SafetyLit - 19 Jan 2001

January 19, 2001

General Topics

Gielen AC, Wilson MEH, McDonald EM, Serwint JR, Andrews JS, Hwang W, Wang M. Arch Pediatr Adolesc Med. 155:42-49, 2001.

Abstract:
Objective- To develop and evaluate an injury prevention anticipatory guidance training program for pediatric residents.

Design- Thirty-one residents were randomly assigned to an intervention or control group. Both groups attended a 1-hour seminar about injury prevention and the American Academy of Pediatrics TIPP (The Injury Prevention Program) materials. The intervention group also received 5 hours of experiential instruction on injury prevention content and counseling skills (SAFE Counseling Framework). Families with infants from birth to age 6 months were enrolled in the study (N = 196); they were followed up until the child was aged 12 to 18 months. Data were collected by means of baseline and follow-up interviews, audiotapes of medical visits, parent exit surveys, and home observations.

Setting- A hospital-based continuity clinic that serves families living in low-income, inner-city neighborhoods.

Outcomes- Physician counseling and parent satisfaction, knowledge, beliefs, and behaviors.

Results- Parents seen by physicians in the intervention group received significantly more injury prevention counseling for 5 of the 6 safety practices, and they were significantly more satisfied with the help their physicians provided on safety topics. They were no less satisfied with their physicians' counseling on other anticipatory guidance topics. Parents' knowledge, beliefs, and home safety behaviors did not differ between the 2 groups.

Conclusions- The frequency and impact of pediatric counseling can be enhanced by experiential training that targets specific injury hazards. Because low-income families face many barriers to carrying out the recommended safety practices, supplemental strategies are needed to ensure safer homes.

McLeod JM. Media and civic socialization of youth. Journal of Adolescent Health, 27(2 Suppl 1):45-51, 2000.

Abstract: Research on the development of citizenship has been reinvigorated by considering adolescents as participants actively engaged in, and interacting with, family, peers, teachers, and the media. This contrasts with earlier top-down transmission models that saw adolescents as passive recipients of information from parents and teachers. Active citizenship is now seen as a largely indirect result of contextualized knowledge and cognitive skills learned from news media use, interpersonal communication, and active participation in school and community volunteer activities. The processes of active citizenship learning are an important part of the moral development of adolescents and young adults.

Berry GL. Multicultural media portrayals and the changing demographic landscape: the psychosocial impact of television representations on the adolescent of color. Journal of Adolescent Health, 27(2 Suppl 1):57-60, 2000.

Abstract: The developmental stage of adolescence can be a challenging period with the need for the young person to negotiate certain early psychosocial and physiologic developmental tasks. The developmental tasks that are common to most adolescents can include some unique social, economic, and educational experiences for minority youth because of the sociocultural construction of American society. This article explores some of the theories, concepts, and creative issues related to the psychosocial impact on adolescents of color and multicultural portrayals that appear on television and in other emerging media.

Roberts DF. Media and youth: access, exposure, and privatization. Journal of Adolescent Health 27(2 Suppl 1):8-14, 2000.

Abstract: Purpose-- To describe U.S. youth's access and exposure to the full array of media, as well as the social contexts in which media exposure occurs.
Methods-- A cross-sectional national random sample of 2065 adolescents aged 8 through 18 years, including oversamples of African-American and Hispanic youth, completed questionnaires about use of television, videotapes, movies, computers, video games, radio, compact discs, tape players, books, newspapers, and magazines.
Results-- U.S. youngsters are immersed in media. Most households contain most media (computers and video game systems are the exception); the majority of youth have their own personal media. The average youth devotes 63/4 h to media; simultaneous use of multiple media increases exposure to 8 h of media messages daily. Overall, media exposure and exposure to individual media vary as a function of age, gender, race/ethnicity, and family socioeconomic level. Television remains the dominant medium. About one-half of the youth sampled uses a computer daily. A substantial proportion of children's and adolescents' media use occurs in the absence of parents.
Conclusions-- American youth devote more time to media than to any other waking activity, as much as one-third of each day. This demands increased parental attention and research into the effects of such extensive exposure.

