SafetyLit Update: 7 October 2002

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7 October 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.

See abstract under Reports of Injury Occurrence
Consumption, knowledge and attitudes of high school pupils towards alcohol and alcoholism: the Israeli experience.

Brook U, Tepper A. Patient Educ Couns 2002; 47(2):115-119.

Correspondence: Uzi Brook, Department of Pediatrics, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon 58100, ISRAEL (email: rbrook@wolfson.health.gov.il).

Five hundred nine high school pupils from Holon (a city in the center of Israel) were surveyed about their consumption, knowledge and attitudes towards alcohol use and alcohol dependence. Two hundred fifty-nine pupils attended a vocational high school and 253 attended an academic high school. Forty percent of the pupils attending the academic school reported that they had drank beer between one to nine times during the last 2 months. In comparison with 72% of the vocational pupils, 42% of the academic pupils and 47% of the vocational pupils drank other alcoholic beverages (such as hard liquor, cognac, whisky or vodka) between one to nine times during the last 2 months. Boys drank alcohol more frequently than girls did. An earlier mean age of beer consumption was found among pupils in the vocational schools-12.8 years; as opposed to pupils in the academic school-13.4 years. Knowledge of most pupils concerning alcoholic beverages and its potential harmful effects was lacking and pupils in the academic school showed a higher level of knowledge in comparison with the vocational pupils. Pupils in the vocational school had more liberal attitudes concerning recurrent consumption of alcoholic beverages than pupils in the academic school. Among the three leading reasons for drinking in the two schools were helping foster a sense of belonging, wish to feel like an adult and desire to forget daily anxieties and conflicts. Pupils in vocational schools are a target population with a higher risk for consuming alcoholic beverages. Discussion groups should be held in school and include personal stories of recovering alcoholics. (Copyright © 2002 Elsevier Science)
Drinking histories of fatally injured drivers.

Baker SP, Braver ER, Chen LH, Li G, Williams AF. Inj Prev 2002; 8(3): 221-226.

Correspondence: Susan P. Baker, Johns Hopkins University Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, Maryland 21205, USA; (email: sbaker@jhsph.edu).

BACKGROUND: About 30% of drivers killed in crashes have high blood alcohol concentrations (BACs) of 0.10+ g/dl. There is a question about whether these drivers primarily are problem drinkers who chronically drink and drive-the so-called hard core drinking drivers.

OBJECTIVE: To investigate drinking histories of fatally injured drivers in relation to their BACs.

METHODS: Design and participants- Retrospective cohort study of 818 fatally injured drivers who were included in the 1993 National Mortality Followback Survey (a national sample of US deaths in which next of kin were interviewed) and whose BACs were recorded by the Fatality Analysis Reporting System, a census of US traffic deaths. Main outcome measure- Problem drinking indicators.

FINDINGS: At least one indicator of potential problem drinking, primarily heavy drinking, was reported for 68% of drivers with very high BACs (0.15+ g/dl), 41% with BACs of 0.10-0.14 g/dl, 32% with BACs of 0.01-0.09 g/dl, and 7% with zero BACs. Spouses provided more credible responses than other relatives: they were more likely to report at least occasional drinking and driving among deceased drivers with high BACs. For the most direct signs of problem drinking (described as a problem drinker during the last month of life or frequently driving after having five or more drinks), spousal reports suggested the prevalence of problem drinking among drivers with very high BACs was 22% (having both indicators), 32% (frequently driving after having five or more drinks), 44% (described as problem drinker), or 57% (having either indicator).

DISCUSSION: Drivers with BACs of 0.10+ g/dl were far more likely than sober drivers to be described as having markers of problem drinking. However, many did not have indicators suggestive of problem drinking. In addition to programs focused on repeat offenders or problem drinkers, countermeasures such as sobriety checkpoints that target a broader spectrum of drinking drivers are appropriate. (Copyright © 2002 BMJ Publishing Group)

See abstract under Rural and Agricultural Issues
Disaster medicine in the 21st century: future hazards, vulnerabilities, and risk.

Arnold JL. Prehospital Disaster Med 2002; 17(1): 3-11.

Correspondence: J. L. Arnold, Department of Emergency Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA; (email: Arnoldmdcs@cs.com).

The prediction of future disasters drives the priorities, urgencies, and perceived adequacies of disaster management, public policy, and government funding. Disasters always arise from some fundamental dysequilibrium between hazards in the environment and the vulnerabilities of human communities. Understanding the major factors that will tend to produce hazards and vulnerabilities in the future plays a key role in disaster risk assessment. The factors tending to produce hazards in the 21st Century include population growth, environmental degradation, infectious agents (including biological warfare agents), hazardous materials (industrial chemicals, chemical warfare agents, nuclear materials, and hazardous waste), economic imbalance (usually within countries), and cultural tribalism. The factors tending to generate vulnerabilities to hazardous events include population growth, aging populations, poverty, maldistribution of populations to disaster-prone areas, urbanization, marginalization of populations to informal settlements within urban areas, and structural vulnerability. An increasing global interconnectedness also will bring hazards and vulnerabilities together in unique ways to produce familiar disasters in unfamiliar forms and unfamiliar disasters in forms not yet imagined. Despite concerns about novel disasters, many of the disasters common today also will be common tomorrow. The risk of any given disaster is modifiable through its manageability. Effective disaster management has the potential to counter many of the factors tending to produce future hazards and vulnerabilities. Hazard mitigation and vulnerability reduction based on a clear understanding of the complex causal chains that comprise disasters will be critical in the complex world of the 21st Century.

Hazardous occupations in Great Britain.

Roberts S. Lancet 2002; 360(9332): 543-544.

Correspondence: Stephen E Roberts, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, OX3 7LF, Oxford, UK; (email: stephen.roberts@uhce.ox.ac.uk).

