Biomedical subjects

C J Cherpitel

Publications and source records attributed to C J Cherpitel.

At least 19 recordsLinked to original sources

PubMed2004

Episodic alcohol use and risk of nonfatal injury.

Usual and acute alcohol consumption are important risk factors for injury. Although alcohol-dependent people are thought to be at increased risk of injury, there are few reports suggesting that their risk is greater than that of nondependent alcohol users in a given episode of alcohol use. The authors conducted a case-crossover analysis of data on 705 injury patients from a hospital emergency department in Mexico City, Mexico, collected in 2002. The majority of the sample was male (60%) and over 30 years old (51%). With use of a multiple matching approach that took into account three control time periods (the day prior to the injury, the same day in the previous week, and the same day in the previous month), the estimated relative risk of injury for patients who reported having consumed alcohol within 6 hours prior to injury (17% of the sample) was 3.97 (95% confidence interval: 2.88, 5.48). This increase in the relative risk was concentrated within the first 2 hours after drinking; there was a positive association of increasing risk with increasing number of drinks consumed. These data suggested that relative risk estimates were the same for patients with and without alcohol use disorders.

Adult↗

PubMed2004

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 6h 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.

Adolescent↗

PubMed2001

Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the emergency department.

OBJECTIVE: This article reports on the selection of screening items to detect Mexican or Mexican-American patients in the emergency department (ED) who have alcohol problems and could benefit from an intervention or a referral for treatment. Items are tested against the Rapid Alcohol Problems Screen (RAPS), which has been optimized from standard screening instruments and has outperformed these instruments. METHOD: The performance of individual items from standard screening instruments (CAGE, TWEAK, AUDIT, TRAUMA and BMAST) against International Classification of Diseases, Tenth Revision and Diagnostic and Statistical Manual, Fourth Revision criteria for alcohol abuse and dependence was evaluated in a merged probability sample (N = 869; 72% men) of 537 ED patients from three hospitals in Pachuca, Mexico, and 332 Mexican-American ED patients in Santa Clara County, CA. Logistic regression and tree-classification models were used for item selection. RESULTS: We found a prevalence of 15% for alcohol dependence and a prevalence of 28% for alcohol abuse or dependence in the merged sample. The RAPS items did not perform as well in terms of sensitivity (93%) as the optimal five items identified in these analyses (sensitivity = 98%) for alcohol dependence, but did demonstrate better specificity (79%) than the optimal five items (65%), which is an important consideration in a time of cost containment. Both sets of items showed better sensitivity and positive predictive value but similar Receiver Operating Characteristic values for respondents in the high acculturation group compared to those at other levels of acculturation. Differences in positive predictive value across all subgroups tended to increase at increased cutpoints, especially for the RAPS. CONCLUSIONS: These analyses suggest that the RAPS performs favorably compared to those items optimized, in this sample of Hispanic ED patients. Based on comparative item performance in these analyses, the RAPS may hold promise as a useful tool for screening for alcohol dependence, but requires further evaluation as a stand-alone instrument in comparison with other standard screening instruments.

Adolescent↗

PubMed2001

Differences in services utilization between white and Mexican American DUI arrestees.

BACKGROUND: Hispanics traditionally have been considered an underserved population in relation to medical care and related services utilization. METHODS: Selected health and social services utilization (both alcohol-specific and non-alcohol-specific) during the last year was compared between a sample of 249 Mexican American (half of whom were born in Mexico) and 250 white participants interviewed in all five DUI (driving under the influence) treatment programs in one northern California county. RESULTS: Among those who met DSM-IV criteria for alcohol dependence and/or alcohol abuse, 49% of the white subjects compared with 59% of the Mexican American subjects reported no utilization, 77% of whites and 82% of Mexican Americans reported no utilization in which drinking was a factor, and 70% of whites and 80% of Mexican Americans reported no contact with an alcohol program. Mexican Americans were also significantly less likely to report contact with more than one program, and among Mexican Americans, those born in Mexico were significantly less likely to report utilization than those born in the U.S. CONCLUSIONS: The data suggest that despite the higher rates of heavy drinking found among Mexican American DUI arrestees (especially those born in Mexico) in this sample, Mexican Americans with an alcohol use disorder are less likely to use health and social services than whites, and this may be related to country of birth and related variables that include health insurance. SIGNIFICANCE: The data suggest that DUI programs may offer one of the few opportunities Mexican American problem drinkers have of establishing contact with the health and social service system and, as such, would be well positioned to also offer other types of alcohol-related health and social services and referrals to this underserved population. These findings have implications for intervention efforts for problem drinking and prevention of DUI among Mexican Americans, which are a rapidly growing ethnic minority in California.