Yen KL, Bank DE, O'Neill AM, Yurt RW. Household Oven Doors: A Burn Hazard in Children. Arch Pediatr Adolesc Med. 155:84-86, 2000.

Abstract: Contact with hot oven doors is an important cause of burns in pediatric patients. These burns are of particular concern because of their frequent localization to the hands, with the resulting negative implications for financial cost, long-term cosmesis, and hand function. A 5-year review of pediatric oven door burn cases admitted to a burn referral center was conducted. Of the 14 cases identified, the median age was 12 months. The median total body surface area (TBSA) was 1.75% (range, 0.5%-4.5%). Twelve of 14 cases involved 1 or both hands. The median length of hospital stay was 10 days. In 7 cases, burns were sustained from contact to an external surface of the oven. Based on the results obtained, we propose several prevention strategies.

Harre N, Brandt T, Dawe M. The Development of Risky Driving in Adolescence. Journal of Safety Research, Vol. 31(4):185-194, 2000.

Abstract: The driving attitudes and self-reported behaviors of New Zealand adolescents in Year 10 of school (n = 168, mean age = 14.2 years) were compared with students in Year 12 (n = 109, mean age = 16.4 years). School year group differences were found for three out of the eight measures of risky attitudes and behaviors, with the older students having riskier responses in each case. Gender differences were found for four of these measures, with males consistently demonstrating riskier attitudes. Suggestions are made about appropriate interventions and the timing of these.

Williams AF, Wells J.K., McCartt AT, and Preusser DF. Buckle Up NOW! An Enforcement Program to Achieve High Belt Use. Journal of Safety Research, 31(4):195-201, 2000.

Abstract: In the mid-1980s, the first formal seat-belt enforcement program in the United States was conducted in Elmira, NY. Front seat-belt use increased from 49% to 80%, and the Elmira program became a model for other such programs. In the spring of 1999, the New York State Police launched a statewide seat-belt enforcement campaign, and the Elmira program was revived as part of this effort. This 3-week program was coordinated by the Chemung County Sheriff's Office, and carried out in cooperation with local police departments as well as the state police. The earlier Elmira program emphasized the health and safety benefits of seat belts and warning periods prior to tickets being issued. The 1999 program featured a strong no-excuses, no-warning enforcement message, 32 belt-use checkpoints, and publicity about the enforcement through a variety of mechanisms, including feedback signs that informed motorists of current belt use rates. Front seat-belt use increased from 69% to 90%. Public opinion surveys indicated the program was well known to Elmira residents, and had the support of 79% of those polled. The 1999 Elmira program demonstrates that high-intensity enforcement programs can increase seat-belt use to very high levels with strong community support.

Begg DJ, Langley JD. Seat-Belt Use and Related Behaviors Among Young Adults. Journal of Safety Research, 31(4):211-220, 2000.

Abstract: Seat-belt use among young adults was examined to identify factors associated with nonuse. This research was part of the Dunedin Multidisciplinary Health and Development Study, which is a study of the health, development, and behavior of a birth cohort of young New Zealanders (n = 1037). At age 21 years, 948 (93%) members of this cohort were administered a face-to-face interview where they were asked about seat-belt use (self and friends), reasons for nonuse, and also their involvement in risky driving practices, motor-vehicle traffic crashes, and some thrill-seeking activities. Results showed relatively high front seat-belt use (85-96%) but low rear use (29-47%). Some differences in use were a function of gender and seating location. Generally, users had higher academic qualifications and lower risky driving behavior (males only), but did not differ significantly as far as crash experiences and thrill-seeking activity was concerned. The main reasons for not using a seat belt were forgetfulness/laziness, a perceived low risk of injury, and discomfort. This study provided information about the background and behavior of young adults who do not use seat belts, which could be helpful when designing strategies to promote seat-belt use in this age group
Elliott MR, Waller PF, Raghunathan TE, Shope JT, Little RJA. Persistence of Violation and Crash Behavior Over Time. Journal of Safety Research, 31(4):229-242, 2000.

