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3 December 2001
We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.
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Alcohol Involvement in Fatal Motor-Vehicle Crashes ---United States, 1999--2000.
US Centers for Disease Control. MMWR 2001; 50(47): 1064-1065.
The full report with table is available free online at the MMWR Website.
This report provides table that compares alcohol involvement in fatal motor-vehicle crashes by age group and blood alcohol concentration (BAC) levels for 1999 and 2000. A fatal crash is considered alcohol-related by the US National Highway Traffic Safety Administration (NHTSA) if either a driver or nonoccupant (e.g., pedestrian) had a BAC of < 0.01 g/dL in a police-reported traffic crash. Because BACs are not available for all persons in fatal crashes, NHTSA estimates the number of alcohol-related traffic fatalities on the basis of a discriminant analysis of information from all cases for which driver or nonoccupant BAC data are available.
Overall during 1999--2000, the number of alcohol-related traffic fatalities increased by 4% (95% confidence interval [CI]=2%--7%). For BACs < 0.10 g/dL (the legal limit for intoxication in most states in 1999 and 2000), fatalities increased by 4% (95% CI=1%--6%); for BACs of 0.01--0.09 g/dL, fatalities increased by 7% (95% CI=2%--12%). A broad range of public health and traffic safety strategies will be needed to stem further increases and reduce the number of alcohol-related traffic fatalities.
Reviews of evidence regarding interventions to reduce alcohol-impaired driving.
Shults RA, Elder RW, Sleet DA, Nichols JL, Alao MO, Carande-Kulis VG, Zaza S, Sosin DM, Thompson RS. Am J Prev Med 2001; 21(4 Suppl 1):66-88.
Correspondence: Ruth A. Shults, Centers for Disease Control, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, Georgia, USA (E-mail: ras1@cdc.gov
BACKGROUND: Alcohol-related motor vehicle crashes are a major public health problem, resulting in 15,786 deaths and more than 300,000 injuries in 1999.
OBJECTIVE: To systematically review the effectiveness and economic efficiency of selected population-based interventions to reduce alcohol-impaired driving.
METHODS: The Guide to Community Preventive Services's methods for systematic reviews were used to evaluate the effectiveness of five interventions to decrease alcohol-impaired driving, using changes in alcohol-related crashes as the primary outcome measure.
RESULTS: Strong evidence was found for the effectiveness of .08 blood alcohol concentration laws, minimum legal drinking age laws, and sobriety checkpoints. Sufficient evidence was found for the effectiveness of lower blood alcohol concentration laws for young and inexperienced drivers and of intervention training programs for servers of alcoholic beverages. Additional information is provided about the applicability, other effects, and barriers to implementation of these interventions.
CONCLUSIONS: These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. They can help decision makers identify and implement effective interventions that fit within an overall strategy to prevent impaired driving.
Evaluation of administration of activated charcoal in the home.
Spiller HA, Rodgers GC. Pediatrics 2001; 108(6): e100.
Correspondence: Henry A. Spiller, Kentucky Regional Poison Center, Box 35070, Louisville, KY 40232-5070. (E-mail: henry.spiller@nortonhealthcare.org).
BACKGROUND: Activated charcoal (AC) is recognized as the treatment of choice for gastrointestinal decontamination after many ingestions. AC use in the home has been limited by concerns that parents would not administer it properly and that children would refuse to take AC. Previous descriptions of home administration have reported mixed results.
OBJECTIVES: To assess the ability of the lay public to successfully administer activated charcoal in the home as treatment for ingestion of a toxic substance.
METHODS: This was an 18-month consecutive case series of all patients for whom AC administration was recommended in the home. Data collected included AC availability in the home and/or a local pharmacy, success in administration, amount administered, time after ingestion to AC administration, difficulties in administration, adverse effects, age and gender of patient, substance involved in poisoning, and medical outcome. All cases were followed for at least 3 days after the ingestion. Patients who initially had home AC recommendation but who ultimately were treated in the emergency department (ED) served as a comparison group.
RESULTS: Home administration of AC was recommended in 138 cases. A total of 115 individuals (83%) were treated with AC in the home, with no failures to administer AC. Reasons for failure to manage at home were 1) mother preferred ED (8 cases), 2) could not locate AC (7 cases), 3) pharmacy closed for the night (6 cases) and 4) no home telephone for follow-up (2 cases). Time to AC administration after ingestion was a mean of 38 minutes (±18.3) for home treatment and 73 minutes (±18.1) for ED treatment. Ninety-five percent of home cases received AC in 60 minutes versus 33% for ED management. AC was in the home in 11 cases at the time of recommendation. The amount of AC administered was a mean of 12.1 g (standard deviation: 6.9) and a median of 12 g. Eight children (6.9%) who were treated at home vomited after AC versus 3 (13%) who received ED treatment. No aspirations or complications occurred.
