3 June 2002
Prevalence of DSM-IV alcohol diagnoses and symptoms in adolescent community and clinical samples.
- Chung T, Martin CS, Armstrong TD, Labouvie EW. J Am Acad Child Adolesc Psychiatry 2002; 41(5):546-554.
Correspondence: Tammy Chung, WPIC/PAARC, University of Pittsburgh Medical Center, 3811 O'Hara Street PA 15213 USA; email: chungta@msx.upmc.edu).
OBJECTIVES: Summary prevalence data are critical to determining the utility of DSM-IV criteria for alcohol use disorders among adolescents. This study examined cross-study consistency in the relative prevalence of DSM-IV alcohol symptoms, the ratio of alcohol abuse to dependence diagnoses, the prevalence of the physiological dependence subtype, and the proportion of subthreshold cases of dependence.
METHOD: DSM-IV alcohol diagnosis and symptom prevalence data were obtained from five community and four clinical adolescent samples.
RESULTS: There was a moderate level of cross-study agreement on the relative prevalence of alcohol symptoms (mean Spearman p = 0.47). The most common symptoms were dependence criteria: tolerance and drinking more or longer than intended. A relatively high degree of variability in the ratio of abuse to dependence diagnoses and the proportion with physiological dependence was observed. All samples included a significant proportion of subthreshold cases of dependence: up to 12% in community and up to 34% in clinical samples.
CONCLUSIONS: Alcohol dependence symptoms of tolerance and drinking more or longer than intended have relatively high prevalence among adolescents. These high prevalence symptoms affect the ratio of abuse to dependence diagnoses in some studies, the prevalence of the physiological dependence subtype, and the proportion of subthreshold cases of dependence. (Copyright © 2002 American Academy of Child and Adolescent Psychiatry)
Δ Jump to Top of Page
Patient safety efforts should focus on medical injuries.
- Layde PM, Cortes LM, Teret SP, Brasel KJ, Kuhn EM, Mercy JA, Hargarten SW, Maas LA. JAMA 2002; 287(15): 1993-1997.
Corresponding Author and Reprints: Peter M. Layde, MD, MSc, Department of Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA; (email: playde@mcw.edu).
The Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health System called for voluntary and mandatory reporting systems to identify and learn from errors in health care. That report and other recent efforts to improve patient safety have focused their attention on medical errors. However, patient safety also may be approached by concentrating on the injury itself. Both approaches consider the subset of patient injuries that are the result of errors. The error-oriented approach includes mistakes that do not harm patients such as near-misses. The injury-oriented approach includes patient harm arising from a diagnostic or therapeutic intervention, including those that are not associated with any identifiable error. The difficulty in reliably identifying medical errors, the adverse impact on patient outcomes of medical injuries regardless of whether they result from error, and the potential preventability of medical injuries not associated with error all suggest that the injury-oriented approach may be more appropriate and more productive. This article considers the benefits for patient safety of a primary focus on medical injury based on the injury prevention model, a public health approach that has proven useful in addressing other types of injuries.
In efforts to improve patient safety, the injury prevention model with a focus on injury provides a useful complement to approaches that focus on error. The injury prevention model provides a coherent theoretical framework for addressing medical injuries comprehensively, including a systematic sequence of methods to identify medical injuries, study their causes, and intervene to reduce their occurrence or severity. A focus on medical injury avoids many of the operational difficulties and institutional and personal barriers to identifying errors. Rather than culpability, it emphasizes preventability, which should be the ultimate goal of patient safety efforts. (Copyright 2002 American Medical Association)
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
Developing a culture of safety in a reluctant audience.
- Schieber RA, Olson SJ. West J Med 2002; 176(3): E1-E2.
Correspondence: Richard A. Schieber, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention (CDC) US Public Health Service US Department of Health and Human Services 4770 Buford Highway, NE Mailstop K-63 Atlanta, GA 30341 USA; (email: rbs4@cdc.gov).
Text available online: ( Download Document ).