Abstract: This analysis examines the ability of previous offenses to predict future high-risk offenses, and similarly, the ability of crashes to predict future high-risk crashes, using the complete driver history data (up to 9 years) for a set of young Michigan subjects. As expected, those with previous ticketed offenses or reported crashes are at greater risk for future offenses or crashes; with a previous-year serious offense doubling the odds of serious offenses during the subsequent year, and a previous-year at-fault crash increasing the odds of subsequent-year at-fault crashes by nearly 50%. There is modest evidence that serious offenses and at-fault crashes may better predict subsequent behavior in females and in more experienced drivers. This latter finding is also evidenced by the fact that records of these young drivers are less predictive of subsequent driving history than is true for records of all drivers in general found in other studies. This suggests that, in the early stages of driving, offenses and crashes are, at least in part, attributable to inexperience, and hence, characteristic of all beginning drivers.
Connor J, Gary Whitlock G, Robyn Norton R, Jackson R. The role of driver sleepiness in car crashes: a systematic review of epidemiological studies. Accident Analysis and Prevention, 33(1):31 - 41, 2001.

Abstract: To assess the available evidence for a causal role of driver sleepiness in car crashes or car crash injury, and to quantify the effect, a systematic review of the international literature was conducted. The review included all studies with a fatigue-related exposure measure, a crash or crash injury outcome measure and a comparison group, regardless of publication status, language or date of the study. Eighteen cross-sectional studies and one case-control study fulfilled the inclusion criteria. The fatigue-related exposures investigated in these studies were sleep disorders (n=14), shift work (n=2), sleep deprivation/fragmentation (n=1), and excessive daytime sleepiness (n=2). Only one study used an injury outcome measure. Studies were limited in their ability to establish a causal relationship by their design, by biases, and in many cases, by small sample sizes. The better quality cross-sectional studies were suggestive of a positive relationship between fatigue and crash risk, but could not provide reliable estimates of the strength of the association. The case-control study provided moderately strong evidence for an association between sleep apnoea and risk of driver injury, with an adjusted odds ratio of 7.2 (95% confidence interval 2.4-21.8). We conclude that the direct epidemiological evidence for a causal role of fatigue in car crashes is weak, but suggestive of an effect. To estimate the burden of injury due to fatigue-related crashes in the population, information is required from well-designed observational epidemiological studies about the prevalence of fatigue in the car driving population and the size of the risk this confers.

Rosman DL. The Western Australian Road Injury Database (1987-1996): ten years of linked police, hospital and death records of road crashes and injuries. Accident Analysis and Prevention, 33(1):81 - 88, 2001.

Abstract: Accurate information about injuries and their causes is essential to road safety research, policy development and evaluation. Such information is most powerful when it is available for all road crashes within a jurisdiction. The Western Australian Road Injury Database achieves this through the on-going linkage of crash details from reports to police with the details of injuries to casualties contained in hospital and death records. Over the 10-year period 1987-1996, 386,132 road crashes involving 142,308 casualties were reported to the police in Western Australia. There were also 47,757 hospital discharge records and 2906 death records related to road crashes during this period. Of the 142,308 police casualties, 17,848 had a matching hospital discharge record and 2454 had a matching death registration. Linkage within the hospital records revealed that the 47,757 discharge records involved 43,179 individuals, of whom 39,073 were admitted to hospital once, 3653 were admitted twice, 374 were admitted three times and 78 were admitted more than three times. Of the 43,179 hospitalised casualties, 817 had a matching death record. Linked police, hospital and death records of road crash casualties provide accurate outcome information for casualties in crashes reported to the police. In addition, estimates of under reporting of crashes for different road user groups can be made by comparing hospital records with and without a matching police record. This article demonstrates the power of a linked system to answer complex research questions related to outcome and under-reporting.

Knight S, Cook LJ, Nechodom PJ, Olson LM, Reading JC, Dean JM. Shoulder belts in motor vehicle crashes: a statewide analysis of restraint efficacy. Accident Analysis and Prevention, 33(1):65 - 71, 2001.