The aim of this study was to investigate the most hazardous of all occupations in Great Britain. The causes of all deaths in British merchant seafaring and trawler fishing, traditionally the two most dangerous occupations, were established for the period between 1976 and 1995 and compared with official mortality statistics for other occupations. Fishermen were 52.4 times more likely to have a fatal accident at work (95% CI 42.9-63.8), and seafarers were 26.2 times more likely (19.8-34.7), compared with other British workers. Although the number of work-related deaths has decreased in recent decades, in relative terms the occupations of fishing and seafaring remain as hazardous as before. If mortality rates in these occupations are to decrease, unsafe working practices, especially unnecessary operations in treacherous conditions, should be reduced. (Copyright © 2002 Elsevier Science)
Occupational injury and illness surveillance: conceptual filters explain underreporting.

Azaroff LS, Levenstein C, Wegman DH. Am J Public Health 2002; 92(9): 1421-1429.

Correspondence: Lenore Azafoff, Department of Work Environment, University of Massachusetts, Lowell, MA 01854, USA; (email: lenore_azaroff@uml.edu).

Occupational health surveillance data are key to effective intervention. However, the US Bureau of Labor Statistics survey significantly underestimates the incidence of work-related injuries and illnesses. Researchers supplement these statistics with data from other systems not designed for surveillance. The authors apply the filter model of Webb et al. to underreporting by the Bureau of Labor Statistics, workers' compensation wage-replacement documents, physician reporting systems, and medical records of treatment charged to workers' compensation. Mechanisms are described for the loss of cases at successive steps of documentation. Empirical findings indicate that workers repeatedly risk adverse consequences for attempting to complete these steps, while systems for ensuring their completion are weak or absent. (Copyright © 2002 American Public Health Association)

Alcohol and / or other drug use among adult non-occupant motor vehicle crash victims.

Weber JE, Maio RF, Blow FC, Hill EM, Barry KL, Waller PF. Alcohol Alcohol 2002; 37(5): 468-471.

Correspondence: James Edward Weber, Department of Emergency Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA; (email: jwmd@umich.edu).

AIMS: To identify the frequency of current or lifetime history of alcohol and/or other drug (AOD) use among the full range (admitted and discharged) of injured bicyclists and pedestrians involved in motor vehicle crashes. METHODS: In a prospective study of non-occupant motor vehicle crash (NOMVC) victims>/=18 years over a 29-month period, blood was obtained for alcohol and drug testing. Current alcohol abuse/alcohol dependence (AA/AD) or drug abuse/drug dependence (DA/DD) was based on the Diagnostic Interview Survey. RESULTS: In all, there were 108 NOMVC victims. Eleven per cent were alcohol (+), 7% drug (+), and 3% both. Sixteen per cent were AA/AD (+), 2.7% DA/DD (+), and 1.4% both. CONCLUSIONS: A substantial portion of patients with NOMVC injuries tested AOD (+) and had a current or lifetime substance abuse (AA/AD; DA/DD) diagnosis. (Copyright © 2002 2002 Medical Council on Alcohol. Published by Oxford University Press.

See abstract under Rural and Agricultural Issues

The association between risk-taking behavior and the use of safety devices in adolescents.

Mathews J, Zollinger T, Przybylski M, Bull M. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 23-36.

Correspondence: Jeff Matthews, Automotive Safety Program, Indiana University School of Medicine,1120 W South Drive, Fesler Hall, Indianapolis, IN 46202-5114, USA; (email: unavailable).

The purpose of this research study was to measure the association between risk taking behavior in adolescents and their use of safety devices. The study focused on three safety devices: seat belts, motorcycle helmets, and bicycle helmets. This is a secondary data analysis using data from the Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention. The results of this study indicate that risky behavior in adolescents is associated with their non-use of safety devices. In general, risky behavior was more associated with the non-use of seatbelts than the use of other safety devices. The results of this study suggest that a comprehensive approach to reducing risky behaviors in adolescent should be considered when planning injury prevention programs. (Copyright © 2001 Association for the Advancement of Automotive Medicine)

Characteristics and risk factors for accident injury in Canada from 1986 to 1996: an analysis of the Canadian Accident Injury Reporting and Evaluation (CAIRE) database.

Mo F, Choi BCK, Clottey C, LeBrun B, Robbins G. Inj Ctl Saf Promo 2002; 9(2): 73-81 .

Correspondence: Frank Mo, Health Canada, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, AL#1910C1, Tunney's Pasture, Ottawa, Ontario K1A 0K9, CANADA; (email: frank_mo@hc-sc.gc.ca).

This study analyzed the database of Canadian Accident Injury Reporting and Evaluation (CAIRE) for the injuries reported from January 1986 to March 1996 in seven provinces at children's or general hospitals in Canada. In order to describe the characteristics of injuries, we compared the different categories of injuries by sex and by age groups, identified patterns of injuries, and detected the products causing injury to Canadian people. The results showed that there were 130,489 injury cases in Canada during the 10 years from 1986 to 1996. The 10-19 year age group had 57,582 cases, representing 44.13% of total injuries, and making it the group with the highest occurrence of injuries. The male injury rate (69.75%) was significantly higher than the female rate (30.25%) (P = 0.0001). Six areas were identified as priorities for intervention: 1) injuries occurring on playgrounds among children and youth; 2) sports and playground apparatus injuries and injuries sustained in transit among young people; 3) the top five causes of injuries; 4) diagnosis and treatment of injuries; 5) consumer products and safety; and 6) nature and physical sites of injuries. Further work is needed in: evaluating injury causes, comparing the results with reports from other countries and the necessary approaches and prevention measures to reduce and control injury occurrences to improve the quality of consumer products, and to protect the health of the population in Canada. (Copyright © 2002 Swets & Zeitlinger)
Variability in drug use prevalence across school districts in the same locale in Ohio.

Falck RS, Wang J, Carlson RG, Siegal HA. J Sch Health 2002; 72(7): 288-293.

Correspondence: Russel Falck, Dept. of Community Health, Center for Interventions, Treatment, and Addictions Research, Wright State University School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA.

