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14 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.
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Alcohol consumption and incidence of workers' compensation claims: a 5-year prospective study of urban transit operators.
Ragland DR, Krause N, Greiner BA, Holman BL, Fisher And JM, Cunradi CB. Alcohol Clin Exp Res 2002; 26(9): 1388-1394.
Correspondence: David R. Ragland, David R. Ragland, PhD, MPH, School of Public Health, 140 Warren Hall #7360, University of California, Berkeley, CA 94720-7360; Fax: 510-643-9922; E-mail: davidr@uclink4.berkeley.edu.
BACKGROUND Numerous studies have linked alcohol impairment on the job to occupational injury. Few studies have looked at the association of nonwork drinking and occupational injury.
METHODS This study examines first workers' compensation claims after a baseline assessment of alcohol consumption and other occupational variables in 1836 transit operators participating in a medical examination for driver's license renewal. A proportional hazard model was used for the analysis.
RESULTS Individuals with higher alcohol consumption were more likely to be male, have more years of driving, and have a higher job-stress score. When these variables were controlled for, individuals with higher alcohol consumption were more likely to have a workers' compensation claim over the follow-up period. Individuals reporting a consumption of 10 to 14 drinks per week had a hazard of 1.30 ( = 0.03), and those reporting 15 or more drinks per week had a hazard of 1.27 ( = 0.05) compared with individuals reporting no drinks consumed per week.
CONCLUSIONS This study indicates that drinking off the job is associated with workers' compensation injury claims. Because it is presumed that most drinking was done outside work, due to high public scrutiny of city transit operators, these results suggest that experience in life outside of work may influence work outcomes. Research should be conducted to identify the mechanisms (e.g., drinking before work, hangover, fatigue) of such effects. (Copyright © 2002 Lippincott Williams & Wilkins)
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The role of the New Zealand forest industry injury surveillance system in a strategic ergonomics, safety and health research programme.
Bentley TA, Parker RJ, Ashby L, Moore DJ, Tappin DC. Appl Ergon 2002; 33(5):395-403.
Correspondeence:Tim Bentley, Department of Management and International Business, Massey University, Albany Campus, Auckland, NEW ZEALAND; (email: t.a.bentley@massey.ac.nz).
Forestry is among the most hazardous of all industry sectors internationally. In New Zealand, highest work-related morbidity and mortality incidence rates are found in the logging sector. The New Zealand Forest Industry Accident Reporting Scheme (ARS) is a forestry injury surveillance system maintained by the Centre for Human Factors and Ergonomics (COHFE). The paper highlights the pivotal role of an industry-wide injury surveillance system in an industry-specific strategic research programme, giving examples of the use of ARS data in identification of priority areas for ergonomics, safety and health research attention, for safety awareness feedback to the industry, and in the evaluation of injury countermeasures. An analysis of injury patterns and trends for one high-risk forestry operation (skid work) is presented to illustrate both the capabilities and limitations of the ARS in its present stage of development. (Copyright © 2002 Elsevier Science)
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Driveway-related motor vehicle injuries in the paediatric population: a preventable tragedy.
Murphy F, White S, Morreau P. N Z Med J 2002; 115(1160): U148
Feilim Murphy, Department of Paediatric Surgery, The Starship Children's Hospital, Auckland, NEW ZEALAND; (email: unavailable).
AIM: To describe the incidence and demographics of children injured by slow-moving vehicles in Auckland driveways in order to develop preventative strategies.
METHODS: We retrospectively reviewed all children less than 15 years, 76 in total, who were injured by a vehicle in a driveway within Auckland between January 1998 and October 2001. Patient demographics and risk factors were identified by clinical note review, contacting the parents, and inspecting the driveways involved.
RESULTS: These injuries occur most commonly in children less than 4 years old (86%), usually boys (58%), who are reversed over by a relative (68%) at the home driveway (71%). There were six deaths within the study period. Head and thoracic injuries predominated and were typically associated with lower limb injuries. Maori and Pacific Island children represented 74% of all the cases. Nineteen drivers saw the child immediately prior to reversal in a presumed safe position. None of the driveways had any fencing to separate the driveway from rest of the property.
