Violence Related Injuries in the Emergency Room: Alcohol,Depression, and Conduct Problems

Objective.?The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October–November, 1996 and June–July, 1997. Method.?The study was a population-based case-control design. Intervention and Measurements: Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week. Setting and Participants: Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group. Results.?Patients reporting drinking within 6 h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5–66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5–15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables. Conclusions.?In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.     

Drinking in the injury event: a comparison of Mexican-American male ER patients in the United States and in Mexico

Probability samples of 66 Mexican-American injured male emergency room (ER) patients in Santa Clara County, CA, and 457 injured male ER patients in Pachuca, Mexico are compared on a number of drinking-in-the-event variables. While those in Pachuca were more likely to be positive on the breathalyzer than those in Santa Clara, they were less likely to attribute a causal association of their drinking with the event. Site (Santa Clara) was found to be a significant (positive) predictor of drinking prior to injury.     

DRINKING IN THE INJURY EVENT: A COMPARISON OF MEXICAN-AMERICAN MALE ER PATIENTS IN THE UNITED STATES AND IN MEXICO

Probability samples of 66 Mexican-American injured male emergency room (ER) patients in Santa Clara County, CA, and 457 injured male ER patients in Pachuca, Mexico are compared on a number of drinking-in-the-event variables. While those in Pachuca were more likely to be positive on the breathalyzer than those in Santa Clara, they were less likely to attribute a causal association of their drinking with the event. Site (Santa Clara) was found to be a significant (positive) predictor of drinking prior to injury.     

Validity of self-reported alcohol consumption in the emergency room: data from the United States, Mexico and Spain.

The validity of self-reported alcohol consumption within 6 hours prior to injury based on breath-analyzer readings obtained at the time of emergency room (ER) admission is compared among probability samples of ER patients in Contra Costa County, California (n = 450), Mexico City (n = 500) and Barcelona, Spain (n = 864). The same questionnaire, study design and methods were used in all three countries to maintain comparability for comparative analyses. The analysis was restricted to those breath analyzed within 6 hours of injury occurrence who reported no drinking following the event. Validity of self-reports was high in all three samples. The proportion of those reporting not drinking prior to injury who had positive breath-analyzer readings was .5% in the U.S., 1.5% in Spain and 3.3% in Mexico. Validity of self-reports was not associated with cause of injury in the United States. In Mexico those injured in motor vehicle accidents or by violence were most likely to deny drinking, while in Spain those injured in violent situations were most likely to report not drinking. Validity of self-reports in these studies is much higher than that found in other U.S. studies, but this may be partly due to the fact that self-reports were obtained after the patient had been breath analyzed.     

Alcohol and drug consumption, depressive features, and family violence as associated with complaints to the Prosecutor's Office in Central Mexico

The article is aimed at reporting the characteristics of the population detected at State Prosecutors' Offices including the two such offices that existed in the city selected for the study, one located in a general hospital for the inspection of violence-related cases (n = 156); and the second in the facility where all detainees are taken when arrested (n = 129), and where victims can file a complaint (n = 186). A household survey undertaken among the population 18 to 65 years of age (n = 887) was used as a group of reference. Both studies were undertaken in Pachuca City, the capital of Hidalgo, located 100 km from Mexico City during the second half of 1996. Face-to-face questionnaires were used to obtain sociodemographic data, drug use and drinking patterns, depressive symptomatology, and family violence. Discriminant and logistic regression analysis were undertaken. The age group from 18 to 24 displayed the highest number of legal complaints and arrests (OR = 1.773). The likelihood for appearing at a State Prosecutor's Office was higher for those living in an atmosphere of threats and injuries within the family (OR = 19) and for those that reported alcohol consumption on the day of the event (OR = 14). Extremely high rates of family violence were obtained in this sample, increasing the likelihood of arriving at the Prosecutor's Office either because arrested or for being a victim. Results confirm the relationship between alcohol use, depression, and violence, reinforcing the need to prevent alcohol abuse, especially among youth.     

