Naimi TS, Brewer RD, Mokdad A, Denny C, Serdula MK, Marks JS. JAMA 2003; 289(1): 70-75.
Correspondence: Timothy S. Naimi, CDC/Alcohol Team, MS K-67, 4770 Buford Hwy, NE, Atlanta, GA 30341, USA; (email: tbn7@cdc.gov).
(Public Domain - Published by JAMA)
BACKGROUND: Binge drinking (consuming >/=5 alcoholic drinks on 1 occasion) generally results in acute impairment and has numerous adverse health consequences. Reports indicate that binge drinking may be increasing in the United States.
OBJECTIVES: To quantify episodes of binge drinking among US adults in 1993-2001, to characterize adults who engage in binge drinking, and to describe state and regional differences in binge drinking.
DESIGN, SETTING, AND PARTICIPANTS: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey of adults aged 18 years or older that is conducted annually in all states. The sample size ranged from 102,263 in 1993 to 212,510 in 2001.
MAIN OUTCOME MEASURES: Binge-drinking prevalence, episodes, and episodes per person per year.
FINDINGS: Between 1993 and 2001, the total number of binge-drinking episodes among US adults increased from approximately 1.2 billion to 1.5 billion; during this time, binge-drinking episodes per person per year increased by 17% (from 6.3 to 7.4, P for trend =.03). Between 1995 and 2001, binge-drinking episodes per person per year increased by 35% (P for trend =.005). Men accounted for 81% of binge-drinking episodes in the study years. Although rates of binge-drinking episodes were highest among those aged 18 to 25 years, 69% of binge-drinking episodes during the study period occurred among those aged 26 years or older. Overall, 47% of binge-drinking episodes occurred among otherwise moderate (ie, non-heavy) drinkers, and 73% of all binge drinkers were moderate drinkers. Binge drinkers were 14 times more likely to drive while impaired by alcohol compared with non-binge drinkers. There were substantial state and regional differences in per capita binge-drinking episodes.
DISCUSSION: Binge drinking is common among most strata of US adults, including among those aged 26 years or older. Per capita binge-drinking episodes have increased, particularly since 1995. Binge drinking is strongly associated with alcohol-impaired driving. Effective interventions to prevent the mortality and morbidity associated with binge drinking should be widely adopted, including screening patients for alcohol abuse in accordance with national guidelines.
Tobacco and alcohol use-prevention program for Hispanic migrant adolescents.
Elder JP, Litrownik AJ, Slymen DJ, Campbell NR, Parra-Medina D, Choe S, Lee V, Ayala GX. Am J Prev Med 2002; 23(4): 269-275.
Correspondence: John P. Elder, San Diego State University Graduate School of Public Health, San Diego, California 92123, USA; (email: jelder@mail.sdsu.edu).
OBJECTIVES: Evaluate a community-based tobacco/alcohol use-prevention program group compared with an attention-control condition (first aid/home safety) group.
METHODS: A total of 660 adolescents and 1 adult caregiver for each were recruited through the Migrant Education Program to participate in an 8-week intervention. Random assignment to the two groups occurred in 22 schools. Seventy 8-week intervention groups (37 tobacco/alcohol and 33 attention-control) were conducted. Assessments occurred at baseline, immediate post-intervention, and 1- and 2-year follow-ups. Susceptibility to smoking and alcohol as well as smoking and drinking over the past 30 days were the primary outcomes of interest.
FINDINGS: Following intervention, no between-group differences in smoking or drinking were significant. Thirty-day smoking started and remained at very low levels, with the highest group prevalence at any measurement period being 4.7% and the lowest 2.5%. Those considered susceptible to smoking dropped by nearly 40% in the attention-control group and by 50% in the intervention group from baseline to the final follow-up. (The overall reduction from post-test to final follow-up was statistically significant.) Less-acculturated children were less likely to report drinking in the past 30 days.
DISCUSSION: The current intervention was not demonstrated to be effective in preventing cigarette or alcohol consumption. This perhaps is due to very low baseline levels of smoking and drinking in the migrant youth participants.
Fighting back against substance abuse: are community coalitions winning?
Hallfors D, Cho H, Livert D, Kadushin C. Am J Prev Med 2002; 23(4): 237-245.
Correspondence: Denise Hallfors, Pacific Institute for Research and Evaluation, Chapel Hill, North Carolina 27514, USA; (email: hallfors@pire.org).
OBJECTIVES: Federal initiatives continue to provide strong support for community antidrug coalitions, but whether this approach actually reduces substance abuse is not clear. This paper examines the strategies that coalitions in a large national demonstration program (Fighting Back) chose to develop, the degree to which they implemented these strategies, and evidence regarding their effects.
METHODS: Coalition strategy implementation was coded and ranked for 12 Fighting Back sites. Effect sizes (intervention over time) for outcomes related to substance use, alcohol and other drug treatment, and community/prevention indicators were also ranked by site. Using rank order correlation, three directional hypotheses compared strategy dose to outcomes.
