SafetyLit Update: 2 December 2002

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2 December 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.

A new approach to student alcohol abuse at Georgetown University.

Minto SD, Bennett RE 2nd, Keltner BR, Porterfield DR. J Am Coll Health 2002; 51(2): 81-87.

Correspondence: Bette R. Keltner, Georgetown University, 3700 Reservoir Road NW, Washington, DC 20057, USA; (email: brk@georgetown.edu).

Large percentages of American high school students have used alcohol and have been exposed to frequent alcohol advertising and product placement in the media. Colleges face three interconnected and often conflicting issues: most students desire to include alcohol in their social activities, student alcohol abuse contributes to serious harm, and laws make it illegal for the majority of students to drink. An ad hoc group of Georgetown University students, faculty, and administrators created an innovative approach to this vexing issue. This report describes the project goals, methods, structure, and experience. (Copyright © 2002, Helen Dwight Reid Educational Foundation - Heldorf Publications)

What ails the Bhopal disaster investigations? (And is there a cure?).

Dhara VR. Int J Occup Environ Health 2002; 8(4): 371-379.

Correspondence: V. Romana Dhara, Occupational Health Program, Harvard School of Public Health, Boston, Massachusetts, USA; (email: rdhara@aol.com).

A review of the health effects of the 1984 disaster in Bhopal, India, shows continuing morbidity of a multi-systemic nature in the exposed population. Scientific questions about epidemiologic issues are discussed with a view to understanding appropriate methods of investigation into the disaster. Other major chemical incidents were reviewed to note some of the common problems associated with public health investigations of disasters, which have included the lack of accident-related and toxicologic information, expertise, and funds. The complexity of the Bhopal crisis was underscored by the severe mortality and morbidity it entailed as well as its occurrence in a developing nation that had little experience in dealing with chemical disasters. Lessons learned from the disaster are discussed, with recommendations for disaster preparedness, long-term monitoring, rehabilitation, and treatment of the gas victims. (Copyright © 2002, Hanley & Belfus)
The public health consequences from acute chlorine releases, 1993-2000.

Horton DK, Berkowitz Z, Kaye WE. J Occup Environ Med 2002; 44(10): 906-913.

Correspondence: D. Kevin Horton, Agency for Toxic Substances and Disease Registry, Division of Health Studies/Epidemiology and Surveillance Branch, 1600 Clifton Road NE, Mailstop E-31, Atlanta, GA 30333, USA; (email: dhorton@cdc.gov).

Chlorine, a commonly used hazardous substance, can be harmful to human health when improperly released. Data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance system were used to conduct a retrospective analysis on the public health consequences from acute chlorine release in 16 states during 1993 through 2000. There was an overall decline in the number of chlorine events during the period analyzed; however, chlorine events were more likely to result in events with victims, evacuations, and decontaminations when compared with nonchlorine events (relative risk [RR] = 4.5, 95% confidence interval [CI] = 4.1 to 5.0; [RR] = 4.8, CI 4.3 to 5.3; and [RR] = 2.0, CI 1.7 to 2.4, respectively). Most chlorine victims were employees and members of the general public. The predominant symptoms sustained were respiratory and eye irritation. Equipment failure and human error were the most frequent factors leading to an event. Continuous employee training and preventive equipment maintenance can help prevent chlorine releases from occurring and minimize exposure to the general public.

Development of a criterion to prevent tympanic membrane perforation caused by children's products.

Rider G, Stool D, Milkovich S. Inj Control Saf Promot 2002; 9(3): 169-173.

Correspondence: Gene Rider, RAM Consulting, 1301 West 22nd Street, Suite 888, Oak Brook, IL 60523, USA; (email: unavailable).

Consumer products or product components that fit into the external ear canal may cause tympanic membrane (TM) perforation injuries to children. The size, shape, and consistency characteristics of the products of components of products responsible for these injuries may be described as long and slender with a consistency stiff enough to penetrate the TM traumatically. Sharp terminal shapes are particularly hazardous. Assessing the hazard level of these products allows us to understand and communicate the risk of injury. This can lead to the creation and use of product design criteria that reduce the risk of these injuries to children. The information presented in this report may be used to develop a criterion for slender components in order to eliminate the potential of TM penetration injuries to children caused by consumer products. (Copyright © 2002, Swets & Zeitlinger)
Incidence of fires and related injuries after giving out free smoke alarms: cluster randomized controlled trial.

DiGuiseppi C, Roberts I, Wade A, Sculpher M, Edwards P, Godward C, Pan H, Slater S. BMJ 2002; 325(7371): 995.

Correspondence: Carolyn DiGuiseppi, Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Campus Box B-119, Denver, CO 80262, USA; (email: Carolyn.DiGuiseppi@uchsc.edu).

OBJECTIVE: To measure the effect of giving out free smoke alarms on rates of fires and rates of fire related injury in a deprived multiethnic urban population. DESIGN: Cluster randomized controlled trial. SETTING: Forty electoral wards in two boroughs of inner London, United Kingdom. PARTICIPANTS: Primarily households including elderly people or children and households that are in housing rented from the borough council. Intervention: 20 050 smoke alarms, fittings, and educational brochures distributed free and installed on request. MAIN OUTCOME MEASURES: Rates of fires and related injuries during two years after the distribution; alarm ownership, installation, and function. RESULTS: Giving out free smoke alarms did not reduce injuries related to fire (rate ratio 1.3; 95% confidence interval 0.9 to 1.9), admissions to hospital and deaths (1.3; 0.7 to 2.3), or fires attended by the fire brigade (1.1; 0.96 to 1.3). Similar proportions of intervention and control households had installed alarms (36/119 (30%) v 35/109 (32%); odds ratio 0.9; 95% confidence interval 0.5 to 1.7) and working alarms (19/118 (16%) v 18/108 (17%); 0.9; 0.4 to 1.8). CONCLUSIONS: Giving out free smoke alarms in a deprived, multiethnic, urban community did not reduce injuries related to fire, mostly because few alarms had been installed or were maintained. (Copyright © 2002, British Medical Journal)

See also abstracts under Violence
How reasonable is reasonable use? The search for safer stepladders.

Clift L, Navarro TB, Thomas DAB. Inj Control Saf Promot 2002; 9(3): 175-184.

