SafetyLit Update: 18 November 2002

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18 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.

See report under Suicide
Effects of alcohol on risk-taking during simulated driving.

Burian SE, Liguori A, Robinson JH. Hum Psychopharmacol 2002; 17(3): 141-150.

Correspondence: Anthony Liguori, Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (email: aliguori@wfubmc.edu)
The effect of alcohol on judgement or conscious risk-taking may increase the likelihood of an automobile accident. This study examined the direct effects of penalty severity and alcohol on risk-taking in a novel simulated-driving lane-choice task. Thirteen male social drinkers received alcohol (0.3 g/kg, 0.5 g/kg, 0.8 g/kg) or placebo during each of four test sessions in a randomized, within subject design. In repeated trials, subjects selected, then drove through a cone-defined lane. Contingent upon performance, points were added (+ 5 for the narrower lane, + 3 for the wider lane) and taken away (- 1, - 3, or - 5 points per hit cone) after each trial. Risk-taking was defined as a selection of the narrower-width lane. The frequency of risk-taking decreased as the penalty increased. The 0.5 g/kg dose, compared to other alcohol doses or placebo, significantly increased risk-taking in the high-risk (5-point penalty) condition. This finding suggests that breath alcohol concentrations within current legal standards can alter a driver's decision-making such that the willingness to enter a high-risk situation is increased. (Copyright © 2002 John Wiley & Sons, Ltd.)

Editorial: Occupational Injury and Safety Research in the AIHA Journal.

Courtney TK. AIHA J 2002; 63(5) 550-553.

Correspondence: Theodore K. Courtney, Liberty Mutual Research Center for Safety and Health, 71 Frankland Road, Hopkinton, MA 01748, USA; (email: Theodore.Courtney@LibertyMutual.com).
This editorial describes the growth and development of injury prevention withing the field of occupational hygiene and discusses the increasing interest in injury prevention research among the editors of the publications of the American Industrial Hygiene Association.

As of 1998, there were some 3,200 Environmental, Health and Safety (EHS) professionals who were joint members of the AIHA and the American Society of Safety Engineers (ASSE). That same year, 2,350 EHS professionals were actively practicing with certification from both the American Board of Industrial Hygiene and the Board of Certified Safety Professionals. Forty-six percent of AIHA members surveyed that year indicated that their work time was primarily spent on non-traditional industrial hygiene topics such as safety and environmental concerns. As this interdisciplinary trend has grown, so too has recognition of the burden of injury and occupational injury particular. It is only in the last several decades that occupational injury (versus occupational disease) has begun to gain the prominence it merits as an occupational, public health, and societal problem.

The report, Injury in America (1985) called for the establishment of a new injury research center within the Centers for Disease Control and Prevention which would consolidate and bring focus to the disparate research efforts scattered across various federal departments. This was realized some years later with the founding of the National Center for Injury Prevention and Control in 1992 which focuses on non-occupational injury and coordinates with NIOSH on occupational injury. Like NIOSH's Education and Research Centers, the NCIPC funds regional centers in non-occupational injury prevention and control. The report also recommended moving away from the concept of injuries as accidental phenomena and introduced the incorporation of intentional injuries, once considered more exclusively a law enforcement or justice problem, as a distinct class of the injury issue in public health.

The increased prominence of injury as a public health concern contributed to rejuvenation in the occupational injury research field as well. While non-occupational disabling injuries outnumber occupational disabling injuries more than 4 to 1, injury prevention efforts in occupational health and safety have a longer and better documented history. Still, in the year Injury in America was published, the Bureau of Labor Statistics (BLS) estimated that there were 5.4 million reported occupational injuries in private industry. While these injuries accounted for more than 95% of reported occupational morbidity in 1985, the majority of NIOSH research in 1985, reflective of overall inadequate federal funding for studying injury, was oriented towards workplace disease.

The 17 years since 1985 have shown a dramatic increase in the interest in occupational injury and safety. National surveillance systems for injuries have improved substantially, particularly in the last decade.

A national emphasis on graduate training programs in injury and safety has also recently emerged. In 2000, Safe Work in the 21st Century was released from the Institute of Medicine recommending that CDC and specifically NIOSH establish training initiatives in occupational injury prevention. NIOSH announced the availability of funding for new graduate training programs in occupational injury epidemiology and safety science in March of 2001.

Pless recently conducted a limited review of journals publishing occupational safety and injury papers and identified a total of 46 journals, 9 of which (including the AIHA Journal) could be classified as "mainstream" peer-reviewed, occupational safety and health journals.

