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• Evaluation of the Latrobe Valley Better Health Injury Prevention Program.

  Day LM, Ozanne-Smith J, Cassell E, Li L. Inj Prev 2001; 7(1):66-9.
  
  Department of Health Behavior and Health Education, University of North Carolina School of Public Health, Chapel Hill 27599-7505, USA. lesley.day@general.monash.edu.au

  OBJECTIVE: To evaluate the Latrobe Valley Better Health Injury Prevention Program, a regional community based intervention in south east Victoria, Australia. METHOD: The evaluation design was quasiexperimental including pre-intervention and post-intervention observations in a predominately town dwelling population of approximately 76,000. There was no comparison community. Process measures included key informant interviews. Impact evaluation utilized self reported changes in injury risk and protective factors, gathered by a random household telephone survey. Outcome evaluation was based on five years of emergency department injury surveillance data for the Latrobe Valley. RESULTS: The program built strategic partnerships, increasing the emphasis on local safety. Activities were implemented in the targeted areas of home, sport, and playground injuries. Some 47,000 educational contacts were made with the community and at least 6,000 resource items distributed. There were significant increases in home safety knowledge. Some changes in the areas of playground and sport safety were achieved after partnership development with relevant agencies. Poisson regression models showed significant decreases in the presentation rate for all home injury and for the more severe home injuries. CONCLUSION: This study clearly demonstrates the difficulty of conducting robust evaluation in the absence of readily available and reliable data and adequate budgets. The Latrobe Valley Better Health Program activities contributed to structural, environmental, and organizational changes that have the potential to reduce injury. The extent of this contribution beyond that made by the statewide injury prevention strategy is not able to be determined.




• Injury in young people with intellectual disability: descriptive epidemiology.
  
  

  Sherrard J, Tonge BJ, Ozanne-Smith J. Inj Prev 2001; 7(1):56-61.
  
  Centre for Developmental Psychiatry, Department of Psychological Medicine, Monash University, Victoria, Australia. jenny.sherrard@general.monash.edu.au

  OBJECTIVES: To assess the public health importance of injury in a representative sample of young people with intellectual disability relative to the general population. SETTING: This study forms part of the Australian Child and Adolescent Development (ACAD) program examining emotional and behavioral problems in a cohort of young people with intellectual disability (IQ<70). The program has collected extensive biopsychosocial data from carers of subjects at two time intervals, 1990 (n = 579) and 1996 (n = 465). METHOD: Carer report of medically attended injury to subjects was collected for the first time during 1996 (age 5-29 years) and supplemented with medical record injury data from hospitals and general practitioners for 147 of the ACAD sample and 110 supplementary subjects. These data were compared with general population injury data to assess relative epidemiological differences. RESULTS: Annual injury mortality and morbidity rates were 150/100,000 and 55.6/1000 persons, with age standardized mortality and morbidity ratios of 8 and 2 respectively. Males and females had similar injury rates. The rate for injury hospitalizations was twice that of the general population. Falls were more common and transport injury and intentional injury less common causes of injury morbidity compared with general population. The patterns of cause, circumstances, and severity of injury in young people with intellectual disability have more similarities with younger children than with their same age group in the general population. CONCLUSION: This study should alert clinicians and others to the increased risk for injury and possible further handicap in this population. It is essential that injury prevention programs be implemented and evaluated for their effectiveness in reducing the substantial additional burden of suffering, care and cost resulting from injury to young people with intellectual disability.




• Injury patterns in rural and urban Uganda.
  
  

  Kobusingye O, Guwatudde D, Lett R. Inj Prev 2001; 7(1):46-50.
  
  Department of Surgery, Makerere University, Kampala, Uganda. olive@imul.com

  OBJECTIVES: To describe and contrast injury patterns in rural and urban Uganda. SETTINGS: One rural and one urban community in Uganda. METHODS: Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire. RESULTS: In the rural setting, 1,673 households, with 7,427 persons, were surveyed. Injuries had an annual mortality rate of 92/100,000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2,322 households, with 10,982 people, were surveyed. Injuries had an annual mortality rate of 217/100,000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1,000/year. Leading causes of death were drowning in the rural setting, and road traffic in the city. CONCLUSION: Injuries are a substantial burden in Uganda, with much higher rates than those in most Western countries. The urban population is at a higher risk than the rural population, and the patterns of injury differ. Interventions to control injuries should be a priority in Uganda.