FINDINGS: None of the hypotheses were supported. Strategies aimed at either youth or community/prevention outcomes showed no effects, while strategies to improve adult-focused outcomes showed significant negative effects over time, compared to matched controls. Coalitions with a more comprehensive array of strategies did not show any superior benefits, and increasing the number of high-dose strategies showed a significant negative effect on overall outcomes.
DISCUSSION: Comprehensive community coalitions are intuitively attractive and politically popular, but the potential for adverse effects must be considered. Efforts to evaluate implementation processes as well as to correlate strategies with theoretically corresponding outcomes are a critical but neglected aspect of prevention research.
Policy and technology for safer guns: An update.
Teret SP, Lewin NL. Ann Emerg Med 2003; 41(1): 32-34.
Correspondence: Stephen P. Teret, Johns Hopkins Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205-1996, USA; (email: steret@jhsph.edu).
Correspondence: Charles Mock, Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA; (email: cmock@u.washington.edu).
OBJECTIVES: Scientifically based injury prevention efforts have not been widely implemented in Latin America. This study was undertaken to evaluate the baseline knowledge and practices of childhood safety on the part of parents in Monterrey, Mexico and in so doing provide information on which to base subsequent injury prevention efforts.
METHODS: Interviews were carried out with parents from three socioeconomic strata (upper, middle, lower). Questionnaires were based on Spanish language materials developed by The Injury Prevention Program (TIPP) of the American Academy of Pediatrics.
FINDINGS: Data were obtained from parents of 1123 children. Overall safety scores (percent safe responses) increased with increasing socioeconomic status. The differences among the socioeconomic groups were most pronounced for transportation and less pronounced for household and recreational safety. The differences were most notable for activities that required a safety related device such as a car seat, seat belt, helmet, or smoke detector. Appropriate use of such devices declined from 47% (upper socioeconomic group) to 25% (middle) to 15% (lower).
DISCUSSION: Considerable differences in the knowledge and especially the practice of childhood safety exist among parents in different socioeconomic levels in Mexico. Future injury prevention efforts need to address these and especially the availability, cost, and utilization of specific highly effective safety devices.
Potential public health importance of the oven ready chip.
Rowland D, Roberts I. Inj Prev 2002; 8(4): 328-329.
Correspondence: Ian Roberts, Public Health Intervention Research Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, UK; (email: Ian.Roberts@LSHTM.ac.uk).
BACKGROUND: Chip pan fires are responsible for 25% of fire related injury in the UK, despite government strategies to encourage safer frying. OBJECTIVES: To establish the feasibility of promoting oven ready chips (fries).
METHODS: The residents in a materially deprived ward of London were surveyed -- sample frame: 1073 of 2145 households participating in a randomized controlled trial.
FINDINGS: Approximately half of those surveyed deep fry, mostly chips, fish, and meat. Ownership of ovens and microwaves was high (99% and 80% respectively). Reasons for deep frying included taste (50%), speed (32%), and tradition (25%).
DISCUSSION: Improving the quality of oven baked alternatives may encourage consumers to change to safer and healthier cooking methods, with potentially important repercussions for public health.
INTRODUCTION: The highest proportions of fatal occupational electrocutions have occurred among those employed in the electrical trades and in the construction and manufacturing industries.
METHODS: Data from 1992 through 1999 were obtained from the Bureau of Labor Statistics Census of Fatal Occupational Injuries.
FINDINGS: Occupational electrocution deaths occurred almost entirely among males, with the highest rates among those aged 20-34 and among whites and American Indians. They were highest during the summer months, in the South, and in establishments employing 10 or fewer workers. The highest rates occurred in the construction, mining, and agriculture, forestry, and fishing industries and among trades associated with these industries.
DISCUSSION: Electrocution continues to be a significant cause of occupational death. Workers need to be provided with safety training and employers, particularly smaller employers, persuaded of the need for safety training.
Occupational injury prevention research: progress and priorities.
Stout NA, Linn HI.Inj Prev 2002; 8(Suppl 4): iv9-iv14
Correspondence: Nancy A Stout, Division of Safety Research, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, West Virginia 26505, USA; (email:nas5@cdc.gov).
The twentieth century witnessed remarkable reductions in the number and rate of occupational fatalities and injuries. However, many preventable injuries and deaths still occur. Barriers to progress in occupational injury prevention are discussed, along with strategies for overcoming them. In mining, the frequency of death has dramatically declined over the century. The latest figures from the BLS indicate that less than 6000 worker deaths from injury occurred in 2000. Catastrophic events have prompted increased attention, resources, and action on workplace hazards and risks, resulting in sweeping changes, including new protective laws. Science based approaches to prevention have contributed to progress. Multidisciplinary collaboration among injury prevention researchers, and collaboration and cooperation among multiple sectors, have improved the relevance and application of injury prevention research and development. Barriers to further progress include lack of evaluation of the effectiveness of prevention strategies and technologies, including cost effectiveness; lack of widespread implementation of known, effective prevention; and lack of efficient transfer and implementation of prevention knowledge and products to the workplace. Evaluation and implementation of prevention efforts are most successfully achieved in partnership between researchers and the industry at risk, which requires outreach efforts on the part of the occupational research community.
