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August 28 - September 1, 2000


  • Laing GL, Logan S. Patterns of unintentional injury in childhood and their relation to socioeconomic factors. Public Health 1999; 113:291-294. (E.40.04 S)

    This population based study was undertaken to estimate the rate of unintentional injury, resulting in attendance at Accident and Emergency Departments, in children (ages 0-14 years) in an inner city area of Southeast London and the relationship with a range of demographic and socioeconomic indices. The annual rate of unintentional injury attendance at EDs was 138.2 per 1000. There was a higher rate of attendance in boys than in girls in all age groups and the gender difference was particularly marked for severe injuries. The findings reported here suggest that, even within this very disadvantaged population, a gradient of risk with socioeconomic status is present, accounting for 33% of the variance between wards. The observed gradients are likely to result from a combination of direct effects of less safe environments in disadvantaged areas and indirect effects of family stress resulting from disadvantage. It is important that the overwhelming importance of social influences is taken into account when trying to achieve a balance in injury prevention programs between advocacy, environmental measures, and interventions focusing on individuals.

  • Hoskin AF. Trends in unintentional injury deaths during the 20th century. Statistical Bulletin 2000; Apr-Jun:18-26. (E.45 S)

    Since 1990 the number of deaths per 100,000 population due to unintentional injuries was reduced by 53%, dropping from 72 to 34. Of the 7 kinds of injury events that accounted for 90% of all unintentional injury deaths in 1998, only 2 experienced increases in rates. Death rates from falls, fires and burns, drowning, poisoning by gases and vapors, and firearms were reduced between 61% and 90%. The mortality rate due to poisoning by solids and liquids, however, increased 19% while that from motor vehicle crashes skyrocketed by 7,500%. In 1910 there were 468,500 vehicles registered in the US and the death rate from MV crashes was 0.2 per 100,000. In 1998, however, there were 215.4 million vehicles and a death rate of 15.2 per 100,000. Deaths due to solid and liquid poisonings ranged between 1500 and 2500 until the late 1960s and now number more than 8000 annually. The increase is greatest among persons between the ages of 25-44 and is largely attributed to illegal drugs. Death rates in this category were lowest in the 1950s and now are as high as in the mid-1910s. Deaths due to falls fluctuated from about 7400 in 1910 to nearly 25,000 annually in the 1940s, to about 11,400 in 1986, and to 16,600 in 1998. Death rates for age groups under 65 years are at their lowest while those for the 65 and older age group have been increasing. Drowning and firearms deaths have decreased fairly steadily since the early 1970s. Death rates for all age groups have shown steady reductions over the century and are now at or near their lowest points. The firearm death rate for 15-24 year olds, however, was and is substantially greater than all other age groups. The number of deaths due to fires and burns and gas and vapor poisonings have been declining since the mid-1960s and late-1970s, respectively. Fire and burn death rates among young children and the elderly have shown the greatest improvement. Reasons for each of these changes and directions for future emphasis are discussed.

  • Kennedy CM, Rodriguez DA. Risk taking in young Hispanic children. Journal of Pediatric Health Care 2000; 13(3 part1):126-135. (E.40.04 S)

    The purpose of this study was to examine risk taking and daring behavior in preschool-aged Hispanic children. The study sought to describe aspects of children's personality, behavior, and culture that may indicate their propensity to take risks that lead to injuries. Forty-five children (ages 4-5) and their parents participated in the study. Instruments included the Acculturation Scale, Child Shyness Report, Injury Report, and the Injury Behavior Checklist. Children were interviewed about risk taking and daring behavior using the Child Sensation Seeking Profile. The children, irrespective of gender or socioeconomic status, reported similar rates of daring and risk taking behavior. Injury behaviors were not predicted by personality profiles of shyness or the child's self-report of risk taking and daring behavior. Actual injuries increased with higher levels of acculturation, but children's injury behaviors reported by parents were low in comparison with other populations. Discrepancies were observed between parental perception and report of children's injury behavior and children's expressed preferences in some domains of daring and risky behavior. Primary care providers must consider ethnic differences in rates and causes of injury when developing interventions and injury prevention programs. These findings can be used to better meet the health promotion goals of Healthy Children 2000.


