SafetyLit - 30 March 2001

March 30, 2001

General:

Investigating a potential hazard of carbonated soft drink bottles. Norris B, Hopkinson N, Cobb R, Wilson JR. Injury Control and Safety Promotion 2000; 7(4):245-259.

In response to concern over the risk of injury from caps missiling from carbonated drinks bottles during opening, a multi-disciplinary study was undertaken to identify the technical and ergonomic factors involved in this potential hazard. the specific conditions causing missiling were identified and an ergonomics approach was used to assess the likelihood of this combination of mainly behavioral factors. It was found that under normal conditions, caps are unlikely to missile, suggesting that the risk from this product is low. Strength data collected in this study suggested that caps were applied with too great a torque for some users - particularly children and the elderly--to be able to open carbonated drink bottles easily. user trials and a field study of naturalistic behavior suggested that tools are used to open bottles and some users may turn the caps the wrong way during opening, which together with an increase in temperature were the main factors likely to cause missiling.

Accidents Will Happen? Unintentional Injury, Maternal Employment, and Child Care Policy. Currie J, Holtz VJ. Los Angeles: University of California at Los Angeles; National Bureau of Economic Research. Working Paper No. W8090; 2001.

In western countries, accidents are the leading cause of death and injury among children, far surpassing diseases as a health threat. We examine the effect of maternal employment and child care policy on rates of accidental injury using both micro data from the National Longitudinal Survey of Youth (NLSY) and Vital Statistics records. We find that the effects of maternal employment on unintentional injuries to children vary by demographic group, with the effects being positive for blacks and negative for whites in models that control for child-specific fixed effects. Estimates from both individual-level NLSY and Vital Statistics data suggest that the effects of maternal employment may be mediated by child care regulations. Most notably, requiring training beyond high school for care givers reduces the incidence of both fatal and non-fatal accidents. Other types of regulation have mixed effects on unintentional injuries, suggesting that child care regulations create winners and losers. In particular, while some children may benefit from safer environments, others that appear to be squeezed out of the more expensive regulated sector and are placed at higher risks of injury.

Safety and health in the construction industry. Ringen K, Seegal J, Englund A. Annu Rev Public Health 1995; 16:165-188.

Workers in the building, renovation, and demolition of roads and commercial structures in the U.S. suffer a disproportionate share of occupational fatalities and lost-time injuries. Nearly all of the injuries and deaths are preventable. The fatality rate from work- related ailments, such as cancers and silicosis, is believed to be excessive, but is not generally computed. The safety and health problems are tied largely to the construction industry's organization and how the work is performed. Many hazardous exposures result from inadequacies in access to information, measurement technology, and personal protective equipment. Potential solutions are in labor- management site safety and health planning and management, education and training of workers and supervisors, new technologies, federal regulation, workers' compensation law, medical monitoring, and occupational health delivery. Public health opportunities involve health care delivery systems, improved preventive medicine, disability determination and rehabilitation programs, and research, beginning with the standardization of data to monitor these problems

Validation of an injury surveillance epidemiological data system used with emergency departments. Stokes M, Ozanne-Smith J, Harrison J, Steenkamp K. Injury Control and Safety Promotion 2000; 7(4):219-232.

OBJECTIVES: To establish ascertainment rates, validity, and the presence of bias within the Victorian Emergency Minimum Data set (VEMD). METHODS: Experienced researchers conducted interviews using a paper-based instrument to collect injury details. These data were obtained in parallel with the routine electronic collection of injury data within four of the 25 VEMD hospitals. Data were matched using the unique data and time of presentation, as well as the birth date. Interviews were conducted with 481 injured persons. RESULTS: Electronic and paper records were successfully matched in 382 cases. A high mean capture rate (82.5%) across hospitals was found when the interview data and VEMD data were compared. Data were mostly coded with some inaccuracy, 82% of the cases had at least one error, yet when compared with interview descriptions, the coded injury and incident data were usually valid (83.9%). However, narrative data provided information beyond coded data for only 14.1% of the cases. CONCLUSIONS: These results suggest that the VEMD is a reliable and valid computerized data set, but that the case narratives require attention.

