28 January 2002
Slippery when wet: the effects of local alcohol access laws on highway safety.
- Baughman R, Conlin M, Dickert-Conlin S, Pepper J. J Health Econ 2001; 20(6):1089-1096.
Correspondence: Stacy Dickert-Conlin, Center for Policy Research, Syracuse University, NY 13244-1020, USA (email: sdickert@maxwell.syr.edu).
Using detailed panel data on local alcohol policy changes in Texas, this paper tests whether the effect of these changes on alcohol-related accidents depends on whether the policy change involves where the alcohol is consumed and the type of alcohol consumed. After controlling for both county and year fixed effects, we find evidence that: (i) the sale of beer and wine may actually decrease expected accidents; and (ii) the sale of higher alcohol-content liquor may present greater risk to highway safety than the sale of just beer and wine.
The role of cocaine in fatal crashes: first results of the Quebec Drug Study.
- Dussault C, Brault M, Lemire AM, Bouchard J. Proc Assoc Adv Automot Med Conf 2001; 45: 125-137. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: C. Dussault, Etudes et strategies en securite routiere, Societe de l'assurance automobile du Quebec, Quebec, CANADA.
As part of a major undertaking to establish the contribution of drugs in road crashes in Quebec, the present study focuses on the role of cocaine. Coroner, forensic laboratory and police accident records from April 1999 to December 2000 were matched for 265 fatally injured drivers of passenger vehicles. Cocaine was found in 7.9% of urine samples and 6.0% of blood samples. In order to set up a control group, two roadside surveys were conducted in August 1999 and 2000. The survey sample was distributed proportionately to the number of fatal accidents per time of day and day of the week. During both daytime and nighttime, a total of 11,952 drivers participated in the two surveys among which 11,574 provided a breath sample (96.8%), 8,177 a saliva sample (68.4%) and 5,931 a urine sample (49.6%). Cocaine was detected in 1.1% of urine samples and 1.0% of saliva samples of the driving population. In both fatally injured drivers and driving population, cocaine was found mostly (> 90%) in four main types of combination: cocaine alone, cocaine + cannabis, cocaine + alcohol, cocaine + cannabis + alcohol. The data collected allowed two different analyses: a case-control (urine/urine) and a responsibility analysis (case-case approach) that compares cocaine cases to drug-free cases. Despite some data limitations, all analyses for the four main types of combination clearly suggest that cocaine use plays a role in fatal crashes.
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Effects of improved access to safety counseling, products, and home visits on parents' safety practices: results of a randomized trial.
- Gielen AC, McDonald EM, Wilson ME, Hwang WT, Serwint JR, Andrews JS, Wang MC. Arch Pediatr Adolesc Med 2002; 156(1):33-40.
Correspondence: Andrea C. Gielen, Center for Injury Research and Policy, Johns Hopkins University, Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA (EMAIL: agielen@jhsph.edu).
OBJECTIVE: To present the results of an intervention trial to enhance parents' home-safety practices through pediatric safety counseling, home visits, and an on-site children's safety center where parents receive personalized education and can purchase reduced-cost products.
METHODS: Pediatricians were randomized to a standard- or an enhanced-intervention group. Parents of their patients were enrolled when the patient was 6 months or younger and observed until 12 to 18 months of age. Setting- A hospital-based pediatric resident continuity clinic that serves families living in low-income, inner-city neighborhoods. Participants First- and second-year pediatric residents and their patient-parent dyads. Interventions- Parents in the standard-intervention group received safety counseling and referral to the children's safety center from their pediatrician. Parents in the enhanced-intervention group received the standard services plus a home-safety visit by a community health worker. Outcomes- Home observers assessed the following safety practices: reduction of hot-water temperature, poison storage, and presence of smoke alarms, safety gates for stairs, and ipecac syrup.
RESULTS: The prevalence of safety practices ranged from 11% of parents who stored poisons safely to 82% who had a working smoke alarm. No significant differences in safety practices were found between study groups. However, families who visited the children's safety center compared with those who did not had a significantly greater number of safety practices (34% vs 17% had > or 3).
CONCLUSIONS: Home visiting was not effective in improving parents' safety practices. Counseling coupled with convenient access to reduced-cost products appears to be an effective strategy for promoting children's home safety.
Biomechanics of slips.
- Redfern MS, Cham R, Gielo-Perczak K, Gronqvist R, Hirvonen M, Lanshammar H, Marpet M, Pai CY, Powers C. Ergonomics 2001; 44(13): 1138-1166.