• News coverage of alcohol and other drugs in U.S. college newspapers.

  Atkin CK, DeJong W. J Drug Educ 2000; 30(4):453-465.

  This study investigated the substance use-related content of a sample of student-run college newspapers. Two independent coders examined 157 news stories, features, editorials, commentaries, letters, photographs, and cartoons. Items about alcohol appeared in one out of every two issues, while items about other drugs appeared in one out of every five issues. Basic information about alcohol and other drug (AOD) use was reported in about one-fifth of the items, while three-fourths dealt with social, legal, safety, or health problems associated with AOD use, especially alcohol consumption. Just over half referred to some type of control policy, most often an enforcement action. Around one-fourth mentioned educational efforts to promote AOD prevention. Very few dealt with detection, intervention, or treatment. Most college newspapers are missing good opportunities for more extensive coverage of AOD issues that would better inform their readers, especially about factors contributing to campus AOD problems and specific program and policy options.

• Use of protective equipment by in-line skaters: an observational study.
  
  

  Beirness DJ, Foss RD, Desmond KJ. Inj Prev 2001; 7(1):51-5.
  
  Traffic Injury Research Foundation, Ottawa, Ontario, Canada. dougb@trafficinjuryresearch.com

  OBJECTIVE: To determine the extent of protective equipment use (that is, helmets, wrist guards, elbow pads, knee pads) in a representative sample of in-line skaters. SETTING: Fifteen municipalities throughout the province of British Columbia. METHOD: A province-wide observational survey was conducted in the summer of 1999. Skaters were observed at four types of sites (commuter, recreational, neighborhood, general community) in 15 municipalities to provide a representative sample of in-line skaters. RESULTS: The observed use of protective equipment by the 877 in-line skaters was relatively low: wrist guards 25%, helmets 13%, elbow pads 14%, and knee pads 10%. CONCLUSION: Despite the availability of relatively inexpensive protective equipment, few in-line skaters take advantage of the opportunity to protect themselves from injury. Policies and programs that serve to increase the use of protective equipment by in-line skaters are needed to help reduce the frequency of skating related injuries.




• Sports activities related to injuries? A survey among 9-19 year olds in Switzerland.
  
  

  Michaud PA, Renaud A, Narring F. Inj Prev 2001; 7(1):41-5.
  
  Groupe de Recherche sur la Sante des Adolescents, Institut Universitaire de Medecine Sociale et Preventive, Lausanne, Switzerland. Michaud@inst.hospvd.ch

  BACKGROUND: Most data on sports injuries are gathered in clinical settings so that their epidemiology in the general population is not well known. OBJECTIVE: To explore the link between sports injuries with the type and the amount of sports activity and biological factors. METHODS: In 1996, 3,609 in-school adolescents 10-19 years (1,847 girls and 1,762 boys) participated in a regional survey. This included anthropometric measurements and a self administered questionnaire. RESULTS: Altogether 28.2% of girls and 35.9% of boys reported one or more sports injuries during the previous year and 2.1% of girls and 6.5% of boys reported at least one hospitalization due to a sports injury. Using the mean rate of injuries as reference level, some sports are highly related to injury occurrence: body building (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5 to 1.9), skate boarding and roller skating (RR 1.6, 1.4 to 1.8), athletics (RR 1.5, 1.3 to 1.7), snow boarding (RR 1.5, 1.4 to 1.6), basketball (RR 1.3, 1.2 to 1.4), soccer (RR 1.3, 1.2 to 1.4), and ice hockey (RR 1.2, 1.1 to 1.3). Using a logistic regression, several variables associated with a higher risk of injury were identified: the amount of physical activity, high risk sports, and Tanner pubertal stages. CONCLUSION: The risk of sports injury increases not so much with age but with exposure to specific sports and with pubertal development.

• A Population-Based Study of Crashes Involving 16- and 17-Year-Old Drivers: The Potential Benefit of Graduated Driver Licensing Restrictions.

  Cvijanovich NZ Cook LJ Mann NC, Dean JM. Pediatrics 2001; 107(4):632-637.
  
