18 February 2002
Substance abuse in teenagers. Trends and consequences.
- Kang M. Aust Fam Physician 2002; 31(1):8-11.
Correspondence: Melissa King, NSW Centre for the Advancement of Adolescent Health, Department of Adolescent Medicine, Children's Hospital, Westmead, New South Wales, AUSTRALIA (email: MelissaK@chw.edu.au).
Over the past few decades there has been growing concern about the use and abuse of alcohol and other drugs by adolescents. Alcohol and tobacco remain the most often used drugs in adolescence, and are the drugs associated with greatest morbidity and mortality, but there is some evidence that the use of illicit drugs is increasing. Morbidity and mortality from substance abuse can occur directly from the effects of the drug, from the mode of administration or from environmental factors associated with drug use. Drug related deaths compromise 24% of all deaths in the 12-24 year old age group. This is likely to be an underestimate as alcohol related traffic accidents are excluded from this figure.
The effects of alcohol consumption on mortality and morbidity: a 26-year follow-up study.
- Theobald H, Johansson SE, Bygren LO, Engfeldt P. J Stud Alcohol 2001; 62(6):783-789.
Correspondence: Peter Engfeldt, Department of Clinical Sciences, Family Medicine Stockholm, Karolinska Institutet, Sweden (email: Peter.Engfeldt@klinvet.ki.se
).
OBJECTIVES: To investigate the long-term effects of the consumption of alcohol on mortality and morbidity.
METHODS: A sample of 32,185 (50.5% female) individuals was randomly selected from the 450,000 inhabitants of Stockholm County, Sweden, in 1969. Alcohol consumption data were obtained from postal questionnaires; response rate was 87% (n = 28,001). Data on mortality and morbidity were obtained from the National Cause of Death Register, the Cancer Register and the Inpatient Register 1971-1996.
RESULTS: The reference groups were moderate consumers of alcoholic beverages. High-consumption men had increased risks of mortality from cardiovascular diseases (relative risk ratio [RR] = 1.28; 95% confidence interval [CI]: 1.12-1.46), accidents or poisoning (RR = 2.10; CI: 1.67-2.65) and gastrointestinal diseases (RR = 4.65; CI: 2.93-7.36). High-consumption women had an increased risk of mortality only from accidents or poisoning (RR = 2.95; CI: 1.82-4.78) and gastrointestinal diseases (RR = 3.60; CI: 1.40-9.24). For low-consumption women, there was an increased risk of mortality from cardiovascular diseases (RR = 1.25; CI: 1.07-1.47). Low-consumption men also had an increased mortality from cardiovascular diseases (RR = 1.23; CI: 1.05-1.44). The results with respect to morbidity almost mirrored the results for mortality, with one exception; for low-consumption men, the morbidity from cardiovascular diseases was not increased.
CONCLUSIONS: The mortality and morbidity associated with different levels of alcohol consumption are associated with the same diseases, which suggests that alcohol may be one of the causative factors for these diseases. The reasons for the differences between genders, regarding responses to the negative effects of alcohol consumption, are still unknown.
Alcohol and mortality from external causes.
- Dawson DA. J Stud Alcohol 2001; 62(6):790-797.
Correspondence: D.A. Dawson, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland 20892-7003, USA. ( email: ddawson@willco.niaaa.nih.gov).
OBJECTIVES: The aim of this study was to examine the relationship between alcohol consumption,
considering both volume of intake and drinking pattern, and the risk of death from external causes.
METHODS: A prospective study of mortality from external causes was conducted using data from the 1988 National Health Interview Survey linked with the National Death Index for 1988 through 1995. During the 7.5-year follow-up interval, there were 155 deaths from external causes among the 42,910 adults 18 years of age and over included in the sample. Proportional hazards models were used to adjust for censoring due to competing causes of death and for the effects of potentially confounding background variables including age, gender, marital status, education, smoking and poor health at baseline.
