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Most previous brief intervention (BI) studies have focused on alcohol or drug use, instead of both substances. Our primary aim was to determine if an alcohol- and drug-use BI reduced alcohol use and increased alcohol treatment services utilization among adult emergency department (ED) patients who drink alcohol and require an intervention for their drug use. Our secondary aims were to assess when the greatest relative reductions in alcohol use occurred, and which patients (stratified by need for an alcohol use intervention) reduced their alcohol use the most. In this secondary analysis, we studied a sub-sample of participants from the Brief Intervention for Drug Misuse in the Emergency Department (BIDMED) randomized, controlled trial of a BI vs. no BI, whose responses to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) indicated a need for a BI for any drug use, and who also reported alcohol use. Participants were stratified by their ASSIST alcohol subscore: 1) no BI needed, 2) a BI needed, or 3) an intensive intervention needed for alcohol use. Alcohol use and alcohol treatment services utilization were measured every 3 months for 12 months post-enrollment. Of these 833 participants, median age was 29 years-old, 46% were female; 55% were white/non-Hispanic, 27% black/non-Hispanic, and 15% Hispanic. Although any alcohol use, alcohol use frequency, days of alcohol use, typical drinks consumed/day, and most drinks consumed/day decreased in both the BI and no BI arms, there were no differences between study arms. Few patients sought alcohol use treatment services in follow-up, and utilization also did not differ by study arm. Compared to baseline, alcohol use reduced the most during the first 3 months after enrollment, yet reduced little afterward. Participants whose ASSIST alcohol subscores indicated a need for an intensive intervention generally had the greatest relative decreases in alcohol use. These results indicate that the BI was not efficacious in reducing alcohol use among alcohol- and drug-using adult ED patients than the self-assessments alone, but suggest that self-assessments with or without a BI may confer reductions in alcohol use.

In this randomized, controlled trial among 957 English- or Spanish-speaking drug misusing adult emergency department (ED) patients, we determined if a tailored brief intervention (BI) increased uptake of rapid HIV/ HCV screening, and identified factors associated with greater screening uptake. Rapid HIV/HCV screening uptake was greater in the control than the BI arm (45 vs. 38 %; p < 0.04). Screening uptake depended on elapsed study time and which research staff member offered testing. In the control arm, uptake was lowest for those spending