CONCLUSIONS: A combination of targeted public health messages to increase awareness, safer driveway design and the fencing of domestic rental properties will prevent these injuries.
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Bicycle helmet-wearing variation and associated factors in Ontario teenagers and adults.
Irvine A, Rowe BH, Sahai V. Can J Public Health 2002; 93(5):368-373.
Correspondence: A Irvine, Northern Health Information Partnership, 199 Larch Street, Suite 1104, Sudbury, ON P3E 5P9, CANADA (email: unavailable)
BACKGROUND: The incidence of bicycle helmet use and the factors associated with helmet use in Ontario are presented in this study. The Ontario Health Survey (1996), a population-based survey of Ontario residents, was used as the data source.
METHODS: As the factors associated with helmet use were found to differ between adults and teens, a separate analysis was performed for each age grouping. A logistic regression model (with Bootstrap confidence intervals--95%) was used and adjusted odds ratios (OR) are reported.
RESULTS: Of the 7,693 respondents, 41.1% reported wearing their helmets on a regular basis when riding a bicycle. Helmet use was greatest among 12-14 year olds (71.7%) and lowest among those 15-18 years old (33.3%). In teenagers, drinking alcohol (OR: 2.8) and smoking (OR: 4.4) were strongly associated with helmet non-use. In the adult group, female gender (OR: 1.26), higher income (OR: 1.43), higher education (OR: 1.68), nonsmoking status (OR: 2.0) and abstinence from alcohol (1.27) were associated with helmet use. Living in a rural area was also associated with helmet use in the multi-variable analysis.
CONCLUSION: This study indicates that bicycle helmet non-use is a multifaceted problem and thus any strategy for increasing helmet-wearing rates requires multi-dimensional interventions. The results of this study are discussed within the context of other studies and related to their public health implications.
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Surveillance of drug identification calls: an overlooked poison center responsibility.
Mrvos R, Krenzelok EP. Vet Hum Toxicol 2002; 44(5): 294-295.
Correspondence: Rita Mrvos, Pittsburgh Poison Center, Children's Hospital of Pittsburgh, PA 15213, USA; (email: mrvosr@chplink.chp.edu)
Drug identification calls from the lay public are a source of annoyance to many poison centers, but they also provide valuable information about abused and diverted pharmaceuticals. Daily toxicosurveillance can identify significant problems in advance of being recognized by law enforcement and drug diversion task forces. At our center a single person daily reviews evey chart for recognition of drug identification trends. In February the center received its first reQuest for identification of a tablet with M360 imprint, a generic product that contained 7.5 mg hydrocodone + 750 mg acetaminophen (Mallinckrodt). In 21 d after that identification, 78 additional identification reQuests, and during 2 mo further, a total of 222 requests for M360 identification were received. Law enforcement officials were notified and allowed drug intelligence to determine how this legal pharmaceutical was being diverted for illicit use. Poison Centers provide valuable drug identification service. Realtime surveillance of these calls can provide important information about drug abuse patterns
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Injury prophylaxis in paragliding.
Schulze W, Richter J, Schulze B, Esenwein SA, Buttner-Janz K. Br J Sports Med 2002; 36(5): 365-369.
Correspondence: Wito Schulze, Orthopädische Klinik, Klinikum Hellersdorf, Myslowitzer Str 45, D-12621 Berlin, GERMANY;
Schulzenhaus@web.de).