RESULTS: Relative to lifetime abstainers and infrequent drinkers, the risk of death from external causes increased directly with volume of intake, exhibiting a logarithmic-shaped risk curve. There was no evidence of reduced risk among light or moderate drinkers. When usual quantity and frequency were examined, the only drinkers at significantly increased risk were those who drank less than once a month but usually drank 5+ drinks (or, to a lesser extent, 3+ drinks) and those who drank at least twice a week and usually drank 2+ drinks. Former drinkers also were at increased risk. Age strongly affected the drinking pattern parameters.
CONCLUSIONS: Quantity and frequency of drinking are proxies for in-the-event risks associated with alcohol intake and their cumulative effect on mortality risk. The results are discussed with particular attention to the role of factors that may affect the association between usual quantity of drinks consumed and the in-the-event risk of mortality from external causes.
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Barriers to safe hot tap water: results from a national study of New Zealand plumbers.
- Jaye C, Simpson JC, Langley JD. Inj Prev 2001; 7(4): 302-306.
Correspondence: Jean Simpson, Department of Preventive and Social Medicine, University of Otago, New Zealand (email: jean.simpson@ipru.otago.ac.nz).
BACKGROUND: Many countries still have unacceptably high hospitalizations and deaths from scalds from hot tap water. Prevention strategies implemented in some countries may not work in others. Legislation aimed at changing environments that are conducive to hot tap water scalds may not be effective in many situations for a number of reasons, including lack of acceptability and practicality.
METHODS: A qualitative study of a purposefully selected group of craftsman plumbers across New Zealand was conducted using a structured format with open ended questions. The questionnaire was administered by telephone. Information was sought on the opinions, knowledge, and practice of these plumbers regarding hot tap water safety in homes.
RESULTS: Several barriers to hot tap water safety in homes were identified by the plumbers. These included common characteristics of homes with unsafe hot tap water, such as hot water systems heated by solid fuel, and public ignorance of hot tap water safety. Other factors that emerged from the analysis included a lack of knowledge by plumbers of the hazards of hot tap water, as well as a lack of importance given to hot tap water safety in their plumbing practice. Shower performance and the threat to health posed by legionella were prioritized over the prevention of hot tap water scalds.
CONCLUSION: The findings of this study allow an understanding of the practical barriers to safe hot tap water and the context in which interventions have been applied, often unsuccessfully. This study suggests that plumbers can represent a barrier if they lack knowledge, skills, or commitment to hot tap water safety. Conversely, they represent a potential source of advocacy and practical expertise if well informed, skilled, and committed to hot tap water safety.
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Stop, look, listen, and think? What young children really do when crossing the road.
- Zeedyk MS, Wallace L, Spry L. Accid Anal Prev 2002; 34(1):43-50.
Correspondence: Suzanne Zeedyk, Department of Psychology, University of Dundee, UK. (email: m.s.zeedyk@dundee.ac.uk).
This study sought to provide basic information about children's behaviour in realistic traffic situations. Most literature in this area has focused on children's knowledge about road safety or has assessed their behaviour in simulated traffic environments. However, until more is known about what children actually do in traffic environments, our ability to identify the important elements for inclusion in educational programmes remains limited. Fifty-six children, aged 5-6 years, took part in a 'treasure trail' activity in which they were confronted with two road crossings, one at a T-junction with a moving car and the other between parked cars. Children's performance was videotaped and coded for relevant behaviours such as stopping at the kerb, looking for traffic, direction of gaze, and style of crossing (i.e. walking vs. running). Results revealed that performance was extremely poor. Sixty percent of the children failed to stop before proceeding from the kerb onto the road. Looking for oncoming traffic was exhibited by no more than 41% of the sample, dropping to as low as 7% in some instances. When looking did occur, it was initially as likely to be in the inappropriate direction (i.e. to the left) as in the appropriate direction (i.e. to the right). Consideration of individual performance revealed the existence of individual differences within the sample; such differences were relatively stable across the two road crossings. These findings, based on controlled naturalistic tasks and detailed observational methods, build on earlier studies that are generally able to provide only estimated rates of children's behaviour.
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Accuracy of external cause of injury codes reported in Washington State hospital discharge records.
- LeMier M, Cummings P, West TA. Inj Prev 2001; 7(4):334-338.
Correspondence: Mary LeMier, Washington State Department of Health, Injury Prevention Program, Olympia, USA. (email: mary.lemier@doh.wa.gov).
