SafetyLit - 22 July 2002

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22 July 2002

We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.

Alcohol taxes and beverage prices.

Young D, Bielinska-Kwapisz A. Natl Tax J 2002; 55(1): 57-73.

Correspondence: Douglas J. Young, Department of Agricultural Economics and Economics, Montana State University, Bozeman, MT 59717-0292, USA (email: unavailable).

Alcohol involvement in auto crashes, homicides, and teen drinking is an important policy concern, and the price of alcohol may have significant effects on these behaviors. A number of studies have estimated relationships between alcohol taxes and/or prices on the one hand, and alcohol consumption, motor vehicle fatalities, and other outcomes on the other hand. However, these studies have produced conflicting results, depending on whether taxes or prices are used to measure the cost of alcohol, whether these are for beer, wine, spirits or some combination, and other factors. Studies that use taxes as a measure of the cost of alcohol implicitly assume that taxes are quickly passed on to consumers in the form of higher prices. Given the difficulties of accurately measuring beverage prices, it is questioned whether beer taxes are a good empirical proxy for the price of alcohol. Using pooled cross section-time series data on state and federal alcohol taxes and beverage prices, beer taxes are found to be poor predictors of alcohol prices. Controlling for state and period effects, excise taxes appear to be over-shifted: Retail prices rise by more than the amount of the tax, and the rise occurs within 3 months.

The results have mixed implications for the effectiveness of raising taxes as a method of affecting alcohol consumption and related behaviors. On the one hand, we find that an increase in taxes results in an even larger increase in price by the time it reaches the retail level. On the other hand, state taxes are such a small percentage of retail prices that it would require quite large increases in taxes to have much effect on prices. The ultimate effect on behavior would depend in turn of the price elasticity of demand. (Copyright © 2002 National Tax Association)

See abstract under Suicide
Injury as a field of public health: achievements and controversies.

Bonnie RJ, Guyer B. J Law Med Ethics 2002; 30(2):267-80.

Correspondence: Richard J. Bonnie, Institute of Law, Psychiatry and Public Policy, P.O. Box 800660, University of Virginia Charlottesville, VA 22908-0660, USA; (email: rbonnie@virginia.edu).

The authors describe how the mission of public health has come to encompass the prevention and amelioration of injury. They also highlight the political and ethical challenges now confronting the field, including extension of the analytic tools of public health from unintentional to intentional injuries, integration of behavioral and environmental perspectives, understanding and managing risk-risk trade-offs, responding satisfactorily to charges of paternalism, and maintaining scientific credibility while advocating for controversial interventions. (Copyright © 2002 American Society of Law, Medicine & Ethics)
Safety and safety promotion: definitions for operational developments

Maurice P, Lavoie M, Laflamme L, Svanström L, Romer C,r Anderson R. Inj Control Safety Promot 2001; 8(4): 237-240.

Correspondence: Pierre Maurice,WHO Collaborating Centre for Safety Promotion and Injury Prevention, 2400 d'Estimauville, Beauport, Quebec, G1E 7G9, CANADA; (email: pierre.maurice@ssss.gouv.qc.ca).

OBJECTIVES: This paper proposes definitions of safety and safety promotion. They apply both to unintentional and intentional injuries or violence.

METHODS: These definitions are the result of a consensus reached over a two-year period through a variety of activities involving nearly 50 experts from different sectors (public security, transportation, justice, health and social services, sports and recreation, municipalities.).

FINDINGS: Safety has been defined as a state in which hazards and conditions leading to physical, psychological or material harm are controlled in order to preserve the health and well-being of individuals and the community. Four basic conditions are regarded as essential to achieve safety in a community. Safety promotion was defined as a process that leads to the development and maintenance of those basic conditions. This process involves various actors and may be applied at various levels of intervention. It may put into contribution both environmental and behavioral modifications.

CONCLUSIONS: Common operational definitions of safety and safety promotion can facilitate collaboration among those concerned with safety enhancement (e.g., public safety, health and social services, transport, justice, municipalities, etc.) by describing more precisely the goals they are all trying to achieve and by making possible a better understanding of the potential contribution of each sector and of the common areas where they can collaborate most effectively. (Copyright © 2001 Swets & Zeitlinger)

Satellite remote sensing as a tool in Lahar disaster management.

Kerle N, Oppenheimer C. Disasters 2002; 26(2): 140-160.

Correspondence: Norman Kerle, Volcano Remote Sensing Group, Department of Geography University of Cambridge, Downing Place, Cambridge CB2 3EN, ENGLAND; (email: nk220@cam.ac.uk).

At least 40,000 deaths have been attributed to historic lahars (volcanic mudflows). The most recent lahar disaster occurred in 1998 at Casita volcano, Nicaragua, claiming over 2,500 lives. Lahars can cover large areas and be highly destructive, and constitute a challenge for disaster management. With infrastructure affected and access frequently impeded, disaster management can benefit from the synoptic coverage provided by satellite imagery. This potential has been recognized for other types of natural disasters, but limitations are also known. Dedicated satellite constellations for disaster response and management have been proposed as one solution. Here we investigate the utility of currently available and forthcoming optical and radar sensors as tools in lahar disaster management. Applied to the Casita case, we find that imagery available at the time could not have significantly improved disaster response. However, forthcoming satellites, especially radar, will improve the situation, reducing the benefit of dedicated constellations. (copyright © 2002 Blackwell Publishers)
Traumatic events in a general practice population: the patient's perspective.