OBJECTIVES: To show trends in paragliding injuries and derive recommendations for safety precautions for paraglider pilots on the basis of accident statistics, interviews, questionnaires, medical reports, and current stage of development of paragliding equipment. METHODS: All paragliding accidents in Germany have to be reported. Information on 409 accidents was collected and analysed for the period 1997-1999. RESULTS: There was a substantial decrease in reported accidents (166 in 1997; 127 in 1998; 116 in 1999). The number of accidents resulting in spinal injuries was 62 in 1997, 42 in 1998, and 38 in 1999. The most common cause of accident was deflation of the glider (32.5%), followed by oversteering (13.9%), collision with obstacles (12.0%), take off errors (10.3%), landing errors (13.7%), misjudgment of weather conditions (4.9%), unsatisfactory preflight checks (4.9%), mid-air collisions with other flyers (2.2%), accidents during winching (2.2%), and defective equipment (0.5%). Accidents predominantly occurred in mountain areas. Fewer than 100 flights had been logged for 40% of injured pilots. In a total of 39 accidents in which emergency parachutes were used, 10 pilots were seriously injured (26%) and an additional three were killed (8%). CONCLUSIONS: Injuries in paragliding caused by unpredictable situations can be minimised by (a) using safer gliders in the beginner or intermediate category, (b) improving protection systems, such as padded back protection, and (c) improving pilot skills through performance and safety training. (Copyright © 2002 BMJ Publishing Group)
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Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99.
Nguyen MH, Annest JL, Mercy JA, Ryan GW, Fingerhut LA. Inj Prev 2002; 8(3): 185-191.
Correspondence: Lee Annest, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; USA; (email: lannest@cdc.gov).
OBJECTIVE: To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts.
SETTING: The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually.
METHODS: National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS.
RESULTS: BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881-17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments.
CONCLUSIONS: BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations. (Copyright © 2002 Injury Prevention and BMJ Publishing Group)
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Adjusting our view of injury risk: the burden of nonfatal injuries in infancy.
Powell EC, Tanz RR. Pediatrics 2002; 110(4): 792-796.
Correspondence: Elizabeth C. Powell, Division of Pediatric Emergency Medicine, Box 62, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614, USA; (email: epowell@northwestern.edu).
OBJECTIVE: To describe the incidence, external cause, and types of injuries among infants treated in US emergency departments (EDs) and to compare the external cause of nonfatal to fatal injuries.
DESIGN: ED survey from the National Center for Health Statistics (NCHS) National Hospital Ambulatory Medical Care Survey for 1992-1999 and NCHS mortality data.
PATIENTS: National probability sample of patients treated in EDs; data for children <1 year old were used.
OUTCOME MEASURES: Incidence and external cause of nonfatal injury among infants. Rates were calculated using NCHS data for live births.
RESULTS: The 8-year annualized, weighted estimate of infant injuries was 426 957, a rate of 108.2 per 1000 infant years (95% confidence interval [CI]: 94.8-121.5). There were no significant differences in rates by sex, race, or ethnicity. An estimated 6% were admitted to the hospital (admission rate: 6.1 per 1000). Most injuries occurred in the home. Head trauma accounted for injuries in 12% of children (injury rate: 13.4 per 1000 per year [95% CI: 9.3-17.3]; 21% of children with head trauma had a skull fracture or an intracranial injury. An estimated 30.2 per 1000 (95% CI: 23.8-36.6) had face trauma and 23.9 per 1000 (95% CI: 18.2-29.6) had extremity injuries; open wounds or superficial injuries accounted for many of these injuries. An estimated 4% had extremity fractures (annual rate: 4.6/1000). Falls were the most frequent cause of injury (an estimated 35.1 per 1000 infant years). The rate of motor vehicle traffic injuries was 8.8 per 1000. Foreign bodies accounted for an estimated 5.2 injuries and poisonings for an estimated 3.8 injuries per 1000 infant years. A comparison with infant mortality data showed the ratio of nonfatal to fatal falls to be 8789:1. The ratio of nonfatal to fatal motor vehicle traffic injuries was 197:1. There were an estimated 1271 nonfatal poisonings for each poisoning fatality.
CONCLUSIONS: Nonfatal injuries far outnumber fatalities. Injuries from falls are very common, but they are rarely fatal. Surveillance of nonfatal injuries is essential to accurately describe and understand the burden of injury among infants. Prevention strategies must be developed to address extremely frequent, less serious injuries in infancy. (Copyright © 2002 American Academy of Pediatrics)
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Penetrating injuries in children: Is there a message?
Holland A, Kirby R, Browne G, Ross F, Cass D. J Paediatr Child Health 2002; 38(5):487-491.