Multi-level analysis of causal attribution of injury to alcohol and modifying effects: Data from two international emergency room projects

Although alcohol consumption and injury has received a great deal of attention in the literature, less is known about patient's causal attribution of the injury event to their drinking or factors which modify attribution. Hierarchical linear modeling is used to analyze the relationships of the volume of alcohol consumed prior to injury and feeling drunk at the time of the event with causal attribution, as well as the association of aggregate individual-level and socio-cultural variables on these relationships. Data analyzed are from 1955 ER patients who reported drinking prior to injury included in 35 ERs from 24 studies covering 15 countries from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the WHO Collaborative Study on Alcohol and Injuries. Half of those patients drinking prior to injury attributed a causal association of their injury with alcohol consumption, but the rate of causal attribution varied significantly across studies. When controlling for gender and age, the volume of alcohol consumed and feeling drunk (controlling for volume) were both significantly predictive of attribution and this did not vary across studies. Those who drink at least weekly were less likely to attribute causality at a low volume level, but more likely at high volume levels than less frequent drinkers. Attribution of causality was also less likely at low volume levels in those societies with low detrimental drinking patterns, but more likely at high volume levels or when feeling drunk compared to societies with high detrimental drinking patterns. These findings have important implications for brief intervention in the ER if motivation to change drinking behavior is greater among those attributing a causal association of their drinking with injury.     

Alcohol-related injury in the ER: a cross-national meta-analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)

OBJECTIVE: To examine the impact of usual drinking patterns and related problems on the acute use of alcohol in injury. METHOD: The impact of quantity and frequency of drinking, alcohol problems and dependence symptoms on admission to the emergency room (ER) for an alcohol-related injury (based, separately, on a positive blood alcohol concentration [BAC] and self-reported drinking within 6 hours prior to injury), compared with a nonalcohol related injury, was examined using meta-analysis, across 15 ER studies covering seven countries. RESULTS: Pooled effect size for consuming five or more drinks on an occasion at least monthly was significant but not homogeneous, with odds ratios (ORs) of 4.16 for BAC and 3.92 for self-report. Frequency of drinking among nonheavy drinkers was found to have the largest effect size (5.93 for BAC and 4.93 for self-report). Heavy drinking, controlling for frequency, was also significant (ORs of 2.08 for BAC and 1.86 for self-report), but effect size was homogeneous only for self-report. Effect sizes for consequences of drinking and dependence symptoms were also significant and homogeneous, with ORs of 4.29 and 3.55, respectively, for BAC, and 3.84 and 3.94, respectively, for self-report. In meta-regression analysis, among contextual variables the level to which alcohol use is stigmatized in the culture was most consistently predictive of heavy-drinking effect size on an alcohol-related injury, with larger effect sizes found in those studies reporting a lower level of stigmatization. CONCLUSIONS: Whereas quantity and frequency of drinking were both found to be highly predictive of an alcohol-related injury, sociocultural variables may affect observed associations of heavy drinking with an alcohol-related injury.     

Screening instruments for alcohol problems: a comparison of cut points between Mexican American and Mexican patients in the emergency room

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.     

Predictors of violence following Emergency Department visit for cocaine-related chest pain

This study examined 1-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n=219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n=174; 59% male, 79% African-American, mean age=38.8, standard deviation 9.06; range=19-60). Baseline rates of past year violent victimization and perpetration history were: 38% and 30%, respectively. During the 12-month follow-up, rates of victimization and perpetration outcomes were 35% and 30%, respectively. Predictors of violence outcomes (either victimization or perpetration) in the year post-ED visit based on characteristics were measured at baseline or during the follow-up period (i.e., gender, age, psychological distress, binge drinking days, cocaine use days, marijuana use days, substance abuse/dependence diagnosis, victimization/perpetration history). Victimization during the follow-up was related to younger age, more frequent binge drinking and marijuana use at baseline, and victimization history, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Specifically, participants who reported victimization at baseline were approximately 3 times more likely to report victimization at 12-month follow-up. Perpetration during the follow-up was related to younger age and more frequent binge drinking at baseline, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Overall, no significant gender differences were observed in violence; however, women were more likely than men to report injury during the most severe partner violence incident. Violence is a common problem among patients presenting to an inner-city ED for cocaine-related chest pain, with younger age and frequency of binge drinking being a consistent marker of continued violence involvement. Intervention approaches to link these not-in-treatment cocaine users to services and reduce cocaine use must take into account concomitant alcohol misuse and violence.     

