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Cheryl J Cherpitel

Publications and source records attributed to Cheryl J Cherpitel.

At least 19 recordsLinked to original sources
PubMed2006

Variations of alcohol impairment in different types, causes and contexts of injuries: results of emergency room studies from 16 countries.

OBJECTIVE: The purpose of this paper is to document alcohol impairment (based on a blood alcohol content (BAC) of at least 80 mg%) for different types, causes and location contexts of injuries. DESIGN AND SETTING: Data from 45 studies with 11,536 injury patients were merged to determine variations in the percent of alcohol impairment among injury patients. In each study, emergency room (ER) injury patients were given a short interview on the circumstances of their injury and BAC was measured. RESULTS: Injury severity, measured by number of body regions injured was significantly associated with BACs over 80 mg%. The highest percentage of injury type to involve alcohol was head injury/concussion. In terms of causes of injuries, patients with alcohol impairment were significantly more likely to be involved in violence than any other cause (i.e., vehicle, falling, poisoning or burns). Finally, injuries occurring at a bar or restaurant were significantly more likely to involve alcohol impairment than any other setting. CONCLUSIONS: The results demonstrate considerable variation in the circumstances where alcohol is involved in injuries. These results may be useful for the development of prevention initiatives.

Accidental Falls↗
PubMed2006

Acute alcohol use and the risk of non-fatal injury in sixteen countries.

AIMS: To determine the relative risk (RR) of non-fatal injury associated with alcohol consumption in a series of emergency departments (EDs), possible effect modifiers and the impact of contextual variables on differences across sites. DESIGN: The case-crossover method was used to obtain RR estimates of the effect of alcohol on non-fatal injuries. Meta-analysis was used to evaluate the consistency and magnitude of RR across sites, and the extent to which contextual variables explain differences in effect sizes. PARTICIPANTS: Probability samples of 11,536 injured patients attending 28 EDs studies in 16 countries (1984-2002). The majority of the sample was male (65%) and > 30 years old (53%). MEASUREMENTS: Exposed cases where those that consumed alcohol 6 hours prior to the injury. Usual alcohol consumption served as the control period. FINDINGS: Drinking within 6 hours prior to the injury was reported by 21% of the sample. The estimated (random) pooled relative risk for patients who reported alcohol use within 6 hours prior to injury was 5.69 (95% confidence interval = 4.04-8.00), ranging from 1.05 in Canada to 35.00 in South Africa. Effect size was not homogeneous across studies, as societies with riskier consumption patterns had a higher relative risk for injury. Heavier drinkers also showed lower RR. CONCLUSIONS: Acute alcohol was a risk factor for non-fatal injuries in most sites. Policy measures addressed to the general population are recommended, especially in societies with riskier consumption patterns.

Adult↗
PubMed2006

Alcohol and injury: a risk function analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP).

While emergency room (ER) studies have documented a strong association of alcohol and injury, less is known about the level of risk at which various quantities of alcohol or particular patterns of drinking place the individual for injury. Comparative risk function analyses are carried out in ER samples in seven countries that cover sites in 14 studies included in the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP). Risk of injury is analyzed for the mean number of drinks consumed per day and the number of occasions in which 5 or more drinks were consumed at one time (5+) during the last year. All countries showed similar increases in injury risk to an average volume of about 2 drinks per day, with a leveling off of risk at higher average daily volumes, with the exception of Italy. Risk of injury increased to 12 or more 5+ days for the USA, Canada and Mexico, but leveled off after only 3 5+ days for Argentina and Spain. Poland showed increased risk to 30 5+ days. Similar risk curves were found for both males and females, although females were at lower risk of injury in all countries expect Spain and Poland. In low detrimental drinking pattern societies, risk curves showed higher risk for any drinking and any frequency of 5+ but at higher levels of each, risk levels decreased nearly to levels found for abstainers. Risk functions were also consistent across gender and age groups in low detrimental drinking pattern societies, with higher risk for males and those <30. For those countries with high detrimental drinking patterns, injury risk increased with volume and 5+ drinking primarily among males. This ER-based risk function analysis suggests that risk of injury increases proportionally with increased alcohol consumption at lower consumption levels, but a threshold effect is achieved at relatively low levels of mean daily consumption and higher consumption times. Risk may be culturally specific, dependent, in part, on the manner in which alcohol is used in the culture.