Correspondence: Laurence Clift, Loughborough University, Applied Ergonomics Centre, Research School in Ergonomics and Human Factors, Loughborough, UK; (email: l.clift@lboro.ac.uk).

Stepladder accidents continue to be a major cause of injury at home and at work. Despite this, few changes have been seen in their design or their labeling. Many of the accidents occurring appear to be whilst the stepladder is being utilized in a manner which the user considers reasonable, but the manufacturer considers abuse. This work, sponsored by the Health and Safety Executive, investigates whether this mismatch can be eliminated in order to improve safety.

The research combines user profiling with dynamic trials to establish what behavior stepladders need to sustain. Through innovative measuring techniques, the demands on the stepladder system are quantified and the margin of safety calculated.

Extensive dynamic trials generated data for over 4000 user, stepladder and task combinations. Individuals were given demanding tasks, but permitted to undertake them in a manner they considered reasonable and the resulting data can be considered as representative of the demands they would place on stepladders in everyday use.

From this data, the stepladder and user system has been modeled, allowing manipulation of the stepladder parameters such that a virtual stepladder can be created which provides sufficient stability to tolerate all reasonably foreseeable use. In addition this model is used to generate predictive software which can determine the level of safety provided by real, or theoretical, stepladders. In conclusion, a specification for a simple test is given which could be routinely conducted to determine whether any given stepladder will offer the minimum level of stability considered necessary for safe use. (Copyright © 2002, Swets & Zeitlinger)
Incident-level risk factors for fire fighter injuries at structural fires.

Fabio A, Ta M, Strotmeyer S, Li W, Schmidt E. J Occup Environ Med 2002; 44(11): 1059-1063.

Correspondence: Anthony Fabio, University of Pittsburgh, Center for Injury Research and Control, 200 Lothrop Street, Suite B400-PUH, Pittsburgh, PA 15213, USA; (email: fabioa@msx.upmc.edu).

Firefighting is a demanding occupation, laden with hazardous exposures which result in traumatic injuries. Little epidemiologic evidence exists quantifying these factors, however. We conducted an incident-level case-control study of National Fire Incident Reporting System data of the association between firefighter injury and incident characteristics. Risk factors included 5 or more alarms (OR = 3.85; 95% CI, 3.32-4.48), number of stories (> 3 vs. ground level OR = 2.49; 95% CI, 1.43 to 1.55), and at least one civilian injury (OR = 3.69; 95% CI, 3.55-3.84). Risk of injury was reduced for fires originating 49 feet and higher (OR = 0.57; 95% CI, 0.49-0.66). This analysis suggests that fireground-specific situations such as the number of stories or a civilian injury increase the risk of injury. Given the danger of firefighting, the identification of risk factors through epidemiologic methods is vital to developing safety measures.
Ethical concerns in international occupational health and safety.

London L, Kisting S. Occup Med 2002; 17(4): 587-600.

Correspondence: Leslie London, School of Public Health & Primary Health Care, University of Cape Town, SOUTH AFRICA; (email: ll@cormack.uct.ac.za).

The number of preventable occupational health and safety (OHS) tragedies that occur yearly requires a deeper examination of the ethics that inform health and safety policies and practices. This article selects a few industrial sectors for closer examination to illustrate challenges and opportunities. Topics addressed include: equitable distribution of resources, ethically acceptable global standards for OHS for all workers, and international use of pesticides and the export of banned chemicals. The authors focus on the relationship between less developed and developed countries and attempt to identify areas of collaboration and potentially positive channels for addressing shortcomings. The agricultural sector is examined in particular because of the major role this sector plays in developing countries. Finally, the authors examine the impact of globalization on the international ethical practice of OHS, especially in relation to vulnerable and marginalized groups such as women, children, and informal sector workers, and conclude with recommendations for working towards more equitable global ethical standards in international OHS.

Theory of planned behavior and pedestrians' intentions to violate traffic regulations.

Diaz EM. Transp Res Traf Psychol and Behav 2002; 5F(3): 169-176.

Correspondence: Emilio Moyano Díaz, Escuela de Psicologia, Universidad de Santiago de Chile, Avda Ecuador 3650, 3e piso, Santiago de Chile, CHILE; (email: emoyano@lauca.usach.cl).

Based on the theory of planned behavior, pedestrians' attitudes towards traffic violations and self-ratings of violations, errors and lapses were measured amongst a sample of 146 pedestrians. The evaluation of the planned behavior model using EQS showed a significant fit (chi sq (11)=16.04 p=0.14; normalfitindex=0.937). The reported violations, errors and lapses appears causally related to the intention to violate regulations, and this in turn with positive attitudes, subjective norm and perceived behavioral control. Young people have a more positive attitude towards committing violations as pedestrians than adults and perceive the subjective norm to be less inhibitory, have less control over violations, have a more positive intention to commit violations, and report more violations, errors, and lapses than adults. Men report more frequent violations of the traffic rules than women do. The conclusion is drawn that pedestrians, and in particular young males, are at least in part responsible for the high accident rates and remedial actions are suggested. (Copyright © 2002, Elsevier Science)
Bicycle spoke injuries in children: accident details and consequences.

Article in Dutch.

Sturms LM, van der Sluis CK, Snippe H, Groothoff JW, ten Duis HJ, Eisma WH. Ned Tijdschr Geneeskd 2002; 146(36): 1691-1696.

Correspondence: L.M. Sturms, Centrum voor Revalidatie, Academisch Ziekenhuis, Postbus 30.001, 9700 RB Groningen, THE NETHERLANDS; (email: l.m.sturms@rev.azg.nl).

OBJECTIVE: To describe the accident details and the effects of bicycle-spoke accidents on the physical and psychosocial functioning of children.

DESIGN: Retrospective, descriptive.

METHODS: The parents of 87 children aged between 1-12 who came to the central casualty department at the Groningen University Hospital with bicycle-spoke injuries during the period 1 January 1998 to 31 October 1999, were asked to complete a questionnaire on the accident details, the quality of life and the functional health status (behavior) of their child in January 2000.

FINDINGS: Eighty-seven children fulfilled the inclusion criteria: 44 boys and 43 girls, with a mean age of 4.4 years (SD: 1.6, range: 1.4-10.2). Fifty-nine parents filled out the questionnaire (68%). A quarter of the children had been transported in a bicycle-seat (25%) and half of the children (51%) were seated on the carrier without any foot supports. Twenty-four percent of the bicycles were equipped with unbroken coat guards. The younger children (1-5 years of age) had significantly lower scores regarding motor functioning compared with the reference group (p < 0.001). The study population did not have significantly lower scores for the other quality of life domains compared with the reference groups. Eight parents (14%) attributed behavioral problems to the bicycle-spoke accident.

