Saturday

SBI Report Published 2008 by Join Together with support from the Robert Wood Johnson Foundation

http://www.jointogether.org/aboutus/ourpublications/pdf/sbi-report.pdf
Screening and brief intervention (SBI) has begun to emerge as a critical
strategy for targeting this large but often overlooked population of individuals
who exceed low risk guidelines. The primary goal of screening and brief
intervention efforts is not to identify alcohol- or drug-dependent individuals for
referral to treatment. Rather, these approaches are intended to meet the public
health goal of reducing the harms and societal costs associated with risky
drinking.
A significant advantage for those working to create a positive impact on this
problem is the potential to make significant gains by virtue of the large, easily
identifiable, and accessible group of risky drinkers. Small positive changes
spread over a large group will manifest themselves in the lives of the subjects,
their families and all those around them - an encouraging multiplier effect.
SBI efforts hinge on finding opportunities in general medical, public health
and other systems to identify and address individuals who may benefit from
education and guidance about their substance use. These educational efforts are
directly aimed at helping risky drinkers change their behavior.
Screening involves the use of specific, evidence-based questionnaires in
verbal, written or electronic formats that are designed to detect risky alcohol
and/or drug use. The questions asked in formal screening are intended to
measure quantity and frequency of substance use over defined periods, as well
as the occurrence of its adverse consequences. These screenings are designed to
be quick, often lasting only five to 15 minutes.
A brief intervention generally consists of a nonconfrontational encounter
between a health professional and a patient that is designed to help improve
chances that the patient will reduce risky alcohol consumption or discontinue
harmful drug use. A brief intervention goes beyond the sharing of simple
advice. It uses evidence-based approaches to give the patient tools for changing
his beliefs about substance use and coping with everyday situations that
exacerbate his risk for harmful use.

J TRAUMA: Alcohol and Other Drug Problems among Hospitalized Trauma Patients: Controlling Complications, Mortality, and Trauma Recidivism

The Journal of TRAUMA - Injury, Infection and Critical Care
http://www.cdc.gov/ncipc/Spotlight/JrnTraumaSupl.htm
Alcohol and Other Drug Problems among Hospitalized Trauma Patients: Controlling Complications, Mortality, and Trauma Recidivism – Conference Proceedings
Section 1 = S1-S42
Forewords
Controlling Alcohol Problems among Hospitalized Trauma Patients . . . . . . .
Ronald V. Maier, MD, FACS
S1
The Challenge of Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carlo C. DiClemente, PhD, ABPP
S3
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Daniel W. Hungerford, PhDS5
Steering Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S6
Participant Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S7
Introduction
Interventions in Trauma Centers for Substance Use Disorders: New Insights on an Old Malady. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Daniel W. Hungerford, PhD

S10
Alcohol Interventions in Trauma Centers: The Opportunity and the Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Larry M. Gentilello, MD

S18
Brief Motivational Interventions: An Introduction . . . . . . . . . . . . . . . . . .
Craig Field, PhD, MPH; Daniel W. Hungerford, PhD; Chris Dunn, PhD
S21
The Stages of Change: When are Trauma Patients Truly Ready to Change?.
Chris Dunn, PhD; Daniel W. Hungerford, PhD; Craig Field, PhD; Barbara McCann, PhD
S27
Changing the Battle Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Herbert D. Kleber, MD
S33
Recommendations for Trauma Centers to Improve Screening, Brief Intervention, and Referral to Treatment for Substance Use Disorders . . . . Daniel W. Hungerford, PhD
S37

Section 2 = S43-S75

Conference Proceedings
Day-1 Conference Welcome Keynote Speaker: Jeffrey Runge, MD . . . . . . .
Jeffrey Runge, MD
S43
Session 1
Session 1: The Impact of Alcohol and Other Drug Problems on Trauma Care - Biosketches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S49
The Impact of Alcohol and other Drug Problems on Trauma Care. . . . . . . .
Basil A. Pruitt Jr, MD, FACS
S50
Alcohol and Trauma: The Perfect Storm . . . . . . . . . . . . . . . . . . . . . . . .
Ernest E. Moore, MD
S53
The Impact of Street Drugs on Trauma Care . . . . . . . . . . . . . . . . . . . . .
Charles E. Lucas, MD, FACS
S57
A Rational Approach to Formulating Public Policy on Substance Abuse . . . .
Donald D. Trunkey, MD; Carol Bonnono, RN, CEN
S61
Session 1: Impact of Alcohol and other Drug Problems on Trauma Care-Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S67

