Acute Alcohol Consumption, Alcohol Outlets, and Gun Suicide

Abstract

A case–control study of 149 intentionally self-inflicted gun injury cases (including completed gun suicides) and 302 population-based controls was conducted from 2003 to 2006 in a major US city. Two focal independent variables, acute alcohol consumption and alcohol outlet availability, were measured. Conditional logistic regression was adjusted for confounding variables. Gun suicide risk to individuals in areas of high alcohol outlet availability was less than the gun suicide risk they incurred from acute alcohol consumption, especially to excess. This corroborates prior work but also uncovers new information about the relationships between acute alcohol consumption, alcohol outlets, and gun suicide. Study limitations and implications are discussed.

RESUME

Consommation aiguë d'alcool, points de vente d'alcool, suicide par arme à feu

Une étude portant sur 149 cas-témoins de blessures par balle auto-infligées (incluant les suicides par arme à feu) et 302 enquêtes démographiques a été conduite entre 2003 et 2006 dans une ville importante des États-Unis. L’étude s'est attachés à mesurer deux variables indépendantes, la consommation aiguë d'alcool et l'accessibilité de l'alcool dans les points de vente. Une régression logistique conditionnelle corrigeait les facteurs confondants. Le risque de suicide individuel par arme à feu dans les zones de forte accessibilité des points de vente d'alcool s'est révélé plus faible que le risque de suicide par arme à feu consécutif à une forte consommation d'alcool, en particulier en quantité excessive. Ces résultats corroborent les recherches antérieures mais font également apparaître de nouvelles informations sur le lien entre consommation aiguë d'alcool, points de vente d'alcool et suicide par arme à feu. Les limites et implications de cette étude font actuellement l'objet de discussions.

RESUMEN

Consumo agudo de alcohol, puntos de venta de bebidas alcohólicas y suicidio con arma de fuego

Entre 2003 y 2006, se llevó a cabo un estudio de casos y controles en una importante ciudad de los EE. UU. en el que se estudiaron 149 casos de heridas autoinfligidas intencionalmente con un arma de fuego (incluidos suicidios consumados mediante arma de fuego) y 302 controles basados en la población. Se midieron dos variables focales independientes: el consumo agudo de alcohol y la disponibilidad de puntos de venta de bebidas alcohólicas. La regresión logística condicional se ajustó en función de las variables de confusión. El riesgo de suicidio con arma de fuego para las personas en áreas con alta disponibilidad de puntos de venta de bebidas alcohólicas fue inferior al riesgo de suicidio con arma de fuego a causa del consumo agudo de alcohol, especialmente en exceso. Esto corrobora investigaciones anteriores, pero también revela información nueva acerca de las relaciones entre el consumo agudo de alcohol, los puntos de venta de bebidas alcohólicas y el suicidio con arma de fuego. Se analizan las limitaciones y las implicaciones.

Keywords :

• suicide
• injury
• alcohol
• alcohol outlets
• geography

THE AUTHORS

Charles C. Branas, Ph.D., is an Associate Professor of Epidemiology and the Director of the Cartographic Modeling Laboratory at the University of Pennsylvania. He has also held numerous other university appointments, including as a former Penn fellow at the University Office of the Provost. Dr. Branas works to improve health and healthcare, and is recognized for his efforts to reduce violence and enhance emergency care. Much of his work incorporates human geography and spatial interactions. His studies have taken him to various places, including the neighborhoods of Philadelphia, rural counties across the US, and most recently, cities and small towns in Guatemala. Dr. Branas sits on various boards and scientific panels at the National Institutes of Health, the Centers for Disease Control, the American Trauma Society, and the American Public Health Association, and is a past president of the Society for Advancement of Violence and Injury Research.

Therese S. Richmond, Ph.D., CRNP, is the Andrea B. Laporte Endowed Term Associate Professor of Nursing at the School of Nursing, University of Pennsylvania. She has held numerous university appointments, including serving as a senior fellow at the Leonard Davis Institute of Health Economics, a fellow at the Center for Public Health Interests, and a fellow at the Jerry Lee Center of Criminology. Dr. Richmond's research focuses on improving outcomes after serious injury and the prevention of violence and the impact of violence on individuals and communities. Dr. Richmond sits on a variety of review panels and committees of professional societies, including National Institutes of Health, American Public Health Association, and the Eastern Society of Nursing Research.

Thomas R. Ten Have, Ph.D., MPH, was a Professor of Biostatistics at the University of Pennsylvania. Dr. Ten Have passed away in May 2011 and will be greatly missed by his colleagues and many mentees. Dr. Ten Have's research interests represented the intersection of causal statistical methods and behavioral interventions. He collaborated on trials involving the prevention of suicide; the treatment of substance abuse, anxiety, and depression; and the disparities in screening and treatment of mental health disorders in colored participants. The eldest son of missionaries, he was raised in Korea, Malaysia, and Nepal, before his family moved to Michigan. Dr. Ten Have focused on accounting and algebra in junior college, prior to entering the undergraduate business program at the University of Michigan in Ann Arbor. Of the entire business curriculum, he found himself most interested in data analysis and management. A serendipitous perusal of a pamphlet on statistics that he found in the university counseling office changed the course of his career. He received his MPH and Ph.D. in biostatistics at the University of Michigan and became an associate professor at the Center for Biostatistics and Epidemiology at Pennsylvania State University. In 1997, Dr. Ten Have joined the University of Pennsylvania. In addition to his world-class research and teaching, Dr. Ten Have served as a member of the American Statistical Association, the Institute of Mathematical Statistics, the International Biometrics Society, the Society for Epidemiological Research, and the American Public Health Association. In 1999, he was named a fellow of the American Statistical Association.

Douglas J. Wiebe, Ph.D., is an Assistant Professor at the Department of Biostatistics and Epidemiology at the University of Pennsylvania. He holds secondary appointments in the Department of Emergency Medicine and in the Department of Surgery/Division of Trauma at the University of Pennsylvania, and is a visiting scholar at the Department of Geography at the University of Cambridge, England. Dr. Wiebe's research addresses environmental risk factors for injury and disease, the impact of daily routines on health-related behavior, and the collection and modeling of data with both spatial and temporal components. He serves on study sections for the National Institutes of Health, the National Science Foundation, and the Social Science and Humanities Research Council of Canada.