Objectives In this study, Increasing Viral Testing in the Emergency Department (InVITED), the authors investigated if a brief intervention about human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk-taking behaviors and drug use and misuse in addition to a self-administered risk assessment, compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and impacted beliefs and opinions on HIV/HCV screening. Methods InVITED was a randomized, controlled trial conducted at two urban emergency departments (EDs) from February 2011 to March 2012. ED patients who self-reported drug use within the past 3 months were invited to enroll. Drug misuse severity and need for a brief or more intensive intervention was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of two study arms: a self-administered HIV/HCV risk assessment alone (control arm) or the assessment plus a brief intervention about their drug misuse and screening for HIV/HCV (intervention arm). Beliefs on the value of combined HIV/HCV screening, self-perception of HIV/HCV risk, and opinions on HIV/HCV screening in the ED were measured in both study arms before the HIV/HCV risk assessment (pre), after the assessment in the control arm, and after the brief intervention in the intervention arm (post). Participants in both study arms were offered free combined rapid HIV/HCV screening. Uptake of screening was compared by study arm. Multivariable logistic regression models were used to evaluate factors related to uptake of screening. Results Of the 395 participants in the study, the median age was 28 years (interquartile range [IQR] = 23 to 38 years), 44.8% were female, 82.3% had ever been tested for HIV, and 67.3% had ever been tested for HCV. Uptake of combined rapid HIV/HCV screening was nearly identical by study arm (64.5% vs. 65.2%; Δ = –0.7%; 95% confidence interval [CI] = –10.1% to 8.7%). Of the 256 screened, none had reactive HIV antibody tests, but seven (2.7%) had reactive HCV antibody tests. Multivariable logistic regression analysis results indicated that uptake of screening was not related to study arm assignment, total ASSIST drug scores, need for an intervention for drug misuse, or HIV/HCV sexual risk assessment scores. However, uptake of screening was greater among participants who indicated placing a higher value on combined rapid HIV/HCV screening for themselves and all ED patients and those with higher levels of perceived HIV/HCV risk. Uptake of combined rapid HIV/HCV screening was not related to changes in beliefs regarding the value of combined HIV/HCV screening or self-perceived HIV/HCV risk (post– vs. pre–risk assessment with or without a brief intervention). Opinions regarding the ED as a venue for combined rapid HIV/HCV screening were not related to uptake of screening. Conclusions Uptake of combined rapid HIV/HCV screening is high and considered valuable among drug using and misusing ED patients with little concern about the ED as a screening venue. The brief intervention investigated in this study does not appear to change beliefs regarding screening, self-perceived risk, or uptake of screening for HIV/HCV in this population. Initial beliefs regarding the value of screening and self-perceived risk for these infections predict uptake of screening. Resumen Objetivos El estudio Increasing Viral Testing in the Emergency Department (InVITED) investiga si una intervencion breve sobre los comportamientos de riesgo en relacion con el virus de inmunodeficiencia humana (VIH) y la hepatitis C (VHC), consumo y abuso de drogas, junto con una evaluacion autoadministrada del riesgo, en comparacion con solo la evaluacion autoadministrada del riesgo, incrementaba la aceptacion de despistaje combinado de VIH y VHC, el riesgo autopercibido de VIH/VHC, y las creencias y opiniones del despistaje de VIH/VHC. Metodologia InVITED fue un ensayo clinico controlado y aleatorizado llevado a cabo en dos SU urbanos de febrero de 2011 a marzo de 2012. Se invito a participar a los pacientes del SU que autorefirieron consumo de drogas en los tres ultimos meses. La gravedad del abuso de drogas y la necesidad de una intervencion breve o mas intensa se valoro usando el Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Los pacientes fueron asignados aleatoriamente a uno de los dos brazos del estudio: solamente evaluacion autoadministrada del riesgo de VIH/VHC (grupo control) o la evaluacion mas una intervencion breve sobre sus abusos de drogas y el despistaje de VIH/VHC (grupo de intervencion). Se midieron las creencias acerca del valor del despistaje combinado VIH/VHC, la autopercepcion del riesgo de VIH/VHC, y las opiniones acerca del despistaje de VIH/VHC en el SU en ambos brazos del estudio antes de la evaluacion del riesgo de VIH/VHC (pre), despues de la evaluacion en el grupo control, y despues de la intervencion breve (post). Se ofrecio gratuitamente un test de despistaje rapido VIH/VHC a los participantes de ambos brazos del estudio. La aceptacion del despistaje se comparo segun el brazo del estudio. Se usaron modelos de regresion logistica multivariable para evaluar los factores relacionados con la aceptacion del despistaje. Resultados De los 395 participantes del estudio, la mediana de edad fue de 28 anos (RIC de 23 a 38), un 44,8% fueron mujeres, un 82,3% nunca habia recibido un test de VIH, y un 67,3% nunca de VHC. La aceptacion del despistaje rapido combinado de VIH/VHC fue practicamente igual en ambos brazos del estudio (64,5% contra 65,2%; Δ = -0,7%; IC 95% = -10,1% a 8,7%). De los 256 a los que se les realizo el despistaje, ninguno tuvo un test de anticuerpos de VIH positivo, pero siete (2,7%) presentaron un test de anticuerpos de VHC positivo. Los resultados del analisis de regresion logistica multivariable indicaron que la aceptacion del despistaje no se relaciono con el brazo de asignacion del estudio, el total de las puntuaciones del test ASSIST, la necesidad de una intervencion sobre el abuso de drogas, o las puntuaciones de evaluacion del riesgo sexual de VIH/VHC. Sin embargo, la aceptacion del despistaje fue mayor entre los participantes que indicaron otorgar un mayor valor al despistaje rapido combinado de VIH/VHC para si mismos y para todos los pacientes del SU, y aquellos con mayores niveles de riesgo percibido de VIH/VHC. La aceptacion del despistaje rapido combinado de VIH/VHC no se relaciono con cambios en las creencias sobre el valor del despistaje combinado VIH/VHC o la autopercepcion del riesgo de VIH/VHC (valoracion del riesgo pre, con o sin intervencion breve, frente a post). Las opiniones acerca del SU como un lugar para el despistaje rapido combinado de VIH/VHC no se relacionaron con la aceptacion del despistaje. Conclusiones La aceptacion del despistaje rapido combinado de VIH/VHC es elevada y se considero valiosa entre los pacientes del SU con consumo o abuso de drogas sin mucha preocupacion sobre el SU como lugar de despistaje. La intervencion breve investigada en este estudio no parece cambiar las creencias acerca del despistaje, el riesgo autopercibido, o la aceptacion del despistaje de VIH/VHC en esta poblacion. Las creencias iniciales respecto al valor del despistaje y al riesgo autopercibido para estas infecciones predijeron la aceptacion del despistaje.

