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CORK Bibliography: Injury and Accidents

81 citations. January 2010 to present

Prepared: March 2012

Alvarez FJ; Gomez-Talegon T; Marcos A. Accident rates for drug-dependent patients in treatment for substance dependence: A pilot trial. Traffic Injury Prevention 11(5): 460-465, 2010. (26 refs.)

Objectives: To analyze accident rates among drug-dependent patients before and after treatment for substance dependence. Methods: Self-reported lifetime data and data from the year prior to the start of treatment were analyzed from a cohort including 53 drug-dependent patients, 48 men and 5 women, who had started treatment for substance dependence in an outpatient treatment center in Valladolid, Spain. We also obtained prospective information about treatment dropout and accident rates in the 3-month follow-up period after the start of drug-dependency treatment. Results: Twenty-two percent of drug-dependent patients had an accident in the year prior to starting treatment, and 64.2 percent had an accident in his or her lifetime. Road traffic accidents were the most frequent, with 11.3 percent of patients reporting at least one in the prior year and 45.3 percent reporting at least one road traffic accident in his or her lifetime. Furthermore, drug-dependent patients were frequently under the influence of drugs when driving (13.2%), as well as when performing dangerous activities at work (11.3%), at home (9.4%), and during sporting activities (5.7%) in the year prior to starting treatment. Of the 30 patients who were still undergoing treatment after 3 months, 2 had had accidents during this period (6.6%), one occurring at work and the other at home. Conclusions: Accident involvement, and especially involvement in road traffic accidents, was common among drug-dependent patients. Many accidents occurred in the year prior to treatment initiation. Furthermore, drug-dependent patients often undertook risky activities while under the influence of drugs. There is a need to implement accident prevention strategies, especially strategies that target road traffic accidents, in treatment programs for drug-dependent patients.

Copyright 2010, Taylor & Francis

Assum T. Reduction of the blood alcohol concentration limit in Norway: Effects on knowledge, behavior and accidents. Accident Analysis and Prevention 42(6): 1523-1530, 2010. (21 refs.)

From January 1, 2001, the legal blood alcohol concentration (BAC) limit in Norway was reduced from 0.5 to 0.2 g/l. A before-and-after telephone survey concerning the effects of the reduced BAC limit was carried out. 3001 driver's license holders were interviewed before and after the amendment. The percentage of drivers claiming that they will drink no alcohol before driving has increased from 82 to 91 percent, thus the distinction between driving a motor vehicle and drinking alcohol has become clearer. Drivers influenced by alcohol and involved in accidents have on the average much higher BACs than 0.5 g/l. Statistics on alcohol-related accidents are not available for the years before and after the legal amendment, but single-vehicle night-time and weekend personal-injury and fatal crashes are used as surrogate measures. There are no significant decreases in these proxies from the six years before to the six years after the reductions of the legal limit.

Copyright 2010, Elsevier Science

Benomran FA. Fatal accidental asphyxia in a jack-knife position. Journal of Forensic and Legal Medicine 17(7): 397-400, 2010. (11 refs.)

Accidental death from postural or positional asphyxia takes place when the abnormal position of the victim's body compromises the process of respiration. Diagnosis is largely made by circumstantial evidence supported by absence of any other significant pathology or trauma explaining death. This case report is about a 50-year-old male who had been drinking the previous night and was found dead in the morning inside a tire repair shop. His jack-knifed body had been encompassed, buttocks-down, within the hollow core made by 3 big tires stacked on top of each other. The author was called to the scene of death and had hands-on encounter with the body in-situ where scene photographs were taken. Apart from a blood alcohol of 290 mg/100 ml, marked congestion of the face, petechial hemorrhages on the conjunctivae and lung edema and congestion, autopsy findings were unremarkable. Abrasions on shoulders, lateral aspects of arms and posterior aspects of lower legs indicated friction with internal rims of tires while slipping down. There were no other injuries or pathology to account for his death. Death was determined to be due to accidental postural asphyxia secondary to intoxication by alcohol.

Copyright 2010, Elsevier Science

Bogstrand ST; Normann PT; Rossow I; Larsen M; Morland J; Ekeberg O. Prevalence of alcohol and other substances of abuse among injured patients in a Norwegian emergency department. Drug and Alcohol Dependence 117(2-3): 132-138, 2011. (28 refs.)

Background: Studies have found a high prevalence of both alcohol and other impairing psychoactive drugs in injured patient populations. The aim of this study was to assess the prevalence of potentially impairing psychoactive substances in all patients admitted to a hospital emergency department with injuries from accidents, assault or deliberate self harm. Methods: A total of 1272 patients over 18 years of age, admitted to the hospital within 12 h of injury, were included. Presence of alcohol was determined by an enzymatic method and other drugs by liquid chromatography-mass spectrometry (LC-MS) or gas chromatography-mass spectrometry (GC-MS), both highly specific analytical methods for determining recent intake. Results: There were 510(40%) women in the sample. Of the patients, 38% of the women and 48% of the men had a positive blood sample for psychoactive substances on admission. The most prevalent psychoactive substance was alcohol (27%) with an average concentration of 1.5 g/kg. A further 21% of patients tested showed use of medicinal drugs, and 9% showed use of illicit substances. Cannabis was the most prevalent illicit drug (6.2%). Diazepam (7.4%) and zopiclone (5.3%) were the most prevalent medicinal drugs. In road traffic accidents, 25% of the car drivers had positive findings, about half of them for alcohol. Conclusion: Psychoactive substances were found in nearly half the patients admitted with injuries. The most common substance was alcohol. Alcohol was particularly related to violence, whereas medicinal drugs were most prevalent in accidents at home.

Copyright 2011, Elsevier Science

Brache K; Stockwell T. Drinking patterns and risk behaviors associated with combined alcohol and energy drink consumption in college drinkers. Addictive Behaviors 36(12): 1133-1140, 2011. (35 refs.)

Objective: In recent years the consumption of alcohol mixed with energy drinks (AmED) has become popular in young adults in North America. There have been few studies into the drinking patterns and risk behaviors that accompany this new form of alcoholic beverage consumption and more information is required to support harm reduction and prevention efforts. This paper goes beyond previous research by investigating risk behaviors associated with AmED use while (1) controlling for risk-taking propensity, (2) examining a range of outcomes (e.g. stimulant drug use), and (3) replicating previous findings in a Canadian sample. Method: In winter 2009/10, a web-based survey was completed by 465 students (56% female) attending a university in Western Canada. Regression analyses were used to investigate whether consumption of AmED is associated with heavy drinking, stimulant drug use, and alcohol-related consequences. Results: A total of 105 students (23%) reported consuming AmED in the past 30 days. These students were more likely to be heavier drinkers, than non-AmED users after controlling for risk-taking propensity. More frequent AmED drinkers had twice the odds of experiencing one or more negative consequences from AmED use (e.g. drinking and driving, being hurt or injured), compared to less frequent drinkers after controlling for risk-taking propensity and drinking behavior. Conclusions: Students who consume AmED are at increased risk for harms. Therefore, consuming AmED should be considered "high-risk drinking" for university students and efforts should be made to discourage combined consumption.

Copyright 2011, Elsevier Science

Bruck D; Ball M; Thomas IR. Fire fatality and alcohol intake: Analysis of key risk factors. Journal of Studies on Alcohol and Drugs 72(5): 731-736, 2011. (28 refs.)

Objective: After a brief review of the literature on the role of alcohol in residential fire deaths, a comparison of different risk factors for residential fire fatality was undertaken by closely analyzing the circumstances of fire victims as a function of alcohol intake. Method: Analyses were based on Australian coroners' fire fatality records for the state of Victoria (1998-2006) and considered demographic, behavioral, and environmental factors for the 95 adult fire victims who were tested for alcohol (64 male, 31 female). Results: Most (58%) had a positive blood alcohol concentration (BAC) test, with 31% of the total sample having a BAC of more than 0.20 gm per 100 ml. Odds ratio analyses showed that four variables were significantly more associated with victims who had consumed alcohol compared with sober victims. In descending odds ratio order, these variables were as follows: (a) being aged 18-60 years, (b) involving smoking materials (e.g. cigarettes, pipes), (c) having no conditions preventing escape, and (d) being male. An important new finding is that fire fatalities with positive BAC levels were more than three times less likely to have their clothing alight or exits blocked than sober fire victims. Conclusions: The risk of dying in a fire for alcohol-affected people who are capable of being alerted and escaping may be reduced if they can be alerted more quickly and effectively. Suitable measures for improving smoke alarms via interlinking and the use of an alarm signal demonstrated to be more effective at waking sleepers, including those who are alcohol affected, are discussed.

Copyright 2011, Alcohol Research Documentation

Bujarski SJ; Klanecky AK; McChargue DE. The relationship between alexithymia and alcohol-related risk perceptions: The moderating effect of general trauma in a college population. Addictive Behaviors 35(4): 363-366, 2010. (36 refs.)

The current study explored the moderating influence of general trauma exposure (GTE) on the relationship between alexithymia and alcohol-related risk perceptions. Undergraduate college students (N=237) completed a battery of self-report measures. After controlling for relevant variables, results indicated that the interaction between alexithymia and GTE significantly predicted alcohol-related risk perception. Simple effects revealed that for students who reported higher rates of GTE, alexithymia positively predicted risk perception; this relationship did not exist among students with lower GTE. Exploratory analyses indicated that despite increased risk perception, individuals with GTE also reported greater alcohol-related problems compared to students with low trauma exposure. The current study highlights the importance of examining risk perception abilities in individuals with alexithymia and GTE as well as the impact of risk percept ion on alcohol-related risk behaviors.

Copyright 2010, Elsevier Science

Cherpitel CJ; Ye Y; Greenfield TK; Bond J; Kerr WC; Midanik LT. Alcohol-related injury and driving while intoxicated: A risk function analysis of two alcohol-related events in the 2000 and 2005 National Alcohol Surveys. American Journal of Drug and Alcohol Abuse 36(3): 168-174, 2010. (28 refs.)

Background: National population data on risk of alcohol-related injury or driving while intoxicated (DWI) are scarce. Objective: The association of alcohol-related injury and perceived DWI (PDWI) with both volume and pattern of consumption are examined in a merged sample of respondents from the 2000 and 2005 National Alcohol Surveys using risk function analysis. Methods: Self-reported consumption patterns on 8,736 respondents who consumed at least one drink in the last 12 months were assessed as the average daily volume and frequency of consuming 5 or more (5+), 8 or more (8+), and 12 or more (12+) drinks in a day. Risks were defined using CHAID segmentation analysis implemented with SPSS Answer Tree. Results: For alcohol-related injury (n = 110), those most at risk drank at lower volumes with some high maximum occasions, or at higher volumes, where high maximum occasions had little added effect. Risk was highest for those reporting more than 6 drinks per day (9.7%). For PDWI (n = 696), those most at risk drank at higher volumes and with a greater number of high maximum occasions. Risk was highest for those reporting more than 6 drinks per day and more than one 8+ occasion during the last year (39%). Conclusions: Overall risk appears to increase with increasing volume, but at a given volume level, risk also increases with frequency of high maximum occasions. These data lend relatively weak support for previous findings suggesting that less frequent drinkers who only occasionally consume larger quantities may be at greater risk, and any alcohol consumption appears to carry some risk of these harms.

Copyright 2010, Taylor & Francis

Coghlan M; Macdonald S. The role of substance use and psychosocial characteristics in explaining unintentional injuries. Accident Analysis and Prevention 42(2): 476-479, 2010. (19 refs.)

The objective of this study was to examine the relationship between the use of various substances and selected psychosocial characteristics with unintentional injury. Cross-sectional data was collected from groups of subjects in treatment for a primary problem with cocaine(n=300), cannabis (n=128), alcohol (n=110), other drugs (n=35), tobacco (n=249), or gambling (n=199). Subjects completed a self-administered questionnaire that included questions on various psychosocial scales (i.e., risk-taking/impulsivity, chronic stress, coping, and social supports), frequency of drug and alcohol use, and unintentional injuries in the year prior to treatment. For the univariate analyses. both frequency of cocaine and cannabis use, risk-taking/impulsivity, stress, and coping were significantly related to injuries. For the multivariate analyses, only risk-taking/impulsivity, stress, age, and sex were significantly related to injuries. The results provide important information regarding factors associated with reported injuries among individuals in addiction treatment.

Copyright 2010, Elsevier Science

Colicchio D; Passos ADC. Traffic behavior of medical students. Revista da Associacao Medica Brasileira 56(5): 535-540, 2010. (17 refs.)

OBJECTIVES. To study the traffic behavior of medical students comparing current patterns with those observed in a study previously carried out in the same institution. METHODS. Standard questionnaires were completed by a sample of regularly registered medical students of the "Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo", Brazil, to collect data regarding demographic and economic information and also traffic behavior and accident involvement. Results were compared to those obtained in a similar investigation done in 1997. RESULTS. In 2008, 354 students were interviewed and 377 in 1997. Of all, 431 (59%) had driven right after alcohol ingestion and 21.5% of them had driven under severe influence of alcohol. while 10.5% referred to participation in "street races", with a large difference between genders (12.5% of men and 3.4% of women). Involvement in accidents with victims, fatal or not, was reported by 19.2% of participants. This percentage reached 31.1% among those who had driven under severe influence of alcohol and 42.9% among those who participated in "street races". The 2008 study showed increased use of helmets and seat belts in urban areas, as well as reduction of alcohol consumption before driving. On the other hand, it disclosed less continuous compliance with traffic lights. CONCLUSION. Risky traffic behavior was found to be very frequent among these participants directly involved in accidents with victims. Since this is a distinctive segment of the population, that is aware and has direct contact with the consequences of traffic accidents, we would hope to find a lower incidence of such high risk behavior Information provided by this investigation should lead to a reflection from the academic community intending to introduce educational programs to effectively change student behavior.

Copyright 2010, Association Medica Brasileira

Connorton E; Miller M; Perry MJ; Hemenway D. Mental health and unintentional injurers: Results from the national co-morbidity survey replication. Injury Prevention 17(3): 171-175, 2011. (30 refs.)

