Biomedical subjects

C J Cherpitel

Publications and source records attributed to C J Cherpitel.

At least 55 records · Page 3Linked to original sources

PubMed1995

Alcohol and casualties: comparison of county-wide emergency room data with the county general population.

A representative sample of patients in hospital emergency rooms (ERs) in a Northern California county (n = 3731) were compared with a household probability sample of those living in the same county (n = 2101). The injured in the ER sample were more likely to be black and under 30 than those in the general population sample who reported an injury during the last year which was treated in the ER. ER injured were more likely to be abstainers than injured in the general population and among drinkers, they were also more likely to report social consequences of drinking, but were no more likely to report experiences associated with alcohol dependence. Similar differences were found between the injured and the non-injured in the two samples, with the injured more likely to be male, younger, never married and to report heavy drinking, drunkenness, social consequences of drinking and alcohol dependence experiences. The data suggest that associations of alcohol and injury found in representative samples of the ER population may be generalizable to the injured in the general population from which these patients come, with differences which do exist most likely attributable to characteristics associated with emergency room usage.

Adolescent↗

PubMed1995

Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room.

This study examines sensitivity and specificity figures associated with screens used to predict harmful drinking and alcohol dependence among current drinkers. The study population comes from a probability sample of emergency room patients in Jackson, MS. Data are presented by gender and injury status (injured versus noninjured) for Blacks and for Whites. The Composite International Diagnostic Interview was used to assess ICD-10 criteria for harmful drinking and alcohol dependence, which were taken as standards. Predictors include screening instruments (CAGE, AUDIT, brief MAST, TWEAK, and History of Trauma Scale), breathalyzer reading, self-reported consumption before the injury or noninjury event, quantity and frequency of drinking, and an abbreviated alcohol dependence experiences measure used in general population surveys. Single items from these screening instruments were also tested as predictors. Overall, the TWEAK and the AUDIT performed best in terms of sensitivity and specificity, but variation across subgroups suggests that the search for a good screening instrument for general use must be continued.

Adolescent↗

PubMed1995

Alcohol use among HMO patients in the emergency room, primary care and the general population.

OBJECTIVE: Although heavy drinking and alcohol-related problems are overpresented among patients seen in some primary care settings compared to the general population, it is not known whether those seen for noninjury problems in emergency rooms (ERs) are similar in demographic and drinking characteristics to those seen in primary care clinics. Nor do we know whether alcohol-related problems are over-represented in both of these settings compared to the general population when equal access to health care services is provided, as by membership in the same HMO. Reported here are data from a single northern California health maintenance organization (HMO). METHOD: Probability samples of noninjured patients seen in the ERs of the HMO (n = 579) are compared on demographic characteristics and drinking patterns and problems to those seen in the primary care clinics of the same HMO (n = 295) and to those in the general population of the same county who reported membership in the HMO (n = 737). RESULTS: No differences in drinking patterns, alcohol-related problems or gender or age distribution were found between the clinic patients and the noninjured ER patients. Both the noninjured ER patients and the clinic patients were less likely to report heavy and problem drinking, or treatment for an alcohol-related problem during the last year, as compared to those in the general population. CONCLUSIONS: The data from this HMO study suggest that noninjured patients seen in these particular emergency rooms resemble those seen in primary care, and that, contrary to the commonly held belief that alcohol-related problems are overrepresented in primary care, primary care patients in this HMO population may be less likely to be problem drinkers than those in the general population from which they come.

Adolescent↗

PubMed1995

Analysis of cut points for screening instruments for alcohol problems in the emergency room.

OBJECTIVE: The purpose of this study is to evaluate the performance of a number of alcohol screening instruments (CAGE, Brief MAST, AUDIT, TWEAK), in an emergency room population, against ICD-10 criteria for harmful drinking and for alcohol dependence from the CIDI, by gender, race and injury status. METHOD: A probability sample of patients were interviewed (N = 1,330) at the University of Mississippi Medical Center. Analyses were carried out on only current drinkers (n = 771; 58% of the sample). Instruments were compared on sensitivity, specificity and area under the curve using receiver operating characteristic (ROC) analysis to determine optimum cut points. RESULTS: Overall the TWEAK and AUDIT performed best (in relation to sensitivity and area under the ROC curve) at standard cut points (3 and 8, respectively) for both harmful drinking and alcohol dependence. These instruments did not perform equally well across all subgroups, however, particularly among women, and among whites where the CAGE, with a cut point of 1, outperformed both the TWEAK and AUDIT at standard cut points. The TWEAK at a cut point of 2 also did as well as the CAGE at a cut point of 1 among women. CONCLUSION: These data suggest that standard screening instruments do not perform equally well across ethnic and gender subgroups and that consideration of alternative cut points may be appropriate in some populations.

