The Irish drinking habits of 2002—Drinking and drinking‐related harm in a European comparative perspective

Aims: To examine drinking habits and experiences of adverse consequences of drinking among men and women in Ireland 2002 and to compare some results with earlier European studies using similar data and methods.

Methods: Data on self‐reported drinking habits and experiences of alcohol‐related problems were obtained from a general population survey undertaken in 2002. Two approaches were used: (1) cross‐tabulations of drinking habits and the experience of adverse consequences in various demographic groups (2) logistic regressions predicting the likelihood of experiencing problems.

Results: Self‐reported alcohol consumption confirms statistics on alcohol sales; a lot of alcohol is consumed in Ireland today despite a large fraction of abstainers in the population. Binge drinking is very common, and, out of 100 drinking events, 58 end up in binge drinking for men and 30 for women. Irish drinkers also experience harmful drinking‐related consequences to a larger extent than in other western European countries. Both volume of drinking and binge drinking affect the likelihood of experiencing most alcohol‐related harms. Conclusions: Drinkers in Ireland drink more than in other western European countries and many have risky drinking habits that lead to adverse consequences. It will be an important challenge to find preventive measures that can reduce these problems in Ireland.     

Prevalence and characteristics of patients with risky alcohol consumption presenting to emergency departments in rural Australia

Objective: This study measures the prevalence of problematic alcohol consumption in patients of EDs in rural areas of Australia, relative to the general population in the same rural communities. It also identifies the characteristics associated with risky drinking in rural ED patients. Methods: Surveys containing the Alcohol Use Disorders Identification Test (AUDIT) and questions corresponding to the 2001 Australian Alcohol Guidelines were completed by 1056 patients presenting to five EDs in rural areas of New South Wales, and 756 residents of the same five communities. Results: Relative to the general community, ED patients were statistically significantly more likely to engage in risky alcohol consumption according to the AUDIT (39% vs 20%), alcohol consumption posing a high risk of short‐term harm (26% vs 18%) and alcohol consumption posing a high risk of long‐term harm (7% vs 3%). Although being aged under 40 years of age, being unmarried, not completing school and being assigned less urgent triage categories were associated with risky alcohol use among ED patients, rates of risky consumption were high across all patient subgroups. Conclusions: Risky drinking, across a number of measures, is overrepresented in patients of rural Australian EDs relative to the general community, and this type of consumption is not limited to certain subgroups of patients. There is a need for interventions that address both heavy single occasion drinking and excessive regular consumption in patients of rural Australian EDs, with universal interventions recommended rather than targeted programmes.     

Trends in drinking,smoking and illicit drug use among 15‐ and 16‐year‐olds in the UK (1995–2003)

This paper describes the results of drinking, smoking and illicit drug use among a representative sample of 2,032 UK school students aged 15 and 16 years in a cross‐sectional, single‐phase survey based on a stratified cluster sample of 77 UK secondary schools between March and July 2003. These findings are compared with those of two earlier surveys conducted in 1995 and 1999. Pupils completed a 380‐item standardized questionnaire under examination conditions. Over 90% had consumed alcohol at some time and 75% had experienced being drunk; almost 30% had smoked cigarettes in the past 30 days and almost 40% had tried illicit drugs at some time, mainly cannabis. Comparison with two previous surveys suggests that “binge” drinking among girls had risen and illicit drug use had fallen between 1995 and 1999 and that there was no further change in 2003. For boys, there was a significant drop in the variable “cigarette smoking in the past 30 days” between 1999 and 2003. There were no statistically significant changes in frequency of alcohol consumption and experience of intoxication between 1995 and 2003. The statistically significant increase in binge drinking among girls contrasts with the stability of the other variables considered over the 8 years under consideration. Heavy or “binge” drinking and illicit drug use amongst teenagers are clearly still matters for real concern. The increase in risky drinking among girls requires special attention. Even so, the continued tobacco use of some teenagers remains the major risk to health. It is concluded that past strategies to curb potentially problematic use of alcohol, tobacco and illicit drugs have met with only limited success. Health promotion is clearly not enough to reduce the risks associated with legal and illicit drugs by young people. Innovative “harm minimization” measures should be adopted and evaluated.     