Correspondence: M.S. Redfern, Department of Bioengineering, University of Pittsburgh, PA 15213, USA (email: mredfern@pitt.edu).
REVIEW: The biomechanics of slips are an important component in the prevention of fall-related injuries. The purpose of this paper is to review the available literature on the biomechanics of gait relevant to slips. This knowledge can be used to develop slip resistance testing methodologies and to determine critical differences in human behavior between slips leading to recovery and those resulting in falls. Ground reaction forces at the shoe-floor interface have been extensively studied and are probably the most critical biomechanical factor in slips. The ratio of the shear to normal foot forces generated during gait, known as the required coefficient of friction (RCOF) during normal locomotion on dry surfaces or 'friction used/achievable' during slips, has been one biomechanical variable most closely associated with the measured frictional properties of the shoe/floor interface (usually the coefficient of friction or COF). Other biomechanical factors that also play an important role are the kinematics of the foot at heel contact and human responses to slipping perturbations, often evident in the moments generated at the lower extremity joints and postural adaptations. In addition, it must be realized that the biomechanics are dependent upon the capabilities of the postural control system, the mental set of the individual, and the perception of the environment, particularly, the danger of slipping. The focus of this paper is to review what is known regarding the kinematics and kinetics of walking on surfaces under a variety of environmental conditions. Finally, we discuss future biomechanical research needs to help to improve walkway-friction measurements and safety.
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Occupational slip, trip, and fall-related injuries--can the contribution of slipperiness be isolated?
- Courtney TK, Sorock GS, Manning DP, Collins JW, Holbein-Jenny MA. Ergonomics 2001; 44(13):1118-1137.
Correspondence: Theodore Courtney, Liberty Mutual Research Center for Safety and Health, Hopkinton, MA 01748, USA (email:theodore.courtney@libertymutual.com).
To determine if the contribution of slipperiness to occupational slip, trip and fall (STF)-related injuries could be isolated from injury surveillance systems in the USA, the UK and Sweden, six governmental systems and one industrial system were consulted. The systems varied in their capture approaches and the degree of documentation of exposure to slipping. The burden of STF-related occupational injury ranged from 20 to 40% of disabling occupational injuries in the developed countries studied. The annual direct cost of fall-related occupational injuries in the USA alone was estimated to be approximately US$6 billion. Slipperiness or slipping were found to contribute to between 40 and 50% of fall-related injuries. Slipperiness was more often a factor in same level falls than in falls to lower levels. The evaluation of the burden of slipperiness was hampered by design limitations in many of the data systems utilized. The resolution of large-scale injury registries should be improved by collecting more detailed incident sequence information to better define the full scope and contribution of slipperiness to occupational STF-related injuries. Such improvements would facilitate the allocation of prevention resources towards reduction of first-event risk factors such as slipping.
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See report on in-line skates under Recreation
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Injuries associated with inline skating in the European region.
- Mulder S, Hutten A. Accid Anal Prev 2002; 34(1):65-70.
Correspondence: S. Mulder, Consumer Safety Institute, P.O. Boix 75169, 1070 AD Amsterdam, The Netherlands (email: s.mulder@consafe.nl).
OBJECTIVES: To gain greater awareness and understanding of the circumstances leading to injuries associated with inline skating and to provide indices for determining preventive measures.
METHODS: Data on injuries during inline skating were collected from seven member states of the
European Union (EU) through the European Home and Leisure Accident Surveillance System (EHLASS).
RESULTS: The mean incidence rate for injuries while inline skating is 17 per 100,000 inhabitants. In the EU in 1996, about 65,000 people were treated at an Emergency Department for an inline skate injury (excluding traffic injuries). About 60% of the victims are male, while the age group most at
risk is 10-14 years old. Most injuries are due to a fall and wrist injuries are most common.
CONCLUSIONS: The results of the analysis give indications for possible preventive measures. Although the features of the injuries often differ per country, the countries can learn from each other in preventing these types of injuries. Educational campaigns should be targeted at young teenagers, use of protective equipment (like wrist protectors) and skating techniques. EHLASS has potential for intercountry comparisons, but its value will improve if selecting hospitals and coding agreements will be standardized.
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The Health-Related Quality of Life of Pediatric Traffic Victims.
- Sturms LM, van Der Sluis CK, Groothoff JW, Eisma WH, Jan Ten Duis H. J Trauma 2002; 52(1):88-94.
