Higher Blood Alcohol Concentration Levels Research Articles

Road traffic deaths: A retrospective analysis (2009–2019) in the north of the Italian region Emilia Romagna

Objective International literature and several national studies demonstrate that alcohol and illicit drugs impair driving abilities, diminishing the level of attention, and cause traffic accidents. In Italy, driving under the influence of alcohol or drugs is regulated by Articles 186 and 187 of the National Street Code, which defines penalties and fines for the convicted. The aim of this study was the collection of all available data from 2009 to 2019 focusing on deaths related to road accidents in the Unit of Legal Medicine of Department of Medicine and Surgery at the University of Parma, in order to assess any consumption of alcohol, illicit drugs, and medicinal drugs among drivers. Methods Data were retrieved from autopsy reports found at the Unit of Legal Medicine of Parma University related to 327 subjects who died following road accidents in the Italian areas of Parma, Reggio–Emilia, and Piacenza. The population was divided into subgroups according to age, gender, crash time, and drug positivity. Results Those in the age group 46 to 65 years old were involved in the most accidents, whereas the category with fewest members included subjects under 26 years old. The majority of road accidents occurred during the daytime and on weekends. Among the toxicological investigations carried out (only for drivers), the highest prevalence was found for alcohol (43.1%), followed by illicit drugs (14.4%) and medicinal drugs (7.8%). The prevalence of alcohol and illicit drugs in combination was 11.8%. Regarding subjects positive for alcohol and illicit drugs in combination, 44.4% had a blood alcohol concentration (BAC) > 1.5 g/L and overall, in 61.1% of the total cases a BAC > 0.81 g/L was detected. Conclusions Our results are in line with national and international studies highlighting the prevalence of high BAC levels in most of the cases. Confirmation analyses on blood collected from people who died following road accidents showed levels of BAC above 0.8 g/L (threshold for penal sanctions) in the majority of the subjects who tested positive for alcohol. They also revealed cocaine, cannabis, and benzodiazepines as the most common illicit drugs and medicinal drugs used, respectively, as demonstrated in several international studies.

Alcohol-associated traffic injuries in Verona territory: A nine-year survey.

According to the World Health Organization, as many as 25% of traffic accidents are linked to alcohol abuse. This study describes the results of a nine-year study performed on injured drivers (N = 12,806) in the Verona area of Northern Italy. Blood samples were mandatorily collected on injured drivers who were admitted to the Emergency Health Care Unit of Verona Hospital between 2009 and 2017, after they had been involved in a traffic accident. Blood alcohol concentration (BAC) determination was then undertaken using a validated head space-gas chromatography-flame ionisation detector (HS-GC-FID) method. We found that 21% of drivers tested positive for alcohol (BAC ≥0.01 g/L), while 16.8% presented with BAC levels above the Italian legal limit (>0.5 g/L). Of those who had positive BACs, about 50% presented with very high BAC levels (>1.5 g/L). Daily time distribution analyses, involving 2031 alcohol-positive drivers, showed a surge between 18:00 hours and 06:00 hours (74.3%), with a specific rise during the weekend (58.9%). The percentage of alcohol-related road accidents was 20.6%, which is lower than results reported in other international studies performed over the last 20 years. However, evidence that around 50% of the positive subjects showed a BAC >1.5 g/L confirms the correlation between BAC and accident risk, which becomes even more significant at progressively increasing levels of BAC. The study highlights the need to implement further strategies to both prevent and deter the use of alcohol while driving.