Traditional Injury Scoring Underestimates the Relative Consequences of Orthopedic Injury. Michaels AJ, Madey SM, Krieg JC, Long WB. J Trauma 2001; 50(3):389-396.

OBJECTIVE: To demonstrate that patients with multiple injuries who have orthopedic injuries (ORTHO) face greater challenges regarding functional outcome than those without, to identify domains of post-injury dysfunction, and to illustrate the increasing discordance of functional recovery over time for ORTHO patients in relation to non-ORTHO patients. METHODS: A convenience sample of adult blunt force trauma patients admitted to a Level I trauma center was evaluated at admission, and at 6 and 12 months after injury. Data were collected from the trauma registry (Trauma One), chart review, and interviews. Mailed surveys were completed 6 and 12 months after injury. The Short Form 36 (SF36) general health survey and the Sickness Impact Profile work scale (SIPw) were administered at both time points. Data are presented as mean +/- SEM or percent (%). To compare means, t tests were conducted, and Injury Severity Score (ISS) was controlled by linear regression before the evaluation of the role of ORTHO injury pattern on outcome measures. Significance is noted at the 95% confidence level (p < 0.05). RESULTS: The 165 patients studied averaged 37.2 +/- 1.1 years in age and were 67% men. The mean ISS was 14.4 +/- 0.6 and 61% had ORTHO injury. ORTHO patients were no different from non-ORTHO in any measure of baseline status including the SIPw score and all domains of the SF36, except that the ISS was greater in the ORTHO group (15.6 +/- 0.96 vs. 12.7 +/- 0.73, p = 0.017). Baseline SF36 values were similar to national norms. Follow-up was 75% at 6 months, and 51% at 12 months. Those lost to follow-up differed only in that they were more likely to be men. Sixty-four percent had returned to work 12 months after injury. After controlling for ISS with linear regression, the ORTHO patients had worse scores on all physical measures of the SF36 (bodily pain, physical function, and role-physical). By 12 months after injury, the relative dysfunction of the ORTHO patients had expanded to include the SIPw score (p = 0.016) and six of eight SF36 domains (bodily pain, physical function, role-physical, mental health, role-emotional, and social function, all p < 0.05). CONCLUSION: Injury severity affects both mortality and the potentially more consequential issues of long-term morbidity. Patients with ORTHO injury have relatively worse functional recovery, and this worsens with time. As trauma centers approach the limits of achievable survival, new advances in trauma care can be directed more toward the quality of recovery for our patients. This will be contingent on further development of screening, scoring, and treatment systems designed to address issues of functional outcome across injury boundaries for those who survive.

The emergence of youth suicide: an epidemiologic analysis and public health perspective. Rosenberg ML, Smith JC, Davidson LE, Conn JM. Annu Rev Public Health 1987; 8:417-440.

In this epidemiologic analysis, we examine death certificate data to identify significant patterns and trends in suicide in the United States. Although the overall suicide rate did not change from 1950 to 1980, fundamental and important changes did occur: suicide rates among older persons decreased and rates among younger persons increased markedly. Suicide rates have increased most dramatically among young white men aged 15 to 24. From 1950 to 1980, rates among white males aged 15 to 19 increased by 305%; among white males aged 20 to 24, by 196%. The percentage of suicides in which firearms were used has also increased markedly, most dramatically in young men and women. These fundamental changes in the pattern of suicide in the United States have critical implications for how the mental health and public health communities approach the problem. Suicide has traditionally been considered a mental health problem, and our approach to prevention was based on a portrait of the typical suicidal individual as an older, depressed, white male. The basic prevention strategy involved detection and treatment of depression. If, as some recent research suggests, most young persons at high risk for suicide are not depressed, the whole approach to prevention must be reexamined. There is an urgent need to reexamine and advance our understanding of what causes suicide. Who are the persons at greatest risk, and what can be done to prevent these deaths? Although increased use of drugs and alcohol has been proposed as a possible cause of the increase in suicides, it is only one hypothesis among others that must be examined. The significance of mental illness, suicide clusters and contagion, and the availability of firearms need further study as possible risk factors for youth suicide. Suicide represents the second leading cause of death among young persons aged 15 to 24. A problem of this magnitude should be given high priority by the public health community in planning and implementing research and interventions.