Adolescent↗
PubMed2006

Results of two emergency room studies.

The aim of this paper is to examine to what extent cultural differences in male drinking patterns mediate relationships between alcohol and injury in a Polish context. Male patients admitted to emergency rooms located in two culturally different regions were investigated. Data analysis showed significant differences in patients' socio-demographic characteristics, their drinking patterns as well as their annual alcohol consumption. Logistic regression, however, has not confirmed any impact of site, drinking pattern and their interactions on the risk of injury. The risk of injury tended to decline with age, being more than two times lower for men over 50 years old, and was 2.4 times higher for those with an annual consumption of 12+ liters of pure alcohol.

Adult↗
PubMed2006

The effect of alcohol consumption on emergency department services use among injured patients: A cross-national emergency room study.

OBJECTIVE: Although injured patients in the emergency department (ED) report more frequent use of the ED compared with the general population, and alcohol-related admissions and chronic alcohol misuse have been found to be predictive of future ED admissions, these data are based on only a few U.S. studies. The purpose of this article was to explore the association of alcohol use and ED services use among injured patients cross-nationally. METHOD: Binary and multinomial logistic regression were used to analyze the association of alcohol consumption with prior ED visits among 9,743 injured patients surveyed in 37 EDs in 14 countries and reported in 23 studies from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and World Health Organization Collaborative Study of Alcohol and Injuries. RESULTS: Drinking within 6 hours before injury was associated with prior ED visits during the last 12 months (odds ratio = 1.25, p < .05), with a positive dose-response relationship. Heavy drinkers and those drinkers who were alcohol-dependent were also significantly more likely to report multiple prior ED visits, reflecting an elevated burden of services use. At the ED level, stigmatization of alcohol use was the only significant contextual variable that consistently predicted cross-ED variation in the relationship between drinking and ED use, in which the association was weaker in areas where alcohol use is less accepted. CONCLUSIONS: This study lends additional support to the potential effectiveness of screening for acute and chronic alcohol use among ED injured patients to reduce ED services use and associated costs.

Adolescent↗
PubMed2005

Screening for alcohol problems in two emergency service samples in Poland: comparison of the RAPS4, CAGE and AUDIT.

Prior research on alcohol-related problems among emergency service patients in Poland found substantial alcohol involvement on the part of injured males, suggesting emergency services may be a productive venue for identifying patients who could benefit from a brief intervention or referral for treatment. Performance of the RAPS4, CAGE and AUDIT against ICD-10 and DSM-IV criteria for alcohol dependence and for alcohol abuse/harmful drinking was compared in probability samples of emergency service patients from two regions of Poland. Sensitivity of the RAPS4 and AUDIT was significantly better than the CAGE for alcohol dependence among males in Warsaw, but specificity was poorer. Among females, although numbers were small, sensitivity for alcohol abuse/harmful drinking and for alcohol dependence or abuse/harmful drinking was significantly better for the RAPS4-QF than for the CAGE or AUDIT at a cut point of 8 across both sites. Performance of the AUDIT at a cut point of 3 was similar to the RAPS4-QF for females. Among males, sensitivity was higher but specificity considerably lower for the RAPS4-QF compared to the CAGE at a cut point of 1 or for the AUDIT at a cut point of 8. Alternate cut points for the AUDIT optimized performance. Findings suggest some regional and gender differences in performance of screening instruments in these Polish samples, but no instrument or cut point is optimal in identifying those with alcohol use disorders. Additional cross-cultural research is needed to evaluate the performance of instruments, especially among females with alcohol use disorders.

Adolescent↗
PubMed2005

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.

Adult↗
PubMed2005

The criteria for causation of alcohol in violent injuries based on emergency room data from six countries.

This paper is based on data using similar methods collected from patients at 30 emergency rooms (ERs) in six countries. These data were analyzed with the goal of determining whether alcohol is a likely cause of violence through an application of criteria outlined by Bradford Hill. Analyses were conducted by comparing various measures of alcohol involvement in violent versus accidental injuries. The results supported temporal sequence of events and specificity. The odds ratios of violent versus accidental injury for a blood alcohol concentration (BAC) over 80 mg% were significant for each country, ranging from 2.77 for Mexico to 9.45 for Canada, which supports both the strength of associations and the consistency of findings. No third variables were found from the logistic regression analysis that better explain the relationships between alcohol and violence. A significant dose-response relationship between BAC level and violence was also found. All analyses conducted point to a causal role of alcohol in injuries related to violence.