Occupational fatalities in emergency medical services: a hidden crisis.
Maguire BJ, Hunting KL, Smith GS, Levick NR. Ann Emerg Med 2002; 40(6): 625-632.
Correspondence: Brian J. Maguire, Department of Emergency Health Services, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250; 410-455-3778,fax 410-455-3045, USA; (email: maguire@umbc.edu).
OBJECTIVES: We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States.
METHODS: We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). These rates were compared with the occupational fatality rates of police and firefighters and with the rate of all employed persons in the United States.
FINDINGS: The Census of Fatal Occupational Injuries database documented 91 EMS provider occupational fatalities. The National EMS Memorial Service database contained 70 fatalities, and the Fatality Analysis Reporting System identified 8 ground-transportation EMS occupational fatalities. There was also wide variation in fatality counts by cause of injury. Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period.
DISCUSSION: This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers.
Correspondence: Abraham B Bergman, Department of Pediatrics, Harborview Medical Center (MS 359774), 325 9th Avenue, Seattle, WA 98104, USA; (email: oscarb@u.washington.edu).
In contrast to the steady reduction in mortality and morbidity from collisions involving motor vehicle occupants, relatively little progress has been made in controlling motor vehicle/pedestrian collisions. Engineering modifications are the most effective means of reducing such collisions, but mainly because of their cost, and public apathy about pedestrian safety, are too rarely employed. A modest experiment in community action was undertaken by attempting to induce the authorities of 10 small cities to apply for state funds to create a single model pedestrian refuge in their respective communities. Our hope was that this model would later lead to more widespread improvements. The key elements of the campaign were organizing local pedestrian safety task forces, compiling local pedestrian injury statistics, and publicizing the stories of pedestrian injury victims. At the conclusion of the planning process, all 10 target communities submitted grant applications and all 10 received full grant funding. Five projects were completed as planned, two are under construction, and the plans for three were abandoned. Pedestrian safety is not an issue that captures public attention. To make progress, goals must be modest, and a dedicated constituency must be developed. "Victim advocacy" is a vital part of this process. Progress in injury control requires concerted community action.
Injuries associated with unpowered scooters. Treatment at the Odense University Hospital 1996-2001.
Larsen MH, Nielsen HT, Larsen SE, Lauritsen JM. Ugeskr Laeger 2002; 164(44): 5119-5122.
Correspondence: Michael Hareskov Larsen, UlykkesAnalyseGruppen, afdeling O, Odense Universitetshospital, Sdr. Boulevard 29, DK-5000 Odense C, DENMARK; (email: mhl@dadlnet.dk).
BACKGROUND: Since the beginning of the nineties, skate-boards, in-liners, roller skates, and during the past years non-powered scooters have gained increasing popularity. This surge of enthusiasm has resulted in an increasing number of injuries involving scooters.
MATERIAL AND METHODS: The subject of our study was to ascertain injuries resulting from scooter usage based on consecutive sampling of patients treated at the casualty department of Odense University Hospital in Denmark between January 1st 1996 and December 31st 2001.
FINDINGS: : 162 patients were registered. 86% of the injuries occurred in the years 2000 and 2001. The major part took place among children under the age of fifteen (93% of all). 94% of the injuries were sustained because the person tumbled when scooting. The injuries were distributed as follows: skull/face 51 (32%), upper extremity 78 (48%), lower extremity 31 (17%), and trunk 2 (1%). 43 persons sustained a fracture of which 32 (74%) were located to the upper extremity.
DISCUSSION: Based on the distribution of severe injuries by body regions the results advocates usage of wrist protection at all ages when using a scooter, and parents are advised to restrict usage of scooters to children above the age of eight. Furthermore the study underlines the need for precise registration and code procedures in the emergency room. Otherwise injuries resulting from new products or behaviors cannot be identified.
Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders.
Macnab AJ, Smith T, Gagnon FA, Macnab M. Inj Prev 2002; 8(4): 324-327.
Correspondence: Andrew Macnab, Critical Care Research Office, L317, Children's and Women's Hospital of BC, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, CANADA; (email: amacnab@cw.bc.ca).
OBJECTIVES: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders.
METHODS: During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets.
FINDINGS: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible.
DISCUSSION: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.
Mortality and morbidity in white water rafting in New Zealand.
Correspondence: David O'Hare, Department of Psychology, University of Otago Medical School, Box 56, Dunedin, NEW ZEALAND; (email: ohare@psy.otago.ac.nz).
OBJECTIVES: This study provides the first descriptive overview of fatal and non-fatal injury associated with white water and other recreational river rafting in New Zealand. The current study sought to identify the nature and causes of hospitalizable injuries and to identify the causes of fatal injuries to white water rafters.
DESIGN: The data were obtained from the New Zealand Health Information Service (NZHIS) mortality and morbidity files. Mortality data for the period from 1983 to 1995 and morbidity data from 1983-1996 were used.
PARTICIPANTS: Members of the public who took part in white water and other recreational river rafting activities throughout the above periods.