Alcohol Consumption and Violent Deaths in the City of Sao Paulo in 2015

Background: Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control, making people more vulnerable to violence and accidents, with thus a potential association between alcohol consumption and violent deaths. Objective: To assess the association between alcohol consumption and violent deaths in the city of Sao Paulo, Brazil, in 2015, and its relationship with gender, age, cause of death and blood alcohol concentration (BAC) of victims. Methods: A cross-sectional retrospective study was conducted by collection of data from 2,882 victims of violent deaths subjected to examination of BAC from the archives of the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Results: Alcohol was detected in blood samples of 27.06% of the victims and mean BAC levels were 1.92 ± 1.24 g/L. The mean age of the victims was 33.49 ± 15.19 years. The majority of the victims were male (84.14%) and the prevalence of positive BAC was higher amongst men (28.74%) than women (18.16%). Homicide was the most prevalent cause of death in the sample (36.57%), but there were a higher proportion of traffic accidents victims with positive BAC (32.01%), as well as higher BAC levels in these victims (46.77% in the range of 1.6–2.5 g/L). Conclusions: The results obtained in this study support a potential association between alcohol consumption and violent deaths in the city of Sao Paulo, mainly in traffic accidents victims.

Sensitivity to Experiencing Alcohol Hangovers: Reconsideration of the 0.11% Blood Alcohol Concentration (BAC) Threshold for Having a Hangover.

The 2010 Alcohol Hangover Research Group consensus paper defined a cutoff blood alcohol concentration (BAC) of 0.11% as a toxicological threshold indicating that sufficient alcohol had been consumed to develop a hangover. The cutoff was based on previous research and applied mostly in studies comprising student samples. Previously, we showed that sensitivity to hangovers depends on (estimated) BAC during acute intoxication, with a greater percentage of drinkers reporting hangovers at higher BAC levels. However, a substantial number of participants also reported hangovers at comparatively lower BAC levels. This calls the suitability of the 0.11% threshold into question. Recent research has shown that subjective intoxication, i.e., the level of severity of reported drunkenness, and not BAC, is the most important determinant of hangover severity. Non-student samples often have a much lower alcohol intake compared to student samples, and overall BACs often remain below 0.11%. Despite these lower BACs, many non-student participants report having a hangover, especially when their subjective intoxication levels are high. This may be the case when alcohol consumption on the drinking occasion that results in a hangover significantly exceeds their “normal” drinking level, irrespective of whether they meet the 0.11% threshold in any of these conditions. Whereas consumers may have relative tolerance to the adverse effects at their “regular” drinking level, considerably higher alcohol intake—irrespective of the absolute amount—may consequentially result in a next-day hangover. Taken together, these findings suggest that the 0.11% threshold value as a criterion for having a hangover should be abandoned.

Profile of fire fatalities in Ireland using coronial data

For the first time in the Republic of Ireland, analysis using coronial data describes all fire-related fatalities occurring during the years 2014–2016. Of the 106 fatalities, the majority of those who died were male (69, 65%) and 55 (52%) were 65 years or older. Most fires took place in private dwellings (97, 92%), in rural locations (58, 55%) and the majority were alone at the time of the fire (73, 69%). Fatal fires occurred more frequently during the night and where known (n = 48), the leading cause of fatal fires was due to smoking materials (12, 25%). Mobility was an issue for 16 people (15%) and 32 people (30%) were known to be smokers. Farmers and agricultural workers were over-represented in the data. Alcohol features prominently with alcohol present on toxicology for 54 (51%) fatalities. A Blood Alcohol Concentration (BAC) of at least 160 mg of alcohol per 100 mL of blood (mg/100 ml) was present in 35 fatalities (33% of all fatalities) and of those, the majority were male and in the 35–59 years age group. The high BAC levels in a significant number of fire fatalities, draws attention to the negative impact of alcohol on fire-related mortality.

High levels of alcohol intoxication and strong support for restrictive alcohol policies among music festival visitors