Substance use by adolescents continues to present a problem schools must address. Data from survey research can prove useful in helping schools determine the nature and extent of youth drug use. This study identified variations in drug use prevalence among ninth grade students in different school districts in the same locale in Ohio. Possible explanations for the differences were explored. Students (n = 3,016) from 12 suburban high schools anonymously completed self-report drug use questionnaires. School and community-level data were collected from other sources. Cluster analysis was used to group the school districts. ANOVA revealed statistically significant differences (P < or = 0.001) in levels of drug use by cluster. The cluster with significantly lower levels of drug use consisted of districts with at least one full-time drug abuse prevention coordinator, higher economic levels, and the highest per pupil expenditures. Drug use among youth is influenced, at least in part, by local contextual factors. Local survey data can inform local policy and programs. These findings have practical implications for policymakers, program developers, and school districts in other areas of the country.

See abstract under Occupational Issues
Appropriate indicators for injury control?

McClure RJ, Peel N, Kassulke D, Neale R. Public Health 2002; 116(5): 252-256.

Correspondence to: R J McClure, School of Population Health, The University of Queensland, Queensland, AUSTRALIA; (email: r.mcclure@sph.uq.edu.au).

Indicators are valuable tools used to measure progress towards a desired health outcome. Increased awareness of the public health burden due to injury has lead to a concomitant interest in monitoring the impact of national initiatives that aim to reduce the size of the burden. Several injury indicators have now been proposed. This study examines the ability of each of the suggested indicators to reflect the nature and extent of the burden of non-fatal injury.

A criterion validity, population-based, prospective cohort study was conducted in Brisbane, a sub-tropical Metropolitan City on the eastern seaboard of Australia, over a 12-month period between 1 January and 31 December 1998.

Neither the presence of a long bone fracture nor the need for hospitalisation for 4 or more days were sensitive or specific indicators for ‘serious’ or major injury as defined by the ‘Gold Standard’ Injury Severity Score (ISS). Subsequent analysis, using other public health outcome measures demonstrated that the major component of the illness burden of injury was in fact due to 'minor' not serious injury. However, the suggested indicators demonstrated low sensitivity and specificity for these outcomes as well.

The results of the study support the need to include at least all hospitalisations in any population-based measure of injury and not attempt to simplify the indicator to a more convenient measure aimed at identifying just those cases of 'serious' injury. (Copyright © 2002 Nature Publishing Group)
Measure for measure: the quest for valid indicators of non-fatal injury incidence.

Cryer C, Langley JD, Stephenson SCR, Jarvis SN, Edwards P. Public Health 2002; 116(5): 257-262.

Correspondence to: C Cryer, CHSS at Tunbridge Wells, University of Kent, Oak Lodge, David Salomons’ Estate, Broomhill Road, Tunbridge Wells, Kent TN3 0TG, UK; (email: P.C.Cryer@ukc.ac.uk).

In this edition of Public Health, McClure and colleagues report on research that considered the criterion validity of indicators based on serious long bone fracture and length of stay in hospital. They found that neither were sensitive or specific indicators for serious injury as defined by an Injury Severity Score (ISS) of 16 or more. They contend that their study findings ‘¼ strongly support a return to a measure similar in intent to that encapsulated in the original UK Green Paper¼’. We contend that their analysis does not provide any empirical evidence to support their view that there should be a return to the Green Paper: Our Healthier Nation indicator. Furthermore, we consider the analyses that they carry out to validate both the Saving Lives: Our Healthier Nation and the serious long bone fracture indicators are flawed. We agree that national (or state) indicators are very influential. They encourage preventive action and resource use aimed at producing favourable changes to these indicators. However, each of the four non-fatal indicators considered in their analysis have problems. Formal validation of existing indicators is necessary and the following aspects of validity should be addressed: face; criterion; consistency; and completeness and accuracy of the source date. Taking into account the current national data systems in England, possible options for one or more national non-fatal unintentional injury indicators have been proposed in our paper. Furthermore, the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group is about to embark on the development of a strategic framework for the development of valid indicators of non-fatal injury occurrence. (Copyright © 2002 Nature Publishing Group)

Predisposing and precipitating factors for falls among older people in residential care.

Kallin K, Lundin-Olsson L, Jensen J, Nyberg L, Gustafson Y. Public Health 2002; 116(5): 263-271.

Correspondence: Kristina Kallin, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umea University, Umea, SWEDEN; (email: kristina.kallin@germed.umu.se).

Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures.Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures.We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise. (Copyright © 2002 Nature Publishing Group)
Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk.

van Haastregt JCM, van Rossum E, Diederiks JPM, de Witte LP, Voorhoeve PM, Crebolder H. Patient Educ Couns 2002; 47(4): 301-309.

Correspondence: Jolanda C.M. van Haastregt, Institute for Rehabilitation Research, P.O. Box 192, 6430 AD Hoensbroek, THE NETHERLANDS; (email: jolanda.vanhaastregt@irv.nl).

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year. During the home visits the participants were screened for risk factors potentially influencing falls and mobility. The screening was followed by recommendations, referrals, and other actions aimed at dealing with the hazards observed. Data regarding the intervention process were gathered by means of interviews with nurses and participants, and by means of structured forms and questionnaires administered by the nurses during the intervention period. We conclude that our 1-year multifactorial home visit programme consisting of five home visits is feasible for nurses and participants. Despite this, it seems to be an unsuitable intervention technique to reduce falls and mobility impairments among elderly people at risk. (Copyright © 2002 Elsevier Science)
Food and drink packaging: who is complaining and who should be complaining.

Winder B, Ridgway K, Nelson A, Baldwin J. Appl Ergon 2002; 33(5): 433-438.

Correspondence: Belinda Winder, Ibberson Centre, Department of Mechanical Engineering, University of Sheffield, Sir Frederick Mappin Building, Mappin Street, Sheffield S1 3JD, UK; (email: b.winder@sheffield.ac.uk).

