title: Characteristics associated with alcohol consumption among emergency department patients presenting with road traffic injuries in Hyderabad, India.
abstract: BACKGROUND
  Each year in India, road traffic crashes lead to more than 200,000 deaths and the country has seen an unprecedented rate of roadway fatalities in recent years. At the same time, alcohol consumption per capita among Indians is rising. Despite these increasing trends of road traffic injuries (RTIs) and alcohol use, alcohol is not routinely assessed as a risk factor for RTIs. This study aims to examine the involvement of alcohol among emergency department patients presenting with RTIs in the Indian city of Hyderabad.
  
  
  METHODS
  As part of a prospective study, data were collected from 3366 patients (88.0% male) presenting with RTIs at an emergency department in Hyderabad, India, from September 2013 to February 2014. Logistic regression models were used to assess individual-level and road traffic crash characteristics associated with suspected or reported alcohol consumption six hours prior to the RTI.
  
  
  RESULTS
  Alcohol was suspected or reported among 17.9% of the patients with RTIs. Adjusting for confounders, males experienced 9.8 times greater odds of alcohol-related RTIs than females. Compared to 15-24 year-olds, the odds of alcohol consumption was 1.4 times greater among 25-34 year-olds and 1.7 times greater among 35-44 year-olds, adjusting for confounding factors. Patients who were passengers in vehicles other than motorized two-wheelers had 90% reduced odds of an alcohol-related RTI than motorized two-wheeler drivers. Drivers of non-two-wheelers, passengers on two-wheelers, and pedestrians did not have significantly different odds of an alcohol-related RTI compared to two-wheeler drivers. Nighttime crashes were associated with nearly a threefold increase in the odds of alcohol consumption.
  
  
  CONCLUSIONS
  Given that alcohol was suspected or reported in more than one in six injured ED patients with RTIs, it is clear that alcohol is a serious risk factor for RTIs; this evidence can guide prevention efforts. These findings suggest that evidence-based interventions to reduce drink-driving, such as random breath testing (where law enforcement officials stop drivers on the road to test them for alcohol use), could be more widespread in India. Future studies should assess the effectiveness of greater implementation and enforcement of policies to decrease alcohol's availability to reduce RTIs.
authors.affiliation: Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe St., 8th Floor, Baltimore, MD 21205, USA.
authors.forename: Marissa B
authors.initials: MB
authors.lastname: Esser
authors.affiliation: Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe St., 8th Floor, Baltimore, MD 21205, USA.
authors.forename: Shirin
authors.initials: S
authors.lastname: Wadhwaniya
authors.affiliation: Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe St., 8th Floor, Baltimore, MD 21205, USA. Electronic address: sgupta23@jhu.edu.
authors.forename: Shivam
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Indian Institute of Public Health - Hyderabad, Plot # 1, A.N.V. Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad 500 033, India.
authors.forename: Shailaja
authors.initials: S
authors.lastname: Tetali
authors.affiliation: Department of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety Promotion, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka 560 029, India.
authors.forename: Gopalkrishna
authors.initials: G
authors.lastname: Gururaj
authors.affiliation: Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe St., 8th Floor, Baltimore, MD 21205, USA.
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
authors.affiliation: Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe St., 8th Floor, Baltimore, MD 21205, USA.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000056:Accident Prevention / Q000331:legislation & jurisprudence / Q000379:methods; D000063:Accidents, Traffic / Q000401:mortality / Q000517:prevention & control / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000428:Alcohol Drinking / Q000009:adverse effects / Q000331:legislation & jurisprudence* / Q000401:mortality; D001334:Automobile Driving / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D040442:Public Health Informatics; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
keywords: Alcohol consumption; Alcohol-impaired driving; India; Injury; Road traffic crashes; Road traffic injury