Experience from a multivenue program to increase the use of car restraints in Greece. Petridou E, Moustaki M, Stappa M, Tsoufis Y, Skalkidou A, Trichopoulos D. Injury Control and Safety Promotion 2000; 7(4):233-244.

OBJECTIVES: To evaluate a multivenue educational campaign aimed at increasing the use of car restraints in Greater Athens, Greece. METHODS: From October 1997 to June 1998, the campaign was implemented by a road safety coalition comprising 50 governmental and non-governmental organizations. During the same period, seat belt law enforcement was not intensified within Athens but was increased on the highway system immediately outside Greater Athens.. A pre-intervention survey was conducted in the summer of 1996 among the occupants of 1400 passenger cars and a post intervention survey was carried out in the summer of 1998 (2250 cars). Both surveys followed the same protocol, focusing on the availability and use of seat belts. The data from the two surveys were modeled through multiple logistic regression. RESULTS: The odds ratio of seat belt use was significantly higher in 1998 than in 1996 (1.8 with a 95% confidence interval = 1.5 - 2.1). The prevalence of seat belt use, when available rose from 15% to 20%. However, it must be noted that the prevalence of available seat belts increased. Improvement was evident in highway traffic and among 25-64 year-old car occupants, and in low-speed city and suburban traffic. There is evidence in the 1998 surveys that among front seat occupants, those travelling in larger engine capacity cars, frequently equipped with air bags, were less likely to use seat belts, whereas seat belting was more frequent among occupants of newer car models. CONCLUSION: An education and information campaign in a Southern European country resulted in moderately increased prevalence of seat belt use. A more intensive and sustained effort is required, however, to increase seat belt use in low-speed traffic and among rear seat occupants.

Drugs and Traffic Crash Responsibility: A Study of Injured Motorists in Colorado. Lowenstein SR, Koziol-McLain, J. J Trauma 2001;50(2):313-320.

BACKGROUND: Alcohol is a contributing factor in a large proportion of traffic crashes. However, the role of other drugs is unknown. The objectives of this study are to determine the prevalence of recent drug use among drivers injured in traffic crashes, and to determine the extent to which drugs are responsible for crashes. METHODS: We studied 414 injured drivers who presented to an urban emergency department within 1 hour of their crash. Demographic and injury data were collected from medical records. Urine toxicologic assays were conducted for legal and illegal drugs. Traffic crash reports were analyzed for crash responsibility by a trained crash reconstructionist. The causal role of drugs in traffic crashes was measured by comparing drug assay results in drivers judged responsible for their crashes (cases) and those not responsible (controls). Odds ratios and 95% confidence intervals (CIs) were calculated. RESULTS: Thirty-two percent (95% CI = 27-37) of the urine samples were positive for at least one potentially impairing drug. Marijuana was detected most frequently (17%), surpassing alcohol (14%). Compared with drug- and alcohol-free drivers, the odds of crash responsibility were higher in drivers testing positive for alcohol alone (odds radio [OR] = 3.2, 95% CI = 1.1-9.4) and in drivers testing positive for alcohol in combination with other drugs (OR = 3.5, 95% CI = 1.2-11.4). Marijuana alone was not associated with crash responsibility (OR = 1.1, 95% CI = 0.5-2.4). In a multivariate analysis, controlling for age, gender, seat belt use, and other confounding variables, only alcohol predicted crash responsibility. CONCLUSION: Alcohol remains the dominant drug associated with injury-producing traffic crashes. Marijuana is often detected, but in the absence of alcohol, it is not associated with crash responsibility.

Factors related to driving difficulty and habits in older drivers. Lyman JM, McGwin GJ, Simms RV. Accid Anal Prev 2001; 33(3):413-421.

