SafetyLit Update: 4 November 2002

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4 November 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.

Rearrest Rates After Incarceration for DWI: A Comparative Study in a Southwestern US County.

Kunitz SJ, Woodall WG, Zhao H, Wheeler DR, Lillis R, Rogers E. Am J Public Health 2002 Nov;92(11):1826-1831.

Correspondence: W. Gill Woodall, Center on Alcoholism, Substance Abuse, and Addictions, The University of New Mexico, Albuquerque, NM 87106, USA; (email: gwoodall@umn.edu).

OBJECTIVES: This study was undertaken to assess a 28-day detention and treatment program's effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI).

METHODS: We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program.

RESULTS: Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%.

CONCLUSIONS: Results suggest that this county's program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites. (Copyright © 2002 American Journal of Public Health)
Alcohol-related human losses in Russia in the 1980s and 1990s.

Nemtsov AV. Addiction 2002; 97(11): 1413-1425.

Correspondence: A.V. Nemtsov, Moscow Research Institute of Psychiatry, Russian Federal Ministry of Public Health, 3 Poteshnaya Street, Moscow 107076, RUSSIA. (email: al-nemtsov@mtu-net.ru).

OBJECTIVES : The estimation of alcohol-related human losses in Russia in the 1980s and 1990s.

DESIGN: The estimation was made by comparing changes in the total number of deaths and in specific categories, and alcohol consumption in Russia during this time.

SETTING: The anti-alcohol campaign, launched in 1985, and the market reforms launched in 1992 were associated with large and rapid changes of alcohol -consumption in Russia.

FINDINGS: In the early 1980s, the aggregate number of direct and indirect alcohol-related life losses was more than 500 000 per annum, or 32% of total deaths. Half of the alcohol-related human losses in Russia over the period studied were due to accidents, poisoning and violence. Following the anti-alcohol campaign and reduction in annual per capita alcohol consumption from 14.2 (1984) to 10.5 l (1986), mortality decreased from 1161.6 to 1054.0 per 100 000 of the population. It is estimated that from 1986 to 1991 the lives of 1.22 million people were spared; that is, 11.4% of the number of deaths expected without the anti-alcohol campaign. All categories of deaths were reduced with the exception of neoplasms, infectious and parasitic diseases. In the period of the so-called market reforms both alcohol consumption and mortality increased sharply. The total number of alcohol-related deaths for 1994 was 751 000 in the population, or 33% of all deaths (direct and indirect losses). In 1995 alcohol consumption started to decrease. A decrease in mortality was registered despite the sharp deterioration of the quality of life in the country. However, a new growth of total mortality, fatal alcohol poisonings and number of alcohol psychoses began in 1999-2000.

CONCLUSION: The results of this study show the enormous scale of alcohol-related mortality in Russia. It has been revealed that alcohol-related deaths are at the top of the hierarchy of all premature deaths in the country. Decreasing alcohol consumption is an important means of decreasing total mortality in Russia. (Copyright © 2002 Society for the Study of Addiction - Blackwell Publishing)

Melatonin synthesis: A possible indicator of intolerance to shiftwork.

Griefahn B, Kunemund C, Golka K, Thier R, Degen G. Am J Ind Med 2002; 42(5): 427-36.

Correspondence: Barbara Griefahn, Institute for Occupational Physiology at the University of Dormund, Ardeystr. 67, Dortmund, GERMANY; (email: griefahn@ifado.de).

BACKGROUND: Shift work has been suggestes as a cohntributor to risk of injury.

HYPOTHESIS: Melatonin synthesis, which is directly controlled by the central circadian pacemaker indicates the circadian phase better than rectal temperature.

METHODS: Thirty four men (16-32 years, 7 morning, 13 neither, 14 evening types) performed a constant routine (24-26-hr bedrest, < 30 lux, 18-20 degrees C, hourly isocaloric diet). Salivary melatonin level was determined hourly and rectal temperature was continuously recorded.

RESULTS: The nadir of rectal temperature occurred 1.5 hr (P = 0.017), the onset of melatonin synthesis 3 hr earlier (P < 0.0001) in morning than in evening types. Morningness was not related to the quantitative but significantly to the temporal parameters, closer to those of melatonin than of rectal temperature.