DISCUSSION: Not all children were fully recovered one year after the bicycle-spoke accident. The sequelae included physical as well as behavioral aspects of functioning. The bicycles lacked adequate protective measures.

See abstract under Suicide

Sports participation and high grade renal injuries in children.

Gerstenbluth RE, Spirnak JP, Elder JS. J Urol 2002; 168(6): 2575-2578.

Correspondence: Jack S. Elder, Department of Urology, Rainbow Babies and Children's Hospital, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; (email:jse@po.cwru.edu).

OBJECTIVES: The risk of major renal injury resulting from various forms of sports participation is unknown. Urologists often recommend that children with a solitary kidney avoid contact sports. We reviewed our recent experience with pediatric renal trauma to determine if there is an association between different types of sports activity and high grade renal injury.

MATERIALS AND METHODS: We retrospectively reviewed the medical records of 68 consecutive children with blunt renal injury who were treated at 2 level I trauma centers. Injuries were graded using the renal injury scale of the American Association for the Surgery of Trauma. Records were reviewed for mechanism of injury, associated injuries, management and injury severity score. Statistical analysis was performed using Fisher's exact test or Wilcoxon rank sum test.

FINDINGS: Of the 68 renal lesions 13 were grade I, 15 grade II, 15 grade III, 17 grade IV and 8 grade V. The most common cause of renal trauma was motor vehicle accidents, accounting for 21 injuries (30.1%). Accidents associated with nonmotorized sports activity accounted for 14 injuries (20.6%). Bicycle riding was the most common sports etiology, accounting for 8 of 14 cases (57.1%) at an age range of 5 to 15 years (mean 9.4). None of the bicycle injuries involved collision with a motor vehicle. Bicycling accounted for 1 grade I, 1 grade II, 1 grade III, 2 grade IV and 3 grade V injuries. Football, hockey and sledding were responsible for the remaining 6 sports related injuries. High grade renal injury (grade IV or V) was identified in 5 of 8 bicycle accidents (62.5%) and 1 of 6 nonbicycle sports related injuries (16.7%, p = 0.14). Injury severity scores ranged from 4 to 50 (mean 20.6) for bicycle renal injuries and 4 to 13 (mean 6.7) for nonbicycle sports related trauma (p < 0.05). Parents indicated that blunt trauma from the handlebars was the major factor contributing to renal injury in 3 bicycle cases. Renal trauma from bicycle riding resulted in 1 nephrectomy.

DISCUSSION: Bicycle riding is the most common sports related cause of renal injury in children and is associated with a significant risk of major renal injury. Families of children with a solitary kidney should be aware of this risk factor. Team contact sports are an uncommon cause of high grade renal injury. Current recommendations regarding sports participation by children with a solitary kidney need to be reevaluated. (Copyright © 2002, Lippincott Williams & Wilkins)

Marked injury decline among pedestrians 1987-1994.

Article in Swedish

Bostrom L, Nilsson B. Lakartidningen 2002; 99(28-29): 3018-3020.

Kirurgiska kliniken, Centrallasarettet, Vasteras, SWEDEN; (email: lennart.bostrom@ltvastmanland.se).

A retrospective case study from The Swedish Hospital Discharge Register was performed. There were 8,684 pedestrians in collision with motor vehicles, a total of 12,036 episodes, treated in Swedish hospitals from 1987-1994. Fifty three percent were men and 47% women, having a median age of 47 (range 1-100) years. In average, 17.6 persons were admitted/100,000 population/year. The annual incidence of injured pedestrians in Sweden decreased significantly during this period. Injuries to the extremities were commonest (39% fractures), followed by injuries to the head and neck (34%). The total number of deaths in our series of patients was 444 (5%). Among these, more than half had head, 1/5 orthopedic, 1/20 abdominal or thoracic injuries. Among pedestrians hit by motor vehicles injuries to the extremities were commonest, followed by injuries to the head and neck. The usual victim was an old person. Five percent of the patients treated in hospital died.
Injury morbidity in 18-64-year-olds: impact and risk factors.

Plugge E, Stewar-Brown S, Knight M, Fletcher L. J Public Health Med 2002; 24(1): 27-33.

Correspondence: Emma Plugge, Health Services Research Unit, University of Oxford, Institute of Health Sciences, Old Road, Oxford OX3 7LF, UK; (email: emma.plugge@dphpc.ox.ac.uk).

BACKGROUND: Non-fatal injury is an important public health problem but is thought to be difficult to quantify. This study aimed to estimate the extent of disability attributable to injury in the working age population, and its impact on quality of life, as well as identifying factors associated with an increased risk of disabling and non-disabling injury.

METHODS: Secondary analysis was carried out of data obtained from a postal questionnaire survey of 8889 18-64-year-olds randomly selected from computerized general practitioner records in Oxfordshire, Buckinghamshire, Berkshire and Northamptonshire.

FINDINGS: Sixteen per cent of survey respondents reported an injury requiring medical attention in the previous 12 months, 5 per cent reported an injury that had disabled them for more than 1 month, and a further 5 per cent a longstanding disability as a result of injury. The point prevalence of disability as a result of injury was estimated to be 6.4 per cent. SF-36 scores suggest that the quality of life of people reporting injury-related disability was markedly reduced. Social class is associated less with injury morbidity than with injury mortality. Sport was the commonest cause of all injuries, and of disabling injuries. There was a dose-response relationship between vigorous exercise and injury.

CONCLUSIONS: Injury is a significant cause of disability in the working age population. It is potentially feasible to monitor injury-related disability in postal questionnaire surveys. Estimates of health gain to be achieved from participation in sport should take account of injury-related disability. (Copyright © 2002, Faculty of Public Health Medicine - Oxford University Press)
An epidemic pattern of murder.

Knox EG. J Public Health Med 2002; 24(1): 34-37.

Correspondence: E.G. Knox, Mill Cottege, Great Comberton, Pershore WR 10 3 DU, UK; (email: E.G.Knox@btintemet.com).