Screening Instruments for Alcohol Problems: A Comparison of Cut Points between Mexican American and Mexican Patients in the Emergency Room

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.     

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

Issues. Alcohol-attributable burden of injury is one of the most serious public health problems in Latin America and the Caribbean region (LAC). Although knowledge on alcohol's involvement in injuries has progressed along with the implementation of evidenced-based alcohol policies in developed countries, this was not true for the most part of LAC countries for which reducing alcohol-related injuries is an urgent necessity. Approach. A systematic review was performed in order to identify the most up-to-date information on alcohol and injuries derived from emergency room (ER) studies conducted in LAC. Key Findings. Findings corroborate that alcohol has a high prevalence among injured patients in the ER setting in LAC, with violence-related injuries showing an increased association with alcohol use compared to unintentional injuries. However, a large number of studies did not include all types of injury and the measurement of injury risk associated with alcohol consumption. The amount of alcohol consumed in the event and hazardous drinking patterns seem to be strongly associated with injury occurrence, as well as drinking in public spaces, but a paucity of data relating to social-contextual factors limits the interpretation of the heterogeneity in the magnitude of the association of alcohol and injuries found across studies. Conclusions. There is a lack of ER studies able to support strategies to reduce alcohol-related injuries in a region where effective alcohol policies are scant. Future research should focus on understanding how drinking influenced by local contexts and drinking behaviours may affect the risk of injury within each LAC country.[Andreuccetti G, Carvalho HB, Korcha R, Ye Y, Bond J, Cherpitel CJ. A review of emergency room studies on alcohol and injuries conducted in Latin America and the Caribbean region. Drug Alcohol Rev 2012;31:737-746].     

Violence among individuals in substance abuse treatment: the role of alcohol and cocaine consumption

This study examined factors associated with expressed violence in the 90 days prior to substance abuse (SA) treatment among 125 men and 125 women recently enrolled in treatment. Approximately 85% of the sample reported a significant conflict situation, and over 32% reported an incident of physical violence. Both general alcohol and cocaine use patterns (on days not involving significant interpersonal conflict), as well as alcohol and cocaine use on the day of the violent incident, were associated with violence severity. Regression analyses revealed that race, education, age, and both general drinking and cocaine use patterns were associated with violence severity for the most severe violent incident reported. Similarly, regression analyses focusing on alcohol and cocaine use on the day of the most severe incident revealed that higher drinking levels, younger age, minority status, and the interaction of alcohol and cocaine use were associated with violence severity. The results provide important information regarding factors associated with expression of violence among men and women in SA treatment, and have implications regarding the assessment of violence risk factors. Further, the findings suggest that screening and intervention approaches for violence-related problems should be routine in SA treatment, and appear to be especially indicated for patients reporting alcohol consumption, and co-occurring alcohol and cocaine consumption.     

Drug use and problem drinking associated with primary care and emergency room utilization in the US general population: data from the 2005 national alcohol survey

