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General/Overlapping:

• Cohen LR, Runyan CW, Bowling JM. Social determinants of pediatric residents' injury prevention counseling. Archives of Pediatrics and Adolescent Medicine 1998; 152:169-175. (E.47.02.02 S)
  
  Abstract: Because counseling is the primary method through which pediatricians act to prevent injuries to their patients, pediatric residents' perceptions of professional norms regarding injury prevention are likely to influence the counseling content they discuss and the counseling strategies they employ. This study explores the relationships between perceived professional norms regarding injury prevention and injury prevention counseling by pediatric residents. Although 95% of pediatric residents reported counseling all or almost all parents with children younger than 1 year about car seat use, only 19% reported counseling this many parents about gun safety. Of the 7 behavior change strategies that residents were asked about, respondents were most likely to report "showing approval for safe behaviors" to all or almost all parents (78%). Two thirds reported asking all or almost all parents about the safety of their homes. Pediatric residents' reported injury prevention counseling was correlated with their perceived professional norms regarding such counseling for most of the content areas and behavior change strategies. The authors suggest increasing residents' attention to injury prevention by informing them that it will be a topic included in their board examinations.



• Cheng TL, DeWitt MD, Savageau JA, O'Connor KG. Determinants of counseling in primary care pediatric practice: Physician attitudes about time, money, and health issues. Archives of Pediatrics and Adolescent Medicine 1999; 153:629-635. (E.47.02.02 S)
  
  Abstract: This survey of American Academy of Pediatrics fellows was conducted to assess pediatrician goals and practice in preventive counseling, and to use social learning theory to examine physician attitudes about preventive health issues, time, and reimbursement to explain physician counseling behavior. Assurance of physical health and normal development were the most important goals of child health supervision among the pediatricians surveyed. Goals involving behavioral, family, and safety issues were less important and less likely to be addressed in practice. Most did not regularly discuss family stress, substance abuse, gun safety, and television. In these areas, physicians had less confidence they could provide guidance and lower expectation that they could prevent problems. Only 17% felt that they receive adequate reimbursement for preventive counseling. Most felt that they have adequate time (53%) and receive adequate respect (57%) for the preventive efforts. Concern about time for preventive counseling was associated with less reported counseling. Physician attitudes regarding the importance of a health issue and their confidence and effectiveness in counseling were more predictive of physician practice than their attitudes about time and reimbursement for preventive care.



• Grossman DC, Cummings P, Koepsell TD, Marshall J, D'Ambrosio L, Thompson RS et al. Firearm safety counseling in primary care pediatrics: A randomized, controlled trial. Pediatrics 2000; 106(1):22-26. (E.47.02.02 S)
  
  Abstract: Physicians have been encouraged to counsel families about risks associated with gun ownership, but the effectiveness of physician counseling regarding gun safety is unknown. This article attempts to evaluate the effectiveness of gun safety counseling during well-child care visits. Each family in the intervention group was given a 60-second message by their practitioner that depended on the presence of guns in the home. Families without guns were informed of the health risks associated with gun ownership and given a standard information pamphlet. Families with guns were given the same information about risks and were told that if they chose to keep a gun, they should store it locked and unloaded. They were given instructions on storage and a folder with educational material, a letter from the police department, written storage guidelines, and discount coupons for gun storage devices. Results showed no important differences between intervention and control groups in the rate of acquisition of new guns. Among households with guns at baseline, there were also no differences between groups in the removal of guns, but there was a fairly large nonsignificant difference in the proportion who purchased trigger locks. Based on these results, the authors conclude that a single firearm safety counseling session during a routine office visit was ineffective.

Residential:

• Lallier M, St-Vil D, Dupont J, Tucci M. Falls from heights among children: A retrospective review. Journal of Pediatric Surgery 1999; 34(7):1060-1063. (E.55.06 S)
  
  Abstract: To better understand the epidemiology of falls from height and develop prevention strategies, the authors reviewed all admissions after a fall (minimum height 10 feet) at a single institution from 1994 to 1997. Of 1410 patients admitted after a fall, 64 patients (45 boys and 19 girls, with a mean age of 7.4 years) were included in the study. 78% of children fell from 20 feet or less (2 stories) and 22% from a height greater than 20 feet. Patients fell mainly from balconies (15), windows (13), trees (9), roofs (6), stairs (6), diving board (3), and miscellaneous (12). Over 60% of falls occurred in private homes and during the summer months. Major injuries included head trauma (39%), musculoskeletal injuries (34%), abdominal injuries (12%), maxillofacial injuries (8%), and spinal injuries (6%). The overall survival rate was 98%, with only 1 death after a fall greater than 50 feet. Although rarely mortal, falls from height carry a significant morbidity and are costly to the health care system. Prevention strategies should include awareness campaigns, parents' education about the mechanisms of falls, increased parental supervision during play activities, and legislative measures to ensure the safety of windows and balconies.