Adolescent↗

PubMed1995

Alcohol and injury in the general population: data from two household samples.

OBJECTIVE: While a large literature exists on the association of alcohol and injury, coming largely from studies carried out in hospital emergency rooms (ERs), it is not known how representative ER patients are of those who are injured and treated elsewhere, or of those who are injured and receive no treatment. This article reports data on alcohol, injury and ER treatment in the general population. METHOD: Data were collected in two household probability samples: a national sample (N = 1,144) and a California county sample (N = 3,065). RESULTS: In the national sample those treated in the ER for an injury were more likely to be younger, black and heavier drinkers, and were more likely to report experiences associated with alcohol dependence compared to those with other injuries, treated or untreated. In the county sample, those treated in the ER were more likely to have been drinking prior to the injury event, to be injured on the street and to report the event to be related to violence compared either to those whose injuries were treated elsewhere or to those who received no treatment for their injuries. CONCLUSIONS: These data support the contention that findings on associations of alcohol and injury obtained from ER studies cannot be generalized to other injuries in the same population or to other populations.

Accidents↗

PubMed1994

Cause of casualty and drinking patterns: an emergency room study of unintentional injuries.

A probability sample of 1494 adult casualty patients sampled in four hospitals in a single Californian county were breathalyzed and interviewed regarding the cause of injury, drinking prior to the injury, quantity and frequency of usual drinking, frequency of drunkenness and prior alcohol-related accidents. In the total sample, 9% were positive on the breathalyzer (4% were at or above 0.10), 17% reported drinking within 6 h prior to the injury, and 29% reported heavy drinking during the last year. Overall, 15% reported a prior alcohol-related accident and this was significantly greater among heavy drinkers than other drinkers. Cause of casualty (fall, cutting/piercing, motor vehicle accident, other collision, fire, other cause) in relation to alcohol consumption variables was analyzed separately in gender- and age-specific categories. Few significant associations were found between drinking variables and individual causes of injury. While these findings may be due to the relatively small number of cases for some causes, as well as to other variables not examined here including severity and type of injury, such baseline exploratory data are important in furthering our understanding of alcohol's involvement in casualty occurrence and point to the need for additional research on alcohol and causes of injury.

Accidents↗

PubMed1994

Alcohol use among primary care patients: comparing an HMO with county clinics and the general population.

A probability sample of all patients seen in the four health maintenance organization (HMO) primary care clinics in one Northern California county (N = 314) are compared to patients from all five of the county-operated primary care clinics in the same county (N = 394) and to the general population of the county (N = 3069) on demographic characteristics, drinking patterns and alcohol-related problems. The HMO clinic patients were less likely to report frequent, heavy drinking, drunkenness or alcohol-related problems during the last year compared to those in the county clinics sample, and they were also less likely to report heavy and problem drinking compared to those in the general population. These data suggest problem drinking may not be over-represented in primary care practice in general, but rather may be more closely associated with characteristics of clientele served by a primary care practice than with those characteristics associated with a need for medical attention.

Adolescent↗

PubMed1994

Alcohol consumption and injury in the general population: from a national sample.

The association of alcohol consumption with injuries is well documented in the literature. The majority of data for non-fatal injuries has come from emergency room (ER) studies, however, and little is known of how representative ER samples are of injuries in the general population or of the actual risk at which drinking places the individual for accidental injury. Data were collected (1990) from a national probability household sample (N = 2058; weighted N = 1150) on: the respondent's most recent injury; whether treatment was obtained for that injury, and where; drinking prior to injury; quantity and frequency (Q-F) of usual drinking; frequency of drunkenness; experiences associated with alcohol dependence; and social consequences related to drinking--all during the last year. Injury for the last year was categorized as follows: without injury, untreated injury, injury treated in the ER, other treated injury. Males treated in the ER were significantly more likely to be heavy drinkers and were more likely to report alcohol dependence experiences and social consequences related to drinking than those without injuries, while females treated in the ER were more likely to report social consequences related to drinking compared to those without injuries. Age (OR = 0.87) and Q-F (OR = 1.31) were found to be predictive of reporting an injury during the last year. Among injured none of these variables were predictive of reporting treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Alcohol and injuries resulting from violence: a review of emergency room studies.