Abstract: The purpose of our study was to evaluate the impact of shoulder belt use on motor vehicle crash ejection, morbidity and mortality. We analyzed motor vehicle crash records linked to hospital inpatient data for front seat occupants of passenger cars in Utah between 1994 and 1996 (n=103,035). Stochastic simulations were used to adjust for possible seatbelt misclassification. There were 276 (0.3%) occupants coded as using only a shoulder belt. The adjusted odds of ejection for shoulder only belted occupants was higher compared to lap-shoulder belted (odds ratio (OR)=18.9; 95% confidence interval (CI)=15.1, 25.1) and lap only belted occupants (OR=4.3; 95% CI=2.9, 7.7). There was no difference in the odds of ejection for an occupant using a shoulder belt only and an occupant using no seatbelt (OR=1.1; 95% CI=1.0, 1.3). Occupants using a shoulder belt only were more likely to sustain a fatal or hospitalizing injury than lap-shoulder belted (OR=2.3; 95% CI=1.9, 3.0), and lap only belted occupants (OR=1.8; 95% CI=1.3, 2.7), while controlling for other covariates. Occupants using only a shoulder belt had the same odds of a fatal or hospitalizing injury as unbelted occupants (OR=1.1; 95% CI=0.9, 1.4). Average hospital inpatient length of stay, charges and injury severity scores were similar for all restraint types. These results stress the need for the use of a lap belt in conjunction with the shoulder belt.

Elliott MR, Waller PF, Raghunathan TE, Shope JT, Little RJA. Changes in young adult offense and crash patterns over time. Accident Analysis and Prevention, 33(1):117 - 128, 2001.

Abstract: A study of 13,809 young adult drivers in Michigan examined offenses and crashes (`incidents') for an average of 7 years after their original license date. During this period, 73% of subjects committed an offense that resulted in a conviction and 58% had a crash that was reported to the police. Forty-two percent had committed an offense classified as `serious,' and 21% had an `at-fault' crash. The odds of an offense being serious decreased approximately 8% per year of licensure, independent of gender or age at licensure. Similarly, the odds of a crash being at-fault decreased overall about 6% per year of licensure, but the decline was more than twice as fast for women as for men. Examining the empirical rates directly, it was found that the rate for minor offenses increased somewhat with time and then stabilized, while the rate for serious offenses declined. Also, offenses were less likely to be serious the later they occurred in the sequence of offenses for an individual. For crashes, the risk of having an at-fault crash declined more rapidly than the risk of a not-at-fault crash, although the rate of decrease began to equalize after approximately 5 years of licensure. The proportion of crashes that were at-fault did not decline over the sequence of crashes for an individual. Although crashes and offenses are positively correlated, they follow different trajectories over the early years of licensure.

Parada MA, Cohn LD, Gonzalez E, Byrd T, Cortes M. The validity of self-reported seatbelt use: Hispanic and non-Hispanic drivers in El Paso. Accident Analysis and Prevention, 33(1):139 - 143, 2001.

Abstract: The validity of self-reported seatbelt use among low belt use populations has not been evaluated directly, despite the importance of such data for estimating the effectiveness of community-wide interventions and compliance with state laws. To address this gap in knowledge 612 drivers were recruited from convenience stores located in 12 randomly generated zip code areas located in El Paso, TX. Self-reported seatbelt use was compared with observed seatbelt use in a single sample of participants. Both data sets were collected almost contemporaneously and no participant was aware of having their seatbelt use observed. Hispanic (n=388) and white/non-Hispanic (n=126) drivers over reported seatbelt use by 27 and 21%, respectively. These findings suggest that response bias within low belt use populations may be greater than suggested by state and national data.

Miller TR, Fisher DA, Cohen MA. Costs of Juvenile Violence: Policy Implications. Pedatrics 107(1):3e, 2001.

