|
|
3 September 2001
Rates of Pediatric and Adolescent Injuries by Year of Age
Agran PF, Winn D, Anderson C, Trent R, Walton-Haynes L. Pediatrics 2001; 108(3): e45.
Correspondence: Phyllis F. Agran, University of California, Center for Health Policy and Research, Pediatric Injury Prevention Research Group, 100 Theory Street, Suite 110, Irvine CA 92697-5800, USA (email: pagran@uci.edu).
Available online: http://www.pediatrics.org/cgi/content/full/108/3/e45
The purpose of this study was to analyze causes of injury hospitalization/death by individual year of age and by specific causes of injury and to examine how well aggregate age groups represented individual year-of-age rates. Hospital discharge data and death certificate data for California residents age 0 to 19 years with a principal external cause of injury code (E-code) of E800 to E869, E880 to E929, or E950 to E999, calendar year 1997, were analyzed. Annual rates of injury hospitalization/death by year of age were calculated using combined hospital discharges and deaths as the numerator for major causes and important subcategories. For comparison, rates of injury hospitalization/death were calculated for conventional vital statistics age groups: less than 1 year, 1 to 4 years; 5 to 9 years, 10 to 14 years, and 15 to 19 years. In 1997 in California, 35,277 children and adolescents 0 to 19 years were hospitalized and 1934 died as a result of injury, a ratio of 17 hospitalizations to 1 death. The distribution was bimodal with rates highest among 18-year-olds (732/100,000) and 1-year-olds (495/100,000). Except for children who were 5 to 9 years of age, the group rates for all injuries were not reflective of the individual year-of-age rates. In specific categories of injuries, variation in rates by year of age were masked by age group rates for unintentional poisoning among 1- to 4-year-olds, self-inflicted poisoning for 10- to 19-year-olds, falls from playground equipment among 5- to 9-year-olds, falls from furniture among 1- to 4-year-olds, and motor vehicle occupant injury rates among 10- to 19-year-olds. The peak rate of falls from playground equipment among 6-year-olds (34/100,000) was more than twice the rate for 9-year-olds (15/100,000). Motor vehicle occupant injury rates doubled between 10 and 14 years of age and quadrupled between 14 and 18 years of age. Analyses using conventional age groups did not identify the age of highest risk for many causes of childhood injury. Changes in the rates often transected the traditional age groups and were not apparent with conventional age group analysis. These data can inform on the age at which to begin a specific injury intervention and on how to allocate resources. These data allow pediatricians and other health professionals to be anticipatory in providing injury prevention counseling. The greatest impact can be achieved by making the counseling topic most age appropriate in anticipation of the high-risk period. Costs of alcohol-related crashes: New Zealand estimates and suggested measures for use internationally.
Miller TR, Blewden M. Accid Anal Prev 2001; 33(6): 783-791.
Correspondence: Ted R. Miller, Pacific Institute for Research and Evaluation, Calverton Office Park, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705-3102, USA (email: miller@pire.org).
This paper presents policy-oriented measures of alcohol-related crash incidence and costs in New Zealand (N.Z.). Costs of crashes, where alcohol probably was a contributing factor were computed from official crash costs and police-reported crash/injury counts adjusted for under-reporting of crashes and of alcohol involvement. Alcohol-related crashes cost an estimated $1.2 billion in N.Z. in 1996. They equate to an estimated $0.75 per drink consumed, $17.80 per km driven above the legal limit of 0.08, and $1100 per heavy drinker. People other than the drinkers, who caused the crashes, paid half the costs. An estimated one in 90 drunk-driving trips resulted in a crash (and often a drunk driving conviction) while one in 375 crash-free drunk driving trips also resulted in a drunk-driving conviction. Ten measures of alcohol-related crash incidence and costs are recommended for international use. They include number of alcohol-related deaths and injuries; innocent victims and children harmed in crashes caused by drinkers; annual costs and costs paid by people other than the drinker who caused the crash; crash costs per drink consumed, per heavy drinker, per kilometer driven drunk versus sober; probabilities of crash and of drunk-driving conviction.