The dates and places of 105 suspected or proven murders committed by Dr H. Shipman of Hyde in Greater Manchester between 1984 and 1998 were subjected to epidemiological analysis. These interim data were assembled through a variety of media sources and were based upon court proceedings and police investigations. The analysis revealed a significant excess of case pairs separated jointly by distances < 0.6 km and by times < 7 days. These sequences were also associated with purely geographical groupings within spatial diameters < 0.2 km, but with longer time intervals. This was confirmed by an extended analysis of case triplets occurring within short times and distances. They showed a significant excess. These clusters were probably generated by a combination of psychopathic obsession, of local opportunity, and of caution; and in similar circumstances could occur again. The findings demand the regular display of mortality data in a format permitting the intuitive recognition of similar phenomena elsewhere. (Copyright © 2002, Faculty of Public Health Medicine - Oxford University Press)

Using logistic regression to estimate the influence of accident factors on accident severity.

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

Correspondence: Ali 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. (Copyright © 2002, Elsevier Science)
Reliability assessment of a coding scheme for the physical risk factors of work-related musculoskeletal disorders.

Chen Y, Meyer JD, Song J, McDonald JC, Cherry N. Scand J Work Environ Health 2002; 28(4): 232-237.

Centre for Occupational & Environmental Health, The Faculty of Medicine, University of Manchester, UK; (email: Yiqun.chen@man.ac.uk).

OBJECTIVES: This study assessed the reliability of a novel coding scheme for physical risk factors for musculoskeletal disorders reported to an occupational surveillance scheme.

METHODS: Since 1997 new cases of musculoskeletal disease have been reported as part of a surveillance scheme by over 300 consultant rheumatologists in the United Kingdom; the rheumatologists also gave a short description of the tasks and activities they considered to be causal. With the use of a summary of the activities described, a coding scheme was developed comprising 16 categories of task codes and another 16 categories of movement codes. Four reviewers coded the work activities independently for 576 cases. The fourth rater coded the cases twice. With the use of a single summary kappa statistic and the matrix of kappa coefficients, both interrater reliability and intrarater reliability were assessed.

FINDINGS: The overall interrater agreement on the task codes was good (kappa = 0.73), with the best agreement for keyboard work (kappa = 0.96) and the worst for assembly work (kappa = 0.40, kappa = 0.37). The interrater agreement on movement codes was also good (kappa = 0.79), with the best agreement for kneeling (kappa = 0.94) and the worst for materials handling (kappa = 0.10). The intrarater agreement was somewhat better than the interrater agreement with both codes.

DISCUSSION: The results suggest that the coding scheme was, on the whole, reliable for classifying the physical risk factors reported as causal.
Hazard identification in occupational injury: reflections on standard epidemiologic methods.

Park RM. Int J Occup Environ Health 2002; 8(4): 354-362.

Correspondence: Robert M. Park, Education and Information Division, Risk Evaluation Branch, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA; (email: rhp9@cdc.gov).

To prevent workplace injuries, epidemiologic research must continue to progress beyond methods originally used for acute or chronic diseases. For injury research, exposure assessment requires increased sophistication because exposures comprise multiple, transient factors and complex work activities. Frequently reported risk factors such as age, gender, seniority, or prior injury are often confounders or effect-modifiers of unknown exposures. Injury rate calculations across nominal categories, e.g., department or job classification, identify where hazards are concentrated but provide little insight into their nature; injury counts often perform almost as well. Calculation of rates in relation to time actually spent in plausible etiologic exposure conditions usually is not feasible. Generalization of the Haddon approach for individual injury events to systematically analyze injury case series can identify both the mechanism of injury and the relative occurrences of high-risk conditions. In some contexts, case-crossover designs may elucidate injury causation. National databases and information systems of employers, insurers, and equipment suppliers could contribute case series for injury hazard identification. By enhancing exposure assessment through a focus on case series, epidemiologic research can expand its contribution to preventing workplace injuries.

Risk factors for machinery-related injury among Iowa farmers: a case-control study nested in the Agricultural Health Study.

Sprince NL, Park H, Zwerling C, Lynch CF, Whitten PA, Thu K, Gillette PP, Burmeister LF, Alavanja MC. Int J Occup Environ Health 2002; 8(4): 332-338.

Correspondence: Nancy Sprince, Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City 52242-5000, USA; (email: nancy-sprince@uiowa.edu).

Farm machinery is a major cause of injury morbidity and mortality among farmers. This case-control study assessed risk factors for machinery-related injuries among Iowa farmers. A screener questionnaire sent to 6,999 farmers in 1998 identified 205 farmers who had machinery-related injuries requiring medical advice/treatment in the previous year. Possible risk factors for injury were assessed among these farmers compared with 473 farmers with no injury in the previous year. A multiple logistic regression analysis showed significant associations between machinery-related injury and hours per week spent on farm work (OR = 2.02; 95% CI 1.38-2.94), fewer years of farming experience (OR = 1.79; 95% CI 1.14-2.79), wearing a hearing aid (OR = 4.37; 95% CI 1.55-12.25), and a high CAGE score suggesting problem drinking (OR = 2.49; 95% CI 1.00-6.19). This is the first study to show associations between machinery-related injury and hearing impairment, problem drinking, and fewer years of farming experience. These findings may be useful for future interventions to decrease injuries related to farm machinery. (Copyright © 2002, Hanley & Belfus)

See abstracts under Violence

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, NM 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.
Risk factors for suicide in China: a national case-control psychological autopsy study.

Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Lancet 2002; 360: 1728-1736.

Correspondence: Michael R. Phillips, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing 100096, People's Republic of China; (email: phillips@public3.bta.net.cn).

BACKGROUND: Suicide is the fifth most important cause of death in China, but the reasons fo1 the high rate and unique pattern of characteristics of those who kill themselves are unknown.

METHODS: We pretested, and then administered a comprehensive interview to family members and close associates of 519 people who committed suicide and of 536 people who died from other injuries (controls) randomly selected from 23 geographically representative sites in China.

FINDINGS: After adjustment for sex, age, location of residence, and research site, eight significant predictors of suicide remained in the final unconditional logistic regression model. In order of importance they were: high depression symptom score, previous suicide attempt, acute stress at time of death, low quality of life, high chronic stress, severe interpersonal conflict in the 2 days before death, a blood relative with previous suicidal behavior, and a friend or associate with previous suicidal behavior. Suicide risk increased substantially with exposure to multiple risk factors: none of the 265 deceased people who were exposed to one or fewer of the eight risk factors died by suicide, but 30% (90/299) with two or three risk factors, 85% (320/377) with four or five risk factors, and 96% (109/114) with six or more risk factors died by suicide.