Adolescent↗

PubMed2001

A comparison of substance use and injury among Mexican American emergency room patients in the United States and Mexicans in Mexico.

BACKGROUND: Emergency room (ER) studies have found differences in the association of alcohol with injury (intentional and unintentional) across cultures. These differences may be due to differences in drinking patterns across cultures. Few comparative data have been reported on associations of alcohol and injury between Mexican American ER patients and ER patients living in Mexico, and general population studies suggest that Mexican Americans may adopt more frequent heavy drinking patterns after migrating to the United States. METHODS: A comparative analysis of drinking, drug use, and injury was performed in probability samples of 550 ER patients from Santa Clara County (San Jose, CA) and 1417 ER patients in Pachuca (Hidalgo), Mexico. RESULTS: Both injured and uninjured (i.e., medical conditions) patients in Pachuca were less likely to report heavy drinking, drug use, drunkenness, or alcohol-related problems compared with those in Santa Clara. Those scoring high on level of acculturation in Santa Clara were more likely to report both drinking and drug use before the event, and heavy drinking, drug use, and consequences related to drinking in the last year compared with those scoring lower. Those scoring low on acculturation were similar on substance use variables to those in the Pachuca sample. CONCLUSIONS: Findings suggest that alcohol's association with injury may not just reflect typical drinking patterns in a culture. Among Mexican Americans, this association my vary by acculturation, and those migrating to the United States may be at increased risk for alcohol-related injury as their drinking patterns undergo change to those of the dominant culture. The ER, in this context, may take on increasing importance as a site for health services providers to implement intervention and prevention services for alcohol-related consequences in this ethnic group.

Adolescent↗

PubMed2000

Performance of screening instruments for alcohol problems in the ER: a comparison of Mexican-Americans and Mexicans in Mexico.

The performance of standard screening instruments and alternate measures against ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th revision) criteria for alcohol dependence and separately for harmful drinking/abuse were compared between probability samples of 1511 emergency room (ER) patients from three hospitals in Pachuca, Mexico, and 586 Mexican-American ER patients in Santa Clara County, California. Sensitivity was highest for the Alcohol Use Disorders Identification Test (AUDIT), TWEAK, and Rapid Alcohol Problems Screen (RAPS) for alcohol dependence; sensitivity was highest for holding five or more drinks for harmful drinking/abuse in both samples. All instruments performed better for alcohol dependence than for abuse/harmful drinking. Arrests for drinking and driving performed better in Santa Clara than in Pachuca, while a positive Breathalyzer reading and reporting drinking prior to the event performed better in Pachuca; both were significantly more sensitive among the injured compared to the noninjured in Pachuca. The data suggest that instrument performance may be similar between those in Pachuca and those in the low acculturation group in Santa Clara, relative to those scoring higher on acculturation. While standard screening instruments appear to work reasonably well in both samples for alcohol dependence, variation across gender, injury, and acculturation subgroups suggests attention should be given to choosing the "best" instrument.

Acculturation↗

PubMed2000

Drinking patterns and alcohol dependence: a comparison of primary care patients in a southern county with the regional general population.