  • Thompson DC, Rivara FP. Pool fencing for preventing drowning in children. In: The Cochrane Library. Issue 3, 2000. Oxford, UK: Update Software. (E.60.06 S)

    In most industrialized countries, drowning ranks second or third behind motor vehicles and fires as a cause of unintentional injury deaths to children under the age of 15. Death rates are highest in children less than 5 years old. Pool fencing is a passive environmental intervention designed to reduce unintended access to swimming pools and thus prevent drowning in the preschool age group. This study evaluated the effect of pool fencing as a drowning prevention strategy for young children. In order to be selected for evaluation, a study had to be designed to evaluate pool fencing in a defined population and provide relevant and interpretable data which objectively measured the risk of drowning or near drowning or provided rates of these outcomes in fenced and unfenced pools. Case-control studies that evaluate pool-fencing interventions indicate that pool fencing significantly reduces the risk of drowning. Isolation fencing (enclosing pool only) is superior to perimeter fencing (enclosing property and pool) because perimeter fencing allows access to the pool area through the house. The authors conclude that pool fences should have a dynamic and secure gate and isolate (i.e., four-sided fencing) the pool from the house. Legislation should require isolation fencing with secure, self-latching gates for all pools, public, semi-public, and private.

  • Gardner MM, Robertson MC, Campbell AJ. Exercise in preventing falls and fall related injuries in older people: A review of randomized controlled trials. British Journal of Sports Medicine 2000; 34:7-17. (E.55.06 S)

    This study assessed the effectiveness of exercise programs in preventing falls and/or lowering the risk of falls and fall related injuries in older people. The authors conducted a review of controlled clinical trials designed to lower the risk of falling and/or fall injuries through an exercise only intervention or an intervention that included an exercise component. Eleven trials meeting the criteria for inclusion were reviewed. Eight of the trials had separate exercise interventions, and three used interventions with an exercise component. Five trials showed a significant reduction in the rate of falls or the risk of falling in the intervention group. The authors conclude that exercise in effective in lowering the risk of falls in selected groups and should form part of falls prevention programs. Lowering fall related injuries will reduce health care costs but there is little available information on the costs associated with program replication or the cost effectiveness of exercise programs aimed at preventing falls in older people.


  • McGovern MK, Murphy RX, Okunski WJ, Wasser TE. The influence of air bags and restraining devices on extremity injuries in motor vehicle collisions. Annals of Plastic Surgery 2000; 44(5):481-485. (E.52.02 S)

    The influence of air bags and other restraining devices on injury after motor vehicle collision is not well defined. This study examined the relationship between the use of restraining devices and the incidence of extremity injuries in motor vehicle collisions. A retrospective analysis was performed on MV collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990-1995. Patients were analyzed for the presence or absence of upper and lower extremity injuries and were compared based on their use of restraining devices. Restraining devices were categorized into 4 groups: air bag alone; air bag and seat belt; seat belt or car seat without air bag; and no restraining device. When comparing restraining devices as a group vs. no restraining devices, there was a significant decrease in the incidence of upper and lower extremity injuries. As a group, restraining devices decrease the incidence of extremity trauma sustained by patients injured in MV crashes. Air bags, however, are associated with an increased incidence of upper and lower extremity injures when compared with seat belts alone or when no restraining devices are used.

  • Network of Employers for Traffic Safety (NETS), National Highway Traffic Safety Administration, and National Institute for Occupational Safety and Health. Notice to readers: Drive Safely Work Week September 11-15, 2000. Morbidity and Mortality Weekly Review. V.49(34): 782, 791. (E.50 Misc.)

    Abstract: This is a notification about the fourth annual Drive Safely Work Week sponsored by NETS and its federal partners. Links are given to websites offering further information and materials for purchase.

Alcohol/Drug Use:

  • Alaniz ML. Community identified alcohol issues in the Mexican American community: Research design and utilization. Substance Use and Misuse 2000; 35(1&2):157-169. (E.40.02 S)

    This article describes a community-based study, Alcohol Outlet Density and Mexican American Youth Violence, funded by the California Wellness Foundation Violence Prevention Initiative to the Prevention Research Center in Berkeley, California. The study was conducted in three northern California cities in 1993-1996. The focus is on the inclusionary planning process in designing and implementing the study. Community members were an integral part in the identification of study questions. As a result, the findings of the study are relevant to community activists in advocating alcohol-related policies. The need for more utilization based community studies is emphasized.