This paper reports a questionnaire survey of shoppers at four supermarket stores in the UK. Regression analyses were used to determine factors in consumer complaints with the packaging of food and drink products. Neuroticism and treatment in hospital for an accident involving packaging in the last 3 years were significant associates. Analyses on who was most likely to suffer accidents or injuries while opening food and drink packaging indicated that handedness (that is, being left handed made accidents more likely) and scoring low on a measure of personal control during decision-making were significant associates. Analyses on who suffered the most serious accidents and injuries whilst opening food and drink packaging revealed that the decision-making style of social resistance (that is, the extent to which you resist asking for help from others) was related to susceptibility to the most severe accidents. These findings imply that individual factors (including both personal characteristics and personality traits) should be taken into account when considering the openability of packaging. The results of this study indicate that manufacturers should ensure that novel packaging closures have been tested on left handers in order to discover any unique difficulties for this sub-group, that packaging opening tools specifically for left-handed people should be made available and that manufacturers of packaging should always look at a 'worst case scenario' for their packaging closures as it is evident that some people will continue to struggle with difficult packaging until either they open it or they have injured themselves. (Copyright © 2002 Elsevier Science)

Farmers' self-surveillance of pesticide poisoning: a 12-month pilot in northern Vietnam.

Murphy HH, Hoan NP, Matteson P, Abubakar AL. Int J Occup Environ Health 2002; 8(3): 201-211.

Correspondence: H.H. Murphy, Food and Agriculture Organization, United Nations Program for Community Integrated Pest Management, Asia. (email: hmurf@attglobal.net).

This pilot program was designed to: 1) determine whether farmers could use a simple self-reporting system to estimate the incidence of occupationally related, self-limited pesticide poisonings; 2) describe the frequencies and types of pesticide products used in spraying operations; and 3) assess whether self-reporting and feedback would influence spraying behaviors. For 12 months, 50 farmers in northern Vietnam recorded after every spraying session any adverse health effect and the pesticide used. Data were also gathered from 50 controls. Of the 1,798 recorded spray operations, 8% were asymptomatic, 61% associated with vague ill-defined effects, and 31% accompanied by a least one clear or symptom of poisoning. After six months, the self-reporting farmers' spraying frequency and use of highly hazardous products (Ia/Ib) had declined more significantly than in the controls, as had their moderate adverse health effects. This low-cost surveillance method influenced the behaviors of farmers given access to IPM farmer field schools. The study also demonstrated the value of farmers as informants. (Copyright © 2002 Hanley & Belfus)

See abstract under Reports of Injury Occurrence
See abstract under Violence
Effects of first-aid training in junior high schools.

Engeland A, Røysamb E, Smedslund G, Søgaard AJ. Inj Ctl Saf Promo 2002; 9(2): 99-106.

Correspondence: Geir Smedslund, Norwegian Institute of Public Health, Division of Epidemiology, P.O. Box 4404 Nydalen, N-0403, Oslo, NORWAY; (email: geir.smedslund@fhi.no).

As part of a campaign aimed at increasing first-aid knowledge and skills, a training program was introduced in Norwegian junior high schools in 1997/98. The program comprised a textbook, a video and a teacher's manual. A quasi-experimental design was applied to evaluate the effects. Data were collected by pre- and post-test questionnaires to 82 randomly selected schools. Indexes for knowledge of first aid, attitudes towards giving and learning first aid, self-efficacy, emotions connected with first-aid situations and intended behavior in situations requiring first-aid action were constructed. In the intention-to-treat analysis of these indexes, the difference between the intervention and control group was modest. A separate questionnaire filled in by the teachers showed a low degree of implementation of the program. When comparing those classes that really used the program with the control classes, significant differences were revealed in many of the variables. Both self-efficacy, emotions in situations requiring first-aid skills and attitudes toward giving and learning first aid were of importance for intended behavior. (Copyright © 2002 Swets & Zeitlinger)

Seeking Help From the Internet During Adolescence.

Gould MS, Munfakh JL, Lubell K, Kleinman M, Parker S. J Am Acad Child Adolesc Psychiatry 2002 Oct;41(10):1182-1189.

Correspondence: Madelyn S. Gould, Division of Child and Adolescent Psychiatry, NYSPI, 1051 Riverside Drive, Unit 72, New York, NY 10032, USA; (email: gouldm@childpsych.columbia.edu).

OBJECTIVES: To assess the prevalence and demographic and psychological correlates of Internet use as a help-seeking resource for emotional problems in a community sample of adolescents.

METHODS: A self-report survey was completed by 9th-through 12th-grade students (n = 519) enrolled in health courses in six New York State high schools in the fall/winter of 1999. The relationship between Internet help-seeking behavior and demographic characteristics, hopelessness, functional impairment, and use of various treatment services was examined.

FINDINGS: Nearly one fifth (18.2%) of the adolescents sought help on the Internet for emotional problems in the previous year. The proportions of males and females seeking help on the Internet did not significantly differ (15.6% and 20.8%, respectively). Internet help-seekers were significantly more likely than non-help-seekers to score above the clinical threshold on the Columbia Impairment Scale (34% versus 20.6%; chi sq (1) = 7.4, < .01) or Beck Depression Inventory (16.1% versus 9.1%; chi sq (1) = 3.8, <.05). These at-risk youths tended to combine Internet help-seeking with other sources of help, rather than substituting it for other resources. More than 20% of Internet help-seekers were dissatisfied with the help they received, and only 14% thought it had helped them very much.

DISCUSSION: For the Internet to realize its potential as an effective resource for teenagers struggling with emotional problems, further development is needed. (Copyright © 2002 American Academy of Child and Adolescent Psychiatry)

Vision impairment and older drivers: who's driving?

Keeffe JE, Jin CF, Weih LM, McCarty CA, Taylor HR. Br J Ophthalmol 2002; 86(10): 1118-1121.

Correspondence: Jill Keeffe, PhD, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Locked Bag 8, East Melbourne, Vic 8002, AUSTRALIA; (email: jillek@unimelb.edu.au).