This paper reviews emergency room (ER) studies from a number of countries which have reported findings related to the association of alcohol and injuries resulting from violence. Special attention is given to those studies which used probability samples of patients which were representative of the population served by the emergency room facility where the data were collected, and which compared those admitted to the ER with violence-related injuries with those admitted to the same ER during the same period of time with injuries unrelated to violence. Those with violence-related injuries were more likely to be admitted to the ER with a positive blood alcohol concentration, to report drinking prior to the event, to report more frequency heavy drinking and to report more alcohol-related problems than those admitted with injuries from other causes.

Alcohol Drinking↗

PubMed1994

Injury and the role of alcohol: county-wide emergency room data.

The purpose of this study is to describe variables associated with injury in an emergency room (ER) sample that is representative of an entire U.S. county. A probability sample (n = 3717) of ER patients from the county hospital, 3 of the 6 community hospitals, and the three health maintenance organization hospitals in a single Northern California county were breath-analyzed and interviewed at the time of the ER visit. Injured were most likely to consume only 1 or 2 drinks within < 1 hr of injury occurrence. Twenty-three percent reported feeling drunk at the time of the event, and of these, 45% felt the event would not have happened if they had not been drinking. Breathalyzer reading, feeling drunk at the time of the event, and quantity-frequency (Q-F) of usual drinking were found to be predictive of admission to the ER with an injury, whereas breathalyzer reading, Q-F, and being injured in someone's home were predictive of reporting drinking prior to injury. Although feeling drunk at the time of the event and usual drinking patterns are predictive of injury occurrence, drinking prior to the event may not entail large quantities of alcohol consumed, but relatively small amounts consumed in close proximity to the injury event. These alcohol consumption variables may vary, however, depending on the type, cause, and severity of injury.

Accidents↗

PubMed1994

Alcohol and casualties: a comparison of emergency room and coroner data.

Data from a probability sample of casualty patients treated at a county hospital emergency room (ER) during a 1 year period (N = 1124) are compared to data from coroner reports of all fatalities arising from unnatural causes during the same time period in the same county (N = 304). The two samples are compared on: demographic characteristics, causes of casualty (fall, laceration/puncture wound, motor vehicle, fire, ingestion, other cause), place of injury, and alcohol and drug use prior to the event. Alcohol and drug use data were obtained by breathalyzer and self-reports in the ER sample and by toxicology screening of blood upon autopsy in the coroner sample. The coroner sample was significantly more likely to be male, younger and white compared to the ER sample. A significantly larger proportion of the coroner sample was positive for alcohol (43%) compared to those breathalyzed within 6 hr of injury who reported no drinking after the event (11%) and to those who reported drinking within the 6 hr prior to the event (28%) in the ER sample. Among those who were alcohol positive no difference was found between the coroner sample and the ER sample for the proportion of those who were also drug positive (24% in each). Cases in the coroner sample were no more likely to involve violence (17%) than those in the ER sample (20%). Violence-related fatalities were more likely to involve alcohol (47%) than non-fatal injuries (19%), but were no more likely to involve drug use in combination with alcohol (39% vs. 31%, respectively).

Accidents↗

PubMed1993

Alcohol and injuries: a review of international emergency room studies.

This paper reviews emergency room (ER) studies from a number of countries which have focused on the association of alcohol and casualties. The review emphasizes studies which used probability sample of patients to represent the population of the emergency facility where the data were collected, and which separated injured patients from patients with medical conditions not due to injuries (the 'non-injured'). Reviewed here are studies concerned with: (1) estimated prevalence of positive blood alcohol at the time of the ER visit; (2) self-reported alcohol consumption prior to the event resulting in a need for ER treatment; (3) patients' descriptions of their usual drinking patterns and alcohol-related problems; (4) predictions of casualties and of alcohol-related casualties. Comparisons of findings from several countries are also presented. Comments on limitations of ER studies as well as other issues pertaining to the usefulness and interpretation of such data, and future directions for research in emergency room populations are discussed.

Adolescent↗

PubMed1993

Alcohol and violence-related injuries: an emergency room study.

Drinking patterns, alcohol-related problems and drinking-in-the-injury event were compared between those admitted to the emergency room (ER) with and without injuries resulting from violence. A probability sample of 1770 adult casualty patients in four hospitals in a single California suburban county were breathalyzed and interviewed at the time of the ER visit. Among all males and females over 30, those with violence-related injuries were more likely than those with other injuries to have positive breathalyzer readings and to report drinking prior to the event, frequent heavy drinking, consequences of drinking, experiences associated with alcohol dependence and loss of control and prior treatment for an alcohol problem. The data suggest a need for research to test whether a brief intervention at the time of the ER visit for problem drinking or a referral for more extensive alcohol treatment can effect a reduction in alcohol-related violence and other alcohol-related problems.

