Cross-National Analysis of Alcohol and Injury

拟议的项目正在申请资金，以合并和分析来自世界卫生组织（WHO）酒精与伤害合作研究的数据，该研究目前正在11个国家的急诊室（ER）进行，数据来自33个急诊室站点，仅覆盖8个国家，目前正在酒精研究小组的中心资助下进行分析。将世卫组织研究的数据加入现有的合并数据集，将使现有仅有的两组酒精和伤害数据集（两者都使用类似的数据收集方法和问卷）结合在一起，并将使伤害病例数增加一倍，从5 274例增加到10 774例，并使国家代表性增加到全球地理覆盖范围。将世卫组织的数据添加到目前正在分析的数据中，将加强研究目标，使其超出目前可以处理的范围：1)由于8个国家的数据覆盖了12年的时间跨度，在地理上比较有限，因此更多的伤害病例数量将有助于更精细的估计，并使我们能够确定关于酒精相关伤害的患病率、伤害风险和相关变量的估计随时间和地点的稳定性，而世卫组织的数据将全部在6个月内收集，并实现全球覆盖；2)这些估计也将通过将数据限制在受伤后6小时内到达急诊室的数据来增强，这将减少对事件中饮酒和相关变量的回忆偏差；3)纳入背景数据（未作为世卫组织原始研究的一部分收集的社会文化和组织/行政变量）的分析潜力可以最大限度地作为酒精和伤害关联的重要解释因素，涵盖17个国家的44个ER站点；4)将有机会对以下方面相关的背景变量的影响进行新的分析（现有数据无法实现）：a)酒精中毒临床评估的有效性，以及b)用于识别急诊室患者饮酒问题的简短筛查工具的性能。荟萃分析技术将用于检查跨ER站点的基于个人的关系的一致性。因果模型和层次线性模型将用于检查独立的影响和相互作用的上下文变量与个人和事件层面的变量对关系。由于美国是由许多微观文化组成的，这些微观文化反映了社会文化和组织/行政背景变量，这些变量在收集这些数据的许多国家占主导地位，因此，本文所提出的跨国分析将为美国的酒精伤害关系提供信息。

The proposed project is requesting funding to merge and analyze data from the World Health Organization (WHO) Collaborative Study of Alcohol and injuries, currently underway in emergency rooms (ERs) in 11 countries, with data from 33 ER sites, which cover only eight countries, and is presently being analyzed under the Alcohol Research Group's Center Grant. The addition of data from the WHO study to the existing merged data set will bring together the only two such data sets of alcohol and injury in existence (both of which used a similar methodology and questionnaire for data collection), and would double the number of injury cases from 5,274 to 10,774, as well as increase country representation to geographic coverage worldwide. The addition of the WHO data to those presently being analyzed will enhance research aims beyond that which can presently be addressed as follows: 1) the larger number of injury cases will facilitate more fine-grained estimates and allow us to determine the stability of estimates regarding the prevalence of alcohol- related injury and risk of injury and related variables, over time and place, since the 8-country data cover a temporal span of 12 years, and is more limited geographically, while the WHO data will all have been collected within a six-month period and achieves global coverage; 2) these estimates will also be enhanced by restriction of the data to those arriving at the ER within six hours of the injury, which will reduce bias in the recall of drinking-in-the-event and related variables; 3) the analytic potential of inclusion of contextual data (socio- cultural and organizational/administrative variables which were not collected as part of the original WHO study) can be maximized as important explanatory factors in associations of alcohol and injury, across 44 ER sites in 17 individual countries; 4) the opportunity will be provided for new analyses (not possible with the data on hand) of the influence of contextual variables related to a) the validity of clinical assessment of alcohol intoxication, and b) the performance of a brief screening instrument for identifying problem drinking among ER patients. Meta-analytic techniques will be used to examine the consistency of individual-based relationships across ER sites. Causal modeling and hierarchical linear modeling will be used to examine the independent effects and interactive effects of contextual variables with individual-and event-level variables on relationships. Cross-national analyses such as those proposed here will inform the alcohol-injury nexus in the U.S., since the U.S. is composed of many micro-cultures which reflect the socio- cultural and organizational/administrative contextual variables dominating many of the countries in which these data were collected.