Correspondence: L.M. Strums, Department of Rehabilitation Medicine, University Hospital Groningen, University of Groningen, Postbus 145, NL-9700 AC Groningen, The Netherlands (email: L.M.Sturms@med.rug.nl).
OBJECTIVE: To describe the health-related quality of life (HRQoL) of young traffic victims and to identify those children who are at high risk of a reduced HRQoL.
METHODS: Retrospective analysis of data obtained from a registration system and from questionnaires completed by 211 parents of young traffic victims who attended the department of traumatology in 1996 and 1997.
RESULTS: The overall group of young traffic victims experienced a lower HRQoL sumscore compared with the reference population (p = 0.001). A total of 48 parents (23%) attributed their child's reduced HRQoL specifically to the traffic accident. The socioeconomic status (SES) of the father (p = 0.018) and the Injury Severity Score (p < 0.001) emerged as significant predictors of traffic-related HRQoL.
CONCLUSION: Children of low SES parents and severely injured children are at particularly high risk of a reduced HRQoL following a traffic accident. However, not solely severely injured and hospitalized young traffic victims may suffer a diminished HRQoL but traffic-related injuries of minor or moderate severity may cause substantial problems as well.
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Non-work-related farm fatalities in Australia, 1989-1992.
- Franklin RC, Mitchell RJ, Driscoll TR, Fragar LJ. J Agric Saf Health 2001; 7(4):229-239.
Correspondence: Richard C. Franklin, Australian Centre for Agricultural Health and Safety, Department of Public Health and Community Medicine, University of Sydney, Moree. (email: rfranklin@doh.health.nsw.gov.au).
This study aims to examine farm fatalities, between 1989-1992 in Australia, of individuals not working at the time of the incident. Non-work-related farm fatalities in Australia were studied as part of a larger study of all work-related traumatic fatalities from 1989-1992. Information on 214 unintentional non-work-related farm fatalities was obtained from inspection of coronial files. The information was examined according to type of bystander (bystander to work or bystander to farm equipment) and other farm deaths. Agents such as dams, tractors, utilities, and cars were among the most common causes of death for bystanders involved in fatal incidents. Fire and smoke, creeks or rivers, and cars were the most common agents for other farm deaths. Drowning, vehicle accidents, and being hit by moving objects were among the most common mechanisms of fatal injury for non-work-related farm deaths. The information gained from this study has been used to develop the Child Safety on Farms Strategy for Farmsafe Australia and Farmsafe Australia's Farm Machinery Safety Strategy.
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No reports this week
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Emergency Medical System Responses to Suicide-Related Calls --- Maine, November 1999--October 2000.
- Sonnenfeld N, Bailey D, DiCara C, Bradshaw J, Crosby A, Askland K. MMWR 2002; 51(03): 56-59.
Complete report available online: ( Download Document ).
BACKGROUND: Suicidal acts are morbid and potentially lethal events that are risks for subsequent completed suicide and possibly other health problems (e.g., substance abuse and depression). Suicidal behavior also can have negative consequences on family members, friends, and caregivers. In 1996, the cost of health care and lost wages for suicide attempts in Maine was approximately $115 million. In 1999, a total of 1,079 persons were hospitalized in Maine for self-injurious behavior. Although Maine has no injury-related surveillance systems, the Maine Bureau of Health (MBOH) assessed the use of Emergency Medical Service (EMS) response data to estimate incidence of EMS responses to suicide-related calls in Maine and to summarize the distribution of these responses by patient and event characteristics.
OBJECTIVES: This report describes EMS suicide-related responses during November 1999--October 2000 and indicates that EMS data would be a useful component of an integrated statewide suicidal behavior surveillance system.
METHODS: Maine EMS responders complete a run report form (RRF) for each emergency assistance call. RRF contains a check box titled "concern suicide," which is selected "for patients who have, relevant to this call/run, expressed or displayed any suicidal tendencies or attempts." For any RRF on which "concern suicide" is selected, personal identifiers are removed and the form is sent to the MBOH Injury Prevention Program (MIPP). RRF has defined fields for sex, age, date of birth, incident date, incident location, incident site, town of residence, insurance payor, and EMS service number. EMS responders can provide additional information in a free text field, from which MIPP extracts data on method of attempt or threat and circumstances surrounding the event.