OBJECTIVE: Alcohol-related problems are thought to be overrepresented in primary care settings compared to the general population; however, studies comparing alcohol use problems within primary care settings and within the general population from the same area are relatively rare. METHOD: Data on drinking patterns and alcohol dependence are reported on a probability sample of 767 patients in a primary care system and 1,536 general population respondents sampled from the same region. RESULTS: No differences were found regarding heavy drinking, frequency of drunkenness or prior alcohol treatment, between the primary care sample and those in the general population who reported primary care use during the previous year, although those in the primary care sample were significantly less likely to be alcohol dependent. Compared to those in the general population who reported not using primary care services during the preceding year, the primary care sample was significantly less likely to report frequent drunkenness or prior alcohol treatment. Controlling for the demographic disparity between samples in multivariate analysis, drinking characteristics were not positively predictive of belonging to the primary care sample. CONCLUSIONS: The data suggest that problem drinking does not appear to be overrepresented in this primary care sample, nor among those reporting primary care use in the general population of the region, and that all primary care settings may not hold equal promise for screening for problem drinking patients.

Adolescent↗

PubMed2000

A brief screening instrument for problem drinking in the emergency room: the RAPS4. Rapid Alcohol Problems Screen.

OBJECTIVE: While a number of brief screening instruments for identifying problem drinkers have been tested in clinical settings, instruments have not been found to perform as well for women as for men, or to perform uniformly across ethnic groups. The purpose of this study was to evaluate a shortened version of the RAPS (Rapid Alcohol Problems Screen) in an emergency room (ER) sample (N = 1,429; 51% female) and to determine the most efficient ordering of the items. METHOD: The sensitivity and specificity of each of the RAPS items were examined against current ICD-10 and DSM-IV criteria for alcohol dependence, and separately for harmful drinking or abuse. A four-item version of the RAPS (the RAPS4) was analyzed separately for men and for women, and for blacks, Hispanics and whites/others. RESULTS: Among the five original RAPS items, four items were found to be most efficient, with the single item of feeling guilt or remorse after drinking identifying 83% of those with alcohol dependence and 44% of those meeting criteria for harmful drinking or abuse. A positive response to any one of the four items (RAPS4) gave a sensitivity of 93% and specificity of 87% for alcohol dependence, and sensitivity and specificity were consistently high across gender and ethnic subgroups. Sensitivity and specificity for harmful drinking or abuse were lower (55% and 79%, respectively). CONCLUSIONS: Because of its brevity and high performance across demographic subgroups, the RAPS4 may hold promise in screening for alcohol use disorders in patient populations, and its utility warrants further evaluation in clinical settings.

Adolescent↗

PubMed2000

Variables associated with DUI offender status among whites and Mexican Americans.

OBJECTIVE: Arrests of Hispanics have been found to be overrepresented among arrests for driving under the influence of alcohol (DUI) in California. Variables associated with offender status (first vs multiple) among Mexican-American and white DUI arrestees are analyzed to test the hypothesis that acculturation will be related to DUI among Mexican Americans while risk-taking dispositional variables will be related to DUI among whites. METHOD: A sample of 249 Mexican-American clients (with an oversampling of foreign-born) and 250 white clients were interviewed in all five DUI treatment programs in one northern California county. RESULTS: In univariate analysis, risk taking/impulsivity and sensation seeking were positively associated with multiple offender status among Mexican Americans, but not among whites. Multiple logistic regression found age as the only significant predictor of offender status in either ethnic group; however, path models found significant indirect effects on offender status of attitudes regarding DUI arrest through alcohol consumption, with those reporting having little chance of being arrested for DUI if stopped being less likely to report consuming five or more drinks at a sitting at least weekly, and with Mexican Americans being more likely than whites to believe they will not be arrested and to consider that DUI is not a problem. CONCLUSIONS: The data suggest that there are significant ethnic differences in attitudes and norms toward DUI that are related to frequency of drinking large amounts at one sitting, and future research is needed to determine how these variables along with dispositional and acculturation variables may be associated with DUI offender status.

Acculturation↗

PubMed2000

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.

Adult↗

PubMed1999

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study.

OBJECTIVE: The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured). METHOD: Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine. RESULTS: Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.

Accidents↗

PubMed1999

Drinking patterns and problems, drug use and health services utilization: a comparison of two regions in the US general population.

