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Biomedical subjects

A J Treno

Publications and source records attributed to A J Treno.

At least 19 recordsLinked to original sources
PubMed2000

Effect of community-based interventions on high-risk drinking and alcohol-related injuries.

CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.

Accidents, Traffic↗
PubMed2000

The use of drinking places by gender, age and ethnic groups: an analysis of routine drinking activities.

AIMS: This paper extends a prior analysis of drinking patterns to consider the influence of non-economic variables on the selection of drinking locations. DESIGN: Using data from a general population telephone survey conducted as a part of the Community Trials Project, Tobit models are estimated to determine the influence of background demographic characteristics upon the selection of drinking locations net of other model control variables. PARTICIPANTS AND SETTING: 24,778 current drinkers from four California and two South Carolina communities. FINDINGS: Distinct patterns of premise utilization are found to be associated with age, gender and ethnic subgroups. Additionally these patterns of utilization are differentially linked to drinking and driving, suggesting that patterns of outlet utilization are differentially linked to acute drinking problems (e.g. drunken driving and alcohol-related car crashes). CONCLUSIONS: Observed differences in outlet utilization patterns between age, gender and ethnic subgroups imply that preventive interventions should take into account the manner in which these subpopulations make use of drinking venues.

Adolescent↗
PubMed2000

Alcoholism treatment and medical care costs from Project MATCH.

AIMS: This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. DESIGN: Longitudinal study with pre- and post-treatment initiation. MEASUREMENTS: The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. SETTING: Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). PARTICIPANTS: Two hundred and seventy-nine patients. INTERVENTION: Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. FINDINGS: Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF. CONCLUSIONS: Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment.

Adult↗
PubMed1999

Alcohol and fatal injury: the use of routinely collected fatality data in community prevention evaluation.

BACKGROUND: This study analyzed patterns of alcohol involvement among coroners' cases (which typically include blood alcohol content information) to develop a method for weighting death-certificate cases (which typically do not include blood alcohol content information) for likelihood of alcohol involvement for purposes of alcohol-involved injury intervention evaluation. METHODS: The coroners' data analyzed here were collected from four California communities and correspond to all injury coroner cases between 1987 and 1996 in those communities. The death-certificate data were provided by the State of California, Department of Health Services, and correspond to all injury deaths occurring in that state between 1980 and 1996. Each injury fatality in the death-certificate data was assigned a probability of alcohol involvement based upon the coroners' data. These were then summed to provide an estimate of, or "surrogate measure" for, the total number of alcohol-involved fatal injuries per 10,000 California residents aggregated across the state of California by month for the period from January 1980 to 1990. As a test of this estimate, we examined its responsiveness to an intervention designed to reduce alcohol-involved injuries which was implemented in California in 1990 using a time series analysis technique (ARIMA) that corrects for serial autocorrelation typically found in time ordered data. RESULTS: This analysis found an effect during the postintervention period (p = 0.046). An alternative model testing for intervention effects on all injury fatalities did not find an effect. CONCLUSIONS: This surrogate measure seems responsive to intervention effects and may provide a useful tool for interventions designed to reduce alcohol-involved injuries.

Adolescent↗
PubMed1999

Gender, acculturation, and alcohol consumption among Mexican Americans.

OBJECTIVE: This study examines the relationship between level of acculturation and drinking status among Mexican American males and females in three northern California cities. METHOD: The data analyzed were collected through the use of a telephone survey. The sample size is 932. RESULTS: Our results show that acculturation has a direct effect on drinking status for women in the sample but not for men. At low levels of acculturation, our results show the expected difference in drinking status by gender; with high abstention rates for women and low abstention rates for males. At high levels of acculturation there is a convergence in drinking status with females approximating the proportion of male drinkers in the sample. Additionally, acculturation was associated with "heavier" drinking for females while place of birth was associated with "heavier" drinking for males. CONCLUSIONS: Studies of drinking patterns and related problems need to consider these factors.

Acculturation↗
PubMed1998

Sample selection bias in the emergency room: an examination of the role of alcohol in injury.

AIMS: Injury location, injury cause and patient drinking patterns were used to predict blood alcohol content (BAC) and self-reported drinking before injury using emergency room (ER) data. DESIGN: Models estimating both BAC and self-reported drinking among emergency room injury patients were used; the ER sample was also compared to an injured sample from the general population. SETTING: Data were from three of six communities participating in the project "Preventing Alcohol Trauma: a community trial". PARTICIPANTS: ER data were collected from nine hospitals on Friday and Saturday nights between 6 p.m. and 2 a.m. on alternate weekends from June 1992 to December 1995. Telephone survey data were collected between April 1992 and March 1996. MEASUREMENTS: Drinking measures included drinking frequency, drinks per occasion, and variance. Other measures involved injury time, location, and type; drinking before and after injury; and age, race, gender, education, marital status and household income. Model estimation corrected both for selection bias and censoring of the dependent measure. FINDINGS: The results indicate: (1) ER populations tended to be female, less well educated, non-white, poor and younger; (2) there were significant selection bias effects in the ER sample; (3) assaults were more likely to involve drinking than other injury types; (4) drinking patterns were significant non-linear predictors of alcohol involvement; and (5) self-reported drinking before injury was both a sensitive and specific indicator of measured BAC. CONCLUSIONS: Assaults uniquely involve the use of alcohol and selection bias may threaten ER study validity.