OBJECTIVE: To evaluate the accuracy of external cause of injury codes (E codes) reported in computerized hospital discharge records.
METHODS: All civilian hospitals in Washington State submit computerized data for each hospital discharge to a file maintained by the Department of Health. In 1996, 32 hospitals accounted for 80% of the injury related discharges in this file; from these hospitals, we sampled 1,260 computerized records for injured patients in a stratified, but random, manner. An expert coder then visited the 32 study hospitals, reviewed the medical records that corresponded to each computerized record, and assigned an E code for that hospitalization. The computerized E code information was compared with codes provided by the expert reviewer.
RESULTS: The incidence of hospitalization for injury based upon computerized hospital discharge data was very similar to that based upon chart review: incidence rate ratio 1.0 (95% confidence interval 1.00 to 1.02). Computerized hospital discharge data correctly ranked injuries in regard to both mechanism and intent. Overall agreement on coding was 87% for mechanism of injury, 95% for intent of injury, and 66% for the complete E code. The sensitivity of computerized hospital discharge data for identification of falls, motor vehicle traffic injuries, poisonings, and firearm injuries was 91% or better. The predictive value positive of coding for these four categories of injury ranged from 88% for motor vehicle traffic injuries to 94% for poisonings. The amount of agreement for intent coding ranged from 84% for firearm injuries to 99% for falls. Agreement on coding of the complete E code ranged from 57% for firearm injuries to 72% for poisonings.
CONCLUSIONS: Computerized hospital discharge data can be used with confidence to determine how many injuries are treated in a hospital setting and the relative magnitude of various categories of injury. E codes reported in hospital discharge data are a reliable source of information on the types of information most often used for injury related analyses and priority setting. The detail codes (complete E codes) reported in hospital discharge codes are less reliable and must be used with caution.
Use of Washington State newspapers for submersion injury surveillance.
- Baullinger J, Quan L, Bennett E, Cummings P, Williams K. Inj Prev 2001; 7(4): 339-342.
Correspondence: Linda Qun, University of Washington School of Medicine, USA (email: lquann@chmc.org).
OBJECTIVES: To evaluate the usefulness of newspapers as a surveillance tool for submersion injury, the proportion of submersion events and important details reported in Washington State newspapers was determined. It was also determined whether a letter sent to newspaper editors to encourage reporting changed the proportion and content of reported submersion events.
METHODS: Newspaper articles regarding submersion were collected from 225 Washington newspapers from June 1993 through September 1998. Newspaper articles were linked to computerized state death and hospital records. Reporting during periods before and after a letter was sent encouraging more newspaper articles on submersion injury and preventative factors was compared.
RESULTS: A total of 1,874 submersion victims were identified in the three data sources. Of the 983 victims who had a death certificate, 52% were reported in at least one news article. Of the 471 persons in hospital discharge data, 25% were reported in a newspaper. Reporting of pediatric victims who died increased from 63% to 79% (p=0.008); reporting of hospitalized persons increased from 23% to 27% (p=0.3). There were increases in reporting of swimming ability (7% to 15%, p < 0.001), supervision (82% to 91%, p < 0.001), and alcohol use (7% to 24%, p < 0.001). Reporting of life vest use decreased (35% to 23%, p < 0.001).
CONCLUSIONS: Newspapers failed to report about one half of fatal submersions and three quarters of submersions that resulted in a hospitalization. An effort to improve reporting was associated with an increase in the proportion of pediatric drownings that were reported, but a consistent improvement in content was found. The usefulness of newspaper articles as a surveillance tool may be limited.
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Self-poisonings with drugs by adolescents in the Lund catchment area.
- Borna P, Ekedahl A, Alsen M, Traskman-Bendz L. Nord J Psychiatry 2001;55(5):325-328.
Correspondence: P. Borna, Department of Paediatrics, Lund University, Lund, Sweden.
OBJECTIVE: To investigate which drugs young people who attempt suicide use in the Lund catchment area-eight municipalities in Skane, southern Sweden.
METHODS: All patients aged up to 18 years admitted to Lund University Hospital after deliberate or probably deliberate self-poisoning from 1 January 1991 until 31 December 1995 were included.