Schieber and Olson provide commentary on a report (Forsman L, Eriksson A. Skateboarding injuries of today. Br J Sports Med 2001; 35: 325-328.) of skate boarding in Europe and compare the findings and recommendations to the US population. The abstract for the Forsman-Eriksson report was in last week's SafetyLit Update. Selected text from the Scheiber and Olson report follows below:
Forsman and Eriksson recommend that skateboarders wear protective gear and restrict such activity to skateboard parks. Other experts likewise have recommended the use of wrist guards, elbow pads, and a helmet, based on a demonstrated 10-fold reduction in the risk of either a wrist or elbow injury while in-line skating or a 6-fold reduction in the risk of sustaining a serious brain injury while riding a bicycle. If generalizable to preventing skateboard injuries, these figures are compelling and would put these recommendations on firm scientific grounds.
A problem arises, however, in translating scientific information to the chief target group -- adolescents -- a largely reluctant population. Difficulty with modifying their behavior is not the result of poor communication; the media and various government agencies have addressed this problem. Rather, it is the interplay between the reluctance of teens to adopt safety measures and the lack of sufficient public health resources to change their attitude in this regard. Given that most teens feel impervious to injury, how do we convince them to adopt sound safety practices and still save face with their peers?
Indoor skateboard parks have addressed this problem by mandating the use of safety gear, a requirement borne out of risk management and potential liability. But this is only a partial solution to the wider problem, because skateboards are still used in open public areas and occasionally for transportation. Outlawing the use of skateboards on some roads (such as arterials and collectors) and in areas of high foot traffic may help, but youth will still skate on residential streets where no sidewalk or path is available. Assuming that teens know that safety gear is recommended, what can influence their decision to wear it?
Teens are exposed daily to other important public health messages, especially the dangers of tobacco use, drinking and driving, and unprotected sex. Perhaps youth, accustomed to denying the long-term consequences of such risky behaviors, choose to deny the possibility of immediate consequences of injury. Vast community health promotion and disease prevention campaigns are aimed at teens, yet almost no such programs exist for safety issues apart from teen driving. As scientists and public health educators, we cannot simply abrogate our responsibility to their safety simply because it is a difficult task. We must begin to address the need for adolescent safety among this reluctant audience as they enjoy practicing their distinctive lifestyle.
Who should lead the effort? State health departments lack sufficient resources. School officials focus most of their efforts on education about the dangers of tobacco, drug, and alcohol misuse and in preventing HIV/AIDS and teen pregnancy. Parents are often uninformed or feel powerless to enforce safety rules for their teens, even though studies indicate that youth look to them for guidance. Lawmakers are reluctant to draft legislation addressing personal behaviors unless they are a threat to others and are readily enforced. Even though laws concerning bicycle helmet use have been one of the most effective means of increasing helmet use among children, they have not decisively influenced teens.
The remaining option is peer pressure to change the culture of safety. As more teens are seen using safety gear and riding mainly in skateboard parks, safe skateboarding is more likely to become a social norm. Perhaps manufacturers of skateboards and publishers of skateboard and teen magazines can take a more pro-active role in promoting safety, although in doing so, manufacturers risk acknowledging that the sport may not be completely safe. If manufacturers and marketers actively support campaigns to reduce teen smoking and underage drinking, why not include injury prevention in this regard? Finally, youth must become involved in creating their own solutions. A community dialogue among teens, public health educators, emergency medical technicians, police, and others might generate workable ideas to improve the safety of skateboarding.
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
See item under Pedestrian and Bicycle Issues
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
No reports this week
Δ Jump to Top of Page
Rural work-related accidents in Pelotas, Rio Grande do Sul State, Brazil: a population-based cross-sectional study.
- Fehlberg MF, Santos IS, Tomasi E. Cad Saude Publica 2001; 17(6):1375-1381.
Correspondence: Marta Fernanda Fehlberg, Centro de Controle de Zoonoses, Faculdade de Veterinaria, Universidade Federal de Pelotas, Pelotas, RS, 96010-900, BRAZIL.