  • Cunradi CB, Caetano R, Clark C, Schafer J. Neighborhood poverty as a predictor of intimate partner violence among White, Black, and Hispanic couples in the United States: A multilevel analysis. Annals of Epidemiology 2000; 10:297-308. (E.82 S)

    This study assessed the contribution of neighborhood poverty, measured at the census tract level, to the risk of male to female and female to male partner violence (MFPV, FMPV) among white, black, and Hispanic couples in the U.S. As part of the 1995 National Alcohol Survey, a representative sample of married/cohabiting couples was obtained through a multistage, multicluster household probability sampling frame. The outcome variables were measured through the Conflict Tactics Scale, form R. Neighborhood poverty, indicating residence in a census tract where greater than 20% of the population lived below the Federal poverty line, was assessed by appending 1990 Census data to the primary data set. Multilevel logistic regression models were constructed, with separate analyses performed for each outcome among the white, black, and Hispanic couples. Results showed that couples residing in impoverished neighborhoods are at increased risk for both MFPV and FMPV. The association between residence in an impoverished neighborhood and MFPV was statistically significant for black couples. The association between residence in an impoverished neighborhood and FMPV was statistically significant for black couples and white couples. Characteristics of socioenvironment, such as neighborhood poverty, are associated with the risk of partner violence, particularly among black couples. Policies aimed at reducing community poverty may contribute to effective partner violence prevention strategies.

  • David TJ. Shaken baby (shaken impact) syndrome: Non-accidental head injury in infancy. Journal of the Royal Society of Medicine 1999; 92:556-561. (E.80.02.04 S)
    The shaken baby syndrome has been a source of medical controversy for many years, and has been in the public eye since the televised trial of Louise Woodward in Boston in 1997. This paper outlines the condition and discusses some of the more controversial aspects. Is shaking without other trauma sufficient to cause injury? Can injuries from shaking be dated? Can accidents at home or minor trauma cause the condition? The vast majority of infants with the triad of subdural haematoma, retinal hemmorhage, and DIA have been exposed to gross non-accidental trauma. The relative importance of shaking and impact remains uncertain. Overlap with accidental trauma and injuries occurring at birth is an area of diagnostic difficulty in some cases.

  • Berman H. Health in the aftermath of violence: A critical narrative study of children of war and children of battered women. Canadian Journal of Nursing Research 1999; 31(3):89-109. (E.78 S)

    Growing up amid violence has become reality for many children throughout the world. The health effects of this phenomenon have only recently begun to be addressed by researchers. However, there is growing evidence that children who witness violence suffer many of the same outcomes as those who experience violence directly. This critical narrative study examined the understandings and experiences of health and the relationship between violence and health. The sample, aged 10-17, comprised 2 groups of witnesses to violence: children of war and children of battered women. Analysis of the data revealed 4 categories: health as the absence of illness; health as a prerequisite for participation in desired activities; health as a holistic and multidimensional phenomenon; and health as a necessity for "getting through the day." While the first 3 ideas are consistent with those of children who have not lived amid violence, the 4th is unique to this population. Although no longer living in violence, the participants continued to face myriad physical and emotional health challenges. However, many also revealed an ability to heal. It is argued that violence and health cannot be separated, that exposure to violence has a profound and lasting influence on children's health beliefs and experiences. This paper addresses long and short term strategies for intervention.

  • Azrael D, Miller M, Hemenway D. Are household firearms stored safely? It depends on whom you ask. Pediatrics 2000; 106(3):e31. (E.96.08 S)

    The purpose of this study was to determine gun storage practices in gun owning households with children. A national random telephone survey was conducted in March 1999-July 1999. Twenty-one percent of gun owners compared with 7% of nonowners reported that a household gun was stored loaded, while 9% and 2%, respectively, reported that a household gun was stored loaded and unlocked. Nongun owners were significantly more likely to be female (87% vs 22%) and to report that they lived in a house with only 1 gun (70% vs 57%) and no handguns (51% vs 31%). Based on the reports of actual gun owners, households with children <13 years old were significantly less likely to store a gun loaded and unlocked than were households with teenagers only. The findings suggest that nongun owners, the vast majority of whom are women (87%), may be unaware that guns in their homes are stored in a manner that experts agree is unsafe. The findings reinforce the importance of many pediatricians' current efforts to offer anticipatory guidance about firearms to gun owning families and, in addition, suggest that this guidance can be adapted depending on whether the physician is speaking with a gun-owning or nongun-owning parent. In particular, because gun owners (mostly fathers) are less likely to bring children to the pediatrician's office than are nonowners (mostly mothers), physicians should take advantage of any opportunity that they have to address gun related issues with parents who personally own guns. More commonly, physicians can encourage nongun owners to participate more fully in household decision making about gun storage by letting them know not only about recommended storage practices, but also that many nonowners may not know how guns are actually stored in their own homes.

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