Opportunistic screening and clinician‐delivered brief intervention for high‐risk alcohol use among emergency department attendees: A randomized controlled trial

Objective: To evaluate the feasibility and efficacy of routine opportunistic screening and brief intervention (BI) by ED staff to reduce high‐risk alcohol consumption. Methods: This was an open, randomized controlled trial with allocation blinding performed over 12 months. Using the Paddington Alcohol Test, adult patients were screened for high‐risk alcohol use. Consenting patients who were screened positive were eligible for randomization to no counselling (standard care, SC), same‐day BI by an emergency nurse or doctor or motivational intervention (MI) within 1 week by off‐site drug and alcohol counsellors. Telephone follow up was performed at 1 and 3 months. The primary outcome was maximum self‐reported daily standard drinks consumed. Analysis was by intention to treat. Results: Of 32 965 eligible patients, 10 274 were screened, 1043 were positive, 468 consented to the study, and 161, 159 and 148 were allocated to SC, BI and MI, respectively. In the MI group, 133 declined intervention or failed to attend. At 3 months, 96, 81 and 74 participants in the SC, BI and MI groups, respectively, were contactable and consented to telephone interview. Overall, maximum daily alcohol consumption decreased from a median of 13.5 standard drinks at enrolment to 9.25 drinks at 3 months. At 3 months, SC participants reported fewer drinks than those randomized to MI. Conclusion: In the present study, neither BI nor MI was better than SC in reducing high‐risk alcohol consumption. Uptake of opportunistic screening by ED staff was poor, as was patient compliance with off‐site counselling.     

Assessing alcohol use in college: is it time for a new approach to identify risky drinking behavior?

Abstract

Objectives: The purpose of this study is to demonstrate how traditional risky drinking indicators, such as binge drinking, are inefficient when identifying college students who are in need of alcohol-related services. Methods: Using data collected from the 2010 National College Health Assessment II (NCHA-II), the sensitivity, specificity, positive predictive value and negative predictive value of binge drinking was analyzed relative to experiencing negative alcohol-related consequences in the previous 12 months. Results: Despite a considerable mathematical advantage, binge drinking demonstrated a sensitivity of 0.80 and a specificity of 0.69. Additionally, more than 56% of the sample who were identified as binge drinkers did not experience a major negative consequence in the previous 12 months. Conclusions: Risky drinking indicators constructed solely of frequency, quantity and duration items have a limited capacity to discriminate at-risk college drinkers from the general student body. New indicators comprised of novel drinking behaviors are necessary to properly identify students at high risk.     

The Significance of Marijuana Use Among Alcohol-using Adolescent Emergency Department Patients

Objectives:  The objective was to determine if adolescents presenting to a pediatric emergency department (PED) for an alcohol-related event requiring medical care differ in terms of substance use, behavioral and mental health problems, peer relationships, and parental monitoring based on their history of marijuana use.
Methods:  This was a cross-sectional comparison of adolescents 13–17 years old, with evidence of recent alcohol use, presenting to a PED with a self-reported history of marijuana use. Assessment tools included the Adolescent Drinking Inventory, Adolescent Drinking Questionnaire, Young Adult Drinking and Driving Questionnaire, Center for Epidemiologic Studies Depression Scale, Behavioral Assessment System for Children, and Peer Substance Use and Tolerance of Substance Use Scale.
Results:  Compared to adolescents using alcohol only (AO), adolescents who use alcohol and marijuana (A+M) have higher rates of smoking ( F =  23.62) and binge drinking ( F =  11.56), consume more drinks per sitting ( F =  9.03), have more externalizing behavior problems ( F =  12.53), and report both greater peer tolerance of substance use ( F =  12.99) and lower parental monitoring ( F =  7.12).
Conclusions:  Adolescents who use A+M report greater substance use and more risk factors for substance abuse than AO-using adolescents. Screening for a history of marijuana use may be important when treating adolescents presenting with an alcohol-related event. A+M co-use may identify a high-risk population, which may have important implications for ED clinicians in the care of these patients, providing parental guidance, and planning follow-up care.
ACADEMIC EMERGENCY MEDICINE 2010; 17:63–71 © 2010 by the Society for Academic Emergency Medicine     

Alcohol and acute myocardial infarction

A number of studies from different countries and several large-scale meta-analyses have reported reduced coronary heart disease rates among those regularly consuming mild to moderate amounts of alcohol compared with those abstaining from alcohol. In contrast, various studies have also reported that heavy alcohol consumption promotes the progression of atherosclerosis and that binge drinking might trigger embolic stroke and acute myocardial infarction. We discuss the association between alcohol consumption and acute myocardial infarction on the basis of evidence from literature published recently. Alcohol consumption has both favourable and unfavourable effects on metabolism, lipid profile, blood coagulation and fibrinolysis, blood pressure and vascular tone depending on the amount of alcohol consumed and the way that it is drunk (i.e. drinking habits). We conclude that it is extremely important to warn people of the risks associated with binge drinking and to encourage them to remain within the recommended safe limits for alcohol consumption.     