Epidemiological literature on occupational accidents among rural workers is scarce in Brazil. This population-based cross-sectional study was designed to investigate the characteristics of farming accidents occurring in the rural area of Pelotas, Southern Brazil. A multi-stage sampling scheme was used to select a representative sample of farms. From January to April 1996, a total of 258 rural families were visited, and all 580 rural workers identified in these families answered a standardized questionnaire. Sixty-three rural workers (11%) reported at least one work-related accident in the previous twelve months. There were 82 accidents during the study period, mainly related to the use of hand farm tools (29%) and handling farm animals (27%). The main types of injuries were cuts (50%), bruises (13%), and burns (9%). The body areas most frequently involved were hands (34%), feet (29%), and legs (18%). Among the injured rural workers, only 32% used health services to treat the resulting lesions (46% went to primary health care facilities and 36% to emergency services). (Copyright © 2002 Escola Nacional de Saúde Pública)
Δ Jump to Top of Page
See reports under Violence
Δ Jump to Top of Page
Incidence of Completed and Attempted Suicide in Trabzon, Turkey
- Bilici M, Bekaroglu M, Hocaoglu C, Gurpinar S, Soylu C, Uluutku N. Crisis 2002; 23(1):
Correspondence: Mustafa Bilici, Karadeniz Technical University School of Medicine, Department of Psychiatry, 61080, Trabzon, TURKEY (email: mbilici@meds.ktu.edu.tr).
OBJECTIVE: Studies of completed and attempted suicide in Turkey are based on data of State Institute of Statistics (SIS) and emergency clinics of the large hospitals. This study seeks (1) to find, independent of the SIS and hospital data, the annual incidences of completed and attempted suicide in Trabzon, Turkey; (2) to examine the associated factors between the incidence of completed and attempted suicide.
METHODS: The data are derived by using a method specially designed for this study. Data sources include emergency clinics in all hospitals, village clinics, the Forensic Medical Center of Trabzon, the Governorship of Trabzon, "mukhtars" (local village representatives) of neighborhoods, the Office of the Public Prosecutor of Trabzon, the Police Headquarters and Gendarmerie, and the local press organs.
RESULTS: The incidences of completed and attempted suicide per 100,000 inhabitants turned out to be 2.60 and 31.5, respectively, whereas the SIS reported the incidence of completed suicide to be 1.11 per 100,000 inhabitants in Trabzon in 1995.
CONCLUSIONS: Our results demonstrate that SIS data are inadequate for suicide research in Turkey. Our findings show that the risk of completed and attempted suicide is high in young, unmarried, and unemployed persons, and that these groups must be carefully evaluated for suicide risk. The study highlights the need for culture-specific research on suicidal behavior in Turkey. (Copyright © 2002 International Association for Suicide Prevention and Hogrefe & Huber Publishers)
Suicide and Suicide Attempts in Ankara in 1998: Results of the WHO/EURO Multicentre Study of Suicidal Behaviour.
- Sayil I, Devrimci-Ozguven H. Crisis 2002; 23(1):
Correspondence: Isik Sayil, Medical School of Ankara University, Psikiyatri Anabilim Dali, Dikimevi, Ankara 06590, TURKEY (email: ozguven@medicine.ankara.edu.tr).
BACKGROUND: The rates and associated basic demographic features of attempted and completed suicides in a catchment area in Turkey were investigated as part of the WHO/Euro Multicentre Study of Suicidal Behaviour.
METHODS: All hospitals in the catchment area were screened in order to identify attempted suicides. Statistics for completed suicides were obtained from the State Institute of Statistics (SIS).
RESULTS: The rates of attempted and completed suicides per 100,000 inhabitants over 15 years of age were 31.9 for males and 85.6 for females, and 9.9 for males and 5.6 for females, respectively. The majority of attempted suicides were in the 15-24-year-old age group, as is the case in all other European countries. The majority of completed suicides were also in the 15-24-year-old age group, although in other European centers most completed suicides occur in the 40+ age group. The most frequent methods were overdose for attempted suicide and hanging for completed suicide. The rates of both attempted and completed suicides were lower than those of other participating centers in Europe.