The editorial presents arguments in favor of the AIHA Journal as a leading forum for reports on occupational injury prevention. Significant among these is the statement that the journal's readership includes both researchers in occupational injury and safety and the OSH practitioners in real work environments and who perform the strategic and day-to-day management of health and safety.

No reports this week

Organizational safety: which management practices are most effective in reducing employee injury rates?

Vredenburgh AG. J Safety Res 2002; 33(2): 259-276.

Correspondence: A.G. Vredenburgh, Vredenburgh and Associates, Inc., PMB 353, 2588 El Camino Real, Suite F, Carlsbad, CA 92008, USA; (email: alisonv@nethere.com).

BACKGROUND: While several management practices have been cited as important components of safety programs, how much does each incrementally contribute to injury reduction? This study examined the degree to which six management practices frequently included in safety programs (management commitment, rewards, communication and feedback, selection, training, and participation) contributed to a safe work environment for hospital employees.

METHOD: Participants were solicited via telephone to participate in a research study concerning hospital risk management. Sixty-two hospitals provided data concerning management practices and employee injuries.

FINDINGS: Overall, the management practices reliably predicted injury rates. A factor analysis performed on the management practices scale resulted in the development of six factor scales. A multiple regression performed on these factor scales found that proactive practices reliably predicted injury rates. Remedial measures acted as a suppressor variable. DISCUSSION: While most of the participating hospitals implemented reactive practices (fixing problems once they have occurred), what differentiated the hospitals with low injury rates was that they also employed proactive measures to prevent accidents. The most effective step that hospitals can take is in the front-end hiring and training of new personnel. They should also ensure that the risk management position has a management-level classification. This study also demonstrated that training in itself is not adequate. (Copyright © 2002 Elsevier Science)
The relationship between employees' perceptions of safety and organizational culture.

O'Toole M. J Safety Res 2002; 33(2): 231-243.

Correspondence: M. O'Toole, Manufacturing Engineering Tech and Supervision, Purdue University Calumet, 2200 169th Street, Hammond, IN 46322, USA, USA; (email: mol@calumet.purdue.edu).

BACKGROUND: With limited resources to help reduce occupational injuries, companies struggle with how to best focus these resources to achieve the greatest reduction in injuries for the optimal cost. Safety culture has been identified as a critical factor that sets the tone for importance of safety within an organization.

METHODS: An employee safety perception survey was conducted, and injury data were collected over a 45-month period from a large ready-mix concrete producer located in the southwest region of the United States.

FINDINGS: The results of this preliminary study suggest that the reductions in injuries experienced at the company locations was strongly impacted by the positive employee perceptions on several key factors. Management's commitment to safety was the factor with the greatest positive perception by employees taking the survey.

DISCUSSION: This study was set up as a pilot project and did not unitize an experimental design. That weakness reduces the strength of these findings but adds to the importance of expanding the pilot project with an appropriate experimental design. Management leadership has been identified, along with several other factors, to influence employee perceptions of the safety management system. Those perceptions, in turn, appear to influence employee decisions that relate to at-risk behaviors and decisions on the job. The results suggest that employee perceptions of the safety system are related to management's commitment to safety, which, in turn, appear to be related to injury rates. Management should focus on how to best leverage these key factors to more positively impact injury rates within their companies. (Copyright © 2002 Elsevier Science)

Development and pilot testing of a bicycle safety questionnaire for adult bicyclists.

McCoy CA. Public Health Nurs 2002; 19(6): 440-450.

Correspondence: Carrie A. McCoy, 346 AHC, Department of Nursing, Northern Kentucky University, Highland Heights, KY 41099, USA; (email: mccoy@nku.edu).

Most deaths associated with bicycle riding are reported in those over the age of 16 and the highest death rate per million trips is reported in those over the age of 50, yet most efforts to reduce deaths among bicycle riders have focused on children. The purpose of this study was to pilot test a new instrument designed to assess knowledge of bicycle laws and perception of risk related to specific host behaviors and agents of injury. A pilot study using a descriptive correlational design was conducted among a convenience sample of 104 adult bicycle riders. A 25-item questionnaire was administered to participants (10 knowledge items, 15 belief items). There were no significant differences in total knowledge or belief score for gender, age group, riding frequency, education, or formal bicycle training. Significant differences were found for responses to individual items on both scales. Psychometric testing indicated that items on the knowledge scale were independent. Psychometric testing on the belief scale suggested three underlying constructs measuring beliefs about riding behavior, agents of injury, and user burden. Bicycle riders with previous safety training had significantly different scores on the riding behavior and user burden subscales. (Copyright © 2002 Blackwell Synergy)

See report under Suicide

Skateboard-associated injuries: participation-based estimates and injury characteristics.