RESULTS: Forty-nine (58%) had used a single drug; 20 (24%) had used 3 or more drugs. Fifty-two (61%) used analgesics-paracetamol was used by 38 (45%) and propoxyphene by 17 (20%). Thirty-one (36%) had ingested psychotropics-13 used benzodiazepines, 10 antidepressants, and 8 antipsychotics. Eleven (15%) had used drugs in combination with alcohol.
CONCLUSIONS: It is important to follow changes in self-poisoning patterns, to monitor the effects of preventive work and discover new trends in drug use.
Parasuicides without follow-up.
- Runeson B. Nord J Psychiatry 2001;55(5):319-323.
Correspondence: Bo Runeson, Institute of Clinical Neuroscience, Karolinska Institute, Department of Psychiatry, St Goran's Hospital, SE-112 81 Stockholm, Sweden. (email: bo.runeson@pskl.csso.sll.se).
The aim of this project was to approach subjects who committed parasuicide but did not primarily receive or accept a recommendation for care through the regular routines after referral to a general hospital. Three hundred and twenty-nine consecutive parasuicides in 10- to 89-year-olds (162 men and 167 women) were studied. One hundred were subsequently hospitalized in the departments of psychiatry, 130 were followed up at outpatient facilities, and 96 left without any follow-up. A psychiatric liaison consultation was made in 57% of the total sample. The 96 subjects without follow-up were compared with the subjects who received follow-up. The sample was somewhat younger and included slightly more men. They were single in 54% and unemployed in 43% of the cases. According to the DSM-IV, 27% had a concurrent depression. According to the CAGE questions, 57% had indication of substance addiction. Fifty-four per cent had currently low global functioning, less than 50 points on the GAF. They had not been in contact with psychiatric care previously to the same extent as the others. About 34% of these who did not receive or rejected follow-up initially after a second approach agreed to follow-up when contacted by the project team, referring them to appropriate authorities such as social welfare offices, family counselling, or psychosocial staff within psychiatry or primary care. This may imply that the group delineated is at risk for eventual suicide and that the acceptance of follow-up should be interpreted as an indication that a substantial number needs help and can be successfully encountered by means of a case manager approach.
Suicide attempts and serious suicide threats in the city of Riga and resulting contacts with medical services.
- Rancans E, Alka I, Renberg ES, Jacobsson L. Nord J Psychiatry 2001; 55(4): 279-286.
Correspondence: E. Rancans, Riga Psychoneurological Hospital, Riga, Latvia.
The acute treatment of persons attempting suicide is recognized as very important in a prevention context. The aim of this study is to describe the medical services available to patients who have made suicide attempts or serious threats to commit suicide (SAST) within the city of Riga, to trace their passage through the various medical facilities, and to estimate SAST rates. Data for 1999 were collected from electronic case reports of the Emergency Medical Service (EMS) in Riga and monitoring forms of suicide attempters in Riga Psychoneurological Hospital (RPH) and Narcological Hospital (NH). In 1999 the first contact with the medical service in Riga for 95% of all cases (1024) was the EMS. Of the cases, 51.8% were treated at the general and 17.0% at the orthopaedic hospital. Of all SAST patients 99% have been assessed by at least one psychiatrist, and 43.8% were admitted to the psychiatric hospital at some time. The overall rate of suicide attempts is 149 per 100 000. The male to female ratio for SAST in Riga for individuals aged 15 years and more was 1:0.9. The highest figures were for females aged 15-24 and men aged 25-34. Females used poisonings in 75% of cases, but males used violent suicide methods in 60% of cases, most often involving cutting and associated with the use of alcohol. Data from existing medical services provide reasonably good information on the SAST population in Riga City.
Firearm availability and unintentional firearm deaths, suicide, and homicide among 5-14 year olds.
- Miller M, Azrael D, Hemenway D. J Trauma 2002; 52(2):267-74; discussion 274-275.
Correspondence: M Miller, Harvard School of Public Health, Department of Health Policy and Management, Boston, Massachusetts 02115, USA. (email: mmiller@hsph.harvard.edu).