Section 3 = S76-S100

Session 2
Session 2: Substance Abuse Interventions for Trauma Patients – Biosketches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S76
Session 2: Substance-Abuse Interventions-Setting the Stage for Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carl A. Soderstrom, MD

S77
Screening and Interventions for Alcohol and Drug Problems in Medical Settings: What Works?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Thomas F. Babor, PhD, MPH; Ronald M. Kadden, PhD

S80
Brief Interventions for Hospitalized Trauma Patients. . . . . . . . . . . . . . . .
Chris Dunn, PhD; Brian Ostafin, PhD
S88
Session 2: Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S94

Section 4 = S101-S133

Session 3
Session 3: The Feasibility of Implementing Interventions in Trauma Care Settings-Biosketches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S101
Operational Feasibility of Interventions in Trauma Centers . . . . . . . . . . . .
Anthony A. Meyer, MD, PhD
S102
Barriers to Interventions for Alcohol Problems in Trauma Centers . . . . . . . .
H. Gill Cryer, MD
S104
Implementing Screening, Brief Intervention, and Referral for Alcohol and Drug Use: The Trauma Service Perspective . . . . . . . . . . . . . . . . . . . . .
Michael J. Sise, MD; C Beth Sise, MSN, JD; Dorothy M. Kelley, MSN; Charles W. Simmons, MD; Dennis J. Kelso, PhD

S112
Feasibility of Alcohol Screening and Brief Intervention . . . . . . . . . . . . . .
Carol R. Schermer, MD, MPH
S119
Session 3: Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S124

Section 5 = S134-S166

Session 4
Session 4: Overcoming Obstacles-Choosing Goals and Strategies - Biosketches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S134
Are We the Problem? Overcoming Obstacles to Implementing Intervention Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
David B. Hoyt, MD, FACS

S135
Confronting the Obstacles to Screening and Interventions for Alcohol Problems in Trauma Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Larry M. Gentilello, MD

S137
Interventions-Developing a Plan for Implementation . . . . . . . . . . . . . . . . . . .
J. Wayne Meredith
S144
Session 4: Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S146
Session 5
Session 5: Discussion of Draft Recommendations . . . . . . . . . . . . . . . . . .
S155

Stopping smoking before 15 weeks' gestation is associated with rates of infants similar to those in women who do not smoke

http://www.bmj.com/cgi/reprint/338/mar26_2/b1081reprint/338/mar26_2/b1081

stopping smoking before 15 weeks' gestation is associated with rates of infants similar to those in women who do not smoke

Data from this large prospective cohort study of nulliparous
women have shown that stopping smoking
before 15 weeks gestation is associated with rates of
spontaneous preterm birth and small for gestational
age infants similar to those in women who do not
smoke in pregnancy. Maternity care providers should
strive to assist pregnant women who smoke to stop
early in pregnancy, emphasising the major health benefits
if they cease to smoke before 15 weeks gestation.

Alcohol and Suicide Among Racial/Ethnic Populations --- 17 States, 2005--2006

MMWR-Weekly
June 19, 2009 / 58(23);637-641


Alcohol and Suicide Among Racial/Ethnic Populations --- 17 States, 2005--2006

During 2001--2005, an estimated annual 79,646 alcohol-attributable deaths (AAD) and 2.3 million years of potential life lost (YPLL) were attributed to the harmful effects of excessive alcohol use (1). An estimated 5,800 AAD and 189,667 YPLL were associated annually with suicide (1). The burden of suicide varies widely among racial and ethnic populations in the United States, and limited data are available to describe the role of alcohol in suicides in these populations. To examine the relationship between alcohol and suicide among racial/ethnic populations, CDC analyzed data from the National Violent Death Reporting System (NVDRS) for the 2-year period 2005--2006 (the most recent data available). This report summarizes the results of that analysis, which indicated that the overall prevalence of alcohol intoxication (i.e., blood alcohol concentration [BAC] at or above the legal limit of 0.08 g/dL) was nearly 24% among suicide decedents tested for alcohol, with the highest percentage occurring among American Indian/Alaska Natives (AI/ANs) (37%), followed by Hispanics (29%) and persons aged 20--49 years (28%). These results indicate that many populations can benefit from comprehensive and culturally appropriate suicide-prevention strategies that include efforts to reduce alcohol consumption, especially programs that focus on persons aged <50>