While substance abuse has been found to be over-represented in some primary care settings, we do not know under what circumstances this association may vary, and whether it may be linked to differences in attitudes regarding alcohol use as reflected in regional rates of abstention and heavy or problem drinking. Data are reported from the Southern and Western regions of the 1995 National Alcohol Survey. Alcohol consumption variables were not found to be predictive of primary care utilization. Main effects were found for heavier drinking on emergency room (ER) use for an injury, and interactive effects of region were found for consequences of drinking, with those in the South who reported consequences more likely to have used the ER for either an injury or illness than those in the West. These data suggest that ER utilization may be related to regional differences in drinking patterns, while primary care utilization may not be.

Adult↗

PubMed1999

Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients.

The sensitivity and specificity of several screening instruments including the CAGE, brief MAST, AUDIT, TWEAK, RAPS, and Trauma Scale, were evaluated against both ICD-10 and DSM-IV criteria for alcohol dependence and for harmful drinking and abuse in a probability sample of 586 Hispanic emergency department patients. Screening instruments were not as sensitive for females as for males, for those in the low acculturation group, or for non-dependent drinkers. Acculturation was positively associated with the likelihood of being a current drinker and among current drinkers, was positively associated with alcohol dependence and with harmful drinking or alcohol abuse.

Accidents, Traffic↗

PubMed1999

Alcohol and injury: a comparison of emergency room populations in two Canadian provinces.

The few comparative emergency room (ER) studies reported have found alcohol's role in injury occurrence to vary and suggest that regional and cultural differences in drinking patterns may account, in part, for this variation. To further this research, a probability sample of 1708 ER patients was interviewed regarding the role of alcohol in the event, usual drinking patterns, and alcohol-related problems and a urine sample was obtained to estimate blood alcohol concentration (BAC). The sample was from ERs in two Canadian provinces with distinctly different cultures: primarily English-speaking Alberta and French-speaking Quebec. While differences in demographic and drinking characteristics between injured and noninjured in both the Alberta and Quebec ERs were similar to those in other ER studies, the injured in the Alberta ER were more likely to be positive for estimated BAC; to have higher BAC levels; to report drinking prior to the event; and, among those reporting drinking, to have consumed a larger number of drinks and to report feeling drunk at the time of injury compared to those in Quebec. These differences may be associated with cultural differences in typical drinking patterns, with higher rates of abstinence reported in the Alberta ER, but also with higher rates of heavy drinking and alcohol-related problems, while those in the Quebec ER were more likely to report consuming smaller quantities with greater frequency (typical of wine-drinking cultures). Additional research is needed to explicate further alcohol's role in injury occurrence for planning effective prevention strategies that are both culturally relevant and specific.

Adolescent↗

PubMed1999

Drinking patterns and problems: a comparison of two black primary care samples in two regions.

This paper explores the effect of regional ("wet" vs. "dry") variation in drinking patterns and problems on the prevalence of alcohol-related problems among those seeking care in primary care settings. A sample of black primary care patients interviewed in Hinds County, MS (n = 740) and in Contra Costa County, CA (n = 93) are compared on quantity and frequency of usual drinking, drunkenness, consequences of drinking, and alcohol dependence. Controlling for demographic differences in logistic regression analysis, drinkers in Contra Costa, while no more likely to report heavy drinking, were four times more likely to report alcohol-related consequences, more than five times more likely to report alcohol dependence experiences, and more than nine and a half times more likely to report ever having had treatment for an alcohol problem than those in Hinds County. Data suggest that regional variations in drinking patterns may be reflected in alcohol involvement in primary care caseloads, and that the large variation in the prevalence of alcohol-related problems found in primary care settings may, in part, be attributable to this. All primary care settings do not appear to hold equal promise for screening for and intervening with problem drinking, and further research is needed in determining those settings that provide the greatest potential for targeting prevention efforts.

Adult↗

PubMed1999

Screening for alcohol problems in the U.S. general population: a comparison of the CAGE and TWEAK by gender, ethnicity, and services utilization.