RESULTS: Of the 33 fatalities, over 80% were male. Almost all the fatalities involved drowning, more than a third resulting from the raft capsizing. Nearly half of the 215 hospitalizations resulted from fractures, victims spending an average of 3.3 days in hospital. The effects of submersion, and intracranial injuries were the next most common categories.
CONCLUSIONS AND IMPLICATIONS: In relation to fatalities, the potentially modifiable risk factors involve improved resistance to raft capsizing, and equipment and skills required to stay afloat. In relation to injuries, the potentially modifiable risk factors relate mainly to preventing slipping and falling through the design of footwear, protective equipment, and procedures for entry and egress.
Correspondence: F P Rivara, The Harborview Injury Prevention and Research Center, Departments of Pediatrics and Epidemiology, University of Washington, MPH Box 359960, 325 Ninth Ave, Seattle, WA 98104, USA; (email: fpr@u.washington.edu).
OBJECTIVE: To outline an approach and agenda for research to prevent injuries to children and adolescents.
METHODS: Injuries to children and adolescents 18 years and younger in low, middle, and high income countries were investigated. RESULTS: A new paradigm for considering injury control research is presented. Research studies are suggested for the areas of etiologic research, intervention research, and outcomes research.
CONCLUSIONS: Injuries are an important cause of death and disability adjusted life years lost worldwide. Translation of existing research and rigorous randomized trials are needed to reduce the global burden of trauma.
Development of Child Pedestrian Mathematical Models and Evaluation with Accident Reconstruction.
Liu XJ, Yang JK. Traf Inj Prev 2002; 3(4): 321 - 329.
Correspondence: Xuejun Liu, Crash Safety Division, Department of Machine and Vehicle Systems, Chalmers University of Technology, SE-412 96 Göteborg, SWEDEN; (email: xuejun.liu@me.chalmers.se)
Four mathematical models were developed to represent 3-, 6-, 9-, and 15-year-old child pedestrians. In the absence of biomechanical data of children, resistive properties of various joints and body segments were scaled down from that of a validated adult model. Differences in anatomical structure and age-dependent properties of biological tissues were taken into consideration. In this study, the primary effort was emphasized on the scaling of lateral bending properties of the vertebrae column and knee joint, as well as the contact stiffness of the lower extremity. The scaling factors of contact stiffness for other body regions, such as head and thorax, were adopted from the literature. To evaluate the performance of the child pedestrian models, two real-world accidents were reconstructed by using the accident data from in-depth investigation. The impact responses of child models agreed reasonably well with the actual injury outcomes in accidents.
The use of generalized estimating equations in the analysis of motor vehicle crash data.
Correspondence: Caroline B. Hutchings, Intermountain Injury Control Research Center, School of Medicine, University of Utah, 615 Arapeen Drive, Suite 202, 84108, Salt Lake City, UT, USA; (email: caroline.hutchings@hsc.utah.edu).
The purpose of this study was to determine if it is necessary to use generalized estimating equations (GEEs) in the analysis of seat belt effectiveness in preventing injuries in motor vehicle crashes. The 1992 Utah crash dataset was used, excluding crash participants where seat belt use was not appropriate (n=93,633). The model used in the 1996 Report to Congress [Report to congress on benefits of safety belts and motorcycle helmets, based on data from the Crash Outcome Data Evaluation System (CODES). National Center for Statistics and Analysis, NHTSA, Washington, DC, February 1996] was analyzed for all occupants with logistic regression, one level of nesting (occupants within crashes), and two levels of nesting (occupants within vehicles within crashes) to compare the use of GEEs with logistic regression. When using one level of nesting compared to logistic regression, 13 of 16 variance estimates changed more than 10%, and eight of 16 parameter estimates changed more than 10%. In addition, three of the independent variables changed from significant to insignificant (alpha=0.05). With the use of two levels of nesting, two of 16 variance estimates and three of 16 parameter estimates changed more than 10% from the variance and parameter estimates in one level of nesting. One of the independent variables changed from insignificant to significant (alpha=0.05) in the two levels of nesting model; therefore, only two of the independent variables changed from significant to insignificant when the logistic regression model was compared to the two levels of nesting model. The odds ratio of seat belt effectiveness in preventing injuries was 12% lower when a one-level nested model was used. Based on these results, we stress the need to use a nested model and GEEs when analyzing motor vehicle crash data.
Epidemiology of road traffic trauma in China--1998 in retrospect.
Wang Z, Jiang J. Traf Inj Prev 2002; 3(4): 251 - 256.
Correspondence: Zheng-guo Wang, Research Institute of Surgery, Institute for Traffic Medicine, Third Military Medical University, Daping, Chongqing 400042, PEOPLE'S REPUBLIC OF CHINA; (email: wangzg@public.cta.cq.cn).