Correspondence: Andrew Holland, Department of Academic Surgery, Douglas Cohen Department of Paediatric Surgery and Department of Emergency Medicine, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, AUSTRALIA; (email: AndrewH3@chw.edu.au).
OBJECTIVES: To determine the frequency, management and outcome of penetrating trauma in children. METHODS: A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded. RESULTS: Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades. CONCLUSIONS: Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors. (Copyright © 2002 Blackwell Science)
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How old is that child? Validating the accuracy of age assignments in observational surveys of vehicle restraint use.
Moeller S, Berger L, Salvador JG, Helitzer D. Inj Prev 2002; 8(3): 248-251.
Correspondence: Deborah Helitzer, Office of Evaluation, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA; (email: helitzer@umn.edu).
OBJECTIVES: Many large scale observational studies of child restraint usage require observers to estimate the ages of the vehicle occupants. The accuracy of age assignments were assessed and possible methods to improve observational accuracy in research and field studies of child restraint use were identified.
METHODS: The validation study was performed at fast food restaurants in a metropolitan area. Three, two person teams observed 449 occupants of vehicles with at least one child passenger. The drivers were then interviewed to obtain the actual ages of the vehicle occupants. The primary outcome measure was the per cent of age assignments that were correct by age category (infant, toddler, school age, teen, adult). The observers had previously conducted a statewide child restraint observation study and were trained in estimating age categories.
RESULTS: A total of 391 (87%) of the 449 occupants were assigned to their correct age categories. Incorrect assignments were more common among infants (22% incorrect), but few infants (nine) were observed. The most frequent error was classifying adults (19 years and older) as teenagers (13-18 years). CONCLUSION: Trained, experienced observers approached 90% accuracy in their assignment of children to specific age categories.
Additional study is required to determine whether these results are applicable to different age categories and observers. It is recommended that the National Highway Traffic Safety Administration, the Centers for Disease Control and Prevention, state and local agencies, and other sponsors of observational surveys consider observer competence as an important variable. The validity of age assignments can be assessed by randomly interviewing a sample of drivers. More accurate age estimates will improve decisions regarding prevention programs, funding, and policies. (Copyright © 2002 Injury Prevention and BMJ Publishing Group)
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Epidemiological data and ranking home and leisure accidents for priority-setting.
Mulder S, Blankendaal F, Vriend I, Schoots W, Bouter L. Accid Anal Prev 2002; 34(5): 695-702.
Consumer Safety Institute, Amsterdam, THE NETHERLANDS; (email: s.mulder@consafe.nl)
OBJECTIVE: To determine how to use the multitude of available epidemiological data to rank accidents for prioritisation of prevention.
METHODS: A stepwise method to rank accidents for priority-setting at any time is proposed. The first step is to determine the overall objectives of injury prevention. Based on these objectives, the relevant epidemiological criteria are determined. These criteria need to be weighed by experts in such a way that these weights can be used for every new cycle of priority-setting. Thus, every time the method is applied: first, the relevant types of accidents are identified; second, the epidemiological criteria are determined per type of accident; and third, the types of accidents are ranked by means of standardised weights per criterion. The proposed indirect method is illustrated by an empirical example. The results were compared with a direct method, i.e. ranking by an expert panel.
RESULTS: In the pilot, we ranked four age groups of victims of a home and leisure accident: 0-4, 4-19 and 20-54 years of age, and victims aged 55 years or older. The resulting rankings differ largely per application; number one are victims older than 55 years or those of 20-54 years.
CONCLUSIONS: The proposed method enables a structured, transparent way to set priorities for home and leisure accidents. It is a promising method, although further development is clearly necessary, based on the actual application of the model. (Copyright © 2002 Elsevier Science)
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Study of the effectiveness of the US safety standard for child resistant cigarette lighters.
Smith LE, Greene MA, Singh HA. Inj Prev 2002; 8(3): 192-196.
Correspondence: Linda E. Smith, Hazard Analysis Division, Directorate for Epidemiology, US Consumer Product Safety Commission, Bethesda, Maryland, USA; (email: lsmith@cpsc.gov).