Kyle SB, Nance ML, Rutherford GW Jr, Winston FK. J Trauma 2002; 53(4): 686-690.

Correspondence: Flaura K. Winston, Children's Hospital of Philadelphia, 3535 TraumaLink, 10th Floor, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA (email: flaura@mail.med.upenn.edu).

BACKGROUND Skateboarding is a popular recreational activity but has attendant associated risks. To place this risk in perspective, participation-based rates of injury were determined and compared with those of other selected sports. Skateboard-associated injuries were evaluated over time to determine participation-based trends in injury prevalence.

METHODS Rates of skateboard-associated injury were studied for the 12-year period 1987 to 1998 for participants aged 7 years or older. The National Electronic Injury Surveillance System provided injury estimates for skateboarding and the selected additional sporting activities. The National Sporting Goods Association annual survey of nationally representative households provided participation estimates. A participation-based rate of injury was calculated from these data sets for the selected sports for the year 1998.

RESULTS The 1998 rate of emergency department-treated skateboard-associated injuries-8.9 injuries per 1,000 participants (95% confidence interval [CI], 6.2, 11.6)-was twice as high as in-line skating (3.9 [95% CI, 3.1, 4.8]) and half as high as basketball (21.2 [95% CI, 18.3, 24.1]). The rate of skateboard-associated injuries declined from 1987 to 1993 but is again increasing: the 1998 rate was twice that of 1993 (4.5 [95% CI, 1.6, 7.4] and 8.9 [95% CI, 6.2, 11.6], respectively). Increases occurred primarily among adolescent and young adult skateboarders. The most frequent injuries in 1998 were ankle strain/sprain and wrist fracture: 1.2 (95% CI, 0.8, 1.6) and 0.6 (95% CI, 0.4, 0.8) per 1,000, respectively. Skateboard-associated injuries requiring hospitalization occurred in 2.9% and were 11.4 (95% CI, 7.5, 17.5) times more likely to have occurred as a result of a crash with a motor vehicle than injuries in those patients not hospitalized.

CONCLUSION This study is the first to relate skateboarding and other sport injuries to participation exposures. We found that skateboarding is a comparatively safe sport; however, increased rates of injury are occurring in adolescent and young adult skateboarders. The most common injuries are musculoskeletal; the more serious injuries resulting in hospitalization typically involve a crash with a motor vehicle. This new methodology that uses participation-based injury rates might contribute to more effective injury control initiatives. (Copyright © 2002 Lippincott Williams & Wilkins)

Chronic disease and injury in an agricultural county: The Keokuk County Rural Health Cohort Study.

Merchant JA, Stromquist AM, Kelly KM, Zwerling C, Reynolds SJ, Burmeister LF. J Rural Health 2002; 18(4): 521-535.

Correspondence: James A. Merchant, College of Public Health, The University of Iowa, Iowa City 52242, USA; (email: james-merchant@uiowa.edu).

The Keokuk County Rural Health Study (KCRHS) was designed as a 20-year, prospective cohort study focusing on chronic disease and injury in an agricultural southeastern Iowa county. The goals of the KCRHS are to prospectively describe, measure, and analyze prevalent rural and agriculturally related adverse health outcomes and their respective risk factors and to provide the basis for future community-based intervention programs to reduce disease and injury incidence. Methods of data collection included in-person interviews, medical screenings, and environmental assessments of homes and farms. All households studied were rural; comparisons were made among farm, rural nonfarm, and town households, between men and women, and between smokers and nonsmokers. The present paper reports selected adult baseline data from Round 1 of this study. Residents of farm households were somewhat younger and better educated than residents of rural nonfarm and town households; smoked less; were more likely to have ridden an all-terrain vehicle; and were more likely to report firearms in the home. Eighty-nine percent of the men and 66% of the women engaged in farming or did so in the past. Men more often reported hearing loss, were more often overweight and obese, more often reported an injury, less often reported asthma, and less often saw a medical practitioner. Women reported poorer emotional health and higher rates of depression symptoms. The KCRHS has identified several modifiable health outcomes and risk factors as candidates for further analysis and targets for community-based prevention and intervention programs. (Copyright © 2002 National Rural Health Association)
Maternal and infant outcomes after injury during pregnancy in Washington state from 1989 to 1997.