Objective: To examine whether unintentionally injuring others is associated with subsequent mental illness, and whether mental illness is a risk factor for unintentionally injuring others. Methods: Onset of first psychiatric diagnoses was compared with onset of first unintentional injuring. Multivariate logistic regression estimated the association between unintentional injuring and lifetime prevalence of mental illness, specifically of Diagnostic and Statistical Manual of Mental Disorders IV disorders associated with trauma exposure among respondents of part II of the National Co-morbidity Survey Replication a household survey of 5692 US adults. Analyses controlled for age, sex, race and having been injured in a serious accident. Results: Of 5692 respondents, 110 reported unintentionally causing death or injury to another person. Unintentionally injuring others was a risk factor for subsequent mental health problems. Multivariate regression results showed an increased risk of subsequent depression (OR 3.1, CI 1.7 to 5.7), anxiety (OR 3.3, CI 1.6 to 6.6), posttraumatic stress disorder (PTSD) (OR 6.6, CI 3.1 to 14.0), alcohol use (OR 3.8, CI 1.9 to 7.3) and drug use (OR 8.0, CI 4.1 to 15.3). Conversely, mental health problems were a risk factor for unintentionally injuring another person. Multivariate regression results showed an increased risk of unintentional injuring among those with a prior diagnosis of depression, PTSD, alcohol use, and drug use. Conclusions: After injuring, unintentional injurers are likely to experience depression, anxiety, PTSD and drug or alcohol abuse/dependence compared with non-injurers. Those diagnosed with depression, anxiety, PTSD, alcohol or drug or alcohol abuse/dependence are more likely to cause serious injuries to others.

Copyright 2011, BML Publishing

Corrigan JD; Bogner J; Hungerford DW; Schomer K. Screening and brief intervention for substance misuse among patients with traumatic brain injury. (review). Journal of Trauma, Injury, Infection and Critical Care 69(3): 722-726, 2010. (52 refs.)

Background: Research on screening and brief interventions (SBI) for substance misuse has demonstrated efficacy in a variety of medical settings including emergency departments and trauma centers. However, SBI has not yet been evaluated for persons who incur traumatic brain injury (TBI)-a substantial patient subpopulation for whom substance-related problems are frequent. To examine whether research on SBI efficacy and effectiveness can be generalized to persons with TBI, a systematic review of the literature was conducted to analyze how TBI populations were included in previous studies and whether there was evidence of differential outcomes. Methods: Peer-reviewed studies that investigated SBI for misuse of alcohol or other drugs, that were implemented in emergency departments or trauma centers, and that were published in English since 1985 were examined. From 174 articles initially identified, 28 studies were determined to meet inclusion criteria. Results: The review revealed that research conducted on SBI for injury populations systematically neglected patients with more severe TBI and those who presented with sufficient confusion that they could not provide informed consent. Conclusions: Future effectiveness studies should examine barriers to routine clinical use of SBI and evaluate the generalizability of expected benefits to the full spectrum of injured patients. Researchers should also develop and evaluate systematic accommodations for persons with neurobehavioral impairments who would benefit from brief interventions for substance misuse.

Copyright 2010, Lippincott, Williams & Wilkins

Cortez-Pinto H; Gouveia M; Pinheiro LD; Costa J; Borges M; Carneiro AV. The burden of disease and the cost of illness attributable to alcohol drinking: Results of a national study. Alcoholism: Clinical and Experimental Research 34(8): 1442-1449, 2010. (32 refs.)

Background and Aims: The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal. Methods: Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability-Adjusted Life Years (DALY) lost generated by death or disability. Results: In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%). As for the cost of illness incurred by the health system, our results indicate that euro95.1 millions are attributable to alcohol-related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol-related diseases were estimated in euro95.9 million, totaling euro191.0 million direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%. Conclusion: Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol.

Copyright 2010, Wiley-Blackwell

Cotti CD; Walker DM. The impact of casinos on fatal alcohol-related traffic accidents in the United States. Journal of Health Economics 29(6): 788-796, 2010. (47 refs.)

Casinos have been introduced throughout the US to spur economic development and generate tax revenues. Yet casinos may also be associated with a variety of social ills. One issue that has not been empirically tested in the literature is whether there is a link between casino expansion and alcohol-related fatal traffic accidents. We suspect a link may exist since casinos often serve alcohol to their patrons and by their dispersed nature could Impact driving distances after drinking. Using the variation in the timing and location of casino openings over a 10-year period we isolate the impact of casino introduction on alcohol-related fatal accidents Results indicate that there is a strong link between the presence of a casino in a county and the number of alcohol-related fatal traffic accidents. However this relationship is negatively related to the local-area (county) population. Results prove durable as we subject them to robustness checks.

Copyright 2010, Elsevier Science BV

Crockett A; Stawicki SP; Thomas YM; Jarvis AM; Wang CF; Beery PR et al. Tree stands, not guns, are the midwestern hunter's most dangerous weapon. American Surgeon 76(9): 1006-1010, 2010. (11 refs.)

Although the prevailing stereotype is that most hunting injuries are gunshot wounds inflicted by intoxicated hunting buddies, our experience led us to hypothesize that falls comprise a significant proportion of hunting related injuries. Trauma databases of two Level I trauma centers in central Ohio were queried for all hunting related injuries during a 10-year period. One hundred and thirty patients were identified (90% male, mean age 41.0 years, range 17-76). Fifty per cent of injuries resulted from falls, whereas gunshot wounds accounted for 29 per cent. Most hunters were hunting deer and 92 per cent of falls were from tree stands. Alcohol was involved in only 2.3 per cent, and drugs of abuse in 4.6 per cent. Of gunshots, 58 per cent were self-inflicted, and 42 per cent were shot by another hunter. Tree stand falls were highly morbid, with 59 per cent of fall victims suffering spinal fractures, 47 per cent lower extremity fractures, 18 per cent upper extremity fractures, and 18 per cent closed head injuries. Surgery was required for 81 per cent of fall-related injuries, and 8.2 per cent of fall victims had permanent neurological deficits. In contrast to prevailing beliefs, in our geographic area tree-stand falls are the most common mechanism of hunting related injury requiring admission to a Level 1 trauma center.

Copyright 2010, Southeastern Surgical Congress

Czech S; Shakeshaft AP; Byrnes JM; Doran CM. Comparing the cost of alcohol-related traffic crashes in rural and urban environments. Accident Analysis and Prevention 42(4): 1195-1198, 2010. (22 refs.)

Context: Existing studies have identified that, although to a lesser extent than individual factors such as males and young people, rural (compared to urban) communities represent a disproportionately high-risk of alcohol-related traffic crashes (ARTCs). To date, however, few studies have attempted to apply different costs to alcohol crashes of different severity, to provide more precise, and practically useful, data on which to base public health policy and intervention decisions. Objective: The aim of this study is to quantify the per capita prevalence and differential costs of alcohol crashes of different levels of severity to determine the extent to which urban and rural geographical areas may differ in the costs attributable to ARTCs. Design: A cross-sectional analysis of alcohol-related traffic crash and costs data from 2001 to 2007. Setting and participants: Data from New South Wales, Australia. Main outcome measures: Modified routinely collected traffic accident data to which costs relevant to alcohol crashes of different severity are applied. Results: Although the rate per 10,000 population of alcohol-related crashes is 1.5 times higher in rural, relative to urban, communities, the attributable cost is four times higher, which largely reflects that rural alcohol-fatalities are seven to eight times more prevalent and costly. Conclusions: Given that per capita alcohol-related fatal crashes in rural areas account for a disproportionately large proportion of the harms and costs associated with alcohol-related traffic crashes, the cost-effectiveness of public health interventions and public policy initiatives should consider the relative extent of ARTC-harm in rural versus urban communities.

Copyright 2010, Elsevier Science

Dassanayake T; Michie P; Carter G; Jones A. Effects of benzodiazepines, antidepressants and opioids on driving: A systematic review and meta-analysis of epidemiological and experimental evidence. (review). Drug Safety 34(2): 125-156, 2011. (102 refs.)

Background: Many individuals in the community are prescribed psychoactive drugs with sedative effects. These drugs may affect their daily functions, of which automobile driving is a major component. Objective: To examine the association of three classes of commonly used psychoactive drugs (viz. benzodiazepines and newer non-benzodiazepine hypnotics, antidepressants and opioids) with (i) the risk of traffic accidents (as indexed by epidemiological indicators of risk); and (ii) driving performance (as indexed by experimental measures of driving performance). Methods: A literature search for material published in the English language between January 1966 and January 2010 in PubMed and EMBASE databases was combined with a search for other relevant material referenced in the retrieved articles. Retrieved articles were systematically reviewed, carrying out meta-analyses where possible. Twenty-one epidemiological studies (13 case-control and 8 cohort studies) fulfilled the inclusion criteria by estimating the accident risk associated with drug exposure (ascertained by blood/urine analysis or prescription records). Sixty-nine experimental studies fulfilled the inclusion criteria by testing actual or simulated driving performance after administering a single dose or multiple doses. Results: Two meta-analyses showed that benzodiazepines are associated with a 60% (for case-control studies: pooled odds ratio [OR] 1.59; 95% CI 1.10, 2.31) to 80% (for cohort studies: pooled incidence rate ratio 1.81; 95% CI 1.35, 2.43) increase in the risk of traffic accidents and a 40% (pooled OR 1.41; 95% CI 1.03, 1.94) increase in 'accident responsibility'. Co-ingestion of benzodiazepines and alcohol was associated with a 7.7-fold increase in the accident risk (pooled OR 7.69; 95% CI 4.33, 13.65). Subgroup analysis of case-control studies showed a lower benzodiazepine-associated accident risk in elderly (>65 years of age) drivers (pooled OR 1.13; 95% CI 0.97, 1.31) than in drivers <65 years of age (pooled OR 2.21; 95% CI 1.31, 3.73), a result consistent with age-stratified risk differences reported in cohort studies. Anxiolytics, taken in single or multiple doses during the daytime, impaired driving performance independent of their half-lives. With hypnotics, converging evidence from experimental and epidemiological studies indicates that diazepam, flurazepam, flunitrazepam, nitrazepam and the short half-life non-benzodiazepine hypnotic zopiclone significantly impair driving, at least during the first 2-4 weeks of treatment. The accident risk was higher in the elderly (>65 years of age) who use tricyclic antidepressants (TCAs); however, the evidence for an association of antidepressants with accident risk in younger drivers was equivocal. Sedative but not non-sedative antidepressants were found to cause short-term impairment of several measures of driving performance. Limited epidemiological research reported that opioids may be associated with increased accident risk in the first few weeks of treatment. Conclusions: Benzodiazepine use was associated with a significant increase in the risk of traffic accidents and responsibility of drivers for accidents. The association was more pronounced in the younger drivers. The accident risk was markedly increased by co-ingestion of alcohol. Driving impairment was generally related to plasma half-lives of hypnotics, but with notable exceptions. Anxiolytics, with daytime dosing, impaired driving independent of their half-lives. TCAs appeared to be associated with increased accident risk, at least in the elderly, and caused short-term impairment in driving performance. Opioid users may be at a higher risk of traffic accidents; however, experimental evidence is limited on their effects on driving.

Copyright 2011, Adis International

Dols ST; Gonzalez FJA; Aleixandre NL; Vidal-Infer A; Rodrigo MJT; Valderrama-Zurian JC. Predictors of driving after alcohol and drug use among adolescents in Valencia (Spain). Accident Analysis and Prevention 42(6): 2024-2029, 2010. (25 refs.)

Background: Driving under the influence of alcohol and drugs has been identified as a risk factor for road traffic crashes. We have assessed the prevalence and predictor factors for driving after alcohol and drug use by adolescents. Methods: A cross-sectional survey involving 11,239 students aged 14-18 years from 252 private and public schools in the Valencia region of Spain was conducted. The prevalence and predictors of driving after alcohol use, alcohol and drug use, or drug use during the previous 6 months were measured. Results: Of the students who reported driving (20%), 45.1% indicated driving after alcohol and drug use. The consumption of various drugs was higher among students who drove a vehicle compared with those who did not. The likelihood of driving after consuming alcohol, or alcohol and drugs, increased in line with the number of standard drink units per week, reports of any lifetime alcohol- or drug-related problems, and poor family relationship. In addition, masculine gender and early alcohol use increased the likelihood of driving after consuming alcohol. Conclusions: Driving after alcohol and drug use is quite prevalent among adolescents in the Valencia region of Spain. There is a need for implementation of targeted policies for adolescents. This should focus on education and information on alcohol/drug use and driving.

Copyright 2010, Elsevier Science

Dunlop SM; Romer D. Adolescent and young adult crash risk: Sensation seeking, substance use propensity and substance use behaviors. Journal of Adolescent Health 46(1): 90-92, 2010. (9 refs.)

In a national youth sample, the propensity to use substances was more strongly related to motor vehicle crashes than use of any specific substance studied (cigarette, alcohol, marijuana). Substance use propensity was associated with sensation seeking, suggesting that increased crash risk for these youth is likely a result of general risk-taking tendencies.

Copyright 2010, Society for Adolescent Medicine

Eckersley W; Salmon R; Gebru M. Khat, driver impairment and road traffic injuries: a view from Ethiopia. (editorial). Bulletin of the World Health Organization 88(3, special issue): 235-236, 2010. (6 refs.)

Fell JC; Tippetts S; Voas R. Drinking characteristics of drivers arrested for driving while intoxicated in two police jurisdictions. Traffic Injury Prevention 11(5): 443-452, 2010. (47 refs.)