Measuring the effect of Family Medicine Group enrolment on avoidable visits to emergency departments by patients with diabetes in Quebec,Canada

The Family Medicine Group (FMG) model of primary care in Quebec, Canada, was driven by the voluntary implementation of family physicians. Our main objective was to measure the effect of FMG enrolment on avoidable use of the emergency department (ED) by diabetic patients. We also sought to determine if effects differed according to whether patients were infrequent or frequent users of the ED and according to high‐ versus low‐regional levels of enrolment. We used data from provincial health administrative databases to identify the diabetic patient population over the age of 20 years for each fiscal year between 2003‐2004 and 2011‐2012. We used fixed effects and marginal structural models to estimate the effect of enrolment in FMGs on avoidable use of the ED. Our results indicated that for every 10‐percentage point increase in the population enrolled with an FMG in the year prior to an event, there was a 3% reduction in avoidable visits to the ED made by an individual (RR = 0.97; 95% CI = 0.95, 0.99). We found a significant reduction among diabetic patients who had at most 1 visit to the ED per year (RR = 0.97; 95% CI = 0.95, 0.99) and nonsignificant effects among more frequent users. Within low‐enrolment regions, a 10‐percentage point increase in enrolment in FMG practices at t ? 1 led to an 18% decrease in the number of avoidable ED visits (RR = 0.82; 95% CI = 0.78, 0.87). The effect disappeared when the analyses were restricted to the high‐enrolment regions (RR = 1.00; 95% CI = 0.92, 1.09). The design and implementation of the incentive to promote team‐based practice may not have borne much influence on early adopters who may have been overrepresented by physicians from high‐performing practices before the introduction of the reform.     

Review article: Emergency department data sharing to reduce alcohol‐related violence: A systematic review of the feasibility and effectiveness of community‐level interventions

The present paper aims to review current evidence for the effectiveness and/or feasibility of using inter‐agency data sharing of ED recorded assault information to direct interventions reducing alcohol‐related or nightlife assaults, injury or violence. Potential data‐sharing partners involve police, local council, liquor licensing regulators and venue management. A systematic review of the peer‐reviewed literature was conducted. The initial search discovered 19 506 articles. After removal of duplicates and articles not meeting review criteria, n = 8 articles were included in quantitative and narrative synthesis. Seven of eight studies were conducted in UK EDs, with the remaining study presenting Australian data. All studies included in the review deemed data sharing a worthwhile pursuit. All studies attempting to measure intervention effectiveness reported substantial reductions of assaults and ED attendances post‐intervention, with one reporting no change. Negative logistic feasibility concerns were minimal, with general consensus among authors being that data‐sharing protocols and partnerships could be easily implemented into modern ED triage systems, with minimal cost, staff workload burden, impact to patient safety, service and anonymity, or risk of harm displacement to other licensed venues, or increase to length of patient stay. However, one study reported a potential harm displacement effect to streets surrounding intervention venues. In future, data‐sharing systems should triangulate ED, police and ambulance data sources, and assess intervention effectiveness using randomised controlled trials that account for variations in venue capacity, fluctuations in ED attendance and population levels, seasonal variations in assault and injury, and control for concurrent interventions.     

Binge drinking trends in a UK community‐based sample

Aims To investigate binge drinking trends using unrelated singletons from the GENESiS sample, aged 20–60 years.

Methods The GENESiS study is a questionnaire study based in the UK and includes measures on various mental health items as well as measures of alcohol consumption. Alcohol data from 20?062 subjects were analysed with respect to binge/heavy drinking behaviour as defined by the Office for National Statistics, UK.

Results The average number of units of alcohol per week consumed was 16 for men and 8 for women. Female binge drinking (more than 6 units per drinking session) was found to be very comparable to male binge drinking (more than 8 units per drinking session) with 15% of males reporting binge drinking compared with 18% of females. Binge drinking was found to be most prevalent amongst males and females in their twenties (33% of males vs 38% of females).