This study aimed to understand current patterns of energy drink use and compare the extent of usage of energy drinks and other commonly used and misused substances between adolescent (13-17-years-old) and young adult (18-25-years-old) emergency department (ED) patients.During a 6-week period between June and August 2010, all patients presenting to an adult or pediatric ED were asked to complete a computer-based, anonymous questionnaire regarding use of energy drinks and other substances. Wilcoxon rank-sum, 2-sample tests of binomial proportions, Pearson χ(2) testing, and regression models were used to compare energy drink and substance use by age groups.Past 30-day energy drink use was greater for young adults (57.9%) than adolescents (34.9%) (P0.03). Adolescents typically consumed a mean of 1.5 and young adults a mean of 2.6 energy drinks per day when using energy drinks and drank at most a mean of 2.4 and 2.6 drinks per day, respectively. Among adolescents, energy drink usage was more common than alcohol, "street" or illicit drugs, and tobacco usage, but less common than caffeine product usage. For young adults, energy drink usage was more common than "street" or illicit drugs, but less common than caffeine use, and similar to tobacco and alcohol usage. Young adult energy drink users were more likely than young adult non-energy drink users also to use tobacco and caffeine.Energy drink use is common among ED patients. Given the high prevalence of energy drink use observed, emergency physicians should consider the involvement of energy drinks in the presentations of young people.

ACADEMIC EMERGENCY MEDICINE 2012; 19:924–933 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to assess the relationship between alcohol use and misuse and patient sex among emergency department (ED) patients by comparing self-reported estimates of quantity and frequency of alcohol use, estimated blood alcohol concentrations (eBACs) when typically drinking and during heavy episodic drinking (binging), and alcohol misuse severity, to understand sex differences in alcohol use and misuse for this population. Methods: The authors surveyed a random sample of nonintoxicated, subcritically ill or injured, 18- to 64-year-old English- or Spanish-speaking patients on randomly selected dates and times at two EDs during July 2009 and August 2009. Participants self-administered a questionnaire about their self-reported alcohol use during a typical month within the past 12 months and the Alcohol Use Disorders Identification Test (AUDIT). Using the formulae by Matthews and Miller, sex-specific eBACs were calculated for participants according to their reported weight and the number of reported alcoholic drinks consumed on days when typically drinking and on days of heavy episodic (binge) drinking (five or more drinks/occasion for men, four or more drinks for women). Sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, and dependence) were calculated using AUDIT scores. Wilcoxon rank-sum and Pearson’s chi-square tests were used to compare outcomes by sex. Negative binomial regression was used to assess the relationship between sex and the number of drinks consumed on a typical day, the number of days spent drinking and binging, and estimated AUDIT scores. Logistic regression was used to assess the outcome of the presence of binging according to sex. Multinomial logistic regression was used to compare by sex the percentage of days spent drinking and binging in 1 month, eBACs when typically drinking and when binging, and AUDIT at-risk drinking levels. Incidence rate ratios (IRRs) and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics. Results: Of the 513 participants, 52.1% were women, 55.8% were white non-Hispanic, and their median age was 34 years (interquartile range [IQR] = 25 to 46 years). Men reported greater mean alcohol consumption than women when typically drinking (4.3 vs. 3.3 drinks/day; p

