Acceptability of emergency department-based screening and brief intervention for alcohol problems.

OBJECTIVES: To adapt screening and brief intervention for alcohol problems (SBI) to a high-volume emergency department (ED) setting and evaluate its acceptability to patients. METHODS: Patients at a large public-hospital ED were screened with the Alcohol Use Disorders Identification Test (AUDIT). Screen-positive drinkers (AUDIT score >/= 6) were provided brief, on-site counseling and referral as needed. Three months later, project staff blinded to baseline measures reassessed alcohol intake, alcohol-related harm, alcohol dependence symptoms, and readiness to change. RESULTS: Of 1, 034 patients approached, 78.3% (810) consented to participate (95% CI = 75.5% to 81.2%), and 21.2% (172) screened positive (95% CI = 18.4% to 24.0%). Of 88 patients with complete intervention data, 94.3% (83) accepted an intervention (95% CI = 89.5% to 99.2%), with acceptance rates ranging from 93% to 100% across four alcohol-problem-severity levels (p = 0.7). A majority (59.0%) set goals to decrease or stop drinking (95% CI = 48.4% to 69.6%). The group recontacted (n = 23) experienced statistically significant decreases in alcohol intake, alcohol-related harm, and dependence symptoms, with measures decreasing for 68%, 52%, and 61% of the patients. Readiness to change also showed statistically significant improvement, with scores increasing for 43% of the patients. Moreover, two-thirds of the patients (15/23) reported at follow-up that SBI was a helpful part of their ED visit. CONCLUSIONS: High rates of consent and acceptance of counseling for alcohol problems by patients across a wide range of problem severity indicate that this protocol was acceptable to at-risk patients in a public-hospital ED. Improvements in alcohol-related outcome measures at follow-up were strong enough to warrant controlled studies of intervention efficacy.

Alcohol use prior to pregnancy recognition.

BACKGROUND: Frequent alcohol use during the first 8 weeks of pregnancy can result in spontaneous abortion and dysmorphologic changes in the developing organ systems of the embryo, including the heart, kidneys, and brain. However, few population-based studies are available that describe the prevalence of frequent drinking (6 or more drinks per week) among women prior to and during early pregnancy (the periconceptional period), and the sociodemographic and behavioral factors that characterize these women. Such knowledge is fundamental to the design of targeted interventions for the prevention of fetal alcohol syndrome (FAS) and other prenatal alcohol-related disorders. METHODS: This cross-sectional study used survey data collected by the National Center for Health Statistics as part of the 1988 National Maternal and Infant Health Survey (NMIHS). Weighted prevalence estimates were calculated using SUDAAN, and multivariate analyses were used to determine risk factors for frequent drinking. RESULTS: Forty-five percent of all women surveyed reported consuming alcohol during the 3 months before finding out they were pregnant, and 5% reported consuming 6 or more drinks per week. Sixty percent of women who reported alcohol consumption also reported that they did not learn they were pregnant until after the fourth week of gestation. Risk factors for frequent drinking during the periconceptional period included 1 or more of the following: being unmarried, being a smoker, being white non-Hispanic, being 25 years of age or older, or being college educated. CONCLUSIONS: Half of all pregnant women in this study drank alcohol during the 3 months preceding pregnancy recognition, with 1 in 20 drinking at moderate to heavy levels. The majority did not know they were pregnant until after the fourth week of pregnancy, and many did not know until after the 6th week. Alcohol is a teratogen capable of producing a number of adverse reproductive and infant outcomes. Public health measures needed to reduce these potentially harmful exposures include alcohol assessment, education, and counseling for women of childbearing age, with referral sources for problem drinking, and family planning services for pregnancy postponement until problem drinking is resolved.

Injury recidivism in a rural ED.

STUDY OBJECTIVE: To determine the degree of injury recidivism in our ED population and to identify indicators of injury recidivism. METHODS: We conducted a retrospective review in a university-affiliated department of emergency medicine. The study participants were patients who presented for treatment of an injury. An injury recidivist was defined as a patient who presented for treatment of two or more unique injuries during the 1-year study period. The injured population was divided into three categories: (1) those with a single injury visit, (2) those with two to three injury visits, and (3) those with four or more injury visits. Demographics, mechanism of injury, and outcome data were collected and comparative analyses performed. RESULTS: Of the 37,360 ED patient visits, 12,075 were injury related. Of the injury visit load, 2,838 of the 12,075 (24%) were injury recidivists. Of injured patients, 1,239 of 10,476 (12%) were recidivists. The sex distribution was similar among the groups, but the mean age decreased as the degree of recidivism increased. The degree of recidivism was higher for patients with Medicaid and for those who were uninsured. Lower mean medical charges per visit were found with increasing degree of recidivism, but the average total charges per patient increased with increasing degree of recidivism. Increasing degree of recidivism was associated with decreasing incidence of transportation-related injury but increased incidence of overexertion or intentional injuries. CONCLUSION: A small group of patients account for a significant proportion of ED injury visits. In comparison with injury patients seen once during the year, recidivists represent a younger population of lower socioeconomic status, and they are at increased risk of intentional injury.