Accidents↗
PubMed2005

Risk of injury: a case-crossover analysis of injured emergency service patients in poland.

BACKGROUND: Over the last 15 years large changes in both alcohol consumption and the health care system have occurred in Poland. Substantial fluctuations in alcohol-related mortality followed and burden on health services increased, but data on risk of injury from alcohol consumption are relatively scarce METHODS: Estimates for risk of injury from drinking within six hours prior to the event are reported in samples of emergency services patients from Warsaw (n=508) and Sosnowiec (n=432), using case-crossover analysis based on usual frequency of drinking RESULTS: A four-fold risk of injury was found for those reporting drinking prior to injury compared to those not drinking, and this was significantly greater for those positive for alcohol use disorders compared to those negative. Relative risk of injury was marginally greater in Sosnowiec (5.2) compared to Warsaw (3.4) (p=0.06), and was significantly greater for those under 30. A 17-fold increase in risk for violence-related injury was found, and was significantly greater for females than males. Risk was substantially greater in Sosnowiec compared to Warsaw across all subgroups, but differences were not significant, possibly due to the small numbers of those sustaining injuries from violence in Warsaw. DISCUSSION: Injury risk related to drinking was expected to be significantly greater in Sosnowiec, due to more traditional drinking styles of infrequent intake of large quantities of spirits, than in Warsaw, but this was only partially borne out by these data. Risk estimates for all injuries were similar to those found in other case-crossover studies in emergency departments. Given the high relative risk estimates for injury related to drinking prior to the event, among both problem and non-problem drinkers, hospital-based emergency services in Poland may be an important site for identification of those who could benefit from a brief intervention or referral for a reduction in alcohol-related injuries.

Adult↗
PubMed2005

Multi-level analysis of alcohol-related injury among emergency department patients: a cross-national study.

AIM: The aim of this analysis was to examine the average rate and variation of alcohol-related injury across emergency department (ED) studies, the effect of usual drinking on likelihood of alcohol-related injury, whether cross-study variation in rate of alcohol-related injury can be explained by between-study difference in usual consumption and whether social-cultural contextual variables help explain cross-study variations, after between-study difference in usual consumption has been controlled. DESIGN: Data were merged from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the WHO Collaborative Study on Alcohol and Injuries, together representing 28 studies in 16 countries, and include 8423 (drinking) injury patients who arrived in the ED within 6 hours after injury. Alcohol-related injury was based, separately, on a positive blood alcohol concentration (BAC) and self-reported drinking within 6 hours prior to injury. A multi-level design and hierarchical generalized linear models were used for analysis in which patients were nested within studies. FINDINGS: Overall prevalence of alcohol-related injury was 24% and 29% for positive BAC and self-report, respectively. At the patient level, log-transformed alcohol consumption in the last 12 months was a significant predictor of alcohol-related injury. At the study level significant variation in rates of alcohol-related injury was observed; studies with higher overall average consumption reported a higher rate of alcohol-related injury. When volume was controlled, societies with higher detrimental drinking pattern and higher legal level for intoxication while driving were more likely to have an increased rate of alcohol-related injury. CONCLUSIONS: Alcohol-related injury varies across EDs and countries. While it is associated with an individual's usual alcohol consumption, it is also affected by a number of societal drinking characteristics including the aggregate volume of consumption, overall drinking pattern and legislative policies to control drinking and related harms.

Adolescent↗
PubMed2005

Cross-national performance of the RAPS4/RAPS4-QF for tolerance and heavy drinking: data from 13 countries.

OBJECTIVE: There are little data available on the performance of brief screening instruments for alcohol-use disorders cross-nationally; therefore, we analyzed the performance of one such instrument in a number of countries. METHOD: Performance of the RAPS4 for tolerance and the RAPS4-QF for heavy drinking are analyzed from emergency room data across 13 countries included in the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study on Alcohol and Injuries. RESULTS: The RAPS4 showed good sensitivity and specificity for tolerance across most of the countries, but was higher in countries that were higher on societal-level detrimental drinking patterns. Prevalence of tolerance was also higher in those countries with high detrimental drinking pattern scores. Sensitivity of the RAPS4-QF for heavy drinking was uniformly high across countries, while maintaining good specificity, and did not vary by detrimental drinking patterns. CONCLUSIONS: Findings suggest the RAPS4 and RAPS4-QF may hold promise cross-nationally. Future research should more fully address the performance of brief screening instruments for alcohol-use disorders (using standard diagnostic criteria) cross-nationally, with consideration of the impact of societal drinking patterns.