Mol SS, Dinant GJ, Vilters-Van Montfort PA, Metsemakers JF, Van Den Akker M, Arntz A, Knottnerus JA. Fam Pract 2002; 19(4):390-396.

Correspondence: Saskia Mol, Department of General Practice, Maastricht University, Post Box 616, 6200 MD Maastricht, THE NETHERLANDS; (email: saskia.mol@hag.unimaas.nl).

OBJECTIVES: The aim of the present study was to describe the patient's perspective on the GP's care after violent events: which role is the GP assigned; and how is the care appreciated. Events studied were serious accidents, burglary, robbery, physical and sexual abuse, disasters and war.

METHODS: A postal questionnaire was sent to a random sample of 2997 patients (>/=20 years) from the practice population of 32 GPs (67 500 patients).

FINDINGS: The response was 50%. Forty-two per cent of the respondents had experienced one or more events. Twenty-eight per cent of the victims desired some kind of professional help; more than half of them desired that care from their GP, three-quarters actually seeking it. Most frequently sought care was sympathy, "a number of good talks", and care for physical complaints. Overall, contentment with the GP's contribution was high; patients especially appreciate sympathy and support, as well as initiative on the GP's part in commencing and pursuing care. Of those who felt no need for professional help, 88% found that they could cope with the traumatic event well enough, with or without the help of family and friends. For those who did not seek help, although they did desire it, the main reasons were that they considered their problems insufficiently medical or felt that their GP lacked the time. In the case of physical and sexual abuse, feelings of guilt and issues of patient confidentiality played a role for some patients.

CONCLUSIONS: The number of events experienced by our respondents is lower than in previous studies for burglary, robbery, physical and sexual abuse (adults and children); the occurrence of accidents is similar. The majority of the people who experience traumatic events cope with them well enough without professional help. For those seeking help, the GP plays an important role. Care could be improved as follows: the GP should make it clear to patients that he/she can play a role in caring for them in the aftermath of a traumatic event and stress the confidential nature of the consultation. On the whole, GPs should be more supportive and attentive when being consulted about this topic; also patients would like their doctors to be more active in raising the subject, as well as in initiating follow-up. (Copyright © 2002 Oxford University Press)

See abstract under Research Methods
Rate of occupational accidents in the mining industry since 1950--a successful approach to prevention policy.

Breuer J, Hoffer EM, Hummitzsch W. J Safety Res 2002; 33(1):129-141.

Correspondence: Joachim Breuer, Bergbau-Berufsgenossenschaft, Munscheidtstrasse 18, D-44789 Bochum, GERMANY; (email: e.hoeffer@bergbau-bg.de).

This paper deals with the decrease in the rate of accident insurance claims in the German mining industry over the last five decades. It intends to show that this process is above all the result of a prevention policy where companies and the body responsible for the legal accident insurance in the mining industry, the Bergbau-Berufsgenossenschaft (BBG), work hand in hand. A system like the German accident insurance scheme, combining prevention, rehabilitation, and compensation, enables successful and modern safety and health measures. (Copyright © 2002 Elsevier Science).

Cycling and alcohol.

Andersson AL, Bunketorp O. Injury 2002; 33(6): 467-471.

Correspondence: Anna-Lena Andersson, Kuratorsavdelningen, Department of Geriatrics and Rehabilitation, Uddevalla Hospital, NU Hospital Organization, S-45180, Uddevalla, Sweden (email: anna-lena.andersson@vgregion.se).

OBJECTIVES: To compare the accident and the psychosocial circumstances and the consequences of the injuries sustained by intoxicated (alcohol) and sober cyclists in road traffic accidents.

METHODS: A telephone interview was conducted with 207 adults injured 3 years earlier. The group was selected from the list of 1278 cyclists registered at the hospitals in Goteborg in 1995 and 1996. Ninety-five of the 207 had been registered as under the influence of alcohol and 112, registered as sober, constituted a matched group.

FINDINGS: Compared with the sober group, the intoxicated cyclists more often sustained their injuries at night time (P < 0.001), at the weekend (P < 0.001), on their way to or from a party or a pub/restaurant (P < 0.001) and in single accidents (P < 0.001) with a greater risk of injury to the head or face (P < 0.001). They cycled less during the year (P < 0.001), were not so familiar with the route (P=0.045) or bicycle (P < 0.001), had bicycles without a hand-brake or gears (P=0.045) and less often wore a helmet (P=0.003). Driving licenses had been revoked only in the intoxicated group (P=0.02) and nine out of ten who were divorced were from this group (P=0.004).

CONCLUSIONS: Injury prevention for cyclists should aim at altering the attitude towards cycling intoxicated and increasing the use of a helmet. The alternative is a change in the law in both cases. (Copyright © 2002 Elsevier Science)

Organophosphate poisoning: a multihospital survey.