BackgroundAlcohol intoxication is associated with problems such as violence, injuries, drunk driving and sexual risk-taking, and music festivals are considered a high-risk setting for high levels of alcohol consumption. This study investigates intoxication levels, drinking habits, and opinions on alcohol use and alcohol policies among visitors at one of the largest music festivals in Sweden in 2017.MethodsA cross-sectional study assessing alcohol intoxication levels was conducted at a music festival (~ 50,000 attendees). Two research teams collected data at the two festival entrances during two nights, from approximately 6:00 pm to 01:30 am. Blood alcohol concentration (BAC) levels were measured using breath analyzers. A face-to-face questionnaire was used to interview attendees about their alcohol use in the past 12 months using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), as well as about their personal opinions on alcohol use and alcohol policies (statement). BAC levels were compared between categories of various factors using Mann-Whitney U test and Kruskal-Wallis test. The distributions of BAC, AUDIT-C and statement category across gender was analyzed using Pearson’s Chi-square tests. Associations of BAC levels with different factors were analyzed using Spearman rank correlation and multinomial logistic regression.ResultsA total of 1663 attendees were randomly selected and invited to participate, and 1410 consented (63.7% men, 34.9% women, age 16–64 years). The proportion of drinkers was 81%. Among the drinkers, the median BAC level was 0.082%. Thirty-one percent of the participants had a BAC level above 0.10%. Forty-two percent of the participants reported binge drinking monthly, and 20% said that they binge drank weekly. Sixty-three percent of participants reported risky drinking habits. A self-reported risky alcohol habit increased the risk of a high alcohol intoxication level at the festival. Respondents were supportive of restrictive alcohol policies. Men had significantly higher BAC levels, reported more often risky alcohol habits and were less supportive of restrictive alcohol policies than women.ConclusionsThe results indicate that participants at music festivals in Sweden have high levels of alcohol intoxication and largely support restrictive alcohol policies. Thus, there is both a need and support for the implementation of alcohol prevention strategies at festivals.

High blood alcohol concentration associated with traumatic brain injury among traffic injury patients during New Year festivals in Thailand

Objective: Road traffic injury (RTI) is one of the most significant public health problems in Thailand, especially during New Year and Songkran (Thai traditional New Year) holidays, which have the highest traffic density during the entire year. Drunk driving was reported to be one of the leading causes of RTI in Thailand. This study aimed to investigate the prevalence of patients with high blood alcohol concentration (BAC) and the association of BAC and specific organ injury during New Year and Songkran (Thai traditional New Year) holidays.Methods: A cross-sectional study was performed to analyze the database from the Thai Governmental Road Safety Evaluation Project. Patient data on RTIs were collected from 26 main provincial hospitals during the New Year Festival 2003 and 2004 and Songkran Festival in 2003. Patient characteristics, type of organ injured, and BAC levels were mainly analyzed.Results: During those long holidays, 2,642 RTI patients were identified, among whom 1,341 patients had high BAC levels. High BAC levels were associated with motorcycle users, male sex, middle age, teenagers, being riders or drivers, and not using protective devices. Moreover, high BAC levels were associated with brain injury.Conclusion: Excessive alcohol consumption and RTIs occurred on New Year and Songkran Festival in Thailand. Legislation should be strictly used during these long holidays to control driving under the influence of alcohol, particularly among motorcyclists.

Perception of intoxication in a field study of the night-time economy: Blood alcohol concentration, patron characteristics, and event-level predictors

ObjectiveDetermine the relationship of subjective intoxication to blood alcohol concentration (BAC) and examine whether patron and event-level characteristics modify the relationship of BAC to subjective intoxication. MethodsAn in-situ systematic random sample of alcohol consumers attending night-time entertainment districts between 10pm and 3am on Friday and Saturday nights in five Australian cities completed a brief interview (n=4628). Participants reported age, sex, and pre-drinking, energy drink, tobacco, illicit stimulant and other illicit drug use that night, and their subjective intoxication and BAC were assessed. ResultsMale and female drinkers displayed equally low sensitivity to the impact of alcohol consumption when self-assessing their intoxication (BAC only explained 19% of variance). The marginal effect of BAC was not constant. At low BAC, participants were somewhat sensitive to increases in alcohol consumption, but at higher BAC levels that modest sensitivity dissipated (actual BAC had less impact on self-assessed intoxication). The slope ultimately leveled out to be non-responsive to additional alcohol intake. Staying out late, pre-drinking, and being young introduced biases resulting in higher self-assessed intoxication regardless of actual BAC. Further, both energy drinks and stimulant use modified the association between BAC and perceived intoxication, resulting in more compressed changes in self-assessment as BAC varies up or down, indicating less ability to perceive differences in BAC level. ConclusionsThe ability of intoxicated patrons to detect further intoxication is impaired. Co-consumption of energy drinks and/or stimulant drugs is associated with impaired intoxication judgment, creating an additional challenge for the responsible service and consumption of alcohol.