Alcoholism↗
PubMed2005

Attributable risk of injury associated with alcohol use: cross-national data from the emergency room collaborative alcohol analysis project.

OBJECTIVES: We sought to determine gender- and age-specific attributable risks of all-cause and violence-related injuries associated with alcohol use. METHODS: We used meta-analytic techniques to estimate attributable risks observed in emergency room studies conducted in 7 countries (n=17708). RESULTS: In the case of both alcohol consumption before the injury event and individual drinking patterns, pooled attributable risk effect sizes for all-cause injuries were significant but minimal (2% to 6%). Effect sizes for violence-related injuries were 43% for drinking before an injury event and 27% for individual drinking pattern. Risks were greater for men, but no age-specific differences were found. CONCLUSIONS: This meta-analysis showed that attributable risk of injury is greater for drinking before the injury event than for drinking pattern; in addition, risks were more pronounced for violence-related injuries. Differences in risk were explained by variables related to sociocultural contexts.

Age Factors↗
PubMed2004

Alcohol and injury: multi-level analysis from the emergency room collaborative alcohol analysis project (ERCAAP).

AIMS: To analyze the relationship between individual-level characteristics and site-level contextual variables on the association of acute alcohol use and injury. METHODS: Blood alcohol concentration (BAC) and survey data collected (using similar methodology and instruments) at the time of the emergency department (ED) visit, between 1985 and 2003 on probability samples of injured and non-injured patients (n = 18 438) from 31 EDs in seven countries (Argentina, Canada, Italy, Mexico, Poland, Spain, USA) were analyzed using hierarchical linear modeling (HLM). RESULTS: BAC and self-reported consumption were predictive of an injury (compared to a non-injury), controlling for gender and age, with odds ratios of 1.51 and 1.58, respectively. The likelihood of injury given a positive BAC and self-report was less for heavier drinkers (those reporting five or more drinks on an occasion) than for lighter drinkers, and was greater in those societies with greater detrimental drinking patterns than those with lower detrimental patterns. CONCLUSIONS: These data suggest a moderate, but robust association of a positive BAC and self-report with admission to the ED for an injury, which is modified by the patient's usual heavier drinking and by societal drinking patterns.

Adolescent↗
PubMed2004

Screening for drug use disorders in the emergency department: performance of the rapid drug problems screen (RDPS).

Little research is available on brief screening instruments for identify those meeting diagnostic criteria for drug dependence or abuse. A brief, four-item screening instrument, called the rapid drug problems screen (RDPS), was developed from a similar instrument for alcohol use disorders, the rapid alcohol problems screen (RAPS). Performance of the RDPS was evaluated against DSM-IV and ICD-10 criteria for drug dependence and for dependence or abuse in a sample of 703 emergency department patients in Mexico City. Among males, sensitivity and specificity were 91 and 96%, respectively, for dependence and 93 and 96%, respectively, for dependence or abuse. Neither of the two females meeting diagnostic criteria for dependence or abuse were identified by the RDPS. Area under the receiver-operating characteristic curve indicates an optimum cut point of 1. The data suggest that the RDPS may hold promise as a brief screening instrument for substance use among males, but should be tested in larger populations of females meeting diagnostic criteria for drug use disorders, and across ethnic subgroups in other geographic locales.

Adult↗
PubMed2004

Measuring accuracy of self-reported vehicular offences and blood alcohol concentration levels among whites and Mexican Americans mandated to drinking driver programs.