Objectives Assess the 12-month efficacy of a brief intervention (BI) on reducing drug use and increasing drug treatment services utilisation among adult emergency department (ED) patients. Methods This randomised, controlled trial enrolled 18–64-year-old ED patients needing a drug use intervention. Treatment arm participants received a tailored BI while control arm participants only completed the study questionnaires. Self-reported past 3-month drug use and engagement in drug treatment services were compared by study arm at 3-month intervals over 1 year. Multiple imputations were performed to overcome loss-to-follow-up. Results Of the 1030 participants, follow-up completion ranged 55%–64% over the four follow-ups. At 12 months, the two study arms were similar in regards to mean: (1) proportion reporting any drug use (treatment: 67.1% (61.6 to 72.6), control: 74.4% (69.4 to 79.4)); (2) drug use frequency on a five-point scale (treatment: 3.7 (3.3 to 4.2), control: 4.6 (4.0 to 5.2)); (3) total days of drug use (treatment: 28.3 (23.2 to 33.4), control: 33.4 (28.5 to 38.2)); (4) most number of times drugs used/day (treatment: 4.6 (3.6 to 5.5), control: 6.1 (4.8 to 7.3)) and (5) typical number of times drugs used/day (treatment: 3.3 (2.5 to 4.1), control: 5.1 (3.9 to 6.2)). Utilisation of drug treatment services also was similar by study arm. In multivariable regression analyses, patients who were homeless or had higher drug use at baseline continued to have greater drug use in follow-up. Conclusions Among adult ED patients requiring a drug use intervention, this BI did not decrease drug use or increase drug treatment services utilisation over a 12-month period more than the control condition. Trial registration number NCT01124591; Pre-trial.

Introduction: Among adult emergency department (ED) patients, we sought to examine how estimates of substance use prevalence and the need for interventions can differ, based on the type of screening and assessment strategies employed. Methods: We estimated the prevalence of substance use and the need for interventions using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in a secondary analysis of data from two cross-sectional studies using random samples of English- or Spanish-speaking 18-64-year-old ED patients. In addition, the test performance characteristics of three simplified screening strategies consisting of selected questions from the ASSIST (lifetime use, past three-month use, and past three-month frequency of use) to identify patients in need of a possible intervention were compared against using the full ASSIST. Results: Of 6,432 adult ED patients, the median age was 37 years-old, 56.6% were female, and 61.6% were white. Estimated substance use prevalence among this population differed by how it was measured (lifetime use, past three-month use, past three-month frequency of use, or need for interventions). As compared to using the full ASSIST, the predictive value and accuracy to identify patients in need of any intervention was best for a simplified strategy asking about past three-month substance use. A strategy asking about daily/near-daily use was better in identifying patients needing intensive interventions. However, some patients needing interventions were missed when using these simplified strategies. Conclusion: Substance use prevalence estimates and identification of ED patients needing interventions differ by screening strategies used. EDs should carefully select strategies to identify patients in need of substance use interventions.

Objectives Determine if a brief intervention (BI) reduces the negative consequences of drug use/misuse among adult emergency department (ED) patients, and identify patients more likely to benefit from the BI. Methods This randomized, controlled trial enrolled 1026 18–64 year-old ED patients whose drug misuse indicated a needed for a BI. Differences in total Inventory of Drug Use Consequences (InDUC) scores between the treatment (BI) and control arms (no BI) were assessed every 90 days over a one-year period. Regression models were constructed to identify demographic and clinical factors associated with greater reductions in total InDUC scores. Results Although total InDUC scores decreased for both the treatment and control arms, there were no differences in scores between the treatment and the control arms at baseline at each follow-up. In the regression analyses, participants who were not using drugs or received drug treatment in the past 90 days generally had lower InDUC scores at each follow-up. Conclusions Although negative consequences decreased in both study arms over time, receiving a BI did not lead to a greater reduction in the negative consequences of drug misuse than not receiving a BI. Of importance in the design of future ED drug misuse interventions, participants who were successful in stopping their drug misuse or receiving drug treatment did show fewer negative consequences of drug use/misuse.

