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February 23, 2001

General Topics

• Injury death excesses in smokers: a 1990-95 United States national cohort study. Leistikow BN, Martin DC, Samuels SJ. Inj Prev 2000; 6(4):277-80.
  
  ABSTRACT: OBJECTIVES: Assess injury death relative risks (RR), dose-response, and attributable fractions for current cigarette smokers (smokers) in a recent representative sample of the United States population without and with adjustment for (a) demographic and (b) additional behavioral risk factors. SETTING: United States. METHODS: National Health Interview Survey (NHIS) adult (ages 18+ years) interviewees from 1990 or 1991 were followed through 1995. Referents had never smoked a total of 100 cigarettes. Relative risks were estimated with Stata software's Cox proportional hazard regressions, using NHIS final weights and primary sampling units. The resulting RR and published data were used to estimate population smoking attributable fractions of injury deaths in the United States. RESULTS: The crude, age-race-gender adjusted, and fully (demographic plus educational attainment, marital status, alcohol use level, and seat belt use) adjusted RRs for injury death in smokers were 1.86 (95% confidence interval (CI) 1.30 to 2.66), 1.60 (CI 1.12 to 2.29), and 1.42 (CI 0.99 to 2.05) respectively. Those RRs correspond to United States injury death smoking attributable fractions of 18%, 13%, and 9%, respectively. Those smoker/ injury death RRs each showed a significant dose response relationship (p <0.030). Smokers' unadjusted unintentional injury, motor vehicle crash, and suicide RRs were 1.87 (CI 1.22 to 2.86), 2.14 (CI 1.12 to 4.11), and 2.17 (CI 1.02 to 4.62), respectively. CONCLUSIONS: Smokers in the United States have significant dose-response excesses of injury death, independent of age, race, gender, alcohol use, seat belt use, education, and marital status. This supports earlier studies suggesting that smoking may be a leading contributor to injuries and injury may be a leading burden from smoking, both nationally and globally.

• Safety behavior of in-line skaters. Osberg JS, Stiles SC. Inj Prev 2000; 6(3):229-31.
  
  ABSTRACT: OBJECTIVES AND SETTING: Injuries from in-line skating have risen sharply in many cities around the world. To understand risk taking behavior and safety practices associated with urban in-line skating, 2210 outdoor skaters were observed in Boston, Massachusetts. METHODS: Estimated age, gender, use of helmets, wrist guards, elbow and kneepads were recorded. Skaters were coded as beginner, average, or advanced, and skating locations were classified as street, sidewalk, or bicycle path. RESULTS: About 60% of skaters wore wrist guards, but only 5.7% wore helmets. Males wore less protective equipment than females, and were more likely to skate on streets. Beginners and advanced skaters wore more protective gear than average skaters. Surprisingly, street skaters wore less protective gear than skaters on sidewalks or paths. CONCLUSIONS: Renewed focus on the importance of wearing helmets is needed. Given the higher injury risks for males, clinicians and public health experts need to target male skaters in prevention efforts. In addition, average and advanced skaters need to be convinced that even though they have improved, it is still important to wear protective gear.

• Injuries associated with falls from beds. Macgregor DM. Inj Prev 2000; 6(4):291-2.
  
  ABSTRACT: OBJECTIVES: To assess the severity of injuries due to falls from upper bunks and lower beds and cots, and to ascertain the age group most at risk of such injuries. SETTING: The accident and emergency (A & E) department in the Royal Aberdeen Children's Hospital which has the only paediatric A & E department in the north east of Scotland, serving a catchment area of over half a million people. METHODS: All children attending with an injury sustained due to a fall from a bed or top bunk over five months had their case notes reviewed by the author. RESULTS: Eighty five children were identified, a majority of whom were reported to have fallen out of bed while sleeping. Twenty five sustained a fracture, 27 a head injury, 12 a laceration requiring treatment, and 21 sustained a soft tissue injury to a limb. Fourteen (16%) required admission. Sixty six (78%) of the injuries occurred in children under the age of 6 years. CONCLUSION: These results show a higher incidence of significant injury than previously reported, and demonstrate the inadvisability of letting children under the age of 6 years sleep in upper bunks. In an attempt to make parents more aware of the risks it is recommended that these dangers should be brought to public attention.

• The relative effectiveness of a hidden versus a visible speed camera programme. Keall MD, Povey LJ, Frith WJ. Accid Anal Prev 2001; 33(2):277-84.
  