CONCLUSIONS: Male sex is a risk factor for completed suicide and female sex is a risk factor for attempted suicide, while an age of 15-24 years may be a risk factor for both groups.
Δ Jump to Top of Page
Traffic accidents in a city in Southern Brazil: an evaluation of coverage and quality of data.
- Andrade SM, Mello-Jorge MH. Cad Saude Publica 2001; 17(6):1449-1456.
Correspondence: Selma Maffei de Andrade, Departamento Materno-Infantil e Saude Comunitaria, Universidade Estadual de Londrina, Londrina, PR, 86020-071, BRAZIL (email: semaffei@sercomtel.com.br).
The aim of this study was to analyze police coverage and the validity of data on emergency and hospitalization records as well as on death certificates for traffic casualties in Londrina, Parana State, Brazil. Victims (3,643) of road accidents during the first semester of 1996 were investigated and followed up after 180 days to confirm whether death was due to the accident. Police data recorded only 32.5% of the casualties, the coverage being higher for car occupants (71.6%) and lower for cyclists (8.1%) and pedestrians (24.8%). Agreement was low between original information and that derived from investigation of death certificates (Kappa coefficient 0.10; 95% CI: 0.02-0.17), fair for hospitalization records (Kappa coefficient 0.33; 95% CI: 0.27-0.40), and substantial for emergency records (Kappa coefficient 0.63; 95% CI: 0.61-0.65). Results suggest that police data underestimate the number of traffic casualties and that it is necessary to improve the validity of medical records. (Copyright © 2002 Escola Nacional de Saúde Pública)
Epidemiology, prevention and countermeasures against severe traumatic brain injury in Japan and abroad.
- Nakamura N, Yamaura A, Shigemori M, Ono J, Kawamata T, Sakamoto T; Japanese Data Bank Committee for Traumatic Brain Injury. Neurol Res 2002; 24(1):45-53.
Correspondence: Norio Nakamura, Office of the Japan Society of Neurotraumatology, Department of Neurosurgery, Tokyo Jikei University School of Medicine, Tokyo, JAPAN.
On the basis of accurate statistical reports in regard to traffic accidents and safety in Japan, it is clear that traffic accidents on the road, injured victims and all other losses due to these accidents have been increasing since around 1980. Nevertheless, the number of deaths due to traffic accidents has been gradually declining over the last six years. More detailed analysis of data revealed that the most significant factor for the recent reduction of traffic accident deaths was the marked reduction of deaths related to head injury. From the neurosurgical viewpont, the Japanese Data Bank Committee for Traumatic Brain Injury began its formal activity in 1998. Although the registered number of severe head injuries is statistically too small at present to arrive at conclusions, some interesting points draw our attention. As for intracranial pathology diagnosed by the image of cranial CT scans, two thirds of nontraffic cases have focal brain lesions alone. On the other hand, in traffic cases one third of patients have focal lesions alone and one fourth have diffuse brain lesion exclusively. In this study, in 23% of traffic accidents and 12% of nontraffic accidents, consumption of alcohol led indirectly to head injuries. The schedule and details of countermeasures taken against traffic accidents are discussed from an international viewpoint. (Copyright © 2002 Forefront Publishing)
An international comparative study of self-reported driver behavior.
- Golais I, Karlaftis MG. Transportation Res Traffic Psych Behav 2001; 4(4): 243-256.
Correspondence: Ioannis Golias, Department of Transportation Planning and Engineering, Faculty of Civil Engineering, National Technical University of Athens, 5 Iroon Polytechniou St, Athens 157 73, GREECE; (email: igolias@central.ntua.gr).