OBJECTIVES: To establish the association between impaired vision and drivers' decisions to stop driving, voluntarily restrict driving, and motor vehicle accidents.

METHODS: Driving related questions were included in a population based study that determined the prevalence and incidence of eye disease. Stratified random cluster samples based on census collector districts were selected from the Melbourne Statistical Division. Eligible participants aged 44 years and over were interviewed and underwent a comprehensive ophthalmic examination. The outcomes of interest were the decision to stop driving, limiting driving in specified conditions, and driving accidents. The associations between these outcomes and the legally prescribed visual acuity (<6/12) for a driver's licence were investigated.

FINDINGS: The mean age of the 2594/3040 (85%) eligible participants was 62.5 (range 44-101). People with visual acuity less than 6/12 were no more likely to have an accident than those with better vision (chi(2) = 0.175, p>0.9). Older drivers with impaired vision, more so than younger adults, restrict their driving in visually demanding situations (p < 0.05). Of the current drivers, 2.6% have vision less than that required to obtain a driver's licence. The risk of having an accident increased with distance driven (OR 2.57, CL 1.63, 4.04 for distance >31 000 km) but not with age.

DISCUSSION: There was no greater likelihood of self reported driving accidents for drivers with impaired vision than those with good vision. While many older drivers with impaired vision limit their driving in adverse conditions and some drivers with impaired vision stop driving, there are a significant number of current drivers with impaired vision. Copyright © 2002 British Journal of Ophthalmology)
Graduated driver licensing: what works?

McKnight AJ, Peck RC. Inj Prev 2002; 8:(Suppl 2): 32-36.

Correspondence: A.J. McNight, 78 Farragut Rd., Annapolis, MD 21403, USA; (email: jimmcknight@earthlink.net).

BACKGROUND: Graduated driver licensing (GDL) adds an intermediate stage to driver licensing between the learner permit and full licensure stages that is intended to ameliorate the high risk of novice drivers.

OBJECTIVES: To assess the contribution of various elements of GDL to reduction in the crash rates of young novice drivers.

METHODS: An extensive review of the literature was undertaken to synthesise research findings on crash reduction.

FINDINGS: Increasing the length of the learner period and the amount practice required has reduced crash risk, partly through improved performance and partly by delaying licensure. Intervening early with traffic violators and making full licensure dependent on a clean driving record provide both general and specific deterrents to unsafe driving. Restrictions on night driving and carrying passengers are effective in reducing the increased risk of these situations. The benefits of multistage instruction and testing as well as the use of visible tags to identify novices have not as yet been adequately evaluated.

DISCISSION: While graduated driver licensing has proven a generally effective means of reducing the crash risk of novice drivers, controlled research is needed to assess the benefits of its individual components. (Copyright © 2002 BMJ Publishing Group)
Changes in crash risk following re-timing of traffic signal change intervals.

Retting RA, Chapline JF, Williams AF. Accid Anal Prev 2002; 34(2):215-220.

Correspondence: Richard A. Retting, Insurance Institute for Highway Safety, Arlington, VA 22201-4751, USA; (email: rretting@iihs.org).

More than 1 million motor vehicle crashes occur annually at signalized intersections in the USA. The principal method used to prevent crashes associated with routine changes in signal indications is employment of a traffic signal change interval--a brief yellow and all-red period that follows the green indication. No universal practice exists for selecting the duration of change intervals, and little is known about the influence of the duration of the change interval on crash risk. The purpose of this study was to estimate potential crash effects of modifying the duration of traffic signal change intervals to conform with values associated with a proposed recommended practice published by the Institute of Transportation Engineers. A sample of 122 intersections was identified and randomly assigned to experimental and control groups. Of 51 eligible experimental sites, 40 (78%) needed signal timing changes. For the 3-year period following implementation of signal timing changes, there was an 8% reduction in reportable crashes at experimental sites relative to those occurring at control sites (P = 0.08). For injury crashes, a 12% reduction at experimental sites relative to those occurring at control sites was found (P = 0.03). Pedestrian and bicycle crashes at experimental sites decreased 37% (P = 0.03) relative to controls. Given these results and the relatively low cost of re-timing traffic signals, modifying the duration of traffic signal change intervals to conform with values associated with the Institute of Transportation Engineers' proposed recommended practice should be strongly considered by transportation agencies to reduce the frequency of urban motor vehicle crashes. (Copyright © 2002 Elsevier Science)
Evaluating the crash and citation rates of Utah drivers licensed with medical conditions, 1992-1996.

Vernon DD, Diller EM, Cook LJ, Reading JC, Suruda AJ, Dean JM. Accid Anal Prev 2002; 34(2):237-246.

Correspondence: Don Vernon, University of Utah School of Medicine, Salt Lake City 84108, USA; (email: don.vernon@hsc.utah.edu).

BACKGROUND: Medical problems may affect the ability to drive motor vehicles, and programs that control the issuing of driver licenses to individuals with medical conditions exist in most states. The main activity of these programs is the imposition of restrictions upon the driving privileges of individuals with medical conditions that are deemed to pose some risk to public safety. However, little is known about the effectiveness of these licensing programs.

OBJECTIVE: The objective of this study was to compare the rates of adverse driving events (crash, at-fault crash and citations) experienced by drivers licensed with medical conditions to those of age-, sex- and location-matched controls. Separate comparisons were made for drivers reporting medical conditions licensed with full driving privileges, and those with restricted driving privileges (e.g. speed, area and time of day). DESIGN: Retrospective case-control.

METHODS: The study population was all drivers licensed in the state of Utah who reported a medical condition on their driver license application, over the 5-year period 1992-1996. Drivers enter the program by self-reporting their medical problems. Control drivers were chosen from the entire population of drivers licensed in Utah for the same period. Information on driver license status, participation in the medical conditions program, citations, involvement in crashes, and death certificate data was obtained from the relevant state agencies. Probabilistic linkage methodology was used to link the records in these disparate databases for eventual analysis. Rates of citation, crashes and at-fault crashes, expressed as events per 10000 license days, were calculated separately for program drivers and their corresponding control groups for each medical condition category and restriction status. These data were used to determine an estimate of relative risk (RR) and 95% confidence intervals.