OBJECTIVE: The purpose of this research is to evaluate the effectiveness of the US Consumer Product Safety Commission's (CPSC) Safety Standard for Cigarette Lighters, which requires that disposable cigarette lighters be resistant to operation by children younger than age 5.
METHODS: Fire data on children playing with lighters were solicited from selected US fire departments for incidents occurring from 1997-99, to identify the proportion of such fires caused by children younger than age 5 playing with cigarette lighters. These data were compared with similar data from 1985-87. An odds ratio was used to determine if there was a significant decrease in cigarette lighter fires caused by children younger than age 5 compared to children ages 5 and older. To estimate fires that would have occurred without the standard, the odds ratio, adjusted for population, was applied to 1998 national estimates of fires occurring. National estimates of 1998 fire losses were based on data from the National Fire Incident Reporting System and the National Fire Protection Association to which the 1997-99 age and lighter type distributions were applied. The difference between the fire losses that would have occurred and those that did occur represented fire losses prevented.
RESULTS: In the post-standard study, 48% of the cigarette lighter fires were started by children younger than age 5, compared with 71% in the pre-standard study. The odds ratio of 0.42 was statistically significant (p < 0.01). This represented a 58% reduction in fires caused by the younger age group compared to the older age group. When applied to national fire loss data, an estimated 3300 fires, 100 deaths, 660 injuries, and $52.5 million in property loss were prevented by the standard in 1998, totaling $566.8 million in 1998 societal savings.
CONCLUSIONS: The CPSC standard requiring child resistant cigarette lighters has reduced fire deaths, injuries, and property loss caused by children playing with cigarette lighters and can be expected to prevent additional fire losses in subsequent years. (Copyright © 2002 Injury Prevention and BMJ Publishing Group)
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Fatalities in farming and forestry: an examination of the registry information used in the Swedish national statistics, 1988-1997.
Thelin A. J Agric Saf Health 2002; 8(3): 289-295.
Correspondence: Anders Thelinb, The Swedish Farmers' Safety and Preventive Health Association, and the Department of Public Health, Karolinska institutet, Stockholm, SWEDEN; (email: athelin@wgab.se).
In Sweden, work-related injuries are filed in the ISA, a national information system. The Occupational Safety and Health Administration is responsible for this registry, and local units of the ISA and the Labor Inspectorate provide the information. The risk of dying in a work-related accident is greatestfor those employed in farming and forestry. At the same time, small-scale industries such as farms and other entrepreneurial businesses have difficulties in reporting accidents. It is therefore possible that the registry is incomplete and/or has many errors with respect to this kind of occupational activity. Thus, it is of interest to study the ISA in this area. This study was carried out using information obtainedfrom the Labor Inspectorate (LI), the police, the occupational health service, and local persons. Errors were traced in 28 cases (17%), and at least one piece of necessary information was missing in 165 cases of a total of 167. Approximately 14% of the cases had such fundamental errors that the case should be withdrawn from the registry. Most of the errors concerned the victim's occupation/profession and the kind of work being done at the time of the accident. In order to be an adequate instrument for use in prevention work, the ISA files must be more complete. This is of special importance with respect to the characteristics of the events. At the same time, the number of errors should be reduced. (Copyright © 2002 American Society of Agricultural Engineers)
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Birth cohort effects in New South Wales suicide, 1865-1998.
Morrell S, Page A, Taylor R. Acta Psychiatr Scand 2002; 106(5): 365-372.
Correspondence: Richard Taylor, School of Public Health, University of Sydney, Edward Ford Building, A27, University of Sydney, NSW 2006, AUSTRALIA; (email: richardt@pub.health.usyd.edu.au).
OBJECTIVE: To examine birth cohort effects in New South Wales (NSW) suicide data (1865-1998).
METHOD: Aggregate suicide data were examined after controlling for age and period using descriptive statistics and Poisson regression modelling. Three approaches were applied to address the non-identification of age, period and cohort in age-period-cohort (APC) models of suicide.