Objective: Are drivers arrested for driving while intoxicated (DWI) most likely to be the drinking drivers who are involved in fatal and serious injury crashes? This study determined the drinking characteristics of drivers arrested for DWI or driving under the influence (DUI) and the proportion classified as problem drinkers and hardcore drinking drivers in two police jurisdictions. In addition to determining the drinking characteristics of DWI arrestees, the results were compared to the drinking characteristics of intoxicated drivers killed in traffic crashes. Method: Police officers gathered data at the time of arrest from 1027 drivers apprehended for DWI or DUI in the two communities on their alcohol consumption, their drinking-and-driving frequency, their self-reported alcohol problems, their place of drinking and types of drinks before the arrest, and their perceptions of impaired-driving enforcement intensity. Results: Data analyses indicated that 52 percent of the arrested DWI offenders were considered problem drinkers, 46 percent were repeat offenders, 57 percent were classified as hardcore drinking drivers, 51 percent were drinking at a bar or restaurant before their arrest, and 72 percent were drinking beer before their arrest. Conclusions: Compared to highly intoxicated (blood alcohol concentration [BAC] epsilon.15) drivers killed in traffic crashes, the high-BAC arrestees were substantially more likely to be problem drinkers and to report drinking and driving more often. The limited resources available for combating impaired driving should not be solely allocated to problem drinkers, hardcore drinkers, or repeat offenders because, at most, they constitute only about half of the impaired-driving problem in the United States. General deterrent strategies have the best chance of impacting the total population of at-risk drinking drivers.

Copyright 2010, Taylor & Francis

Field CA; Caetano R. The effectiveness of brief intervention among injured patients with alcohol dependence: Who benefits from brief interventions? Drug and Alcohol Dependence 111(1-2): 13-20, 2010. (60 refs.)

Background: Research investigating the differential effectiveness of Brief Motivational Interventions (BMIs) among alcohol-dependent and non-dependent patients in the medical setting is limited. Clinical guidelines suggest that BMI is most appropriate for patients with less severe alcohol problems. As a result, most studies evaluating the effectiveness of BMI have excluded patients with an indication of alcohol dependence. Methods: A randomized controlled trial of brief intervention in the trauma care setting comparing BMI to treatment as usual plus assessment (TAU+) was conducted. Alcohol dependence status was determined for 1336 patients using DSM-IV diagnostic criteria. The differential effectiveness of BMI among alcohol-dependent and non-dependent patients was determined with regard to volume per week, maximum amount consumed, percent days abstinent, alcohol problems at 6 and 12 months follow-up. In addition, the effect of BMI on dependence status at 6 and 12 months was determined. Results: There was a consistent interaction between BMI and alcohol dependence status, which indicated significantly higher reductions in volume per week at 6 and 12 months follow-up (beta = -.56, p = .03, beta = -.63, p = .02, respectively), maximum amount at 6 months (beta = -.31, p = .04), and significant decreases in percent days abstinent at 12 months (beta = .11, p = .007) and alcohol problems at 12 months (beta = -2.7, p(12) = .04) among patients with alcohol dependence receiving BMI. In addition, patients with alcohol dependence at baseline that received BMI were .59 (95% CI = .39-.91) times less likely to meet criteria for alcohol dependence at six months. Conclusions: These findings suggest that BMI is more beneficial among patients with alcohol dependence who screen positive for an alcohol-related injury.

Copyright 2010, Elsevier Sciences

Gaudio RM; Barbieri S; Feltracco P; Spaziani F; Alberti M; Delantone M et al. Impact of alcohol consumption on winter sports-related injuries. Medicine, Science and the Law 50(3): 122-125, 2010. (10 refs.)

Introduction: This study was carried out to evaluate data about trauma-related winter sports, including risk factors such as high speed, gender, age, alcohol consumption, details about the accident and snow conditions. Methods: A retrospective review was conducted to determine the injury patterns and crash circumstances in holiday skiers and snowboarders. The data recorded were obtained from the database of the Pre-Hospital Emergency Registry of six skiing areas in the Dolomite mountains during the winter seasons November 2004-May 2009, injury data for major traumas from Ski Patrol Injury reports (helicopter, ambulance or ski slopes' patrol reports), and intrahospital Emergency Department data. Alcohol concentration in blood was detected in 200 individuals suffering from major trauma. Results: A total of 4550 injured patients, predominantly male (69%), mean age 22 years (range 16-72), were included in the observational analysis. Knee, wrist and shoulder injuries were frequently associated with major thoracic, abdominal or head traumas (64% of cases). Suboptimal technical level, high speed, low concentration, snow or weather conditions, faulty equipment and protective devices were among the various causes of accidents. The analysis revealed that high alcohol blood concentration was present in 43% of 200 patients. Conclusions: Even though the major causes of accidents were excessive speed, excessive fatigue, technical errors and bad weather conditions, alcohol abuse was often discovered. Random sampling and a non-systematic detection of alcohol blood levels likely led to an underestimation of alcohol consumption-related injuries. It is recommended that investigations into alcoholic intoxication in injured skiers should be carried out on a large scale.

Copyright 2010, Royal Society of Medicine

Grier TL; Morrison S; Knapik JJ; Canham-Chervak M; Jones BH. Risk factors for injuries in the U.S. Army Ordnance School. Military Medicine 176(11): 1292-1299, 2011. (40 refs.)

Objective: To investigate risk factors for time-loss injuries among soldiers attending U.S. Army Ordnance School Advanced Individual Training. Methods: Injuries were obtained from an injury surveillance system. A health questionnaire provided data on age, race, rank, current self-reported injury and illness, and tobacco use. Fitness data was obtained from operations office. Results: Cumulative time-loss injury incidence was 31% for men and 54% for women. For men, higher risk of injury was associated with race, a current self-reported injury, smoking before entering the Army, lower sit-up performance, and slower 2-mile run times. For women, higher risk of injury was associated with race, a current self-reported injury, and slower 2-mile run times. Conclusion: Smoking cessation and fitness training before entry are potential strategies to reduce injuries among soldiers in the Ordnance School.

Copyright 2011, Association of Military Surgeons US

Gruenewald PJ; Freisthler B; Remer L; LaScala EA; Treno AJ; Ponicki WR. Ecological associations of alcohol outlets with underage and young adult injuries. Alcoholism: Clinical and Experimental Research 34(3): 519-527, 2010. (35 refs.)

Objective: This paper argues that associations between rates of 3 specific problems related to alcohol (i.e., accidents, traffic crashes, and assaults) should be differentially related to densities of alcohol outlets among underage youth and young adults based upon age-related patterns of alcohol outlet use. Methods: Zip code-level population models assessed local and distal effects of alcohol outlets upon rates of hospital discharges for these outcomes. Results: Densities of off-premise alcohol outlets were significantly related to injuries from accidents, assaults, and traffic crashes for both underage youth and young adults. Densities of bars were associated with more assaults and densities of restaurants were associated with more traffic crash injuries for young adults. Conclusions: The distribution of alcohol-related injuries relative to alcohol outlets reflect patterns of alcohol outlet use.

Copyright 2010, Research Society on Alcoholism

Gruenewald PJ; Johnson FW. Drinking, driving, and crashing: A traffic-flow model of alcohol-related motor vehicle accidents. Journal of Studies on Alcohol and Drugs 71(2): 237-248, 2010. (37 refs.)

Objective: This study examined the influence of on-premise alcohol-outlet densities and of drinking-driver densities on rates of alcohol-related motor vehicle crashes. A traffic-flow model is developed to represent geographic relationships between residential locations of drinking drivers, alcohol outlets, and alcohol-related motor vehicle crashes. Method: Cross-sectional and time-series cross-sectional spatial analyses were performed using data collected from 144 geographic units over 4 years. Data were obtained from archival and survey sources in six communities. Archival data were obtained within community areas and measured activities of either the resident population or persons visiting these communities. These data included local and highway traffic flow, locations of alcohol outlets, population density, network density of the local roadway system, and single-vehicle nighttime (SVN) crashes. Telephone-survey data obtained from residents of the communities were used to estimate the size of the resident drinking and driving population. Results: Cross-sectional analyses showed that effects relating on-premise densities to alcohol-related crashes were moderated by highway traffic flow. Depending on levels of highway traffic flow, 10% greater densities were related to 0% to 150% greater rates of SVN crashes. Time-series cross-sectional analyses showed that changes in the population pool of drinking drivers and on-premise densities interacted to increase SVN crash rates. Conclusions: A simple traffic-flow model can assess the effects of on-premise alcohol-outlet densities and of drinking-driver densities as they vary across communities to produce alcohol-related crashes. Analyses based on these models can usefully guide policy decisions on the siting of on-premise alcohol outlets.

Copyright 2010, Alcohol Research Documentation

Harrington M; Baird J; Lee C; Nirenberg T; Longabaugh R; Mello M et al. Identifying subtypes of dual alcohol and marijuana users: A methodological approach using cluster analysis. Addictive Behaviors 37(1): 119-123, 2012. (19 refs.)

Alcohol is the most common psychoactive substance used with marijuana. However, little is known about the potential impact of different levels of use of both alcohol and marijuana and their influence on risky behaviors, injuries and psychosocial functioning. A systematic approach to identifying patterns of alcohol and marijuana use associated with increased risks has not yet been identified in the literature. We report on the secondary analysis of data collected from a RCT conducted in a busy urban emergency department. Cluster analysis was performed on the patterns of past 30-day alcohol and marijuana use in two random subsamples N(1)=210 and N(2)=217. Four distinct subtypes of those who use both alcohol and marijuana were identified: (1) Daily Marijuana and Weekly Alcohol users; (2) Weekly Alcohol and Weekly Marijuana users; (3) Daily Alcohol and Daily Marijuana users; and (4) Daily Alcohol, Weekly Marijuana users. The four subtypes were replicated in both subsamples and examination of the external validity using ANOVA to determine cluster differences on psychosocial and behavioral variables confirmed the theoretical relevance of different patterns of alcohol and marijuana use. There were significantly different psychosocial negative consequences and related risky behaviors among subtypes. We found that Daily Alcohol and Daily Marijuana users are at the highest risk to experience more negative consequences and engage in a broader spectrum of risky behaviors related to both substances, than the other three types of alcohol and marijuana users.

Copyright 2012, Elsevier Science

Hughes K; Bellis MA; Calafat A; Blay N; Kokkevi A; Boyiadji G et al. Substance use, violence, and unintentional injury in young holidaymakers visiting Mediterranean destinations. Journal of Travel Medicine 18(2): 80-89, 2011. (44 refs.)

Methods. A cross-sectional comparative survey of 6,502 British and German holidaymakers aged 16 to 35 years was undertaken in airports in Cyprus, Greece, Italy, Portugal, and Spain. Results. Overall, 3.8% of participants reported having been in a physical fight (violence) on holiday and 5.9% reported unintentional injury. Two thirds reported having been drunk on holiday and over 10% using illicit drugs. Levels of drunkenness, drug use, violence, and unintentional injury all varied with nationality and holiday destination. Violence was independently associated with being male, choosing the destination for its nightlife, staying 8 to 14 days, smoking and using drugs on holiday, frequent drunkenness, and visiting Majorca (both nationalities) or Crete (British only). Predictors of unintentional injury were being male, younger, using drugs other than just cannabis on holiday, frequent drunkenness, and visiting Crete (both nationalities). Conclusions. Violence and unintentional injury are substantial risks for patrons of international resorts offering a hedonistic nightlife. Understanding those characteristics of resorts and their visitors most closely associated with such risks should help inform prevention initiatives that protect both the health of tourists and the economy of resorts marketed as safe and enjoyable places to visit.

Copyright 2011, Wiley-Blackwell

Impinen A; Makela P; Karjalainen K; Rahkonen O; Lintonen T; Lillsunde P et al. High mortality among people suspected of drunk-driving. An 18-year register-based follow-up. Drug and Alcohol Dependence 110(1-2): 80-84, 2010. (34 refs.)

Objectives: The aim of this study was to examine the overall and cause-specific mortality of DUI arrestees compared to a reference population with no history of DUI and to recognize the risk factors of premature death. Methods: The data used were a register of all DUI arrestees between April 1988 and December 2006. All drivers with drug-positive samples were excluded. DUI arrestees were compared to a reference population with no previous history of DUI. Overall and cause-specific hazard ratios were calculated and risk factors were estimated. Results: Alcohol causes, diseases of the circulatory system and accidents constituted the most common causes of death among DUI arrestees. Suspected DUI was linked with higher mortality in every observed cause of death. The risk of death by alcohol-related or external cause was especially high. Among women DUI arrests caused sharper increase to the risk of death than increase found among male arrestees. Within the group of DUI arrestees the risk of death was affected by age, sex, marital status, education, multiple arrests as well as time and observed blood alcohol level of the arrest. Half of the suspected DUI cases and one in five of the references had alcohol as a contributing factor to death. Conclusions: Arrest on suspicion of drunk-driving is an indicator for elevated risk of death. Alcohol is often related to deaths of DUI arrestees. Drunk-drivers should be efficiently guided with respect to evaluations and treatments for harmful drinking.

Copyright 2010, Elsevier Science

Kim JK; Ulfarsson GF; Shankar VN; Mannering FL. A note on modeling pedestrian-injury severity in motor-vehicle crashes with the mixed logit model. Accident Analysis and Prevention 42(6): 1751-1758, 2010. (26 refs.)

Pedestrian-injury severity has been traditionally modeled with approaches that have assumed that the effect of each variable is fixed across injury observations. This assumption ignores possible unobserved heterogeneity which is likely to be particularly important in pedestrian injuries because unobserved physical health, strength, and behavior may significantly affect the pedestrians' ability to absorb collision forces. To address such unobserved heterogeneity, this research applies a mixed logit model to analyze pedestrian-injury severity in pedestrian-vehicle crashes. Using police-reported collision data from 1997 through 2000 from North Carolina, several factors were found to more than double the average probability of fatal injury for pedestrians in motor-vehicle crashes including: darkness without streetlights (400% increase in fatality probability), vehicle is a truck (370% increase), freeway (330% increase), speeding involved (360% increase), and collisions involving a motorist who had been drinking (250% increase). It was also found that the effect of pedestrian age was normally distributed across observations, and that as pedestrians became older the probability of fatal injury increased substantially. Heterogeneity in the mean of the random parameters for the freeway and pedestrian-solely-at-fault collision indicators was related to pedestrian gender, and heterogeneity in the mean of the random parameters for the traffic-sign and motorist-back-up indicators was related to pedestrian age.

Copyright 2010, Elsevier Science

Kjelsberg E; Laake P. Is the high mortality risk in sentenced offenders independent of previous imprisonment? European Journal of Epidemiology 25(4): 237-243, 2010. (25 refs.)