Although brief interventions (BIs) have shown some success for smoking cessation and alcohol misuse, it is not known if they can be applied in the emergency department (ED) to drug use and misuse. The objectives of this investigation were to assess the 3-month efficacy of a BI to reduce drug use and misuse, increase drug treatment services utilization among adult ED patients, and identify subgroups more likely to benefit from the BI.This randomized, controlled trial enrolled 18- to 64-year-old English- or Spanish-speaking patients from two urban, academic EDs whose responses to the Alcohol, Smoking, and Substance Involvement Screening Test indicated a need for a brief or intensive intervention. Treatment participants received a tailored BI, while control participants only completed the study questionnaires. At the 3-month follow-up, each participant's past 3-month drug use and misuse and treatment utilization were compared to his or her baseline enrollment data. Regression modeling was used to identify subgroups of patients (per demographic and clinical factors) more likely to stop or reduce their drug use or misuse or engage in drug treatment by the 3-month follow-up assessment.Of the 1,030 participants, the median age was 30 years (interquartile range = 24 to 42 years), and 46% were female; 57% were white/non-Hispanic, 24.9% were black/non-Hispanic, and 15% were Hispanic. The most commonly misused drugs were marijuana, prescription opioids, cocaine/crack, and benzodiazepines. Although at follow-up the proportions of participants reporting any past 3-month drug misuse had decreased in both study arms (control 84% vs. treatment 78%), the decreases were similar between the two study arms (Δ-6.3%; 95% confidence interval [CI] = -13.0% to 0.0). In addition, at follow-up there were no differences between study arms in those who were currently receiving drug treatment (Δ1.8; 95% CI = -3.5 to 6.8), who had received treatment during the past 3 months (Δ-2.0; 95% CI = -6.5 to 2.4), or who at least contacted a treatment program (Δ 1.7; 95% CI = -2.4 to 6.1). Those whose baseline screening indicated the need for a brief instead of a more intensive intervention, and those currently engaged in drug treatment at the 3-month follow-up, were generally more likely to stop or decrease their drug use/misuse.The BI employed in this study did not reduce drug use and misuse or increase treatment utilization more than the control condition over a 3-month period. Future research should help determine what role, if any, BIs should play in affecting drug use and misuse among ED patients.

Background: Patients with a clinical diagnosis of transient ischemic attack (TIA) who have imaging evidence of infarction portend a high risk of short-term recurrent stroke. Emergency Department Observation Units (EDOU) offer an alternative to hospital admission and are becoming increasingly utilized for acute cerebrovascular emergencies. Hypothesis: We sought to determine whether an EDOU protocol emphasizing etiologic determination and individualized secondary prevention could be a safe alternative to hospital admission for suspected TIA patients with and without brain infarction. Methods: We prospectively studied 189 patients admitted to the TIA EDOU of a single tertiary care academic medical center. There was no ABCD2 cutoff for eligibility and exclusion criteria included persistent deficits or another diagnosis warranting hospitalization. Patients underwent DW-MRI/MRA of the head and neck unless contraindicated, transthoracic echocardiogram and bedside neurologist evaluation. Etiologic subtyping was determined using the Causative Classification System (CCS). 30-day follow-up was performed on all patients by telephone and/or review of medical records. This study was approved by the hospital IRB. Results: Acute ischemic stroke was diagnosed in 31 (16%) of patients, including 30 with DWI lesions and 1 in whom MRI was contraindicated, but had clinical worsening while in the EDOU. An evident or probable etiology was determined by CCS subtyping in 38% of strokes and 32% of TIAs (17% atherosclerosis, 12% cardioembolism, 5% small vessel). Of the total cohort, 84% were discharged from the EDOU including 16 (52%) with confirmed stroke. Median LOS was 22 hours (IQR: 17-25). At 30 days, one patient was found to have a small recurrent stroke (0.7%). There was 1 non-stroke related death. Twenty (11%) overall returned to the ED, the vast majority (70%) from the non-stroke cohort. Conclusions: Not all ischemic stroke patients require hospitalization. An EDOU is a safe and effective alternative for the complete diagnostic evaluation and management of patients with transient neurologic symptoms. Further study of cost and quality effectiveness in warranted.