The 1998 epidemiological data on road traffic trauma (RTT) in China were collected, analyzed, and compared with data from 1997. The data were gathered from the Traffic Administration Bureau and literature, then analyzed and discussed. The following results are reported: (1) The amount of road traffic accidents (RTA), fatalities, and injuries were 346,129, 78,067, and 22,272, an increase of 13.78%, 5.69%, and 17.14%, respectively, compared to 1997. (2) Among the causes of RTA, human factors accounted for 92.8%, motor vehicle drivers 84.3%; mechanical 4.1%, and road conditions 0.1%. (3) With respect to fatalities and injuries, pedestrians accounted for 26.1% and 13.1%, bicyclists 17.4% and 13.3%, motorcyclists 15.4% and 19.2%, respectively. (4) Ages of the fatalities included <9 years old 6.1% and > 65 years old 7.8%. The safety of these age groups should receive more attention. (5) The amount of RTAs and fatalities in mixed roads accounted for 55.9% and 67.2%. These outcomes indicate a need for focus on comprehensive treatment of RTA and RTT. In conclusion, RTA and RTT have continuously increased in China. The main reasons are lack of good traffic administration and lax enforcement of traffic regulations. If these two areas can be strengthened, traffic safety will be greatly improved.
Epidemiology and Severity of Injuries Caused by Road Traffic Accidents in the Metropolitan Area of Rome.
Costanzo A, Messina J, F. Taggi F, Pitidis A, Natalini E, Stagnitti F, Calderale S, Ribaldi S. Traf Inj Prev 2002; 3(4): 311 - 315.
Correspondence: A. Costanzo, University of Rome La Sapienza,c/o Instituto di Clinica Ortopedica e Traumatologica, piazzale Aldo Moro 5, 00185 Rome, ITALY; (email: costanzo@mclink.it).
The mortality rate due to road traffic accidents is 11.3 deaths per 100,000 inhabitants during 1994 in the area; morbidity incidence (per 100,000 inhabitants) we estimate to be 1,170 arrivals to first-aid centers and 263 hospitalizations during 1997. The cases at General Hospital "Umberto I" during 1997 represent about one-third of the whole area. In severe cases (ISS > 16) 15-29 year-old males account for modal value; women are concentrated at elder age, and males represent 72% of the total number. Vehicle type and sex are determinants of the risk of severe trauma. There is a strong linear relationship between age, severity, and lethality rate (R2 = 0.88), but severity is the variable that plays the major role on lethality. These variables (age, severity, and lethality rate) are crucial to define death risk. Most deaths occur within the early 24 hours of hospitalization. Lethality reflects a system failure phenomenon with critical points at 24 hours and after 7 days since the accident.
Severe injuries following road traffic accidents with registered motor vehicles among the inhabitants of the municipality of Odense 1990-1999.
BACKGROUND: Since 1990, the number of persons treated at the Odense University Hospital for injuries following road traffic with registered motor vehicles has increased. In this study we wanted to examine if the increase included an increase in more severe injuries.
METHODS: The study included all inhabitants in the Municipality of Odense treated at the Odense University Hospital for more severe injuries (MAIS > or = 3) following road traffic accidents as drivers or passengers in registered motor vehicles during the period January 1st 1990 to December 31st 1999.
FINDINGS: 241 persons were included. 177 (73 per cent) were men. The median age was 29.5 years for men and 57 years for women. The total incidence was 1.3 injuries per inhabitant/year. No significant increase was recorded during the period 1990 to 1998. Single accidents without counterpart were the most frequent type of accidents (55 per ent). 66 per cent of the persons were hospitalized and 24 per cent died as a result of their injuries. Injuries localized at the head and neck were most frequent (29 per cent) followed by injuries localized at legs and arms (18 per cent and 23 per cent).
DISCUSSION: The incidence of more severe injuries following road traffic accidents with registered motor vehicles was constant during the period. Accidents involving young men and single accidents were dominating. Prophylactic measures should be aimed at this type of road users.
Motor vehicle and fall related deaths among older Americans 1990-98: sex, race, and ethnic disparities.
Correspondence: Judy A Stevens, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-63, Atlanta, GA 30341, USA; (email: jas2@cdc.gov).
(Published by BMJ Publishing Group)
OBJECTIVES: To examine differences in motor vehicle and fall related death rates among older adults by sex, race, and ethnicity.
METHODS: Annual mortality tapes for 1990-98 provided demographic data including race and ethnicity, date, and cause of death. Trend analyses were conducted using Poisson regression.
FINDINGS: From 1990-98, overall motor vehicle related death rates remained stable while death rates from unintentional falls increased. Motor vehicle and fall related death rates were higher among men. Motor vehicle related death rates were higher among people of color while fall related death rates were higher among whites. Among whites, fall death rates increased significantly during the study period, with an annual relative increase of 3.6% for men and 3.2% for women.
DISCUSSION: The risk of death from motor vehicle and fall related injuries among older adults differed by sex, race and ethnicity, results obscured by simple age and sex specific death rates. This study found important patterns and disparities in these death rates by race and ethnicity useful for identifying high risk groups and guiding prevention strategies.
Research and dissemination needs for ergonomics in agriculture.
Estill CF, Baron S, Steege AL. Public Health Rep 2002; 117(5): 440-445.
Correspondence: Cheryl Fairfield Estill, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 4676 Columbia Pkwy., MS C-24, Cincinnati, OH 45226, USA; (email clf4@cdc.gov).