Adult↗
PubMed1998

Drinking over the life course within gender and ethnic groups: a hyperparametric analysis.

OBJECTIVE: This study examines drinking patterns over the life course among males and females and among three ethnic groups (whites, blacks and Hispanics) in order to compare gender group and ethnic group differences in alcohol use as a continuous function of age. METHOD: Data are from a general population sample of 13,553 respondents aged 12 to 80 interviewed by telephone in 20 urban areas of the United States. Drinking measures include total consumption, drinking participation, drinking frequency and average drinks per occasion. RESULTS: In the total sample over age cohorts, total consumption, participation and average drinks per occasion rose rapidly before age 21, peaked in young adulthood and declined gradually thereafter. Drinking frequency rose rapidly before age 21, but generally showed no decline thereafter. As expected, compared to women, men consumed more total alcohol, were more likely to participate in drinking, drank more often and drank more per occasion. Men did not differ from women in the age at which peak drinking occurred. Relationships of drinking to ethnicity were more complex. Although white total consumption exceeded that of blacks and Hispanics over the entire life course, the other drinking measures involved interactions in which white participation and frequency exceeded that of blacks and Hispanics in later adulthood, but black and Hispanic average drinks per occasion exceeded that of whites in later adulthood. CONCLUSIONS: Differences in drinking patterns over the life course among gender groups and ethnic groups are largely a result of differences in rates of change over age cohorts in alcohol use, both in rates of increase in youth and of decrease thereafter.

Adolescent↗
PubMed1998

Age-related differences in risks of drinking and driving in gender and ethnic groups.

We examine the extent to which empirically observed age-related differences in rates of drinking and driving can be explained by concurrent differences in drinking patterns. Building on previous research showing significant age differences in drinking patterns between men and women and among three ethnic groups, Whites, Blacks, and Hispanics, our study considers whether there are unique gender and ethnic group differences in patterns of drinking and driving. Data were from 4395 respondents 12 to 80 years old in a general population survey of 20 urban areas in the United States. During the month preceding the interview, 1130 (25.7%) of all respondents had driven after having one or more drinks. Drinking pattern measures included drinking frequency, average drinking quantity, and the variance in the number of drinks consumed per occasion. To assess the relationships of drinking patterns to drinking and driving across age groups, two sets of analyses were conducted, one set in which age differences in drinking patterns were statistically controlled and one set in which they were not. Although the statistical control for drinking patterns reduced age differences between gender and ethnic groups, it did not eliminate them. The reduction demonstrated that part of observed group differences in driving after drinking over age among gender and ethnic groups is due to age-related differences in drinking patterns. However, despite controlling drinking patterns young respondents remained more likely to drink and drive. A supplementary analysis of self-reported incidents of driving while intoxicated (i.e., driving after having five or more drinks) further indicated that, controlling for drinking patterns, young respondents are most at risk.

Accidents, Traffic↗
PubMed1997

Evaluation design for a community prevention trial. An environmental approach to reduce alcohol-involved trauma.

The Community Prevention Trial was 5-year effort to reduce alcohol-involved injuries and death through a comprehensive program of community awareness and policy activities. The three experimental communities were of approximately 100,000 population each (one in Northern California, one in Southern California, and one in South Carolina). Matched comparison communities were used for each experimental community. This article describes the evaluation approach used in a program that sought to change environmental factors not a specific population or target group. This approach demanded unique evaluation approaches for determining overall community aggregate effects, that is, distal outcomes, as well as changes in key mediating variables, that is, process effects. The problem of trending and lagged effects of community prevention programs are discussed.

Accident Prevention↗
PubMed1997

Community mobilization, organizing, and media advocacy. A discussion of methodological issues.

Community Mobilization refers to those activities that prepare communities to accept, receive, and support prevention interventions designed to reduce alcohol-involved trauma. Media advocacy refers to the strategic use of media by those seeking to advance a social or public policy initiative. Within the Community Prevention Trial, both of these activities were critical elements. This article presents the evaluation design for community mobilization and media advocacy implemented for the project. Here the authors argue for the need to include both structured and unstructured community monitoring instruments, coding of local alcohol-related news coverage, and surveying community members about the exposure to alcohol-related problems, and support for project interventions. This article also presents an audience segmentation analysis and discusses the implications of this analysis for media advocacy efforts.

Accident Prevention↗
PubMed1997

Documenting community-level outcomes. Lessons from drinking and driving.