The mortality in prisoners is high. However, our knowledge about the mortality in convicted offenders, irrespective of incarceration history, is limited. Our aim was to investigate possible predictors for over-all and cause specific mortality in a nation-wide study of convicted offenders with and without previous imprisonment. This case-control study drew random samples of deceased and living offenders (N = 1,112) from four complete cohorts of convicted offenders, two male (born 1967 and 1977, respectively), and two female (born 1967-70 and 1977-80, respectively). All criminal records were systematized and information about date and cause of death was collected on those deceased. Multivariable analyses demonstrated that age at first court conviction (OR = 0.88, 95% CI = 0.84-0.93), drug related crimes (OR = 1.99, 95% CI = 1.23-3.22), and crime diversity (1.51, 95% CI = 1.07-2.13) were significant predictors of premature death in males. In females, age at first court conviction (OR = 0.92, 95% CI = 0.88-0.97), drug related crimes (OR = 2.24, 95% CI = 1.37-3.69) and belonging to the oldest cohort (OR = 2.10, 95% CI = 1.35-3.26) were significant predictors of premature death. Age at first court conviction remained a significant predictor for death in all cause specific multivariable mortality analyses. In addition, having committed drug related crimes and high crime diversity were strong predictors for substance related deaths. Males did more often die in accidents or commit suicide. Somatic deaths were most often encountered in the oldest cohort. Incarceration did not remain a significant predictor for premature death in any of the multivariable analyses. Measures intended to prevent premature death in convicted offenders should target wider populations than hitherto acknowledged.

Copyright 2010, Springer

Landberg J. Population drinking and fatal injuries in Eastern Europe: A time-series analysis of six countries. European Addiction Research 16(1): 43-52, 2010. (38 refs.)

Aims: To estimate to what extent injury mortality rates in 6 Eastern European countries are affected by changes in population drinking during the post-war period. Data and Methods: The analysis included injury mortality rates and per capita alcohol consumption in Russia, Belarus, Poland, Hungary, Bulgaria and the former Czechoslovakia. Total population and gender-specific models were estimated using auto regressive integrated moving average time-series modelling. Results: The estimates for the total population were generally positive and significant. For Russia and Belarus, a 1-litre increase in per capita consumption was associated with an increase in injury mortality of 7.5 and 5.5 per 100,000 inhabitants, respectively. The estimates for the remaining countries ranged between 1.4 and 2.0. The gender-specific estimates displayed national variations similar to the total population estimates although the estimates for males were higher than for females in all countries. Conclusions: The results suggest that changes in per capita consumption have a significant impact on injury mortality in these countries, but the strength of the association tends to be stronger in countries where intoxication-oriented drinking is more common.

Copyright 2010, Karger

Leung SY. Benzodiazepines, opioids and driving: An overview of the experimental research. Drug and Alcohol Review 30(3): 281- 286, 2011. (53 refs.)

Issues. Road crashes contribute significantly to the total burden of injury in Australia, with the risk of injury being associated with the presence of drugs and/or alcohol in the driver's blood. Increasingly, some of the most commonly detected drugs include prescription medicines, the most notable of these being benzodiazepines and opioids. However, there is a paucity of experimental research into the effects of prescribed psychoactive drugs on driving behaviours. Approach. This paper provides an overview of experimental studies investigating the effects of prescribed doses of benzodiazepines and opioids on driving ability, and points to future directions for research. Key Findings. There is growing epidemiological evidence linking the therapeutic use of benzodiazepines and opioids to an increased crash risk. However, the current experimental literature remains unclear. Limitations to study methodologies have resulted in inconsistent findings. Implications. Limited experimental evidence exists to inform policy and guidelines regarding fitness-to-drive for patients taking prescribed benzodiazepines and opioids. Conclusion. Further experimental research is required to elucidate the effects of these medications on driving, under varying conditions and in different medical contexts. This will ensure that doctors prescribing benzodiazepines and opioids are well informed, and can appropriately advise patients of the risks associated with driving whilst taking these medications.

Copyright 2011, Wiley-Blackwell

Li GH; Baker SP; Zhao Q; Brady JE; Lang BH; Rebok GW et al. Drug violations and aviation accidents: Findings from the US mandatory drug testing programs. Addiction 106(7): 1287-1292, 2011. (26 refs.)

Aims: To assess the role of drug violations in aviation accidents. Design: Case-control analysis. Setting: Commercial aviation in the United States. Participants: Aviation employees who were tested for drugs during 1995-2005 under the post-accident testing program (cases, n = 4977) or under the random testing program (controls, n = 1 129 922). Measurements Point prevalence of drug violations, odds ratio of accident involvement and attributable risk in the population. A drug violation was defined as a confirmed positive test for marijuana (>= 50 ng/ml), cocaine (>= 300 ng/ml), amphetamines (>= 1000 ng/ml), opiates (>= 2000 ng/ml) or phencyclidine (>= 25 ng/ml). Findings The prevalence of drug violations was 0.64% [95% confidence interval (CI): 0.62-0.65%] in random drug tests and 1.82% (95% CI: 1.47-2.24%) in post-accident tests. The odds of accident involvement for employees who tested positive for drugs was almost three times the odds for those who tested negative (odds ratio 2.90, 95% CI: 2.35-3.57), with an estimated attributable risk of 1.2%. Marijuana accounted for 67.3% of the illicit drugs detected. The proportion of illicit drugs represented by amphetamines increased progressively during the study period, from 3.4% in 1995 to 10.3% in 2005 (P < 0.0001). Conclusions: Use of illicit drugs by aviation employees is associated with a significantly increased risk of accident involvement. Due to the very low prevalence, drug violations contribute to only a small fraction of aviation accidents.

Copyright 2011, Society for the Study of Addiction

Livingston M; Matthews S; Barratt MJ; Lloyd B; Room R. Diverging trends in alcohol consumption and alcohol-related harm in Victoria. Australian and New Zealand Journal of Public Health 34(4): 368-373, 2010. (32 refs.)

Objective: To examine recent trends in alcohol-related harm and risky drinking in Victoria, Australia. Methods: The study compiled eight measures of alcohol-related harm from published and unpublished sources, covering data relating to health, crime, alcohol treatment and traffic crashes for the financial years 1999/2000 to 2007/08. In addition, published estimates of short and long-term risky drinking from three-sets of surveys between 2001 and 2007 were examined. Results: Six of the eight harm indicators substantially increased, while only alcohol-related mortality and single-vehicle night-time crashes remained relatively stable. In particular, rates of emergency presentations for intoxication and alcohol-related ambulance attendances increased dramatically. Contrastingly, survey-derived estimates of the rate of risky-drinking among Victorians were stable over the time-period examined. Conclusions: Evidence across the data examined suggests significant increases in alcohol-related harm taking place during a period of relatively stable alcohol consumption levels. This disparity may be accounted for by changing drinking patterns among small, high-risk, subgroups of the population. Implications: The sharply increasing rates of alcohol-related harm among Victorians suggest that changes to alcohol policies focusing on improving public health are necessary.

Copyright 2010, Public Health Association of Australia

MacLeod JBA; Hungerford DW. Alcohol-related injury visits: Do we know the true prevalence in US trauma centres? Injury 41(7): 847-851, 2010. (37 refs.)

Introduction: Alcohol consumption is a significant risk factor for injuries. Further, level I trauma centres are mandated to screen and provide a brief intervention for identified problem drinkers. However, a valid population-based estimate of the magnitude of the problem is unknown. Therefore, the goal of this study is to evaluate the extent to which the present literature provides a valid estimate of the prevalence of alcohol-related visits to U.S. trauma centres. Methods: A Medline search for all articles from 1966 to 2007 that might provide prevalence estimates of alcohol-related visits to U.S. trauma centres yielded 836 articles in English language journals. This review included only papers whose main or secondary goal was to estimate the prevalence of positive blood alcohol concentration (BAC) or acute intoxication. Both a crude aggregate estimate and sample size adjusted estimate were calculated from the included papers and the coverage and comparability of methods were evaluated. Results: Of the 15 studies that met inclusion criteria, incidence estimates of alcohol-related visits ranged from 26.2% to 62.5% and yielded an aggregate, weighted estimate of 32.5%. Target population, capture rate, and threshold for a positive screening result varied considerably across studies. No study provided a comprehensive estimate, i.e., of all trauma patients hospitalised, treated and released, or who died. Conclusions: Although the incidence of alcohol-related visits to U.S. trauma centres appears very high perhaps higher than any other medical setting, the validity of our aggregate estimate is threatened by crucial methodological considerations. The lack of a methodologically valid prevalence estimate hinders efforts to devise appropriate policies for trauma centres and across medical settings.

Copyright 2010, Elsevier Science

Mann RE; Stoduto G; Butters J; Ialomiteanu A; Boase P; Asbridge M et al. Age group differences in collision risk. Journal of Safety Research 41(5): 445-449, 2010. (26 refs.)

Introduction: The purpose of the current study was to examine differences in factors associated with self-reported collision involvement of three age groups of drivers based on a large representative sample of Ontario adults. Method: This study was based on data from the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults 18 years and older from 2002 to 2005. Three age groups were examined: 18-34 (n = 1,294), 35-54 (n = 2,428), and 55+ (n = 1,576). For each age group sample, a logistic regression analysis was conducted of self-reported collision involvement in the last 12 months by risk factor measures of driving exposure (kilometers driven in a typical week, driving is stressful, and driving on busy roads), consuming five or more drinks of alcohol on one occasion (past 12 months), cannabis use (lifetime, and past 12 months), and driving after drinking among drinkers (past 12 months), controlling for demographics (gender, region, income, and marital status). Results: The study identified differences in factors associated with self-reported collision involvement of the three age groups of adult drivers. The logistic regression model for the youngest group revealed that drivers who reported that driving was stressful at least some of the time, drank five or more drinks on an occasion, and drove after drinking had an increased risk of collision involvement. For the middle age group, those who reported using cannabis in the last 12 months had significantly increased odds of reporting collision involvement. None of the risk factor measures showed significant associations with collision risk for older drivers (aged 55+). Impact: The results suggest potential areas for intervention and new directions for future research.

Copyright 2010, National Safety Council

Mann RE; Stoduto G; Vingilis E; Asbridge M; Wickens CM; Ialomiteanu A et al. Alcohol and driving factors in collision risk. Accident Analysis and Prevention 42(6): 1538-1544, 2010. (51 refs.)

In this study we examine the effect of several alcohol-related measures on self-reported collision involvement within the previous 12 months while controlling for demographic and driving exposure factors based on a large representative sample of adults in Ontario. Data are based on the 2002-2006 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older (n = 8542). Three logistic regressions of self-reported collision involvement in the past 12 months were implemented, each consisting of 3 steps: (1) demographic factors and driving exposure entered, (2) driving after drinking within the last 12 months entered, and (3) one of three alcohol-related measures (AUDIT subscales of alcohol consumption, dependence and problems) entered. In each step, measures from the preceding step were included in order to control for those variables. In Step 1, age (OR = 0.989), region overall, Central East region (OR = 0.71), West region (OR = 0.67), and North region (OR = 0.67), income overall and those who did not state income (OR = 0.64), marital status overall and those married or living common law (OR = 0.60), and number of kilometers driven in a typical week (OR = 1.00) were found to be significant predictors of collision involvement. The analyses revealed that driving after drinking was a significant predictor of collision involvement in Step 2 (OR = 1.51) and each of the Step 3 models (ORs = 1.52, 1.37, 1.34). The AUDIT Consumption subscale was not a significant factor in collision risk. Both the AUDIT Dependence and AUDIT Problems subscales were significantly related to collision risk (ORs 1.13 and 1.10, respectively). These findings suggest that alcohol, in addition to its effects on collision risk through its acute impairment of driving skills, may also affect collision risk through processes involved when individuals develop alcohol problems or alcohol dependence.

Copyright 2010, Elsevier Science

Martin ND; Grabo DJ; Tang LL; Sullivan J; Kaulback KR; Weinstein MS et al. Are roadside pedestrian injury patterns predictable in a densely populated, urban setting? Journal of Surgical Research 163(2): 323-326, 2010. (13 refs.)

Background. Roadside pedestrian injuries represent a significant portion of trauma team activations, especially at urban trauma centers. Patient demo-graphics and severity of injury vary greatly in this patient population. Herein, we hypothesize that injury patterns may be predictable, especially with respect to age. Materials and Methods. All patients with roadside pedestrian injuries evaluated at our urban, level one trauma center from January 2006 through December 2008 were retrospectively reviewed. Data were collected from the institutional trauma registry. Age was used as an independent variable and compared with injury type, substance abuse, discharge setting, and mortality. Results. There were 226 roadside pedestrian injuries during the study period. Patients were divided into groups according to age, under 20 y, 21-40 y, 4165 y, and over 65 y. Head injuries were more prevalent in patients over age 65, 30.4% versus 14.0% (P = 0.05). There was a trend for increasing alcohol use in the younger population. The likelihood of discharge to a rehab facility increased with age, 0%, 11.8%, 38.2%, 50.0%, respectively (P < 0.001). Mortality was significantly higher in patients older than 65 y, 15.2% versus 3.3% (P = 0.049). Conclusions. Roadside pedestrian injuries have predictable injury patterns based on age. Older patients are more likely to have a head injury, longer length of stay, need for a rehab stay, and have a higher mortality. Further studies are needed to correlate precise injuries with collision mechanism and evaluate specific risk factors in this high risk population.

Copyright 2010, Elsevier Science

McCartt AT; Hellinga LA; Kirley BB. The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States. Journal of Safety Research 41(2): 173-181, 2010. (74 refs.)

Objective: To examine trends in alcohol consumption and alcohol-related crashes among people younger than 21 in the United States and to review evidence on the effects of minimum legal drinking age (MLDA) laws. Methods: Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed. Results: MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970s. and most of the decline occurred by the early 1990 S. These were the years when states were establishing, or reinstating, a MLDA-21. Among fatally injured drivers ages 16-20, the percentage with positive BACs declined from 61% in 1982 to 31% in 1995, a bigger decline than for older age groups: declines occurred among the ages directly affected by raising MLDAs (ages 18-20) and among young teenagers not directly affected (ages 16-17). Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking. Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21. Conclusions: The cause and effect relationship between MLDAs of 21 and reductions in highway crashes is clear. Initiatives to lower the drinking age to 18 ignore the demonstrated public health benefits of MLDAs of 21. Impact on Industry: Lowering the drinking age to 18 will increase highway crash deaths among young people.