RESULTS: Apparent cohort effects in male and female suicide using a minimum constraints APC model of age, period and cohort were no longer present in female suicide when a surrogate period APC model was used, and were absent in both male and female suicide when identifiable cohort effects were isolated using a 'drift' adjusted approach to APC modelling.
CONCLUSION: Increases in youth suicide rates in NSW occurring since the 1960s cannot be attributed to cohort effects, such as family influences on development. The causes of youth suicide are thus effects operating contemporaneously. (Copyright © 2002 Blackwell Munksgaard)
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Are booster seats needed: comparing occupant outcomes ages 4-7 versus 8-13.
Miller T, Zaloshnja E, Sheppard M. Annu Proc Assoc Adv Automot Med Conf 2002; 46: 249-259.
Ted R. Miller, Pacific Institute for Research & Evaluation, Calverton, Maryland, USA; (email: miller@pire.org).
Booster seat laws are premised on the need to improve seat belt fit for young children to reduce their injury risk. This paper provides the first extensive examination of national crash data for children in seat belts. Using regression and other models, we found no evidence that crash-involved children ages 4-7 in lap-shoulder belts fare worse on average than similarly restrained children ages 8-13 or, in sensitivity analysis, than similarly restrained adults ages 18-34. If anything, they may fare better.
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Barriers to booster seat use and strategies to increase their use.
Simpson EM, Moll EK, Kassam-Adams N, Miller GJ, Winston FK. Pediatrics 2002; 110(4): 729-736.
Correspondence: Flaura K. Winston, Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, 3535 TraumaLink, 10th Fl, Philadelphia, PA 19104, USA; (email: flaura@mail.med.upenn.edu).
OBJECTIVE: Children who have outgrown child safety seats and been placed in adult seat belts are at increased risk for injury. Pediatricians and other advocates have been called on to encourage booster seat use in these children. The objective of this study was to identify barriers to booster seat use and strategies to increase their use.
METHODS: A qualitative study consisting of focus groups and follow-up in-depth discussions were conducted among parents and/or children to elicit barriers and strategies to appropriate/best practice child restraint system use. Phase I focus groups (parents and children) identified barriers to booster seat use along with children's self-reported likes and dislikes about booster seats. Phase II focus groups (parents only) identified additional barriers to booster seat use and suggestions for strategies to increase the use of booster seats. In-depth telephone discussions (parents only) were conducted after each phase of focus groups to identify new themes and to explore further previously emerged topics that were not conducive to probing in focus group settings.
RESULTS: This study demonstrated that although knowledge of the benefits and purpose of booster seats is an important issue in promoting booster seat use, it is not the only issue. In particular, differences in risk perception, awareness/knowledge, and parenting style were noted when comparing parents of children in booster seats with those whose children were in seat belts. Media campaigns, improved laws, parenting education, and extending the use of child restraints to older ages were among the strategies suggested by parents to increase booster seat use.
CONCLUSIONS: Anticipatory guidance regarding booster seats may be new for many pediatricians. This article arms pediatricians with insights from parents about their perceptions regarding booster seats and how parents think that the booster seat message can be most effectively delivered. Furthermore, it gives insight into how parents make safety decisions for their children and the important role of children in this decision-making process. (Copright © 2002 American Academy of Pediatrics)
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Promoting parental management of teen driving.
Simons-Morton BG, Hartos JL, Leaf WA. Inj Prev 2002; 8:(Suppl 2): 24-30.
Correspondence: B.G. Simons-Morton, Prevention Research Branch, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd, 7B05 Bethesda, MD 20892-7510, USA; (email: mortonb@mail.nih.gov).
OBJECTIVE: Parenting may be an important protective factor against teen driving risk; however, parents do not limit teen driving as much as might be expected. The Checkpoint Program was designed to promote parental management of teen driving through the use of staged persuasive communications.
METHODS: Parent-teen dyads (n = 452) were recruited when teens received learner's permits and interviewed over the telephone at baseline, licensure, and three months post-licensure. After baseline, families were randomized to either the intervention group that received persuasive communications or to the comparison group that received general information about driving safety.
