CROSS NATIONAL ER ANALYSIS OF ALCOHOL AND CASUALTY

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DESCRIPTION: This project will compile, merge and analyze data on alcohol and injury from 30 emergency rooms (ERs), representing 15 ER studies across six countries, including the U.S., Mexico, Canada, Australia, Italy and Spain. These studies used similar methodologies with uniform scientific rigor, and together include over 21,000 patients. The proposed analysis will go beyond the examination of individual and event-level variables, to include social and cultural factors and organizational indicators pertaining to ER services. Specific aims include: 1) an examination of the similarities and differences across ER studies with respect to: a) aggregate measures of risk of injury; b) findings on the impact of individual risk factors for injury in general and by type; c) the impact of drinking-in-the-event; d) casual attribution of drinking to injury; e) epidemiologic profiles of alcohol-related injury; development and standardization of operational measures of cultural, organizational and administrative factors which affect the distribution of alcohol-related injuries and the association of risk factors and injury rates in ER studies; and, 3) development and testing comparative models of: a) risk factors for injury; b) acute impact of drinking on injury risk by type; c) causal attribution of drinking to injury; d) epidemiologic profiles of alcohol-related injury in relation to a combination of individual, organizational and cultural characteristics. Analytic techniques will include meta-analysis (Aim 1) and merged regressions, causal modeling and multilevel modeling (Aim 3). The project will provide the first available data on gender-specific risk of injury for various types of injury, contributing to the developing body of knowledge on recommended "safe" levels of drinking. The project will also inform current estimates of the attributable risk of alcohol and injury cross injury type, important for establishing prevention priorities, and will provide a profile for alcohol-involved injuries, which will serve as a basis for developing an on-going monitoring system to inform prevention and policy development. The project will also provide new data on contextual factors affecting causal attribution of alcohol and injury (important for tailoring effective intervention strategies), and will provide the first comparative data on the interaction of socio-cultural differences in drinking and medical care, and organization and administrative differences in ER services delivery systems across countries, with injury, demographic and individual drinking characteristics which affect ER treatment seeking, the alcohol burden in ER caseloads, and associations of alcohol and injury based in ER studies.