Estimated blood alcohol concentrations achieved by consuming supersized alcopops

ABSTRACTBackground: Producers of supersized alcopops have ignored requests from a number of state attorneys general to reduce the alcohol concentration in these products. To the contrary, new flavor options have since been released that contain even greater alcohol content so that some alcopop products now contain 5.5 standard alcoholic drinks in a single-serving can. Though alcohol content of supersized alcopops has risen, little attention has been paid to the blood alcohol concentration (BAC) level consumers can expect to achieve from drinking these products. Objectives: To estimate BAC levels expected from consuming one or two cans of supersized alcopop, relative to beer. Methods: Median weight data from the National Health and Nutrition Examination Survey were used in Matthews and Miller’s (1979) BAC estimation formula. Results: Consuming a single supersized alcopop over the course of 2 hours can put youth and young adults well over the legal per se driving limit of 0.08 g/dL. Consuming two cans puts them at risk of alcohol poisoning. Conclusions: Estimates provided here show that supersized alcopop consumers obtain dangerously high BAC levels. Reductions in the alcohol content of supersized alcopops should be an urgent priority for public health policy and law.

Closed-Course Study to Examine the Effect of Alcohol Impairment on a Driver’s Ability to Identify and Read Signs

Because alcohol has been found to be the primary contributing factor in many wrong-way crash studies, researchers at Texas A&M Research Institute conducted a nighttime closed-course study to investigate the behaviors of alcohol-impaired drivers and determine their interpretations of various traffic control devices. Researchers found that alcohol-impaired drivers tended to look less to the left and right and more toward the pavement in front of the vehicle. In addition, researchers confirmed that alcohol-impaired drivers did not actively search the forward-facing scene as much as nonimpaired drivers. Instead, alcohol-impaired drivers concentrated their glances in a smaller area within the forward-facing scene. Researchers also confirmed that drivers at higher blood alcohol concentration levels took longer to locate signs and had to be closer to a sign before they could identify the sign background color and read the sign legend. In addition, alcohol-impaired drivers had to be closer to signs with flashing red LEDs around the border before they could read the legend compared with signs without flashing LEDs.

Characteristics of individuals who use alcohol at the time of attempting suicide

ObjectiveThe aim of this study was to analyze the clinical characteristics of individuals who used alcohol at the time of attempting suicide.MethodsWe divided 143 individuals who attempted suicide by consuming drugs into two groups on the basis of their blood alcohol concentration level: drinker group (n = 79) and non-drinker group (n = 64). We compared epidemiological characteristics and suicidal behavior between the groups by using the Suicidal Intent Scale (SIS) and the Risk Rescue Rating Scale (RRRS). In addition, we administered the Glasgow Coma Scale (GCS) and the Acute Physiology and Chronic Health Evaluation–II (APACHE–II) to evaluate the medical lethality of the individuals who attempted suicide. We used Student's t-test, Pearson's correlation analysis, and multiple linear regression to analyze the data.ResultsThe drinker group scored lower on the SIS's planning subscale than the non-drinker group did (P = 0.022). The drinker group's blood alcohol concentration levels were negatively correlated with the rescue potential of their suicidal attempt (P = 0.031) and the APACHE-II score (P = 0.003). Higher blood alcohol concentration levels predicted poorer medical outcomes measured by the APACHE-II (P = 0.004).ConclusionOur findings support the notion that alcohol use increases suicidal impulsivity, decreases rescue potential, and worsens medical outcomes. Therefore, suicide prevention programs need to include education and counselling about the risks associated with alcohol use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Police Documentation of Alcohol Involvement in Hospitalized Injured Drivers