CONCLUSIONS: The melatonin onset is a more reliable indicator of the diurnal type than the nadir of rectal temperature. As morningness has been associated with intolerance to shiftwork, melatonin profiling provides a suitable basis for the establishment of directed preventive measures. (Copyright © 2002 Wiley-Liss)

Outcomes of pediatric pedestrian injuries by locations of event.

Di Scala C, Sege R, Li G. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 241-250.

Correspondence: C. Di Scala, Department of Pediatrics, Tufts/NEMC, Boston, Massachusetts, USA.

Data from the National Pediatric Trauma Registry October 1995-October 2000, containing medical records of children under 20 years old hospitalized for pedestrian injuries, were examined. Demographics and outcome measures (nature and severity of injury, utilization of resources, deaths, and disability at discharge) were compared by location of occurrence. Pediatric pedestrian injuries resulted in severe outcomes whether the events occurred in driveways, public places, or in the road. Off the road injuries accounted for a significant proportion (13.2%) of all serious pedestrian injuries and disproportionately affected the youngest children. Prevention should consider the child's age and the location of injury occurrence. (Copyright © 2001 Association for the Advancement of Automotive Medicine)

A case of fatal poisoning with the aconite plant: quantitative analysis in biological fluid.

Elliott SP. Sci Justice 2002; 42(2): 111-115.

Correspondence: Simon Elliott, Regional Laboratory for Toxicology, City Hospital N.H.S. Teaching Trust, Dudley Road, Birmingham B18 7QH, UK; (email: simon.elliott@swbh.nhs.uk.

In recent years recorded cases of plant poisoning have become rare, this may in part be due to the possibility of plant ingestion not being indicated at the beginning of an investigation. Aconitum napellus (aconite, Wolfsbane, Monkshood) is one of the most poisonous plants in the UK. It contains various potent alkaloids such as aconitine, isoaconitine, lycaconitine and napelline. Ingestion of Aconitum plant extracts can result in severe, potentially fatal toxic effects. This paper describes the analytical findings in a recent death in the UK. resulting from deliberate ingestion of Aconitum napellus extract. The concentrations of aconitine measured by HPLC-DAD in the post mortem femoral blood and urine were 10.8 micrograms/L and 264 micrograms/L, respectively. The aconitine concentration in the ante mortem urine was 334 micrograms/L and was estimated to be 6 micrograms/L in the ante mortem serum. Hence, accidental, suicidal or homicidal poisoning due to the ingestion of plant material remains a possibility and should be borne in mind when investigating sudden or unexplained death. (Copyright © 2002 Forensic Science Society)

Analysis of 1089 burn patients in province of Kurdistan, Iran.

A Rastegar-Lari A, Alaghehbandan A. Ann Epidemiol 2002; 12(7): 526.

Correspondence: A. Rastegar-Lari, Department of Microbiology, Iran University of Medical Sciences, Tehran, IRAN; (email: unavailable).

OBJECTIVES: The aim of this epidemiological study was to provide descriptive characteristics, incidence, mortality, and risk factors associated with burn injuries in Kurdistan to assist in developing effective burn prevention programs.

METHODS: A medical record review was conducted of the 1089 burn patients admitted to burn units in Kurdistan over the six-year period beginning on 21 March 1994. Data were collected on the size and outcome of the burn, and on demographic information. These data were supplemented by data from the 1996 population census.

RESULTS: The incidence rate for burn hospitalization was 13.5 per 100,000 person-years. The median age of patients was 18 years old, with 58% of the patients under age 20 years. The median BBS was 40%. The incidence rate of burns according to gender was 18 per 100,000 person-years for females and 9.1 per 100,000 person-years for males (P(2) < 0.000001). Also there was statistical significant association between mortality rate and age groups/gender/BBS (P(2) < 0.000001). Flame was the most common type of burn (694/1089, 63.7%). There was also a significant correlation between age and type of burn (P(2) < 0.000001). Ninety-one percent (991/1089) of the burns were unintentional (12.3 per 100,000 person-years), while suicide attempts by self immolation of persons aged 13 years and older accounted for 12.7% (98/771) (2 per 100,000 person-years). The mortality rate was 4.5 per 100,000 person-years.