Inclusion criteria for this analysis were 1) "concern suicide" box checked on the RRF, 2) confirmed Maine residency, 3) aged >10 years, and 4) presence of a unique RRF number. If RRFs were duplicated, only one was counted as a case. Of the 2,152 RRFs received during November 1999--October 2000, a total of 2,036 (95%) were eligible for inclusion in the analysis, of which 967 (47.5%) were made for the intra- or interinstitutional transportation of suicidal residents from nursing homes, psychiatric, correctional, or medical facilities. Data were evaluated separately for all responses and for the 1,069 noninstitutional (NI) responses. All age-adjusted rates were standardized to the 2000 U.S. standard population and included both completed suicides and nonlethal attempts.
RESULTS: For all calls, age-adjusted EMS response rates to "concern suicide" in Maine were 179.2 per 100,000 females and 142.3 per 100,000 for males. For females, age-specific rates were highest among those aged 15--19 years (384.8); for males, rates were highest for those aged 20--24 year (258.1). Because geographic and event data are limited for the institutionalized subgroup, the remainder of the descriptive analysis was limited to the NI cases. For the 1,069 NI cases, age-adjusted EMS response rates were 92.5 and 76.5 among females and males, respectively. Female rates of suicide-related EMS calls were highest among those aged 15--19 years (206.2), but were generally high among females aged 20--44 years (range: 138.8--160.2). Male rates of suicide-related EMS calls were highest among those aged 20--24 years (170.3) and high among those aged 15--19 and 25--34 years (range: 96.0--110.4). Age-specific rates were statistically similar for females aged 20--34 years and >55 years and for males aged 25--54 years. All other age-specific rate differences were statistically significant (p < 0.05). In comparison, suicide completion rates (derived from medical examiner data) were uniform across all female age groups (range: 0--10.7) and were highest among males aged >45 years (range: 25.0--34.8).
Suicidal ideation in the Finnish general population. A 12-month follow-up study.
- Hintikka J., Pesonen T, Saarinen P, Tanskanen A, Lehtonen J, Viinamäki H. Soc Psychiatry Psychiatr Epidemiol 2001; 36(12): 590-594.
Correspondence: Jukka Hintikka, Kuopio University Hospital, Department of Psychiatry, P. O. Box 1777, 70211 Kuopio, Finland (email: Jukka.Hintikka@kuh.fi).
BACKGROUND: The epidemiology of suicidal ideation has remained a relatively unstudied area.
OBJECTIVES: The aim of this study was to investigate the incidence, prevalence and persistence of and recovery from suicidal ideation in a sample of the Finnish general population.
METHODS: Postal questionnaires including the Beck Depression Inventory (BDI) were mailed to the study subjects (n = 1,593) at baseline and on follow-up after 12 months. The suicidality item of BDI was used to screen suicidal ideation.
RESULTS: The 12-month incidence (4.6 %) and prevalence of suicidal ideation (14.7 %) were higher in men than in women (3.1 % and 9.2 %, respectively). Sixty-nine per cent of those men and 59 % of those women who had suicidal ideation at baseline continued to have suicidal thoughts on follow-up. Suicidal ideation and the severity of depression associated strongly. Over half of the men and women who had persistent suicidal ideation had not visited any health services for help with psychological distress during the 12-month follow-up period. Daily smoking associated with a decreased probability of recovery from suicidal ideation.
CONCLUSIONS: Suicidal ideation is common and persistent at the population level. Seeking professional help for depression with suicidal tendencies is disproportionately low in relation to the high prevalence of suicidal ideation.
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Car size and injury risk: a model for injury risk in frontal collisions.
- Wood DP, Simms CK. Accid Anal Prev 2002; 34(1):93-99.
Correspondence: Dennis P. Wood, Denis Wood Associates, Isoldes tower, 1 Essex Quay, Dublin 8, Ireland.
Empirical studies have established that when pairs of similar cars collide, the relative injury risk between pairs of different size is inversely related to their mass ratio. Further empirical studies have shown that in frontal collisions between dissimilar cars, relative injury risk is inversely proportional to mass ratio raised to the power of n. The value of the exponent n increases with impact speed, with n approximately 1 at low speeds and n ranging from 2.81 to 3.74 for fatalities. In this paper a theory is derived which explains relative injury risk in terms of three parameters: length (or size) ratio, mass ratio and the ratio of collision energy absorption between the colliding vehicles. It is proposed that the ratio of collision energy absorption between colliding vehicles is a function of the structural collapse forces imposed at maximum dynamic crush. The theory shows that the fundamental factor in collisions between pairs of similar cars is size, i.e. length. For collisions between two dissimilar cars, Monte-Carlo simulations using generalized characterizations for the car population yield theoretical predictions that match empirical findings ranging from minor injuries (AISI +) to fatal (AIS6) injuries.