BACKGROUND: In the United States, only motor vehicle crashes and cancer claim more lives among children than do firearms. This national study attempts to determine whether firearm prevalence is related to rates of unintentional firearm deaths, suicides, and homicides among children.
METHODS: Pooled cross-sectional time-series data (1988-1997) were used to estimate the association between the rate of violent death among 5-14 year olds and four proxies of firearm availability, across states and regions.
RESULTS: A statistically significant association exists between gun availability and the rates of unintentional firearm deaths, homicides, and suicides. The elevated rates of suicide and homicide among children living in states with more guns is not entirely explained by a state's poverty, education, or urbanization and is driven by lethal firearm violence, not by lethal non-firearm violence.
CONCLUSION: A disproportionately high number of 5-14 year olds died from suicide, homicide, and unintentional firearm deaths in states and regions where guns were more prevalent.
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Study on characteristics of fractures from road traffic accidents in 306 cases.
- Hou S, Zhang Y, Wu W. Chin J Traumatol 2002 Feb;5(1):52-54.
Correspondence: S. HouOrthopaedic Center, 304th Hospital of PLA, Beijing 100037, China.
OBJECTIVE: To investigate the characteristics of bone fractures from road traffic accidents and analyze their injury mechanisms so as to provide reference for the research and medical care of traffic trauma. METHODS: Three hundred and six patients with fractures from road traffic accidents were included into this study. A total of 507 fractures were identified and the injury mechanism, location distribution and frequency were analyzed.
RESULTS: The most common location of fractures was the lower extremities, followed by the upper extremities, skull and maxillofacial region, and the rarest was the spine. A total of 56% of the patients suffered from multiple fractures. The fractures of the patella, femur and pelvis and the fract ures of the olecranon, humerus and shoulder often happened simultaneously.
CONCLUSIONS: The injury mechanisms can be classified into four types: impact, incoordinate movement, stretch injury and crush and extrusion. The fractures from traffic accidents have the following characteristics: centrifugal distribution of the injuries, multiple fractures, force transmission and ipsilateral occurrence.
An instrumented vehicle assessment of problem behavior and driving style: do younger males really take more risks?
- Boyce TE, Geller ES. Accid Anal Prev 2002; 34(1): 51-64.
Correspondence: Thomas E. Boyce, Department of Psychology, University of Nevada-Reno, 89557, USA. (email: teboyce@unr.edu).
An instrumented vehicle was used to obtain behavioral data from 61 drivers ranging in age from 18 to 82. Each driver completed a personality questionnaire and participated in a study described as an evaluation of cognitive mapping and way-finding abilities. An evaluation of relationships between age, personality and driving style revealed that driver age and type A personality characteristics were significant predictors of vehicle speed and following distance, P < 0.05. However, contrary to the earlier research, which relies heavily on a self-reported driving criterion, no significant gender differences were obtained. A factor analysis of several at-risk driving behaviors identified a cluster of correlated driving behaviors that appeared to share a common characteristic identified as aggressive/impatient driving. It is suggested that the correlated cluster of driving behavior provide objective support for the assumptions of response generalization and problem behavior theory. Results are discussed with regard to implications for safe driving interventions and a problem behavior syndrome.
Effects of work zone presence on injury and non-injury crashes.
- Khattak AJ, Khattak AJ, Council FM. Accid Anal Prev 2002; 34(1): 19-29.
Correspondence: Asad Khattak, Department of City and Regional Planning, University of North Carolina, Chapel Hill 27599, USA; (email: khattak@unc.edu)
Work zones in the United States have approximately 700 traffic-related fatalities, 24,000 injury crashes, and 52,000 non-injury crashes every year. Due to future highway reconstruction needs, work zones are likely to increase in number, duration, and length. This study focuses on analyzing the effect of work zone duration mainly due to its policy-sensitivity. To do so, we created a unique dataset of California freeway work zones that included crash data (crash frequency and injury severity), road inventory data (average daily traffic (ADT) and urban/rural character), and work zone related data (duration, length, and location). Then, we investigated crash rates and crash frequencies in the pre-work zone and during-work zone periods. For the freeway work zones investigated in this study, the total crash rate in the during-work zone period was 21.5% higher (0.79 crashes per million vehicle kilometer (MVKM)) than the pre-work zone period (0.65 crashes per MVKM). Compared with the pre-work zone period, the increase in non-injury and injury crash rates in the during-work zone period was 23.8% and 17.3%, respectively. Next, crash frequencies were investigated using negative binomial models, which showed that frequencies increased with increasing work zone duration, length, and average daily traffic. The important finding is that after controlling for various factors, longer work zone duration significantly increases both injury and non-injury crash frequencies. The implications of the study findings are discussed in the paper.