Abstract:
Objective. Violence involving children has been one of the least documented areas of violent crime. The purpose of this study was to develop cost estimates to assess the magnitude of juvenile violence in Pennsylvania in terms of both victimizations and perpetrators. Our study is the first to address 4 critical questions. First, how large a share of violence is juvenile violence? Second, is the juvenile violence problem primarily a problem of violence by juveniles or of violence against juveniles? Third, is the juvenile violence pattern different in urban and rural areas? Fourth, does the public spend more on victims or on perpetrators of juvenile violence?

Methods. Archival data on the number of violent crimes committed in the state in 1993 were used and adjusted for underreporting. The incidence of juvenile violence has 2 dimensions: 1) juvenile perpetrator violence, which consists of violent crimes committed by juveniles regardless of victim age; and 2) juvenile victim violence, which includes violent crimes committed against juveniles regardless of perpetrator age.Cost estimates were developed to reflect the costs incurred by society for both victims and perpetrators. Two major categories of costs were computed: 1) victimization costs and 2) perpetrator costs.Victimization costs of juvenile violence include the costs related to victims of both juvenile perpetrator violence and juvenile victim violence. These costs were computed in 5 categories: 1) medical care costs, 2) future earnings losses, 3) public program costs, 4) property damage and losses, and 5) quality of life losses. Victim costs per violent crime were adapted from national estimates that we broke down by rural/urban location and by victim age. National estimates were multiplied times price and wage adjusters for Pennsylvania. We applied a 2.5% discount rate to adjust future losses extending beyond a year (eg, future work loss, quality of life losses) to their present value. Perpetrator costs of juvenile crime included the expenditures for juvenile offenders who committed violent crimes against other juveniles and adults. The costs associated with adult perpetrators of violent crimes against juveniles were not studied. The major elements of perpetrator costs were: 1) probation costs, 2) detention costs, 3) residential treatment program costs, 4) alternative placement costs, and 5) incarceration costs.

Results. In 1993, there were 63 500 cases of violence by juveniles against other juveniles, 30 400 cases of violence by juveniles against adults, and 31 300 cases of adult violence against juveniles. Nearly 9 of 10 violent crimes committed by juveniles and 7 of 10 violent crimes committed against juveniles involved rape or assault. Of the 377 000 estimated violent crimes overall committed in Pennsylvania in 1993, juveniles were 25% of both perpetrators and victims.For most violent crimes, the largest contributors to national estimates of average total costs per victim were quality of life losses followed by future earnings losses. The absolute level of quality of life and future earnings losses, however, varied considerably across crimes. The quality of life and future earnings losses related to murder and rape were larger for juvenile victims than for adult victims because juveniles suffer larger productivity losses because of their longer expected work lives. Victim age was also related to differences in medical care costs of rape victims because of higher average mental health treatment costs for the juvenile victims.Estimated total victim costs of all violent crime in Pennsylvania in 1993 exceeded $11.6 billion. Of this total, juvenile violence accounted for $5.4 billion of victim costs (47%). Quality of life losses accounted for 83% of total victim costs and future earnings losses accounted for 11%. Including Medicare and Medicaid costs, public programs targeted toward the victims of juvenile violence cost an estimated $42 million. The victim costs of violence against juveniles ($4.5 billion) greatly exceeded the victim costs of violence by juveniles ($2.6 billion). Most juvenile violence occurred in the urban counties of the state, which together accounted for >72% and nearly 71% of the total violent crimes committed by juveniles and against juveniles, respectively. As with the incidence of violent crime, victim costs were higher in urban counties than in rural ones ($4.0 billion vs $1.4 billion), accounting for nearly 75% of total victim costs. In both urban and rural counties, the largest share of victim costs of juvenile violence was for crimes by adults against juveniles; the smallest share was for violent crimes by juveniles against adults. Several violent crimesrape, assault, and robberywere more likely to result in physical injury when committed in rural areas.The estimated total criminal justice costs for perpetrators of juvenile violence in Pennsylvania exceeded $46 million in 1993. Juvenile treatment program costs accounted for 55% of total perpetrator costs, and probation costs and detention costs ~20% each. Incarceration costs, although large per unit, accounted for only 6% of total costs.Total public spending on victims and perpetrators of juvenile violence was approximately equal. On a per capita basis, however, spending per known perpetrator was nearly 5 times greater than spending per known victim.