BACKGROUND: Substance use problems are overrepresented in probability samples of patients in primary care settings including the emergency room (ER) compared to the general population. While large proportions of those with alcohol or drug use disorders are most likely to obtain services for these problems outside the mental health or substance abuse treatment system, accounting, in part, for this overrepresentation, little is known about the association of alcohol misuse or drug use with health services utilization in the general population. METHODS: The prevalence and predictive value of alcohol misuse and drug use on ER and primary care use was analyzed on 6919 respondents from the 2005 National Alcohol Survey (NAS). RESULTS: Among those reporting an ER visit during the last year, 24% were positive for risky drinking (14+ drinks weekly for men and 7+ for females and/or 5+/4+ in a day in the last 12 months), 8% for problem drinking, 3% for alcohol dependence, and 7% for illicit drug use greater than monthly. Figures for primary care users were, respectively: 24%, 5%, 3%, and 3%. ER users were more likely to be positive for problem drinking and greater than monthly illicit drug use compared to non-ER users, while no significant differences were found in substance use for users and non-users of primary care. In logistic regression controlling for gender, age, and health insurance, problem drinkers were twice as likely as non-problem drinkers (Odds ratio, OR=1.99) (p<0.01), and those reporting greater than monthly drug use were almost twice as likely as those using drugs less frequently or not at all (OR=1.92; p=0.01) to report ER use, while those reporting alcohol dependence were 1.63 times more likely to report primary care use (p<0.05). CONCLUSION: These data support the belief that both the ER and other primary care settings are important sites for identifying those with substance use problems and for initiating a brief intervention.     

Drinking in the Injury Event: A Comparison of Emergency Room Populations in the United States,Mexico, and Spain

Variables related to drinking in the injury event were compared among probability samples of emergency room patients in Contra Costa County, California (N = 1,001), Mexico City (N = 1,688) and Barcelona, Spain (N = 1,684). Drinking companions and places of drinking prior to injury, place of injury associated with drinking, amount of alcohol consumed, proximity of drinking with the injury event, perceived drunkenness at the time, and causal attribution of drinking with the event were all found to vary among the samples. The data suggest that the context in which alcohol is involved in the injury event is affected by the context in which alcohol is typically consumed in a culture and is important in analyzing alcohol's role in injury occurrence and situations which may be considered high-risk for alcohol-related injuries.     

Alcohol and Drug Consumption,Depressive Features,and Family Violence as Associated with Complaints to the Prosecutor's Office in Central Mexico

The article is aimed at reporting the characteristics of the population detected at State Prosecutors' Offices including the two such offices that existed in the city selected for the study, one located in a general hospital for the inspection of violence-related cases (n = 156); and the second in the facility where all detainees are taken when arrested (n = 129), and where victims can file a complaint (n = 186). A household survey undertaken among the population 18 to 65 years of age (n = 887) was used as a group of reference. Both studies were undertaken in Pachuca City, the capital of Hidalgo, located 100 km from Mexico City during the second half of 1996. Face-to-face questionnaires were used to obtain sociodemographic data, drug use and drinking patterns, depressive symptomatology, and family violence. Discriminant and logistic regression analysis were undertaken. The age group from 18 to 24 displayed the highest number of legal complaints and arrests (OR = 1.773). The likelihood for appearing at a State Prosecutor's Office was higher for those living in an atmosphere of threats and injuries within the family (OR = 19) and for those that reported alcohol consumption on the day of the event (OR = 14). Extremely high rates of family violence were obtained in this sample, increasing the likelihood of arriving at the Prosecutor's Office either because arrested or for being a victim. Results confirm the relationship between alcohol use, depression, and violence, reinforcing the need to prevent alcohol abuse, ^{1 1}The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note. especially among youth.     

The relationship of alcohol use to cocaine relapse in cocaine dependent patients in an aftercare study