Copyright 2010, Elsevier Science

Mclaughlin M. Alcohol-associated illness and injury and ambulance calls in a midwestern college town: A four-year retrospective analysis. Prehospital Emergency Care 14(4): 485-490, 2010. (9 refs.)

Background. Alcohol is often a factor in illness and injury among college-aged individuals. Ambulance services responding to 9-1-1 calls in college towns regularly encounter patients who have consumed alcohol to the point of intoxication and subsequently suffered an injury or experienced an illness necessitating prehospital emergency care. Objectives. The first objective was to review ambulance calls in a Midwestern college town in order to identify patterns or trends related to alcohol consumption. Another objective was to determine to what extent, if any, underage drinking was a factor in these calls. A final objective was to determine whether there were types of illness or injuries related to 9-1-1 calls that were involved with alcohol consumption among college-aged students. Methods. This was a retrospective study using secondary data of four years of ambulance calls that occurred in a specific geographic region of a college town. All patient care reports (PCRs) included alcohol consumption as a pertinent factor in the call. Data were de-identified and in some cases aggregated to ensure confidentiality. Descriptive statistics were used to identify prevalence and incidence of injury and illness and patient demographics. Results. Of the ambulance calls for service in the geographic area, 44.4% to 45.8% identified as "downtown" had alcohol consumption as a reported factor in the PCR. The number of calls for service that involved patients below the legal drinking age (21 years) was small but increased between 2004 and 2007. Calls involving male patients made up the majority of calls with alcohol as a factor. The majority of alcohol-related calls for service were for traumatic injuries, sexual assaults and rapes, poisonings or drug ingestions, and altered levels of consciousness. Conclusion. Alcohol consumption was a comorbid factor in illness and injury that necessitated prehospital emergency medical care in one Midwestern college town. Further research is needed to determine whether these results can be generalized beyond this one geographic location or if causality can be determined between alcohol consumption and injuries or illnesses that lead to emergency medical services calls.

Copyright 2010, Taylor & Francis

Meuleners LB; Duke J; Lee AH; Palamara P; Hildebrand J; Ng JQ. Psychoactive medications and crash involvement requiring hospitalization for older drivers: A population-based study. Journal of the American Geriatrics Society 59(9): 1575-1580, 2011. (46 refs.)

Objectives: To determine the association between psychoactive medications and crash risk in drivers aged 60 and older. Design: Retrospective population-based case-crossover study. Setting: A database study that linked the Western Australian Hospital Morbidity Data System and the Pharmaceutical Benefits Scheme. Participants: Six hundred sixteen individuals aged 60 and older who were hospitalized as the result of a motor vehicle crash between 2002 and 2008 in Western Australia. Measurements: Hospitalization after a motor vehicle crash. Results: Greater risk for a hospitalization crash was found for older drivers prescribed benzodiazepines (odds ratio (OR) = 5.3, 95% confidence interval (CI) = 3.6-7.8, P < .001), antidepressants (OR = 1.8, 95% CI = 1.0-3.3, P = .04), and opioid analgesics (OR = 1.5, 95% CI = 1.0-2.3, P = .05). Crash risk was significantly greater in men prescribed a benzodiazepine (OR = 6.2, 95% CI = 3.2-12.2, P < .001) or an antidepressant (OR = 2.7, 95% CI = 1.1-6.9, P = .03). Women prescribed benzodiazepines (OR = 4.9, 95% CI = 3.1-7.8, P < .001) or opioid analgesics (OR = 1.8, 95% CI = 1.1-3.0, P = .03) also had a significantly greater crash risk. Subgroup analyses further suggested that drivers with (OR = 4.0, 95% CI = 2.9-8.1, P < .001) and without (OR = 6.0, 95% CI = 3.8-9.5, P < .001) a chronic condition who were prescribed benzodiazepines were at greater crash risk. Drivers with a chronic condition taking antidepressants (OR = 3.4, 95% CI = 1.3-8.5, P = .01) also had a greater crash risk. CONCLUSION: Psychoactive medication usage was associated with greater risk of a motor vehicle crash requiring hospitalization in older drivers.

Copyright 2011, Wiley-Blackwell

Mrazova K; Navratil T; Pelclova D. Use and accidental exposure to hallucinogenic agents reported to the Czech Toxicological Information Centre from 1995 to 2008. Substance Use & Misuse 46(4): 460-465, 2011. (24 refs.)

Intoxication by hallucinogenic agents is relatively common in the Czech Republic, with most cases of the use of these agents being by adolescents and young people. The objective of the study was to evaluate the number, trends, gender and age of the subjects, and the severity of exposure in intoxication by hallucinogenic plant and mushroom substances, in comparison with synthetic drugs, brought to the attention of the Toxicological Information Centre (TIC) through inquiries over the past 14 years (1995--2008) (from total 3,702 calls concerning the use of both natural and synthetic drugs, 917 calls were due to the use of hallucinogenic plants and mushrooms).

Copyright 2011, Informa Healthcare

Murphy DA; Shetty V; Zigler C; Researchell J; Yamashita DD. Willingness of facial injury patients to change causal substance using behaviors. Substance Abuse 31(1): 35-42, 2010. (21 refs.)

Many injuries due to interpersonal violence among patients presenting to urban trauma centers for treatment are preventable, with alcohol and illicit drug use presenting as common antecedent risk factors. However, many patients with such problems do not seek treatment. Substance use patients were surveyed to determine how many recognized they had a problem and whether they had previously received treatment for substance use problems. Almost 60% of the patients treated for a facial injury screened for problem alcohol use, and slightly more than 25% screened for problem drug use. Only approximately one third of patients indicated any movement towards dealing with these problems and of these, only 20% had actually sought treatment. Employment had an effect on treatment seeking, with fewer employed patients seeking help. Utilizing the critical window of opportunity for emergency department (ED) personnel to make referrals may have an impact on treatment seeking for problem level substance use.

Copyright 2010, Taylor & Francis

Nagata-Kobayashi S; Koyama H; Asai A; Noguchi Y; Maeno T; Fukushima O et al. Experiences of alcohol-related harassment among medical students. Medical Education 44(12): 1213-1223, 2010. (30 refs.)

Objectives: Although fatal accidents caused by alcohol-related harassment occur frequently among college students, this issue has not been adequately examined. This study set out to investigate the prevalence of alcohol-related harassment among medical students in Japan. Methods: A multi-institutional, cross-sectional survey was carried out across seven medical schools in Japan. A self-report anonymous questionnaire was distributed to 1152 medical students; 951 respondents (82.6%) satisfactorily completed it. From the responses, we determined the reported prevalences of the following types of alcohol-related harassment among medical students by senior medical students or doctors: (i) being coerced into drinking alcohol; (ii) being compelled to drink an alcoholic beverage all at once (the ikki drinking game); (iii) being deliberately forced to drink until unconscious, and (iv) being subjected to verbal abuse, physical abuse or sexual harassment in relation to alcohol. The prevalence of becoming a harasser among medical students was also measured. Multivariate regressions were used to assess the associations between experiences of alcohol-related harassment and student characteristics. Results: A total of 821 respondents (86.3%) had experienced alcohol-related harassment and 686 (72.1%) had harassed others. Experiences of the ikki drinking game were frequently reported by both victims (n = 686, 72.1% of all respondents) and harassers (n = 595, 62.6% of all respondents). In multivariate regression, having an experience of alcohol-related harassment correlated with both being harassed (odds ratio [OR] 14.22, 95% confidence interval [CI] 8.73-23.98) and being a harasser (OR 13.19, 95% CI 8.05-22.34). The pres-ence of senior members of medical college clubs who were regular drinkers also correlated with both being harassed (OR 2.96, 95% CI 1.88-4.67) and being a harasser (OR 2.97, 95% CI 2.06-4.27). Conclusions: Alcohol-related harassment among medical students is common and tends to occur at drinking parties with senior college club members. Hence, one of the most important strategies for preventing alcohol-related harassment may be to disrupt this vicious cycle.

Copyright 2010, Wiley-Blackwell

Nelson AL; Groer S; Palacios P; Mitchell D; Sabharwal S; Kirby RL et al. Wheelchair-related falls in veterans with spinal cord injury residing in the community: A prospective cohort study. Archives of Physical Medicine and Rehabilitation 91(8): 1166-1173, 2010. (44 refs.)

Objectives: (1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment. Design: This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records. Setting: Three Veterans' Administration hospitals. Participants: Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702). Interventions: Not applicable. Main Outcome Measures: Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment. Results: Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls. Conclusions: This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment.

Copyright 2010, WB Saunders

O'Connor RJ; Fix BV; Hammond D; Giovino GA; Hyland A; Fong GT et al. The impact of reduced ignition propensity cigarette regulation on smoking behaviour in a cohort of Ontario smokers. Injury Prevention 16(6): e-article 10.1136/ip.2009.025114, 2010. (16 refs.)

This study examined the degree to which legislation intended to reduce the incidence of cigarette-caused fires influenced the behaviours of a cohort of smokers in Ontario. A random digit dialled telephone survey of adult smokers residing in Ontario was conducted in 2005, ending 1 month prior to the reduced ignition propensity (RIP) regulation's implementation date. A follow-up survey was conducted one year later. Of the baseline participants, 73.0% (n=435) completed the follow-up survey. The frequency of fire risk behaviours was similar across both surveys. At baseline, only 3.7% of smokers interviewed reported that their cigarettes went out on their own 'often' while smoking. Following the implementation of the reduced ignition propensity legislation, this increased significantly to 14.7%. Results suggest that the proportion of Ontario smokers who reported engaging in behaviour such as leaving a cigarette burning unattended and smoking in bed actually declined, although these declines were not statistically significant across all measures of fire risk.

Copyright 2010, B M J Publishing Group

O'Neill TB; Rawlins JM; Rea S; Wood FM. Methamphetamine laboratory-related burns in Western Australia - Why the explosion? Burns 37(6): 1044-1048, 2011. (19 refs.)

Introduction: With increasing numbers of illicit drug users in both urban and rural communities, users and producers are becoming increasingly enterprising in their sourcing of mind altering drugs. An example of this is the 'amateur' production of methamphetamine in domestic dwellings. We describe the mechanism of burn seen in methamphetamine production, the pattern of clinical injury, and the difficulties in treating these patients. Methods: A 12 month retrospective study of five patient groups presenting to our burn service with injuries following methamphetamine laboratory explosion. Results: Out of five patient groups we have treated 9 individual patients (with one patient presenting on two different occasions) with burns following methamphetamine laboratory explosion. All patients were male and required hospital admission. The cause of the explosive injury was initially reported as barbeque or oven related, :assault, or accident in all patients. Two patients (in separate events) required intubation for associated inhalation injury. Burn size varied from 1% to 40% BSA. 7 patients required surgical debridement and skin grafting. Injury type was thermal and chemical. All patients had difficult follow-up due to low levels of clinic attendance. Conclusion: Methamphetamine laboratory explosion burns are difficult injuries from the start. Invariably the true circumstances surrounding the injury are not clear, and clinicians should be suspicious of a meth lab explosion in suspect individuals with burns plus airway injury. Patient management is complex and often requires substantial analgesic and anxiolytic medication in conjunction with clinical psychology and psychiatry as an inpatient.

Copyright 2011, Elsevier Science

Opreanu RC; Kuhn D; Basson MD. Influence of alcohol on mortality in traumatic brain injury. (review). Journal of the American College of Surgeons 210(6): 997-1007, 2010. (133 refs.)

Traumatic brain injury (TBI) represents a major public health problem. Each year, 1.4 million people sustain TBIs in the United States; 235,000 patients are hospitalized and 50,000 die. The leading cause of TBI in the general population is falls, where rates are highest among children ages 0 to 4 years and among adults ages 75 years or older. Falls are followed closely by motor-vehicle crashes and assaults as overall causes of TBI. However, motor-vehicle crashes result in the greatest number of TBI-related deaths and hospitalizations. Alcohol contributes considerably to the morbidity and mortality of trauma patients, regardless of the type of injury suffered. Serum alcohol levels correlate closely with extent of injury. In 2006, alcohol intoxication was involved in 32% of fatal motor-vehicle crashes in the United States. Approximately half of the alcohol-related deaths in trauma occur in prehospital settings. Specifically in TBI, 35% to 81% of the injured patients are alcohol-intoxicated and 42% of TBI patients were heavy drinkers before injury. A study from the National Trauma Databank found similar rates. In contrast to the strong correlation between alcohol and prehospital mortality in TBI victims, the effects of alcohol on the outcomes of injured patients surviving the field and admitted to the hospital is less clear. Some clinical studies seem to suggest, surprisingly, a beneficial effect of alcohol in injured patients with TBI. This review analyzes basic research in animal models and available clinical information to provide a realistic perspective on the effect of alcohol on outcomes of patients admitted to the hospital with a diagnosis of TBI. Although high-dose alcohol can worsen TBI, low or moderate doses of alcohol can be neuroprotective. Various mechanisms have been suggested for this neuroprotective effect, including inhibition of N-methyl-D-aspartic acid receptors (NMDAr) or sympathetic response. We will review the extant data in support of these theories. Each study found lower mortality in intoxicated patients with TBI. Clinical studies tend to suggest a protective effect of pretraumatic alcohol intoxication on TBI outcomes, but such studies also have substantial limitations. Drinking patterns after TBI have recently received considerably more attention in the literature. In general, after TBI, alcohol drinking varies over time. Early in the recovery period, alcohol use tends to decline. Twenty to eighty percent of patients with previous alcohol abuse problems tend to stop abusing alcohol for at least a short period of time after TBI. However, many of these patients relapse into the alcohol abuse patterns of their preinjury period. Heavy drinking actually increases with time after TBI. Secondary prevention of alcohol abuse after TBI is as important as primary prevention and should be emphasized in the first month after the injury.

