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June 17, 2001
Alcohol Consumption with Age: A Cross-sectional and Longitudinal Study of the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1995
Eigenbrodt ML, Mosley TH , Hutchinson RG, Watson RL, Chambless LE, Szklo M Am J Epidemiol 2001; 153(11): 1102-1111.
Correspondence: Marsha L. Eigenbrodt, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, 101A Rosenau Hall CB #7400, Chapel Hill, NC 27599-7400 USA .
Previous cross-sectional and longitudinal studies assessing the association between age and drinking are inconsistent. Evaluating 15,425 Black and White men and women from four communities, this study sought to determine whether there was a consistent relation between age and drinking in cross-sectional and longitudinal analyses and to determine change in drinking status and level of consumption (occasional, light to moderate, and heavier drinkers) at follow-up. Cross-sectional analyses of drinking were performed for Atherosclerosis Risk in Communities examinations 1 (1987–1989) and 3 (1993–1995). The changes in drinking status and level were determined for the 12,565 persons with information at both examinations. Prevalence of drinking was generally inversely associated with age in the cross-sectional analyses for all ethnic/gender groups, and drinking prevalence decreased over the 6 years of follow-up for all except Black women. Only among Black drinkers was younger age associated with a higher level of alcohol consumption in both cross-sectional and prospective analyses. Thus, whether drinking prevalence declines, the amount consumed by drinkers is decreased, or whether both factors contribute to the decrease appears to vary with ethnicity and gender. The change in drinking level was substantial with more than 40% of baseline drinkers reporting drinking cessation or a different level of consumption at follow-up.
Risk Factors for All-Terrain Vehicle Injuries: A National Case-Control Study
Rodgers GB, Adler P. Am J Epidemiol 2001; 153(11): 1112-1118.
Correspondence: Gregory B. Rodger, Directorate for Economic Analysis, US Consumer Product Safety Commission, Washington, DC.
A case-control study design was used to determine and quantify all-terrain vehicle (ATV) risk factors. The analysis was based on the results of two national probability surveys conducted in 1997: a survey of injured ATV drivers treated in hospital emergency departments and a survey of the general population of ATV users. Cases were drawn from the injury survey; controls (ATV drivers who had not been injured) were drawn from the user survey. Risk factors were quantified by means of a binary logistic regression analysis. After adjustment for covariates, injury risks were systematically related to a number of driver characteristics (age, gender, driving experience), driver use patterns (monthly driving times, recreational vs. nonrecreational use), and vehicle characteristics (number of wheels, engine size). The results of the analysis suggest that future safety efforts should focus on reducing child injuries, getting new drivers to participate in hands-on training programs, and encouraging consumers to dispose of the three-wheel ATVs still in use.
The road to danger: the comparative risks of driving while sleepy.
Powell NB, Schechtman KB, Riley RW, Li K, Troell R, Guilleminault C. Laryngoscope 2001; 111(5):887-893
Correspondence: Nelson B. Powell, Stanford Sleep Disorders and Research Center, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, 401 Quarry Road Suite 3301-A Stanford, CA 94305, USA.
A large sector of the population of the United States has sleep deprivation directly leading to excessive daytime sleepiness. The prevalence of excessive daytime sleepiness in this population ranges from 0.3% to 13.3%. The consequences of even 1 to 2 hours of sleep loss nightly may result in decrements in daytime functions resulting in human error, accidents, and catastrophic events. The magnitude of risks in the workplace or on the highways resulting from sleepiness is not fully understood or appreciated by the general population. Hence, to more clearly emphasize the magnitude of these risks, we question whether mild sleep deprivation may have the same effect as alcohol on reaction times and driving performance. Sixteen healthy matched adult subjects (50% women) were stratified into two groups, sleep deprived and alcohol challenged. The sleep-deprived group was further subdivided into acute (one night without sleep) and chronic (2 h less sleep nightly for 7 d) sleep deprivation. Each group underwent baseline reaction time testing and then drove on a closed course set up to test performance. Seven days later, the group repeated this sequence after either sleep deprivation or alcohol intake. There were no significant between-group differences (sleep deprivation or alcohol challenged) in the changes before and after intervention for all 11 reaction time test metrics. Moreover, with few exceptions, the magnitude of change was nearly identical in the two groups, despite a mean blood alcohol concentration of 0.089 g/dL in the alcohol-challenged group. On-track driving performances were similar (P =.724) when change scores (hits and errors) between groups were compared (baseline minus final driving trial). This comparative model suggests that the potential risks of driving while sleepy are at least as dangerous as the risks of driving illegally under the influence of alcohol.
A comparative model: reaction time performance in sleep-disordered breathing versus alcohol-impaired controls.