NVDRS is an active, state-based surveillance system that collects information on homicides, suicides, deaths of undetermined intent, deaths from legal intervention (e.g., involving a person killed by an on-duty police officer), and unintentional firearm deaths. Suicide decedents are identified as those with death certificates that list International Classification of Diseases, 10th Revision codes X60--84 or Y87.0 as the primary cause of death. Information on race and ethnicity are recorded as separate items in NVDRS consistent with other vital statistics reporting; for this analysis, CDC used five racial/ethnic categories: Hispanic, non-Hispanic white, non-Hispanic black, non-Hispanic AI/AN, and non-Hispanic Asian/Pacific Islander (A/PI). Analysis was limited to persons aged ≥10 years. Data from 2 years, 2005 and 2006, were aggregated to produce more stable estimates than could be obtained from an analysis of data from a single year.

A total of 19,255 suicides occurred in the 17 states contributing data to NVDRS during 2005--2006 (Alaska, California,* Colorado, Georgia, Kentucky, Massachusetts, Maryland, North Carolina, New Jersey, New Mexico, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin) (2). This analysis excluded 21 decedents because they were aged <10>

Alcohol-related information was assessed by NVDRS through questions asked of next of kin, judgment by medical or law enforcement officials, or laboratory data. Information collected related to 1) the decedent's alcohol dependence or problem (whether the victim was perceived by self or others to have a problem with, or to be addicted to, alcohol); 2) suspected alcohol use (whether alcohol use by the decedent in the hours preceding the incident was suspected, based on witness or investigator reports or circumstantial evidence, such as empty alcohol containers around the decedent); 3) testing for alcohol (i.e., whether the decedents blood was tested for the presence of alcohol); 4) alcohol test results (recorded as positive, negative, not applicable [i.e., not tested], or unknown); and 5) the decedent's BAC measured in g/dL. A BAC ≥0.08 g/dL was used to define intoxication consistent with the standard set by the U.S. Department of Transportation (3). Coroner and medical examiner records indicated that nearly 70% of the decedents were tested for BAC. The analysis of BAC excluded persons not tested for alcohol and persons who were tested for alcohol but for whom no quantitative values were recorded.

BAC was examined both as a continuous variable and as a multiple of the legal limit (≥0.24, ≥0.16, ≥0.08, and <0.08>

The highest percentage of suicide decedents characterized as dependent on alcohol was observed among non-Hispanic AI/ANs (21%); the lowest percentage was observed among non-Hispanic blacks (7%) (Table). Recent alcohol use was suspected in approximately 46% of non-Hispanic AI/ANs, nearly 30% of Hispanics, and 26% of non-Hispanic whites.

The highest percentage of suicide decedents tested for alcohol was among non-Hispanic blacks (76%). Alcohol was detected in the blood of 33.2% of decedents tested, with the highest percentages occurring among non-Hispanic AI/AN (45.5%) and Hispanic (39.0%) subjects tested (Table).

For all age groups, the highest percentage of decedents with BACs ≥0.08 g/dL was among AI/ANs aged 30--39 years (54.3%), followed by AI/AN and Hispanic decedents aged 20--29 years (50.0% and 37.3%, respectively). Among decedents tested who were aged 10--19 years (all of whom were under the legal drinking age in the United States), 12% had BACs ≥0.08 g/dL; the levels ranged from 1.3% in non-Hispanic blacks to 28.6% in non-Hispanic A/PIs (Figure 1). Among male decedents tested, 25% tested above legal intoxication; among females tested, 18% tested above legal intoxication (Figure 2). Males had a significantly higher percentage with BACs ≥0.08 g/dL than females (p<0.02, p="0.99,">

Reported by: AE Crosby, MD, V Espitia-Hardeman, MSc, HA Hill, MD, PhD, L Ortega, MD, C Clavel-Arcas, MD, National Center for Injury Prevention and Control, CDC.