See: Farm-related fatalities included under Rural and Agricultural Issues (below) Farm-related fatalities involving children in Australia, 1989-1992.
Mitchell RJ, Franklin RC, Driscoll TR, Fragar LJ. Aust N Z J Public Health 2001; 25(4):307-314.
Correspondence: Rebecca J. Mitchell, Injury Prevention and Policy Unit, NSW Health, New South Wales, Australia. (email: rmitc@doh.health.nsw.gov.au).
The authors report on the types of and circumstances surrounding unintentional farm-related fatal injuries involving children aged less than 15 years in Australia. Information concerning 115 deaths were obtained from inspection of coronial files for the period 1989-92. Children less than 15 years made up 20% of all unintentional farm-related fatalities in Australia, with children less than 5 years representing 63% of all child fatalities. The majority of children were fatally injured while bystanders to farm work and equipment used on the farm (including dams), with drowning the most common mechanism of the fatal incident for children aged both 5 years or less and 5-9 years. Vehicle accidents were common for children aged 10-14 years. -
Injuries among children and youth in farm households: Regional Rural Injury Study-I.
Gerberich SG, Gibson RW, French LR, Renier CM, Lee TY, Carr WP, Shutske J. Inj Prev 2001; 7(2):117-122.
Correspondence: Susan G. Gerberich, Regional Injury Prevention Research Center, Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Minneapolis 55455, USA. (email: gerbe001@umn.edu).
The authors report on the incidence and consequences of both farming and non-farming related injuries and the potential risk factors for farming related injuries among children and youth, aged 0-19 years, who lived in farm households in a large region of the United States. Data were collected from randomly selected farm households during 1990. Rates and rate ratios with 95% confidence intervals were calculated for sociodemographic and exposure variables. Multivariate analyses were conducted, using a priori and backward stepwise logistic regression models. Within the population of 3,939 farm households and 13,144 persons, children and youth accounted for 33%. Injury rates for farming and non-farming sources, respectively, were 1,683 and 6,980 per 100,000 persons. Animals (40%) were the primary sources of the farming operation related injuries; sports/recreation sources (61%) were associated primarily with non-farming related injuries. Of the farming and non-farming operation related injury cases, 83% and 90%, respectively, required some type of health care; moreover, 17% and 24%, respectively, were restricted from regular activities for one month or more. Through multivariate analyses, important increased rate ratios were observed for operating a tractor, working with dairy cattle, and being male. Increased rate ratios for working with beef cattle, operating a harvester, and living on a farm where there were all terrain vehicles in use, and a decreased rate ratio for living on a farm where there were sheep, appeared suggestive. Based on the relevant rates, injury consequences, and potential risk factors identified, injuries to children and youth on farms represent a significant problem. Future analytic studies are essential to identify more specific risk factors that can serve as a basis for development of appropriate intervention efforts. Given the population at risk, and the opportunity for intervention in this unique occupational setting, many of these injuries may be readily amenable to prevention efforts.
Suicide prevention in Aboriginal communities: application of community gatekeeper training.
Capp K, Deane FP, Lambert G. Aust N Z J Public Health 2001; 25(4): 315-321.
Correspondence: Kim Capp, Illawarra Institute for Mental Health, University of Wollongong, New South Wales 2522, AUSTRALIA. (email: iiMH@uow.edu.au).
Concern over the high rate of suicide among Aboriginal people on the south coast of NSW led to the development of a project aimed at preventing youth suicide in the Aboriginal communities of the Shoalhaven. This paper describes the development, implementation and evaluation of the project. Following extensive consultation with the Aboriginal community, a range of culturally appropriate interventions were developed. The main focus was a series of community gatekeeper training workshops, which aimed to increase the potential of members of the Aboriginal community to identify and support people at risk of suicide and to facilitate their access to helping services. Evaluation of the workshops demonstrated an increase in participants’ knowledge about suicide, greater confidence in identification of people who are suicidal, and high levels of intentions to provide help. Attitudes, subjective norms and barriers predicted intentions to help. The project indicated community members could be successfully trained in the recognition of individuals at risk of suicidal behavior. Gatekeepers’ attitudes and perceived barriers to helping predicted intentions to help those in need. There is a need for longer-term follow-up to assess the extent to which new knowledge and skills are used in practice.
