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)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
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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Cherpitel, Cheryl J; Witbrodt, Jane; Ye, Yu et al. (2018) A multi-level analysis of emergency department data on drinking patterns, alcohol policy and cause of injury in 28 countries. Drug Alcohol Depend 192:172-178
Cremonte, Mariana; Biscarra, Maria Ayelén; Conde, Karina et al. (2018) Epidemiology of alcohol consumption and related problems in Latin American countries: Contributions of psychology. Int J Psychol 53:245-252
Andreuccetti, G; Cherpitel, C J; Carvalho, H B et al. (2018) Alcohol in combination with illicit drugs among fatal injuries in Sao Paulo, Brazil: An epidemiological study on the association between acute substance use and injury. Injury 49:2186-2192
Cherpitel, Cheryl J; Ye, Yu; Stockwell, Tim et al. (2018) Recall bias across 7 days in self-reported alcohol consumption prior to injury among emergency department patients. Drug Alcohol Rev 37:382-388
Cherpitel, Cheryl J (2018) Commentary on Egerton-Warburton et al. (2018): Alcohol-related injury in the emergency department and the alcohol attributable fraction. Addiction 113:633-634
Cherpitel, Cheryl J; Witbrodt, Jane; Korcha, Rachael A et al. (2018) Multi-level analysis of alcohol-related injury, societal drinking pattern and alcohol control policy: emergency department data from 28 countries. Addiction 113:2031-2040
Ye, Yu; Shield, Kevin; Cherpitel, Cheryl J et al. (2018) Estimating alcohol-attributable fractions for injuries based on data from emergency department and observational studies: a comparison of two methods. Addiction :
Korcha, Rachael A; Witbrodt, Jane; Cherpitel, Cheryl J et al. (2018) Development of the International Alcohol Policy and Injury Index. Rev Panam Salud Publica 42:
Cherpitel, Cheryl J; Ye, Yu; Monteiro, Maristela (2018) Risk of violence-related injury from alcohol consumption and its burden to society in Latin America and the Caribbean. Rev Panam Salud Publica 42:
Andreuccetti, Gabriel; Ye, Yu; Kang, Jaewook et al. (2017) The Effects of Acute Cannabis Use on Nontraffic Injury Risk: Reviewing the Available Literature and Identifying Ways Forward. Contemp Drug Probl 44:147-158

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