CONCLUSIONS: AC can be administered successfully by the lay public in the home. Home use of AC significantly reduces the time to AC administration.
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Motorcyclists' interpretations of risk and hazard.
Natalier K. J Sociology 2001; 37(1): 65-80.
Correspondence: Kristin Natalier, School of Social Sciences, University of Queensland, Room 729, Michie Building, Brisbane, AUSTRALIA (E-mail: k.natalier@mailbox.uq.edu.au).
BACKGROUND: Injury and death rates mark motorcycling as a hazardous activity. IN Australia, motorcyclists have a far higher rate of fatalities per 10,000 registered vehicles than users of other motor vehicle types.
OBJECTIVES: To investigate the understanding of risk among motorcyclists.
METHODS: Data were collected through focused interviews from motorcyclists from Tasmania, Australia (n=30, age 17 - 65 years, 25 of whom were male).
RESULTS: Objective indicators of risk such as cause-of-death statistics have little resonance for those who ride motorcycles. Central to motorcyclists' understandings of their pursuit is the celebration of technique and a belief in the ability to control their riding experiences. The importance of the lived experience of riding encourages motorcyclists to marginalize expert systems of knowledge in favor of their own practical experience. Through these processes, the potential of injury and death are downplayed.
CONCLUSIONS: Motorcyclists' activities occur within the context of an ambivalent relationship to risk. They attempt to marginalize the risks of motorcycling when even a cursory knowledge of the statistics, in association with their own crashes and close calls renders their interpretation insupportable. Motorcyclists emphasize their embodied experience as a key constitutive element of control. Citing their expertise motorcyclists create the grounds for their opinion that motorcycling may be hazardous for others but isn't particularly hazardous for them.
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Trends in Booster Seat Use Among Young Children in Crashes.
Durbin DR, Kallan MJ, Winston FK. Pediatrics 2001; 108(6): e109.
Correspondence: Dennis R. Durbin, Center for Clinical Epidemiology and Biostatistics, Room 711 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104 USA. (E-mail: ddurbin@cceb.med.upenn.edu).
BACKGROUND: Booster seat use in the United States is extremely low among 4- to 8-year-old children, the group targeted for their use. However, more recent attention has been paid to the role of booster seats for children who have outgrown their forward-facing child safety seat. In particular, several states are currently considering upgrades to their child restraint laws to include the use of booster seats for children over 4 years of age.
OBJECTIVES: To examine recent trends in booster seat use among children involved in automobile crashes in 3 large regions of the United States.
METHODS: This study was performed as part of the Partners for Child Passenger Safety project, an ongoing, child-specific crash surveillance system that links insurance claims data to telephone survey and crash investigation data. All crashes occurring between December 1, 1998, and November 30, 2000, involving a child occupant between 2 to 8 years of age riding in a model year 1990 or newer vehicle reported to State Farm Insurance Companies from 15 states and Washington, DC, were eligible for this study. A probability sample of eligible crashes was selected for a telephone survey with the driver of the vehicle using a previously validated instrument. The study sample was weighted according to each subject’s probability of selection, with analyses conducted on the weighted sample.
RESULTS: The weighted study sample consisted of 53 834 children between 2 to 8 years old, 11.5% of whom were using a booster seat at the time of the crash. Booster seat use peaked at age 3 and dropped dramatically after age 4. Over the period of study, booster seat use among 4- to 8-year-olds increased from 4% to 13%. Among 4-year-olds specifically, booster use increased from 14% to 34%. Among children using booster seats, approximately half used shield boosters and half used belt-positioning boosters.
CONCLUSIONS: Although overall booster seat use among the targeted population of 4- to 8-year-old children remains low, significant increases have been noted among specific age groups of children over the past 2 years. These data may be useful to pediatricians, legislators, and educators in efforts to target interventions designed to increase appropriate booster seat use in these children.
Reviews of evidence regarding interventions to increase the use of safety belts.
Dinh-Zarr TB, Sleet DA, Shults RA, Zaza S, Elder RW, Nichols JL, Thompson RS, Sosin DM. Am J Prev Med 2001; 21(4 Suppl 1):48-65.
Correspondence: David Sleet, Centers for Disease Control, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, Georgia, USA (E-mail: dds6@cdc.gov).