Predicting at-fault car accidents of older drivers
De Raedt R, Ponjaert-Kristoffersen I. Accid Anal Prev 2001; 33(6): 809-819.
Correspondence: Rudi De Raedt, Department of Developmental and Lifespan Psychology, Free University of Brussels, Pleinlaan 2, 3C247, B-1050 Brussels, BELGIUM (email: Rudi.De.Raedt@vub.ac.be).
Motor vehicle crashes are difficult to predict using screening tests. The objective of this exploratory study is to determine whether detailed accident analysis taking into account the specific accident type might enhance the predictive power of a standardised road test and a set of selected neuropsychological tests. Moreover, this study addresses the validity and reliability of performance-based driving evaluation. The sample consisted of 84 older drivers between 65 and 96 years of age who were referred for a fitness-to-drive evaluation. Using discriminant analyses, the subjects were classified as drivers with and without at-fault accidents. We compared the accuracy of neuropsychological tests and a road test for postdicting all accidents, accidents classified into two categories and accidents classified into four different categories. The percentages of correctly classified subject were highest at the level of the most detailed classification. These results suggest that, although accident prediction is difficult, the predictability of car accidents by neurocognitive measurements and a road test increases when the kind of accident is specified.
Potential benefits of restrictions on the transport of teenage passengers by 16 and 17 year old drivers.
Chen LH, Braver ER, Baker SP, Li G. Inj Prev 2001; 7(2):129-134.
Correspondence: Li-Hui Chen, Johns Hopkins School of Public Health, Baltimore, Maryland 21205, USA. (email: lhchen@jhsph.edu).
The presence of passengers is associated with fatal motor vehicle crashes of teenage drivers. A restriction against newly licensed teenage drivers carrying passengers has been included in some, but not all, graduated licensing systems. The purpose of this study was to predict the net effects on all types of road users, including vehicle occupants and non-occupants, of possible prohibitions against 16-17 year old drivers carrying passengers. Two national datasets, the Fatality Analysis Reporting System (FARS), a census of fatal crashes, and the Nationwide Personal Transportation Survey, a sample of trips in the United States, were used to compute 1995 road user death rates. Potential effects of restrictions on drivers ages 16-17 carrying passengers younger than 20 were estimated, based on road user death rates and potential choices made by passengers who would have traveled with 16-17 year old drivers if there were no restrictions. There were 1,181 road user deaths in 1995 involving drivers ages 16-17 whose passengers were all younger than age 20. The predicted number of lives in the United States that would be saved annually ranges from 83 to 493 (corresponding to reductions of 7-42% in road user deaths) for drivers ages 16 and 17 combined. Similar percentages of reductions (8-44%) were predicted solely for 16 year old drivers. Assuming passenger restrictions would apply to all 16 year old drivers and at least one third of 17 year old drivers, an estimated 60-344 fewer deaths per year may occur if restrictions are mandated. The authors conclude that restrictions on carrying passengers younger than 20 should be considered for inclusion in graduated licensing systems. Even if fewer than half the drivers obey the restrictions, a substantial reduction in road user deaths would be expected.
The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review.
Mann RE, Macdonald S, Stoduto LG, Bondy S, Jonah B, Shaikh A. Accid Anal Prev 2001; 33(5):569-583.
Correspondence: Robert E. Mann, Social, Prevention and Health Policy Research Department, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, London, Ontario N6G 4X8, CANADA . (email: robert_mann@camh.net).