CONCLUSION: Burn injuries appear to be a substantial problem in Kurdistan, Iran. It is important to implement health education programs to reduce burn injuries. Strategies could include broadcast flashes on television or radio, depicting situations that increase risk in conjunction with information derived from epidemiological studies about risk factors. Such broadcasts should also call attention to strategies to prevent burn accidents. (Copyright © 2002 Elsevier Science)
The trend of injury epidemic in Ningxia.

Liu T, Xia Q, Li L, Li C. Zhonghua Yu Fang Yi Xue Za Zhi 2002; 36(5): 327-329.

Correspondence: T. Liu, Department of Disease Control, Health Bureau, Ningxia Hui Autonomous Region, Yinchuan 750001, CHINA.

OBJECTIVE: To study the epidemiological transition of injuries in Ningxia.

METHODS: Demographic and mortality data during 1990s in Ningxia were collected and analyzed for temporal trend with linear regression model.

RESULTS: During the past decade, mortality of injury raised by 28.22% among the residents in Ningxia and ranked the 3rd place in the causes of deaths. In 1999, the top four leading causes of injury deaths were traffic accident, suicide, drowning and poisoning. Overall injury mortality and mortalities of traffic accident and suicide increased, but mortality of drowning decreased during the past decade. As predicted, suicide will rank the 1st place in the causes of deaths among the residents in Ningxia by 2005.

CONCLUSIONS: Injury was one of major risk factors influencing health and death among the residents in Ningxia, with a temporal trend in its incidence. Effective research, prevention and control of traffic accident, suicide, drowning and poisoning should be focused.

Identification of traumatic spinal cord injuries in Alberta, Canada.

Dryden DM, Saunders LD, BH Rowe, May LA, Yiannakoulias N, Svenson L, Schopflocher D, Voaklander DC, others. Ann Epidemiol 2002; 12(7): 527-528.

Correspondence: LD Saunders, 13-106, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, CANADA; (email: duncan.saunders@ualberta.ca).

OBJECTIVES: : To estimate the annual incidence rate of traumatic spinal cord injury.

METHODS: Records from 3 sources were searched to identify new cases of SCI in the province of Alberta, Canada from April 1, 1997 to March 31, 2000. The first source was administrative data from the Alberta Department of Health and Wellness (ADHW). In Alberta, all medically necessary hospital and physician services are provided through a publicly funded health care plan, and records of these services are maintained by ADHW. The database includes a unique identifier for individuals, demographic information, and multiple ICD-9-CM diagnostic and procedure codes. A search was conducted to identify all hospitalizations for SCI (ICD-9-CM codes 806.x or 952.x). The second data source was the Alberta Trauma Registry (ATR), a database of all injured patients admitted to a trauma center in Alberta with an Injury Severity Score >/=12. The ATR was searched using ICD-9-CM codes. The third source was death certificates from the Medical Examiner's Office (ME). A keyword search (cervical, spinal or neck) identified potential SCI-related deaths and a manual chart review confirmed a SCI.

RESULTS: ADHW files identified 429 cases of SCI. An additional 28 cases were identified from the ATR. From the ME, a further 55 people were identified, of whom 50 died at the scene of injury. For those individuals who were transported to hospital (n = 462), only 4 were located in all 3 data sources. It was expected that all of the 224 ATR cases would be identified in the ADHW database, however, only 196 (87.5%) were identified in both files. Using all 3 sources, 512 individuals sustained a SCI during the 3-year period for an estimated SCI incidence rate of 5.8/100,000 population/year.

CONCLUSION: Multiples sources of data were required in order to provide an accurate estimate of traumatic SCI in Alberta. Reliance on any one source could result in an underestimate of the true incidence of SCI. (Copyright © 2002 Elsevier Science)

Facial injuries caused by animals in northern Nigeria.

Ugboko V, Olasoji H, Ajike S, Amole A, Ogundipe O. Br J Oral Maxillofac Surg 2002; 40(5): 433-437.