Freeway speed limits and traffic fatalities in Washington State.
- Ossiander EM, Cummings P. Accid Anal Prev 2002; 34(1):13-8.
Correspondence: Eric Ossiander, Washington State Department of Health, Olympia 98504-7812, USA. eric.ossiander@doh.wa.gov).
BACKGROUND: In 1987 individual states in the USA were allowed to raise speed limits on rural freeways from 55 to 65 mph. Analyses of the impact of the increased speed limits on highway safety have produced conflicting results. OBJECTIVE: To determine if the 1987 speed limit increase on Washington State's rural freeways affected the incidence of fatal crashes or all crashes on rural freeways, or affected average vehicle speeds or speed variance. DESIGN: An ecological study of crashes and vehicle speeds on Washington State freeways from 1974 through 1994. RESULTS: The incidence of fatal crashes more than doubled after 1987, compared with what would have been expected if there had been no speed limit increase, rate ratio 2.1 (95% confidence interval (CI), 1.6-2.7). This resulted in an excess of 26.4 deaths per year on rural freeways in Washington State. The total crash rate did not change substantially, rate ratio 1.1 (95% CI, 1.0-1.3). Average vehicle speed increased by 5.5 mph. Speed variance was not affected by the speed limit increase. CONCLUSIONS: The speed limit increase was associated with a higher fatal crash rate and more deaths on freeways in Washington State.
The effect of population safety belt usage rates on motor vehicle-related fatalities.
- Derrig RA, Segui-Gomez M, Abtahi A, Liu LL. Accid Anal Prev 2002; 34(1): 101-110.
Correspondence: Richard A. Derrig, Automobile Insurers Bureau of Massachusetts, Boston 02110-1103, USA. (email: richard@aib.org).
The effectiveness of safety belt usage in reducing mortality and morbidity among traffic crash victims has been well established. Population safety belt usage rates have been increasing from 11% in 1980 to 68% in 1995, as measured by observational surveys sponsored by the National Highway Traffic Safety Administration (NHTSA). Safety incentive grants from NHTSA to the States with higher than average usage rates are expected to total $500 million during 1999-2003. In this paper, longitudinal annual motor vehicle-related fatality levels are analyzed by state to estimate the effect of the population safety belt usage rate on traffic fatality rates in the presence of known confounders such as alcohol use and youthful drivers. Consideration of alternative models applied to 14 years of data shows that the population safety belt usage rate (at least, at the current rates) is associated with little or no effect on reducing fatality rates. On the other hand, higher safety belt usage rates arising from states with primary enforcement laws tend to suggest reductions in fatality rates. Such results call into question the NHTSA policy of basing incentive programs on overall safety belt usage rates.
Age of drinking onset, driving after drinking, and involvement in alcohol related motor-vehicle crashes.
- Hingson R, Heeren T, Levenson S, Jamanka A, Voas R. Accid Anal Prev 2002; 34(1):85-92.
Boston University School of Public Health, Social and Behavioral Sciences Department TW2, MA 02128, USA; (email: rhingson@bu.edu).