  Intermountain Injury Control Research Center, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.

  OBJECTIVE: To evaluate the potential effectiveness of graduated driver licensing programs using population-based linked data for motor vehicle crashes (MVCs) that involved teenaged drivers (TDs). METHODS: Utah crash, inpatient hospital discharge, and emergency department databases were analyzed and probabilistically linked. We computed hospital charges and compared violations, contributing factors, seatbelt use, and passengers for TDs (16-17 years old) relative to adult drivers (18-59 years old). RESULTS: TDs comprised 5.8% of the study population, but were involved in 19.0% of MVCs. TD crashes resulted in $11 million in inpatient hospital charges and 158 fatalities. TD crashes were 1.70 times (95% confidence interval [CI]: 1.34, 2.04) less likely to result in fatal injury to drivers than were crashes that involved adult drivers, but TDs were 2.20 times (95% CI: 1.96, 2.47) more likely to receive citations. The following were findings of the study: 1) 11% of all TD crashes but 19% of fatal TD crashes occurred between 2200 and 0600 hours; 2) TDs used seatbelts less often than did adult drivers (79.1% vs 84.4%) and less often with passengers present (81.9% vs 75.0%; 3) TDs were 1.72 times (95% CI: 1.38, 2.14) more likely to be involved in crashes that resulted in seriously or fatally injured occupants when driving with passengers than when driving alone. CONCLUSIONS: TDs are overrepresented in MVCs. TD crashes have a higher fatality rate at night, and TDs wear seatbelts less often than do adult drivers. Passengers affect TD crash characteristics. Graduated driver licensing programs that target state-specific characteristics of TDs may decrease morbidity and mortality.




• Crash and injury reduction following installation of roundabouts in the United States.

  Retting RA, Persaud BN, Garder PE, Lord D. Am J Public Health 2001; 91(4):628-31.
  
  rretting@iihs.org

  OBJECTIVES: This study estimated potential reductions in motor vehicle crashes and injuries associated with the use of roundabouts as an alternative to signal and stop sign control at intersections in the United States. METHODS: An empiric Bayes procedure was used to estimate changes in motor vehicle crashes following conversion of 24 intersections from stop sign and traffic signal control to modern roundabouts. RESULTS: There were highly significant reductions of 38% for all crash severities combined and of 76% for all injury crashes. Reductions in the numbers of fatal and incapacitating injury crashes were estimated at about 90%. CONCLUSIONS: Results are consistent with numerous international studies and suggest that roundabout installation should be strongly promoted as an effective safety treatment.




• Blood alcohol concentration and management of road trauma patients in the emergency department.

  Fabbri A, Marchesini G, Morselli-Labate AM, Rossi F, Cicognani A, Dente M et al. J Trauma 2001; 50(3):521-528.

  BACKGROUND: The effects of blood alcohol on injury after crash are controversial, and safe limits are not settled. We examined if a positive blood alcohol concentration, even in a nontoxic range, affects management and outcome of injured patients after road crashes. METHODS: In this prospective cohort study, we recruited all adult subjects admitted to an emergency department within 4 hours after a road crash. Outcomes were mortality or expected permanent disability, and data related to patients' management. RESULTS: Alcohol-positive trauma patients were more frequently critical at admission (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.18-3.02), and had an increased risk of combined mortality or expected permanent disability (OR, 1.67; 95% CI, 1.08-2.58), need for intensive care (OR, 1.87; 95% CI, 1.01-3.46), surgery (OR, 1.91; 95% CI, 1.37-2.66) and blood transfusions (OR, 2.09; 95% CI, 1.20-3.64), and acute medical complications (OR, 1.94; 95% CI, 1.33-2.85). All these events were explained by higher trauma severity. Only the risk of unsuspected injuries, diagnosed only at final evaluation, was independently associated with a positive blood alcohol concentration (OR, 4.98; 95% CI, 3.62-6.87), in addition to trauma severity and preexisting chronic conditions. Blood alcohol measurement significantly improved the accuracy in predicting unsuspected injuries, from 81.3% to 86.2%. CONCLUSION: In injured patients after a road crash, a positive blood alcohol concentration increases the chance that the final diagnosis will include more injuries than initially documented. More careful monitoring is needed in alcohol-positive trauma patients, independent of clinical status, injury severity, and overt symptoms of alcohol intoxication.