Copyright 2010, Elsevier Science

Orriols L; Delorme B; Gadegbeku B; Tricotel A; Contrand B; Laumon B et al. Prescription medicines and the risk of road traffic crashes: A French registry-based study. PLoS Medicine 7(11): e-article 1000366, 2010. (32 refs.)

Background: In recent decades, increased attention has been focused on the impact of disabilities and medicinal drug use on road safety. The aim of our study was to investigate the association between prescription medicines and the risk of road traffic crashes, and estimate the attributable fraction. Methods and Findings: We extracted and matched data from three French nationwide databases: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers identified by their national health care number involved in an injurious crash in France, between July 2005 and May 2008, were included in the study. Medicines were grouped according to the four risk levels of the French classification system (from 0 [no risk] to 3 [high risk]). We included 72,685 drivers involved in injurious crashes. Users of level 2 (odds ratio [OR] = 1.31 [1.24-1.40]) and level 3 (OR = 1.25 [1.12-1.40]) prescription medicines were at higher risk of being responsible for a crash. The association remained after adjustment for the presence of a long-term chronic disease. The fraction of road traffic crashes attributable to levels 2 and 3 medications was 3.3% [2.7%-3.9%]. A within-person case-crossover analysis showed that drivers were more likely to be exposed to level 3 medications on the crash day than on a control day, 30 days earlier (OR = 1.15 [1.05-1.27]). Conclusion: The use of prescription medicines is associated with a substantial number of road traffic crashes in France. In light of the results, warning messages appear to be relevant for level 2 and 3 medications and questionable for level 1 medications. A follow-up study is needed to evaluate the impact of the warning labeling system on road traffic crash prevention.

Copyright 2010, Public Library of Science

Pedapati EV; Bateman ST. Toddlers requiring pediatric intensive care unit admission following at-home exposure to buprenorphine/naloxone. Pediatric Critical Care Medicine 12(2): E102-E107, 2011. (38 refs.)

Background: Sublingual buprenorphine is an alternative to methadone for office-based treatment of opioid dependence. Recent reports have examined a growing number of unintentional buprenorphine exposures in children resulting in significant toxicity, even after a single lick or taste of a sublingual tablet. Here, we report a series of unintentional buprenorphine exposures in toddlers over a 2.5-yr period that led to admission to the pediatric intensive care unit. Objectives: The goals of this study were to determine: 1) the prevalence of symptomatic buprenorphine exposure in children < 3 yrs of age; 2) the severity of toxicity associated with such exposures; and 3) effective clinical interventions. Methods and Main Results: A retrospective case review was performed on records from the pediatric intensive care unit at an academic medical center located in the northeastern United States. Unintentional buprenorphine/naloxone exposure (n = 9) accounted for the largest single fraction of toxic ingestions among patients younger than 3 yrs within the study period (9/33, 27%). All exposures occurred at the child's place of residence n = 9, 100%). Clinical signs of opioid toxicity were evident in all nine cases, with the most common symptom being drowsiness or lethargy (n = 9, 100%), followed by miosis (n = 6, 67%) and respiratory depression (n = 5, 56%). Six patients were effectively treated with naloxone (n = 6, 67%). Conclusions: The increased use and similarity to candy of the current formulation of buprenorphine pose a special risk to children, especially toddlers. Buprenorphine exposure in children < 3 yrs old can cause significant opioid toxidrome. Naloxone is an effective agent for reversal of symptoms; however, given buprenorphine's high affinity and long action, higher doses or continuous infusion may be required. Adults on buprenorphine should be educated on the risks posed to young children in their household and the appropriate storage of medication.

Copyright 2011, Lippincott, Williams & Wilkins

Pereira RE; Perdona GDC; Zini LC; Cury MBS; Ruzzene MAM; Martin CCS et al. Relation between alcohol consumption and traffic violations and accidents in the region of Ribeirao Preto, Sao Paulo State. Forensic Science International 207(1-3): 164-169, 2011. (37 refs.)

In recent years, alcohol consumption has been considered an important public health problem. Ethanol, the alcohol used in beverages, is a drug that affects the central nervous system (CNS) and impairs driving skills and co-ordination, increasing risk of deaths and injuries derived from crashes and road accidents. Consumption of alcoholic beverages is implicated with premature deaths, injuries and damages caused by motor vehicle crashes, which result in high costs to government and society. Considering that alcohol consumption is the main responsible factor for deaths and disabilities in young people, the aim of this work was to evaluate the prevalence of blood alcohol in offenders and/or fatal and non-fatal victims of traffic occurrences in the region of Ribeirao Preto, Sao Paulo State, from 2005 to 2007. The results revealed that in 2134 cases investigated, blood alcohol positivity was generally found in young adults, 25-45 years old and male. The study showed the high risk of drinking and driving and the importance in establishing actions of prevention and intervention to promote the reduction in the number of traffic occurrences related to consumption of alcoholic beverages.

Copyright 2011, Elsevier Science

Petraglia AL; Huang JH; Amenta PS; Jallo JI. Anabolic steroids and head injury. Comments. Neurosurgery 70(1): 209-210, 2012. (0 refs.)

Phillips DP; Brewer KM. The relationship between serious injury and blood alcohol concentration (BAC) in fatal motor vehicle accidents: BAC=0.01% is associated with significantly more dangerous accidents than BAC=0.00%. Addiction 106(9): 1614-1622, 2011. (34 refs.)

Aim: To analyze the severity of automotive injuries associated with blood alcohol concentration (BAC) in increments of 0.01%. Design/setting: Epidemiological study using the Fatality Analysis Reporting System. Participants: All people in US fatal automotive accidents, 1994-2008 (n = 1 495 667). Measurements The ratio of serious: non-serious injuries for drivers, by BAC. Findings Accident severity increases significantly even when the driver is merely 'buzzed', a finding that persists after standardization for various confounding factors. Three mechanisms mediate between buzzed driving and high accident severity: compared to sober drivers, buzzed drivers are significantly more likely to speed, to be improperly seatbelted and to drive the striking vehicle. In addition, there is a strong 'dose-response' relationship for all three factors in relation to accident severity (e. g. the greater the BAC, the greater the average speed of the driver and the greater the severity of the accident). Conclusions: The severity of life-threatening motor vehicle accidents increases significantly at blood alcohol concentrations (BACs) far lower than the current US limit of 0.08%. Lowering the legal limit could save lives, prevent serious injuries and reduce financial and social costs associated with motor vehicle accidents.

Copyright 2011, Society for the Study of Addiction to Alcohol and Other Drugs

Pizza F; Contardi S; Antognini AB; Zagoraiou M; Borrotti M; Mostacci B et al. Sleep quality and motor vehicle crashes in adolescents. Journal of Clinical Sleep Medicine 6(1): 41-45, 2010. (40 refs.)

Study objectives: Sleep-related complaints are common in adolescents, but their impact on the rate of motor vehicle crashes accidents is poorly known. We studied subjective sleep quality, driving habits, and self-reported car crashes in high-school adolescents. Methods: Self-administered questionnaires (with items exploring driving habits) were distributed to 339 students who had a driver's license and attended 1 of 7 high schools in Bologna, Italy. Statistical analysis were performed to describe lifestyle habits, sleep quality, sleepiness, and their relationship with the binary dependent variable (presence or absence of car crashes) to identify the factors significantly affecting the probability of car crashes in a multivariate binary logistic regression model. Results: Nineteen percent of the sample reported bad sleep, 64% complained of daytime sleepiness, and 40% reported sleepiness while driving. Eighty students (24%), 76% of which were males, reported that they had already crashed at least once, and 15% considered sleepiness to have been the main cause of their crash. As compared with adolescents who had not had a crash, those who had at least 1 previous crash reported that they more frequently used to drive (79% vs 62%), drove at night (25% vs 9%), drove while sleepy (56% vs 35%), had bad sleep (29% vs 16%), and used stimulants such as caffeinated soft drinks (32% vs 19%), tobacco (54% vs 27%), and drugs (21% vs 7%). The logistic procedure established a significant predictive role of male sex (p < 0.0001; odds ratio = 3.3), tobacco use (p < 0.0001; odds ratio = 3.2), sleepiness while driving (p 0.010; odds ratio = 2.1), and bad sleep (p = 0.047; odds ratio 1.9) for the crash risk. Conclusions: Our results confirm the high prevalence of sleep-related complaints among adolescents and highlight their independent role on self-reported crash risk.

Copyright 2010, American Academy of Sleep Medicine

Ravera S; van Rein N; de Gier JJ; de Jong-van den Berg LTW. Road traffic accidents and psychotropic medication use in the Netherlands: A case-control study. British Journal of Clinical Pharmacology 72(3): 505-513, 2011. (57 refs.)

Aim: To examine the association between the use of commonly prescribed psychotropic medications and road traffic accident risk. Methods: A record-linkage database was used to perform a case-control study in the Netherlands. The data came from three sources: pharmacy prescription data, police traffic accident data and driving licence data. Cases were defined as drivers, who had a traffic accident that required medical assistance between 2000 and 2007. Controls were defined as adults, who had a driving licence and had no traffic accident during the study period. Four controls were matched for each case. The following psychotropic medicine groups were examined: antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants stratified in the two groups, SSRIs and other antidepressants. Various variables, such as age, gender, medicine half-life and alcohol use, were considered for the analysis. Results: Three thousand nine hundred and sixty-three cases and 18 828 controls were included in the case-control analysis. A significant association was found between traffic accident risk and exposure to anxiolytics (OR = 1.54, 95% CI 1.11, 2.15), and SSRIs (OR = 2.03, 95% CI 1.31, 3.14). A statistically significant increased risk was also seen in chronic anxiolytic users, females and young users (18 to 29 years old), chronic SSRI users, females and middle-aged users (30 to 59 years old), and intermediate half-life hypnotic users. Conclusions: The results of this study support previous findings and confirm that psychoactive medications can constitute a problem in traffic safety. Both health care providers and patients should be properly informed of the potential risks associated with the use of these medicines.

Copyright 2011, Wiley-Blackwell

Rehm J; Baliunas D; Borges GLG; Graham K; Irving H; Kehoe T et al. The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction 105(5): 817-843, 2010. (277 refs.)

Aims: As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. Methods: Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. Results: Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose-response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. Conclusions: Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol-disease relationships.

Copyright 2010, Society for the Study of Addiction to Alcohol and Other Drugs

Romano E; Voas RB. Drug and alcohol involvement in four types of fatal crashes. Journal of Studies on Alcohol and Drugs 72(4): 567-576, 2011. (22 refs.)

Objective: The aim of this study was to explore the relationship of drunk and drugged driving to the occurrence of fatal crashes associated with speeding, failure to obey/yield, inattention, and seat belt nonuse. Method: We examined data for fatally injured drivers involved in single-vehicle crashes killed in states in which more than 79% of the drivers were tested for drugs other than alcohol and had a known result. Results: About 25% of the drivers tested positive for drugs, a figure almost double that estimated by the 2007 National Roadside Survey. Cannabinoids and stimulants each contributed to about 23% of the drug-positive results (6% among all fatally injured single-vehicle drivers). Stimulants more than cannabinoids were found to be associated with the four types of crashes under study. Some drugs showed a protective effect over the four crash types under study. Significant interactions between drugs and alcohol were observed. Stimulants contributed to the different types of fatal crashes irrespective of the levels of alcohol consumed by the drivers. Conclusions: This study provides further evidence of a link between drug consumption and fatal crashes. It also opens the door to some interesting and sometimes unexpected questions regarding the way drugs contribute to crashes, which we found varies depending on the type of crash considered, the class of drug, and the presence of alcohol. Research is also needed on drugs that could have a protective effect on the occurrence of fatal crashes. These findings could be highly relevant to the design of drug-related traffic laws and programs targeted at curbing drugged driving.

Copyright 2011, Alcohol Research Documentation

Ronen A; Chassidim HS; Gershon P; Parmet Y; Rabinovich A; Bar-Hamburger R et al. The effect of alcohol, THC and their combination on perceived effects, willingness to drive and performance of driving and non-driving tasks. Accident Analysis and Prevention 42(6): 1855-1865, 2010. (37 refs.)

Background: Driving under the influence of drugs (DUID) is one of the main causes of car accidents. Alcohol and marijuana are the most popular drugs among recreational users. Many classify these drugs as "Light" drugs and therefore allow themselves to drive after consuming them. Objective: The study had two main objectives: 1) to investigate the effect of alcohol (BAC = 0.05%), THC (13 mg) and their combination on driving and non-driving tasks. 2) to investigate the extent to which people are willing to drive based on their subjective sensations and their perceived effects of the drugs. Method: 7 healthy men and 5 healthy women, ages 24-29, all recreational users of alcohol and marijuana, completed 5 experimental sessions. Sessions included: drinking and smoking placebo, drinking alcohol and smoking placebo, drinking placebo and smoking THC, drinking alcohol and smoking THC, drinking placebo and smoking placebo 24 hours after drinking alcohol and smoking THC. Three types of measures were used: subjective perceptions (with questionnaires), performance parameters of the driving and non-driving tasks (arithmetic task and a secondary target detection task) and physiological changes (heart rate). Results: Overall, the combination of alcohol and THC had the most intense effect after intake. This effect was reflected in performance impairments observed in the driving and non-driving tasks, in the subjective sensations after intake, and in the physiological measures. Despite significant differences in the size of the effects after the various treatments, there were no differences in the distances subjects were willing to drive while under the influence on each of the treatments.

Copyright 2010, Elsevier Science

Rossat A; Fantino B; Bongue B; Colvez A; Nitenberg C; Annweiler C et al. Association between benzodiazepines and recurrent falls: A cross-sectional elderly population-based study. Journal of Nutrition, Health & Aging 15(1): 72-77, 2011. (31 refs.)