Risk factors for fatal road traffic accidents in Udine, Italy.
- Valent F, Schiava F, Savonitto C, Gallo T, Brusaferro S, Barbone F. Accid Anal Prev 2002; 34(1): 71-84.
Correspondence: Fabio Barbone, Cattedra di Igiene ed Epidemiologia, DPMSC, University of Udine, Via Colugna 40, 33100 Udine, Italy. (email: fbarbone@epi2.soph.uab.edu).
BACKGROUND: In the Province of Udine, Northeast Italy, mortality from road accidents is 37% higher than in the country as a whole.
OBJECTIVES: To identify the major risk factors for fatal crashes in this area, we analyzed the Police reports of 10,320 road traffic accidents that occurred from 1991 to 1996.
METHODS: Logistic regression was used to evaluate the association of characteristics of drivers and accidents with accident severity.
RESULTS: The risk of involvement in fatal rather than non-fatal accidents was lower among females than among males (odds ratio (OR) = 0.65; 95% confidence interval (95% CI), 0.53-0.80). Compared with subjects < 30 years of age, subjects aged > or = 65 had a significantly increased risk of fatal injury as pedestrians (OR = 10.87; 95% CI, 4.45-26.54), car drivers (OR = 1.85; 95% CI, 1.08-3.18), moped riders (OR = 3.53; 95% CI, 1.42-8.78), and bicycle riders (OR = 7.72; 95% CI, 2.56-23.29). In accidents that occurred from 1:00 to 5:00 h the risk of death was higher than from 6:00 to 11:00 h among pedestrians (OR = 8.88; 95% CI, 2.58-30.52), car drivers (OR = 4.95; 95% CI, 3.09-7.95), motorcycle riders (OR = 13.44; 95%CI, 2.54-71.05) and moped riders (OR = 8.76; 95% CI, 2.42-31.69). Risk of death among pedestrians, car drivers, moped, and bicycle riders was also significantly increased on roads outside the urban center. Driver's injury was strongly associated with lack of use of seat belts (OR = 13.27; 95% CI, 9.39-18.74, for fatal injury; OR = 2.49; 95% CI, 2.17-2.86, for non-fatal injury).
CONCLUSIONS: Simple interventions focused on protecting the weakest road users and based on law enforcement, behavioral change and environmental modification might result in reducing the significant excess of road traffic accident mortality found in the study area.
An alternative accident prediction model for highway-rail interfaces.
- Austin RD, Carson JL. Accid Anal Prev 2002; 34(1): 31-42.
Correspondence: Jodi L. Carson, Western Transportation Institute, 214 Cobleigh Hall, Montana State University, Bozeman 59717, USA (email: jodic@ce.montana.edu).
Safety levels at highway/rail interfaces continue to be of major concern despite an ever-increasing focus on improved design and appurtenance application practices. Despite the encouraging trend towards improved safety, accident frequencies remain high, many of which result in fatalities. More than half of these accidents occur at public crossings, where active warning devices (i.e. gates, lights, bells, etc.) are in place and functioning properly. This phenomenon speaks directly to the need to re-examine both safety evaluation (i.e. accident prediction) methods and design practices at highway-rail crossings. With respect to earlier developed accident prediction methods, the Peabody Dimmick Formula, the New Hampshire Index and the National Cooperative Highway Research Program (NCHRP) Hazard Index, all lack descriptive capabilities due to their limited number of explanatory variables. Further, each has unique limitations that are detailed in this paper. The US Department of Transportation's (USDOT) Accident Prediction Formula, which is most widely, also has limitations related to the complexity of the three-stage formula and its decline in accident prediction model accuracy over time. This investigation resulted in the development of an alternate highway-rail crossing accident prediction model, using negative binomial regression that shows great promise. The benefit to be gained through the application of this alternate model is (1) a greatly simplified, one-step estimation process; (2) comparable supporting data requirements and (3) interpretation of both the magnitude and direction of the effect of the factors found to significantly influence highway-rail crossing accident frequencies.
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Violence and social inequalities: mortality rates due to homicides and life conditions in Salvador, Brazil.
- Macedo AC, Paim JS, daSilva LMV, Costa MCN. Rev Saúde Pública 2001, 35(6): 515-522.
Correspondence: Jairnilson S. Paim, Rua Padre Feijó, 29, 4o andar, CHR Canela 40110-170 Salvador, BA, Brasil (email: jairnil@ufba.br).
BACKGROUND: Some studies have been questioning the association between poverty and violence.