Correspondence and requests for offprints to: Dr V. I. Ugboko, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolow University, ILE-IFE, NIGERIA; (email: vugboko@yahoo.com).

We did a retrospective survey of 34 patients who sustained facial injuries after animal associated incidents and presented to three Nigerian teaching hospitals. There were 27 male (79%) and 7 female patients, whose ages ranged from 6 to 40 years. Sixteen (47%) were less than 15 years.Cows (n=14), camels (n=9), and donkeys (n=6) were the most commonly involved. Three dog bites were seen. Knocks from cows' horns (n=9) were the predominant mechanism of injury, followed by falls (n=8) and kicks (n=7).There were many facial lacerations and fractures, and the cheek (n=14), forehead (n=13), and chin (n=10) were the most common sites of soft tissue injury. All injuries were considered to be contaminated irrespective of the duration of the injury. Treatment consisted of thorough debridement and irrigation, primary closure where feasible, and secondary reconstruction in others. All patients were given prophylactic broad-spectrum antibiotics. Overall, outcome was satisfactory except for a few cases of scar formation, facial nerve palsy, and partial laryngeal stenosis.Associated injuries were recorded in nine cases (27%), with rupture of the globe in three patients (9%). One patient died of associated abdominal injuries after being trampled by a herd of cattle.There is a need for adequate protective measures to forstall animal - related incidents that could result in severe facial and other injuries. (Copyright © 2002 The British Association of Oral and Maxillofacial Surgeons)
Children's injuries in agriculture related events: the effect of supervision on the injury experience.

Pryor SK, Caruth AK, McCoy CA. Issues Compr Pediatr Nurs 2002; 25(3): 189-205.

Correspondence: Susan K. Pryor College of Nursing and Health Sciences, Southeastern Louisiana University, Baton Rouge, Louisiana, USA; (email: spryor@selu.edu)

An international health problem and the leading cause of death and disability among children in the United States are unintentional injuries. Children in rural areas in the United States have the highest death rate related to unintentional injuries regardless of age (Crawley, 1996). Using Haddon's Injury Model as the theoretical framework, the purpose of this study is threefold. First the study describes actual injuries that were sustained by farm children. Second, the research identifies the type of supervision the farm children and adolescents were receiving at the time of the injury, and finally the study examines injury risk in relation to supervision. Descriptive and categorical data analysis methods were used to examine the associations between farm-related injury and supervision type. Out of 177 children living in the home under 18 years of age, 32 children sustained at least one injury and eight sustained two injuries within one year from the time of the survey. The majority of children needed medical attention because of their injuries (n = 37). Children were more likely to sustain farm-related injury when they were supervised by a caregiver engaged in farm work versus supervised at home (p =.007). The findings of this study support Haddon's Injury Model, which suggests injuries occur because of an uncontrolled interaction between a host, an agent, and the environment. Examining the children's role within the framework of Haddon's Injury Model, will assist researchers in designing evidenced-based research that addresses the interaction between the host, agent, and environmental factors. Results from these studies will be useful in identifying effective interventions in the pre-event phase, as well as maximizing quality of life in the postevent phase. (Copyright © 2002 Taylor & Francis Health Sciences)

Evaluation of the THINK FIRST For KIDS injury prevention curriculum for primary students.

Greene A, Barnett P, Crossen J, Sexton G, Ruzicka P, Neuwelt E. Inj Prev 2002; 8(3): 257-258.

Correspondence: Edward A. Neuwelt, Oregon Health Sciences University, Department of Neurology, Portland, Oregon Oregon State Health Division, Portland, Oregon, USA; (email: neuwelte@ohsu.edu).

THINK FIRST is a national non-profit organization whose mission is to educate young people about the prevention of brain and spinal cord injuries. This paper describes a study conducted by THINK FIRST of Oregon on one of its injury prevention curricula, THINK FIRST for KIDS.
Evaluation of clumsiness in children.

Hamilton SS. Am Fam Physician 2002; 66(8): 1435-1440.

Correspondence: S. Sutton Hamilton, Blackstone Family Practice Residency of Virginia Commonwealth University School of Medicine, 23824, USA; (email: hamilton@bfpc.net).