Editorial Note:

Researchers have proposed various mechanisms regarding the role of acute or chronic alcohol use in suicidal behavior (4). These include alcohol's effect on promoting depression and hopelessness, promoting disinhibition of negative behavior and impulsivity, impairing problem solving, and contributing to disruption in interpersonal relationships (4). Although numerous studies show that alcohol use often plays a role in suicide, the association can vary from population to population. The results of this analysis indicate that alcohol intoxication likely was present in nearly one quarter of the tested suicide deaths recorded by NVDRS in 17 states during 2005--2006; especially among non-Hispanic AI/ANs and Hispanics. Racial/ethnic differences in the prevalence of problem drinking cannot explain the pattern in alcohol-associated suicides. Data from the Behavioral Risk Factor Surveillance System that examined binge drinking among different racial/ethnic populations showed that the highest percentage occurred among Hispanics (5).

The analysis by sex reveals that the percentage(s) of tested subjects with BACs at or over the legal limit for intoxication was higher for males than females in all racial/ethnic populations except non-Hispanic AI/ANs, for whom the percentage(s)for each sex were equal. Among suicide decedents, other studies also show higher levels of intoxication among males compared with females (4).

The findings of this report are subject to at least five limitations. First, police and coroner records might estimate alcohol use inaccurately because persons considered unlikely to have been drinking often are not tested. For example, one study showed that women were rarely tested for alcohol, and males aged ≥60 years were tested less commonly than young adult males (6). Second, injury mortality deaths probably underestimate from 25% to 35% the actual numbers for AI/ANs and certain other racial/ethnic populations, such as Hispanics, because of the misclassification of race/ethnicity of decedents on death certificates (7). Third, incorrect or incomplete information might have resulted in misclassification of the intent of the deceased, especially when distinguishing among suicide, undetermined deaths, and unintentional injury deaths (4). Studies estimate that 2%--45% of suicides are misclassified as other causes, whereas few (zero to 1%) deaths classified as suicides have been found to be actually attributable to other causes (4). Fourth, autopsy practices and laboratory protocols differ from jurisdiction to jurisdiction, potentially leading to uneven assessment of alcohol-related factors. NVDRS provides some recommendations for participating states that can reduce these differences (2,6), but the extent to which these recommendations have led to improvements is not known. Finally, these results reflect the data from the 17 states studied and are not nationally representative.

Effective, comprehensive suicide-prevention programs have been developed. These programs focus on an array of risk or protective factors, including alcohol consumption, substance misuse, and social support; however, few have been developed specifically for minority populations (4). Some international studies suggest that measures to restrict alcohol use can reduce suicides (8). The measures include raising the minimum legal drinking age; increasing taxes on alcohol sales; limiting the sale of alcohol products by age of purchaser, time of day available, or business type; and mandating that workplaces be alcohol-free. An example of a successful comprehensive prevention program that included a component addressing alcohol misuse and was implemented in an AI/AN community is the Natural Helpers program (9). This multicomponent program involved personnel who were trained to respond to young persons in crisis, notify mental health professionals in the event of a crisis, and provide health education in the schools and community. Other program components included outreach to families after a suicide or traumatic death, immediate response and follow-up for reported at-risk youth, alcohol and substance-abuse programs, community education about suicide prevention, and suicide-risk screening in mental health and social service programs.

Acknowledgments

This report is based, in part, on contributions by NVDRS staff at state health departments; and L Frazier and J Barnes, National Center for Injury Prevention and Control, CDC.