OBJECTIVE: To examine the relationship between alcohol use and cocaine relapse. METHOD: Ninety-eight cocaine-dependent male patients in aftercare were followed for 6 months following completion of an intensive outpatient rehabilitation program (IOP). Past and current alcohol dependence was assessed at entrance into aftercare, and drinking behavior prior to cocaine relapse and "near miss" episodes was assessed at 3- and 6-month follow-ups. Data on cocaine and alcohol use throughout the follow-up were also obtained. RESULTS: Patients who had never met criteria for alcohol dependence and those with current alcohol dependence had worse cocaine outcomes (cocaine use on 10% and 7% of the days in the follow-up, respectively) than those with past alcohol dependence (cocaine use on 3% of the days in the follow-up), although alcohol dependence status no longer predicted cocaine use outcomes when cocaine use in IOP was controlled. Alcohol use in 4 of the first 5 follow-up months significantly predicted cocaine relapse status in the next month after cocaine use in IOP and alcohol dependence diagnosis at baseline were controlled. Patients who experienced cocaine relapses were much more likely to report drinking before the onset of the episode than those who had "near misses," particularly on the day of the episode (40% vs. 6% at 3 months; 62% vs. 0% at 6 months). Alcohol did not appear to be a factor in the relapses of cocaine patients with no history of alcohol dependence, even though they did report drinking on 5% of the days in the follow-up. CONCLUSIONS: Relapse prevention efforts with cocaine abusers who have histories of alcohol dependence should include interventions designed to reduce drinking.     

Alcohol use among Mexican American U.S.–Mexico border residents: Differences between those who drink and who do not drink in Mexico

The predominately Hispanic U.S.–Mexico border population is at an elevated risk for drinking and associated problems due to the area's low SES, poor services infrastructure, and drug-related violence. Among Mexican American residents, recent studies suggest this risk is particularly pronounced among younger age groups, and a key characteristic of this elevated risk involves crossing the border to drink in Mexico (where the legal drinking age is 18). However, few studies have compared the drinking behavior of U.S. residents who consume alcohol on the Mexico side of the border with those who do not. We address this gap in the present study. A multistage household probability sample of 1307 Mexican American border residents was interviewed about their drinking and associated problems over the past year. The survey response rate was 67%. Among current drinkers who reported going to Mexico in the past 12 months (N = 468), 36.1% reported consuming alcohol in Mexico. Those who drank in Mexico reported significantly more drinks per week (12.8 versus 8.7, p < .05), were more likely to have binged (58.3% versus 35.4%, p < .001), and were more likely to report one or more alcohol problem (35.5% versus 19.5%, p < .01) than those who did not drink in Mexico. Among those who drank in Mexico, men reported significantly more drinks per day while in Mexico than women (6.2 versus 4.0, p < .001). Male gender and lower income were significant predictors of drinking in Mexico. These findings suggest that drinking in Mexico contributes to the heightened risk for drinking and associated problems seen in previous research among Mexican Americans living on the U.S.–Mexico border.     

560名急诊外伤患者饮酒状况的研究

目的 :研究急诊室就诊的外伤患者 ,受伤前的饮酒情况及饮酒与外伤的相关性。方法 :使用呼出气体酒精浓度测定仪进行呼出气体酒精浓度测定和问卷调查。结果 :(1)酒后外伤组和非酒后外伤组在受伤前 1a的饮酒频率比较差异有显著性 (P <0 0 1) ;(2 )在受伤前 1a里 ,一次饮 10 0 - 2 5 0g或 2 5 0g及以上高度白酒的频率两组比较差异有显著性 (P <0 0 0 1) ;(3)酒后外伤者的既往最大饮酒量大于非酒后外伤组 (P <0 0 0 1) ;(4)酒后外伤者发生外伤前的饮酒量少于平时最大饮酒量 ,两者比较差异有显著性 (P <0 0 0 1)。结论 :饮酒的频率及饮酒的量可能与外伤的发生有关     

Prediction of alcohol-related casualties: a comparison of two emergency room populations

Logistic regression was used to compare the predictive value of alcohol consumption variables on casualty occurrence in probability samples of two diverse emergency room (ER) populations who were breathalyzed and interviewed at the time of ER admission: San Francisco General Hospital (N = 1459) and four hospitals representative of a nearby California county (N = 1756). Previous analyses suggested differences in the association of alcohol consumption and injury in these two samples. Age, breathalyzer reading and feeling drunk at the time of the event were consistent predictors of injury status in both samples while breathalyzer reading, quantity and frequency of usual drinking and place of injury occurrence (workplace vs. home) were consistent predictors of alcohol-related injuries (self-reported drinking 6 h prior to event).