BACKGROUND: Differences in self-reported rates of drinking and driving compared to official statistics have been found for Hispanics compared to whites, and is thought to be related to underreporting among Hispanics. METHODS: Self-reported and California Department of Motor Vehicles (DMV)-reported number of vehicular offences and blood alcohol concentration (BAC) levels were compared between a sample of 249 respondents of Mexican descent (half of whom were born in Mexico) and 250 white non-Hispanics convicted of driving under the influence of alcohol (DUI) in all five DUI treatment programs in one Northern California county. RESULTS: Of those Mexico-born respondents, 11% underreported compared to 7% for their America-born counterparts, while 3% of whites underreported. In addition, Mexico-born respondents underreported BAC levels more, on average, when comparing to DMV reports than their America-born counterparts and whites. Underreporting of BAC level was positively associated with individuals' negative attitudes towards drinking and negatively associated with frequency of heavy drinking, alcohol dependence, and the number of safety-related tickets or DUIs in the past year. CONCLUSIONS: Interview data combined with DMV data suggest that there are ethnic differences in accuracy of reporting vehicular offences and BAC levels, consistent with those found from other studies.

Adolescent↗
PubMed2004

Acute alcohol use and suicidal behavior: a review of the literature.

BACKGROUND: Both acute and chronic use of alcohol are associated with suicidal behavior. However, the differing relationship of each component of alcohol use and possible causal mechanisms remain unclear. METHODS: This article reviews and summarizes associations between acute alcohol consumption (with and without intoxication) and suicidal behavior (both completed suicide and suicide attempts) among adults 19 years and older, as presented in literature published between 1991 and 2001. Possible mechanisms and methodologic challenges for evaluating the association are also discussed. An application of a research design (the case-crossover study) that has the potential for addressing the effects of acute alcohol use over and above usual or chronic use is presented. RESULTS: The majority of articles reviewed were restricted to descriptive studies that documented the prevalence of suicide completers or attempters who tested positive for alcohol use. A wide range of alcohol-positive cases were found for both completed suicide (10-69%) and suicide attempts (10-73%). Common methodologic limitations included the lack of control groups (for evaluating risk conferred by alcohol use), selection and ascertainment bias, and small sample sizes. The results of the case-crossover pilot study indicated substantially higher risk of suicide during or shortly after use of alcohol compared with alcohol-free periods. CONCLUSIONS: Although there is a substantial literature of published studies on acute alcohol use and suicidal behavior, the majority of studies focus on completed suicide and report prevalence estimates. Findings from such studies are subject to several possible sources of bias and have not advanced our knowledge of mechanisms in the association between acute alcohol use and suicidal behavior. The case-crossover design may help to overcome some limitations of these studies and facilitate evaluation of associations and possible causal mechanisms by which acute alcohol use is linked to suicidal behavior.

Alcohol Drinking↗
PubMed2004

Emergency room injury presentations as an indicator of alcohol-related problems in the community: a multilevel analysis of an international study.

OBJECTIVE: This study describes and examines the development of surrogate measures of acute alcohol-related injury for use in the evaluation of community-based prevention initiatives. METHOD: An international collaborative study of alcohol and injury, the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), provided a subset of data on 8580 emergency room (ER) presentations from five countries and 28 ER facilities. RESULTS: Presentations most likely to be alcohol related were those made between 12:00 AM and 4:59 AM (56%), on Fridays, Saturdays or Sundays (26%); and those among injured persons who were male (28%), who were aged between 18 and 45 years (24%) or who were unmarried (24%). Multilevel logistic regression models confirmed the significance of the above variables as predictors of alcohol involvement prior to the injury event. The strongest predictor variable was presentation between 12 midnight and 4:59 AM with an odds ratio of 4.92 (Wald Test chi2 = 397.6, p < .001). Being male had an odds ratio of 3.01 (Wald Test chi2 = 247.25, p < .001), and presenting on a Friday, Saturday or Sunday night had an odds ratio of 1.50 (Wald Test chi2 = 49.6, p < .001), whereas being under 45 (odds ratio [OR] = 1.20, p < .05) and being unmarried (OR = 1.2, p < .01) were less strong predictors. Combining all these values for variables raised the probability of prior alcohol involvement in such injury presentations to 0.65, although only 3.37% of all cases met these criteria, limiting applicability of this combined variable as a surrogate measure for intervention studies. Probabilities of prior alcohol involvement are presented with other combinations of values for the predictor variables. CONCLUSIONS: Frequency of nighttime injury presentations to ER facilities, particularly by men, can be used as a reliable surrogate measure of alcohol-related injuries for various epidemiological and evaluation purposes.

Accidents↗