OBJECTIVES: This study's purpose is to assess the distribution of homicide indicators associated with living conditions in Salvador, Brazil.
METHODS: A cluster study for the years 1991 to 1994 was carried out including the 75 data centers of the city of Salvador, BA, Brazil. Using death certificates for the study period, yearly mortality rates and mortality ratios were estimated. The 1991 census data of monthly wages and years of education for all family providers were used to define a four-category variable related to living conditions. Mortality rates due to homicide and the relative risk regarding the lowest living condition area were calculated for each social stratum. The 95% confidence intervals were calculated using the Confidence Interval Analysis software.
RESULTS: The highest mortality rates due to homicide were seen in the poorest areas. The relative risk due to homicide for the lowest and the highest living condition areas was statistically significant at 5% level and ranged from 2.9 to 5.1.
CONCLUSIONS: The data show a strong association between social inequalities and homicide in this urban area, emphasizing the importance of crime reduction programs.
Pediatric violence-related injuries in Boston: results of a city-wide emergency department surveillance program.
- Sege RD, Kharasch S, Perron C, Supran S, O'Malley P, Li W, Stone D. Arch Pediatr Adolesc Med 2002; 156(1): 73-76.
Correspondence: Pediatric and Adolescent Health Research Center, the Floating Hospital for Children's National Medical Center, New England Medical Center, Boston, MA, USA (email: rsege@lifespan.org).
BACKGROUND: Violence-related injuries among children are common, but age-based incidence data are not easily available.
OBJECTIVES: To describe injuries due to violence in a population-based case series of children and to estimate injury incidence.
METHODS: DESIGN: Prospective surveillance of children residing in Boston, Mass, who received pediatric emergency department treatment for violence-related injury during a 4-year period beginning April 15, 1995. SETTING: Pediatric emergency departments in Boston. PATIENTS: Children aged 3 through 18 years who came to a hospital emergency department between April 1995 and April 1999. Violence-related injuries were defined as those resulting from a situation of conflict involving 2 or more persons with intent to harm, as assessed by health care personnel caring for the patients. Self-inflicted injuries and injuries caused by child abuse (including any injury resulting from a conflict with a parent or guardian) were excluded. Homicides of Boston children aged 3 through 18 years who were killed during the study period were included based on police data. MAIN OUTCOME MEASURE: Population-based violence-related injury rates.
RESULTS: There were 2035 injury-related visits caused by violence, which reflects a rate of 52.7 (95% confidence interval, 50.5-54.9) per 10 000 person-years. Most injuries were relatively minor; 6.4% of visits resulted in admission. The youth violence-related injury rate in Boston declined at an average rate of 12% annually during the period studied.
CONCLUSION: Pediatric emergency department monitoring of violence-related injury in Boston suggests that childhood injuries due to violence declined during the late 1990s.
Preterm delivery and the severity of violence during pregnancy.
- Covington DL, Hage M, Hall T, Mathis M. J Reprod Med 2001; 46(12):1031-1039.
Correspondence: D.L. covington, Coastal Area Health Education Center, New Hanover Regional Medical Center, Wilmington, North Carolina, USA (email: dcovington@ec.rr.com).
OBJECTIVES: To determine the severity and consequences of physical violence during pregnancy among participants in a health department prenatal care coordination program.
METHODS: The prospective cohort study included all program participants from 1994 to 1996. Care coordinators screened participants for physical violence during pregnancy using a validated, systematic assessment protocol three times during prenatal care. The protocol was linked with prenatal records, delivery records and infant records to document complications and infant outcomes. Multiple logistic regression was used to assess the relationship between severe physical violence during pregnancy and pregnancy outcome while controlling for confounding factors.
RESULTS: Among the 550 participants, 13.5% reported violence during pregnancy; it included 6.7% severe violence (hitting, kicking, injury with a weapon and abdominal injury) and 6.7% moderate violence (threats, slapping, shoving and sexual abuse). Severe physical prenatal violence was significantly associated with spontaneous preterm labor, preterm delivery, very preterm delivery, very low birth weight, preterm/low birth weight, mean birth weight, mean newborn hospital charges, five-minute Apgar < 7, neonatal intensive care unit admission, and fetal or neonatal death. Body site injured, timing of violence and number of violent incidents were significant factors associated with violence during pregnancy and preterm delivery.
CONCLUSION: Because severe physical violence during pregnancy was a significant problem in this population, intervention programs are needed to reduce prenatal violence and its consequences.
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