Parents and physicians often dismiss seemingly minor motor difficulties in children. Approximately 6 percent of school-aged children have coordination problems serious enough to interfere with academic performance and social integration. These problems often arise during the early school years and manifest in difficulties with such simple motor tasks as running, buttoning, or using scissors. Increasing evidence shows that rather than improving over time, these motor difficulties remain stable throughout adolescence and adulthood. While these children are initially singled out for motor difficulties, their problems are rarely limited to poor motor coordination. Many of them have a range of associated deficits, such as attention-deficit/hyperactivity disorder, learning disabilities, poor handwriting and drawing skills, and emotional immaturity. Associated problems magnify with time, and as teenagers, these children have higher rates of educational, social, and emotional problems. Diagnosis is determined by taking a careful history that includes a review of fine motor, visual, adaptive, and gross motor milestones, and performing a physical examination. Formal standardized testing may be indicated. Referral to occupational therapy that is appropriately individualized to the needs of each child appears to be effective. To aid in management, the family physician must be aware of this condition, as well as the associated coexisting deficits. (Copyright © 2002 American Academy of Family Physicians)

Alcohol and suicide death among American Indians of New Mexico: 1980-1998.

May PA, Van Winkle NW, Williams MB, McFeeley PJ, DeBruyn LM, Serna P. Suicide Life Threat Behav 2002; 32(3): 240-255.

Correspondence: Philip A. May, Center on Alcoholism, Substance Abuse, and Addictions, The University of New Mexico, Albuquerque 87106, USA; (email: pmay@unm.edu).

The relationship between alcohol use prior to suicide was explored among American Indian decedents in New Mexico for the years 1980 through 1998. The suicide data were collected from New Mexico Vital Statistics and toxicology reports from the New Mexico Office of the Medical Investigator and matched on a case-by-case basis. Detailed analyses were undertaken for all cases of resident New Mexico Indians from the Navajo, Pueblo, and Apache cultures. Alcohol was detected in 69% of all suicides of American Indians with some variance by major tribal cultural groups (range = 62.1% to 84.4%). This is higher than in suicides among the overall New Mexico population (44.3%). The mean blood alcohol concentration (BAC) of the drinking Indian decedents at suicide was 0.198 (+/- SD of .088). Mean BACs were high for both males (0.199) and females (0.180) who had been drinking. Over 90% of the Indian decedents who had been drinking had BACs greater than the legal intoxication level of 0.08. The Navajo had the lowest percentage of cases that were alcohol involved, and their mean BAC was lower than the other two cultural groups. Alcohol use for completed suicides also varied somewhat by age, sex, method of suicide, and place of occurrence, but very little by whether the decedent was an on or off reservation resident. Analyses indicated that alcohol use prior to suicide was significantly more associated with male suicides than for females, and it was negatively correlated for those who died by overdose and also those using other drugs at suicide. Otherwise, alcohol use did not significantly differentiate American Indian suicides by age, use of firearms, hanging, use of other methods, or residence, for the presence of alcohol was a factor very commonly associated with all of these variables. Heavy alcohol consumption is, therefore, an important factor in over two thirds of all completed suicides among the Indians of New Mexico.

Reductions in injury crashes associated with red light camera enforcement in Oxnard, California.

Retting RA, Kyrychenko SY. Am J Public Health 2002; 92(11): 1822-1825.

Richard A. Retting and Sergey Y. Kyrychenko are with the Insurance Institute for Highway Safety, Arlington, VA 22201-4751, USA; (email: rretting@iihs.org).

OBJECTIVES: This study estimated the impact of red light camera enforcement on motor vehicle crashes in one of the first US communities to employ such cameras-Oxnard, California. METHODS: Crash data were analyzed for Oxnard and for 3 comparison cities. Changes in crash frequencies were compared for Oxnard and control cities and for signalized and nonsignalized intersections by means of a generalized linear regression model. RESULTS: Overall, crashes at signalized intersections throughout Oxnard were reduced by 7% and injury crashes were reduced by 29%. Right-angle crashes, those most associated with red light violations, were reduced by 32%; right-angle crashes involving injuries were reduced by 68%. CONCLUSIONS: Because red light cameras can be a permanent component of the transportation infrastructure, crash reductions attributed to camera enforcement should be sustainable. (Copyright © 2002 American Journal of Public Health)
Using logistic regression to estimate the influence of accident factors on accident severity.