BACKGROUND: The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor vehicle crashes. If all motor vehicle occupants consistently wore safety belts, an estimated 9553 deaths would have been prevented in 1999 alone.
OBJECTIVE: To systematically review the effectiveness and economic efficiency of selected population-based interventions to increase the prevalence of seatbelt wearing.
METHODS: The Guide to Community Preventive Services's methods for systematic reviews were used to evaluate the effectiveness of three interventions to increase safety belt use. Effectiveness was assessed on the basis of changes in safety belt use and number of crash-related injuries.
RESULTS: Strong evidence was found for the effectiveness of safety belt laws in general and for the incremental effectiveness of primary safety belt laws relative to secondary laws. Strong evidence for the effectiveness of enhanced enforcement programs for safety belt laws was also found. Additional information is provided about the applicability, other effects, and barriers to implementation of these interventions.
CONCLUSIONS: These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. They can help decision makers identify and implement effective interventions that fit within an overall strategy to increase safety belt use.
Reviews of evidence regarding interventions to increase use of child safety seats.
Zaza S, Sleet DA, Thompson RS, Sosin DM, Bolen JC.Am J Prev Med 2001; 21(4 Suppl 1):31-47.
Correspondence: Stephanie Zaza, US Centers for Disease Control, Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Atlanta, Georgia, USA (E-mail: sxz2@cdc.gov).
BACKGROUND: In 1998, nearly 600 child occupants of motor vehicles aged younger than 4 years died in motor vehicle crashes. Yet approximately 29% of children aged 4 years and younger do not ride in appropriate child safety seat restraints, which, when correctly installed and used, reduce the need for hospitalization in this age group by 69% and the risk of death by approximately 70% for infants and by 47% to 54% for toddlers (aged 1 to 4 years).
METHODS: The systematic review development team reviewed the scientific evidence of effectiveness for five interventions to increase child safety seat use. For each intervention, changes in the use of child safety seats or injury rates were the outcome measures evaluated to determine the success of the intervention. Database searching was concluded in March 1998. More than 3500 citations were screened; of these citations, 72 met the inclusion criteria for the reviews.
RESULTS: The systematic review process identified strong evidence of effectiveness for child safety seat laws and distribution plus education programs. In addition, community-wide information plus enhanced enforcement campaigns and incentive plus education programs had sufficient evidence of effectiveness. Insufficient evidence was identified for education-only programs aimed at parents, young children, healthcare professionals, or law enforcement personnel.
CONCLUSIONS: Evidence is available about the effectiveness of four of the five interventions. This scientific evidence, along with the accompanying recommendations of the Task Force elsewhere in this supplement, can be a powerful tool for securing the resources and commitment required to implement these strategies.
Methods for conducting systematic reviews of the evidence of effectiveness and economic efficiency of interventions to reduce injuries to motor vehicle occupants.
Zaza S, Carande-Kulis VG, Sleet DA, Sosin DM, Elder RW, Shults RA, Dinh-Zarr TB, Nichols JL, Thompson RS. Am J Prev Med 2001; 21(4 Suppl 1):23-30.
Correspondence: Stephanie Zaza, US Centers for Disease Control, Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Atlanta, Georgia, USA (E-mail: sxz2@cdc.gov).
BACKGROUND: Motor vehicle occupant injury prevention is included in the Guide to Community Preventive Services because of the enormous health impact of these largely preventable injuries. This article describes the methods for conducting systematic literature reviews of interventions for three key injury prevention strategies: increasing child safety seat use, increasing safety belt use, and decreasing alcohol-impaired driving.
METHODS: Systematic review methods follow those established for the Guide to Community Preventive Services and include: (1) recruiting a systematic review development team, (2) developing a conceptual approach for selecting interventions and for selecting outcomes that define the success of the interventions, (3) defining and conducting a search for evidence of effectiveness, (4) evaluating and summarizing the body of evidence of effectiveness, (5) evaluating other potential beneficial and harmful effects of the interventions, (6) evaluating economic efficiency, (7) identifying implementation barriers, (8) translating the strength of the evidence into recommendations, and (9) identifying and summarizing research gaps.
RESULTS: The systematic review development team evaluated 13 interventions for the three strategic areas. More than 10,000 titles and abstracts were identified and screened; of these, 277 met the a priori systematic review inclusion criteria. Systematic review findings for each of the 13 interventions are provided in the accompanying articles in this supplement.
CONCLUSIONS: The general methods established for conducting systematic reviews for the Guide to Community Preventive Services were successfully applied to interventions to reduce injuries to motor vehicle occupants.
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