Schiff MA, Holt VL, Daling JR. J Trauma 2002; 53(5): 939-945.

Correspondence: Melissa Schiff, Harborview Injury Prevention and Research Center, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104-1549, USA; (email: mschiff@u.washington.edu).

BACKGROUND: Few population-based studies have assessed maternal and infant outcomes after nonfatal injuries occurring during pregnancy.

METHODS: We performed a retrospective cohort study to assess outcomes of pregnant women hospitalized for injury in Washington State from 1989 to 1997. We used the Injury Severity Score (ISS) to classify 266 nonseverely injured (ISS of 1-8) and 28 severely injured (ISS > 9) pregnant women who delivered at their injury hospitalization. We compared these women to 12,578 pregnant women randomly selected from Washington State birth and fetal death certificates who had no injury hospitalization during pregnancy.

FINDINGS: Nonseverely injured pregnant women were at increased risk of placental abruption and their infants were at increased risk of hypoxia and fetal death. Severely injured pregnant women were at a 17-fold (95% confidence interval, 6.2-46.8) increased risk of placental abruption and their infants were at increased risk of prematurity, low birth weight, and fetal distress, and a 30-fold (95% confidence interval, 9.4-97.1) increased risk of fetal death.

DISCUSSION: Nonsevere as well as severe injuries resulting in hospitalization during pregnancy can result in adverse maternal and infant outcomes. (Copyright © 2002 Lippincott Williams & Wilkins)
Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents.

Pickett W, Garner MJ, Boyce WF, King MA. Soc Sci Med 2002; 55(6): 1055-1168.

Correspondence: W. Pickett, Department of Emergency Medicine, Queen's University, Kingston General Hospital, ON, CANADA; (email: PickettW@post.queensu.ca).

This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.

Epidemiology and socioeconomics.

Kuhn F, Morris R, Mester V, Witherspoon CD, Mann L, Maisiak R. Ophthalmol Clin North Am 2002; 15(2): 145-151.

Correspondence: F Kuhn, United States Eye Injury Registry, Helen Keller Foundation for Research and Education, Department of Ophthalmology, University of Alabama at Birmingham, AL, USA; (email: fkuhn@mindspring.com).

Ophthalmologists should be responsible for a systemic collection of standardized data on the occurrence of eye injuries. Such a database is the key for designing prophylactic measures to successfully prevent ocular trauma. The USEIR model, whether reporting takes place over the Internet [www.USEIRonline.org www.WEIRonline.org (worldwide)] or on paper, has proved to be an efficient epidemiological tool. Use of this model in different countries has allowed making unbiased comparisons between regions or countries, highlighting injury patterns that may be different in different geographical areas, and pinpointing areas where prophylaxis (through legislation and public campaigns) appears most effective. Participation of all ophthalmologists who evaluate/treat patients with serious eye trauma is strongly encouraged.

Hot iron burns in children.

Simons M, Brady D, McGrady M, Plaza A, Kimble R. Burns 2002; 28(6): 587-590.

Correspondence: Roy Kimble, Queens University, Ireland, Belfast, UK; (email: royk@mailbox.uq.edu.au).

Burns for contact with irons are an important preventable cause of burns in children. The objective of this study, was to document and describe these burns. The report describes 50 children with iron burns who were treated at our Burns Unit between 1997 and 2001. METHODS: Prospective data collection demographics, nature of contact with iron, site, body surface area (BSA), medical and surgical interventions and complications and hand preference were examined. RESULTS: The median of age patients was 17 months. The majority of burns were caused by touching the iron (44%) or by pulling the cord (38%). Most of the children were supervised (74%) and the iron was switched off in 34% of the injuries. Seventy-six percent of children sustained hand burns. Although, burn areas were relatively small, 36% required grafting. Residual scarring occurred in 42% and contractures in 10%. Surgical release of contractures was required in 4%. CONCLUSION: There is clearly a wide scope for prevention of hot iron burns. A public education campaign is now planned including: leaflets distributed at the point of purchase of the iron, public education via media outlets and lobbying of iron manufacturers to improve safety features. (Copyright © 2002 Elsevier Science)

See abstract under Reports of Injury Occurrence
Use of protective equipment among California farmers.