Al-Ghamdi AS. Accid Anal Prev 2002 Nov;34(6):729-741.

Correspondence: A.S. Al-Ghamdi, College of Engineering, King Saud University, Riyadh, SAUDI ARABIA; (email: asghamdi@ksu.edu.sa).

Logistic regression was applied to accident-related data collected from traffic police records in order to examine the contribution of several variables to accident severity. A total of 560 subjects involved in serious accidents were sampled. Accident severity (the dependent variable) in this study is a dichotomous variable with two categories, fatal and non-fatal. Therefore, each of the subjects sampled was classified as being in either a fatal or non-fatal accident. Because of the binary nature of this dependent variable, a logistic regression approach was found suitable. Of nine independent variables obtained from police accident reports, two were found most significantly associated with accident severity, namely, location and cause of accident. A statistical interpretation is given of the model-developed estimates in terms of the odds ratio concept. The findings show that logistic regression as used in this research is a promising tool in providing meaningful interpretations that can be used for future safety improvements in Riyadh.
The effect on accidents of technical inspections of heavy vehicles in Norway.

Elvik R. Accid Anal Prev 2002; 34(6): 753-762.

Correspondence: Rune Elvik, Institute of Transport Economics, Oslo, NORWAY; (email: rune.elvik@toi.no).

This paper presents a study of the effects on accidents of technical inspections of heavy vehicles (trucks and buses) in Norway. Multiple regression analysis is applied in order to estimate the effects of technical inspections, controlling for annual trend in accident rate, the number of new drivers and annual economic growth. It is found that abolishing inspections may result in an increase of 5-10% in the number of heavy vehicles involved in injury accidents; increasing the number of inspections by 100% is associated with a similar reduction in the number of accidents. These results are not statistically significant and highly uncertain. The study clearly illustrates many of the difficulties often encountered in non-experimental accident research. (Copyright © 2002 Elsevier Science)
The independent contribution of driver, crash, and vehicle characteristics to driver fatalities.

Bedard M, Guyatt GH, Stones MJ, Hirdes JP. Accid Anal Prev 2002; 34(6): 717-727.

Correspondence: M. Bedard, Lakehead Psychiatric Hospital, Thunder Bay, Ont., CANADA; (email: mbedard@baynet.net).

Several driver, crash, and vehicle characteristics may affect the fatality risk of drivers involved in crashes. To determine the independent contribution of these variables to drivers' fatality risk, we used data from single-vehicle crashes with fixed objects contained in the US Fatal Accident Reporting System. A multivariate logistic regression revealed that the odds ratio (OR) of a fatal injury increased with age, reaching 4.98 (99% confidence interval (CI) = 2.01-12.37) for drivers aged 80 + compared with drivers aged 40-49 years. Female gender (OR = 1.54, 99% CI = 1.35-1.76) and blood alcohol concentration greater than 0.30 (OR = 3.16. 99% CI = 1.96-5.09) were also associated with higher fatality odds. In comparison with front impacts, driver-side impacts doubled the odds of a fatality (OR = 2.26, 99% CI = 1.92-2.65), and speeds in excess of 111 kilometers per hour (kph: 69 mph) prior to or at impact were related to higher fatality odds (OR = 2.64, 99% CI = 1.82-3.83) compared with speeds of less than 56 kph (35 mph). Three-point seatbelts were protective against fatal injuries (OR = 0.46, 99% CI = 0.39-0.53 compared with no belt). These data suggest that increasing seatbelt use, reducing speed, and reducing the number and severity of driver-side impacts may prevent fatalities. The importance of age and gender suggests that the specific safety needs of older drivers and female drivers may need to be addressed separately from those of men and younger drivers. (Copyright © 2002 Elsevier Science)
Responses of teenagers and their parents to California's graduated licensing system.

Williams AF, Nelson LA, Leaf WA. Accid Anal Prev 2002; 34(6): 835-842.

Correspondence: Alan F. Williams, Insurance Institute for Highway Safety, Arlington, VA 22201-4751, USA; (email: awilliams@iihs.org).