References

  1. CDC. Alcohol-related disease impact (ARDI). Atlanta, GA: US Department of Health and Human Services; 2008. Available at http://www.cdc.gov/alcohol/ardi.htm.
  2. Paulozzi L, Mercy J, Frazier L, Annest L; CDC. CDC's National Violent Death Reporting System: background and methodology. Inj Prev 2004;10:47--52.
  3. US Department of Health and Human Services. The Surgeon General's call to action to prevent and reduce underage drinking. Rockville, MD: US Department of Health and Human Services; 2007. Available at http://www.surgeongeneral.gov/topics/underagedrinking.
  4. Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, eds. Reducing suicide: a national imperative. Washington, DC: National Academies Press; 2002.
  5. Naimi TS, Brewer RD, Molded A, Denny C, Ferula MK, Marks JS. Binge drinking among US adults. JAMA 2003;289:70--5.
  6. Timmermans S. Postmortem: how medical examiners explain suspicious deaths. Chicago, IL: University of Chicago Press; 2006.
  7. Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund E. The validity of race and Hispanic origin reporting on death certificates in the United States. Vital Health Stat 2 2008;148:1--23.
  8. Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA 2005;294:2064--74.
  9. May PA, Serna P, Hurt L, DeBruyn LM. Outcome evaluation of a public health approach to suicide prevention in an American Indian tribal nation. Am J Public Health 2005;95:1238--44.

* The California system covers four major metropolitan counties.

Additional information about NVDRS methods is available at http://www.cdc.gov/ncipc/pub-res/nvdrs-coding/vs3/nvdrs_coding_manual_version_3-a.pdf and http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5801a1.htm.

TABLE. Alcohol-related characteristics among suicide decedents, by race/ethnicity --- National Violent Death Reporting System, 17 states, 2005--2006

Race/Ethnicity

Total (N = 18,994)

Hispanic (n = 1,111)

White, non-Hispanic (n = 15,774)

Black, non-Hispanic (n = 1,329)

AI/AN, non-Hispanic (n = 329)

A/PI,§ non-Hispanic (n = 451)

Characteristic

No.

(%)

(95% CI*)

No.

(%)

(95% CI)

No.

(%)

(95% CI)

No.

(%)

(95% CI)

No.

(%)

(95% CI)

No.

(%)

(95% CI)

Alcohol dependence

2,961

(15.6)

(15.1--16.1)

193

(17.4)

(15.1--19.6)

2,576

(16.3)

(15.8--16.9)

90

(6.8)

(5.4--8.1)

69

(21.0)

(16.6--25.4)

33

(7.3)

(4.9--9.7)

Recent alcohol use suspected**

4,783

(25.2)

(24.6--25.8)

328

(29.5)

(26.8--32.2)

4,020

(25.5)

(24.8--26.2)

217

(16.3)

(14.3--18.3)

152

(46.2)

(40.8--51.6)

66

(14.6)

(11.4--17.9)

Tested for alcohol

13,208

(69.5)

(68.9--70.2)

763

(68.7)

(66.0--71.4)

10,944

(69.4)

(68.7--70.1)

1,044

(75.6)

(73.2--77.9)

225

(68.4)

(63.4--73.4)

272

(60.3)

(55.8--64.8)

Alcohol test positive††§§¶¶

4,322

(33.2)

(32.4--34.0)

296

(39.2)

(35.7--42.6)

3,616

(33.6)

(32.7--34.5)

247

(24.9)

(22.2--27.6)

101

(45.5)

(39.0--52.0)

62

(22.9)

(17.9--27.9)

Blood alcohol concentration (g/dL)§§***

≥0.24

608

(5.4)

(5.0--5.8)

43

(6.7)

(4.8--8.6)

520

(5.6)

(5.1--6.0)

15

(1.8)

(0.9--2.6)

27

(13.2)

(8.5--17.8)

3

(1.6)

(0.0--3.4)

≥0.16

1,531

(13.6)

(13.0--14.3)

122

(18.9)

(15.9--22.0)

1,300

(14.0)

(13.2--14.6)

53

(6.2)

(4.6--7.8)

49

(23.9)

(18.1--29.7)

7

(3.7)

(1.0--6.4)

≥0.08

2,649

(23.6)

(22.8--24.4)

185

(28.7)

(25.2--32.2)

2,243

(24.1)

(23.2--24.9)

123

(14.3)

(12.0--16.7)

76

(37.1)

(30.5--43.7)

22

(11.6)

(7.1--16.2)

<0.08

8,569

(76.4)

(75.6--77.2)

459

(71.3)

(67.8--74.8)

7,078

(75.9)

(75.1--76.8)

736

(85.7)

(83.3--88.0)

129

(62.9)

(56.3--69.5)

167

(88.4)

(83.8--92.9)

* Confidence interval.