Schenker MB, Orenstein MR, Samuels SJ. Am J Ind Med 2002 Nov;42(5):455-464.

Correspondence: Marc B. Schenker, Department of Epidemiology and Preventive Medicine, University of California, Davis, One Shields Avenue, TB168, Davis, CA 95616-8638, USA (email: mbschenker@ucdavis.edu).

BACKGROUND: Agriculture is a hazardous industry associated with many occupational injuries and illnesses. We describe California farmers' self-reported exposure to five agricultural hazards and their use of protective equipment.

METHODS: A telephone survey of 1,947 California farmers recorded information on occupational exposure, health outcomes and use of protective equipment to lessen risk from exposure to dust, sun, noise, pesticides and tractors.

FINDINGS: Over 93% of respondents reported using personal protection around pesticides; however, fewer than 1/3 used consistent protection against other hazards. Younger age and male sex were associated with better use of protection from dust, noise, pesticide and tractors, but negatively associated with sun protection. There was no consistent relationship of protective behaviors with cigarette smoking, living on the farm, marital status, or time in non-administrative farmwork. Risk perception was strongly associated with behavior; farmers concerned about specific health problems were much more likely to use protective equipment.

DISCUSSION: Some farmer characteristics are associated with more safe behaviors, but efforts to encourage protective behaviors on farms should be broadly based in view of a lack of a single risk-taking profile among California farmers. (Copyright © 2002 Wiley-Liss)

Youth risk behavior surveillance--United States, 2001.

Grunbaum JA, Kann L, Kinchen SA, Williams B, Ross JG, Lowry R, Kolbe L. J Sch Health 2002 Oct;72(8):313-328.

Correspondence: Jo Anne Grunbaum, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770, Buford Highway, NE, MS-K33, Atlanta, GA 30341, USA; (email: jpg9@CDC.GOV).

Priority health-risk behaviors, which contribute to the leading causes of mortality and morbidity among youth and adults, often are established during youth, extend into adulthood, are interrelated, and are preventable. This report covers data during February-December 2001. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults; these behaviors contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity. The YRBSS includes a national school-based survey conducted by CDC as well as state, territorial, and local school-based surveys conducted by education and health agencies. This report summarizes results from the national survey, 34 state surveys, and 18 local surveys conducted among students in grades 9-12 during February-December 2001. In the United States, approximately three-fourths of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2001 national Youth Risk Behavior Survey demonstrated that numerous high school students engage in behaviors that increase their likelihood of death from these four causes: 14.1% had rarely or never worn a seat belt during the 30 days preceding the survey; 30.7% had ridden with a driver who had been drinking alcohol; 17.4% had carried a weapon during the 30 days preceding the survey; 47.1% had drunk alcohol during the 30 days preceding the survey; 23.9% had used marijuana during the 30 days preceding the survey; and 8.8% had attempted suicide during the 12 months preceding the survey. Substantial morbidity and social problems among young persons also result from unintended pregnancies and STDs, including HIV infection. In 2001, 45.6% of high school students had ever had sexual intercourse; 42.1% of sexually active students had not used a condom at last sexual intercourse; and 2.3% had ever injected an illegal drug. Two-thirds of all deaths among persons aged > or = 25 years result from only two causes: cardiovascular disease and cancer. The majority of risk behaviors associated with these two causes of death are initiated during adolescence. In 2001, 28.5% of high school students had smoked cigarettes during the 30 days preceding the survey; 78.6% had not eaten > or = 5 servings per day of fruits and vegetables during the 7 days preceding the survey; 10.5% were overweight; and 67.8% did not attend physical education class daily. Health and education officials at national, state, and local levels are using these YRBSS data to analyze and improve policies and programs to reduce priority health-risk behaviors among youth. The YRBSS data also are being used to measure progress toward achieving 16 national health objectives for 2010 and 3 of the 10 leading health indicators.

Can the Edinburgh Risk of Repetition Scale predict repetition of deliberate self-poisoning in an Australian clinical setting?

Carter GL, Clover KA, Bryant JL, Whyte IM. Suicide Life Threat Behav 2002; 32(3): 230-239.

Correspondence: Gregory Carter, Department of Consultation-Liaison Psychiatry, Newcastle Mater Hospital, NSW, AUSTRALIA; (email: carter@mail.newcastle.edu.au).