  ABSTRACT: Overtly operated mobile speed cameras have been used in New Zealand since late 1993. Their operation has been confined to specific sites (called 'speed camera areas') which are mainly road sections with a record of speed-related crashes. A trial of hidden speed cameras began in mid-1997 in 100 km/h speed limit areas in one of New Zealand's four Police regions. This trial was still in progress at the time of writing and the current paper reports the results of an evaluation of the first year of the trial. During that period, the hidden cameras and related publicity were found (compared with the generally highly visible speed camera enforcement in the rest of New Zealand) to be associated with net falls in speeds, crashes and casualties both in speed camera areas and on 100 km/h speed limit roads generally. There were initial changes in public attitudes in response to the programme that later largely reverted to pre-trial levels. Compared with the localised effect of visible cameras on speeds and crashes mainly in speed camera areas, the hidden cameras had a more general effect on all roads. As further crash, speed and attitude data become available, the longer-term effects of the hidden camera programme will be evaluated.



• Accident prototypical scenarios, a tool for road safety research and diagnostic studies. Fleury D, Brenac T. Accid Anal Prev 2001; 33(2):267-76.
  
  ABSTRACT: The concept of prototypical accident scenario has been used since the late 1980s in French road safety research. A prototypical scenario can be defined as a prototype of the accident process corresponding to a series of accidents which are similar in terms of the chain of facts and causal relationships found throughout the various accident stages. This concept provides a means of combining and generalising the knowledge obtained from accident case studies, based on in-depth investigation methods or on detailed analyses of police reports. Applications of this concept are developed in both the field of traffic accident research and safety studies (diagnoses) in preparation for engineering measures or local safety policies. This paper presents the prototypical scenario concept, its theoretical background, and the way it is used for safety research and studies.



• Capture-recapture: a useful methodological tool for counting traffic related injuries? Morrison A, Stone DH. Inj Prev 2000; 6(4):299-304.
  
  ABSTRACT: INTRODUCTION: Although the capture-recapture technique is increasingly employed in studies of human populations to correct for under-ascertainment in traditional epidemiological surveillance, it has rarely been used in injury research. OBJECTIVES: To estimate the completeness of official data sources on traffic related injuries (TRIs) by using the capture-recapture technique and to calculate an ascertainment corrected number of fatal and serious TRIs among Scottish young people aged 15-24 years. The appropriateness of the approach in this context is also assessed. METHOD: A two sample capture-recapture technique was applied to two official sources of TRI data. Data on TRIs were obtained from the Scottish Health Service and the STATS19 dataset at the University of Essex Data Archive for 1995. Four standards (A-D) of matching were applied to fatalities and serious TRIs to allow plausible relaxation of matching standards within the context of the data collection setting. The completeness of each data source was assessed, and an ascertainment corrected number of fatalities and serious TRIs calculated. RESULTS: The ascertainment corrected number of TRI fatalities among 15-24 year olds using standard D was 104. This represents only a small increase in the number of fatalities using capture-recapture than when using each individual dataset. The completeness of the Scottish Health Service database for TRI fatalities was 93%. The STATS19 database was 95% complete. The ascertainment corrected number of TRI hospital admissions was 1969. The STATS19 and the Scottish Health Service databases were approximately two thirds and three quarters complete respectively for non-fatal TRIs requiring hospitalisation. CONCLUSIONS: Injury researchers have advocated the linkage of major datasets to supplement and improve the quality of injury data. Using capture-recapture we found that routine databases enumerate TRI fatalities accurately, in contrast to injury morbidity databases that do not. Capture-recapture is a potentially useful method of evaluating the completeness of data sources and identifying biases within datasets. However, ascertainment corrected rates should be viewed with caution. A number of requirements of the capture-recapture technique are unachieved in this study of injury in the human population.



• Are aggressive people aggressive drivers? A study of the relationship between self-reported general aggressiveness, driver anger and aggressive driving. Lajunen T, Parker D. Accid Anal Prev 2001; 33(2):243-55.
  
  ABSTRACT: In this study the relationships among self-reported general aggressiveness, impulsiveness, driver anger, and aggressive responses to anger-provoking situations on the road were studied. The British version of a driver anger scale (UK DAS), aggression questionnaire (AQ), and an impulsiveness questionnaire (I7) together with background questions (gender, age, annual mileage) were administered to a sample of 270 British drivers. Variation in strength of correlations between anger and aggressive reactions in the 21 UK DAS items showed that the relationship between driver anger and aggression depends in part on the characteristics of the situation. In addition, three path models for describing the relationships among the measures were constructed separately for women and men. The models suggested that the effects of verbal aggressiveness on self-reported driver aggression were mediated by driver anger whereas physical aggressiveness was directly related to aggressive behaviour. Age was negatively related to both driver anger and aggression among men whereas annual mileage was negatively related to aggression among women. The models constructed indicate that aggressive driver behaviour is a complex phenomenon with a range of psychological causes.



• Restraint use patterns for older child passengers in Michigan. Eby DW, Kostyniuk LP, Vivoda JM. Accid Anal Prev 2001; 33(2):235-42.
  