American Indian/Alaska Native.

§ Asian/Pacific Islander.

Based on whether the decedent was perceived by self (before death) or others (before or after death) to have a problem with alcohol or to be addicted to alcohol.

** Based on whether alcohol use by the decedent that preceded and influenced the incident was suspected, based on witness or investigator reports or circumstantial evidence, such as empty alcohol containers around the decedent.

†† Defined as alcohol present in the blood at levels above the limits of detection of the test.

§§ Among those with known test results.

¶¶ Number of decedents for whom alcohol test result was unknown was 195 total, seven for Hispanics, 172 for non-Hispanic whites, 12 for non-Hispanic blacks, three for AI/ANs, and one for A/PIs.

*** Number of decedents for whom alcohol test result was unknown was 1,990 total, 119 for Hispanics, 1,623 for non-Hispanic whites, 145 for non-Hispanic blacks, 20 for AI/ANs, and 83 for A/PIs.

FIGURE 1. Percentage of suicide decedents with blood alcohol concentrations (BACs) ≥0.08 g/dL,* by race/ethnicity and age group --- National Violent Death Reporting System, 17 states, 2005--2006

0.08 g/dL, by race/ethnicity and age group for 17 states during 2005-2006, according to the National Violent Death Reporting System. For all age groups, the highest proportion of decedents with BACs >0.08 g/dL was among American Indians/Alaska Natives (AI/ANs) aged 30-39 years, followed by AI/AN and Hispanic decedents aged 20-29 years. Among decedents tested who were aged 10-19 years (all of whom were under the legal drinking age in the United States), 12% had BACs >0.08 g/dL; the levels ranged from 1% in non-Hispanic blacks to 29% in non-Hispanic Asians/Pacific Islanders." width="641" height="474">

* Sample sizes are based on the number of decedents tested for alcohol minus the number for whom the BAC value was unknown.

Among those with known test results.

§ 95% confidence interval.

Alternative Text: The figure above shows the percentage of suicide decedents with blood alcohol concentrations (BAC) >0.08 g/dL, by race/ethnicity and age group for 17 states during 2005-2006, according to the National Violent Death Reporting System. For all age groups, the highest proportion of decedents with BACs >0.08 g/dL was among American Indians/Alaska Natives (AI/ANs) aged 30-39 years, followed by AI/AN and Hispanic decedents aged 20-29 years. Among decedents tested who were aged 10-19 years (all of whom were under the legal drinking age in the United States), 12% had BACs >0.08 g/dL; the levels ranged from 1% in non-Hispanic blacks to 29% in non-Hispanic Asians/Pacific Islanders.

FIGURE 2. Percentage of suicide decedents with blood alcohol concentrations (BACs) ≥0.08 g/dL,* by race/ethnicity and sex --- National Violent Death Reporting System, 17 states, 2005--2006

0.08 g/dL, by race/ethnicity and sex for 17 states during 2005-2006, according to the National Violent Death Reporting System. Among male decedents tested, 25% tested above legal intoxication; among females tested, 18% tested above legal intoxication. Males had a significantly higher percentage with BACs >0.08 g/dL than females (p<0.02, p="0.99," width="501" height="535">

* Sample sizes are based on the number of decedents tested for alcohol minus the number for whom the BAC value was unknown.

Among those with known test results.

§ 95% confidence interval.

Alternative Text: The figure above shows the percentage of suicide decedents with blood alcohol concentrations (BAC) >0.08 g/dL, by race/ethnicity and sex for 17 states during 2005-2006, according to the National Violent Death Reporting System. Among male decedents tested, 25% tested above legal intoxication; among females tested, 18% tested above legal intoxication. Males had a significantly higher percentage with BACs >0.08 g/dL than females (p<0.02, p="0.99,">

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