(Public domain. Published by Oxford University Press)
In 1998, the National Institute for Occupational Safety and Health convened a conference of researchers interested in the ergonomics of agricultural workers. Participants included 20 representatives from universities, state governments, private agricultural and insurance companies, migrant worker organizations, agricultural industry organizations, and the Agricultural Extension Service. The attendees divided into three groups and brainstormed about research ideas and dissemination methods related to ergonomics for farm workers. The groups separately reported that interventions, cost-benefit analyses, and cultural belief systems were the main topics that needed to be researched to reduce physical risk factors for musculoskeletal disorders. The participants also presented ideas for disseminating information to farm owners and workers.
Correspondence: Robert Vermeiren, University Department of Child and Adolescent Psychiatry, Middelheimhospital, University of Antwerp, BELGIUM; (email: rvermeiren@europemail.com).
OBJECTIVES: To investigate characteristics of suicidal and violent behavior in a community school sample of adolescents.
METHODS: Self-report questionnaires were administered to 794 male students (aged 12-18 years) from Antwerp, Belgium. Subjects were classified into four groups: a suicidal-only ( = 40; suicidal ideation and/or self-harming behavior), a violent-only ( = 142), a suicidal-violent ( = 21), and a control group ( = 591).
FINDINGS: Compared with controls, higher levels of internalizing problems, risk-taking behavior (substance use, diminished perception of risk, sensation seeking), and aggression were found in the comparison groups. The suicidal-violent group had the highest levels of depression, somatization, overt and covert aggression, and risk-taking behavior. Compared with the suicidal-only group, the violent-only group had less depression, anxiety, and covert aggression, but higher levels of overt aggression, sensation seeking, diminished perception of risk, and marijuana use.
DISCUSSION: Although adolescent suicidal and violent behavior are both related to internalizing problems, aggression, and risk-taking behavior, marked differences in severity and nature exist in these relationships. Differentiation of suicidal youths based on the presence or absence of violent behavior may add to our understanding of suicidal phenomena and may thus have important clinical consequences.
Correspondence: Veronica Pearson, Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong, PEOPLE'S REPUBLIC OF CHINA; (email: vpearson@hkucc.hku.hk).
This article reports on a sample of 147 women under age 35 living in rural areas in China who had attempted suicide and were treated in the emergency room of hospitals in four different locations. The interview instrument took 2 to 3 hours to complete and included audiotaped in-depth interviews with the patient and family members (separately); detailed evaluation of the circumstances surrounding the attempt, life events, and the family environment; and a formal psychiatric evaluation by an attending-level psychiatrist. Overwhelmingly, the method used by the attempters was poisoning with highly lethal pesticides and organic fertilizers. The women's suicidal behavior was characterized by high levels of impulsivity; little effort to seclude themselves before and after ingesting poison; and low rates of mental illness, including depression. Detailed suggestions are made about ways to implement suicide prevention strategies within the particular social and economic context of China.
Why people engage in parasuicide: a cross-cultural study of intentions.
Hjelmeland H, Hawton K, Nordvik H, Bille-Brahe U, De Leo D, Fekete S, Grad O, Haring C, Kerkhof JF, Lonnqvist J, Michel K, Renberg ES, Schmidtke A, Van Heeringen K, Wasserman D. Suicide Life Threat Behav 2002; 32(4): 380-393.
Correspondence: Heidi Hjelmeland, Department of Psychology, Norwegian University of Science and Technology, Trondheim, NORWAY; (email: heidi.hjelmeland@svt.ntnu.no).
Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.
Religiosity, attributional style, and social support as psychosocial buffers for African American and white adolescents' perceived risk for suicide.
Psychosocial buffers were evaluated for their relative contributions to adolescents' perceived risk for suicide. A community sample of African American and White adolescents (N = 1,098) rated the likelihood that they would die by suicide and completed standardized measures of depression, hopelessness, intrinsic and extrinsic religiosity, orthodoxy, social support, and causal attributional style. Orthodoxy-commitment to core beliefs-emerged as the single strongest correlate after controlling for the effects of other buffers. The effect of depression on perceived suicide risk was moderated by the adolescent's degree of orthodoxy. Commitment to core, life-saving beliefs may help explain the religion-suicide link for adolescents.
BACKGROUND: The use of seat belts is among the most effective methods of reducing injury in motor vehicle crashes. We examined trends in seat belt use by university students from 13 European countries between 1990 and 2000, in relation to changes in legislation, attitudes, and hazardous driver behaviors.
METHODS: Data were collected via an anonymous standardized questionnaire from university students in Belgium, England, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, the Netherlands, Poland, Portugal, and Spain. There were 10,576 respondents in 1990, and 10,294 in 2000. Data were also collected from 1672 students in the United States in 2000. Analyses were performed in early 2002.
FINDINGS: Reported seat belt use increased from 63% to 73% in male students, and from 66% to 77% in female students over the decade. There were marked increases in seat belt use in countries with changes in legislation or enforcement from 1990 to 2000, with 24% to 64% more respondents reporting seat belt use in 2000. The prevalence of use and noted changes during this period correlated with findings from national surveys (r= 0.91). Attitudes to seat belt use were associated with behavior both within and between countries. Nonuse of seat belts was positively related to alcohol-impaired driving and failure to obey speed limits.
