The purpose of this review is to update research on the prevention of alcohol-related traffic deaths since the 1988 Surgeon General's Workshop on Drunk Driving. Four primary areas of research are ...reviewed here: (a) general deterrence policies, (b) alcohol control policies, (c) mass communications campaigns, including advertising restrictions, and (d) community traffic safety programs. Modern efforts to combat drunk driving in the United States began with specific deterrence strategies to punish convicted drunk drivers, and then evolved to include general deterrence strategies that were targeted to the population as a whole. Efforts next expanded to include the alcohol side of the problem, with measures installed to decrease underage drinking and excessive alcohol consumption. In the next several years, greater efforts are needed on all these fronts. Also needed, however, are programs that integrate drunk driving prevention with other traffic safety initiatives.
ABSTRACT
Aim Failure to disclose cocaine use can have a negative impact on medical care and research validity. This study was performed to identify predictors of cocaine non‐disclosure among ...individuals who self‐reported heroin use during a medical care encounter.
Design A prospective comparison of self‐report of cocaine use among heroin users and hair analysis for cocaine.
Setting Four health‐care clinics at an academic, inner‐city hospital.
Participants Patients presenting for a health‐care visit who were willing to self‐report use of heroin and were not engaged in any form of drug treatment.
Measurements (1) Self‐report using standardized instruments: the Drug Addiction Severity Test (DAST), the Addiction Severity Index (ASI) and quantity/frequency questions for heroin and cocaine use. (2) Biochemical evidence: analysis of hair by radioimmunoassay (RIA) for cocaine and opiate levels.
Findings Among 336 heroin users who tested positive for cocaine in hair, 34.2% did not report their recent cocaine use. The mean cocaine level for discordant individuals was significantly lower than for concordant individuals (109.6 ng/10 mg versus 470.57 ng/10 mg; P < 0.0001). Multivariate predictors of disclosure included opiate and cocaine levels in hair and the ASI drug severity subscore.
Conclusions Although self‐report has been validated for treatment system patients, almost a third of the out‐of‐treatment heroin users in this medical clinic study failed to disclose concomitant cocaine use. The likelihood of non‐disclosure was greatest for heavy users of heroin and light users of cocaine. Confirmation of self‐report with biochemical analysis in the medical setting may be necessary to improve both clinical care and research validity.
Compares the level of knowledge about human immunodeficiency virus (HIV) transmission and risk behavior of 1,057 foreign-born and 1,963 U.S.-born high school and middle school students in Boston ...(Massachusetts). Results suggest that Acquired Immunodeficiency Syndrome education should be taught to immigrant students in their native languages. (SLD)
To study whether alcoholic workers had seen physicians during the year they were identified by their company, whether they recalled physicians' warnings about drinking, and whether such warnings ...affected outcomes 2 years later.
Workers were interviewed at intake and 2 years later: subgroups who did and did not see physicians and who did and did not recall warnings were compared.
A company-union employee assistance program.
Two hundred problem drinkers, newly identified on the job, predominantly male, blue-collar workers.
Drinking, drunkenness, average daily alcohol consumption, and impairment score.
Among the 200 participants, 74% saw physicians in the index year; only 22% recalled warnings. Recall of a warning was associated with liver disease, continued drinking while ill, supervisors' job warnings, older age, and marijuana use. Two years later, those warned were more likely to be abstaining, and sober, and were less impaired.
Recalling a physician's warning at intake into alcoholism treatment was associated with better prognosis 2 years later. However, among this group of employees whose drinking was serious enough to be identified on the job, fewer than a quarter recalled physicians' warnings, even though more than three quarters had seen physicians in the year preceding intake.
The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce alcohol-impaired driving, related ...driving risks, and traffic deaths and injuries.
Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993. In annual roadside surveys conducted at randomly selected locations, safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed. Four statewide telephone surveys (n = 15188) monitored self-reported driving after drinking.
In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years, fatal crashes declined 25%, from 178 to 120, and fatal crashes involving alcohol decreased 42%, from 69 to 36. Visible injuries per 100 crashes declined 5%, from 21.1 to 16.6. The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half.
Interventions organized by multiple city departments and private citizens can reduce driving after drinking, related driving risks, and traffic deaths and injuries.
Predictors of disclosure of continued cocaine use Tassiopoulos, Katherine; Bernstein, Judith; Heeren, Timothy ...
Addictive behaviors,
2006, 2006-Jan, 2006-1-00, 20060101, Volume:
31, Issue:
1
Journal Article
Peer reviewed
Lack of disclosure of substance use is common in research and treatment settings and is frequently higher at follow-up than at baseline interviews. The aim of this study was to determine predictors ...of cocaine use disclosure at follow-up among 525 individuals who reported and tested positive for baseline use. Measurements included self-reported quantity and frequency of use, and hair analysis by radioimmune assay. Forty-two percent of individuals with biochemical evidence of continued cocaine use denied this use. In adjusted analyses, self-reported substance abuse treatment contact after enrollment was associated with lower disclosure (OR 0.63, 95% CI 0.43, 0.93). Other predictors were race, hair cocaine level, and opiates in hair. Failure to stop use after seeking treatment may result in reduced disclosure of continued use, possibly because of unwillingness to admit failure.
Alcohol is a major factor in traffic crashes, and crashes involving alcohol are more likely to result in injuries and deaths than crashes where alcohol is not a factor. Increasing blood alcohol ...concentrations (BACs) have been linked to increased crash risk. Male drivers, particularly those ages 22 to 45; people with drinking problems and prior drinking and driving convictions; and drivers who do not wear safety belts are disproportionately likely to be involved in alcohol-related fatal crashes. Alcohol-dependent people are over-represented in all alcohol-related traffic crashes, as are those who begin drinking at younger ages. Though there are more than 82 million drinking-driving trips in a given year at BACs of 0.08 percent and higher (and 10 percent of drinking-driving trips are at BACs of 0.08 percent and higher), there are only 1.5 million arrests for drinking and driving each year. Despite overall marked reductions in alcohol-related traffic deaths since the early 1980s, there has been little reduction since the mid-1990s, and alcohol-related traffic deaths have increased slightly in the past 3 years.
In a review of the English language literature on alcohol and unintentional injury we identified 21 studies on falls, 36 on drownings and 32 on bums from 1947‐1986. The proportion of fatal and ...non‐fatal fall victims who had been drinking ranged from 21–77%, and 18–53% respectively. In three more recent studies, 35–63% of persons fatally injured in falls had been drinking. In five other studies 13–37% of persons injured in non fatal falls had been drinking. In our earlier review of drowning studies with complete ascertainment and duration of submergence specified, 27–47% of those who drowned had positive BAC's. In eight subsequent studies, alcohol was identified in 21–47% of drowning deaths. In our earlier review alcohol was involved in 9‐86% of bum deaths. In five more recent US studies, alcohol was found in 12–61 % of fatally injured burn victims. Case control studies are needed to establish whether alcohol increases the risk of trauma. Studies are also needed of interventions to reduce the proportion of these injuries where alcohol is involved.
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