• Kingma J, Ten Duis H-J. Severity of injuries due to accidental fall across the life span: A retrospective hospital based study. Perceptual and Motor Skills 2000; 90:62-72. (E.55.06 S)
  
  Abstract: This retrospective study investigated injuries due to accidental fall across the life span for which patients were admitted to the Emergency Unit of the Groningen Hospital during 1990-1997. The analysis yielded two main findings: the highest percentage of injuries for all accidental falls occurred in the age group 20-24 years; and the age range 10-64 years comprised 64% of all patients injured in an accidental fall, however, the proportion of accidental falls with regard to other causes of injuries by age group was highest in the age groups 0-9 years and over 60 years. The percentage of clinically treated patients increased across the age groups. Fractures comprised the major type of injury in older persons, followed by contusion. 34% of falls occurred at home, with significantly more females injured than males.

Sports/Playgrounds/Recreational:

• Metzel JD. Sports medicine in pediatric practice: Keeping pace with the changing times. Pediatric Annals 2000; 29(3):146-148. (E.61 S)
  
  Abstract: This article reviews the current statistics regarding participation in sports among young athletes, discusses the importance of the preparticipation examination, and the evaluation and treatment of sports injuries. The author encourages pediatricians to counsel patients regarding injury prevention and injury recognition, and suggests possible improvements in pediatric medical education in the field of sports medicine.



• American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Climatic heat stress and the exercising child and adolescent. Pediatrics 2000; 106(1):158-159. (E.73 S)
  
  Abstract: For morphologic and physiologic reasons, exercising children do not adapt as effectively as adults when exposed to a high climatic heat stress. This may affect their performance and well-being, as well as increase their risk for heat related illness. This policy statement summarizes approaches for the prevention of the detrimental effects of children's activity in hot or humid climates, including the prevention of exercise induced dehydration.

Transportation:

• U.S.Department of Transportation, Bureau of Transportation Statistics. Bicycle and Pedestrian Data: Sources, Needs, and Gaps. BTS00-02, 1-76. 2000. Washington, DC: U.S. Department of Transportation, Bureau of Transportation Statistics. (E.51 S)
  
  Abstract: This study reviews existing bicycle and pedestrian data and data needs. Primary data sources are classified by four types: usage, trip, and user characteristics; user preferences; facilities; and crash and safety data. Key types of secondary data were also identified, including research study results and manuals of practice. Priorities for data needs and opportunities for recommendations for improving the quality of bicycle and pedestrian data are discussed in some detail.



• Borglund ST, Hayes JS, Eckes JM. Florida's bicycle helmet law and a bicycle safety educational program: Did they help? Journal of Emergency Nursing 1999; 25:496-500. (E.51.02.02 S)
  
  Abstract: This research studied the effectiveness of Florida's mandatory bicycle helmet law for children and a community bicycle safety campaign promoting helmet use. Children's use of helmets before and after the law's enactment and the type and extent of head injuries sustained in bicycle crashes were evaluated. The study and control groups each consisted of 72 children, predominantly 7-12 year old boys. Known helmet use rose from 5.6% to 20.8%, with children aged 10-12 years having the greatest increase in helmet use (27%). Helmet use rose in urban and suburban areas. Changes in the type and extent of head injuries were mixed. Injury severity scores were higher for nonhelmeted children in the after-law group. Although helmet use increased after passage of the law, it remains too low. Community bicycle safety programs that promote helmet use remain an important adjunct to mandatory helmet use laws.



• Gilchrist J, Schieber RA, Leadbetter S, Davidson SC. Police enforcement as part of a comprehensive bicycle helmet program. Pediatrics 2000; 106(1):6-9. (E.51.02.02 S)
  
  Abstract: Although bicycle helmets are highly effective against head injury, only 24% of US children regularly wear one. Georgia mandated bicycle helmet use for children, effective July 1993. During that summer, one rural Georgia community passed an ordinance instructing police officers to impound the bicycle of any unhelmeted child. This study evaluates the effect of active police enforcement of this ordinance, combined with a helmet giveaway and education program. Before the program began, none of the 97 observed riders wore a helmet. During the next 5 months, helmet use among 358 observed children averaged 45%, a significant increase in all race and gender groups. Adult use did not increase significantly. Police impounded 167 bicycles during the study, an average of 1 per day. Two years after program initiation, 21 of 39 child riders (54%) were observed wearing helmets. Without enforcement, the state and local laws did not prompt helmet use in this community, yet active police enforcement, couple with helmet giveaways and education, was effective and lasting.