In 1998, California adopted a strong graduated licensing system that lengthened the learner's permit stage from 1 month to a mandatory 6 months and introduced passenger and nighttime restrictions for initial license holders. The passenger restriction (no passengers younger than 20 for the first 6 months) is stronger than such restrictions in any other state; the nighttime ban is relatively weak, not beginning until midnight. Surveys were undertaken to learn what teenagers and their parents thought about the new requirements and how they responded to them. Two groups of beginning California license holders were surveyed three times during the first year of licensure; their parents were interviewed twice. One group (n = 543) was subject to the graduated licensing requirements, the other (n = 814) was not. Parents strongly endorsed the new system. The vast majority approved of the new permit requirements and the nighttime and passenger restrictions. Among parents whose children were subject to the new requirements, 79% were strongly in favor of the new system and only 4% were neutral or opposed. Teenagers were less favorable toward the new requirements. Most approved of the new learner's permit rules, and the majority of teenagers favored the night restriction, but only about one-third endorsed the passenger restriction. Compliance with the new rules was not close to universal, but the new licensing system resulted in young people holding their learner's permits longer, accumulating more practice driving prior to licensure and decreased the amount of reported driving after midnight and transportation of teenagers when initially licensed. Most teenagers subject to the new rules said they were able to do the activities they wanted despite the changes; almost three-quarters said they were not affected much by either the nighttime or passenger restriction. Overall the results indicate that the new licensing system is accepted favorably by teenagers and their parents and has substantially increased the types of behaviors that collectively should lead to crash and injury reductions.
Driving performance of drivers with impaired central visual field acuity.

Lamble D, Summala H, Hyvarinen L. Accid Anal Prev 2002; 34(5): 711-716.

Correspondence: David Lamble, Department of Psychology, University of Helsinki, FINLAND; (email: david.lamble@helsinki.fi).

This study investigated the performance of drivers with impairment to their central field of vision but with normal peripheral vision, due to retinoschisis, in a safety critical driving tasks. The performance of five male drivers with impaired vision (VA 0.2), aged between 40 and 50 years, all with more than 250,000 km life-time driving experience and a good safety record, and five normal vision controls, matched by gender, age, driving experience and safety record, were tested in 40 km/h city traffic and in a motorway car following situation. All participants displayed appropriate driving ability in city traffic and all were able to detect and respond adequately to a conflicting 'stunt pedestrian' and 'stunt cyclist' situation. There were no apparent differences between the drivers with impaired vision and those with normal vision. In the car following situation, the participants drove at 80 km/h, 50 m behind a lead car, on a 30 km section of motorway in normal traffic. During each trial, the lead car started to decelerate at an average of 0.53 m/s2 while the participant either looked at the car in front (control) or performed a memory and addition task (non-visual attention) while looking at the car in front. The participants were required to press the brake pedal when they noticed a decrease in headway. The participant's brake reaction time to the onset of the lead car's brake lights was also tested. The drivers with impaired vision were significantly slower, by 0.2 s, in detecting the onset of brake lights than the normal vision drivers. Their headway closure detection was 0.7 s slower than normal vision drivers, but this difference was not statistically significant in this small data. In spite of some impairment in car following (central vision task), the results together with the clean record of these drivers with retinoschisis support the idea that visual acuity of 0.5 (the European Union norm) is not a necessary prerequisite for safe driving. (Copyright 2002 Elsevier Science)
Booster seats: a community based study of installation and use by parents and caregivers.

Stepanski BM, Ray LU, Nichols L. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 37-48.

Division of Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, California, USA.

This paper describes characteristics of child safety seat misuse among attendees at 41 inspections held between February 1999-April 2001 in San Diego County, CA. Standardized criteria were assessed by certified technicians. These 41 events consisted of 988 inspections for proper installation and adjustment. 963 had a determined seat type (rear-facing, forward facing, belt positioning boosters, shield boosters, other restraint, vehicle safety belts). Each seat type had specific criteria for misuse ranging from 3 to 15 measures. 95.6% had at least one error, which could reduce the seat's protection of its occupant from injury in a crash. (Copyright © 2001 Association for the Advancement of Automotive Medicine)

Social stressors in relation to intimate partner violence against Native American women.