Conclusions. Contrary to recent concerns over rates of violence among juveniles, the results of this study suggest that violence against children and adolescents is a much larger problem than is violence committed by youth. Although incidence data suggest that juveniles are 25% of both victims and perpetrators, our cost estimates show that because of differences in the distributions of youth and adult victims across crimes and the impacts on victims, greater losses are associated with violence against youth than with violence by youth. Although the analysis presented here is based on data from 1993 (when juvenile violence peaked), recently published national crime and injury data suggest that our findings regarding juvenile victim versus juvenile perpetrator violence continue to hold.The finding that total public spending on victims of juvenile violence roughly equals total spending on juvenile perpetrators of violence is both novel and provocative. Public debate is needed about whether equity in expenditures on victims versus perpetrators is appropriate, as well as the extent to which resources should be directed toward prevention programs (which are not costed here). juvenile violence, costs, victims, perpetrators.

Cantor J. Media violence. Journal of Adolescent Health, 27(2 Suppl 1):30-34, 2000.

Abstract: Research on the effects of media violence is not well understood by the general public. Despite this fact, there is an overwhelming consensus in the scientific literature about the unhealthy effects of media violence. Meta-analyses show that media-violence viewing consistently is associated with higher levels of antisocial behavior, ranging from the trivial (imitative violence directed against toys) to the serious (criminal violence), with many consequential outcomes in between (acceptance of violence as a solution to problems, increased feelings of hostility, and the apparent delivery of painful stimulation to another person). Desensitization is another well-documented effect of viewing violence, which is observable in reduced arousal and emotional disturbance while witnessing violence, the reduced tendency to intervene in a fight, and less sympathy for the victims of violence. Although there is evidence that youth who are already violent are more likely to seek out violent entertainment, there is strong evidence that the relationship between violence viewing and antisocial behavior is bidirectional. There is growing evidence that media violence also engenders intense fear in children which often lasts days, months, and even years. The media's potential role in solutions to these problems is only beginning to be explored, in investigations examining the uses and effects of movie ratings, television ratings, and the V-chip, and the effects of media literacy programs and public education efforts. Future research should explore important individual differences in responses to media violence and effective ways to intervene in the negative effects

Robinson TN, Wilde ML, MA; Navracruz LC, Haydel KF, Ann Varady A. Effects of Reducing Children's Television and Video Game Use on Aggressive Behavior: A Randomized Controlled Trial. Arch Pediatr Adolesc Med. 155:17-23, 2001.

Abstract:
Context-- The relationship between exposure to aggression in the media and children's aggressive behavior is well documented. However, few potential solutions have been evaluated.

Objective-- To assess the effects of reducing television, videotape, and video game use on aggressive behavior and perceptions of a mean and scary world.

Design-- Randomized, controlled, school-based trial.

Setting-- Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif.

Participants-- Third- and fourth-grade students (mean age, 8.9 years) and their parents or guardians.

Intervention-- Children in one elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use.

Main Outcome Measures-- In September (preintervention) and April (postintervention) of a single school year, children rated their peers' aggressive behavior and reported their perceptions of the world as a mean and scary place. A 60% random sample of children were observed for physical and verbal aggression on the playground. Parents were interviewed by telephone and reported aggressive and delinquent behaviors on the child behavior checklist. The primary outcome measure was peer ratings of aggressive behavior.

Results-- Compared with controls, children in the intervention group had statistically significant decreases in peer ratings of aggression (adjusted mean difference, -2.4%; 95% confidence interval [CI], -4.6 to -0.2; P = .03) and observed verbal aggression (adjusted mean difference, -0.10 act per minute per child; 95% CI, -0.18 to -0.03; P = .01). Differences in observed physical aggression, parent reports of aggressive behavior, and perceptions of a mean and scary world were not statistically significant but favored the intervention group.

Conclusions-- An intervention to reduce television, videotape, and video game use decreases aggressive behavior in elementary schoolchildren. These findings support the causal influences of these media on aggression and the potential benefits of reducing children's media use.

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