7 January 2002
Court procedures for handling intoxicated drivers.
- Voas RB, Fisher DA. Alcohol Res Health 2001; 25(1): 32-42.
Correspondence: Robert B. Voas, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, Maryland 20705, USA (email: voas@pire.org).
The courts have implemented numerous approaches to reduce the probability of recidivism among people apprehended for or convicted of driving while intoxicated. Although traditional punitive sanctions, such as fines and incarceration, are commonly used, they have not eliminated drinking and driving in the United States. Consequently, the court system has developed additional sanctioning procedures that show promise. For example, rehabilitative programs (e.g., alcohol education and alcoholism treatment) can reduce recidivism, at least marginally. These programs appear to be more effective when combined with license suspension. In addition to license suspension, several alternative methods for limiting driving opportunities of offenders have proven effective, including impounding offenders' vehicles or license plates, installing ignition interlocks, and requiring electronic home monitoring or house arrest. Effective court monitoring is a critical component in supporting recovery and compelling offenders to participate in rehabilitation programs. This role of the courts in monitoring offenders will likely increase as the use of intrusive, alternative sanctions grows.
Adverse outcomes of alcohol use in adolescents.
- Bonomo Y, Coffey C, Wolfe R, Lynskey M, Bowes G, Patton G. Addiction 2001; 96(10):1485-1496.
Correspondence: Yvonn Bonomo, Centre for Adolescent Health, Department of Pediatrics, University of Melbourne, Australia (email: y.bonomo@pgrad.unimelb.edu.au).
OBJECTIVES: To compare the occurrence of behaviors occurring under the influence of alcohol in 16-17-year-olds and determine associated risk factors for the different behaviors.
METHODS: Cross-sectional survey administered by laptop computers in secondary schools across the state of Victoria, Australia.
RESULTS: The participation rate was 79%. Seventy per cent of participants drank alcohol; 17% of drinkers reported alcohol-related violence (accidents or injuries) and 15% reported problems relating to sex under the influence of alcohol (having sex and later regretting it or having had unsafe sex) in the previous 12 months. Males were more likely to report alcohol-related violence (20% compared to 14% females). For alcohol-related injuries, strong independent associations were found with dose of alcohol consumed (prop. cum. OR 2.3, 95% CI 1.3-4.0), frequency of alcohol consumption (prop. cum. OR 2.7, 95% CI 0.94-7.5), antisocial behavior (prop. cum. OR 2.4, 95% CI 1.4-4.1) and peer drinking (prop. cum. OR 3.3, 95% CI 1.4-8.1). For alcohol-related sexual risk-taking, psychiatric morbidity (prop. cum. OR 4.1, 95% CI 1.9-9.0) and high frequency of alcohol consumption (prop. cum. OR 2.0, 95% CI 0.87-4.6) had strong independent associations.
CONCLUSIONS: Physical injury and high-risk sexual behavior under the influence of alcohol are common in teenagers. Alcohol-related physical injury appears closely related to patterns of alcohol consumption whereas alcohol-related sexual risk-taking is most closely associated with symptoms of depression and anxiety.
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The public health approach to motor vehicles, tobacco, and alcohol with applications to firearms policy.
- Hemenway D. J Public Health Policy 2001; 22(4):381-402.
Correspondence: David Hemenway,Department of Health Policy and Management, Kresge Building, Room 401 677 Huntington Avenue, Boston, MA 02115 USA (email: hemenway@hsph.harvard.edu).
The public health approach that has been used to reduce problems causes by motor vehicles, tobacco and alcohol is applied to firearms policy. manufacturers try to focus prevention efforts on the user rather than the product, and promote education and law enforcement policies directed toward the consumer. Public health efforts emphasize the systematic collection of data, scientific inquiry, and a multi-faceted policy approach that includes modifying the product and the environment. The endeavor to reduce gun violence is part of the general and continuing public health struggle to reduce harms caused by consumer products.
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Traumatic stress and ways of coping of community residents exposed to a train disaster.
- Chung MC, Farmer S, Werrett J, Easthope Y, Chung C. Aust N Z J Psychiatry 2001; 35(4):528-534.
Correspondence: Man Cheung Chung, Department of Psychology, University of Plymouth, Devon, UK. (email: m.chung@plymouth.ac.uk).
OBJECTIVES: The aims of this study were to examine the degree of traumatic stress and the coping strategies employed by community residents who lived on both sides of a rail track where a train collision occurred in 1996 in Stafford, UK. The hypothesis was that there would be a high level of traumatic stress and that emotion-focused coping would be the predictor to distress.