Using a large data base of 20,725 questionnaires from 19 European countries, this article uses a combination of factor analysis and tree based regression to determine driver groups with homogeneous self-reported behavior and determine whether regional differences in driving behaviors exist. Self-reported behavior, including speeding, reckless driving, seat belt use, and drinking and driving are examined. The results suggest that speeding and general reckless (dangerous) behavior are related, perhaps capturing a driver's "risk taking" or "pre-trip violations" behavior. Similarly, seat belt use and driving under the influence of alcohol are also related and may represent a driver's "law abiding" tendency or "during-trip violations" behavior. Further, important regional differences and similarities between European drivers are uncovered. Northern European drivers report a significantly higher compliance with drinking and driving laws and seat belt use regulations than do Southern and Eastern European drivers. (Copyright © 2002 Elsevier Science Ltd.)
Modifying driver behaviour with passenger feedback.
- Hutton KA, Sibley CG, Harper DN, Hunt M. Transportation Res Traffic Psych Behav 2001; 4(4): 257-269.
Correspondence: Maree Hunt, School of Psychology, Victoria University of Wellington, P.O. Box 600, Wellington, NEW ZEALAND; (email: maree.hunt@vuw.ac.nz).
A feedback programme was employed to help drivers improve their safety behaviour based on the idea that particular types of driver error result from contingency traps as defined by Fuller [Journal of Applied Behaviour Analysis, 24 (1991) 73]. Two drivers and their single respective passengers participated. For each driver, repeated in-car observations were made of four unsafe driving behaviours. Two of these were sequentially targeted in the behavioural intervention that involved the passengers providing informational feedback to their driver. Both drivers showed a marked improvement across the targeted behaviours. The study demonstrated the applicability of behaviour analysis to the traffic domain and the efficacy of individual feedback as a behavioural tool for positive behaviour modification. (Copyright © 2002 Elsevier Science Ltd.)
The influence of desire for control on drivers' risk-taking behaviour.
- Hammond TB, Horswill MS. Transportation Res Traffic Psych Behav 2001; 4(4): 271-277.
Correspondence: Mark S. Horswill, Department of Psychology, The University of Reading, P.O. Box 238, Reading RG6 6AL, UK; (email: m.s.horswill@reading.ac.uk).
Increases in perceived control over the driving task are known to increase intended driving speeds. Also, some people like being in control more than others. In the present study, we compared drivers with a high desire for control and drivers with a low desire for control, as measured on Burger and Cooper's (1979) [Motivation and Emotion 3 (4) (1979) 381] Desirability of Control Scale. Using validated video simulation techniques, we found that drivers with a high desire for control intended to drive at faster speeds and were willing to pull out into smaller gaps in traffic. We discuss the results in terms of an illusion of control and we describe implications for road safety interventions. (Copyright © 2002 Elsevier Science Ltd.)
Personality subtypes of young drivers. Relationship to risk-taking preferences, accident involvement, and response to a traffic safety campaign.
- Ulleberg P. Transportation Res Traffic Psych Behav 2001; 4(4): 279-297.
Correspondence: Pål Ulleberg, Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, NORWAY; (email: pal.ulleberg@svt.ntnu.no).
The present study aimed at identifying subtypes of young drivers (N=2524) and evaluate how these responded to a traffic safety campaign. On basis of a cluster analysis of personality measures, six subtypes of young drivers were identified. The subtypes were found to differ on self-reported risky driving behaviour, attitudes towards traffic safety, risk perception, estimation of own driving skills, and accident involvement. Two of the subtypes were identified as high-risk groups in traffic. The first high-risk group consisted of mostly men, characterised by low levels of altruism and anxiety, and high levels of sensation-seeking, irresponsibility, and driving related aggression. The second high-risk group reported high sensation seeking, aggression, anxiety, and driving anger. The subtypes were also found to differ on how they evaluated and responded to the traffic safety campaign. The results indicated that the campaign seemed to appeal most to the low-risk subtypes. Gender differences within each subtype were also found on the different traffic related measures, as well as on response to the campaign. It is concluded that young drivers should not be treated as a homogenous group pertaining to road safety. Practical suggestions on how to promote safe driving among these subtypes are also discussed. (Copyright © 2002 Elsevier Science Ltd.)