DISCUSSION: Despite substantial differences between characteristics of people who commit suicide in China and the west, risk factors for suicide do not differ greatly. Suicide prevention programs that concentrate on a single risk factor are unlikely to reduce suicide rates substantially; preventive efforts should focus on individuals exposed to multiple risk factors.
United Kingdom legislation on pack sizes of analgesics: background, rationale, and effects on suicide and deliberate self-harm.

Hawton K. Suicide Life Threat Behav 2002; 32(3): 223-229.

Correspondence: Keith Hawton, Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7J8, UK; (email: keith.hawton@psychiatry.ox.ac.uk).

Following increasing concern in the UK about the mortality and morbidity associated with self-poisoning with analgesics, especially paracetamol (Tylenol, acetaminophen), legislation was introduced in 1998 to modify packs sold over-the-counter. The most important change was a reduction in the maximum size of packs. In this paper the background to the legislation, the rationale behind it, and its early impact are reviewed. The changes have had significant positive initial benefits on the mortality and morbidity associated with self-poisoning with analgesics.
Deliberate self harm in adolescents: self report survey in schools in England.

Hawton K, Rodham K, Evans E, Weatherall R. BMJ 2002; 325(7374): 1207-1211

Correspondence: Keith Hawton, Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7J8, UK; (email: keith.hawton@psychiatry.ox.ac.uk).

OBJECTIVE: To determine the prevalence of deliberate self harm in adolescents and the factors associated with it.

DESIGN: Cross sectional survey using anonymous self report questionnaire. SETTING: 41 schools in England.

PARTICIPANTS: 6020 pupils aged 15 and 16 years. MAIN OUTCOME MEASURE: Deliberate self harm.

FINDINGS: 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behavior in friends and family members, drug use, and low self esteem.

DISCUSSION: Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk. (Copyright © 2002, BMJ)
Repetition of suicidal behavior in elderly Europeans: a prospective longitudinal study.

De Leo D, Padoani W, Lonnqvist J, Kerkhof AJ, Bille-Brahe U, Michel K, Salander-Renberg E, Schmidtke A, Wasserman D, Caon F, Scocco P. J Affect Disord 2002; 72(3): 291-295.

Correspondence: D. De Leo, Psychogeriatric Service, University of Padova c/o Ospedale Geriatrico, Via Vendramini 7, 35137, Padova, ITALY; (email: serv.psicoger@unipd.it).

The aim of this study was to assess any predictive factors for repeated attempted suicide and completed suicide in a 1-year follow-up on a sample of elderly European suicide attempters (60 years and over). From 1990 to 1993, 63 subjects completed the first interview and were recontacted after 1 year. At follow-up, eight subjects (12.7%) had taken their lives and seven (11.1%) had repeated at least one suicide attempt. On comparison of repeaters and non-repeaters, differences emerged in terms of death of the father in childhood and for mean Suicidal Intent Score. At the end of follow-up period, repeaters reported a more frequent desire to repeat suicidal behavior and judged their mental health and social assistance received to be worse. Suicides and non-repeaters differed especially in relation to death of father during childhood and number of contacts with General Practitioner. Interpretation of the results must take into account the smallness of the test sample, the difficulties in obtaining complete data for the follow-up interview, the lack of a control group and a diagnosis formulated in a hospital consultation setting. The study confirms, however, the high risk of repetition of suicidal behavior in the elderly. In old age suicidal ideation is often sustained over long periods of time and requests for help are addressed to relatives and GPs. An interesting finding is the more frequent death of the father during childhood among repeaters. (Copyright © 2002, Elsevier Science)

Driver workload response to in-vehicle device operations.

Jerome CJ, Ganey HC, Mouloua M, Hancock PA. Int J Occup Saf Ergon 2002; 8(4):539-548.

Correspondence: C.J. Jerome, Department of Psychology, University of Central Florida, Orlando, USA; (email: cjjerome@yahoo.com).

A central concern of Intelligent Transportation Systems (ITS) is the effect of in-vehicle devices (e.g., cell phones, navigation systems, radios, etc.) on driver performance and safety. As diverse and innovative technologies are designed and implemented for in-vehicle use, questions regarding the presence and use of these devices assume progressively greater importance. Further concerns for advanced driver training require us to develop and validate reliable and effective procedures for assessing such effects. This work examines a number of candidate procedures, in particular the evaluation of change in cognitive workload as a strategy by which such goals might be achieved.
Traffic-related fatalities among older drivers and passengers: past and future trends.

Bedard M, Stones MJ, Guyatt GH, Hirdes JP. Gerontologist 2001; 41(6): 751-756.

Michel Bédard, Lakehead Psychiatric Hospital, 580 North Algoma Street, Thunder Bay, Ontario P7B 5G4, CANADA; (email: mbedard@baynet.net).

OBJECTIVES: This study was initiated to forecast the number of older drivers and passengers who may be fatally injured in traffic crashes in future years.

DESIGN AND METHODS: The study was based on data from the U.S. Fatality Analysis Reporting System covering the period from 1975 to 1998. Projections were based on least squares regression models.

FINDINGS: About 35,000 drivers and passengers died in traffic crashes each year from 1975 to 1998. Older adults (65 and older) accounted for 10% of all fatalities in 1975, 17% in 1998, and a projected 27% by 2015, the same proportion predicted for drivers and passengers aged younger than 30. On the basis of these projections, the number of fatally injured women and men aged 65 and older will increase respectively by 373% and 271% between 1975 and 2015.

DISCUSSION: If current trends continue, the number of fatalities among older drivers and passengers and those aged younger than 30, may be equivalent early in this century. These projections call for further research into conditions that may lead to crashes involving older drivers and for the development and implementation of initiatives to curb traffic-related fatalities among older adults. (Copyright © 2001, Gerontological Society of America)
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: Michel Bedard, Lakehead Psychiatric Hospital, Thunder Bay, Ontario, 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 seat belts were protective against fatal injuries (OR = 0.46, 99% CI = 0.39-0.53 compared with no belt). These data suggest that increasing seat belt 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)
Signal detection in conditions of everyday life traffic dilemmas.