Objectives: To evaluate the association between chronic medical conditions, functional, cognitive, and visual impairments and driving difficulty and habits among older drivers. Design: Cross-sectional study. Setting: Mobile County, Alabama. Participants: A total of 901 residents of Mobile County, Alabama aged 65 or older who possessed a driver's license in 1996. Measurements: Information on demographic characteristics, functional limitations, chronic medical conditions, driving habits, and visual and cognitive function were collected via telephone. The three dependent variables in this study were difficulty with driving, defined as any reported difficulty in 3 driving situations (e.g. at night), low annual estimated mileage, defined as driving less than 3000 miles in 1996, and low number of days (3) driven per week. Results: A history of falls, kidney disease or stroke was associated with difficulty driving. Older drivers with a history of kidney disease were more likely to report a low annual mileage than subjects without kidney disease. Low annual mileage was also associated with cognitive impairment. In general, older drivers with a functional impairment were more likely to drive less than 4 days per week. Older drivers with a history of cataracts or high blood pressure were more likely to report a low number of days driven per week, while subjects with visual impairment were at increased risk of experiencing difficulty driving as well as low number of days driven per week. Conclusions: The results underscore the need to further understand the factors negatively affecting driving independence and mobility in older drivers, as well as the importance of improved communication between older adults and health care professionals regarding driving.

Secular trends of motor vehicle mortality in the United States, 1910-1994. Li G, Shahpar C, Grabowski JG, Baker SP. Accid Anal Prev 2001; 33(3):423-432.

To examine the secular trends of mortality from motor vehicle crashes, the authors compiled annual population and mortality data for the United States from 1910 to 1994 and performed an age-period-cohort analysis through graphical presentation, median polish, and Poisson regression modeling. During the 85-year study period, death rates from motor vehicle crashes showed two peaks, first in 1935-39 and then in 1965-69. Age and period effects accounted for 94% of the variation in motor vehicle mortality in men and 84% of the variation in women. Age patterns of motor vehicle mortality varied greatly with birth cohorts: for those who were born before 1910, death rates increased with age; for those born after 1910, death rates peaked at age 20-24 years for men and at age 15-19 years for women. A crossover characterized by a downward trend in death rates among the elderly and an upward trend among adolescents and young adults was observed in both sexes. The complex age, period, and cohort patterns of motor vehicle mortality are likely to have been shaped by changes in traffic patterns and driver behavior, and by improvements in safety design and emergency medical service systems.

Trends and subgroup differences in transportation-related injury risk and safety behaviors among high school students, 1991-1997. Everett SA, Shults RA, Barrios LC, Sacks JJ, Lowry R, Oeltmann J. J Adol Health 2001; 28(3):228-234.

PURPOSE: To examine national trends in transportation-related injury risk and safety behaviors among U.S. high school students. METHODS: To examine secular trends in riding with a driver who had been drinking, driving after drinking, and using seat belts, bicycle helmets, and motorcycle helmets, we used logistic regression to analyze data from national Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered, anonymous survey that uses a national probability sample of U.S. students in public and private schools from grades 9-12 (N = 55,734 for all years combined). RESULTS: The percentages of students who rode with a driver who had been drinking (36.6% in 1997), drove after drinking alcohol (16.9% in 1997), always wore seat belts (33.2% in 1997), and always wore a motorcycle helmet when riding a motorcycle (45.0% in 1997) remained stable between 1991 and 1997. From 1991 to 1997, the percentage of bicycle riders who always wore a helmet when bicycling showed a small but statistically significant increase (1.1% in 1991 to 3.8% in 1997), but helmet use remained low. CONCLUSION: Many young people place themselves at unnecessary risk for motor vehicle- and bicycle-related crash injuries and fatalities. Improved motor vehicle- and bicycle-related injury prevention strategies are needed that specifically target adolescents.

Physical Abuse of Women Before, During, and After Pregnancy. Martin SL, Mackie L, Kupper LL, Buescher PA, Moracco KE. JAMA. 2001; 285(12):1581-1584.