Malcoe LH, Duran BM, Ficek EE. Ann Epidemiol 2002; 12(7): 525.

Correspondence: Lorraine Halinka Malcoe, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA; (email: lhmalcoe@salud.unm.edu).

OBJECTIVE: To identify associations between various social stressors and intimate partner violence (IPV) against Native American women.

METHODS: A cross-sectional, in-person interview study was conducted with 431 low-income Native American women 14 through 45 years of age. Participants included Native women (79.3% response rate) attending tribally operated Women-Infant and Children's Nutritional Program (WIC) clinics in western Oklahoma during a six month period in 1999 as well as a convenience sample of Native women recruited from tribal facilities and a vocational school. Intimate partner violence was assessed using modified, revised Conflict Tactics Scales. Participant's, partner's, and family social stress measures were examined in relation to severe physical and sexual IPV during the past year.

RESULTS: Among women with a steady male partner (n = 370), past-year prevalence of severe IPV was 23.6% (95% confidence interval [CI]: 19.5, 28.4). In logistic regression analyses controlling for the participant's age as well as problem drinking behavior of the participant and partner, three social stressor variables remained strongly associated with severe IPV: women receiving welfare assistance had a 2.7-fold (95% CI: 1.1, 6.8) increased odds of severe IPV; women scoring high on a nine item socioeconomic stressor scale had a 2.5-fold (CI: 1.2, 5.1) increased odds of IPV; and for each 1 unit increase in partner's perceived stress score, the odds of severe IPV increased 2.3-fold (95% CI: 1.4, 3.7).

CONCLUSION: Within a low-income population of Native Americans, social stressors were found to be strongly associated with past-year severe IPV. These data suggest that IPV intervention and prevention strategies for Native American women would need to take into account the social and historical context of Native women and their families. (Copyright © 2002 Elsevier Science)
Predicting intentions versus predicting behaviors: domestic violence prevention from a theory of reasoned action perspective.

Nabi RL, Southwell B, Hornik R. Health Commun 2002; 14(4): 429-449.

Correspondence: Robin L. Nabi, Department of Communication, University of Arizona, Tucson 85721, USA; (email: rnabi@u.arizona.edu).

A central assumption of many models of human behavior is that intention to perform a behavior is highly predictive of actual behavior. This article presents evidence that belies this notion. Based on a survey of 1,250 Philadelphia adults, a clear and consistent pattern emerged suggesting that beliefs related to domestic violence correlate with intentions to act with respect to domestic violence but rarely correlate with reported actions (e.g., talking to the abused woman). Numerous methodological and substantive explanations for this finding are offered with emphasis placed on the complexity of the context in which an action to prevent a domestic violence incident occurs. We conclude by arguing that despite the small, insignificant relationships between beliefs and behaviors found, worthwhile aggregate effects on behavior might still exist, thus reaffirming the role of communication campaign efforts.
Maternal-fetal lead poisoning from a 15-year-old bullet.

Raymond LW, Ford MD, Porter WG, Saxe JS, Ullrich CG. J Matern Fetal Neonatal Med 2002; 11(1): 63-66.

Correspondence: L.W. Raymond, Carolina Poison Center, Charlotte, North Carolina, USA.

Blood lead was mildly elevated (31 microg/dl, where 25 microg/dl is the upper limit of the normal range) in a woman with lumbar bullet fragments who was evaluated for anemia in the 23rd week of pregnancy. She required Cesarean section at term for pre-eclampsia and fetal distress. The infant had multiple congenital abnormalities. Postpartum maternal blood lead level was 75-85 microg/dl. The infant's blood lead level was also elevated. Chelation lowered the infant's blood lead level, but not the mother's. Surgical debulking of the lumbar lead deposits was followed by a fall in blood lead level from 65 to 52 microg/dl. This case demonstrates a remarkable gestational rise in maternal blood lead level. The infant's congenital abnormalities could be causally related to lead. (Copyright © 2002 Parthenon Publishing Group)

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Rev. 03-Nov-2002 at 19:25 hours.