Young people's perceptions of traffic injury risks, prevention and enforcement measures: a qualitative study.

The purpose of this qualitative study is to investigate young people's perceptions, in Barcelona, Spain, about the evolution, magnitude, causes and determinants of traffic crashes, to describe their opinions on road safety regulations, and to explore their suggestions and proposals. Interviews were conducted with 43 key informants and 12 focus groups involving 98 participants. Discussion guides were designed to get insight on perceptions of relevance and trends in road traffic injuries, determinants of these, regulations and enforcement, as well as to gather their own ideas for reducing traffic injuries. Young people are aware that traffic injuries are a relevant and increasingly serious problem. The main determinants identified are: driving under the influence of drugs and alcohol, fatigue, night driving, unsafe infrastructures, age of drivers and lack of public transport alternatives. Young people admit that fines, speed cameras and alcohol breath testing reduce risky driving. They prefer community work to fines. They have a poor image of public administrations in charge of prevention of traffic injuries. They demand information on traffic regulations and politicians' decisions, and a considerable increase in weekend and night time public transport. Effectiveness of interventions to reduce traffic injuries can be improved by taking the recipients' perceptions into account.

[Why is it so difficult to legislate on alcohol in Spain?]. / Por qué es tan difícil legislar sobre alcohol en España?

Wine belongs to the Mediterranean culture. Drinking alcohol is part of our social life, and its negative consequences have often been minimised, blame being apportioned rather to the individual, who doesn't know how to drink, than to the agent causing the harm. In recent years, road accidents and binge-drinking among young people have put alcohol on the political agenda. Adolescents and young adults have increased their consumption, and a pattern of binge-drinking has developed based on the open-air 'fiesta' nightlife, where groups of young people drink large bottles in the streets and squares (botellón). Educational campaigns and material have been mounted and produced, but two consecutive draft laws on measures for the prevention of alcohol-related harm have failed to be approved, coming up on both occasions against the same vested interests. This editorial reviews the ambivalence of society towards regulations on alcohol and the current state of the art. The first draft law (2002) was about preventing alcohol problems in the general population; the second (2006) was limited to the question of prevention among minors. Nobody could oppose it, not even the industry. However, an interested bias put the accent on wine--which allegedly should be considered not as alcohol but rather as food, and consequently removed from the law--so that discussion of the draft law became a 'wine war', with predictable consequences. Once again, a draft law on alcohol was shelved sine die and tossed into a corner to gather dust. WithIn this pessimistic scene, though, there are still some positive signs. No economic or political motives should constitute an obstacle to the protection of minors, at the very least.

[Short-term effectiveness of brief interventions in alcohol-positive traffic casualties]. / Efectividad a corto plazo de las intervenciones breves realizadas en pacientes lesionados por accidente de tráfico con alcoholemia positiva.

OBJECTIVES: To investigate the effectiveness of brief interventions to reduce alcohol intake in traffic casualties with a positive blood alcohol concentration. METHODS: Nine hundred forty-eight eligible casualties (97.6% of eligible casualties within a universe of 1106) were screened for alcohol and 126 (13.3%) were identified as positive. Interventions were performed in 85, randomly allocated to a minimal intervention (simple advice) or a brief intervention (motivational intervention). Telephone follow-up was scheduled for months 3, 6 and 12. The present study reports the results of follow-up at month 3. RESULTS: Fifty-seven patients (67%) were followed up at month 3. A total of 73.7% had reduced their alcohol intake and this percentage was greater in the group who underwent the brief intervention (p = 0.06; effect size 0.5) and among heavy drinkers (p < 0.05). CONCLUSIONS: The data indicate the effectiveness of the brief intervention, although the sample size does not allow definitive conclusions to be drawn.

Substance use among non-fatally injured patients attended at emergency departments in Spain.

AIMS: To describe the prevalence of recent use of alcohol, medication, and illegal drugs among patients who attended emergency departments (EDs) as a result of suffering an injury due to any external mechanism and to identify factors associated with alcohol and drug use. METHODS: A cross-sectional study was conducted in eight university hospitals in Spain. Participants were adult patients admitted to a trauma ED. Oral fluid was used to test for psychoactive substances analyzed by gas chromatography-mass spectrometry. Socio-demographic data and information on circumstances of the injury were collected through interviews. RESULTS: The analysis included 1579 patients admitted to the EDs (56.4% men). Among young people (< 40 years), 21.4% of men and 8.5% of women were positive for any illegal substance, primarily cannabinoids or cocaine; 24.7% of men and 14.8% of women were positive for alcohol. Among patients > or = 40 years, 7.4% of men and 1.6% of women were positive for any illegal substance, and 16.3% and 11.0% respectively for alcohol. Prevalence of substance detected varied across mechanism of injury, gender and age group. Night-time injury was associated with substance use. CONCLUSIONS: A high proportion of injured patients who were treated in an EDs tested positive for psychoactive drugs. Routine testing at trauma departments would maximize the identification of patients who may benefit from referral to specialized addiction treatment centers, or brief interventions.

Does the short form of the Alcohol Use Disorders Identification Test (AUDIT-C) work at a trauma emergency department?

The accuracy of the consumption items of AUDIT (AUDIT-C) was analyzed, using the full AUDIT score as gold standard, in 120 traffic casualties (78% men and 22% women), median age 27 years (IQR = [22-34]), entering an urban emergency room between 2001 and 2003, with (67%) and without (33%) a positive blood alcohol level (> or =0.2 g/L). Sensitivity, specificity, predictive value, overall accuracy, and receiver operating characteristics of AUDIT-C were measured. Diagnostic accuracy was 0.79, using cutoff indices of > or =5 for males and > or =4 for females. AUDIT-C may be useful in emergency departments for a stepwise screening. Further validation of this test with larger samples and different settings is warranted.