This study tested the ability of the Edinburgh Risk of Repetition Scale (ERRS) to identify patients at high risk for repeat deliberate self-poisoning (DSP). Consecutive DSP patients (N= 1,317) over a 3-year period were followed-up for 12 months. A statistically significant relationship between ERRS scores and repetition was observed; however, sensitivity and specificity were low. Logistic regression analysis revealed only "previous parasuicide" contributed significantly to repetition. The ERRS had limited value in identifying patients at high risk of repeat DSP in this clinical population. (Copyright © 2002 American Association of Suicidology)
Psychiatric and substance use disorders as risk factors for attempted suicide among adolescents: a case control study.

Kelly TM, Cornelius JR, Lynch KG. Suicide Life Threat Behav 2002; 32(3): 301-312.

Correspondence: Thomas M. Kelly, Western Psychiatric Institute and Clinic, Pittsburgh Adolescent Alcohol Research Center, University of Pittsburgh Medical School, PA 15213, USA; (email: kellytm@msx.upmc.edu).

The objective of this research was to test substance-related and non-substance-related psychiatric disorders as predictors of attempted suicide among adolescents. Ninety-six psychiatrically disordered suicide attempters were matched one-to-one to 96 psychiatrically disordered non-attempters on age, race, gender, and the presence/absence of major depression. Conditional logistic regression was used to test psychiatric risk factors for their power to predict attempted suicide among adolescents. Bipolar disorder, cocaine use disorders, and conduct disorder were found to be predictive of attempted suicide in univariate testing. Bipolar disorder, inhalant use disorders, cocaine use disorders, and hallucinogen use disorders were found to be predictive of attempted suicide, after adjusting for all other covariates. Loglinear analyses revealed high odds ratios associated with the comorbidities of alcohol use disorder with conduct disorder and drug use disorders with conduct disorder in both groups. Higher rates of cocaine use disorder/conduct disorder, hallucinogen use disorder/conduct disorder, and alcohol use disorder/ conduct disorder were found among suicide attempters. Evaluation of these particular comorbid conditions should be part of the adolescent suicide risk assessment. (Copyright © 2002 American Association of Suicidology)
Lesbian, gay, and bisexual suicidal behavior: testing a constructivist model.

McBee-Strayer SM, Rogers JR. Suicide Life Threat Behav 2002; 32(3): 272-283.

Correspondence: James R. Rogers, Department of Counseling, 127 Carroll Hall, University of Ankron, Ankron, OH 44325-5007, USA; (email: jrrogers@uankron.edu).

The present investigation surveyed 162 self-identified lesbian, gay, and bisexual individuals recruited from LGB-related social organizations or contacted through networking procedures with regard to suicidal behaviors, suicide risk factors, and reasons for living. Approximately 41% of the respondents indicated a serious consideration of suicide including the identification of a specific suicide plan (23%) or a past suicide attempt (36%) with significant intent to die (13%). Forty-six percent of the sample indicated at least some degree of chance of attempting suicide in the future. Grounded in the existential-constructivist theory of suicide (Rogers, 2001), empirically and theoretically identified suicide risk factors were found as a group to predict suicidal ideation (R2 = .16) and attempts (R2 = .17), with abuse-related items independently predicting both suicidal ideation (R2 = .03) and attempts (R2 = .08). Items related to self-identity issues and social acceptance were predictive of suicidal ideation (R2 = .04), while substance abuse was predictive of suicidal ideation (R2 = .05) and attempts (R2 = .13) for males only. The established factor structure of the Reasons for Living Inventory (Linehan et al., 1983) was not supported in the current data, suggesting that it may not be an appropriate measure of reasons for living with LGB individuals. (Copyright © 2002 American Association of Suicidology)

Also see abstract under Violence
Traffic safety and the switch to a primary seat belt law: the California experience.

Houston DJ, Richardson LE Jr. Accid Anal Prev 2002; 34(6): 743-751.

Correspondence: David J. Houston, Department of Political Science, University of Tennessee, Knoxville, 37996-0410, USA; (email: dhouston@utk.edu).

This study explores whether the change of an existing seat belt law from secondary to primary enforcement enhances traffic safety. In particular, we examine traffic fatalities and injuries in California from 1988 to 1997. During the first half of this period, California law provided for secondary enforcement of its mandatory seat belt law, but in 1993 it upgraded the law to primary enforcement. Controlling for the number of motor vehicle collisions, a Box-Tiao intervention analysis of the time series is used to compare the monthly fatalities and injuries before and after the change in the enforcement provision. The results show that California experienced an improvement in traffic safety in terms of a significant reduction in injuries, but the change in enforcement provision had no statistically significant impact on fatalities. (Copyright © 2002 Elsevier Science)
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 F. Tamburro, Division of Critical Care Medicine, St Jude Children's Research Hospital, 332 North Lauderdale, Memphis, TN 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 Injury Prevention)
An algorithm for assessing the risk of traffic accident.

