Previous studies have shown that acute alcohol use is associated with injury, but few have provided relative risks (RR) estimates of this association. The case-crossover analytic strategy is used here to determine the risk of injury associated with alcohol consumption within six hours prior to the injury event.  Data included here are from 32 emergency departments (ED) grouped in 16 study sites (1984-2002) in the US, Mexico, Canada, Australia, Spain, Italy, Argentina and Poland.  Meta-analysis was used to evaluate the consistency and magnitude of relative risk across ER sites, and the extent to which contextual  (socio-cultural and organizational) variables explain effect sizes. The majority of the sample was male (63%) and >=30 years old (53%). Of the 11,043 injury cases in these analyses, 2,242 patients (22% of the sample) reported drinking six hours prior to the injury.  When usual alcohol consumption during the past 12 months served as the baseline control value for the patient, the estimated (fixed) pooled Relative Risk (RR) for patients who reported alcohol use within six hours prior the injury was 8.39 (95%  Confidence Interval = 7.94-8.87), ranging from a low RR of 2.80 in Warsaw to a high RR of 27.72 in Acapulco. Alcohol consumed within only one hour prior to the injury was associated with a higher risk.  Drinking prior to injury was found to significantly increase the risk of injury relative to usual use and effect size (fixed and random) were not homogeneous in a cross-cultural perspective.