RESULTS: Both parents and teens in the intervention group reported significantly greater limits on teen driving at licensure and three months post-licensure. In multivariate analyses, intervention and baseline driving expectations had significant effects on driving limits at licensure. Intervention and driving limits established at licensure were associated with three month driving limits.
CONCLUSION: The findings indicate that exposure to the Checkpoints Program increased parental limits on teen driving. (Copyright © 2002 Injury Prevention and BMJ Publishing Group)
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Rationale for graduated licensing and the risks it should address.
Williams AF, Ferguson SA. Inj Prev 2002; 8:(Suppl 2): 9-16.
Correspondence: Alan F. Williams, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201, USA; (email: awilliams@iihs.org).
The increased crash risk of young, beginning drivers has long been cause for concern. Graduated licensing systems, which seek to phase in driving experience gradually over time, have recently been adopted by many states in an effort to reduce these risks. In an attempt to define the basic rationale for graduated licensing, relevant research evidence that describes the conditions under which risk is known to be increased for young drivers was reviewed. Potential changes in licensing laws that best address these known risk factors are described. It was found that certain situations contribute to even greater crash risk, most notably nighttime driving and driving with passengers in the peer group. The underlying premise for graduated licensing is that while crash risk of young drivers is heightened under all situations, some situations are more or less risky than others. If experience can be gained initially under lower risk conditions, both in the learning stage and when first licensed, crash risk will be reduced. (Copyright © 2002 Injury Prevention and BMJ Publishing Group)
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The safety value of driver education an training.
Mayhew DR, Simpson HM. Inj Prev 2002; 8:(Suppl 2): 3-8.
Correspondence: Daniel R. Mayhew, Traffic Injury Research Foundation (TIRF), Ottawa, Ontario, Canada. Highway Safety Research Center, Indiana University of Pennsylvania, R&P Building or Robert Shaw Building, Indiana, PA 15705-1092, USA; (email: danm@trafficinjuryresearch.com).
BACKGROUND: New drivers, especially young ones, have extremely high crash rates. Formal instruction, which includes in-class education and in-vehicle training, has been used as a means to address this problem.
OBJECTIVES: To summarize the evidence on the safety value of such programs and suggest improvements in program delivery and content that may produce safety benefits.
METHODS: The empirical evidence was reviewed and summarized to determine if formal instruction has been shown to produce reductions in collisions, and to identify ways it might achieve this objective.
RESULTS: The international literature provides little support for the hypothesis that formal driver instruction is an effective safety measure. It is argued that such an outcome is not entirely unexpected given that traditional programs fail to address adequately the age and experience related factors that render young drivers at increased risk of collision.
CONCLUSIONS: Education/training programs might prove to be effective in reducing collisions if they are more empirically based, addressing critical age and experience related factors. At the same time, more research into the behaviors and crash experiences of novice drivers is needed to refine our understanding of the problem. (Copyright © 2002 Injury Prevention and BMJ Publishing Group)
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Maxillofacial injuries caused by terrorist bomb attack in Nairobi, Kenya.
Odhiambo WA, Guthua SW, Macigo FG, Akama MK. Int J Oral Maxillofac Surg 2002; 31(4): 374-377.
Correspondence: Walter A. Odhiambo, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Nairobi, PO Box 19676, Nairobi, KENYA; (email: Wodhis@healthnet.or.ke).
Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team. (Copyright © 2002 Elsevier Science / International Association of Oral & Maxillofacial Surgeons)
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Prevalence of battering among 1780 outpatients at an internal medicine institution in Mexico.
Diaz-Olavarrieta C, Ellertson C, Paz F, de Leon S, Alarcon-Segovia D. Soc Sci Med 2002; 55(9): 1589-1602.