Weissmann-Brenner A, David A, Vidan A, Hourvitz A. Isr Med Assoc J 2002; 4(7): 573-576.

BACKGROUND: Organophosphates are frequently used as insecticides in the household and in agricultural areas, thus posing a risk for accidental exposure.

OBJECTIVES: To describe the characteristics, clinical course and outcome of 97 patients admitted to emergency rooms with a diagnosis of acute OP poisoning.

METHODS: The clinical details of 97 patients were collected from 6 different hospitals in Israel. Diagnosis of intoxication was based on clinical findings, butyrylcholinesterase levels and, in several cases, the material brought to the hospital. Demographic, intoxication and clinical data were analyzed.

FINDINGS: The study group comprised 64 men and 33 women whose age range was 1-70 years (mean 19.8 +/- 17.1); more than one-third of the patients were less than 10 years old. Accidental exposure was the cause of intoxication in 51.5% of the patients, and suicide in 20.6% of exposures. Intoxication occurred at home in most patients (67%), and the route of intoxication was oral in 65% of them. The patients arrived at the hospital 20 minutes to 72 hours after intoxication. Nine patients were asymptomatic; 53 presented with mild intoxication, 22 with moderate, and 13 had severe intoxication, 5 of whom died. There was a direct correlation between the degree of inhibition of butyrylcholinesterase levels and the severity of intoxication. Treatment included decontamination and antidotal medication. Duration of hospitalization ranged between 1 and 14 days (average 2.9 days).

CONCLUSIONS: Organophosphates may cause severe morbidity and mortality. Medical staff should therefore be aware of the clinical manifestations and the antidotal treatment for this poisoning. (Copyright © 2002 Israel Medical Association)

Catastrophic pediatric sports injuries.

Luckstead EF, Patel DR. Pediatr Clin North Am 2002; 49(3):581-591.

Eugene F. Luckstead, Pediatric Medicine Department, Texas Tech Medical School-Amarillo, 1400 Coulter Drive, Amarillo, TX 79160, USA; (email: gene@cortex.ama.ttuhsc.edu).

The high school sports of wrestling, gymnastics, ice hockey, baseball, track, and cheer leading should receive closer attention to prevent injury. Safer equipment and sport-specific conditioning should be provided and injuries strictly monitored. Greater attention must also be paid to swimming and diving techniques, and continued observation is needed for heat stroke and heat intolerance in sports such as football, wrestling, basketball, track and field, and cross-country. An increased awareness of commotio cordis in sports other than baseball should include ice hockey, football, track field events, and lacrosse. American football because of the sheer numbers and associated catastrophic injury potential must continue to be monitored at the highest medical levels. (Copyright © 2002 Elsevier Science)

An introduction to the Barell body region by nature of injury diagnosis matrix.

Barell V, Aharonson-Daniel L, Fingerhut LA, Mackenzie EJ, Ziv A, Boyko V, Abargel A, Avitzour M, Heruti R. Inj Prev 2002; 8(2): 91-96.

Correspondence: Limor Aharonson-Daniel, Trauma and Emergency Medicine Research Unit, The Gertner Institute, Tel Hashomer, 52621 ISRAEL; (email: limorad@gertner.health.gov.il).

BACKGROUND: The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes describing trauma.

OBJECTIVES: To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems, or other sources of non-fatal injury data. This tool could also be used to characterize the patterns of injury using a manageable number of clinically meaningful diagnostic categories and to serve as a standard for case mix comparison across time and place.

CONCEPT: The matrix displays 12 nature of injury columns and 36 body region rows placing each ICD-9-CM code in the range from 800 to 995 in a unique cell location in the matrix. Each cell includes the codes associated with a given injury. The matrix rows and columns can easily be collapsed to get broader groupings or expanded if more specific sites are required. The current matrix offers three standard levels of detail through predefined collapsing of body regions from 36 rows to nine rows to five rows.

MATRIX DEVELOPMENT: This paper presents stages in the development and the major concepts and properties of the matrix, using data from the Israeli national trauma registry, and from the US National Hospital Discharge Survey. The matrix introduces new ideas such as the separation of traumatic brain injury (TBI), into three types. Injuries to the eye have been separated from other facial injuries. Other head injuries such as open wounds and burns were categorized separately. Injuries to the spinal cord and spinal column were also separated as are the abdomen and pelvis. Extremities have been divided into upper and lower with a further subdivision into more specific regions. Hip fractures were separated from other lower extremity fractures.

FORTHCOMING DEVELOPMENTS: The matrix will be used for the development of standard methods for the analysis of multiple injuries and the creation of patient injury profiles. To meet the growing use of ICD-10 and to be applicable to a wider range of countries, the matrix will be translated to ICD-10 and eventually to ICD-10-CM.

CONCLUSION: The Barell injury diagnosis matrix has the potential to serve as a basic tool in epidemiological and clinical analyses of injury data. (Copyright © 2002 British Medical Journal Publications Group)
Loglinear model for analysis of cross-tabulated coal mine injury data.

