Miller et al. (1989), alcoholic women are labeled more negatively than nonalcoholic women and men and even alcoholic men; a variety of labels for alcoholic women denote or connote sexual looseness. Violence may be perceived as more socially acceptable when directed at a negatively labeled woman and drinking may reinforce this negative label.

Drinking by offenders and victims is clearly associated with domestic and criminal violence, but too little is known about causal mechanisms through which alcohol may contribute to increased interpersonal violence and aggression. A clearer understanding will require the development of integrated models that simultaneously account for the interplay between the characteristics of the perpetrator, the characteristics of the victim, the perpetrator-victim relationship, the environmental settings in which violence takes place, and the cultural definitions establishing alcohol expectancies and behavioral

norms.

Summary

Empirical research has repeatedly documented high rates of alcohol involvement in an array of serious and fatal injury events, including motor vehicle crashes, general aviation crashes, drownings, bicycle crashes, spousal violence, suicide, and homicide. Alcohol seems to play a significant role in intentional and unintentional injuries, and evidence suggests that it is associated

with high-risk behavior that promotes sexually transmitted disease.

Although the number of people killed or injured in alcohol-related traffic crashes continues to be high, there is evidence of a decline in alcohol-related traffic fatalities during the past decade. The rate of decline, however, was not consistent across age categories. In addition, among females aged 18 to 34 years, the rate of alcohol-related traffic crashes increased between 1976 and 1985.

Compared with motor vehicle crashes, aviation crashes are quite rare and there has been limited research on alcohol and air traffic safety. However, findings suggest that alcohol plays a more prominent role in general aviation crashes than in commercial airline crashes. Also, research indicates that hangover effects may impair pilot performance for several hours after the elimination of blood alcohol.

Estimates suggest that alcohol is associated with a significant number of adult drownings. The rate of alcohol involvement in drownings appears to vary by gender, age, and activity type. Emerging evidence indicates that alcohol also may be an important risk factor in waterrelated spinal cord injuries.

Findings from recent studies strongly suggest that alcohol contributes to behavior that increases the risk for contracting sexually transmitted diseases. However, ongoing studies suggest that the relationship between substance use and sexual behavior is quite complex.

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