The effects of music tempo on simulated driving performance and vehicular control.
- Warren Brodsky, Transportation Res Traffic Psych Behav 2001; 4(4): 219-241.
Correspondence: Warren Brodsky, Department of the Arts, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, ISRAEL; (email: wbrodsky@bgumail.bgu.ac.il).
The automobile is currently the most popular and frequently reported location for listening to music. Yet, not much is known about the effects of music on driving performance, and only a handful of studies report that music-evoked arousal generated by loudness decreases automotive performance. Nevertheless, music tempo increases driving risks by competing for attentional space; the greater number of temporal events which must be processed, and the frequency of temporal changes which require larger memory storage, distract operations and optimal driving capacities. The current study explored the effects of music tempo on PC-controlled simulated driving. It was hypothesized that simulated driving while listening to fast-paced music would increase heart rate (HR), decrease simulated lap time, and increase virtual traffic violations. The study found that music tempo consistently affected both simulated driving speed and perceived speed estimates: as the tempo of background music increased, so too did simulated driving speed and speed estimate. Further, the tempo of background music consistently affected the frequency of virtual traffic violations: disregarded red traffic-lights (RLs), lane crossings (LNs), and collisions (ACs) were most frequent with fast-paced music. The number of music-related automobile accidents and fatalities is not a known statistic. Police investigators, drivers, and traffic researchers themselves are not mindful of the risks associated with listening to music while driving. Implications of the study point to a need for drivers' education courses to raise public awareness about the effects of music during driving. (Copyright © 2002 Elsevier Science Ltd.)
Δ Jump to Top of Page
Prevalence and complications of physical violence during pregnancy.
- Rachana C, Suraiya K, Hisham AS, Abdulaziz AM, Hai A. Eur J Obstet Gynecol Reprod Biol 2002; 103(1):26-29.
Correspondence: Chibber Rachana, Department of Obstetrics and Gynaecology, College of Medicine and Medical Sciences, King Faisal University, King Fahd Teaching Hospital of the University, 31952, P.O. Box 2208 Dammam, Al-Khobar, SAUDI ARABIA; (email: rchibber@hospital.kfu.edu.sa).
OBJECTIVES: To assess the incidence of self-reported physical violence in pregnancy and describe the association with foeto-maternal complications and birth outcome.
METHODS: Seven thousand one hundred and five pregnant women over a 3 year period were assessed for self-reported physical violence. Maternal ante-natal hospitalization, low birth weight and pre-term delivery. Odd ratio (OR) and 95% confidence interval (CI) were calculated to measure association between physical violence, maternal morbidity and birth outcome.
RESULTS: The prevalence of physical violence was 21%. Women who reported/experienced physical violence, were more likely to be hospitalized ante-natally for maternal complications such as trauma due to blows/kicks on the pregnant abdomen, abruptio-placenta, pre-term labor and kidney infections. There was a positive association between physical violence during pregnancy and cesarean section, abruptio-placenta, fetal distress, and pre-maturity.
CONCLUSION: Physical violence during pregnancy is common and is associated with adverse materno-fetal outcome. (Copyright © 2002 Elsevier Science)
The effects of domestic violence during pregnancy on maternal and infant health.
- Huth-Bocks AC, Levendosky AA, Bogat GA. Violence Vict 2002; 17(2):169-185.
Correspondence: Alissa C. Huth-Bocks, Department of Psychology, Michigan State University, East Lansing 48824-1117, USA; (email: huthalis@msu.edu).
The present study examined the impact of domestic violence on maternal and infant health by assessing maternal health during pregnancy and infant health at two months postpartum. Two hundred and two women (68 battered and 134 non-battered) were recruited from the community and completed both pregnancy and 2-month postpartum interviews. Results revealed that domestic violence during pregnancy was associated with numerous health problems for mothers and infants including more health problems during pregnancy, more likelihood of premature labor, later entrance into prenatal care, lower infant birth weight, greater utilization of health care resources, and more prenatal substance use. After income was controlled, the relationship between violence and timing of prenatal care and infant birth weight became nonsignificant. Maternal social support was found to protect against the effects of violence for several health outcomes. The current findings suggest the need for domestic violence screening during pregnancy, as well as clinical interventions for battered, pregnant women in order to prevent serious physical and emotional problems for both mothers and their infants. (Copyright 2002 Springer Publishing)
Academic and school health issues among children exposed to maternal intimate partner abuse.