Conclusions This study revealed that, for both men and women, there was evidence of substantial numbers drinking heavily and in a binge drinking pattern, particularly in young adults.     

Caffeinated Cocktails: Energy Drink Consumption, High-risk Drinking, and Alcohol-related Consequences among College Students

Objectives:  The consumption of alcohol mixed with energy drinks (AmED) is popular on college campuses in the United States. Limited research suggests that energy drink consumption lessens subjective intoxication in persons who also have consumed alcohol. This study examines the relationship between energy drink use, high-risk drinking behavior, and alcohol-related consequences.
Methods:  In Fall 2006, a Web-based survey was conducted in a stratified random sample of 4,271 college students from 10 universities in North Carolina.
Results:  A total of 697 students (24% of past 30-day drinkers) reported consuming AmED in the past 30 days. Students who were male, white, intramural athletes, fraternity or sorority members or pledges, and younger were significantly more likely to consume AmED. In multivariable analyses, consumption of AmED was associated with increased heavy episodic drinking (6.4 days vs. 3.4 days on average; p < 0.001) and twice as many episodes of weekly drunkenness (1.4 days/week vs. 0.73 days/week; p < 0.001). Students who reported consuming AmED had significantly higher prevalence of alcohol-related consequences, including being taken advantage of sexually, taking advantage of another sexually, riding with an intoxicated driver, being physically hurt or injured, and requiring medical treatment (p < 0.05). The effect of consuming AmED on driving while intoxicated depended on a student's reported typical alcohol consumption (interaction p = 0.027).
Conclusions:  Almost one-quarter of college student current drinkers reported mixing alcohol with energy drinks. These students are at increased risk for alcohol-related consequences, even after adjusting for the amount of alcohol consumed. Further research is necessary to understand this association and to develop targeted interventions to reduce risk.     

Readiness to change problematic drinking assessed in the emergency department as a predictor of change

OBJECTIVES: The goal of this study was to determine if baseline readiness to change the drinking behavior (pre-contemplation, contemplation, preparation, and action stages) was predictive of change in drinking after unrelated emergency department (ED) visit and screening and interviewing for alcohol problems. METHODS: From August 1998 through December 2000, the Alcohol Use Disorders Identification Test (AUDIT) was administered to all consented ED patients aged 18 to 29 years. A brief motivational interviewing was provided to screen-positive patients (AUDIT score >5 of 40). Outcome at 3-month follow-up was measured as a decrease in the scores within the AUDIT domains of alcohol intake, harm, and dependency. RESULTS: Sixty percent of the screen-positive patients continued to drink at 3 months. Patients became more open to change their drinking behavior. Compared with patients in the pre-contemplation stage, those in the action stage were twice as likely to reduce their alcohol intake (OR, 2.24; 95% CI, 1.06-4.72), nearly 3 times as likely to reduce their alcohol-related harm behavior (OR, 2.80; 95% CI, 1.59-4.91), and almost 4 times more likely to decrease their dependency symptoms (OR, 3.59; 95% CI, 1.97-6.57). Compared with pre-contemplation patients, those in the contemplation stage were nearly twice as likely to reduce their alcohol-related harm (OR, 1.85; 95% CI, 1.02-3.33) and those in the preparation stage were more than twice as likely to reduce their dependency symptoms (OR, 2.20, 95% CI, 1.13-4.27). CONCLUSIONS: Stages of change at baseline appeared to be significant predictors of change in alcohol intake, harm, and dependency symptoms among young adult ED patients.     

Reducing the harm from adolescent alcohol consumption: results from an adapted version of SHAHRP in Northern Ireland

Background: The study aimed to trial an adapted version of the School Health and Alcohol Harm Reduction Project (SHAHRP) in Northern Ireland. The intervention aims to enhance alcohol-related knowledge, create more healthy alcohol-related attitudes and reduce alcohol-related harms in 14–16-year-olds.

Method: A non-randomised control longitudinal design with intervention and control groups assessed students at baseline and 12, 24 and 32 months after baseline. Students were from post-primary schools (high schools) in the Eastern Health Board Area in Northern Ireland. Two thousand three hundred and forty nine participants were recruited at baseline (mean age 13.84) with an attrition rate of 12.8%% at 32-month follow-up. The intervention was an adapted, culturally competent version of SHAHRP, a curriculum programme delivered in two consecutive academic years, with an explicit harm reduction goal. Knowledge, attitudes, alcohol consumption, context of use, harm associated with own alcohol use and the alcohol use of other people were assessed at all time points.