Simple advice for injured hazardous drinkers: an implementation study.

AIM: To evaluate the implementation of a screening and intervention procedure for hazardous drinkers in the routine praxis of an emergency service, without increasing the ED (emergency department) staff. METHODS: Four stages of the implementation process were undertaken: exploration and adoption, programme installation, and initial implementation. Two hospitals participated, with a coordinator, four trainers and all the emergency nursing staff. Eligible patients were males over age 15 presenting at the weekend with a traffic injury. Screening was performed with five questions (the three items of alcohol use disorders identification test (AUDIT-C) plus two questions about drinking within 6 h before the crash). Hazardous drinkers and drivers who had driven while intoxicated were offered simple advice. The programme implementation was evaluated by reviewing the patients' forms and by interviews and surveys of the nursing staff. RESULTS: The study lasted for 27 weeks. Knowledge and compliance with the programme were good. However, only 25% of the eligible patients were identified. Simple advice was accomplished by 94.7% of those in need of it. Although the majority of nurses felt at ease performing the intervention, 75% considered the programme as a work overload and only 21% reckoned that it was feasible for the emergency service. CONCLUSION: The emergency setting poses important barriers to the implementation of brief interventions.

[New and old addictions: implications for public health]. / Nuevas y viejas adicciones: implicaciones para la salud pública.

According to certain authors, any pleasure giving behaviour may become a habit, and depending on the circumstances, an addiction. The objective of this study is to examine the situation of addictions in Spain and the responses generated by health policies. In recent years, both the type and pattern of drug consumption in Spain, has undergone a noticeable change. Studies of the evolution of tobacco consumption suggest that the peak has passed, even though prevalence is still high. Alcohol consumption per capita has fallen by 25% in the last 25 years. During the same period, pattern of consumption has been modified. Sporadic drinking, in episodes of binging and drinking away from meals, is one of the patterns on the rise. According to the European Monitoring Centre for Drugs and Drug Addiction, in Spain, 27.8% of the population between 15- 64 years old has consumed an illegal drug at least once in their lives, with the prevalence rising to 38% among the 15- 34 year olds. Cannabis is the most consumed (29% among 1564 age group), followed by cocaine (5.9%), and ecstasy (4.6%). Spain, comparing with other countries of European Union, is the third in cannabis, ecstasy, and amphetamine and the first in cocaine consumption. With respect to the so-called behavioral addictions, no consensus in the field of psychiatry has been reached. The only psychological addiction with clear diagnostic criteria is gambling. The rest (Internet, sex, etc.), perhaps for their novelty, continue to be the object of controversy. New addictions, as much to addictive substances as to addictive behaviors, run parallel to the development of industrialized societies, leisure, free time, and a new way of life. This is the new challenge for Public Health.

Do young heroin users in Madrid, Barcelona and Seville have sufficient knowledge of the risk factors for unintentional opioid overdose?

To identify the self-perceived reasons for unintentional opioid overdose of young heroin users in three Spanish cities and their agreement with objective risk factors for overdose. Computer-Assisted Personal Interviews (CAPI) were held with 991 street-recruited current heroin users aged 18-30. The general reasons for overdose and the reasons for the last overdose suffered were explored with open-ended (OEQs) and pre-coded questions (PCQs). Limited knowledge of overdose risk factors was defined as mention of fewer than two objective risk factors for unintentional overdose in the OEQ. Univariate, bivariate, and logistic regression methods were used. 77.8% (Seville), 64.9% (Madrid) and 57.2% (Barcelona) of participants have limited knowledge of overdose risk factors. Residence in Seville and not having attended courses or meetings on overdoses were significantly associated with limited knowledge, after adjusting for other factors. The most frequently identified general reasons in OEQ or PCQ were using heroin in large amounts (66.8%), together with tranquilizers (62.0%), adulterated (60.7%), or purer than usual (57.6%). Most reasons were selected more frequently in PCQ than in OEQ, especially rapid injection of the entire dose and using heroin shortly after using tranquilizers or alcohol, by injection, or after a period of abstinence. The results were similar for overdoses suffered by participants. Most young heroin users do not have sufficient knowledge of overdose risk factors, especially the use of heroin by injection, after a period of abstinence, or together with alcohol or methadone. Specific informational or educational programs adapted to the local context are critically needed.

[Characteristics of road accident victims with positive blood alcohol levels]. / Características de los lesionados por accidente de tráfico con alcoholemia positiva.

OBJECTIVE: To identify the differential features of positive blood alcohol level (BAL) in people injured in road crashes who were attended an acute care service. METHODS: Cross-sectional study of persons aged 18 years old or older injured in motor vehicle crashes who were attended in the Traumatology Emergency Department of Vall d'Hebron Hospital (Spain) between July 2001 and February 2002. RESULTS: The study sample included 431 patients. A positive alcohol test was found in 13.7% of the sample. A statistically significant and independent association was found between positive BAL and male sex (odds ratio [OR] = 2.5 [95% CI, 1.3-5.4]), hospital admission (OR = 2.7 [95% CI, 1.3-5.4]), being attended on a weekend (OR = 3.7 [95% CI, 2.0-6.9]) and being attended during the night and early morning (OR = 4.6 [95% CI, 2.0-10.3]) or in the morning (OR = 3.6 [95% CI, 1.5-8.4]). CONCLUSIONS: The present study identifies a subgroup of people injured in motor vehicle crashes with a greater likelihood of positive BAL, in whom more active screening and secondary prevention activities should be implemented within traumatology and acute care settings.