Adolescent↗

PubMed1993

Alcohol, injury, and risk-taking behavior: data from a national sample.

The association of alcohol consumption and injury is well documented in the literature. It has also been suggested that alcohol consumption is associated with risk-taking behaviors. No studies have reported the association of alcohol consumption and risk-taking behaviors with injury across all injury types, however. Data were collected (1990) from a national probability household sample (n = 2058; weighted n = 1150) on: injuries that required treatment during the last year; quantity and frequency (Q-F) of drinking; and behaviors associated with risk perception, risk-taking/impulsivity, and sensation seeking. The injured (12% of the sample) were more likely to be male, younger, and to report moderate and heavy drinking and more frequent drunkenness compared with those with no injuries. They were also less likely to score high on risk perception and more likely to score high on risk-taking/impulsivity and sensation seeking than those with no injuries. However, using logistic regression analysis to predict a treated injury during the last year, only the interaction term of gender by Q-F was significant, with Q-F a significant predictor of injury among males but not among females.

Accident Proneness↗

PubMed1993

Prediction of alcohol-related casualties in the emergency room: a U.S.-Spain comparison.

Alcohol consumption variables predictive of casualties are compared in probability samples of emergency room (ER) patients in two countries with different drinking patterns; (1) Spain, where frequent light drinking is the typical pattern (N = 2,072), and (2) the U.S. (i.e., California), where less frequent heavier drinking is more typical (N = 1,756). Logistic regression was used to evaluate the predictive value of breath-analyzer readings, drinking patterns and problems, time and place of injury, and demographic characteristics on ER admission for injuries vs noninjuries and for alcohol-related injuries vs non-alcohol-related injuries. Quantity and frequency of drinking, time and place of injury, and feeling drunk at the time of the event were predictive of casualties in California. Drinking patterns were less predictive of injury occurrence and of alcohol-related injury in Spain. One possible explanation for this difference may be that drinking is integrated into society as part of the wine drinking culture in Spain, while in the U.S. drinking occasions are more circumscribed by appropriateness of time and place.

Accidents↗

PubMed1993

Alcohol consumption among emergency room patients: comparison of county/community hospitals and an HMO.

This study examines the associations of drinking patterns and problems to injury vs noninjury status among emergency room (ER) patients. Data come from two distinctly different health care systems in the same county: (1) the county hospital and three community hospitals (N = 2,626) and (2) the three health maintenance organization (HMO) hospitals (N = 1,102). Results indicate that alcohol's role in injury cases seen in the ER differs from its contribution to noninjury cases. Further, the demographic characteristics of ER populations--and the associated drinking patterns--also vary from site to site, and these also affect the contribution of alcohol to events requiring ER treatment. Both studies used similar methods and data collection instruments. Probability samples of patients were breath analyzed and interviewed regarding self-reported consumption (within 6 hours prior to the injury or illness), usual drinking patterns and alcohol-related problems. In both samples injured were more likely than noninjured to have positive breath-analyzer readings and to report heavy drinking, more frequent drunkenness, prior alcohol-related accidents and prior treatment for an alcohol-related problem, but were no more likely to report harmful consequences of drinking or alcohol dependence experiences during the last year. Both injured and noninjured in the county/community sample reported higher rates of heavy and problem drinking than their counterparts in the HMO sample, while those in the HMO sample reported rates for heavy and problem drinking similar to those found in the general population of the county.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Timing of the breath analyzer: does it make a difference?

The purpose of this article is to examine in an emergency room (ER) population the concordance of self-reports of no alcohol consumption prior to injury with breath-analyzer readings in two groups: (1) those patients from whom reports were obtained after they were breath analyzed compared to (2) patients from whom reports were obtained prior to obtaining the breath-analyzer reading. Data were collected on a probability sample of patients attending three health maintenance organization ERs. Among those sampled were 159 patients admitted for initial treatment of an injury, who were breath analyzed within 6 hours of the event and reported no drinking following the event that lead to injury. Of these, 119 were breath analyzed prior to the interview, and none who reported not drinking were positive on the breath analyzer, while of the 37 breath analyzed after the interview, only one was positive who had reported not drinking. Obtaining the breath-analyzer reading following the interview was not found to affect the rate of refusal to provide a breath-analyzer reading; however, it was found to adversely affect obtaining the breath-analyzer reading for other reasons. The data suggest that the concordance of negative self-reports of consumption with breath-analyzer readings remains high in ER populations regardless of when the breath-analyzer reading is obtained; however, it appears best to obtain the reading prior to interviewing the patient for reasons explained below.

Adolescent↗

PubMed1993

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.

Adolescent↗