DISCUSSION: Legislation has a substantial impact on the use of vehicle seat belts, but additional gains require efforts to change attitudes within the university student population.
Assessing community child passenger safety efforts in three Northwest Tribes.
Smith ML, Berger LR. Inj Prev 2002; 8(4): 289-292.
Correspondence: Lawrence Berger, University of New Mexico, 1335 Bryn Mawr Drive NE, Albuquerque, NM 87106-1101, USA; (email: bergerlaw@msn.com).
OBJECTIVE: To identify strengths and weaknesses in community based child passenger safety programs by developing a scoring instrument and conducting observations of child restraint use in three Native American communities.
SETTING: The three communities are autonomous Tribal reservations in the Pacific Northwest. Their per capita incomes and rates of unemployment are comparable.
METHODS: In each community, 100 children under 5 years old were observed for car seat use. A six item community assessment tool (100 points maximum) awarded points for such items as the type (primary or secondary) and enforcement of child restraint laws; availability of car seats from distribution programs; extent of educational programs; and access to data on vehicle injuries.
FINDINGS: For children from birth to 4 years, the car seat use rate ranged from 12%-21%. Rates for infants (71%-80%) far exceeded rates for 1-4 year old children (5%-14%). Community scores ranged from 0 to 31.5 points. There was no correlation between scores and observed car seat use. One reason was the total lack of enforcement of restraint laws.
DISCUSSION: A community assessment tool can highlight weaknesses in child passenger efforts. Linking such a tool with an objective measure of impact can be applied to other injury problems, such as fire safety or domestic violence. The very process of creating and implementing a community assessment can enhance agency collaboration and publicize evidence based "best practices" for injury prevention. Further study is needed to address methodologic issues and to examine crash and medical data in relation to community child passenger safety scores.
Child passenger safety: potential impact of the Washington State booster seat law on childcare centers.
Correspondence: Brittany Chang, Department of Pediatrics, Box 359774, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104-2499, USA; (email: changba@u.washington.edu).
OBJECTIVES: To examine factors associated with compliance and with perceived readiness for the new Washington State booster seat law, and to identify perceived barriers to compliance among licensed childcare centers. Design/methods: Surveys were mailed to a random sample of 550 licensed childcare centers in Washington State, approximately nine months before the law was to go into effect.
FINDINGS: Only 18% of centers reported being compliant with the law at the time of the survey. Factors associated with current compliance included awareness and knowledge of the law, and being comfortable asking staff and parents to use booster seats. A lack of center-owned booster seats was associated with a lower likelihood of compliance. Only 43% of centers had already started preparing for the law, and only 48% believed they would definitely be ready in time.
DISCUSSION: This study suggests that Washington State childcare centers need support and assistance to increase their knowledge of booster seats and reduce the financial costs of compliance.
Attitudes of novice teen drivers and parents about Pennsylvania's graduated driver licensing program: a focus group analysis.
McKay MP, Coben J. Traf Inj Prev 2002; 3(4): 257-261.
Correspondence: Mary Pat McKay, MCP/Hahnemann School of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA; (email: mmcay@wpahs.org).
Graduated driver licensing systems are being introduced throughout the United States. Pennsylvania has had a three-tiered system since 1993, but legislation significantly strengthened the system in 1999. The changes included prolonging the learner phase to 180 days, adding a passenger restriction to the junior licensing phase, and moving the nighttime driving curfew to 11 P.M. from midnight. This project was designed to qualitatively assess the reactions of teen drivers and their parents to a strengthened graduated driver licensing system, and to determine their beliefs about the causes of high crash risk for teen drivers. In October 2000, a scripted interview technique was used to conduct eight focus groups in western Pennsylvania including 35 family pairs (parent and teen). A total of 35 teens (21 girls and 14 boys) and 38 parents (31 mothers and 7 fathers) participated. The parents believed the high teen crash rate is primarily the result of inexperience and generally supported the new system, particularly endorsing the prolonged 6-month learner phase. They found the 11 P.M. nighttime driving curfew somewhat inconvenient, particularly for school events, but still had an overall favorable opinion of the curfew. The teens believed the high crash rate for teen drivers is the result of immaturity and personality issues, especially a tendency to want to show off for friends. They did not like the new system's restrictions on their driving, believing the 6-month learner phase was "too long" and that the curfew was "too early." Both parents and teens generally accepted the new passenger limitations; some parents suggested the need for even stricter passenger limitations. When discussing additional possible measures for improving novice teen driving, the suggestions included raising the standards of the testing protocols and requiring driver's education programs. Results suggest parents and teens have different beliefs about the primary causes of the high crash rate for teen drivers. There are significant disparities between their beliefs and recent evidence assessing teen crash risk factors. Their reactions to the components of Pennsylvania's strengthened graduated driver licensing system appear to be influenced by these beliefs, suggesting that education is an important feature of new legislation.