METHOD: This was a cross-sectional survey with a retrospective design in which 66 community residents, who lived between 30 and 100 feet away from the crash site, were interviewed. The study began approximately 7 months after the disaster. The Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC) were administered to the residents.
RESULTS: On the whole, the results did not entirely support the hypothesis. The residents were found to have experienced some intrusive thoughts and avoidance behavior but their mean scores were significantly lower than those of standardized samples. Thirty-five per cent scored at 4 or above on the GHQ-28. Traumatic stress was predicted by both emotion-focused and problem-focused coping strategies.
CONCLUSION: Although community residents were not on the train or related to the dead or injured in any way, they could, after being exposed to a train disaster, manifest traumatic stress symptoms which had long-lasting effects. Such traumatic stress was found to be associated with coping strategies of community residents characterized by their efforts to manage or alter the source of stress, and by their efforts to regulate stressful emotions.
When disaster strikes--the need to be "wise before the event": Crisis intervention with children and adolescents.
- Yule W. Adv Mind Body Med 2001; 17(3): 191-196.
Correspondence: William Yule, Applied Child Psychology, University of London Institute of Psychiatry,
De Crespigny Park, Denmark Hill, London SE5 8AF, UK (email: unavailable).
Addresses issues in providing crisis intervention to children and adolescents affected by a traumatic event or disaster. These include the need for risk analysis and preparation, cross-agency disaster plans, coordinated efforts to provide evidence-based intervention packages for local implementation with a modicum of training and supervision, and psychological debriefing for children. Although few studies have evaluated the effects of debriefing on children, the author makes several recommendations for how to respond to children traumatized by an emergency event. The key to improvements in crisis interventions is seen to be forward planning and better outcome measurement studies.
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Dog bite and injury prevention--analysis, critical review, and research agenda.
- Ozanne-Smith J, Ashby K, Stathakis VZ. Inj Prev 2001; 7(4): 321-326.
Correspondence: Joan Ozanne-Smith, Monash University Accident Research Centre, Monash University, Victoria, Australia. (email: joan.ozanne-smith@general.monash.edu.au).
OBJECTIVES: To analyze Australian dog bite injury data and make international comparisons; to review risk and protective factors relating to the dog, injured person, and environment; and to recommend action for prevention and research.
METHODS: Australian dog bite injury data, complemented by detailed Victorian and regional data from routine health records and vital statistics, were analyzed to determine incidence, severity, nature, circumstances, and trends. International comparison data were extracted from published reports. Risk and protective factor studies were selected for review from electronic and bibliographic searches where data were recent, sample sizes substantial, and bias limited.
RESULTS: The Australian dog bite death rate (0.004/100,000) is lower than both the United States (0.05-0.07/100,000) and Canadian rates (0.007/100,000). Victorian hospitalized trend rates were stable between 1987 and 1998, but there was a decline for children <5 years (p=0.019) corresponding with a reduction in dog ownership. Children 0-4 years have the highest rate of serious injury, particularly facial. Adults have longer hospitalizations, most frequently for upper extremity injury. Risk factors include: child, males, households with dogs, certain breeds, male dogs, home location, and leashed dog.
CONCLUSIONS: Dog bite rates are high and it may therefore be assumed that current preventative interventions are inadequate. Responsible dog ownership, including separating young children from dogs, avoiding high risk dogs, neutering, regulatory enforcement, and standardized monitoring of bite rates are required. Controlled investigations of further risk and protective factors, and validated methods of breed identification, are needed.
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Risk factors for injury among veterinarians.
- Gabel CL, Gerberich SG. Epidemiology 2002; 13(1): 80-86.
Correspondence: Susan G. Gerberich, Regional Injury Prevention Research Center, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA (email: gerbe001@tc.umn.edu).
BACKGROUND: Work-related injuries among veterinarians are a major problem, but little is known of the specific risk factors involved.
OBJECTIVES: The purpose of this study was to identify risk factors for job-related injury among veterinarians.
METHODS: The researchers conducted a nested case-control study from a comprehensive population-based study of practicing Minnesota veterinarians. The researchers questioned cases (N=193) on exposures occurring in the month before their injury and controls (N=495) on exposures occurring ina randomly selected month. Logistic regression was used to model the dependence of veterinary work-related injuryon each exposure of interest and associated confounders.