Ng KS, Hung WT, Wong WG. J Safety Res 2002; 33(3):387-410.

Correspondence: Kwok-suen Ng, Department of Civil and Structural Engineering, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, CHINA; (email: ceks.ng@polyu.edu.hk).

OBJECTIVES: This study is aimed at developing an algorithm to estimate the number of traffic accidents and assess the risk of traffic accidents in a study area.

METHOD: The algorithm involves a combination of mapping technique (Geographical Information System (GIS) techniques) and statistical methods (cluster analysis and regression analysis). Geographical Information System is used to locate accidents on a digital map and realize their distribution. Cluster analysis is used to group the homogeneous data together. Regression analysis is performed to realize the relation between the number of accident events and the potential causal factors. Negative binomial regression model is found to be an appropriate mathematical form to mimic this relation. Accident risk of the area, derived from historical accident records and causal factors, is also determined in the algorithm. The risk is computed using the Empirical Bayes (EB) approach. A case study of Hong Kong is presented to illustrate the effectiveness of the proposed algorithm.

RESULTS: The results show that the algorithm improves accident risk estimation when comparing to the estimated risk based on only the historical accident records. The algorithm is found to be more efficient, especially in the case of fatality and pedestrian-related accident analysis.

DISCUSSION: The output of the proposed algorithm can help authorities effectively identify areas with high accident risk. In addition, it can serve as a reference for town planners considering road safety. (Copyright © 2002 Elsevier Science)
Automobile restraints for children: a review for clinicians.

Howard AW. CMAJ 2002; 167(7): 769-773.

Correspondence: Andrew W. Howard, Hospital for Sick Children, Toronto ON M5G 1X8, CANADA; (email: andrew.howard@sickkids.ca).

More Canadian children die of road traffic injuries than of any other cause. Nonuse and misuse of child restraints is common and leads to preventable severe injuries or deaths. This article, intended for clinicians interested in injury prevention counselling, advocacy, research, and treatment of child occupants in car crashes, reviews current knowledge about child safety seats and discusses controversies related to their use. Children should sit in the back seat of a vehicle and should be properly restrained in a current age- and size-appropriate device (rear-facing infant seat, child safety seat, booster seat, or lap and shoulder seat belt) that is properly adjusted. The centre rear seat is safer than side positions, but a lap belt alone should be avoided. The age at which children should start sitting in a forward-facing position is controversial. Children should be seated away from air bags. Resources to aid in patient counselling are described. (Copyright 2002 Canadian Medical Association)
Motorcycle Safety - an Oxymoron.

Lambert J. Proceedings of the Road Safety Research, Policing and Enforcement Conference 2002.

Correspondence: John Lambert, John Lambert & Associates Pty Ltd, 235 Wandana Drive, Wandana Heights, Victoria, 3216 AUSTRALIA; (email: lambertj@pipeline.com.au).

Road trauma levels have stabilized in Australia and in Victoria may be increasing. About 15% of fatalities, 10% of serious injuries and 7% of minor injuries relate to motorcycle travel though these vehicles account for only about 0.6% of vehicle occupant travel. Principle reasons for this high level and motorcycle deaths and hospitalisation are: 1) Motorcycle riders and pillions are unprotected road users; 2) Motorcycles are capable of very high acceleration rates compared to cars and very high speeds, but such acceleration and speed can only be safely undertaken in straight line travel;· Motorcycles are inherently unstable; 3) Humans can only survive direct impact with cars or fixed objects up to impact speeds of around 80 - 90 km/h; 4) There are significantly higher levels of "illegal" activity associated with motorcycle travel; 5) Motorcycle riders have a belief set that allows them to rationalise away the risks of motorcycle travel; and 6) Motorcyclists and others incorrectly believe that drivers should see them, and that if the drivers don't see them the crash is the drivers fault.

Gains in light vehicle related road safety have been achieved through occupant protection, pedestrian friendly vehicle front design, and effective enforcement. For heavy vehicles gains have been achieved through speed limiters, fatigue management requirements, extra requirements in regard to drink driving, and effective enforcement. But there have been little gains in motorcycle safety. As a result the relative rate of motorcycle fatalities per unit of travel has increased from around 13 times higher to 30 times higher than for other vehicle "occupants" over the past 20 years. Relative hospitalisation rates are likely to have increased to a similar degree.

