domestic animals to aid in epidemiological investigations, determine exposures, and generate demographic data. We produced a data set that outlined vaccination status, ownership, and rabies results. Our data demonstrate that a large percentage of felines submitted for rabies testing were not vaccinated or did not have a current rabies vaccination, while canines were largely vaccinated. Despite massive vaccination campaigns, free clinics, and education, these companion animals still occasionally contract rabies. Barring translocation events, we note that rabies-positive cats and dogs in New York State have exclusively contracted a raccoon variant. While the United States has made tremendous strides in reducing its rabies burden, we hope these data will encourage responsible pet ownership including rabies vaccinations to reduce unnecessary animal mortality, long quarantines, and post-exposure prophylaxis in humans.     

HIV and diarrhea in the era of HAART: 1998 New York State hospitalizations

BACKGROUND: This study reflects an attempt to identify the causes of diarrheal illness in hospitalized HIV patients in light of therapeutic advancements in HIV management. METHODS: The study identifies the various etiologies associated with diarrhea among HIV patients hospitalized in New York State in 1998. Data for this study were extracted from the New York State Department of Health Statewide Planning and Research Cooperative System. Pathogens recognized to cause diarrhea in persons with HIV and general codes identifying diarrhea were examined by using the principal and all secondary diagnoses based on the International Classification of Diseases 9th Revision Clinical Modification codes. RESULTS: Based on the Statewide Planning and Research Cooperative System data set, more than 15,000 patients with HIV were hospitalized in 1998. Among the HIV patients hospitalized, 2.8% were admitted with a diarrheal diagnosis. The following diagnoses occurred the most frequently among HIV patients hospitalized with a diarrheal illness: Clostridium difficile (51.3%), other protozoal diseases (18.1%), and other organisms, not elsewhere specified (11.7%). CONCLUSIONS: In the era of highly active antiretroviral therapy, diarrhea is still an occurring symptom in HIV patients. Despite the relatively small percentage of hospitalizations attributed to diarrhea, clinicians must remember that even "mild" to "moderate" diarrhea can have a debilitating impact among persons with the symptom.     

Neighborhood ecology and drug dependence mortality: an analysis of New York City census tracts

Drug dependence mortality appears to be highly concentrated in certain disadvantaged populations and in certain disadvantaged areas. Using a relatively large sample of census tract data for New York City, 1991-1995 (N = 2,037), the present study examines the structural covariates of drug dependence mortality rates. Spatially lagged negative binomial regression analyses indicated considerable support for previous findings regarding the importance of poverty as a predictor of drug mortality. Furthermore, two variables especially relevant for the social disorganization and deviant opportunity perspectives in criminology exhibited significant independent effects: the neighborhood homeownership rate and the prevalence of boarded-up housing. The results support various policy initiatives concerned with the relationship between neighborhood environment and public health.     

Heroin diffusion in the mid-Hudson region of New York State

Aims Prompted by the history of heroin diffusion in the United States, press reports and building on previous research into retail heroin distribution, ethnographic research was undertaken identifying and describing retail distribution and diffusion of heroin in and into medium‐ and small‐sized towns in the mid‐Hudson region of New York State. Methods In conjunction with fieldwork, in‐depth tape‐recorded interviews were conducted with recent admissions (30 days) at 28 different drug treatment facilities located in the region. Interviews were also conducted with drug counselors, narcotic officers, drug treatment administrators and the county commissioners of mental hygiene. Findings Heroin‐dependent individuals who have access to cheaper heroin in urban areas, such as New York City, Newark, and Patterson, New Jersey, drive retail heroin distribution in the mid‐Hudson region. They travel to these cities, purchase heroin in quantity (costing $8–10 per bag), return to the region and sell premium‐priced heroin ($20‐$25 per bag) mostly to irregular users who do not have access to retail drug sellers in urban areas. Conclusion Price disparity contributes to a recurrent process whereby irregular users who are able to gain access to cheaper heroin in urban areas, return to the mid‐Hudson and sell premium‐priced heroin to other users who do not have access to cheaper heroin. This process contributes to the diffusion of heroin abuse.     

The prevalence and sociodemographic correlates of high-risk and problem drinking at an industrial worksite

The study of 833 employees aimed to determine the prevalence and sociodemographic correlates of high-risk and problem drinking in an industrial population. Variables measured included stressful life events, neuroticism, job satisfaction, years of service, job classification and type of shift. As measured by a 7-day retrospective diary, 12.5% of the sample were abstainers, 78.7% were light drinkers and 8.8% were high-risk drinkers. As measured by the Mortimer-Filkins test of problem drinking, 79.2% were non-problem drinkers, 15.2% were presumptive problem drinkers and 5.7% were problem drinkers. Variables that best predicted high–risk drinking were marital status, type of shift and education. Variables that best predicted problem drinking were stressful life events, marital status, education and neuroticism. The results indicate the need for a work-based intervention and provide information to identify at-risk employees and assist in the design of appropriate treatment programmes, including assistance with social and other problems.