Rosenbloom T, Wolf Y. Accid Anal Prev 2002;34(6):763-772.

Correspondence: Tova Rosenbloom, Department of Criminology, Bar-Ilan University, Ramat Gan 52900, ISRAEL; (email: rosenbt1@mail.biu.ac.il).

This paper shows how the paradigm of signal detection could serve as a viable means for the analysis of drivers' choices in conditions of everyday life traffic dilemmas. The participants were 28 drivers, most of them professional, who spend at least 6 h a day on the road. All agreed to have a note-taking silent passenger for the entire journey, every day during a period of 3-4 weeks. All completed the sensation-seeking questionnaire. Their 'to do or not to do' choices in conditions of four (out of a total of six) traffic dilemmas (amber light, distance keeping, stopping in road-crossing and merging in routes) were analyzable in terms of a modification of the paradigm of signal detection. In accord with the basics of the paradigm of signal detection, the rate of success of the drivers to detect signals of danger on the road (perceptual sensitivity) fell into the range of partial uncertainty (more than 50% and not too much above this level)! The choices made by thrill-and-adventure-seeking drivers were more lenient than the choices of the drivers who scored lower on this dimension. (Copyright © 2002, Elsevier Science)
Use of a fixed-base driving simulator to evaluate the effects of experience and PC-based risk awareness training on drivers' decisions.

Fisher DL, Laurie NE, Glaser R, Connerney K, Pollatsek A, Duffy SA, Brock J. Hum Factors 2002; 44(2): 287-302.

Correspondence: Donald Fisher, Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA; (email: fisher@ecs.umass.edu)

Driver education classes were once seen as a remedy for young drivers' over involvement in crashes, but research results from the early 1970s were disappointing. Few changes in the content or methods of instruction occurred until recently, but this could change rapidly. Personal computers (PCs) can now present videos or photorealistic simulations of risky, cognitively demanding traffic scenarios that require quick responses without putting the participant at risk. As such programs proliferate, evaluating their effectiveness poses a major challenge. We report the use of a fixed-base driving simulator to study the effects of both experience on the road and PC-based risk awareness training on younger drivers' part-task simulator driving performance in risky traffic scenarios. We ran three groups of drivers on the simulator: one group first trained on the PC (younger, inexperienced drivers) and two groups who received no PC training (younger, inexperienced and experienced drivers). Overall, the younger, inexperienced drivers who were trained on a PC operated their vehicles in risky scenarios in ways that differed measurably from those of the untrained younger, inexperienced drivers and, more important, in ways that we believe would decrease their exposure to risk considering that, on average, their behavior was more similar to the behavior of the untrained, experienced drivers. More research is needed to demonstrate whether these findings apply on the open road to the larger population of younger drivers. However, at least initially, the research suggests that PC-based risk awareness training programs have the potential to reduce the high crash rate among younger, inexperienced drivers. (Copyright © 2002 Human Factors & Ergonomics Society)
Effects of an in-vehicle collision avoidance warning system on short- and long-term driving performance.

Ben-Yaacov A, Maltz M, Shinar D. Hum Factors 2002; 44(2):235-342.

Correspondence: David Shinar, Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, ISRAEL; (email: shinar@bgumail.bgu.ac.il).

Many new in-vehicle systems focus on accident prevention by facilitating the driving task. One such driving aid is an in-vehicle collision avoidance warning system (IVCAWS), used to alert the driver to an impending collision. Our study evaluated the effects of an imperfect IVCAWS both on driver headway maintenance and on driver behavior in response to warning system errors. Our results showed that drivers tend to overestimate their headway and consequently drive with short and potentially dangerous headways, and that IVCAWSs are a useful tool for educating drivers to estimate headway more accurately. Moreover, our study showed that after a relatively short exposure to the system, drivers were able to maintain longer and safer headways for at least six months. The practical implications of these results are that the use of an IVCAWS should be considered for inclusion in driver education and training programs. (Copyright © 2002 Human Factors & Ergonomics Society)
Analysis of causes of death in long-term survivors of injuries sustained in traffic accidents.

Article in Serbo-Croatian.

Milic J, Nikolic S, Mihailovic Z. Srp Arh Celok Lek 2002; 130(5-6): 149-53.

Correspondence: J Milic, Institute of Forensic Medicine, University School of Medicine, Belgrade.

BACKGROUND: The manner of death, i.e. if death is moros or violent, is the most important fact for the court and therefore, the most important part of the finding of autopsy reports. To recognize the manner of death in cases with long outliving period after injury could be difficult for forensic pathologists. In such cases, the dissector should be able to point out the direct relationship between initial injury and death by using his (her) own experience and medical knowledge. Could the deaths provoked by low injuries be prevented? These injuries have score of 3 by Abbreviated Injury Scale (AIS) i.e. 12-20 by injury Severity Score (ISS).

OBJECTIVES: The purpose of this paper is to suggest the measures for improvement of postmortem autopsy diagnosis of causes of death in cases with long outliving period (more than 15 days) after initial traffic injury.

MATERIAL AND METHOD: A retrospective autopsy study was performed. It included the material of the Institute of Forensic Medicine in Belgrade for 1998. The autopsy report and accessible clinical medical data were analyzed for persons fatally injured in traffic accidents who outlived trauma more than 15 days. The sample was statistically prepared (chi 2 test, correlation coefficient).

RESULTS: The sample included 31 persons injured in traffic accidents with outliving period longer than 15 days: 21 males and 10 females (chi 2 = 0.047; p > 0.1). Average age was 49.90 years (SD = 18.28). All persons in our sample were over the age of 19. The most commonly injured persons were pedestrians (16). The mean outliving period was 41.19 days (SD = 12.60). There was a weak positive correlation between outliving period and age in our sample (coefficient of linear correlation r = 0.35). The authors combined the autopsy and available clinical data in order to get the ISS value for each case. The mean ISS value was 36.18 (SD = 8.70). There was no correlation between outliving period and severity of trauma (coefficient of linear correlation r < 0.14). All deaths in our sample were violent according to autopsy reports. In autopsy reports, dissectors always noted only one injured body region: head and neck injuries in 21 cases, chest injuries in 3, trauma of locomotor system in 5 and in 2 cases abdominal injuries. However, by analyzing these reports, the authors emphasized that in 22 cases one body region was severely injured, in 7 cases two body regions and three regions in 2 cases. According to the authors severe injury has score 3 or more by 3. In four cases the dissectors pointed no complication of initial injuries as a competitive cause of death. In 15 cases they mentioned it as general, and in the rest of cases as decided (e.g. pneumonia, sepsis, thromboembolism, etc.). In five cases, the complications of initial injury were the precipitated and immediate cause of death (the initial injury in all these cases was less than 16 by ISS i.e. severe but not critical). The seven cases were treated microscopically. These microscopical findings only proved the already established microscopical autopsy findings and were not crucial for case solution. It was alarming, that one third of cases in our sample were completed without considering the clinical medical data. This is forensic vitium artis. Nowadays, there are a few syndromes which could be the cause of death i.e. fat embolism syndrome, multiple organ failure) and systemic inflammatory response syndrome. The diagnosis of these syndromes is possible only clinically: the autopsy and histological findings are not specific.