This study assessed whether persons who begin drinking at younger ages are more likely to report drunk driving and alcohol-related crash involvement over the life course, even after controlling analytically for diagnosis of alcohol dependence, years of drinking alcohol, and other personal characteristics associated with the age respondents started drinking. A national survey asked 42,862 respondents the age that they started drinking, whether they drove after drinking too much, and whether they were in motor-vehicle crashes because of their drinking. This analysis focused on 27,081 (65%), who reported ever drinking in their lifetime. The earlier the age respondents started drinking, the more likely they were to report driving after drinking too much and being in a motor-vehicle crash because of their drinking even after adjusting for current/ever diagnosis of alcohol dependence, number of years respondents had been drinking, and other characteristics and behaviors associated with the age respondents started drinking. Particularly, among persons who were never alcohol-dependent, those who began drinking in each age group under 21, relative to those starting at age 21 or older, were more likely to report "ever" and "in the past year" being in a crash after drinking too much. The traffic safety benefits of delaying drinking may extend well beyond the legal drinking age of 21.
Impact of graduated driver licensing restrictions on crashes involving young drivers in New Zealand.
Begg DJ, Stephenson S, Alsop J, Langley J. Inj Prev 2001; 7(4): 292-296.
Correspondence: Dorothy Begg, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. (email: dorothy.begg@ipru.otago.ac.nz).
OBJECTIVES: To determine the impact on young driver crashes of the three main driving restrictions in the New Zealand graduated driver licensing (GDL) system: night-time curfew, no carrying of young passengers, and a blood alcohol limit of 30 mg/100 ml.
METHODS: The database for this study was created by linking police crash reports to hospital inpatient records (1980-95). Multivariate logistic regression was used to compare car crashes involving a young driver licensed before GDL (n=2,252) with those who held a restricted graduated licence (n=980) and with those who held a full graduated licence (n=1,273), for each of the main driving restrictions.
RESULTS: Compared with the pre-GDL group, the restricted licence drivers had fewer crashes at night (p=0.003), fewer involving passengers of all ages (p=0.018), and fewer where alcohol was suspected (p=0.034), but not fewer involving young casualties (p=0.980). Compared with the pre-GDL drivers, those with the full graduated licence had fewer night crashes (p=0.042) but did not differ significantly for any of the other factors examined.
CONCLUSIONS: These results suggest that some of the GDL restrictions, especially the night-time curfew, have contributed to a reduction in serious crashes involving young drivers.
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Exposure to violence and its relationship to psychopathology in adolescents.
- Ward CL, Flisher AJ, Zissis C, Muller M, Lombard C. Inj Prev 2001; 7(4): 297-301.
Department of Psychiatry and Mental Health, University of Cape Town, South Africa. (email: cward@curie.uct.ac.za).
OBJECTIVES: This study aimed to establish prevalence of adolescents' exposure to violence and related symptoms in the South African context and to explore relationships between exposure and symptoms. SETTING: Four high schools in Cape Town, South Africa.
METHODS: Self report questionnaires were administered to 104 students. Types of violence explored included: witnessing or being a victim of violence perpetrated by someone known to the child or in the home and witnessing or being a victim of violence perpetrated by a stranger. The Harvard Trauma Scale, Beck Depression Inventory, and Zung Self-Rating Anxiety Scale were used to assess potentially related symptoms.
RESULTS: The majority of children had been exposed to at least one type of violence, and exposure to the one type of violence was related to the other type. Symptoms of post-traumatic stress disorder and depression appear to be related to most types of exposure to violence, but anxiety symptoms only to exposure to violence perpetrated by someone known to the child or in the home.
CONCLUSIONS: Rates of exposure to violence, and related symptoms, were unacceptably high. Symptoms were associated with exposure to violence.
Predictors of injury from fighting among adolescent males.
- Hammig BJ, Dahlberg LL, Swahn MH. Inj Prev 2001; 7(4):312-315.
Correspondence: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA; (email: bhammig@siu.edu).
OBJECTIVES: To identify violence related behaviors associated with injuries among adolescent males involved in fights.
METHODS: Data from the National Longitudinal Study of Adolescent Health were used to develop weighted estimates of injury prevalence and associations between injury and violence related behaviors.
RESULTS: Forty seven per cent injured others and 18% were themselves injured in a fight among adolescent males in the preceding 12 months. Group fighting, fighting with strangers, and weapon use were predictive of injury in this sample.
CONCLUSIONS: These findings suggest that injuries associated with fighting are a health risk among adolescent males. Certain behaviors, such as fighting in groups and fighting with strangers, increase the likelihood of injuries requiring medical attention.
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