- Kernic MA, Holt VL, Wolf ME, McKnight B, Huebner CE, Rivara FP. Arch Pediatr Adolesc Med 2002; 156(6):549-555.
Correspondence: Mary A. Kernic, Harborview Injury Prevention and Research Center, 325 Ninth Ave, Campus Box 359960, Seattle, WA 98104-2499 USA; (email: mkernic@u.washington.edu).
OBJECTIVES: To determine the association between children's exposure to maternal intimate partner violence (IPV) and academic problems and school health concerns. METHODS: DESIGN- The study population consisted of 153 children aged 5 to 16 years who attended public school and whose mothers experienced police- or court-reported IPV. The comparison group consisted of public school peers of the exposed children. Generalized linear modeling using a binomial distribution and log-link function served as the primary method of analysis. SETTING- Urban public school district. MAIN OUTCOME MEASURES- The occurrence of academic problems and type-specific school nurse visits during the 1-year study period.
RESULTS: Children whose mothers experienced IPV were more likely to be suspended from school (relative risk [RR], 1.8; 95% confidence interval [CI], 1.2-1.7) and to have had frequent non-suspension-related absences (RR, 1.6; 95% CI, 1.0-2.3) than comparison children after adjusting for relevant confounders. Intimate partner violence-exposed children were more likely to have a school nurse visit for social or emotional complaints (RR, 2.2; 95% CI, 1.3-3.9), a visit that resulted in being sent home from school (RR, 1.6; 95% CI, 1.1-2.3), or a visit that led to referral to the school speech pathologist (RR, 7.5; 95% CI, 1.9-29.6) relative to comparison schoolchildren after adjusting for relevant confounders.
CONCLUSIONS: Children's exposure to maternal IPV is significantly associated with the occurrence of academic problems and school health concerns. Describing the increased risk of the academic and health problems exhibited by IPV-exposed children relative to nonexposed children offers the possibility of improving the likelihood that clinicians will identify the woman who experienced abuse and her children, and promote referral to appropriate resources. (Copyright © 2002 American Medical Association)
The spatial dynamics of violence and alcohol outlets.
- Lipton R, Gruenewald P. J Stud Alcohol 2002; 63(2):187-195.
Correspondence: Robert I. Lipton, Prevention Research Center, 2150 Shattuck Avenue, Suite 900, Berkeley, California 94704, USA; (email: rlipton@prev.org).
OBJECTIVES: This study examines whether the association between violence and population density is moderated by the presence of alcohol outlets, both within a target geographical area and in adjacent geographical areas. The effect of sociodemographic variables on violence is also examined controlling for spatial confounding.
METHODS: Zip code areas (N = 766) in California from four distinct areas (three urban and one rural) were examined for rates of violence, taking into consideration population characteristics of persons living in those areas and the potential interaction effects of alcohol outlets on violence rates. Population characteristics were assessed using Census data: outlet densities were obtained from the California Department of Alcohol Beverage Control; and violence rates were abstracted from hospital discharge data. A spatial population model of the production of violence was used to examine the relationships of population characteristics of target and surrounding areas to violence rates.
RESULTS: The density of bars was found to be strongly associated with greater rates of assault, while density of restaurants was associated with less violence. Both appeared to have greatest effect in densely populated areas. Local and nearby population characteristics were also found to be related to greater rates of violence.
CONCLUSIONS: While limited to cross-sectional data, the current study suggests that alcohol outlets, in the presence of socioeconomic measures, moderate the occurrence of violence in urban areas. (Copyright © 2002 Center of Alcohol Studies)
|