OBJECTIVE: The purpose of this study was to compare the performance of two screening instruments for alcohol problems, the CAGE and the TWEAK, against ICD-10 and DSM-IV criteria for alcohol dependence by gender and ethnicity, and to evaluate whether characteristics associated with health services utilization may affect the performance of screening instruments, in a representative sample of the U.S. adult general population. METHOD: Data are from the Alcohol Research Group's 1995 National Alcohol Survey; these were weighted to account for the design effect inherent in multistage cluster sampling and oversampling of blacks and Hispanics. Effective sample size was 2,443: 797 blacks, 642 Hispanics and 1,004 whites and others (primarily Asian and Native American). Sensitivity and specificity were examined for both screening instruments. Logistic regression was used to evaluate the predictive value, separately, for the CAGE and TWEAK, controlling for gender, ethnicity, region of the country and service use (primary care and emergency room). RESULTS: The TWEAK was more sensitive for men than for women, but no differences were found by service use, while the CAGE was more sensitive for men who had used the emergency room during the preceding year compared with those who had not. The TWEAK was more sensitive than the CAGE among white and Hispanic men, among men who had not used the emergency room and among whites who had no service use. Performance of neither the CAGE nor the TWEAK was found to vary by region of the country. CONCLUSIONS: Data suggest that while the performance of screening instruments may vary across demographic subgroups in the general population, instruments may perform equally well for identifying problem drinkers in general populations as in clinical populations.

Adolescent↗

PubMed1999

Substance use, injury, and risk-taking dispositions in the general population.

Alcohol consumption has been found to be associated with injury occurrence and with risk-taking dispositions, and these dispositions, themselves, have been found to be associated with injury. Few studies have analyzed both alcohol consumption and risk-taking dispositions, or illicit drug use, on risk of injury across all types of injuries. Data on risk perception, risk-taking/impulsivity, sensation seeking, alcohol and drug use, demographic characteristics, and injury in the last year are reported from the 1995 National Alcohol Survey of 4925 respondents living in households in the 48 contiguous states. Moderate drinking, alcohol treatment, drug use, simultaneous use of alcohol and drugs, and risk-taking dispositions were all positively associated with reporting an injury. In multiple logistic regression, only risk-taking dispositions maintained significance when other variables were controlled. In separate regressions by ethnicity, risk-taking dispositions were significant predictors of injury for whites, whereas none of the variables were significant for blacks or Hispanics. Data suggest that risk-taking dispositions may be more important predictors of injury than either drinking or drug use variables, but this may vary by ethnicity. Risk-taking disposition may influence the effectiveness of strategies to reduce alcohol-related injuries; future research is important, therefore, for informing intervention and prevention efforts.

Adolescent↗

PubMed1998

Male drinking and violence-related injury in the emergency room.

AIMS: To present epidemiological measures of associations between violence-related injuries (assaults and fights), alcohol consumption prior to the event, and drinking patterns among males attending hospital emergency rooms (ERs) in Mexico City. DESIGN: All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using a case-control design. SETTING: Eight ERs in Mexico City that were representative of the types of emergency care systems available in that city (from public, private and social security systems hospitals). PARTICIPANTS: Cases were males patients (n = 445) admitted to the ER because of a fight or an assault. The control group was comprised of patients (n = 320) admitted to the ER because of accidents that are less frequently reported a alcohol-related (i.e. work-place accidents, animal bites or recreational accidents excluding near drowning). MEASUREMENTS: A breath sample to estimate BAG, as well as an interviewer-administered questionnaire were used. FINDINGS: Alcohol consumption prior to injury was found to be a more important risk factor than usual drinking for injuries resulting from violence, while quantity of usual alcohol consumption was more predictive of violence-related injuries than frequency of drinking. CONCLUSIONS: These data suggest the importance of using more appropriate control groups when estimating associations of alcohol and violence-related injuries so that associations will not be underestimated. More research is needed to establish unbiased estimates of alcohol-related violence.

Adolescent↗