Objective: Injured drivers with blood alcohol concentration (BAC) above the legal limit are rarely convicted of impaired driving. One explanation is that police may have difficulty recognizing alcohol intoxication in injured drivers. In this study, we compare police documentation of alcohol involvement with BAC measured on arrival at a hospital. Our objectives were to determine how often police document alcohol involvement in injured drivers with BAC ≥ 0.05 percent and identify factors that influence police documentation of alcohol involvement. Methods: We included injured drivers (1999–2003) who were admitted to a British Columbia trauma center or treated in the Vancouver General Hospital emergency department. We used probabilistic linkage to obtain police collision reports. Police were considered to have indicated alcohol involvement if (1) police documented that alcohol contributed to the crash, (2) the driver received an administrative sanction for impaired driving, or (3) the driver was criminally convicted of impaired driving. The proportion of drivers for whom police indicated alcohol involvement was determined relative to age, gender, BAC levels, crash severity, and crash characteristics. Multivariate logistic regression was used to identify factors independently associated with police indication of alcohol involvement. Results: Two thousand four hundred and ten injured drivers (73.5% male) were matched to a police report. Overall, 857 (35.6%) drivers tested positive for alcohol (BAC ≥ 0) and 736/857 (85.9%) of alcohol-positive drivers had a BAC ≥ 0.05 percent (the legal limit in British Columbia). Of the 736 drivers with a BAC > 0.05 percent at time of admission, police indicated alcohol involvement in 530 (72.0%). The criminal code conviction rate for impaired driving was 4.7 percent for drivers with 0.08 percent ≤ BAC < 0.16 percent and 13.6 percent for drivers with BAC > 0.16 percent. The following factors were associated with higher odds of police indicating alcohol involvement: (1) increasing blood alcohol levels, (2) a prior record of impaired driving, (3) involvement in a single-vehicle crash, (4) involvement in a nighttime crash, and (5) traffic violations or unsafe driving actions recorded by police. Conclusions: Police recognized and documented alcohol involvement in 72 percent of injured drivers with BAC ≥ 0.05 percent. Police documentation of alcohol involvement was more common at higher BAC levels, in nighttime or single-vehicle crashes, for drivers who committed traffic violations or drove unsafely, and for drivers with a prior record of impaired driving. The low conviction rate of injured impaired drivers does not appear to be due to police inability to recognize alcohol involvement.

The separate effects of self-estimated and actual alcohol intoxication on risk taking: A field experiment.

Many risky actions are carried out under the influence of alcohol. However, the effect of alcoholic intoxication over the willingness to take risks is complex and still remains unclear. We conduct an economic field experiment in a natural, drinking and risk-taking environment to analyze how both actual and self-estimated blood alcohol concentration (BAC) levels influence subjects’ choices over monetary lotteries. Our results reveal a negative impact of both actual and self-estimated BAC levels on risk-taking. However, for male and young subjects, we find a positive relationship between BAC underestimation (a pattern of estimation error which mainly occurs at high BAC levels) and the willingness to choose riskier lotteries. Our findings suggest that a risk compensation mechanism is activated only when individuals’ own intoxication level is consciously self-perceived to be high. We conclude therefore that human propensity to engage in risky activities under the influence of alcohol is not due to an enhanced preference for risky choices. In addition to the suggestion in the existing literature that such propensity is due to a weakened ability to perceive risks, our results indicate that an impaired self-perception of own intoxication level may also be an important factor.