RESULTS: Increased rates were associated with prior injuries RR = 1.7, 95% CI=1.1-2.6); participation in sports (RR = 1.7, CI=1.05-2.6), no sharps boxes present (RR = 1.8, CI=1.01-3.2), current smoking (RR = 4.1, CI=1.8-9.1), and 6 or fewer hours of sleep (RR = 1.8, CI=1.0-3.3). A dose response was identified for lifting patients. Decreased rates were noted for participation in aerobic activities (RR=0.6, CI=0.4-0.99), perception of lower risk (RR = 0.4 CI = 0.2-0.9), and experience (RR = 0.6, CI = 0.4-0.9).
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No reports this week
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Public beliefs about the preventability of unintentional injury deaths.
- Girasek DC. Accid Anal Prev 2001; 33(4):455-465.
Correspondence: Deborah C. Girasek, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. (email: dgirasek@usuhs.mil).
BACKGROUND: Throughout the first half of life, injuries kill more Americans than any other cause. Yet, no major voluntary organization, such as an American Heart Association or American Cancer Society, exists to coordinate efforts to support injury research and prevention.
OBJECTIVES: To assess whether members of the lay public believe that deaths due to motor vehicle crashes, falls, drowning, fires / burns, and poisonings are preventable.
METHODS: This report is based upon the results of a national random digit dialed telephone survey in which 943 adults were queried. Subjects reported the proportion of deaths due to motor vehicle crashes, falls, fires/burns, drowning and poisoning that they felt were preventable. Bivariate and multivariate tests were conducted using SPSS for Windows. Independent variables included age, sex, income, education, race, Hispanic origin, religiosity, political persuasion, risk-taking proclivity, population density, geographic region, personal history of serious injury, relationship to a fatally injured person, perceived alcohol involvement, and knowledge of injury countermeasures.
RESULTS: On average, respondents believed that 56% of "fatal accidents" were preventable; as were 62% of motor vehicle crash deaths, 53% of fall deaths, 67% of drownings, 62% of fire/burn fatalities and 70% of accidental poisonings. Logistic regression models predicting preventability beliefs differed according to the type of injury event in question, but socio-economic status and perceived alcohol involvement were positive predictors of beliefs related to all of the injuries under study. Those who could name countermeasures for a given type of fatal injury were more likely to believe that such deaths could be prevented.
CONCLUSIONS: Most respondents apparently believe that most fatal injuries are preventable. The report includes an extensive discussion of the implications of the study results.
Injury proneness and personality.
- Marusic A, Musek J, Gudjonsson G. Nord J Psychiatry 2001; 55(3): 157-161.
Correspondence: Andrej Marusic, MRC SGDP Research Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK (e-mail a.marusic@iop.kcl.ac.uk).
The aim of this research was to investigate some personality factors among groups of 43 physically injured inpatients and 43 non-injured hospital-based controls. The participants completed the Eysenck Personality Questionnaire (EPQ) and the Coping Styles Questionnaire (CSQ). Logistic regression was used to compare the two groups on six psychological risk factors. The univariate regression models suggested three possible risk factors: extroversion, sensitization, and avoidance coping style. The multivariate regression model supported only extroversion and sensitization of emotion. Next, patients in the experimental group were questioned about whether they had considered preventive measures before the accident and whether they felt responsible for their injuries. Correlation analysis showed that introverted subjects felt more responsible for the sustained injuries than their extroverted counterparts. Sensitizers and subjects who scored high on psychoticism, neuroticism, and emotional coping had not considered preventive measures as often as others. Finally, the principal component analysis of risk factors was used to extract two correlates of injury-prone behavior: extroversion and sensitized avoidance. It was concluded that psychological factors play an important role in predicting injury that is significant enough to require inpatient treatment. Two potential mechanisms of psychological impact have been suggested, notably distraction in extroverted subjects and overestimation in sensitizing avoiders.
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No reports this week
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Non-fatal animal related injuries to youth occurring on farms in the United States, 1998.
- Hendricks KJ, Adekoya N. Inj Prev 2001; 7(4): 307-311.
Correspondence: Kitty J. Hendricks, Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA. (email: kjt1@cdc.gov).
OBJECTIVES: To provide data on the magnitude and patterns of animal related on-farm injuries to youth in the United States.
METHODS: Data source- A survey of 26,000 farm households conducted for the National Institute for Occupational Safety and Health by the United States Department of Agriculture in 1998. Subjects- Youth younger than 20 years of age.
RESULTS: There were an estimated 6,438 animal related on-farm injuries to youth in 1998. 70% occurred to farm residents; 69% were work related. Males accounted for 64% and approximately 41% occurred to those younger than 10; 37% involved horses and 31% cattle. Most horse related injuries occurred to females and a majority of the cattle related injuries were to males. Additionally, most of the cattle related injuries were work related, while horse related injuries were mainly nonwork.