This pilot study assessed the prevalence of physiologic and behavioral adverse effects among adolescent (13-17 years) and adult (18-25 years) emergency department patients who reported energy drink and/or caffeinated-only beverage use within the 30 days prior to emergency department presentation. It was hypothesized that energy drink users would report more adverse effects than those who used only traditional caffeinated beverages such as coffee, tea, or soft drinks.This cross-sectional pilot study was conducted in two urban emergency departments, one adult and one pediatric. Eligible patients were enrolled during a 6-week period between June and August 2010. Participants completed a tablet computer-based, self-administered, anonymous questionnaire about their past 30-day energy drink and/or caffeinated-only beverage use, substance use, and experience of 10 physiologic and 10 behavioral symptoms. Multivariable logistic regression and negative binomial regression models, adjusted for age, gender, and substance use, were created to compare the occurrence of each adverse effect between energy drink and caffeinated-only beverage users. Odds ratios (ORs) and incidence rate ratios (IRRs) were estimated.Of those enrolled, 53.3% reported consuming energy drinks, 39.1% caffeinated-only beverages, and 7.6% no energy drinks or caffeinated-only beverages within the past 30 days. In multivariable logistic regression models, energy drink users were more likely than caffeinated-only beverage users to report having "gotten into trouble at home, school, or work" in the past 30 days (OR: 3.12 [1.24-7.88]). In the negative binomial regression multivariable models, more behavioral effects were reported among drug users (IRR: 1.50 [1.18-1.93]), and more physiologic effects were reported among tobacco users (IRR: 1.42 [1.13-1.80]) and females (IRR: 1.48 [1.21-1.80]), but not among energy drink users.Energy drink users and substance users are more likely to report specific physiologic and behavioral adverse effects. Emergency department clinicians should consider asking patients about energy drink and traditional caffeine usage and substance use when assessing patient symptoms.

Background Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients. Methods A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed. Results Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women. Conclusions The apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.

The objective was to assess the relationship between alcohol use and misuse and patient sex among emergency department (ED) patients by comparing self-reported estimates of quantity and frequency of alcohol use, estimated blood alcohol concentrations (eBACs) when typically drinking and during heavy episodic drinking (binging), and alcohol misuse severity, to understand sex differences in alcohol use and misuse for this population.The authors surveyed a random sample of nonintoxicated, subcritically ill or injured, 18- to 64-year-old English- or Spanish-speaking patients on randomly selected dates and times at two EDs during July 2009 and August 2009. Participants self-administered a questionnaire about their self-reported alcohol use during a typical month within the past 12 months and the Alcohol Use Disorders Identification Test (AUDIT). Using the formulae by Matthews and Miller, sex-specific eBACs were calculated for participants according to their reported weight and the number of reported alcoholic drinks consumed on days when typically drinking and on days of heavy episodic (binge) drinking (five or more drinks/occasion for men, four or more drinks for women). Sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, and dependence) were calculated using AUDIT scores. Wilcoxon rank-sum and Pearson's chi-square tests were used to compare outcomes by sex. Negative binomial regression was used to assess the relationship between sex and the number of drinks consumed on a typical day, the number of days spent drinking and binging, and estimated AUDIT scores. Logistic regression was used to assess the outcome of the presence of binging according to sex. Multinomial logistic regression was used to compare by sex the percentage of days spent drinking and binging in 1 month, eBACs when typically drinking and when binging, and AUDIT at-risk drinking levels. Incidence rate ratios (IRRs) and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics.Of the 513 participants, 52.1% were women, 55.8% were white non-Hispanic, and their median age was 34 years (interquartile range [IQR] = 25 to 46 years). Men reported greater mean alcohol consumption than women when typically drinking (4.3 vs. 3.3 drinks/day; p0.001) and during heavy episodic drinking (8.6 vs. 5.3 drinks/occasion; p0.001). Men spent more days drinking (IRR = 1.41, 95% CI = 1.19 to 1.65) and engaging in heavy episodic drinking (IRR = 1.68, 95% CI = 1.31 to 2.17) than women. Additionally, men were more likely to engage in heavy episodic drinking (AOR = 1.72, 95% CI = 1.16 to 2.56) than women. However, the mean eBACs for men and women were similar when typically drinking (0.05 vs. 0.06; p0.13) and during heavy episodic drinking (0.13 vs. 0.12; p0.13). Mean AUDIT scores were greater for men than women (7.5 vs. 5.3; p0.001), although alcohol misuse severity levels were similar between men and women (24.4% vs. 26.6% for hazardous, 2.8% vs. 2.2% for harmful, and 6.5% vs. 3.4% for dependence; p0.38).Although men drink more than women, women have similar eBACs with comparable levels of alcohol misuse. Women may benefit from recognizing that they are reaching similar levels of intoxication compared to men. Addressing these differences and possible health implications in future ED brief interventions may induce changes in problematic alcohol use among women.