DISCUSSION: As long as a direct chain of events can be traced from the injury to the death, then the initial injury must be considered to be the basic cause of death, and this fact may have profound legal implications for both civil compensation and criminal responsibility. Some of the most difficult problems in forensic pathology concern deaths from which posttraumatic complications are disputed as being fatal causative factors. The agony and dying are irreversible dynamic pathophysiological processes. By autopsy only the morphological consequences of these processes could be noted by dissector. The dynamics of dying, direct correlation between initial injury and death, as well as appearance and development of complications provoked by trauma could be established only by clinical medical data. Therefore, medical clinical data are crucial for forensic pathologists and for solving the problems about the mode and manner of death in cases with long outliving period. Microscopical findings have only academic and scientific importance and are less useful in daily practice. The authors suggest that all complications of injury must be generally involved in autopsy reports, and all severe injuries should separately be registered both in medical data and autopsy reports. The finding of cause of death must include all observed severe injuries and not only one of the most severe injuries and its complications.
Traffic deaths and superstition on Friday the 13th.

Nayha S. Am J Psychiatry 2002; 159(12): 2110-2111.

Correspondence: Simo Näyhä, University of Oulu, FINLAND; (email: simo.nayha@oulu.fi)

OBJECTIVE: This study compared deaths from traffic accidents on Friday the 13th with those on other Fridays in a national population.

METHOD: The author examined the daily deaths from traffic accidents by sex and age and the mean daily temperature in Finland, 1971-1997. Adjusted risk ratios for death on Friday the 13th versus other Fridays were obtained by negative binomial regression.

FINDINGS: In men, the adjusted risk ratio for dying on Friday the 13th, compared with other Fridays, was 1.02, but for women, it was 1.63. An estimated 38% of traffic deaths involving women on this day were attributable to Friday the 13th itself.

DISCUSSION: Friday the 13th may be a dangerous day for women, largely because of anxiety from superstition. The risk of traffic deaths on this date could be reduced by one-third, although the absolute gain would remain very small: only one death per 5 million person-days. (Copyright © 2002, American Psychiatric Association)

Violence prevention in the schools: Implications for occupational therapy.

Robbins JE. Work 2001;17(1):75-82.

Correspondence: Jill Robbins, Sargent College, Boston University, Boston, MA, USA. E-mail: Jill_Robbins@msn.com

The prevalence of violence in the United States has begun to take its toll on the youth in schools. As children spend the majority of their waking hours in school, it is there that programs to prevent violence should be implemented. Various factors compiled from the literature including traits of children "at-risk", lack of adult supervision, and architectural barriers, are identified as contributing to on-campus crime. Skills training for educators, school officials, parents, and children, in addition to reduction of architectural barriers, are discussed as methods to promote awareness and prevention. Implications for occupational therapy practitioners are discussed.
Violence risk and protective factors among youth held back in school.

Borowsky IW, Ireland M, Resnick MD. Ambul Pediatr 2002; 2(6): 475-484.

Correspondence: Iris Wagman Borowsky, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA; (email: borow004@umn.edu).

OBJECTIVES: To identify risk and protective factors for violence perpetration among youth with a history of grade retention. Design.-Longitudinal analysis of in-home interviews of 13 781 adolescents in grades 7 through 12 conducted in 1995 and 1996.

METHODS: Serious interpersonal violence perpetration at time 2 by time 1 independent variables including measures of community and school context, family context, and individual characteristics.

FINDINGS: The 20% of girls and 28% of boys who had repeated 1 or more grades were more likely than those who had not to be in the top quintile of violence perpetration at time 2 (P <.001). For both girls and boys with a history of grade repetition, predictive risk factors with an odds ratio of 3 or greater (P <.001) included time 1 violence perpetration, violence victimization, weapon carrying, school problems, and alcohol and marijuana use. Although a high grade point average was a significant protective factor against violence perpetration for both girls (odds ratio, 0.36; P <.05) and boys (odds ratio, 0.23; P <.001), performance on a validated measure of verbal knowledge was not associated with violence perpetration over the study period. School connectedness, parent-family connectedness, and emotional well-being were also significant universal protectors against violence perpetration.

DISCUSSION: Youth who are held back in school are at heightened risk for violence perpetration. Violence-related behaviors and substance use considerably increase the likelihood of this outcome. The findings suggest that schools can participate in violence prevention by providing youth with a positive community and academic experience. (Copyright © 2002, The Ambulatory Pediatric Association)
A case-site/control-site study of workplace violent injury.

Schaffer KB, Casteel C, Kraus JF. J Occup Environ Med 2002; 44(11): 1018-1026.

Correspondence: Kathryn Brown-Schaffer, Southern California Injury Prevention Research Center, UCLA School of Public Health, Los Angeles, CA, USA; (email: ktbrown@ucla.edu).

Workers in retail and service industries are at high risk for workplace violence. While studies have examined the association between environmental and community factors on robbery risk, few have examined risk factors for fatal and nonfatal employee violent injury. A matched case-site/control-site study was conducted among various retail and service establishments in seven California counties. An interview and environmental assessment was performed in each participating business. Over half of the injury events occurring in case-site were robbery-related, and nearly 13% were fatal. Businesses open 24 hours and those having a history of violent events were found to be at increased risk for employee injury.
Workplace homicides in Chicago. Risk factors from 1965 to 1990.

Beauchamp Hewitt J, Levin PF, Misner ST. AAOHN J 2002; 50(9): 406-12.