  ABSTRACT: The purpose of the present study was to conduct the first statewide direct observation survey of restraint use designed specifically for older child passengers (4-15 years of age). We also sought to determine the factors that were related to belt use by older child passengers in Michigan so that effective programs could be developed to promote use of restraint devices in this age group. The study found that older child restraint use was about 58% statewide. Restraint use was highest in regions where overall belt use was higher, when the driver was using a safety belt, in sport utility vehicles and vans/minivans, and in the front-right seating position. No difference in restraint use was found for the day of week, the sex of the child, or the type of site where data was collected. The study provides the largest scale analysis to date on older child occupant restraint use patterns. The data provide some much needed empirical data on the restraint use patterns of older child passengers for development of theory to better understand and predict lack of restraint use in this age group.



• Social differences in traffic injury risks in childhood and youth--a literature review and a research agenda. Laflamme L, Diderichsen F. Inj Prev 2000; 6(4):293-8.
  
  ABSTRACT: OBJECTIVES: The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda. METHOD: A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries. RESULTS: For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender. CONCLUSIONS: The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.



• Misuse of booster seats. Morris SD, Arbogast KB, Durbin DR, Winston FK. Inj Prev 2000 Dec;6(4):281-4.
  
  ABSTRACT: OBJECTIVE: To describe several aspects of booster seat use and misuse in a sample of children attending child safety seat clinics. METHODS: Booster seat practices were assessed at 76 child safety seat clinics held between April 1997 and January 1999 in Pennsylvania and southern New Jersey. At each assessment, a child passenger safety team evaluated the booster seat and identified modes of misuse. RESULTS: Altogether 227 booster seats were observed. Sixty eight per cent (68%) of shield boosters and 20% of belt positioning boosters were misused. Thirty two per cent of the children using a shield booster weighed more than 40 lb (18.1 kg); 68% of children in shield boosters and 63% in belt positioning boosters weighed less than 40 lb. CONCLUSION: This study identified a relatively high rate of booster seat misuse. Shield boosters were more likely to be misused than belt positioning booster seats. Significant numbers of children weighing more than 40 lb were using possibly dangerous shield boosters. The majority of children in this study were less than 40 lb. In this weight range, a convertible child restraint system provides better protection than a booster seat. Booster seat use should only be initiated once the child has completely outgrown their convertible child restraint system.

• National estimates of non-fatal firearm related injuries other than gunshot wounds. Hootman JM, Annest JL, Mercy JA, Ryan GW, Hargarten SW. Inj Prev 2000; 6(4):268-74.
  
  ABSTRACT: OBJECTIVE: To characterize non-fatal firearm related injuries other than gunshot wounds (non-GSWs) treated in hospital emergency departments in the United States that occur during routine gun handling and recreational use as well as violence related use of a firearm. METHODS: Cases were identified through the National Electronic Injury Surveillance System (NEISS). During the study period, 1 January 1993 through 31 December 1996, NEISS consisted of a nationally representative sample of 91 hospitals in the United States having at least six beds and providing 24 hour emergency services. RESULTS: An estimated 65 374, or an average of 16,300 per year, non-fatal, non-GSWs were treated in American hospital emergency departments during the four year study period. Fifty seven per cent of all the non-fatal, non-GSWs were violence related, most of which involved being struck by a firearm. The majority of unintentional non-fatal, non-GSWs were self inflicted and occurred during routine gun handling or recreational use of a firearm; 43% of these injuries resulted from gun recoils. CONCLUSIONS: Non-fatal, non-GSWs make a notable contribution to the public health burden of firearm related injuries. Firearm related injury prevention programs should focus on not only the reduction of gunshot wounds but also the reduction of unintentional and violence related non-GSWs.



• Gun use in the United States: results from two national surveys. Hemenway D, Azrael D, Miller M. Inj Prev 2000; 6(4):263-7.
  
  ABSTRACT: OBJECTIVES: To determine the relative incidence of gun victimization versus self defense gun use by civilians in the United States, and the circumstances and probable legality of the self defense uses. METHODS: National random digit dial telephone surveys of the adult population were conducted in 1996 and 1999. The Harvard surveys appear unique among private surveys in two respects: asking (1) open ended questions about defensive gun use incidents and (2) detailed questions about both gun victimization and self defense gun use. Five criminal court judges were asked to assess whether the self reported defensive gun uses were likely to have been legal. RESULTS: Even after excluding many reported firearm victimizations, far more survey respondents report having been threatened or intimidated with a gun than having used a gun to protect themselves. A majority of the reported self defense gun uses were rated as probably illegal by a majority of judges. This was so even under the assumption that the respondent had a permit to own and carry the gun, and that the respondent had described the event honestly. CONCLUSIONS: Guns are used to threaten and intimidate far more often than they are used in self defense. Most self reported self defense gun uses may well be illegal and against the interests of society.

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