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）酒精和伤害合作研究的数据，目前正在11个国家的急诊室（ER）进行，数据来自33个ER站点，仅覆盖8个国家，目前正在酒精研究小组的中心赠款下进行分析。 在现有的合并数据集中增加世卫组织研究的数据，将把现有的仅有的两个酒精和伤害数据集（两者都使用类似的方法和调查问卷收集数据）合并在一起，并将使伤害案件数量增加一倍，从5 274起增加到10 774起，并将国家代表性扩大到全世界的地理覆盖范围。 将世卫组织的数据加入目前正在分析的数据将加强研究目标，超出目前可以解决的以下问题：1）更多的伤害案例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流行率和伤害风险以及相关变量的估计的稳定性，随着时间和地点的变化，由于8个国家的数据涵盖12年的时间跨度，地理上更为有限，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人来提高，这将减少回忆饮酒事件和相关变量的偏差; 3）包含上下文数据的分析潜力（社会文化和组织/行政变量，未作为世卫组织原始研究的一部分收集）在17个国家的44个急诊中心，可以最大限度地作为酒精和伤害相关性的重要解释因素; 4）将提供新的分析机会（现有数据不可能）与a）酒精中毒临床评估的有效性相关的背景变量的影响，和B）用于在ER患者中识别问题饮酒的简要筛选工具的性能。元分析技术将用于检查ER研究中心之间基于个体的关系的一致性。 因果关系模型和层次线性模型将被用来检查独立的影响和相互作用的影响，与个人和事件水平的变量关系的背景变量。 像这里提出的这样的跨国分析将为美国的酒精伤害关系提供信息，因为美国是由许多微观文化组成的，这些微观文化反映了在这些数据收集的许多国家中占主导地位的社会文化和组织/行政背景变量。

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.