Correspondence: J. Beauchamp Hewitt, University of Wisconsin-Milwaukee, School of Nursing, Milwaukee, WI, USA; (email: jbhewitt@uwm.edu).

Using data from police records, this study examined risk factors related to 940 workplace homicides occurring in Chicago between 1965 and 1990. Black men were predominantly both victims (49%) and offenders (75%). The median age for victims was 42 years, but only 25 years for offenders. Women (40%) were more likely than men (6%) to be killed by intimates. Firearms were involved in 83% of all homicides, and robbery was the primary motive (62%). Workplace homicides occurred most frequently in taverns (22%). Alcohol use by tavern workers was involved in 48% of the homicides. Wide disparity in the number of workplace homicides occurred in Chicago's 77 community areas. Strategies to deter robbery and alcohol use, as well as to prevent domestic violence in the workplace, need to be implemented and evaluated. Occupational health nurses play a pivotal role in effective violence prevention. (Copyright © 2002, American Association of Occupational Health Nurses
Experiences of threats and violence in the Swedish ambulance service.

Suserud BO, Blomquist M, Johansson I. Accid Emerg Nurs 2002; 10(3): 127-135.

Correspondence: Björn-Ove Suserud, Borås University College, School of Health Sciences, Kunskapscentrum PreHospen, 501 90 Borås, SWEDEN; (email: bjornove.suserud@hb.se).

Ambulance personnel often meet people in a crisis situation that requires a readiness to act, and which takes for granted a broad knowledge in caring, together with an ability to size up the circumstances in each separate incident. The afflicted individual's first contact with a medic in an emergency situation is very often ambulance personnel and this first meeting can involve incidents that may radically change the existing state of things for the ill or injured and, maybe, even for near relatives. Sometimes these situations can lead to threats and acts of violence aimed at the ambulance staff. The aim of the study was to describe how ambulance personnel perceive, how they are subjected to, and are influenced by, threats and violence in their day-to-day work. The empirical study was descriptive and consisted of a questionnaire comprising a total of 13 questions. Answers from the 66 respondents revealed that 53 persons (80.3%) were subjected to threats and/or violence. The majority were of the opinion that the relationship between the paramedic and the patient was most certainly affected when threat or violence is a part of the situation. The study shows that many ambulance personnel have, on occasion, been subjected to one or several threats and/or situations involving the use of violence. The majority regarded this as an unpleasant experience. (Copyright © 2002 Elsevier Science)
Guns and gun threats at college.

Miller M, Hemenway D, Wechsler H. J Am Coll Health 2002; 51(2): 53-56.

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

A random sample of more than 10,000 undergraduate students, selected from 119 4-year colleges, answered a mailed questionnaire about gun possession and gun threats. Approximately 4.3% of the students reported that they had a working firearm at college, and 1.6% of them have been threatened with a gun while at school. Students are more likely to have a firearm at college and to be threatened with a gun while at college if they are male, live off campus, binge drink, engage in risky and aggressive behavior after drinking, and attend institutions in regions of the United States where household firearm prevalence is high. Having a firearm for protection is also strongly associated with being threatened with a gun while at college. Students who reported having firearms at college disproportionately reported that they engaged in behaviors that put themselves and others at risk for injury. (Copyright © 2002 Helen Dwight Reid Educational Foundation - Heldorf Publications)
Rates of Household Firearm Ownership and Homicide Across US Regions and States, 1988-1997.

Miller M, Azrael D, Hemenway D. Am J Public Health 2002; 92(12):1988-1893.

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

OBJECTIVES: In this study we explored the association between rates of household firearm ownership and homicide across the United States, by age groups.

METHODS: We used cross-sectional time-series data (1988-1997) to estimate the association between rates of household firearm ownership and homicide.

FINDINGS: In region- and state-level analyses, a robust association between rates of household firearm ownership and homicide was found. Regionally, the association exists for victims aged 5 to 14 years and those 35 years and older. At the state level, the association exists for every age group over age 5, even after controlling for poverty, urbanization, unemployment, alcohol consumption, and nonlethal violent crime.

DISCUSSION: Although our study cannot determine causation, we found that in areas where household firearm ownership rates were higher, a disproportionately large number of people died from homicide. Copyright © 2002, American Public Health Association)
Risk factors and behaviors associated with adolescent violence and aggression.

Valois RF, MacDonald JM, Bretous L, Fischer MA, Drane JW. Am J Health Behav 2002; 26(6): 454-464.

Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia 29208, USA; (email: RFValois@gwm.sc.edu).

OBJECTIVE: To explore risk factors and behaviors associated with aggressive and violent behaviors among adolescents.

METHODS: A comprehensive review of research literature from various disciplines associated with improving the health and well-being of adolescents.

FINDINGS: Risk factors and behaviors associated with adolescent aggression and violence are discussed via 6 major factor categories: individual, family, school/academic, peer-related, community and neighborhood, and situational.

DISCUSSION: Adolescent aggression and violence develops and manifests within a complex constellation of factors. Prevention intervention efforts should be theory based, multicomponent, and multisystem; they should begin in middle school and continue into high school with a comprehensive evaluation design. (Copyright © 2002, American Academy of Health Behavior - PNG Publications)
School climate, observed risky behaviors, and victimization as predictors of high school students' fear and judgments of school violence as a problem.

Astor RA, Benbenishty R, Zeira A, Vinokur A. Health Educ Behav 2002; 29(6): 716-736.

Correspondence: Ron Avi Astor, School of Education and Social Work, University of Southern California 90089-0411, USA; (email: rastor@usc.edu).

The primary aim of this study is to explore how school-related variables predict high school students' subjective judgments of school violence. Using a nationally representative sample (Israel) of 3,518 high school-aged youth, this study tested the hypotheses that (a) students' personal fear of attending school due to violence and (b) students' assessment of a school violence problem are best understood as separate conceptual constructs. The findings support the proposition that student fear of attending school and assessments of school violence as a problem are influenced by different types of school-related variables. Student fear of attending school due to violence was directly related to experiences of personal victimization by students and school staff. In contrast with fear, students' judgments of their schools' overall violence problem were directly associated with the variables of school climate, observed risk behaviors, and personal victimization. Implications for policy, theory, and future research are highlighted. (Copyright © 2002 Society for Public Health Education)

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Rev. 17 Nov 2002