Alcohol-related crashes cluster on Friday and Saturday evenings. One objective of this study was to contrast the demographic characteristics of operators who drive at these times with those who do not, through the comparison of data from two of the most widely used methods for gathering information on drinking and driving: Random Digit Dialing Telephone Surveys and Roadside Voluntary Breath Test Surveys. Roadside surveys set up at locations where alcohol-related crashes occur provide a better sample of those drivers most at risk of crash involvement. Telephone surveys, because they do not generally measure the exposure of drivers both in the location of driving and the number of miles driven, are less suited to identifying the drivers at risk. However, they highlight the large number of individuals who drive during high-risk times but avoid high-risk locations.

Accidents, Traffic↗
PubMed1997

Summing up. Recommendations and experiences for evaluation of community-level prevention programs.

This article provides recommendations and observations about evaluation of a locally based prevention project to reduce problems at a total community or aggregate level. The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus assumptions about using random assignment and/or comparison communities as means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.

Accident Prevention↗
PubMed1997

The contribution of drinking patterns to the relative risk of injury in six communities: a self-report based probability approach.

OBJECTIVE: This article reports the results of an analysis of the relationships between demographic and alcohol consumption variables and the likelihood of injury occurring during the 6-month period prior to survey administration. METHODS: The date examined are from a general population survey administered to 22,626 respondents (56.9% female) as part of a community trial project to reduce alcohol-involved injury currently being conducted in six communities in California and South Carolina. Three models that relate consumption patterns and exogenous background variables to injury are evaluated. The first considers only demographic background variables. The second model adds three consumption measures (i.e., frequency, average drinks per occasion and variance) to the first. The third adds a control for community of residence. A fourth model is estimated using frequency and average drinks per occasion, by omitting variance. RESULTS: Findings indicate that likelihood of injury is affected by demographic, alcohol consumption and community of residence variables. Specifically, likelihood of injury is significantly related to being young, white, male and single, and having a high variance drinking pattern. Community level effects were found, with California respondents being more likely to experience injuries, controlling for other model variables. Although measures for education and income were included in our analysis, no effects for these variables could be found. Also, other drinking measures (i.e., drinking frequency and average drinks per occasion) were not found to be significantly related to injury, although estimated coefficients were in the predicted direction. CONCLUSIONS: Complementary to studies that have noted that a large portion of injuries involve persons who have been drinking prior to injury, our findings suggest a link between likelihood of injury and general drinking patterns.

Adolescent↗
PubMed1997

A community prevention trial to reduce alcohol-involved accidental injury and death: overview.

The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.

Accident Prevention↗
PubMed1997

Community mobilization: evaluation of an environmental approach to local action.

"Community mobilization" in the Community Trials Project refers to organizing community members to support and implement policies to reduce alcohol-involved trauma. This paper defines the conceptual model of mobilization used in the project. In evaluating the project, we were guided by the conceptual model and we used structured materials from interviews with local staff in all three experimental communities; we found that the overall goal of mobilization (implementation of policies) was achieved. Additional observations based on naturalistic case studies of the communities include: (1) the importance of an established research base, (2) the varying role and problematic nature of coalitions, (3) the strategic advantage of early project support among the general population, (4) the role played by key leaders in mobilization, (5) the advantages of a multi-component design, and (6) the key role played by media advocacy.

Accident Prevention↗
PubMed1997

Media advocacy in community prevention: news as a means to advance policy change.

Media advocacy within the Community Trials Project refers to the strategic use of news media to advance a social or public policy initiative. First, this paper presents a conceptual model that guided analyses of media advocacy. Secondly, it documents increases in alcohol-related news coverage. Thirdly, it compares changes in perceived risk of arrest after drinking and driving that can be linked to increased DUI news coverage. Fourthly, it examines community awareness of enforcement efforts in terms of both media advocacy efforts and traditional public information campaigns. Results indicate that: (1) training in media advocacy can increase coverage of news events generated by local community members including volunteers, (2) increased news coverage can be generated for both electronic (television) and print media, (3) increased news coverage did focus public attention on specific issues in support of prevention components, (4) while there are differential audiences/readers for the print (newspaper) and electronic (TV) media, both audiences are affected and (5) media advocacy can be more effective than a paid public information campaign in increasing public awareness of alcohol issues.

Accident Prevention↗
PubMed1997

Summing up: lessons from a comprehensive community prevention trial.

This paper presents the findings and lessons from a community prevention trial involving three experimental communities in the United States to reduce alcohol-involved trauma. The paper provides recommendations for other community prevention efforts. Effectiveness was demonstrated by: (a) 78 fewer alcohol-involved traffic crashes as a result of the Drinking and Driving Component alone (approximately a 10% reduction); (b) a significant reduction in underage sales of alcohol, i.e. off-premise outlets sold to minors about one-half as often as in comparison communities; (c) increased implementation of responsible beverage service policies by bars and restaurants; and (d) increased adoption of local ordinances and regulations to reduce concentrations of alcohol outlets.

Accident Prevention↗