In this review evidence on the impact of introducing or lowering legal blood alcohol limits on traffic safety measures is examined. There is substantial variability in the types and rigour of methods used to evaluate these legislative measures, and thus not surprisingly there is variability in the results observed. In most but not all cases where an evaluation of an introduced or lowered legal limit has been conducted, some beneficial effect on traffic safety measures has been reported. These effects are in some cases relatively small, and in other cases may be temporary. In some jurisdictions, lasting reductions in collision rates have been reported. Available evidence suggests that where beneficial effects are observed they are due to general deterrence, and not restricted only to drivers at blood alcohol concentrations (BAC) specifically affected by the legal change. Cannabis use and traffic accidents in a birth cohort of young adults.
Fergusson DM, Horwood LJ. Accid Anal Prev 2001; 33(6): 703-711.
Correspondence: David M. Fergusson, Christchurch Health and Development Study, Department of Psychological Medicine, Christchurch School of Medicine, PO Box 4345, Christchurch, NEW ZEALAND
(email: david.fergusson@chmeds.ac.nz).
The authors examined associations between cannabis use and traffic accident risks in a birth cohort of 907 young New Zealanders studied from 18 to 21 years. During the course of a 21-year longitudinal study of a birth cohort of 907 New Zealand born children information was gathered on (a) annual frequency of cannabis use over the period from 18 to 21 years; (b) annual rates of traffic accidents during the period 18-21 years; (c) measures of driver behaviours and characteristics. The association between cannabis use and traffic accident risk was examined among the 907 sample members who reported driving a motor vehicle between the ages of 18 and 21 years. There were statistically significant relationships between reported annual cannabis use and annual accident rates. This association was present only for `active' accidents in which driver behaviours contributed to the accident; those using cannabis more than 50 times per year had estimated rates of active accidents that were 1.6 (95% CI 1.2-2.0) times higher than the rate for non-users. However, statistical control for driver behaviours and characteristics related to cannabis use (drink driving behaviour; risky/illegal driving behaviours; driver attitudes; gender) eliminated the association between cannabis use and traffic accident risks. The authors conclude that although cannabis use was associated with increased risks of traffic accidents among members of this birth cohort, these increased risks appear to reflect the characteristics of the young people who used cannabis rather than the effects of cannabis use on driver performance.
See: Costs of alcohol-related crashes under Reports of Injury Occurrence (above)
Rural population survey of behavioral and demographic risk factors for loaded firearms.
Nordstrom DL, Zwerling C, Stromquist AM, Burmeister LF, Merchant JA. Inj Prev 2001; 7(2):112-116.
Correspondence: David L. Nordstrom, Division of Public Health, Wisconsin Department of Health and Family Services, 1 West Wilson Street, Room 218, Madison, WI 53703, USA. (email: nordsdl@dhfs.state.wi.us).
This study examines firearm prevalence and storage practices in rural households in the state of Iowa. Adults from a stratified random sample of 983 households in a rural Iowa county were interviewed. The chi square test of independence was used to assess association between loaded, unlocked firearms and seven behavioral and demographic risk factors. Nearly 67% of respondents reported firearms in their households. Nearly 7% of households had a loaded, unlocked gun. Prevalence of firearms at home was higher while prevalence of loaded, unlocked guns was lower than reported in other surveys. Prevalence of loaded, unlocked guns in farm households, 10.5%, was about twice the level in town households, 5.5% (chi sq test, p=0.033). Having taken a gun safety course was associated with more than double the prevalence of a loaded, unlocked gun, 13.5% v 5.1% (chi sq test, p=0.001). The prevalence of loaded, unlocked guns in households with a handgun, 19.3%, was four and one half times higher than in households with a long gun only, 4.2% (chi sq test, p=0.001). Households with someone with a lifetime prevalence of alcohol abuse or dependence were about twice as likely as other households, 13.0% v 6.6% (chi sq test, p=0.004), to report having loaded, unlocked firearms.
Back to "New This Week" Menu
Rev. 01-Sep-2001 at 10:16 hours.
|