FINDINGS: As a group, medical conditions drivers had modestly elevated rates of adverse driving events compared with control drivers (RR 1.09-1.74). Rates in the largest medical category, 'cardiovascular conditions', were not higher than controls. Rates were higher than control for some conditions, such as 'alcohol' and 'learning and memory', for some adverse events (RR 2.2 -5.75). Drivers with more than one medical condition appeared comparable to the general group of medical conditions program drivers.

DISCUSSION: Drivers in Utah medical conditions program had modestly elevated rates of adverse driving events compared to matched controls. Possible underreporting of medical conditions and accurate assessment of exposure rates are potential weaknesses in the program. (Copyright © 2002 Elsevier Science)
Developmental sources of crash risk in young drivers.

Arnett JJ. Inj Prev 2002; 8(Suppl 2):17-23.

Correspondence: J.J. Arnett, 4409 Van Buren Street, University Park MD 20782, USA; (email: arnett@wam.umd.edu).

This research was performed to outline various sources of crash risk among young drivers that are developmental (age based) factors. First, a distinction is made between adolescence (ages 10-18) and emerging adulthood (ages 18-25) in order to shed light on the reasons for especially high crash rates among 16-17 year old drivers relative to 18-25 year olds. Then various developmental sources of risk in adolescence are described, including the power of friends, the optimistic bias, and adolescent emotionality. The reasons for especially high crash rates among young males are discussed, with an emphasis on how American ideas about manhood promote driving risks. Finally, a cross national comparison between adolescents in the United States and Denmark shows how developmental risks interact with driving policies. The high crash rates of adolescents relative to emerging adults and of emerging adults relative to older drivers can be explained in part by developmental factors. (Copyright © 2002 BMJ Publishing Group)
Association between the inception of a SAFE KIDS Coalition and changes in pediatric unintentional injury rates.

Tamburro RF, Shorr RI, Bush AJ, Kritchevsky SB, Stidham GL, Helms SA. Inj Prev 2002; 8(3): 242-245.

Correspondence: Robert Tamburro, Division of Critical Care Medicine, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee 38105, USA; (email: robert.tamburro@stjude.org).

OBJECTIVE: To assess the relationship between the implementation of a SAFE KIDS Coalition and pediatric unintentional injury rates.

SETTING: Shelby County, Tennessee.

DESIGN: Retrospective observational analysis.

PATIENTS: County residents nine years of age or younger presenting to the children's medical center, its emergency department, or its outpatient clinics from 1990-97.

INTERVENTION: Implementation of a SAFE KIDS Coalition.

MAIN OUTCOME MEASURES: Rates of unintentional injuries targeted by the SAFE KIDS Coalition that resulted in hospitalization or in death. Rates of motor vehicle occupant injuries that resulted in hospitalization or in death. Rates of non-targeted unintentional injuries, namely injuries secondary to animals and by exposure to toxic plants. Rates of severe injuries (defined as those targeted injuries that required hospitalization or resulted in death), and specifically, severe motor vehicle occupant injuries were compared before and after the inception of the coalition using Poisson regression analysis.

FINDINGS: The relative risk of targeted severe injury rates decreased after implementation of the coalition even after controlling for changes in hospital admission rates. Specifically, severe motor vehicle occupant injury rates decreased 30% (relative risk 0.70; 95% confidence interval 0.54 to 0.89) after initiation of the coalition.

DISCUSSION: The implementation of a SAFE KIDS Coalition was associated with a decrease in severe targeted injuries, most notably, severe motor vehicle occupant injuries. Although causality cannot be determined, these data suggest that the presence of a coalition may be associated with decreased severe unintentional injury rates. (Copyright © 2002 BMJ Publishing Group)

World report on violence and health.

World Health Organization. Geneva, Switzeralnd: World Health Organization. (2002).

Report available online HERE.

Objectives of the Report: The specific objectives of the Report are to describe the magnitude and impact of violence throughout the world; describe the key risk factors for violence; summarize the types of intervention and policy responses that have been tried and what is known about their effectiveness; and make recommendations for action at local, national, and international levels.

Content of the Report: The Report examines a broad spectrum of violence including child abuse and neglect by caregivers, youth violence, violence by intimate partners, sexual violence, elder abuse, suicide, and collective violence. One chapter is devoted to each of these seven topics. The Report also includes a statistical annex with country and regional data derived from the WHO Mortality and Morbidity Database and a list of resources for violence prevention.

Main Messages of the Report:

Violence is a major public health problem worldwide. Each year, millions of people die as the result of injuries due to violence. Many more survive their injuries, but live with a permanent disability. Violence is among the leading causes of death among people aged 15-44 years worldwide, accounting for 14% of deaths among males and 7% of deaths among females.

In addition to death and disability, violence contributes to a variety of other health consequences. These include depression, alcohol and substance abuse, smoking, eating and sleeping disorders, and HIV and other sexually transmitted diseases.

Violence, however, is preventable – it is not an intractable social problem or an inevitable part of the human condition. The wide variation in violence among and within nations over time suggests that violence is the product of complex, yet modifiable social and environmental factors.

Violence results from interplay of individual, relationship, community, and societal factors. Some of the factors associated with violence include a history of early aggression, impulsiveness, harsh punitive discipline, poor monitoring and supervision of children, associating with delinquent peers, witnessing violence, drug trafficking, access to firearms, gender and income inequality, and norms that support violence as a way to resolve conflict.

Creating safe and healthy communities around the globe requires commitment on the part of multiple sectors at the international, national, and community levels to document the problem, build the knowledge base, promote the design and testing of prevention programs, and promote the dissemination of lessons learned.