Maiti J, Bhattacherjee A, Bangdiwala SI. Inj Control Safety Promot 2001; 8(4): 229-236.

Correspondence: J. Maiti, Department of Mining and Geology, B.E. College, (DU), Shibpur, INDIA; (email: unavailable).

Mine accidents/injuries can be cross-classified against the variables of interest in a contingency table and their associations can be assessed through aggregate statistics. However, there is a need to develop a coherent and structured procedure for analysis of accident data, which will allow one to identify associations between two or more variables multivariately. In this study, the loglinear model, which has been proposed as a mathematical representation of the contingency table, was applied to accident data from a group of coal mines to assess the associations/interactions between two or more variables multivariately through their main and interaction effects. The case study results revealed that the variables 'occupation' and 'workplace location' were highly associated with degree of injury. It was also clearly indicated that the workers with more than 20 years of experience exhibited high injury rate patterns. While designing training programs for miners, focused attention should be given to specific categories of workers to reduce accident/injuries at the case study mines. (Copyright © 2001 Swets & Zeitlinger)

An international comparison of adolescent and young adult mortality.

Heuveline P. Ann Am Acad Polit Soc Sci 2002; 580: 172-200.

Correspondence: Patrick Heuveline, Population Research Center, 155 East 60th Street, Chicago, IL 60637, USA; (email: pheuveli@midway.uchicago.edu).

Using data from the WHO Mortality Database and cause of death statistics, Heuveline analyzes mortality rates for three of the main causes of deaths between the ages of 15 and 34 (motor vehicle injuries, homicide, and suicide) from 1950 to 1996, and across 26 countries. This summary representation of international differences displays regional clusters and discusses the position of the US among industrialized nations. (Copyright © 2002 Sage Publications)

Descriptive epidemiology of a cluster of hand injuries from snowblowers.

Proano L, Partridge R. J Emerg Med 2002; 22(4): 341-344.

Correspondence: Lawrence Proano, Department of Emergency Medicine, Rhode Island Hospital, Davol Room 141, 593 Eddy Street, Providence, RI 02903, USA; (email: Lawrence_Proano@Brown.EDU).

The objective of the study is to describe the nature and type of snowblower-related hand injuries, including long term follow up. A retrospective study was performed of a cluster of patients injured by snowblower use, presenting to an urban Emergency Department (ED) following a major snowstorm. For each patient, demographic data and subsequent records from outpatient management were reviewed. Interviews were conducted 3 years later to assess long-term outcomes. Eleven patients, all male, presented to the ED with snowblower injuries, all to the hand. Injuries included soft tissue lacerations and partial to complete amputations. Ten patients were treated and released and one was admitted. In a 3 year follow-up, few patients reported major sequela. Almost half reported persistent pain, or minor disability. In conclusion, in our series, snowblower injuries resulted exclusively in trauma to the hand. Most injuries can be managed on an outpatient basis. Many patients experience persistent symptoms. All patients had entirely preventable injuries. (Copyright © 2002 Elsevier Science)

Farm-related fatal injury of young and older adults in Australia, 1989-1992.

Mitchell RJ, Franklin RC, Driscoll TR, Fragar LJ. Aust J Rural Health 2002; 10(4): 209-219.

Correspondence: Rebecca J. Mitchell, Injury Prevention and Policy Unit, NSW Health, North Sydney, Australian Centre for Agricultural Health and Safety, Department of Public Health and Community Medicine, University of Sydney, Moree, and National Occupational Health and Safety Commission, Sydney, New South Wales, AUSTRALIA; (email: rmitc@doh.health.nsw.gov.au).

This paper describes the types of, and circumstances surrounding, unintentional farm-related fatal injuries involving young and older adults in Australia. Information was obtained from an inspection of coronial files for the period 1989-1992. Around 14% of all farm-related fatalities in Australia during 1989-1992 were of young adults aged 15-24 years and approximately one-quarter were of older adults aged >/= 55 years. Young adults were commonly fatally injured in motor vehicle incidents and in incidents involving firearms. Tractors were the most common agent involved in fatal incidents involving older adults. Intervention measures to prevent fatalities of older adults in agriculture should focus on the safe use of tractors, while for young adults it appears prevention efforts should center around safe use of firearms and operation of motor vehicles on the farm. Ways to overcome barriers to the use of injury prevention measures in rural Australia should be further explored. (Copyright © 2002 National Rural Health Alliance)

School-related injuries: incidence, causes, and consequences.

[Article in French]

Predine R, Chau N, Lorentz N, Predine E, Legras B, Benamghar L, Pierson A, Guillaume S, Aptel E, Mergel B. Rev Epidemiol Sante Publique 2002; 50(3): 265-276.

Correspondence: Nearkasen Chau, INSERM U420 Epidemiologie Sante Travail, Faculte de Medecine, Universite Henri-Poincare - Nancy-1, BP 184, 54505 Vandoeuvre-les-Nancy Cedex, FRANCE; (email: Nearkasen.Chau@nancy.inserm.fr).

BACKGROUND: School accidents are frequent but little epidemiological information is available to guide prevention. In this study we examined the incidence, causes, and consequences of school accidents as a function of the pupil's characteristics.