This paper describes how helmets significantly decrease morbidity and mortality from motorcycle crashes and that many areas of the world lack universal helmet laws. In order to educate motorcyclists in areas without helmet laws, more knowledge of motorcyclists systems are needed. A 29-question web-based survey was designed to assess motorcyclists attitudes, norms and behaviors towards helmets in a state with a limited helmet law. Survey invitations were mailed to 2006–2008 registrants for the states required motorcycle safety course. Of the 414 surveys completed 68.4% of respondents reported always wearing a helmet. Compared with always helmeted (AH), non-helmeted (NH) respondents were more likely to be male, less educated and reporting previous crashes. The strongest correlates of being NH (vs AH) were attitudes that helmets were not protective (6.7% vs 0.4%, p

Study objectives: We examine differences in the occurrence of traumatic brain injury (TBI) in children who were injured while riding bicycles and were treated in a pediatric emergency department (ED) during a 6-year period. Methods: A retrospective review of patient data collected from an urban pediatric ED for children aged 0 to 16 years between 1997 and 2003 was carried out. The search tracked International Classification of Diseases, Ninth Revision (ICD-9) codes consistent with TBI as defined by Guidelines for Surveillance of Central Nervous System Injury. The external cause-of-injury codes (E-codes) linked to these ICD-9 codes were examined for those consistent with TBI that occurred while the child was riding a bicycle. The E-codes included were E-826.1 and E-810 to E-825, all with .6 as a fourth digit modifier. Patients' personal identifiers were removed, and then the remaining data were sorted according to age, sex, and admission status. The data were separated by age group: 8 years and younger, 9 to 11 years old consistent with grades 4 to 6, 12 to 14 years old consistent with middle school (grades 7 to 9), and 15 to 16 years. The 2 groups of particular interest were the 9- to 11-year-old group and the 12- to 14-year-old group. They were contrasted to determine whether there is a statistical difference in the incidence of TBI caused by injuries obtained while riding a bicycle. The incidence of TBI was also examined as it related to sex across the age groups. Results: From 1997 to 2003, there were 4,509 pediatric ED visits for TBI, with 175 (3.9%) for bicycle-related TBI. There were 42 bicycle-related TBIs in the 9- to 11-year-old group and 66 bicycle-related TBIs in the 12- to 14-year-old group, which accounted for 24% and 38%, respectively, of all bicycle-related TBI. The difference between the 2 age groups was statistically significant (χ 2 [1]=5.33; P =.02.) The difference between boys and girls was also of interest. Male patients were treated more frequently than female patients across all ages in the study. An examination of data from all children 0 to 16 years showed that male patients were nearly 5 times as likely to visit the ED because of bicycle-related TBI. Male patients accounted for 146 visits and female patients, 29. The difference was statistically significant (χ 2 [1]=78.2; P Conclusion: The study suggests that children of middle school age have an increased incidence of bicycle-related TBI, which could be due to differences in helmet use, riding styles, riding frequency, distance traveled, safety measures observed, or level of parental supervision, all of which needs to be delineated with further research. Boys were much more likely to sustain TBI than their female peers, which correlates with Centers for Disease Control and Prevention surveillance data for TBI that demonstrate that males are more likely to sustain TBI. Adolescents have been defined as particularly noncompliant in helmet use compared with younger children, which may explain increased TBI in this age group. Increased risk-taking in this age group could also have played an important role in the difference. These results identify children of middle school age to be particularly at risk for bicycle-related TBI. The study also demonstrates that males across all ages are at higher risk than females for bicycle-related TBI. Therefore, it may be useful to implement injury prevention techniques targeted toward this high-risk group.