• A population based study of unintentional firearm fatalities.
  
  

  Cherry D, Runyan C, Butts J. Inj Prev 2001; 7(1):62-5.
  
  Department of Health Behavior and Health Education, University of North Carolina School of Public Health, Chapel Hill 27599-7505, USA. carol_runyan@unc.edu

  OBJECTIVES: To describe the circumstances of fatal unintentional firearm injuries in a statewide population in a region of the United States with high firearm fatality rates and to compare to similar data from an earlier period in the same state. METHODS: Analyses of North Carolina medical examiner database (1985-94) and review of medical examiner case reports (1990-94) and comparison to similar data from 1979-82. RESULTS: A total of 390 unintentional shooting deaths occurred (0.59/100,000 population) between 1985-94 with the highest rate in the ages 15-24. Between 1990-94, handguns were responsible for 59% of these deaths compared to 40% in the 1979-82 period. Younger victims were more likely to be shot by family or friends, though, 53% of all deaths were self inflicted. In 45 cases, the person firing the weapon was reported to believe that the gun was unloaded or had the safety device activated. CONCLUSIONS: This study demonstrates changes in patterns of unintentional firearm fatalities in North Carolina in two decades, particularly the increase in incidence of events involving handguns. The results highlight the need for additional attention to efforts governing access to firearms, particularly handguns; technological advances in designing safer guns, and additional emphasis on safe storage policies and practices.




• Surveillance for Fatal and Nonfatal Firearm-Related Injuries --- United States, 1993--1998.

  Gotsch KE, Annest JL, Mercy JA, Ryan GW. MMWR 2001; 50(SS02):1-32.
  
  Available online: http://www.cdc.gov/mmwr/mmwr_ss.html

  PROBLEM: Firearm-related injuries are the second leading cause of injury-related death in the United States. REPORTING PERIOD: January 1993--December 1998. DESCRIPTION OF THE SYSTEMS: Data presented in this report regarding nonfatal injuries are from the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission. National estimates of nonfatal firearm-related injuries were derived using weighted data for patients treated in a nationally representative, stratified probability sample of U.S. hospital emergency departments (EDs). Death data presented in this report are from CDC's National Vital Statistics System, which includes information from all death certificates filed in the 50 states and the District of Columbia. Population data for calculating rates were obtained from the U.S. Bureau of the Census. RESULTS: During 1993--1998, an estimated average of 115,000 firearm-related injuries (including 35,200 fatal and 79,400 nonfatal injuries) occurred annually in the United States. Males were seven times more likely to die or be treated in a hospital ED for a gunshot wound than females. The proportion of firearm-related injuries that resulted in death increased from younger to older age groups. Approximately 68% of firearm-related injuries for teenagers and young adults aged 15--24 years were from interpersonal violence, and 78% of firearm-related injuries among older persons aged >65 years were from intentionally self-inflicted gunshot wounds. Black males aged 20--24 years had the highest average annual fatal (166.7/100,000 population) and nonfatal (689.4/100,000 population) firearm-related injury rates during the 6-year period. Although 51.4% of intentionally self-inflicted nonfatal wounds were to the head or neck, 71.8% of unintentional and 45.8% of assault-related nonfatal wounds were to the extremities. During the 6-year period, estimates are that quarterly fatal firearm-related injury rates declined 29.3%, and quarterly nonfatal firearm-related injury rates declined 46.9%. Firearm-related injury rates declined for intentionally self-inflicted, assault, and unintentional causes. INTERPRETATION: Data in this report regarding trends in firearm-related injury rates during 1993--1998 indicate that both mortality and morbidity from gunshot wounds declined substantially in the United States. However, firearm-related injury continues to be a public health concern accounting for approximately 31,000 deaths and 64,500 nonfatal injuries treated in hospital EDs in 1998. PUBLIC HEALTH ACTION: A state-based, national reporting system is needed to track the incidence, detailed circumstances, characteristics of the shooter and injured person, and long-term consequences of fatal and nonfatal firearm-related injuries. These data would be useful for the design, implementation, and evaluation of prevention programs aimed at reducing the burden of firearm-related injuries in the United States.

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