METHODS: An epidemiological study was conducted in all 2 396 adolescents attending two secondary school groups. Sociodemographic characteristics of the pupils and data on school accidents during a one-year period were collected using a questionnaire filled out by the school nurse in the presence of the victims. The chi-square independence test, Fisher's exact test and the logistic regression method were used for the statistical analysis.

FINDINGS: Sports and physical training (SPT) accidents accounted for 52.8% of the accidents, recreation accidents for 12.7% and other accidents for 33.6%. The annual incidence of one accident or more, for all types of accidents combined, was 12.9%, that for two or more accidents 2.3%. The rate of SPT and recreation accidents decreased strongly with age. SPT accidents were more frequent in girls, the other accidents more frequent in boys. Among the SPT accidents, 69.2% occurred under training conditions and 33.7% were caused by another person. Causes mentioned by the victims were: carelessness (26.0%), clumsiness (17.5%), misappreciation of risk (13.8%), tiredness (9.5%), nervous irritation (8.6%), rowdyism (6.0%), disrespect of the teacher's instructions (6.0%). The lesions were: contusions (50.7%), wounds (18.7%), tendinitis (11.7%), wrenches (9.2%), others (7.3%). They differed between age groups, sex, and category of sports. Localizations were mainly: fingers (27.4%), other localizations of the upper limb (20.1%), head (20.6%). A physician was consulted for 19.5% of the accidents and hospitalization followed 2.7%. Absence from school and exemption from SPT were frequent (11.4% and 16.3% respectively).

CONCLUSION: The results could be used to inform adolescents so they and their families could become more aware of the risk of school accidents. Prevention should mainly focus on the younger children. An effort must be made regarding risk assessment in order to help the pupils become more careful and responsible during their sports activities. The choice of these activities and the materials used should be made more suitable for adolescents. (Copyright © 2002 Masson)

Can suicide coverage lead to copycats?

Jamieson KH. Am Editor 2002; 824: 22-23.

Correspondence: Kathleen Hall Jamieson, Annenberg Public Policy Center, 3620 Walnut Street Philadelphia, PA 19104-6220, USA; (email: kjamieson@asc.upenn.edu).

BACKGROUND: Research has shown that some elements of suicide coverage could lead those on the edge to follow suit; new guidelines are designed to remove those elements from coverage. Between 1984 and 1987, journalists in Vienna, Austria covered the deaths of individuals who jumped in front of trains in the subway system. The reporting was extensive and graphic. Suicides by the same method rose. In 1987, a campaign informed reporters that news stories might be contributing to the problem. When the amount of reporting on the deaths dropped, subway suicides and nonfatal attempts fell by more than 80 percent. The total number of suicides in Vienna declined as well.

Social scientists have long known that suicides increase when media reports of suicide increase, and the same happens when a particular suicide is treated prominently — for example on the front page or at the beginning of a broadcast. We also know that when a particular method of suicide is described in detail copycat suicides often follow.

Surgeon General David Satcher and a number of public health organizations released recommendations last year for reporters covering suicide. The guidelines urge reporters to avoid mentioning the method of suicide in the headline, avoid prominent or repeated reporting on an individual suicide, avoid detailed descriptions of the method and avoid romanticizing the act of suicide or suggesting that such acts are the inexplicable acts of otherwise happy and normal individuals. The recommendations also urged discussion of the role of psychiatric disorders, particularly depression and other mood disorders and alcohol and drug abuse, in suicide. In fact, over 90 percent of suicide victims have a significant psychiatric illness at the time of their deaths, and these mental illnesses are often undiagnosed, untreated, or both.

This was not the first time guidelines for suicide coverage had been released. In 1994, the Centers for Disease Control published recommendations for coverage of suicide. Yet, when in 2001, the Annenberg Public Policy Center interviewed 61 reporters and 15 editors who had reported on acts of suicide, we found no awareness of the guidelines. Indeed, a number of those interviewed were unaware of the possibility that some types of reporting could increase copycat suicides. However, the fact that reporters didn't know about the guidelines didn't mean they weren't following them.

OBJECTIVES: To assess suicide reporting practices in the nations top newspapers.

METHODS: We reviewed all coverage of suicide in 1990, 1995, and 1999 in The New York Times and the reports of suicide in the other nine top circulation newspapers.

FINDINGS: We found many examples that might have promoted copycat suicides. In 60 percent of the articles either the fact of suicide or the method was mentioned in the headline. In most of the papers the typical article about suicide was placed within the first nine pages of the paper. Some romanticized suicide, for example the headline of a New York Times article read "Eighth-Grade Sweethearts in a Love Suicide" (Nov. 9, 1995). In addition, only 7.9 percent of the articles in The New York Times cited depression as a factor in the reported suicide.

Since the copycat effect of celebrity suicides is well documented — celebrity suicides are more likely to produce imitation due to the prominence and amount of coverage they receive — we searched for print or broadcast coverage of four well-known people who killed themselves. We found that coverage failed to follow the recommendations of the 1994 CDC guidelines. Many of the stories included explicit details on method and contained sensationalist headlines. Yet, in other cases celebrity suicide was covered responsibly.