Reducing speeds of motorcycles has potential to significantly reduce motorcycle trauma both through reduced impact speeds with heavy objects and moderation of the appeal of motorcycles in respect of high speed travel. Research suggests a rider has a greater than 60% chance of being killed if they hit an object at 60 km/h, and 95% at 80 km/h.

About one in three motorcycle crashes involve unregistered motorcycles, unlicensed riders or both. Yet motorcycles have no requirement for a front number plate and they are difficult to intercept in traffic because they can travel between lanes.

Motorcyclists have a mistaken belief that they can control their riding environment to the degree they can eliminate risk. Yet the cost of road trauma for motorcycles are around A$0.50 per km versus A$0.025 for cars. For average annual kilometres the total costs are A$3000 - A$3500 per year versus A$450 - A$500.Yet owners pay similar third party insurance costs to car owners in the range of A$350 to A$500.

Based on the above, gains in motorcycle safety would be best achieved through speed limiting them to say 110 km/h, requiring full size front and rear number plates as an aid to enforcement, and ensuring the full cost of third party insurance is born by motorcycle riders.

'Road rage' in Arizona: armed and dangerous.

Miller M, Azrael D, Hemenway D, Solop FI. Accid Anal Prev 2002; 34(6): 807-814.

Correspondence: Matthew Miller, Department of Health Policy & Management, Harvard School of Public Health, Boston, MA 02115, USA; (email: mmiller@hsph.harvard.edu)

Little is known about the relationship between firearm carrying and hostile behavior on the roadway. To explore a possible association between firearm carrying by drivers and hostile driving behavior we conducted a random-digit-dial survey of 790 licensed drivers in Arizona. In addition to demographic questions, we asked whether respondents had carried a gun while driving in the 12 months prior to the survey. Respondents were also asked if they, in anger, had personally made obscene gestures, cursed or shouted at other drivers, impeded another drivers progress with their vehicle, aggressively 'followed another driver too closely', or brandished a gun at another driver. We used multivariable logistic regression to explore correlates of hostile driving behavior while taking into account several demographic and behavioral characteristics. Overall 11% of drivers always (4%) or sometimes (7%) carried a gun with them in their vehicle; 34% report having made obscene gestures/cursed/shouted angrily; 28% report aggressively following or blocking other drivers with their vehicle. In both crude and multivariate adjusted analyses, self-report of engaging in hostile behavior while driving was significantly more common among men, young adults, and individuals who carried a firearm in their car. Our findings suggest that, at least among Arizona motorists, having a gun in the car is a strong marker for aggressive and illegal behavior behind the wheel. (Copyright © 2002 Elsevier Science)
Underestimates of unintentional firearm fatalities: comparing Supplementary Homicide Report data with the National Vital Statistics System.

Barber C, Hemenway D, Hochstadt J, Azrael D. Inj Prev 2002; 8(3): 252-256.

Correspondence: Catherine Barber, Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA 02115, USA; (email: cbarber@hsph.harvard.edu).

OBJECTIVE: A growing body of evidence suggests that the nation's vital statistics system undercounts unintentional firearm deaths that are not self inflicted. This issue was examined by comparing how unintentional firearm injuries identified in police Supplementary Homicide Report (SHR) data were coded in the National Vital Statistics System.

METHODS: National Vital Statistics System data are based on death certificates and divide firearm fatalities into six subcategories: homicide, suicide, accident, legal intervention, war operations, and undetermined. SHRs are completed by local police departments as part of the FBI's Uniform Crime Reports program. The SHR divides homicides into two categories: "murder and non-negligent manslaughter" (type A) and "negligent manslaughter" (type B). Type B shooting deaths are those that are inflicted by another person and that a police investigation determined were inflicted unintentionally, as in a child killing a playmate after mistaking a gun for a toy. In 1997, the SHR classified 168 shooting victims this way. Using probabilistic matching, 140 of these victims were linked to their death certificate records.

FINDINGS: Among the 140 linked cases, 75% were recorded on the death certificate as homicides and only 23% as accidents.

CONCLUSION: Official data from the National Vital Statistics System almost certainly undercount firearm accidents when the victim is shot by another person. (Copyright © 2002 Injury Prevention)

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Rev. 17 Nov 2002