Nonfatal Bicycle Accident Risk After an Evening of Alcohol Consumption

Introduction: After an evening of alcohol consumption, blood alcohol concentration (BAC) may reach intoxica- tion levels above legal limits for operating a car or bicycle. In the Netherlands, legal limits for participating in traffic are 0.05% for experienced drivers and 0.02% for novice drivers. The purpose of this study was to determine bicycle accident risk of Dutch students after an evening of alcohol consumption. Methods: A survey was conducted among 800 University and college students in Utrecht, The Netherlands. The survey included retrospective questions concerning alcohol consumption on a typical night out and the start and end time of con- sumption. For those who travel home by bicycle, BAC was computed and relative risk of having a bicycle accident. Fi- nally, they reported the likelihood (0 - 100 %) that they would consume less alcohol when police controls for drunk bicy- cling were comparable to those for car drivers (with a similar chance of getting caught and a similar fine for driving when drunk). Results: 761 surveys (95.3 %) were eligible for statistical evaluation. 690 students reported going to the pub for a night out, on average 1.6 times per week. 445 students (64.5 %) reported traveling home by bicycle often or always. They re- ported drinking an average of 6.8 alcoholic drinks (Standardized drinks contain 12 gram alcohol) and their mean (SD) BAC when traveling home was 0.95 (0.9)%. The percentage of past year accidents or injury among those traveling home by bicycle often or always but consumed no alcohol (BAC=0%) was 2%. Alcohol consumption significantly increased the risk of bicycle accidents (Odds ratio: 6.8). Odds ratio of having a bicycle accident increased exponentially when having a higher BAC: 2.5 (BAC = 0-0.2%), 6.8 (BAC = 0.2-0.5%), 6.0 (BAC = 0.5-1.0%), 16.4 (BAC = 1.0-1.5%) and 11.1 (BAC > 1.5%). Logistic regression analysis revealed a significant (p<0.006) relationship between alcohol consumption and the risk of a bicycle accident. Students who travel home by bicycle report that there is a 41.9% chance that they will consume less alcohol on a night out when police controls for driving drunk are the same as for car drivers. This was not related to BAC levels. Conclusions: On average, students have blood alcohol concentrations that are five-fold higher than allowed to participate in traffic. Nevertheless, most of them travel home by bicycle after an evening of alcohol consumption. This is of great concern, since the risk of having a bicycle accident increases with higher BAC levels.

Traumatic Brain Injury Hospitalizations Among American Indians/Alaska Natives

To compare the incidence of nonfatal traumatic brain injury (TBI) hospitalization among American Indians/Alaska Natives (AI/AN) with that of other race groups and to assess alcohol and protective equipment (PE) use among those who sustained TBI related to a motor vehicle (MV) incident. Data were obtained from 13 states funded by the Centers for Disease Control and Prevention to conduct TBI surveillance from 1997 to 1999. Rates by race and by cause were calculated for the 13 states combined. Blood alcohol concentration (BAC) levels and PE use were compared between AI/AN and "other" races in a subgroup of these states. Although not significantly different, AI/AN had the highest overall age-adjusted TBI hospitalization rate (71.5 per 100,000). Rates were significantly higher among AI/AN than among whites for ages 20 to 44 years (78.5 per 100,000 vs 54.7 per 100,000, P < .0001). MV incidents were the leading cause of TBI (40.1% of cases) among AI/AN, and AI/AN injured in MV incidents had higher BAC levels (65.7% > or = 0.08 g/dL vs 31.6% > or = 0.08 g/dL, P < .0001) and lower PE use (22.0% vs 40.4%, P < .0001) than the "other" race group. AI/AN have high rates of TBI hospitalization compared with other races. High BAC levels and low use of PE in MV incidents appear to be associated with the higher rates in this population.

Statistical Evaluation of Standardized Field Sobriety Tests

Standardized Field Sobriety Tests (SFSTs) are used as qualitative indicators of impairment by alcohol in individuals suspected of DUI. Stuster and Burns authored a report on this testing and presented the SFSTs as being 91% accurate in predicting Blood Alcohol Concentration (BAC) as lying at or above 0.08%. Their conclusions regarding accuracy are heavily weighted by the large number of subjects with very high BAC levels. This present study re-analyzes the original data with a more complete statistical evaluation. Our evaluation indicates that the accuracy of the SFSTs depends on the BAC level and is much poorer than that indicated by Stuster and Burns. While the SFSTs may be usable for evaluating suspects for BAC, the means of evaluation must be significantly modified to represent the large degree of variability of BAC in relation to SFST test scores. The tests are likely to be mainly useful in identifying subjects with a BAC substantially greater than 0.08%. Given the moderate to high correlation of the tests with BAC, there is potential for improved application of the test after further development, including a more diverse sample of BAC levels, adjustment of the scoring system and a statistically-based method for using the SFST to predict a BAC greater than 0.08%.