CONCLUSIONS: The media can play a powerful role in educating the public about suicide prevention. Stories about suicide can inform readers and viewers about the likely causes of suicide, its warning signs, trends in suicide rates and recent treatment advances. They can also highlight opportunities to help prevent suicide. Discussing the availability of effective treatments that are available (but underutilized) for most of the conditions that lead to suicide may encourage vulnerable individuals to seek help. (Copyright © 2002 The American Society of Newspaper Editors)

The new guidelines are available online from the Annenberg Public Policy Center of the University of Pennsylvania.

The Effect of Duration and Delay of Licensure on Risk of Crash: A Bayesian Analysis of Repeated Time-To-Event Measures.

Elliott MR, Raghunathan TE, Shope JT. J Am Stat Assn 2002; 97(458): 420-431.

Correspondence: Michael R. Elliott, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 612 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 USA; (email: melliott@cceb.upenn.edu).

The driving history records of a sample of 13,794 Michigan public school students were followed for up to 13 years from their initial time-of-license to determine the separate effects of duration of licensure and delay of licensure on risk of crash. We propose a subject specific lognormal accelerated failure time to model the expected time-to-crash as a function of age at time of licensure, duration of licensure, and a set of control covariates. When multiple time-to-crash measures are observed for an individual, within-subject correlation can create substantial bias in the estimation of the effect of duration of licensure under an independence model. Generalized estimating equations provide consistent estimators of the variance when independence is misspecified but do not correct for this bias. Full maximum likelihood models generally require numerical integration and differentiation, and in practice, parameter estimates were unattainable for the dataset of interest. We instead adopt a Bayesian approach, imputing the unobserved failure times and slope-intercept random effects to account for right censoring and between-subject variability. We implement this approach using a Gibbs algorithm. We assess model fit via posterior predictive distributions. Our approach also allows for subject-specific risk estimates based on subject-level history. We compare the repeated sampling properties of this approach with those obtained using some frequentist approaches, and find that duration of licensure is a stronger predictor of risk of crash than age of licensure. (Copyright © 2002 American Statistical Association).
Factors Related to More Severe Older Driver Traffic Crash Injuries.

Khattak AJ, Pawlovich MD, Souleyrette RR, Hallmark SL. J Transp Eng 2002; 128(3): 243-249.

Correspondence: Aemal J. Khattak, Dept. of Civil Engineering, Mid-America Transportation Center, University of Nebraska, W348 Nebraska Hall, Lincoln, NE 68588-0531, USA; (email: akhattak2@unl.edu).

The population of the U.S. is aging, and the number of older persons licensed to drive keeps increasing. With the aging population and increase in the number of older licensed drivers, addressing safety issues related to older drivers is becoming more crucial every day. This paper reports on the analysis of 1990–1999 crash data from the State of Iowa in which an older driver (age 65 years) was injured. The main focus of the study was to isolate factors that contribute to more severe injuries to older drivers involved in traffic crashes. The ordered probit modeling technique was used to investigate factors from vehicle, roadway, driver, crash, and environmental characteristics that can potentially contribute to older driver crash injury severity. Model findings were primarily as expected. New findings from this study were that older drivers who consumed alcohol were more likely to be seriously injured and older driver injuries in farm vehicles were more severe as compared with other types of vehicles. The authors discuss implications of the findings for the safety of older drivers.(Copyright © 2002 American Society of Civil Engineers)
In-vehicle cell phones: Fatal distraction?

Curry DG. Prof Saf 2002; 47(3): 28-33.

Correspondence: David G Curry, Packer Engineering, 1950 North Washington, Napierville, IL 60563, USA; (email: unavailable)

Available online: http://www.asse.org/cellfatal.htm

Debate in the popular press regarding the issue of cell phone use on American roadways is extremely prevalent, highly vituperative and often devoid of hard data. Editorials are rife with emotional personal accounts of tragedies or near tragedies, but suspiciously empty of facts regarding the issues involved or experimental evidence supporting the positions espoused.

The resulting public consensus is that in-vehicle use of these products presents a danger that must be addressed. The rash of legislation proposing various types of quick fixes is proof that lawmakers are being crowded into a position that "something must be done about this problem," even though real data surrounding the issue are mixed at best. In an attempt to support an alternative solution, this article cites publicly available facts and figures in order to place the problem in perspective. (Copyright © 2002 American Society of Safety Engineers)
The distracted driver: how dangerous is multitasking?

Peters GA, Peters BJ. Prof Saf 2002; 47(3): 34-40.

Correspondence: George A. Peters, Peters & Peters,2001 Wilshire Blvd Ste 221, Santa Monica, CA 90403, USA; (email: unavailable)

Available online: http://www.asse.org/celldanger.htm

Driver distraction is a growing problem. Preoccupation with in-vehicle electronic gadgets (such as cell phones and CD players) may degrade driving performance -- as may interaction with vehicle occupants and vehicle system controls. A health promotion campaign may be the most effective way to educate drivers about the hazards of distraction and the need for vigilance on the roadways. (Copyright © 2002 American Society of Safety Engineers)
Interdependence of nonoverlapping cortical systems in dual cognitive tasks.

