1. Risky Drinking Behavior – Alcohol use and Injury in La Crosse County Stephen Hargarten, MD, MPH Injury Research Center, Medical College of Wisconsin Brenda Rooney, PhD, MPH Gundersen Lutheran Medical Center Keri Briel Frisch, MS Injury Research Center, Medical College of Wisconsin

2. Public Health Approach Source: Suicide Prevention Resource Center

3. Translated into a Program Planning Model Where are we now? - Data - Assessment - Problem Identification How do we get there? - Activities, interventions - What does the evidence say? How do we know it worked? What indicators will we measure? What will we compare them to? How will we measure them? What will we do with results? Where do we want to be? Outcomes (short and long term) (Source: Barbara Hill, MSSW, Ann Christiansen, MPH, Clare Guse, MS, Peter Layde, MD,MSc as part of the Wisconsin Injury Prevention Coalition project.)

4. Define the problem with data Burden of alcohol-related injury in La Crosse County data from: WISH (Wisconsin Interactive Health Statistics) Medical examiner Emergency department and inpatient data Wisconsin CODES (Crash Outcome and Evaluation System) WVDRS (Wisconsin Violent Death Reporting System) Police Departments Universities

5. Acknowledgements The partners would like to acknowledge the special efforts of the following individuals in contributing to the development of this report: Al Bliss, Health Educator, La Crosse County Health Department Mary Czinner, Program Coordinator, Injury Research Center at the Medical College of Wisconsin Keri Briel Frisch, MS, Program Manger, Injury Research Center at the Medical College of Wisconsin Clare Guse, MS, Senior Biostatistian, Injury Research Center at the Medical College of Wisconsin Robert Hanrahan, medical student, Medical College of Wisconsin Stephen Hargarten, MD, MPH, Director, Injury Research Center at the Medical College of Wisconsin Michelle Hirsch, Programmer, Gundersen Lutheran Brianna Kopp, MPH, Injury Prevention and Surveillance Coordinator, Wisconsin Injury Prevention Program Brenda Rooney, PhD, MPH, Clinical Epidemiologist and Medical Director, Department of Community and Preventive Care Services, Gundersen Lutheran Medical Center John Steers, Medical Examiner, La Crosse County Julie Berg, Programmer, Franciscan Skemp Police departments of City of La Crosse, City of Campbell, City of Holmen, City of West Salem and the La Crosse County Sheriff’s Department Viterbo University, University of Wisconsin-La Crosse, Western Technical College

6. Preliminary results

7. Deaths due to injury 2002-2006 Deaths of La Crosse county residents aged 15-24; population size 22,056 Cause of DeathNumber of deathsRate (per 100,000) YPLL (total years lost to age 75) Unintentional Injuries 119.94601 Suicide109.03554 Homicide43.61219 All cancer43.61228 Diabetes mellitus21.81110 Source: WISH, Wisconsin Interactive Health Statistics

8. Alcohol-related injury deaths 2003-2007 Deaths in La Crosse county aged 15-24 Number of deaths SexCause of deathManner of death Blood alcohol range 2003- 2007 1413 Male 1 Female 6 Motor Veh. Crash 4 drowning 1 fall 1 pedestrian 2 suicide 9 Unintentional 2 Intentional 2 Undetermined.15-.32 Source: Office of the Medical Examiner

9. Hospital data Discharge data from Gundersen Lutheran and Franciscan Skemp ECodes for emergency department visits and inpatient stays “La Crosse” residents vs. “Other” nonresidents treated in facilities 2004-2006 combined Comparison to state from Wisconsin Inpatient Hospital Discharge Data

10. Alcohol-related injury emergency department visits 2004-2006: Homicide-Assault 44/393 75/400 13/108 24/126

11. Alcohol-related injury inpatient stays 2004-2006: Homicide-Assault 9/19 17/34 4/18 22/46

12. Alcohol-related injury emergency department visits 2004-2006: Suicide-Self harm 7/141 15/82 3/41 0/17

13. Alcohol-related injury inpatient stays 2004-2006 : Suicide-Self harm 50/156 149/388 53/192 153/373

14. Alcohol-related injury emergency department visits 2004-2006: Motor Vehicle Crash 35/553 35/834 13/245 14/374

15. Alcohol-related injury inpatient stays 2004-2006: Motor Vehicle Crash 24/64 36/154 42/142 68/313

16. Alcohol-related injury emergency department visits 2004-2006: Falls 45/961 147/3240 30/436 45/1167

17. Alcohol-related injury inpatient stays 2004-2006 : Falls 12/64 122/1252 8/83 66/1014

18. Alcohol-related injury emergency department visits

19. La Crosse ED visits compared to state

20. ED highlights 2004-2006 19,364 unintentional injury related ED visits (6,321 visits for 12-24 year olds) 1,308 intentional injury related ED visits (683 visits for 12-24 year olds) 595 alcohol-related unintentional injury visits (198 visits for 12-24 year olds) 181 alcohol-related intentional injury visits (67 visits for 12-24 year olds)

21. Alcohol-related injury inpatient stays

22. La Crosse inpatient stays compared to state

23. Inpatient highlights 2004-2006 4,767 unintentional injury related inpatient stays (698 visits for 12-24 year olds) 1,226 intentional injury related inpatient stays (385 visits for 12-24 year olds) 566 alcohol-related unintentional injury stays (122 visits for 12-24 year olds) 457 alcohol-related intentional injury stays (116 visits for 12-24 year olds)

24. Limitations of hospital data Relies upon E-codes system in place at hospital Youth probably less likely coded for alcohol use

25. Alcohol-related studies show Alcohol Is Associated with Up to 70% Domestic Abuse 40-50% Traffic Fatalities Up to 80% Homicides 68% Manslaughters 69% Drownings 38% Child Abuse Up to 60% Rapes 37-40% Assaults 20-36% Suicides Source: Public Health Strategies to Reduce Alcohol-Related Illness, Injury and Death in Milwaukee County, Milwaukee Academy of Medicine, 1998

26. IOM Report on Underage Drinking In 1999, 40 percent of people under 21 who were victims of drownings, burns and falls tested positive for alcohol In 2000, alcohol-related traffic fatalities constituted almost 37 percent of all fatal youth traffic fatalities It is estimated that 50 percent of youth violent crime is alcohol-related

27. Using data to target interventions: MVC

28. Burden on law enforcement Alcohol-related police calls 2006- August 2007 City of La Crosse4,028 Campbell*67 Holmen*40 West Salem*65 La Crosse County Sheriff*317 *primarily liquor law violations, OWI, underage drinking

29. City of La Crosse Police Dept Age and sex of those involved in alcohol-related calls

30. Discussion Does this represent the problem? Other data sources to investigate? Evidence-based strategies to address the problem

31. Burden of Alcohol-related Injury Report Completion in May 2008 Available in printed copies at final coalition meeting June 2008 Available online through the La Crosse Medical Health Science Consortium (LMHSC) or the Injury Research Center (IRC)