Alcohol and Injury: A Comparison of Emergency Room Populations in Two Canadian Provinces*

The few comparative emergency room (ER) studies reported have found alcohol's role in injury occurrence to vary and suggest that regional and cultural differences in drinking patterns may account, in part, for this variation. To further this research, a probability sample of 1708 ER patients was interviewed regarding the role of alcohol in the event, usual drinking patterns, and alcohol-related problems and a urine sample was obtained to estimate blood alcohol concentration (BAC). The sample was from ERs in two Canadian provinces with distinctly different cultures: primarily English-speaking Alberta and French-speaking Quebec. While differences in demographic and drinking characteristics between injured and noninjured in both the Alberta and Quebec ERs were similar to those in other ER studies, the injured in the Alberta ER were more likely to be positive for estimated BAC; to have higher BAC levels; to report drinking prior to the event; and, among those reporting drinking, to have consumed a larger number of drinks and to report feeling drunk at the time of injury compared to those in Quebec. These differences may be associated with cultural differences in typical drinking patterns, with higher rates of abstinence reported in the Alberta ER, but also with higher rates of heavy drinking and alcohol-related problems, while those in the Quebec ER were more likely to report consuming smaller quantities with greater frequency (typical of wine-drinking cultures). Additional research is needed to explicate further alcohol's role in injury occurrence for planning effective prevention strategies that are both culturally relevant and specific.

Alcohol's effect on fatality risk from a physical insult.

Although alcohol's effect on the risk of being involved in a traffic crash is well known, its influence on the risk of death, given that a crash has occurred, is more uncertain. One study published a few years ago finds that alcohol increases such risk. The present study examines alcohol's effect on fatality risk in a crash using data and methods independent of the previous study, and provides estimates as a function of blood alcohol concentration (BAC). Data for drivers with measured BAC who were fatally injured in a two-car crash were selected from the Fatal Accident Reporting System (FARS). The study uses two sets of fatal crashes. For one, the probability that a BAC = 0 driver was killed is low, so that if alcohol increased fatality risk, this would generate additional fatalities at higher BAC levels. For the other set of crashes, fatality risk was sufficiently close to 100% that other factors had little opportunity to influence it. Dividing the fatalities that can be affected by alcohol by those that cannot measures alcohol's influence on fatality risk, and gives that a driver with BAC = 0.1% is 1.9 +/- 0.2 times as likely as is a BAC = 0 driver to be killed in the same crash. The corresponding ratio for a BAC = 0.25% driver is 3.3 +/- 0.5. While derived using the "laboratory" of traffic, there does not appear to be any obvious reason why the results should not apply to physical trauma in general, so a BAC of 0.1% doubles the risk of death from a given impact, and a BAC of 0.25% triples the risk.

Blood alcohol tests, prevalence of involvement, and outcomes following brain injury.

We collected data on all residents of San Diego County, California who were hospitalized for or died from a brain injury in 1981. The objectives were to assess the frequency of blood alcohol concentration (BAC) testing and the associations of BAC prevalence with the external cause of the brain injury and case outcome. We found that high BAC levels were most frequent among brain-injured subjects between the ages of 25 and 44 and among those subjects involved in motor vehicle crashes and assaults. Contrary to expectations, injury severity and hospital mortality were inversely related to BAC level, controlling for other predictors. We believe that these inverse associations might be due to differential rates of BAC testing by severity. Among brain-injured survivors with more severe injuries, however, we found that BAC level was positively associated with the prevalence of physician-diagnosed neurological impairment at discharge and with the length of hospitalization.