Just MA, Carpenter PA, Keller TA, Emery L, Zajac H, Thulborn KR. NeuroImage 2001; 14: 417-426.

Marcel Adam Just, Center for Cognitive Brain Imaging, Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA; (email: just@cmu.edu).

One of the classic questions about human thinking concerns the limited ability to perform two cognitive tasks concurrently, such as a novice driver's difficulty in simultaneously driving and conversing. Limitations on the concurrent performance of two unrelated tasks challenge the tacitly assumed independence of two brain systems that seemingly have little overlap. The current study used fMRI (functional magnetic resonance imaging) to measure cortical activation during the concurrent performance of two high-level cognitive tasks that involve different sensory modalities and activate largely nonoverlapping areas of sensory and association cortex. One task was auditory sentence comprehension, and the other was the mental rotation of visually depicted 3-D objects. If the neural systems underlying the two tasks functioned independently, then in the dual task the brain activation in the main areas supporting the cognitive processing should be approximately the conjunction of the activation for each of the two tasks performed alone. We found instead that in the dual task, the activation in association areas (primarily temporal and parietal areas of cortex) was substantially less than the sum of the activation when the two tasks were performed alone, suggesting some mutual constraint among association areas. A similar result was obtained for sensory areas as well. (Copyright © 2001 Academic Press)
Effect of a concurrent auditory task on visual search performance in a driving-related image-flicker task.

Richard CM, Wright RD, Ee C, Prime SL, Shimizu Y, Vavrik J. Hum Factors 2002; 44(1): 108-119.

Correspondence: Christian M. Richard, Human Factors Transportation Center, Battelle Seattle Research Center, 4500 Sand Point Way NE, Seattle, Washington 98105-3949, USA; (email: richardc@battelle.org).

The effect of a concurrent auditory task on visual search was investigated using an image-flicker technique. Participants were undergraduate university students with normal or corrected-to-normal vision who searched for changes in images of driving scenes that involved either driving-related (e.g., traffic light) or driving-unrelated (e.g., mailbox) scene elements. The results indicated that response times were significantly slower if the search was accompanied by a concurrent auditory task. In addition, slower overall responses to scenes involving driving-unrelated changes suggest that the underlying process affected by the concurrent auditory task is strategic in nature. These results were interpreted in terms of their implications for using a cellular telephone while driving. Actual or potential applications of this research include the development of safer in-vehicle communication devices. (Copyright © 2002 Human Factors & Ergonomics Society)
The Effects of Mandatory Seat Belt Laws on Motor Vehicle Fatalities in the United States.

Calkins LN, Zlatoper TJ. Soc Sci Q 2001; 82(4): 716-732.

Correspondence: Lindsay Noble Calkins, Department of Economics and Finance, Boler School of Business, John Carroll University,20700 North Park Blvd. University Heights, Ohio 44118, USA; (email: calkins@jcu.edu).

OBJECTIVES: This article assesses the effectiveness of mandated seat belt usage. The theory of offsetting behavior asserts that when drivers feel safer, they compensate by driving less cautiously. As a consequence, any lifesaving effects from mandated safety devices such as seat belts could be significantly diminished or entirely offset.

METHODS: This article uses regression analysis and two years (1988 and 1997) of state-level data to test for the presence of offsetting behavior by estimating models explaining total and nonoccupant motor vehicle deaths. In addition to accounting for several factors generally acknowledged as being determinants of highway deaths, the models control for the impact of primary and secondary seat belt laws.

FINDINGS: The findings suggest the existence of offsetting behavior by drivers of motor vehicles.

CONCLUSIONS: We need to recognize the probability of such compensatory behavior and direct our efforts at ways of ameliorating the adverse effects. (Copyright © 2001 Blackwell Publishers and the Southwestern Social Science Association)
When do AIS 1 neck injuries result in long-term consequences? Vehicle and human factors.

Krafft M. Traffic Inj Prev 2002; 3(2): 89-97.

Correspondence: Maria Krafft, Folksam Research, 106 60 Stockholm, SWEDEN; (email: maria.krafft@folksam.se).

AIS 1 neck injuries are the most frequent injury among car occupants in car collisions. The main public-health problem concerning neck injuries are those resulting in long-term consequences. Yet epidemiological studies mostly focus on data based on the initial injury outcome. This study compares the characteristics of rear impacts causing both short- and long-term consequences to the neck. Real life data from Swedish insurance material during 1990-1993 were used, where the resultant impact injuries to the neck were divided into two groups: occupants self-reporting initial symptoms shortly after the crash and a subgroup were the initial symptoms later developed into long-term consequences, estimated by medical specialists (chronic symptoms at least one year after the impact). The influence of change of velocity, crash pulse of the struck car, and the risk of long-term consequences to the neck in different car models, were evaluated. The relative risk of neck injury in terms of initial injury was strongly influenced by the mass ratio between the struck and the striking car while other parameters such as crash pulse seemed to be an influencing factor in crashes causing long-term consequences. Also, there was a 2.7 times higher risk of sustaining long-term consequences to the neck in a vehicle manufactured in the end of the 1980s or beginning of the 90s than in one manufactured in the beginning of 1980. If one of the main reasons for the increasing number of long-term disabling neck injuries is associated with the influence of crash-pulse and factors related to newer car models, the situation will gradually become worse as the older car fleet is replaced. There is an increasing need for effective preventive measures, based on long-term disability data.