CONCLUSIONS: One out of every five youth injuries occurring on farms in the United States is animal related. These animal related injuries were due to both work and non-work related exposures. The large number of horse and cattle related injuries highlights a need for intervention strategies based on the injury circumstances common to these animals.
See item 1 under Occupational Issues
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No reports this week
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A role of sunshine in the triggering of suicide.
- Petridou E, Papadopoulos FC, Frangakis CE, Skalkiou A, Trichopoulos D. Epidemiology 2002; 13(1): 106-109.
Correspondence: Dimitrios Trichopoulos, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115 USA (email: dtrichop@hsph.harvard.edu).
BACKGROUND: Several reports indicate that suicide follows a seasonal pattern with a dominant peak during the month of maximum daylight.
OBJECTIVES: The purpose of this study was to evaluate the hypothesis that sunshine exposure may trigger suicidal behavior.
METHODS: The researchers gathered data on the distribution of suicide by month from 20 countries belonging to the Organization for Economic Cooperation and Development. Daylight duration for every country were retrieved from the Internet web site www.sunrisesunset.com. Parameters of seasonality within countries were estimated using the Poisson regression variant of the circular normal distribution.
RESULTS: The researchers report a consistent pattern of seasonality with peak incidence around June in the northern hemisphere and December in the southern hemisphere. Moreover, there was a positive association between the seasonal amplitude of suicide (measures by relative risk) and total sunshine in the corresponding country.
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Why arent sobriety checkpoints widely adopted as an enforcement strategy in the United States?
- Fell JC, Ferguson SA, Williams AF, Fields M. Proc Assoc Adv Automot Med Conf 2001; 45:425-428. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: James Fell, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, Maryland 20705, USA (email: fell@pire.org).
Sobriety checkpoints have been used by police in the United States for at least the past two decades to enforce impaired driving laws. Research has indicated that sobriety checkpoints are effective in reducing drinking and driving and alcohol-related fatal crashes. Despite this evidence, many police agencies have been unenthusiastic about using checkpoints. Information was collected from all 50 states plus the District of Columbia on the use of sobriety checkpoints. A total of 37 states reported conducting sobriety checkpoints at least once or twice during the year. Only 11 states reported that checkpoints were conducted on a weekly basis. Thirteen states do not conduct checkpoints either because of legal or policy issues. More detailed information was collected from 5 states that conduct checkpoints frequently and matched with information from 5 similar states that conduct checkpoints infrequently. States with frequent checkpoint programs had several common features such as program themes, support from task forces and citizen activist groups, use of a moderate number of police at the checkpoints, and use of all available funding mechanisms (federal, state, local) to support them. States with infrequent checkpoints claimed a lack of funding and police resources for not conducting more checkpoints, preferred saturation patrols over checkpoints because they were more "productive," and used large numbers of police officers at checkpoints.
Acceptability of the Checkpoints Parent-Teen Driving Agreement: pilot test.
- Hartos JL, Nissen WJ, Simons-Morton BG. Am J Prev Med 2001; 21(2):138-141.
Correspondence: Jessica L. Hartos, Prevention Research Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892-7510, USA. (email: jessica_hartos@nih.gov).
BACKGROUND: Parent-teen driving agreements are potentially important tools to facilitate parental management of teen driving and reduce adolescent driving risk. The Checkpoints Parent-Teen Driving Agreement (Checkpoints P-TDA) was designed so that parents could initially impose strict limitations on teen driving in high-risk driving conditions (e.g., at night and with teen passengers) and gradually increase driving privileges over time as teens demonstrate responsible driving behavior.
OBJECTIVES: To assess the acceptability of the format and content of the Checkpoints P-TDA.
METHODS: The researchers conducted a pilot test with a convenience sample of 47 families recruited as their teens tested for a driver's license at five private driving schools in Connecticut. Family members were interviewed at the driving schools about potential limits on teen driving, asked to use the driving agreement, and re-interviewed within 3 months about acceptability of the driving agreement and initial driving limits placed on teens.
RESULTS: Most families (38 of 47) used and liked the agreement. In addition, most parents placed the recommended strict initial limits on teen driving related to driving unsupervised at night, with teen passengers, and on high-speed roads. Moreover, parents reported placing more strict limits on their teens' driving than they originally intended.
CONCLUSIONS: The results showed promise for the acceptability of the Checkpoints P-TDA, which will be tested statewide.