Background: While the association between benzodiazepines (BZD) and single fall is long-known, the association between BZD and recurrent falls has been few studied. Objective: The aims of this study were 1) to examine whether BZD were associated with recurrent falls while taking into account the effect of potential confounders, and 2) to determine whether there was an interaction in terms of risk of falls between BZD and balance impairment in a community-dwelling population-based adults aged 65 and older. Study design: Cross-sectional. Setting: Three health centers in North-East of France. Population: 7643 community-dwelling volunteers aged 65 and older. Outcome measures: The use of BZD, the Mini Mental State Examination (MMSE) score, the Clock Drawing Test (CDT), the One Leg Balance (OLB) test, the Five Times Sit-To-Stand test (FTSS), and a history of falls were recorded. Subjects were separated into 4 groups based on the number of falls: 0, 1, 2 and >= 3 falls. Results: Among the 1456 (19.2%) fallers, 994 (13.0%) were single fallers and 462 (6.1%) were recurrent fallers (i.e., > 2 falls). The number of falls increased significantly with age (Incident Rate Ratio (IRR) = 1.04, P < 0.001), female gender (IRR = 2.24, P < 0.001), the use of benzodiazepine (IRR = 1.65 P < 0.001) and especially while subjects used bromazepam (IRR = 1.44, P = 0.006), clobazam (IRR = 3.01, P = 0.014) and prazepam (IRR = 2.29, P < 0.001). A low MMSE score (IRR = 0.96, P < 0.001), an impaired CDT (IRR = 0.91, P < 0.001), and a bad performance at OLB and FTSS (respectively IRR = 1.85, P < 0.001 and IRR = 1.26, P < 0.001) were related to the recurrence of falls. After adjustment only the advance in age (IRR = 1.02, P < 0.001), female gender (IRR = 2.15, P < 0.001), clobazam (IRR = 2.54, P = 0.04), prazepam (IRR = 1.63, P = 0.03) and OLB (IRR = 1.55, P < 0.001) were still significantly related to the number of falls. Conclusion: The current study shows that the age, the female gender, the use of clobazam or prazepam and a low score at OLB are related to the recurrence of falls.

Copyright 2011, Springer

Schutte C; Hanks R. Impact of the presence of alcohol at the time of injury on acute and one-year cognitive and functional recovery after traumatic brain injury. International Journal of Neuroscience 120(8): 551-556, 2010. (23 refs.)

The presence of alcohol is clearly a risk factor for sustaining a traumatic brain injury (TBI); however, the impact of alcohol on injury severity, and functional or cognitive outcome is unclear, as there is mixed evidence in the literature. This study examined 482 participants in a large urban medical center with documented mild-complicated to severe TBI and blood alcohol testing for functional and cognitive outcome. Functional outcomes were measured by the Functional Independence Measure (FIM) and cognitive outcomes were measured using neuropsychological tests known to be sensitive to the sequelae of TBI. Consistent with the hypotheses, there was a statistically significant negative impact of alcohol intoxication at the time of injury on Glasgow Coma Scale (GCS); however intoxication only lowered GCS by an average of 1.9 points. There was a statistically significant relationship between blood alcohol levels (BAL) and FIM at the time of admission to inpatient rehabilitation, but BAL accounted for only 3% of the variance in FIM total score. There was no relationship between BAL and FIM at discharge from rehabilitation or at 1-year follow-up. There was no statistically significant relationship between BAL at the time of injury and cognitive functioning at 1-year follow-up; however, contrary to the hypotheses GCS failed to show a strong relationship with cognitive outcome.

Copyright 2010, Taylor & Francis

Seidenberg AB; Rees VW; Alpert HR; O'Connor RJ; Connolly GN. Ignition strength of 25 international cigarette brands. Tobacco Control 20(1): 77-80, 2011. (22 refs.)

Background: Cigarette-ignited fires are a leading cause of fire death and injury throughout the world and remain a global public health and safety problem. To reduce this harm, a small number of countries now require cigarettes to have reduced ignition propensity (RIP). It is not known if cigarette manufacturers are voluntarily introducing RIP cigarettes in other countries to help save lives. Methods Using the ASTM E2187-04 test method, per cent full length burn (%FLB) was measured for three popular brands from each of seven countries that did not have RIP legislation at the time of purchase. Results were compared with %FLB measurements from four popular US brands purchased in a jurisdiction (Vermont) with an RIP law. SRM 1082 reference cigarette was also tested to assure laboratory quality control. Results: All cigarette brands purchased in countries not requiring fire safety standards for cigarettes exceeded 75% FLB. In contrast, none of the cigarette brands from the USA exceeded 10% FLB. The SRM 1082 reference cigarette demonstrated 5% FLB. Conclusion Cigarette ignition propensity can be greatly reduced through legislation that requires cigarette fire safety standards. RIP cigarettes have the potential to significantly decrease the number of fire deaths, injuries and destruction of property caused by cigarette-ignited fires. Appropriate standards should be applied in cigarette markets globally.

Copyright 2011, BMJ Publishing

Shope JT. Adolescent motor vehicle crash risk: What's needed to understand and reduce the risk? Journal of Adolescent Health 46(1): 1-2, 2010. (15 refs.)

Son CH; Topyan K. The effect of alcoholic beverage excise tax on alcohol-attributable injury mortalities. European Journal of Health Economics 12(2): 103-113, 2011. (51 refs.)

This study examines the effect of state excise taxes on different types of alcoholic beverages (spirits, wine, and beer) on alcohol-attributable injury mortalities-deaths caused by motor vehicle accidents, suicides, homicides, and falls-in the United States between 1995 and 2004, using state-level panel data. There is evidence that injury deaths attributable to alcohol respond differently to changes in state excise taxes on alcohol-specific beverages. This study examines the direct relationship between injury deaths and excise taxes without testing the degree of the association between excise taxes and alcohol consumption. The study finds that beer taxes are negatively related to motor vehicle accident mortality, while wine taxes are negatively associated with suicides and falls. The positive coefficient of the spirit taxes on falls implies a substitution effect between spirits and wine, suggesting that an increase in spirit tax will cause spirit buyers to purchase more wine. This study finds no evidence of a relationship between homicides and state excise taxes on alcohol. Thus, the study concludes that injury deaths attributable to alcohol respond differently to the excise taxes on different types of alcoholic beverages.

Copyright 2011, Springer

Stenbacka M; Leifman A; Dalal K; Jansson B. Early predictors of injury mortality among Swedish conscripts A 35-year cohort study. Accident Analysis and Prevention 43(1): 228-234, 2011. (36 refs.)

Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents' family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18-20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and chi(2) tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26-0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR = 5.40) than illicit drug use (HR = 2.70) even after adjusted for behavioural risk factors: (HR = 3.43) and (HR = 1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especially alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

Copyright 2011, Elsevier Science

Stenbacka M; Leifman A; Romelsjo A. Mortality and cause of death among 1705 illicit drug users: A 37 year follow up. Drug and Alcohol Review 29(1): 21-27, 2010. (30 refs.)

Introduction and Aims. To examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years. Design and Methods. People with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in-patient care stays until 2003. Results. More than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25-30 years younger than the general population. The standardised rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person-years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In-patient care stays with both alcohol and drug-related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15-24 years) and cardiovascular diseases and tumours among the oldest (>= 55 years). Discussion and Conclusions. Accidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures.

Copyright 2010, Australian Medical and Professional Society on Alcohol and Other Drugs

Sternfeld I; Perras N; Culross PL. Development of a coroner-based surveillance system for drug-related deaths in Los Angeles County. Journal of Urban Health. Bulletin Of the New York Academy Of Medicine 87(4): 656-669, 2010. (46 refs.)

Existing data sources do not provide comprehensive and timely information to adequately monitor drug-related mortality in Los Angeles County. To fill this gap, a surveillance system using coroner data was developed to examine patterns in drug-related deaths. The coroner provided data on all injury deaths in Los Angeles County. A list of keywords that indicate a death was caused by drug use was developed. The cause of death variables in the coroner data were searched for mentions of one of the keywords; if a keyword was detected, that death was classified as drug related. The effectiveness of the keyword list in classifying drug-related deaths was evaluated by matching records in the coroner death data to records in the state death files. Then, the drug-related deaths identified using the keywords were compared to drug-related deaths in the state mortality files identified using International Classification of Death codes. Toxicological test results were used to categorize drug-related deaths based on the type and legality of the drug(s) ingested. Mortality rates were calculated for each category of drug and legal status and for different demographic groups. Compared to the gold standard state mortality files, the coroner data had a sensitivity of 95.6% for identifying drug-related deaths. Over three quarters of all drug-related deaths tested positive for opiates and/or stimulants. Males, Whites, and 35-54-year-olds each accounted for more than half of all drug-related deaths. The surveillance of drug-related deaths using coroner data has several advantages: data are available in a timely fashion, the data include information about the specific substances each victim ingested, and the data can be broken down to compare mortality among specific subpopulations.

Copyright 2010, Springer

Sullivan EV; Rose J; Pfefferbaum A. Mechanisms of postural control in alcoholic men and women: Biomechanical analysis of musculoskeletal coordination during quiet standing. Alcoholism: Clinical and Experimental Research 34(3): 528-537, 2010. (46 refs.)

Background: Excessive sway during quiet standing is a common sequela of chronic alcoholism even with prolonged sobriety. Whether alcoholic men and women who have remained abstinent from alcohol for weeks to months differ from each other in the degree of residual postural instability and biomechanical control mechanisms has not been directly tested. Method: We used a force platform to characterize center-of-pressure biomechanical features of postural sway, with and without stabilizing conditions from touch, vision, and stance, in 34 alcoholic men, 15 alcoholic women, 22 control men, and 29 control women. Groups were matched in age (49.4 years), general intelligence, socioeconomic status, and handedness. Each alcoholic group was sober for an average of 75 days. Results: Analysis of postural sway when using all 3 stabilizing conditions versus none revealed diagnosis and sex differences in ability to balance. Alcoholics had significantly longer sway paths, especially in the anterior-posterior direction, than controls when maintaining erect posture without balance aids. With stabilizing conditions the sway paths of all groups shortened significantly, especially those of alcoholic men, who demonstrated a 3.1-fold improvement in sway path difference between the easiest and most challenging conditions; the remaining 3 groups, each showed a similar to 2.4-fold improvement. Application of a mechanical model to partition sway paths into open-loop and closed-loop postural control systems revealed that the sway paths of the alcoholic men but not alcoholic women were characterized by greater short-term (open-loop) diffusion coefficients without aids, often associated with muscle stiffening response. With stabilizing factors, all 4 groups showed similar long-term (closed loop) postural control. Correlations between cognitive abilities and closed-loop sway indices were more robust in alcoholic men than alcoholic women. Conclusions: Reduction in sway and closed-loop activity during quiet standing with stabilizing factors shows some differential expression in men and women with histories of alcohol dependence. Nonetheless, enduring deficits in postural instability of both alcoholic men and alcoholic women suggest persisting liability for falling.

Copyright 2010, Research Society on Alcoholism

Taylor B; Irving HM; Kanteres F; Room R; Borges G; Cherpitel C et al. The more you drink, the harder you fall: A systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug and Alcohol Dependence 110(1-2): 108-116, 2010. (63 refs.)

Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol consumption, but much of the injury literature employs usual consumption habits to assess risk instead. An analysis of the acute dose-response relationship between alcohol and injury is warranted to generate single occasion- and dose-specific relative risks. A systematic literature review and meta-analysis was conducted to fill this gap. Linear and best-fit first-order model were used to model the data. Usual tests of heterogeneity and publication bias were run. Separate meta-analyses were run for motor vehicle and non-motor vehicle injuries, as well as case-control and case-crossover studies. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents, the odds ratio increases by 1.24 (95% CI: 1.18-1.31) per 10-g in pure alcohol increase to 52.0 (95% CI: 34.50-78.28) at 120g. For non-motor vehicle injury, the OR increases by 1.30(95% CI: 1.26-1.34) to an OR of 24.2 at 140g (95% CI: 16.2-36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI: 1.22-1.55). Efforts to reduce drinking both on an individual level and a population level are important. No level of consumption is safe when driving and less than 2 drinks per occasion should be encouraged to reduce the risk of injury.

Copyright 2010, Elsevier Science

Thornley S; Kool B; Robinson E; Marshall R; Smith GS; Ameratunga S. Alcohol and risk of admission to hospital for unintentional cutting or piercing injuries at home: A population-based case-crossover study. BMC Public Health 11: e-article 852, 2011. (58 refs.)

Background: Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home. Methods: A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts. Results: Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers. Conclusions: Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.

Copyright 2011, BioMed Central Ltd

Thygerson SM; Merrill RM; Cook LJ; Thomas AM. Comparison of factors influencing emergency department visits and hospitalization among drivers in work and nonwork-related motor vehicle crashes in Utah, 1999-2005. Accident Analysis and Prevention 43(1): 209-213, 2011. (20 refs.)

This study identified contributing factors in the occurrence of motor vehicle crashes (MVCs) and the severity of crashes according to work-related status in Utah. Analyses were based on probabilistically linked data involving police crash reports and hospital inpatient and emergency department (ED) records for the years 1999-2005. Of 643,647 drivers involved in crashes, 73,437 (11.4%) went to the emergency department (ED) and 4989 (0.8%) were hospitalized. Of the drivers in crashes visiting the ED, 2330 (3.2%) were working at the time of the crash and of drivers in crashes who were hospitalized, 235 (4.7%) were working at the time of the crash. There was no significant difference between those working versus not working at the time of the crash in safety belt use (82%[53,947/66,188] for ED cases and 60% [2,489/4,176] for hospitalized cases) or fatigue (4%[ 2,697/70,536] for ED cases and 9% [450/4,824] for hospitalized cases) among drivers in crashes, but there was a significant difference with respect to alcohol drinking between workers versus nonworkers (ED: 1% [31/2,237] vs. 5% [3,455/68,299], P < 0.001; hospitalized: 3% [7/228] vs. 15% [673/4,596], P < 0.001). Of those attending the ED because of a crash, workers were significantly more likely to have broken bones, bleeding wounds, or to die. Of those hospitalized because of a crash, workers were significantly less likely to have caused the crash (65% [145/223] vs. 73% [3,315/4,566], P < 0.001). Yet although those drivers who were working at the time of the crash compared with those not working were less likely to have alcohol involved or to have caused the crash, there remains room for improvement among workers with respect to these factors, as well as safety belt use and fatigue.