School Injuries:

• Knight S, Junkins EP, Lightfoot A, Cazier CF, Olson L. Injuries sustained by students in shop class. Pediatrics 2000; 106(1):10-13. (E.68 S)
  Abstract: Injuries in the school environment are a serious public health problem. Injuries occurring within the school shop class are a part of this problem that has received little or no attention. This study describes the epidemiology of shop class injuries in Utah public schools from 1992-1996. During these years, 14,133 students in grades 7-12 were injured at school, of which 1,008 (7.1%) were injured in a shop class. The majority (88.4%) of shop class injuries involved equipment use. Equipment was misused in 37.9% and malfunctioned in 3.5% of the incidents. Table saws (15.0%), other saws (15.0%), and band saws (12.5%) were involved in nearly half of the equipment injuries. Of the 1,008 students injured in shop class, 7 (0.7%) required inpatient hospital care, at a total cost of $26,747. These findings stress the need for school administrators, teachers, and students to develop and improve safety policies and practices in school shop classes.

Drugs/Alcohol:

• d'Abbs P, Togni S. Liquor licensing and community action in regional and remote Australia: A review of recent initiatives. Australian and New Zealand Journal of Public Health 2000; 24(1):45-53. (E.40.02 S)
  
  Abstract: This study reviews the effectiveness of community based initiatives involving restrictions on alcohol availability in remote and regional locations in Australia, and assesses their implications for other communities or towns contemplating similar measures. Restrictions were found to have a modest but real impact on alcohol consumption, and a significant impact of indicators of alcohol related harm, especially violence. Restrictions were also found to have widespread community support, often qualified by a belief that other measures were also required. Five issues are identified that are likely to arise in other settings where restrictions are contemplated: the issue of representativeness; selection of particular kinds of restrictions on availability; selection of most appropriate additional measures; universal vs. selective restrictions; and the role of liquor licensing authorities in imposing or facilitating restrictions.



• Feldman L, Harvey B, Holowaty P, Shortt L. Alcohol use beliefs and behaviors among high school students. Journal of Adolescent Health 1999; 24:48-58. (E.40.02 S)
  
  Abstract: This cross-sectional study of grade 9-13 students in Canada attempted to determine whether relationships exist between alcohol use and various sociodemographic and lifestyle behaviors and to assist in the development and implementation of alcohol abuse prevention programs. A total of 24% of students reported never having tasted alcohol, 22% have tasted alcohol but do not currently drink, 39% are current moderate drinkers, 11% are current heavy drinkers, and 5% did not answer. Reasons stated most often for not drinking were "bad for health" and "upbringing," while reasons most often stated for drinking were "enjoy it" and "to get in a party mood." Student drinking patterns were significantly related to gender, ethnicity, grade, and the reported drinking habits of parents and friends. Older male adolescents who describe their ethnicity as Canadian are at higher risk for heavy drinking than students who are younger or female, or identify their ethnicity as European or Asian. Current heavy drinkers are at higher risk than other students for engaging in other high-risk behaviors such as drinking and driving, being a passenger in a car when the driver is intoxicated, and daily smoking.

Adolescent Violence:

• O'Donnell L, Stueve A, San Doval A, Duran R, Atnafou R, Haber D et al. Violence prevention and young adolescents' participation in community youth service. Journal of Adolescent Health 1999; 24:28-37. (E.80.06 S)
  
  Abstract: This study examined whether participation in a school sponsored community youth service program reduces self-reported violent behaviors among young urban adolescents. A total of 972 students in grades 7-8 at two large, urban, public middle schools (one intervention and one control) were surveyed at baseline and at a 6-month follow-up. All students in the intervention school received the Reach for Health classroom curriculum that included a 10 lesson unit focusing on violence prevention. In addition, half the students participated in the Reach for Health Community Youth Service program (CYS). Results showed a statistically significant interaction among grade, CYS participation, and violence at follow-up. There was no significant difference between controls and students in the curriculum-only intervention. Within the intervention school, 8th grade students (who received the broadest CYS experience) reported less violence at follow-up than did the curriculum only students.



• Borowsky IW, Ireland M. National survey of pediatricians' violence prevention counseling. Archives of Pediatrics and Adolescent Medicine 1999; 153:1170-1176. (E.76 S)
  
  Abstract: This national sample of pediatricians was conducted to assess the knowledge, attitudes, training, and practices of pediatricians concerning violence prevention counseling in the areas of family violence, discipline, television viewing, peer violence, and guns in the home. Results indicate that most pediatricians never or rarely screen for family and community violence, peer violence, and weapons. Regarding preparation for providing violence prevention counseling, 76% of residents and 83% of practitioners rated their training as inadequate. Receiving training in the prevention of child/adolescent violence in medical school, residency, or fellowship/continuing education were major determinants of more frequent violence prevention counseling. Pediatricians who believed that parents rarely or never follow through on a physician's advice about safe gun storage, switching to nonviolent disciplining techniques, or limiting their child's television viewing were less likely to ask or advise patients in these areas. The authors recommend comprehensive information about violence prevention be integrated into medical education, and the efficacy of violence prevention counseling strategies be evaluated.