Utility of Long-Term Alcohol Biomarkers for Alcohol-Related Injury Risk Screening

Heavy episodic drinking places young adults at increased risk for injury and trauma.  Despite this, those experiencing serious injuries are not consistently screened for alcohol involvement by health professionals unless there is an obvious sign of alcohol intoxication at the time of the event.   When screening occurs, it may employ questions of unknown validity or tests to detect current intoxication.   We explored the potential utility of using a long term, direct alcohol biomarker, ethylglucuronide (EtG), derived from hair and fingernails to screen for injury risk in a probability sample of 606 college students in a Midwestern urban setting. Estimates for these analyses are based on 425 complete responses.  Our outcome measure evaluated whether or not a student experienced being “hurt or injured… due to your drinking during the past three months” (16% or n=68 reported experiencing an alcohol related injury).   Students with elevated hair (EtG> 30 pg/ng) or fingernail (EtG > 20 pg/ng) biomarkers had 3.31 times the odds of reporting an alcohol related injury (95%CI: 1.94, 5.67) compared to those without elevated biomarkers.  This point estimate falls within the 95% confidence bounds of the odds for alcohol related injury among those classified as 90 day hazardous drinkers from the self-reported AUDIT C (3.27, 21.20), suggesting considerable predictive overlap between these two indicators of recent heavy drinking behavior.  These data suggest that long term, direct alcohol biomarkers may have utility for screening for alcohol related injury risk in health care and other settings where alternative assessment strategies may be impracticable.