Victim, perpetrator, family, and incident characteristics of infant and child homicide in the United States Air Force.

Lucas DR, Wezner KC, Milner JS, McCanne TR, Harris IN, Monroe-Posey C, Nelson JP. Child Abuse Negl 2002; 26(2): 167-186.

Correspondence: Don R. Lucas, Psychology Department, Northwest Vista College, 3535 North Ellison Drive, San Antonio, TX, USA; (email: dlucas@accd.edu.

OBJECTIVE: The present study describes factors related to fatal abuse in three age groups in the United States Air Force (USAF).

METHODS: Records from 32 substantiated cases of fatal child abuse in the USAF were independently reviewed for 60 predefined factors.

FINDINGS: Males were over-represented in young child victims (between 1 year and 4 years of age) and child victims (between 4 years and 15 years of age) but not in infant victims (between 24 hours and 1 year of age). African-American infant victims and perpetrators were over-represented. Younger victims were more likely to have been previously physically abused by the perpetrator. Perpetrators were predominantly male and the biological fathers of the victims. Infant and young child perpetrators reported childhood abuse histories, while child perpetrators reported the highest frequency of mental health contact. Victims' families reported significant life stressors. Families of young child victims were more likely divorced, separated, or single. Incidents with infants and young children tended to occur without witnesses; incidents with child victims tended to have the victim's sibling(s) and/or mother present. Fatal incidents were more frequent on the weekend, in the home, and initiated by some family disturbance.

CONCLUSIONS: Differences among groups in factors related to infant and child homicide across age groups may assist in the development of more tailored abuse prevention efforts and may also guide future investigations. (Copyright © 2002 Elsevier Science and the International Society for Prevention of Child Abuse and Neglect)
The nature of newspaper coverage of homicide.

Taylor CA, Sorenson SB. Inj Prev 2002; 8(2):121-127.

Correspondence: Catherine A Taylor, Violence Prevention Research Group, UCLA School of Public Health, 650 CE Young Drive South, Box 951772, Los Angeles, CA 90095–1772, USA; (email: cataylor@ucla.edu).

OBJECTIVES: Previous research has shown that some homicides are more likely than others to receive newspaper coverage (for example, homicides by strangers). The present investigation examined whether, once the decision has been made to report on a homicide, the nature of the coverage (that is, how much visibility is given to a story, what information is included, and how a story is written) differs according to two key variables, victim ethnicity, and victim-suspect relationship.

METHODS: Homicide articles from the 1990-94 issues of the Los Angeles Times were stratified according to the predictors of interest (victim ethnicity and victim-suspect relationship) and a sample was drawn. Data that characterized two primary aspects of newspaper coverage, prominence and story framing (including background information, story focus, use of opinions, story tone, and "hook" or leading introductory lines) were abstracted from the articles. Descriptive statistics and cross tabulations were generated. Multivariate analyses were conducted to examine the predictive value of victim ethnicity and victim-suspect relationship on the nature of the newspaper coverage.

FINDINGS: Newspaper coverage of homicide was generally factual, episodic, and unemotional in tone. Victim-suspect relationship, but not victim ethnicity, was related to how a story was covered, particularly the story frame. Homicides by intimates were covered consistently differently from other types of homicides; these stories were less likely to be opinion dominated, be emotional, and begin with a "hook".

CONCLUSION: Victim-suspect relationship was related to the nature of coverage of homicides in a large, metropolitan newspaper. Given the agenda setting and issue framing functions of the news media, these findings have implications for the manner in which the public and policy makers perceive homicides and, consequently, for the support afforded to various types of solutions for addressing and preventing violence. (Copyright © 2002 British Medical Journal Publishing Group)
Armed Americans: The impact of firearm availability on national homicide rates.

Hoskin AW. Just Q 2001; 18(3): 569-592.

Correspondence: Anthony W Hoskin, Albright College, 13th and Bern Streets, PO Box 15234, Reading, PA 19612-5234, USA; (email: anthonyh@alb.edu).

This study examines the relationship between firearm availability and national homicide rates. The theoretical and empirical literatures are reviewed, and a cross-national two-stage least squares regression analysis is described. The relationship between a circa 1990 measure of firearm availability and the average 1990-1994 homicide rate is examined across 36 countries. Two-stage least squares regression, which controls for homicide's effect on firearm availability in addition to a number of other confounding factors, reveals a statistically significant positive effect of firearm availability on national homicide rates. The magnitude of the association is considerable. The observed relationship is found to be insensitive to sample composition. Results also indicate that homicide rates do not influence levels of firearm availability. The limitations of the study and avenues for future research are discussed. (Copyright © 2001 Academy of Criminal Justice Sciences)

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Rev. 20-July-2002.