This competing continuation builds on and extends research which analyzed ER data from the 12-site WHO Collaborative Study on Alcohol and Injuries, 33 sites in 8 countries comprising the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), and 30 sites in 13 countries added in the previous project period, data from studies all of which used similar methodology and instrumentation on probability samples of ER patients.
Study aims are to: 1) examine risk of alcohol-related injury for self-reported consumption within 6 hours prior to all-cause injury and by injury cause (traffic, falls, intimate partner violence, other violence, burns, near drowning, poisoning, attempted suicide) by country/region level drinking patterns, context of drinking, alcohol control policy, and ER-level characteristics;2) estimate relative risk (RR) of injury related to alcohol consumption volume (dose-response relationship) by cause of injury, comparing estimates with and without adjusting for individual-level injury context, and comparing estimates across regions of varying aggregate level detrimental drinking pattern (DDP), drinking context and alcohol policies;3) estimate alcohol attributable fraction (AAF) by cause of injury, combining ER data and general population (GP) data, applying ER-based RR of injury related to drinking and predicted acute drinking exposure based on both individual-level and GP usual drinking pattern data.
Aims address objectives of the Global Strategy to Reduce the Harmful Use of Alcohol, endorsed by the World Health Assembly in May 2010, in strengthening the knowledge base on the magnitude and determinants of alcohol-related harm, and, among other aims, will inform five of their 10 recommended policy target areas: community action, drinking-driving, alcohol availability, marketing of alcoholic beverages and pricing. Data will be added on 21,007 patients from 44 ER sites in 16 countries, cumulating in 43,453 injured patients from 119 ER sites covering 37 countries. Hierarchical linear modeling and case-crossover analysis and will examine contextual variables, including alcohol policy with individual and event-level variables on the alcohol-injury nexus, addressing a major gap in this literature. Coupled with GP data, this data set is one of a kind in providing the requisite number of patients to analyze specific alcohol policy control domains and variables in relation to specific causes of injury, adjust bias in RR of injury related to context of the event, and apply a new ER-based approach to estimating AAF by injury cause, based on both ER and GP drinking pattern data, which has the potential for extrapolation to countries with similar profiles (e.g., per capita consumption, DDP), for which ER studies are not available but GP pattern data are, and for GPs for which there are no exposure data, but where demographic and archival data are available. This work will, importantly, inform U.S. policy, potentially leading to policy change, as the U.S. is composed of many micro-cultures reflected in the contextual environment dominating many of the countries in which these data were collected.

Public Health Relevance

This proposal addresses a number of highly important areas related to estimating alcohol attributable fraction of injury morbidity, worldwide, for informing te global burden of disease, and will inform U.S. policy, potentially leading to policy change as well as intervention and prevention strategies, important to policymakers, public health professionals and the research community.

National Institute of Health (NIH)
Research Project (R01)
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Behavioral Genetics and Epidemiology Study Section (BGES)
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Breslow, Rosalind
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United States
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da Silva, Rosiane Lopes; Diehl, Alessandra; Cherpitel, Cheryl J et al. (2015) Violence and non-violence-related injuries and alcohol in women from developed and developing countries: a multi-site emergency room study. Addict Behav 41:252-5
Cherpitel, Cheryl J; Ye, Yu; Bond, Jason et al. (2015) Relative risk of injury from acute alcohol consumption: modeling the dose-response relationship in emergency department data from 18 countries. Addiction 110:279-88
Macdonald, Scott; Cherpitel, Cheryl J; Stockwell, Tim et al. (2014) Concordance of self-reported drug use and saliva drug tests in a sample of emergency department patients. J Subst Use 19:147-151
Korcha, Rachael A; Cherpitel, Cheryl J; Witbrodt, Jane et al. (2014) Violence-related injury and gender: the role of alcohol and alcohol combined with illicit drugs. Drug Alcohol Rev 33:43-50
Bond, Jason; Ye, Yu; Cherpitel, Cheryl J et al. (2014) A Comparison of two Case-crossover Methods for Studying the Dose-Response Relationship Between Alcohol and Injury. Contemp Drug Probl 41:04
Brousse, Georges; Arnaud, Benjamin; Geneste, Julie et al. (2014) How CAGE, RAPS4-QF, and AUDIT Can Help Practitioners for Patients Admitted with Acute Alcohol Intoxication in Emergency Departments? Front Psychiatry 5:72
Cremonte, Mariana; Cherpitel, Cheryl J (2014) Alcohol intake and risk of injury. Medicina (B Aires) 74:287-92
Swi?tkiewicz, Gra?yna; Moskalewicz, Jacek; Cherpitel, Cheryl J et al. (2014) Comparison of different methods assessing alcohol contribution to emergency room visits. Alkohol Narkom 27:9-17
Andreuccetti, Gabriel; Carvalho, Heraclito B; Ye, Yu et al. (2014) Does beverage type and drinking context matter in an alcohol-related injury? Evidence from emergency department patients in Latin America. Drug Alcohol Depend 137:90-7
Bond, Jason; Witbrodt, Jane; Ye, Yu et al. (2014) Exploring structural relationships between blood alcohol concentration and signs and clinical assessment of intoxication in alcohol-involved injury cases. Alcohol Alcohol 49:417-22

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