CONTEXT: Clinicians who care for new mothers and infants need information concerning postpartum physical abuse of women as a foundation on which to develop appropriate clinical screening and intervention procedures. However, no previous population-based studies have been conducted of postpartum physical abuse. OBJECTIVES: To examine patterns of physical abuse before, during, and after pregnancy in a representative statewide sample of North Carolina women. DESIGN: Survey of participants in the North Carolina Pregnancy Risk Assessment Monitoring System (NC PRAMS). Of the 3542 women invited to participate in NC PRAMS between July 1, 1997, and December 31, 1998, 75% (n = 2648) responded. MAIN OUTCOME MEASURES: Prevalence of physical abuse during the 12 months before pregnancy, during pregnancy, and after infant delivery; injuries and medical interventions resulting from postpartum abuse; and patterns of abuse over time in relation to sociodemographic characteristics and use of well-baby care. RESULTS: The prevalence of abuse before pregnancy was 6.9% (95% confidence interval [CI], 5.6%-8.2%) compared with 6.1% (95% CI, 4.8%-7.4%) during pregnancy and 3.2% (95% CI, 2.3%-4.1%) during a mean postpartum period of 3.6 months. Abuse during a previous period was strongly predictive of later abuse. Most women who were abused after pregnancy (77%) were injured, but only 23% received medical treatment for their injuries. Virtually all abused and nonabused women used well-baby care; private physicians were the most common source of care. The mean number of well-baby care visits did not differ significantly by maternal patterns of abuse. CONCLUSION: Since well-baby care use is similar for abused and nonabused mothers, pediatric practices may be important settings for screening women for violence.

Factors Preventing Gun Acquisition and Carrying Among Incarcerated Adolescent Males. Freed LH, Webster DW, Longwell JJ, Carrese J, Wilson MH. Arch Pediatr Adolesc Med 2001; 155(3):335-341.

CONTEXT: Despite the wide availability of guns in the United States, not all delinquent adolescents own guns and not all adolescent gun owners carry them at all times. Research about the factors that prevent high-risk youth from acquiring and carrying guns is limited. OBJECTIVE: To determine, from the perspective of incarcerated adolescent males, factors that prevent acquiring or carrying guns, either on a temporary or permanent basis. DESIGN AND SETTING: In-depth, semistructured interviews were conducted with randomly selected incarcerated adolescent males at a residential juvenile justice facility from January to May 1998. Transcribed interviews were examined for recurrent themes. PARTICIPANTS: Forty-five incarcerated adolescent males. MAIN OUTCOME MEASURES: Reported factors limiting gun acquisition and carrying. RESULTS: Seventy-one percent of the sample had either owned or carried a gun out of their home. We identified 6 recurring themes that, at least on occasion, prevented or delayed delinquent youth from acquiring or carrying guns. The most commonly cited factors were fear of being arrested and incarcerated and lack of perceived need for a gun. Other themes included not wanting to hurt oneself or others, respect for the opinions of others, inability to find a source for a desired gun, and lack of money to acquire a desired gun. CONCLUSIONS: We identified 6 factors that limited gun acquisition and carrying among a sample of incarcerated male adolescents. Knowledge of these factors should inform intervention efforts to reduce youth gun acquisition and carrying.

Witnessing Violence Among Inner-city Children of Substance-Abusing and Non-Substance-Abusing Women. Schuler ME, Nair P. Arch Pediatr Adolesc Med 2001; 155(3):342-346.

OBJECTIVES: To determine if children of substance-abusing mothers witness more violence than children of non-substance-abusing (control) mothers, and to determine if children who witness violence have more behavioral problems and higher stress scores than children who do not witness violence. DESIGN: Cross-sectional research design comparing exposure to violence among children of substance-abusing mothers and control mothers of low socioeconomic status. SETTING: An inner-city pediatric clinic. Participants: Forty substance-abusing mothers and their children, and 40 non-substance-abusing mothers and their children, examined when the children were 6 years old. MAIN OUTCOME MEASURES: Maternal report of children's exposure to violence was assessed using the Exposure to Violence Interview and the Conflict Tactics Scale. Maternal report of children's behavior was assessed using the Child Behavior Checklist and the Children's Response to Stress Inventory. RESULTS: Children of substance-abusing mothers did not witness more violence than the control children (P >.05). However, 6-year-old inner-city children in the present study witnessed a high rate of violence: 43% had seen someone beaten up, 13% had seen someone threatened with a knife, and 7% had seen someone stabbed or shot. Children witnessing violence had significantly higher aggressive, delinquent, anxious/depressed, withdrawn, attention, and social problems (P < .05) on the Child Behavior Checklist, and higher stress scores (P = .05) on the Children's Response to Stress Inventory. CONCLUSIONS: More than half of the 6-year-old inner-city children in the present study witnessed some form of violence. Witnessing violence was associated with more behavioral problems and higher stress scores as assessed through maternal report. Subsequent research should examine the long-term effects of this exposure to violence among young children.

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