A science-based public health approach focused on prevention may contribute to reducing violence. Public health officials have a very important role to play in this process. Through their vision and leadership, much can be done to establish national plans and policies for violence prevention, to help facilitate the collection of data to document and respond to the problem, to build important partnerships with other sectors, and to ensure an adequate commitment of resources to prevention efforts.
Risk factors for domestic violence: findings from a South African cross-sectional study.

Jewkes R, Levin J, Penn-Kekana L. Soc Sci Med 2002; 55(9): 1603-1617.

Correspondence: Rachel Jewkes, Gender and Health Group, Medical Research Council, Private Bag X385, 0001, Pretoria, SOUTH AFRICA; (email: rachel.jewkes@mrc.ac.za).

In 1998 a cross-sectional study of violence against women was undertaken in three provinces of South Africa. The objectives were to measure the prevalence of physical, sexual and emotional abuse of women, to identify risk factors and associated health problems and health service use. A multi-stage sampling design was used with clusters sampled with probability proportional to number of households and households were randomly selected from within clusters. One randomly selected woman aged 18-49 years was interviewed in each selected home. Interviews were held with a total 1306 women, the response rate was 90.3% of eligible women. For the risk factor analysis, multiple logistic regression models were fitted from a large pool of candidate explanatory variables, while allowing for sampling design and interviewer effects. The lifetime prevalence of experiencing physical violence from a current or ex-husband or boyfriend was 24.6%, and 9.5% had been assaulted in the previous year. Domestic violence was significantly positively associated with violence in her childhood, her having no further education, liberal ideas on women's roles, drinking alcohol, having another partner in the year, having a confidant(e), his boy child preference, conflict over his drinking, either partner financially supporting the home, frequent conflict generally, and living outside the Northern Province. No significant associations were found with partners' ages, employment, migrant status, financial disparity, cohabitation, household possessions, urbanisation, marital status, crowding, communication, his having other partners, his education, her attitudes towards violence or her perceptions of cultural norms on women's role. The findings suggest that domestic violence is most strongly related to the status of women in a society and to the normative use of violence in conflict situations or as part of the exercise of power. We conclude by discussing implications for developing theory on causal factors in domestic violence. (Copyright © 2002 Elsevier Science)
Effect of abuse on health: results of a national survey.

Diaz A, Simantov E, Rickert VI. Arch Pediatr Adolesc Med 2002; 156(8):811-817.

Correspondence: Angela Diaz, Mount Sinai Adolescent Health Center, 320 E 94th St, New York, NY 10128, USA; (email: angela.diaz@msnyuhealth.org).

HYPOTHESIS: The magnitude of risk would be highest for those reporting both types of abuse compared with those reporting 1 type or none.

OBJECTIVE: To examine the independent associations between physical or sexual abuse or both and self-reported health status, mental health, and health-risk behaviors among a national school-based sample of adolescent girls.

DESIGN: A secondary data analysis of a cross-sectional survey.

SETTING: A nationally representative sample of 3015 girls in grades 5 through 12 from 265 public, private, and parochial schools (with an oversampling of urban schools) completed an anonymous survey conducted by the Commonwealth Fund Adolescent Health Survey.

PATIENTS OR OTHER PARTICIPANTS: Girls were eligible for this study if they responded to 2 questions assessing past physical and sexual abuse.

FINDINGS: Among the respondents, 246 (8%) reported a history of physical abuse; 140 (5%), sexual abuse; and 160 (5%), both. Logistic regression controlling for grade, ethnicity, family structure, and socioeconomic status found that those who reported both types of abuse compared with those who did not report any were significantly more likely to experience moderate to severe depressive symptoms (adjusted odds ratio [AOR], 5.10), moderate to high levels of life stress (AOR, 3.28), regular smoking (AOR, 5.90), regular alcohol consumption (AOR, 3.76), use of other illicit drugs in the past 30 days (AOR, 3.44), and fair to poor health status (AOR, 1.74). Finally, girls who reported both types of abuse were 2.07 times more likely to report moderate to high depressive symptoms compared with those reporting only sexual abuse (95% confidence interval, 1.14-3.74).

DISCUSSION: The magnitude of risk for adolescents reporting both types of abuse compared with no abuse is much greater than that for either abuse type alone. However, compared with both types, no significant increase in risk was detected in those reporting physical abuse only, and only depressive symptoms increased in those reporting sexual abuse only. (Copyright © 2002 American Medical Association)
Children's reports of emotional, physical and sexual maltreatment by educational staff in Israel.

Benbenishty R, Zeira A, Astor RA. Child Abuse Negl 2002; 26(8): 763-782.

Correspondence: Rami Benbenishty, Paul Baerwald School of Social Work, Hebrew University of Jerusalem, ISRAEL; (email: msrami@mscc.huji.ac.il).

OBJECTIVES: This paper reports on the first nationally representative study on the prevalence of emotional, physical, and sexual victimization of children by school staff in Israel. The study identifies groups of children that are at higher risk for such maltreatment. We examine the differences in staff-induced victimization by the children's gender, age group (junior high vs. high school), cultural groups (Jewish non-religious, Jewish-religious and Arab schools) and by socioeconomic status of the children's families.

METHOD: The study is based on a nationally representative sample of 10,410 Israeli students in Grades 7-11 in 161 schools across Israel. Students completed questionnaires during class. In addition, we obtained data on the socioeconomic status of the families of the students in each school.

FINDINGS: Overall, children reported high rates of victimization by staff members. Almost a quarter of all children participating in this study reported being emotionally maltreated by a staff member, almost a fifth (18.7%) reported being a victim of at least one type of physical forms of maltreatment, and 8.2% reported on at least one sexually inappropriate behavior by a staff member. The most vulnerable groups for all types of maltreatment were males, children in junior high schools, children in Arab schools, and children in schools with a high concentration of students coming from low-income and low-education families.