Copyright 2011, Elsevier Science

Tinker SC; Reefhuis J; Dellinger AM; Jamieson DJ. Epidemiology of maternal injuries during pregnancy in a population-based study, 1997-2005. Journal of Women's Health 19(12): 2211-2218, 2010. (34 refs.)

Background: Maternal injuries during pregnancy are common and can cause adverse pregnancy outcomes. We sought to describe factors related to injury during pregnancy. Methods: We analyzed data from the National Birth Defects Prevention Study (NBDPS), a population-based, case-control study of birth defects in 10 U. S. states. We estimated the proportion of control mothers, a random sample of mothers delivering infants without major birth defects in the study regions, who reported an injury during pregnancy. We assessed associations with maternal and paternal characteristics using logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: Between October 1997 and December 2005, 490 (7.4%) of 6609 mothers reported 527 injuries during pregnancy. Falls caused over half of reported injuries during pregnancy (51.6%), and 9.5% of reported injuries were intentionally inflicted. Mothers who reported an injury during pregnancy were more likely to be aged <18 years vs. 18-29 years (aOR 2.84, 95% CI 1.54-5.23) and less likely to be aged >= 30 years (aOR 0.67, 95% CI 0.51-0.89). They were more likely to use alcohol during pregnancy (aOR for nonbinge drinking 1.38, 95% CI 1.05-1.81), to smoke during pregnancy (aOR 1.37, 95% CI 1.02-1.85), to have epilepsy (aOR 3.31, 95% CI 1.48-7.38), and to be employed (aOR 1.44, 95% CI 1.08-1.93) than mothers who did not report an injury. Conclusions: We identified several factors associated with maternal injury during pregnancy, an important step in identifying women who may be at higher risk and in designing interventions to prevent injuries during pregnancy.

Copyright 2010, Mary Ann Liebert

Tsui KL; Sze NN; So FL; Wong SC. Association between drink driving and severity of crash injuries to road users. Hong Kong Journal of Emergency Medicine 17(1): 34-39, 2010. (15 refs.)

Objective: To determine the association between alcohol impairment in drivers and risk of severe injury in other road users in Hong Kong. Method: The Road Casualty Injury Information System (RoCIS) was set up by linking a regional hospital injury registry to the police traffic injury database. Based on the year 2004 linked dataset, a specific model namely the External Casualty Model (ECM) was designed to measure the association between severe injury outcome of other (non-driver) road user casualties (as stratified by ISS groups [ISS <9 or ISS >= 9]) and the level of alcohol impairment (as measured by breath alcohol concentration [BAC <22 mu g/100 ml or BAC >= 22 mu g/100 ml]) in drivers involving in the crash, controlling for the driver's demographics (age and sex) and behaviour (as measured by driving-offence points [DOP]) and another attribute (day of week of crash). Binary logistic regression was used in the analysis. Results: Out of 1818 matched RoCIS cases in the year 2004, 439 ECM records were available for analysis. Alcohol impaired drivers led to a significantly higher risk of severe injury to other road users (OR=4.2, 95%CI=1.21, 14.36, p=0.02). Crashes on weekdays seemingly led to a lower severe injury risk (OR=0.57, p=0.08) than crashes on weekends. DOP of drivers did not predict a higher severe injury risk to other road users. Conclusions: Alcohol impairment on driver increases the risk of severe injury to other road users by four times. Road safety education campaign should stress on this adverse impact of drink driving on innocent people.

Copyright 2010, Medcom Ltd

Turner J; Keller A; Bauerle J. The longitudinal pattern of alcohol-related injury in a college population: Emergency department data compared to self-reported data. American Journal of Drug and Alcohol Abuse 36(4): 194-198, 2010. (10 refs.)

Background: Self-report survey is the most common method of obtaining information from college students on substance use and its consequences. However, the validity and reliability of self-report data, especially in relationship to harmful substance use, is frequently called into question. Objectives: To establish the convergent validity of self-reported alcohol-related injury data and data from a university-affiliated hospital Emergency Department (ED) across a seven year period. (2) To examine the trend lines for relative risk of alcohol-related injury. Methods: Two existing data sets at a major public university are compared: records of 1,253 ED admissions for alcohol-related reasons and 13,518 survey responses. Convergent validity is evaluated with the Pearson correlation coefficients of the two data sets for 2001/2002 through 2007/2008. Longitudinal trends for each data set are evaluated by change in relative risk. Results: Over the seven years, 51% of ED visits for alcohol-related reasons were due to injury, and 14% of survey respondents who drank alcohol reported alcohol-related injury. Both decreased significantly over the years: from 62% to 45% for ED reports and from 24% to 9% for self reports. ED visits for alcohol-related injury and self-reported alcohol-related injury are highly correlated: r = .67, 45% shared variance. Conclusions: The comparison establishes convergent validity for the self-report data and decreased rates of alcohol-related injury. Scientific Significance: These findings support the validity in college populations of self-report data about negative consequences associated with drinking alcohol.

Copyright 2010, Taylor & Francis

Vingilis E; Wilk P. Self-reported motor vehicle injury prevention strategies, risky driving behaviours, and subsequent motor vehicle injuries: Analysis of Canadian national population health survey. Canadian Public Policy 36(Supplement S): s69-s80, 2010. (42 refs.)

The purpose of this study was to examine self-reported motor vehicle injury prevention strategies, speeding and impaired driving, and the effects of speeding and impaired driving on subsequent motor vehicle collision injuries, using the Canadian National Population Health Survey (NPHS). Strategies commonly reported were preventing impaired drivers from driving, using designated drivers, and requiring passengers to use seatbelts. Yet a substantial minority, particularly young males, reported engaging in risky driving behaviours such as speeding and impaired driving. Self-reported speeders and impaired drivers had significantly higher odds of reporting injuries from subsequent motor vehicle collisions. Specifically, those who reported sometimes/rarely or never obeying the speed limits were two and a half times more likely to report a subsequent motor vehicle injury, while those who reported impaired driving one or more times in the past 12 months were two times more likely to report a subsequent motor vehicle injury. These findings support the need for continued focus on speeding, drinking and driving, and other risky driving behaviours to reduce collisions in Canada.

Copyright 2010, Canadian Public Policy

Wagenaar AC; Tobler AL; Komro KA. Effects of alcohol tax and price policies on morbidity and mortality: A systematic review. American Journal of Public Health 100(11): 2270-2278, 2010. (70 refs.)

Objectives. We systematically reviewed the effects of alcohol taxes and prices on alcohol-related morbidity and mortality to assess their public health impact. Methods. We searched 12 databases, along with articles' reference lists, for studies providing estimates of the relationship between alcohol taxes and prices and measures of risky behavior or morbidity and mortality, then coded for effect sizes and numerous population and study characteristics. We combined independent estimates in random-effects models to obtain aggregate effect estimates. Results. We identified 50 articles, containing 340 estimates. Meta-estimates were r=-0.347 for alcohol-related disease and injury outcomes, -0.022 for violence, -0.048 for suicide, -0.112 for traffic crash outcomes, -0.055 for sexually transmitted diseases, -0.022 for other drug use, and -0.014 for crime and other misbehavior measures. All except suicide were statistically significant. Conclusions. Public policies affecting the price of alcoholic beverages have significant effects on alcohol-related disease and injury rates. Our results suggest that doubling the alcohol tax would reduce alcohol-related mortality by an average of 35%, traffic crash deaths by 11%, sexually transmitted disease by 6%, violence by 2%, and crime by 1.4%.

Copyright 2010, American Public Health Association

Waldman HB; Perlman SP; Rader R. Analysis of the Uniform Accident and Sickness Policy Provision Law: Lessons for social work practice, policy, and research. Social Work in Health Care 49(7): 618-629, 2010. (35 refs.)

The Uniform Accident and Sickness Policy Provision Law (UPPL) is a state statute that allows insurance companies in 26 states to deny claims for accidents and injuries incurred by persons under the influence of drugs or alcohol. Serious repercussions can result for patients and health care professionals as states enforce this law. To examine differences within the laws that might facilitate amendments or reduce insurance companies' ability to deny claims, a content analysis was carried out of each state's UPPL law. Results showed no meaningful differences between each state's laws. These results indicate patients and health professionals share similar risk related to the UPPL regardless of state.

Copyright 2010, Taylor & Francis

Wang LM; Wheeler K; Bai L; Stallones L; Dong YM; Ge J et al. Alcohol consumption and work-related injuries among farmers in Heilongjiang Province, People's Republic of China. American Journal of Industrial Medicine 53(8): 825-835, 2010. (35 refs.)

Background: Alcohol consumption has been found to be associated with work-related injuries among workers around the world, but this association has not well been studied among agricultural workers in China. Methods: This population-based survey aimed to study the association between alcohol use and work-related agricultural injury. Farmers in a northeastern province of China were questioned about work-related injury in the past year (May 2007 April 2008), alcohol use, farming practices, and sociodemographic factors. The Chi-square test and logistic regression analyses were used to investigate the role of alcohol drinking in agricultural injuries. Results: Among 2,050 farmers who completed the survey, the 12-month prevalence of work-related injury was 12.2%. The leading external cause of injury was exposure to mechanical force. The odds of injury among farmers with past month drinking, who drank distilled spirits, and reported intoxication were respectively 1.77 (95% CI = 1.27-2.47), 1.89 (95% CI = 1.35 2.66), 2.12 (95% CI = 1.42-3.11). The odds of injury also significantly increased with greater average amounts of pure alcohol per day, with increased frequency of drinking per week, and with greater reported years of drinking. Each alcohol use variable was associated with injury in logistic regression models while controlling for sex, age, years of farm work, months of farm work in the past 12 months, driving a motor vehicle, and agricultural machinery use. Conclusions: We found a significant association between alcohol consumption and work-related injuries among farmers. Our findings stress the need for culturally appropriate interventions which affect alcohol use and prevent injuries among Chinese farmers.

Copyright 2010, Wiley-Liss

Williams M; Mohsin M; Weber D; Jalaludin B; Crozier J. Alcohol consumption and injury risk: A case-crossover study in Sydney, Australia. Drug and Alcohol Review 30(4): 344-354, 2011. (54 refs.)

Introduction and Aims. Alcohol contributes to traumatic outcomes that kill or disable at a relatively young age, resulting in the loss of many years of life or disability. Harm from alcohol consumption can result from chronic or acute alcohol use. The aims of this study are to determine the prevalence of alcohol-related injury and contextual factors contributing to injury risk in an ethnically diverse population of Sydney. Design and Methods. The study was undertaken in emergency departments of six hospitals between 2005 and 2006 and used a case-crossover design. The 1599 attendees surveyed (response rate 64.2%) were aged over 14 years and had presented with an injury to the emergency department. Results. Attendees were predominantly male, young, 40% spoke a language other than English at home and 17% had been drinking in the 6 h prior to their injury. Those born overseas drank at lower levels than their Australian born counterparts. The risk of sustaining an injury was 1.42 times greater in attendees consuming alcohol compared with those who had not. At very high intake levels (>90 g) the risk of injury was statistically significant for both men and women (men odds ratio: 1.88, 95% confidence interval: 1.46-2.42; women odds ratio: 1.89, 95% confidence interval: 1.04-3.43). Drinking at a licensed premise and drinking alone or with a group of people also significantly increased the risk of injury. Discussion and Conclusions. The results support current Australian policy concerning alcohol but indicate that further restrictions and increased warnings for the community may be warranted.

Copyright 2011, Wiley-Blackwell

Wintemute GJ. Association between firearm ownership, firearm-related risk and risk reduction behaviours and alcohol-related risk behaviours. Injury Prevention 17(6): 422-427, 2011. (26 refs.)

Alcohol use and firearm ownership are risk factors for violent injury and death. To determine whether firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours, the author conducted a cross-sectional study using Behavioral Risk Factor Surveillance System data for eight states in the USA from 1996 to 1997 (the most recent data available). Altogether, 15 474 respondents provided information on firearm exposure. After adjustment for demographics and state of residence, firearm owners were more likely than those with no firearms at home to have >= 5 drinks on one occasion (OR 1.32; 95% CI 1.16 to 1.50), to drink and drive (OR 1.79; 95% CI 1.34 to 2.39) and to have >= 60 drinks per month (OR 1.45; 95% CI 1.14 to 1.83). Heavy alcohol use was most common among firearm owners who also engaged in behaviours such as carrying a firearm for protection against other people and keeping a firearm at home that was both loaded and not locked away. The author concludes that firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours.

Copyright 2011, BMJ Publishing

Yang YH; Lai JN; Lee CH; Wang JD; Chen PC. Increased risk of hospitalization related to motor vehicle accidents among people taking zolpidem: A case-crossover study. Journal of Epidemiology 21(1): 37-43, 2011. (21 refs.)

Background: Several epidemiological and experimental studies have found a positive association between the risk of motor vehicle accidents (MVAs) and use of zopiclone and benzodiazepines. There is, however, little evidence of any risk of MVA attributable to the use of zolpidem 1 day before such accidents. We attempted to determine whether the use of zolpidem 1 day before is associated with an increased risk of an MVA. Methods: Using a 1-million-person randomly sampled cohort from the Taiwan National Health Insurance reimbursement database, 12 929 subjects were identified as having been hospitalized between 1998 and 2004 due to an MVA. Using a case-crossover design, we selected the day before an MVA as the case period for each subject, and the 91st, 182nd, and 273rd days before the case period as 3 retrospective control periods. Conditional logistical regression models were constructed to calculate the odds ratio (OR) of having an MVA and the exposure of zolpidem 1 day before. We calculated doses of benzodiazepines, zopiclone, and zolpidem based on their defined daily dose. Results: The adjusted OR for involvement in an MVA after taking 1 defined daily dose of zolpidem was 1.74 (95% confidence interval: 1.25-2.43). There were also positive effects for different washout periods and cumulative doses at 7, 14, 21, and 28 days before the occurrence of an MVA. Conclusions: Use of zolpidem 1 day before might be associated with an increased risk of MVA. Thus, precautionary warnings should be provided when prescribing zolpidem.

Copyright 2011, Japan Epidemiological Association