Powell NB, Riley RW, Schechtman KB, Blumen MB, Dinges DF, Guilleminault C. Laryngoscope 1999; 109(10):1648-1664
Correspondence: Nelson B. Powell, Stanford Sleep Disorders and Research Center, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, 401 Quarry Road Suite 3301-A Stanford, CA 94305, USA.
Patients with sleep-disordered breathing have reaction time deficits that may lead to catastrophic accidents and loss of life. Although safety guidelines do not exist for unsafe levels of sleepiness, they have been established for unsafe levels of alcohol consumption. Since reaction time performance is altered in both, we prospectively used seven measures of reaction time performance as a comparative model in alcohol-challenged normal subjects with corresponding measures in subjects with sleep-disordered breathing. Eighty healthy volunteers (29.1+/-7.5 y of age, 56.3% female subjects) performed four reaction time trials using a psychomotor test at baseline and at three subsequent rising alcohol-influenced time points. The same test without alcohol was given to 113 subjects (47.2+/-10.8 y of age, 19.3% female subjects) with mild to moderate sleep-disordered breathing. Mean blood alcohol concentrations (BACs) in the alcohol-influenced subjects at baseline and three trials were 0, 0.057, 0.080, and 0.083 g/dL. The sleep-disordered subjects had mean respiratory disturbance indices of 29.2 events per hour of sleep. On all seven reaction time measures, their performance was worse than that of the alcohol subjects when BACs were 0.057 g/dL. For three of the measures, the sleep-disordered subjects performed as poorly as or worse than the alcohol subjects when alcohol levels were 0.080 g/dL. These results could not be explained by sex or age differences. The data demonstrate that sleep-disordered subjects in this study (with a mean age of 47 y) with mild to moderate sleep-disordered breathing had worse test reaction time performance parameters than healthy, nonsleepy subjects (with a mean age of 29 y) whose BAC is illegally high for driving a commercial motor vehicle in California. This comparative model points out the potential risks of daytime sleepiness in those with sleep-disordered breathing relative to a culturally accepted standard of impairment.
The distracted driver.
Peters GA, Peters BJ. J R Soc Promotion Health 2001; 121(1):23-28.
Correspondence: George A. Peters, Peters and Peters, 2001 Wilshire Blvd., Suite 221, Santa Monica, CA 90403, USA
A serious health problem is developing from automobile collisions caused by distracted drivers. This is a result of the rapid proliferation of portable cellular telephones and personal organizers used while driving, the development of more sophisticated entertainment systems and instrument panel controls, the advent of navigation and television displays in vehicles and promises of sophisticated wireless e-mail, FAX and Internet services in the vehicle. Preoccupation with electronic gadgets may also degrade human driving performance. Many drivers however, sincerely believe they have the talent to do several things at the same time, such as hold and look at a cellular telephone in one hand and drive with a beverage container in the other hand whilst at the same time, exercise their personal skills. Obviously, they believe that they do not need two hands on the steering wheel and two eyes on the road. This is a unique situation requiring intensive health promotion as distracted or 'offensive driving' may be habit forming and difficult to change, any significant design remedies will be slow to arrive and may be circumvented, and the regulatory laws have proved difficult or impossible to enforce. This special need may require research to determine the most effective techniques for health promotion.
Causes of traumatic death during pregnancy (letters)
Weiss HL and Horon IL. JAMA 2001; 285(2):2854-2855.
Full text of the letter and author's reply are available online HERE.
Doctors Weiss and Horon engage in a lively exchange about the importance of motor vehicle-related injuries as a cause of death among pregnant women. Weiss raised interesting questions about the potential for bias, classification, and inclusion problems in a recent JAMA report, Horon IL & Cheng D, Enhanced Surveillance for Pregnancy-Associated Mortality-Maryland, 1993-1998 (abstract available online
HERE). Horon replied that the criticisms lack merit.
Interpersonal antecedents of drivers' aggression
Yagel D. Transportation Research: Psychology and Behaviour 2001; 4(2):119-131.
Correspondence: Dana Yagil, Department of Human Services - Social Welfare & Health Studies, University of Haifa, Mount Carmel, Haifa 31905, Israel dyagil@research.haifa.ac.il
The theory of social information processing, which suggests that attributions affect aggressive reactions to another person's provocative behavior, was applied to the context of driving. Respondents were 150 male drivers, who were presented with three scenarios describing frustrating driving situations caused by another driver, male or female. Hostile and non-hostile attributions, and the preference for either aggressive or non-aggressive reactions were measured for each scenario. Aggregate image of drivers as well as driving-related emotions were also measured. A path analysis showed that irritability and competitiveness mediate the relationship between aggressive reactions, on the one hand, and hostility, anxiety, and drivers' image, on the other. Hostile attributions were found to be directed more toward male than toward female drivers and were related to a negative image of drivers. The results are discussed with regard to interpersonal aspects of driving behavior.
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