Gestational weight gain among average-weight and overweight women--what is excessive?

OBJECTIVE: Our purpose was to determine the association between increased gestational weight gain and birth weight outcomes for low-income women. STUDY DESIGN: A total of 53,541 single, live infants delivered from 1990 to 1991 to white, black, and Hispanic women in eight states were evaluated. Multiple logistic regression was used to calculate risk of low and high (> 4500 gm) birth weight, adjusting for selected factors. RESULTS: The association between gestational weight gain and birth weight varied by prepregnancy body mass index. Risk for low birth weight decreased with increasing weight gain for average-weight women. There was no reduction in risk for low birth weight, however, beyond weight gains of 30 to 34 pounds for overweight women and 15 to 19 pounds for very-overweight women. Risk for high birth weight, however, increased with increasing weight gain in all three groups. CONCLUSION: Very-overweight women (body mass index > 29 kg/m2) may benefit from an upper guideline of 25 pounds of weight gain to help reduce risk for high birth weight.

Pregnancy nutrition surveillance system--United States, 1979-1990.

Since 1979, the CDC Pregnancy Nutrition Surveillance System (PNSS) has monitored behavior and nutritional risk factors among low-income pregnant women participating in public health programs. Although the states contributing to the system have varied over the period, the PNSS is able to characterize the behavior and health outcomes of pregnant women from diverse low-income populations. In 1990, 66.2% of the women in the system initiated prenatal care during the first trimester of pregnancy; 26.4% smoked during pregnancy. Since 1979, the prevalence of smoking remained relatively stable for white women, but declined for blacks and Hispanics. Prepregnancy body mass index (BMI, defined as kg/m2) showed marked changes from 1979 through 1990; the prevalence of underweight (BMI < 19.8) declined steadily and the prevalence of overweight (BMI > 26) increased steadily. In 1990, 39.3% of the women had gestational weight gains below levels recommended by the National Academy of Sciences. Both prepregnancy underweight and inadequate gestational weight gain were associated with greater risk for low birth weight in the PNSS. The prevalence of anemia at each trimester has remained stable since 1979. In 1990, 9.8%, 13.8%, and 33% of the women reported by the PNSS were anemic in the first, second, and third trimesters, respectively. Anemia in the first trimester appeared to be strongly associated with a high risk of low birth weight; this association was attenuated in later trimesters. These findings indicate the need to improve iron nutrition among low-income women.

Eating patterns and energy and nutrient intakes of US women.

A longitudinal multivariate analysis was used to determine whether differences in energy and nutrient intakes were present for women classified into different eating patterns. Ten multidimensional eating patterns were created based on the proportion of energy consumed at home and at seven away-from-home locations. Data were from 1,120 women aged 19 through 50 years who were surveyed up to six times over a 1-year period as part of the 1985 Continuing Survey of Food Intake by Individuals, US Department of Agriculture. Data from 5,993 days were analyzed. To examine differences in energy and nutrient intakes, longitudinal multivariate analyses were used to control for eating pattern and factors such as demographics, season, and day of week. Younger women in the Fast Food eating pattern consumed the greatest intakes of energy, total fat, saturated fat, cholesterol, and sodium. Well-educated, higher-income women in the Restaurant pattern consumed diets with the highest overall fat density. Nutrient densities for dietary fiber, calcium, vitamin C, and folacin were particularly low in away-from-home eating patterns. In contrast, moderately educated, middle-aged and middle-income women in the Home Mixed eating pattern (70% at home, 30% away from home) consumed the most healthful diets. We conclude that knowledge of demographics such as income and education is not enough to target dietary interventions. Rather, educational efforts must consider both demographics and the location of away-from-home eating. This will allow development of behavioral change strategies that consider food choices dictated by the eating environment as well as personal knowledge and attitude factors related to adoption of healthful food choices.