Correspondence: Claudia Díaz-Olavarrieta, Instituto Nacional de Neurologia y Neurocirugia, Insurgentes Sur 3877, Mexico DF, 14269, MEXICO; (email: claudido@hotmail.com
Violence against women has recently drawn attention in the medical community as a leading cause of preventable morbidity and mortality. Specific algorithms designed to identify women at risk can be applied to create an opportunity for screening, diagnosis and treatment during medical care initiated for common conditions. This study investigated the incidence and history of battering among women seeking general medical care, and looked for potential risk factors and associations with presenting symptoms. We used a self-administered, anonymous survey to question 1780 adult female outpatients visiting a tertiary care internal medicine teaching hospital in Mexico City. We calculated current abuse (physical and/or sexual abuse by a partner within the past year), abuse during pregnancy, childhood abuse, and lifetime abuse. We found levels of violence against women in Mexico comparable to those reported from other countries. 152 women (9%) reported current physical and/or sexual abuse. An identical number also reported abuse during pregnancy. Lifetime prevalence was 41%. Women currently or previously abused reported more physical symptoms in the last six months than did non-abused participants. Pelvic pain, depression, headache and substance abuse were frequent among abused women. Currently abused women also scored higher (p < 0.01) on indicators of depression. Current abuse correlated strongly with a childhood history of physical and/or sexual abuse, with low educational level of the victim, with substance abuse by the partner or by the woman herself, and with higher parity. (Copyright © 2002 Elsevier Science)
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Who's at risk? Factors associated with intimate partner violence in the Philippines.
Hindin M, Adair L. Soc Sci Med 2002; 55(8): 1385-1399.
Correspondence: Michelle J. Hindin, Department of Population and Family Health Sciences, The Bloomberg School of Public Health, The Johns Hopkins University, 650 N Wolfe Street, E4139, 21205, Baltimore, MD, USA; (email: mhindin@jhsph.edu
We describe the individual and household characteristics associated with intimate partner violence (IPV) in the Philippines, using data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS). We also examine 56 in-depth interview transcripts to explore the context of IPV. We focus our analysis on patterns of household decision-making as a measure of the interpersonal dynamics between husbands and wives. Thirteen percent of women in our sample reported IPV. While economic factors are often implicated in the cycle of violence in households, we find employment status and relative earnings do not predict IPV. Lower levels of household wealth and urban residence are associated with a higher likelihood of IPV. Patterns of household decision-making emerge as strong predictors of violence. The greater the number of decision-making domains men dominate, the more likely they are to use IPV; however, we also find that when women dominate household decisions, they are also more likely to experience IPV. Only 6% of women reported IPV when all household decisions were made jointly compared to 25% when no decisions were made jointly. (Copyright © 2002 Elsevier Science)
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Social capital and violence in the United States, 1974-1993.
Galea S, Karpati A, Kennedy B. Soc Sci Med 2002; 55(8): 1373-1383.
Correspondence: Sandro Galea, Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 5th Avenue, Room 556, New York, NY 10029, USA; (email:sgalea@nyam.org).
Social capital is a characteristic of communities. Cross-sectional studies have shown that social capital is inversely associated with homicide and violent crime. We hypothesized that variations in social capital in US states over time can predict variations in regional homicide mortality both across and within time periods. We analyzed serial cross-sectional data for measures of social capital and age-adjusted homicide rates between 1974 and 1993. We used perception of social trust and per capita membership in voluntary associations, obtained from responses to the General Social Surveys, as the principal measures of social capital. We controlled for potential confounding by mean levels of income, urbanization, and region. Measures of perceived trust were strongly inversely correlated with homicide rates in an aggregate cross-sectional analysis (r=-0.51, p < 0.001) and also within each time period. Social capital was an independent predictor of rates of violence when controlling for income, region, and urbanization (p < 0.001). Homicide rates also predicted levels of social capital in adjusted models (p < 0.001). To investigate directionality of this relationship we developed Markov transition matrices that described the change in the states' levels of social capital and homicide across time intervals. Analysis of the transitional probabilities confirmed that a simple unidirectional association between social capital and violence was not sufficient to describe this association. There is likely an impact of violence on levels of perceived trust in communities that complements the hypothesized effect of social capital on homicide. We conclude that the relationship between social capital and violence over time is non-linear and dynamic. More complex analytic models describing the relationship between violence and ecological social determinants need to be considered. (Copyright © 2002 Elsevier Science)
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