Robert Woolard

Community health advocates (CHAs), known as Promotores in Spanish-speaking communities, are an important resource for the mobilization, empowerment, and the delivery of health education messages in Hispanic/Latino communities. This article focuses on understanding cultural, didactic, and logistical aspects of preparing CHAs to become competent to perform a Screening Brief Intervention and Referral to Treatment in the emergency room. The CHAs training emphasizes making connections with Mexican-origin young adults aged 18 to 30, and capitalizing on a teachable moment to effect change in alcohol consumption and negative outcomes associated with alcohol use. We outline a CHA recruitment, content/methods training, and the analysis of advantages and challenges presented by the delivery of an intervention by CHAs.

Hispanics, particularly men of Mexican origin, are more likely to engage in heavy drinking and experience alcohol-related problems, but less likely to obtain treatment for alcohol problems than non-Hispanic men. Our previous research indicates that heavy-drinking Hispanics who received a brief motivational intervention (BMI) were significantly more likely than Hispanics receiving standard care to reduce subsequent alcohol use. Among Hispanics who drink heavily the BMI effectively reduced alcohol use but did not impact alcohol-related problems or treatment utilization. We hypothesized that an adapted BMI that integrates cultural values and addresses acculturative stress among Hispanics would be more effective.

Background: This study examines factors related to general health and health behavior, including smoking, that may be associated with binge drinking, drinking “at risk,” and potential for alcohol use disorder among young adults of Mexican ancestry. Methods: A total of 2191 young adult emergency department (ED) patients (18–30 years) of Mexican ancestry in a public hospital proximate to the US-Mexico border completed health surveys while they were waiting to be treated, including questions on general health, drinking, smoking, and drug use. Results: Thirty-seven percent of the study participants reported binge drinking, 38% were “at-risk” alcohol users (above National Institute on Alcohol Abuse and Alcoholism guidelines), and 22% were Rapid Alcohol Problem Screen (RAPS) positive (indicating potential for alcohol use disorder). Smoking was reported by 31%, marijuana use by 16%, and other drug use by 9%. Multiple variable models revealed that smoking was the strongest factor associated with binge drinking. Those who smoked were 3.1 (P < .0001) times more likely to binge drink. Other factors independently associated with binge drinking were age 22–25 years (odds ratio [OR] = 1.5, P = .003), male gender (OR = 1.5, P = .0001), and ED visit for injury (OR = 1.4, P = .007). Conclusions: There is a strong association of smoking and binge drinking. Study findings suggest that brief interventions designed to reduce preventable health risks for young Hispanics should include discussion of both binge drinking and smoking behaviors.

This article reviews studies and current practices of brief motivational intervention in the emergency department and identifies factors related to the effectiveness of brief intervention. Studies of brief intervention in the emergency department have had mixed results with most studies finding improvements in intervention and control groups. Most report brief intervention reducing alcohol's negative consequences without reducing consumption. Clinical practice is incorporating brief intervention as part of emergency treatment, and further research is needed to determine the factors responsible for the improvements noted in most studies.

This article summarizes the work and discussions of the funding and sustainability work group at the 2009 Academic Emergency Medicine consensus conference “Public Health in the ED: Surveillance, Screening, and Intervention.” The funding and sustainability session participants were asked to address the following overarching question: “What are the opportunities and what is needed to encourage academic emergency medicine (EM) to take advantage of the opportunities for funding available for public health research initiatives and build stronger academic programs focusing on public health within EM?” Prior to the session, members of the group reviewed research funding for EM in public health, as well as the priorities of federal agencies and foundations. Recommendations for actions by EM summarize the findings of workshop.

Background: Brief intervention (BI) to reduce hazardous drinking and negative consequences such as injury has been effective when given in the emergency department (ED). The effectiveness and effect of BI has varied between injured and uninjured ED patients. This study compares injured and uninjured ED patients who admit to alcohol and marijuana use to determine their need and their readiness for BI. Patients and Methods: Participants volunteered to enter a randomized controlled trial of BI to reduce hazardous alcohol and marijuana use. Adult ED patients who had had alcohol in the last month and smoked marijuana in the last year were recruited. Those patients who were admitted to hospital, were under police custody, or were seeking treatment for substance use or psychiatric disorder were excluded. Research assistants interviewed participants using a validated questionnaire. Data were analyzed using SAS (version 9.1). Binominal tests of proportions, t-test analyses, and transformations were conducted as appropriate. Results: Injured (n = 249) and uninjured (n = 266) study participants reported very high, statistically equivalent (P > 0.05), rates of binge drinking (4-5 days/month), marijuana use (13 days/month), driving under the influence of marijuana or alcohol (>49% in the last 3 months), injury (>83% in the last year), and other negative consequences (>64% in the last 3 months) prior to their ED visit. These behaviors and the consequences demonstrate a need for change. Both injured and uninjured subjects were ready to change (>56%) and confident they could change (>91%) alcohol and marijuana use. Discussion: ED patients who admit to alcohol and marijuana use also use other hazardous substances and participate in high-risk behaviors. In both injured and uninjured patients who admit using alcohol and marijuana, the ED visit is an opportunity to deliver BI to reduce alcohol and marijuana use and associated risk behaviors and the subsequent injury and negative consequences. Given their risk behaviors and experience of negative consequences, members of both injured and uninjured groups have an equal need for BI. Fortunately, in both groups, a high number of members express motivation to change.

Our objective was to examine attitudes on reporting alcohol-impaired drivers by physicians of different specialties who are most likely to treat motor vehicle crash (MVC) patients. Specific objectives included examining 1) degree of comfort with reporting to police or Department of Motor Vehicles (DMV), 2) variability in attitudes across specialties surveyed, 3) perceived barriers to reporting, and 4) general attitudes on treating alcoholism. Physicians reported that they felt more comfortable with reporting to a medical review board of DMV than to police in all three of the case examples, which included treating a patient who is a clinically diagnosed alcohol-impaired MVC driver (66% DMV report, 36% police report), MVC driver at legal limit of blood alcohol concentration (63% DMV report, 32% police report), and an MVC driver with a very high blood alcohol concentration (81% DMV report, 53% police report). There was no difference between specialties in comfort with reporting, though emergency medicine physicians were less likely to screen and refer patients for counseling. The primary reasons given for not reporting an alcohol-impaired driver were physician–patient confidentiality and perceived threat of civil action by patients.