Motor vehicle crashes among teens: impact of the graduated licensing law in San Diego.
- Smith AM, Pierce J, Ray LU, Murrin PA. Proc Assoc Adv Automot Med Conf 2001; 45:379-385. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Alan M. Smith, County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, 6255 Mission Gorge Road, San Diego, CA 92120-3599 USA (email: asmit1he@co.san-diego.ca.us).
To assess the effect of California's graduated driver's license (GDL) law in San Diego County, we compared motor vehicle crash and passenger injury rates involving 16-year-old drivers for 1999 and 2000, the first two years of the law, against 1997, using data from a statewide database of all injury crashes. While the crash rate per 1,000 drivers did not change following GDL, a significant decline in the percentage of 16-year-olds with a driver's license corresponded with large decreases in population-based crash and injury rates.
Do parent-imposed delayed licensure and restricted driving reduce risky driving behaviors among newly licensed teens?
- Hartos JL, Eitel P, Simons-Morton B. Prev Sci 2001; 2(2):113-122.
Correspondence: Jessica L. Hartos, Prevention Research Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892-7510, USA. (email: jessica_hartos@nih.gov).
BACKGROUND: Motor vehicle crashes are the leading cause of death and injury to teenagers. Crash risks result from their age, inexperience, and risky driving.
OBJECTIVES: The purpose of this study was to determine whether parent-imposed delayed licensure and restricted driving are related to fewer teenage risky driving behaviors.
METHODS: At baseline, 275 teenagers with a learner's permit and one of their parents were interviewed about driving attitudes and teenage behaviors. One year later, 161 of the teenagers had since obtained a provisional license and were reinterviewed about time of licensure, parental restrictions on driving, and driving attitudes and behaviors.
RESULTS: The results indicated that parents delayed licensure until teens were "ready," and limited their driving in terms of trip and risk conditions. Higher levels of risky driving behaviors were predicted by younger ages at licensure and fewer limits on driving in the first month, in addition to male gender, higher conflict over driving, lower perceptions of dangers related to driving, more problem behaviors at baseline, and more high-risk driving (e.g., at night, teenage passengers). Overall, the results indicate that a combination of being older at licensure and restricting driving under high-risk conditions at licensure may be an effective way to curb teens' risky driving behaviors.
Illicit drugs and fitness to drive: Assessment in Spanish medical driving test centres.
- del Rio MC, Alvarez FJ. Drug Alcohol Dependence. Vol 64(1): 19-25.
Drugs and Alcohol Research Group, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain (email: alvarez@med.uva.es).
This study investigated the incidence of problems related to illicit drugs and fitness to drive among 8043 Spanish drivers assessed in 25 Medical Driving Test Centres at national level. In accordance with Spanish and European Union legislation, driving licenses cannot be issued or renewed to people suffering from illicit drug-related problems. A small percentage (0.3%; n=24) of drivers interviewed had problems relating to drug use (abuse, dependence and induced disorders) and half of them (n=12) were also diagnosed as having problems with alcohol. Drivers with illicit drug-related problems were more often involved in road accidents and committed more traffic infractions during the last year (33.3%, n=8, and 79.2%, n=19, respectively) than those without problems related to illegal drug taking (12.3%, n=986, and 9.3%, n=748, respectively). Of drivers with drug problems 70.8% (n=17) were considered fit to drive. The results show that the incidence of drug-related problems is rare among Spanish drivers, and that in three out of four cases drivers with drug-related problems were considered fit to drive.
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Risk factors for physical injury among women assaulted by current or former spouses.
- Thompson MP; Saltzman LE, Johnson H. Violence Against Women 2001; 7(8): 886-899.
Correspondence: Martie P. Thompson, CDC-National Center for Injury Prevention and Control, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA (email: mgt8@cdc.gov).
OBJECTIVES: To determine risk factors for physical injuries to women resulting from partner violence.
METHODS: Data from 1,946 women who participated in the Canadian Violence Against Women Survey were examined using several statistical methods.
RESULTS: Multivariate results indicate that experiencing violence before the union, having a partner who was drinking at the time of the assault, having children who witnessed the assault, experiencing previous violence by the same partner, fearing one's life was in danger, and experiencing high levels of emotional abuse were related to an increased risk of both minor and severe injuries. Both models had good predictive value: 80% concordance rate when predicting minor injuries and 90% concordance rate when predicting severe injuries.
CONCLUSIONS: Knowledge of a woman's status on these risk factors would allow public health practitioners to intervene with battered women more effectively to prevent injuries.
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