CONCLUSIONS: The overall prevalence rates of staff maltreatment should be considered high and unacceptable. Although rates of physical and sexual maltreatment were lower than emotional maltreatment, they were still high and are worthy of greater attention. Both cultural beliefs and low family socioeconomic status increase vulnerability to staff maltreatment. We suggest conducting an educational campaign to reduce rates of staff maltreatment. We also recommend allocating more resources to support staff in low SES neighborhoods, to alleviate their stress and to provide them with the support that would reduce maltreatment of children in the educational system.
Children Who Witness Violence, and Parent Report of Children's Behavior.

Augustyn M, Frank DA, Posner M, Zuckerman B. Arch Pediatr Adolesc Med 2002; 156(8):800-803.

Correspondence: Marilyn C. Augustyn, Boston University Medical Center, Maternity 5, One BMC Pl, Boston, MA 02118, USA; (email: augustyn@bu.edu).

OBJECTIVES: To examine how much distress children report in response to violence that they have witnessed and how this is associated with parental reports of children's behavior. METHODS: As part of a study of in utero exposure to cocaine, children completed the Levonn interview for assessing children's symptoms of distress in response to witnessing violence. The children's caregivers completed the Exposure to Violence Interview (EVI), a caretaker-report measure of the child's exposure to violent events during the last 12 months. The EVI was analyzed as a 3-level variable: no exposure, low exposure, and high exposure. The caregivers also completed the Children's Behavior Checklist (CBCL). RESULTS: Of 94 six-year-old children, 58% had no exposure to violence, 36% had low exposure to violence, and 6% had high exposure to violence, according to caretaker reports. The children's median+/-SD Levonn score was 64 (SD +/- 19.3). The mean SD +/- CBCL total T-score was 53 (SD +/- 10.2). In multiple regression analyses with gender, low and high exposure on EVI, Levonn, and prenatal cocaine exposure status as predictors, the Levonn score explained 4.8% of total variance in children's CBCL internalizing scores, 9.1% of the total variance in CBCL externalizing score, and 12.2% of the total variance in CBCL total score (P =.04, P =.004, and P < .001, respectively). CONCLUSIONS: After accounting for the caretaker's report of the level of the child's exposure to violence, the child's own report significantly increased the amount of variance in predicting child behavior problems with the CBCL. These findings indicate that clinicians and researchers should elicit children's own accounts of exposure to violence in addition to the caretakers' when attempting to understand children's behavior. (Copyright © 2002 American Medical Association)
Prevalence of youth access to alcohol or a gun in the home.

Swahn MH, Hammig BJ, Ikeda RM. Inj Prev 2002; 8(3): 227-230.

Correspondence: Monica H Swahn, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341-3724, USA; (email: zfa4@cdc.gov).

OBJECTIVES: To estimate the national prevalence of youth access to alcohol, a gun, or both alcohol and a gun, in their home and to describe the demographic characteristics associated with access to either alcohol or a gun.

METHODS: Cross sectional data from the 1995 in-home survey of the National Longitudinal Study of Adolescent Health, which used a nationally representative randomly selected school based sample (n=18 924) of adolescents in grades 7-12, were analyzed. The current analyses were restricted to those adolescents 12-18 years of age (n=18 454). Crude logistic regression analyses was used to determine the demographic characteristics associated with access to alcohol or a gun in the home.

FINDINGS: Overall, 28.7% of US adolescents reported having easy access to alcohol in the home. Availability of alcohol was associated with race/ethnicity, mother's education, family structure, and welfare status. Similarly, 24.3% of US adolescents reported easy access to a gun in the home. Availability of a gun in the home was associated with gender, race/ethnicity, mother's education, family structure, and welfare status. Among those that reported that a gun was available in their home, most reported availability of a shotgun (63.0%) followed by a rifle (61.3%), handgun (57.3%), and other gun (16.4%). Ten per cent of adolescents reported availability of both alcohol and a gun in their home.

DISCUSSION: One quarter of US adolescents reported easy access to either alcohol or a gun in their home. Given the risks associated with the misuse of alcohol and guns among adolescents, efforts to increase public awareness of the availability of alcohol and guns in the home are needed. (Copyright © 2002 BMJ Publishing Group)
Assessing adolescents who threaten homicide in schools.

Twemlow SW, Fonagy P, Sacco FC, Vernberg E. Am J Psychoanal 2002; 62(3): 213-235.

Correspondence: Stuart W. Twemlow, Child and Family Center, Menninger Clinic, Topeka, Kansas, USA; (email: stwemlow@aol.com).

Psychoanalytic and psychiatric perspectives on children who threaten to kill others are reviewed in the context of the need for an interdisciplinary approach to the problem. Converging technologies derived from a psychoanalytically informed social systems model are compared to law enforcement approaches, psychoanalytic understanding of the individual dynamics of the child, and empirical research on conduct disordered adolescents. The interdisciplinary orientation of a broadly trained community psychoanalyst allows a unique contribution when trying to distinguish adolescents who make a threat from those who pose a threat. Case vignettes are used to illustrate the hypotheses.
Conflict resolution and peer mediation in middle schools: extending the process and outcome knowledge base.

Smith SW, Daunic AP, Miller MD, Robinson TR. J Soc Psychol 2002; 142(5): 567-586.

Correspondence: Stephen W. Smith, Department of Special Education, University of Florida, Gainesville 32611, USA; (email: swsmith@coe.ufl.edu).

Many professional educators are implementing school-based prevention focused on conflict resolution (CR) and peer mediation (PM). The authors conducted research on CR-PM in 3 middle schools. Specifically, they surveyed teachers and students, tracked disciplinary incidents across school years, collected mediation data, and compared mediators with a matched sample to determine attitudinal change as a result of PM training and experience. The authors also surveyed peer mediators and disputants about program satisfaction, as well as peer mediators and their parents about the generalization of PM skills. The authors conclude with implications for developing future CR programs, including a focus on mediation-process evaluation as well as schoolwide outcome measures and the use of peer mediation training as an intervention for students at risk. (Copyright © 2002 Heldref Publications)

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