Results: There were significant intervention effects on all measures (intervention vs. controls) with differential effects observed for teacher-delivered and outside facilitator-delivered SHAHRP.

Conclusion: The study provides evidence of the cultural applicability of a harm reduction intervention (SHAHRP) for risky drinking in adolescents in a UK context.     

Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients

We describe an emergency department (ED)-based, Latino patient focused, unblinded, randomized controlled trial to empirically test if automated bilingual computerized alcohol screening and brief intervention (AB-CASI), a digital health tool, is superior to standard care (SC) on measures of alcohol consumption, alcohol-related negative behaviors and consequences, and 30-day treatment engagement. The trial design addresses the full spectrum of unhealthy drinking from high-risk drinking to severe alcohol use disorder (AUD). In an effort to surmount known ED-based alcohol screening, brief intervention, and referral to treatment process barriers, while addressing racial/ethnic alcohol-related health disparities among Latino groups, this trial will purposively use a digital health tool and seek enrollment of English and/or Spanish speaking self-identified adult Latino ED patients. Participants will be randomized (1:1) to AB-CASI or SC, stratified by AUD severity and preferred language (English vs. Spanish). The primary outcome will be the number of binge drinking days assessed using the 28-day timeline followback method at 12 months post-randomization. Secondary outcomes will include mean number of drinks/week and number of episodes of driving impaired, riding with an impaired driver, injuries, arrests, and tardiness and days absent from work/school. A sample size of 820 is necessary to provide 80% power to detect a 1.14 difference between AB-CASI and SC in the primary outcome. Showing efficacy of this promising bilingual ED-based brief intervention tool in Latino patients has the potential to widely and efficiently expand prevention efforts and facilitate meaningful contact with specialized treatment services.     

Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients

We describe an emergency department (ED)-based, Latino patient focused, unblinded, randomized controlled trial to empirically test if automated bilingual computerized alcohol screening and brief intervention (AB-CASI), a digital health tool, is superior to standard care (SC) on measures of alcohol consumption, alcohol-related negative behaviors and consequences, and 30-day treatment engagement. The trial design addresses the full spectrum of unhealthy drinking from high-risk drinking to severe alcohol use disorder (AUD). In an effort to surmount known ED-based alcohol screening, brief intervention, and referral to treatment process barriers, while addressing racial/ethnic alcohol-related health disparities among Latino groups, this trial will purposively use a digital health tool and seek enrollment of English and/or Spanish speaking self-identified adult Latino ED patients. Participants will be randomized (1:1) to AB-CASI or SC, stratified by AUD severity and preferred language (English vs. Spanish). The primary outcome will be the number of binge drinking days assessed using the 28-day timeline followback method at 12 months post-randomization. Secondary outcomes will include mean number of drinks/week and number of episodes of driving impaired, riding with an impaired driver, injuries, arrests, and tardiness and days absent from work/school. A sample size of 820 is necessary to provide 80% power to detect a 1.14 difference between AB-CASI and SC in the primary outcome. Showing efficacy of this promising bilingual ED-based brief intervention tool in Latino patients has the potential to widely and efficiently expand prevention efforts and facilitate meaningful contact with specialized treatment services.     

Alcohol use among young adults presenting to the emergency department

Objectives: To determine the prevalence of young ED patients at risk from hazardous alcohol consumption, to identify high‐risk patient subgroups and evaluate the feasibility of use of the Alcohol Use Disorders Identification Test (AUDIT) in this setting. Methods: We undertook a cross‐sectional survey of 336 ED patients aged 18–30 years, inclusive. All were breathalysed prior to self‐administering the AUDIT. A ‘positive’ AUDIT score (≥8) defined hazardous alcohol consumption. AUDIT scores were correlated with sex and trauma diagnosis. Results: One hundred and thirty‐one (39.0%, 95% confidence interval [CI] 33.8–44.5) patients were classified as AUDIT‐positive. Men were significantly more likely to be AUDIT‐positive (49%vs 23%, P < 0.001) and had significantly higher total AUDIT scores (P < 0.001) than women. Trauma patients were significantly more likely to be AUDIT‐positive (P < 0.001) and had significantly higher AUDIT scores than non‐trauma patients (P < 0.001). Of the six patients who recorded a positive breath alcohol reading, all were AUDIT‐positive. One hundred (76.3%, 95% CI 68.0–83.1) AUDIT‐positive patients did not report others being concerned about their drinking or had not been given advice to cut down. Conclusion: It is feasible to use the AUDIT screening tool in the ED to identify those at risk from hazardous drinking. In our ED there is a high prevalence of hazardous alcohol consumption in young adult patients, many of whom have not previously received advice to cut down on their drinking.     

Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency Department

This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on “Public Health in the ED: Screening, Surveillance, and Intervention.” The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening—develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention—conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups—conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies—a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow‐up; and d) examine alternatives to specialized treatment referral. 5) Translation—conduct translational and cost‐effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.     

Intermediate dose metoclopramide is not more effective than standard dose metoclopramide for patients who present to the emergency department with nausea and vomiting: a pilot study

Objective: To determine whether intermediate dose metoclopramide is more effective than standard dose metoclopramide for patients who present to the ED with nausea and vomiting. Methods: This prospective, single‐blind, randomized trial was conducted in the ED of two community teaching hospitals in a convenience sample of adult patients who presented to ED with nausea and vomiting. Patients were randomized to receive either 10 mg metoclopramide IV or 0.4 mg/kg IV (up to a maximum dose of 32 mg). The outcomes measured were: change in nausea score (measured on a 11‐point verbal rating scale), requirement for other anti‐emetic drug administration, and presence of side‐effects. Results: Fifty‐eight patients were eligible for analysis (34 in 10 mg group and 24 in 0.4 mg/kg group). Median reduction in nausea score in 10 mg group was four (range 0–10, 95% CI 3–5) compared with five for 0.4 mg/kg group (range ?1–10, 95% CI 4–6). This difference was not statistically significant (P = 0.629). Five patients in the 10 mg group required rescue anti‐emetic, compared with three in the 0.4 mg/kg group (P = 1.00). There were no side‐effects in the 10 mg group and two in the 0.4 mg/kg group. Conclusion: This study suggests that there is no difference in effectiveness between 10 mg and 0.4 mg/kg of metoclopramide in the ED population with nausea and vomiting.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Alcohol consumption and sociodemographic predictors across Hispanic national groups

Objective: To examine differences in alcohol consumption among Hispanic national groups in the United States [Puerto Ricans, Mexican, Cuban, and Dominican South Central (D/SC) Americans] and identify sociodemographic predictors of drinking and binge drinking (four drinks for women and five for men in a 2-hr period).

Method: The study used a household probability sample of adult Hispanics in five metropolitan areas in the United States. Comprehensive data on alcohol consumption were collected. Analyses included bivariate and multivariate regression techniques.

Results: Puerto Rican and Mexican American men reported higher drinking rates, weekly consumption, and binge drinking than D/SC and Cuban Americans. Women drank significantly less than men. Mexican American women reported the highest abstention rate (61%); Puerto Rican women drank more per week and binged more frequently compared with their counterparts in other groups. Puerto Rican origin, initiating drinking during high school years (<18), and male gender (US- or foreign-born) were significant predictors of weekly alcohol consumption. Being younger, being single, Puerto Rican or D/SC American origin, initiating drinking at <18 years, being a US- or foreign-born male and being a US-born female were significant predictors of binge drinking.

Conclusions: There are considerable differences in drinking behavior across Hispanic national groups as well as between men and women. Results underscore the need to recognize heterogeneity in drinking practices while designing effective prevention interventions in the community.     

Alcohol-related activities in primary health care

ABSTRACT

Background: Brief alcohol intervention (BI) is recommended for use in health care. However, too little is known about its use in everyday work.

Objective: The aim of this study was to examine the activity of asking patients about alcohol use, offering them BI, and documenting these issues in physicians’ and nurses’ consultations as a part of everyday primary health care (PHC) work.

Methods: All PHC workers (n = 104) of seven health care centers were asked to report information on 30 consecutive adult patients. Altogether, 78 PHC workers (75.0%) participated in this study and reported information on 2,047 patients.

Results: A total of 1,112 (56.4%) patients had been asked about alcohol use at some point. According to the PHC workers, 115 (10.4%) of the patients who had been asked about alcohol use were risky drinkers. BI was offered to 103 (89.6%) risky drinkers. Alcohol-related documentation was found in 452 (42.0%) of the records of patients who had been asked about alcohol use.

Discussion: The BI activity of PHC professionals is high if the patient is considered a risky drinker. However, the overall incidence of inquiry could be increased and alcohol-related documentation still remains low.