Defective Color Perception Among Car Drivers in Addis Ababa, Ethiopia
Abebe Y, Wondmikun Y. Traf Inj Prev 2002; 3(4): 294 - 297.
Correspondence: Yekoye Abebe, Department of Physiology, Gondar College of Medical Sciences, Gondar, ETHIOPIA (email: gcms@telcom.net.et).
The objective of the study was to determine the benefits of screening for color vision impairment on the ability to operate a motor vehicle safely. The study was cross-sectional in its methodology in which color vision of 1,879 randomly selected drivers was tested using Ishihare color plates. There were 85 (4.5%) cases of defective color vision. Among them, 83 (97.6%) were males and 2 (2.4%) were females. Of the 83 male cases of defective color vision, 56 (65.9%) were deuteranopes and 29 (34.1%) protanopes. The two color-blind females were deuteranopes. During the past 3 years, 27 (31.8%) color-blind subjects were reported to have had road traffic accidents compared to the total accidents of 398 (21.2%). The probability that color-blind drivers would encounter an accident was about twice as high as among non-color-blind drivers (OR = 1.94; 95% CI, 1.18-3.17; p < 0.02). We conclude that the compulsory examination of color vision in driver's license seekers in Ethiopia does not screen out color-blind individuals. Therefore, the techniques of screening should be improved either to restrict the acquisition of licenses or at least to train drivers to compensate for their defect.
Personal, temporal and spatial characteristics of seriously injured crash-involved seat belt non-users in Hawaii.
Correspondence: Karl Kim Department of Urban and Regional Planning, University of Hawaii at Manoa, 2424 Maile Way, #107, Honolulu, HI 96822, USA; (email: karlk@hawaii.edu or Sungyop Kim sungyop@u.washington.edu).
The characteristics of crash-involved seat belt non-users in a high use state (Hawaii) are examined in order to better design enforcement and education programs. Using police crash report data over a 10-year period (1986-1995), we compare belted and unbelted drivers and front seat occupants, who were seriously injured in crashes, in terms of personal (age, gender, alcohol involvement, etc.) and crash characteristics (time, location, roadway factors, etc.). A logistic regression model combined with the spline method is used to analyze and categorize the salient differences between users and non-users. We find that unbelted occupants are more likely to be male, younger, unlicensed, intoxicated and driving pickup trucks versus other vehicles. Moreover, non-users are more likely than users to be involved in speed-related crashes in rural areas during the nighttime. Passengers are 70 times more likely to be unbelted if the driver is also unbelted than passengers of vehicles with belted drivers. While our general findings are similar to other seat belt studies, the contribution of this paper is in terms of a deeper understanding of the relative importance of various factors associated with non-use among seriously injured occupants as well as demonstrating a powerful methodology for analyzing safety problems entailing the categorization of various groups. While the former has implication for seat belt enforcement and education programs, the latter is relevant to a host of other research questions.
A before-and-after study of driver stopping propensity at red light camera intersections.
This paper reports a before-and-after study which evaluated the impacts of installing and operating red light cameras at two "T" and one "X" signalized intersections on driver stopping propensity upon the onset of amber. Rather than using video cameras, a special purpose data logger working in conjunction with loop sensors was used to gather traffic parameters, vehicle stopping/crossing movements, and signal phases. Logistic modeling was employed to model the revealed stopping/crossing decisions of non-platoon vehicle drivers in response to the onset of amber with traffic, situational and behavioral variables, including their interactions. The results indicate that the variable Cam_Inst that gathered the impacts of red light camera (RLC) installation on driver decision-making at signalized intersection was significant at 5% level only for the camera approach model of the cross-intersection. The significance of Cam_Inst was undermined for the camera approaches at the T-intersections by the inclusion of a significant two-order variable defining the interaction of Cam_Inst with distance from the stop-line. One may, thus, infer that RLC has a fixed-quantum effect at the cross-intersection, but an accentuated effect with distance at the two T-intersections. Lastly, the effects of a RLC at an intersection on the stopping decision at the non-camera approaches were minimal.
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: Christian 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.
Unintended shootings in a large metropolitan area: An incident-based analysis.
Ismach RB, Reza A, Ary R, Sampson TR, Bartolomeos K, Kellermann AL. Ann Emerg Med 2003; 41(1): 10-17.
Correspondence: Arthur L. Kellermann, MD, MPH, Center for Injury Control, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322; (email: akell01@emory.edu).
OBJECTIVES: We determine the proportion of unintended shootings that might be prevented by promoting safe storage, safe handling, and/or safer firearm designs.
METHODS: A regional firearm injury surveillance system was used to identify fatal and nonfatal unintentional shootings in a 5-county metropolitan area. Case reports were reviewed, and the causes of each shooting were independently classified by 4 members of the research team. A consensus conference was held to resolve disagreements.
FINDINGS: Between May 1, 1996, and June 30, 2000, 216 cases of unintentional firearm injury were identified, 3.8% of the shootings documented during the study period. Six (2.8%) were fatal. The majority of victims were between 15 and 34 years of age. One fourth (54) of the shootings involved victims younger than 18 years. Handguns were involved in 87% of the incidents. Enough information was available to characterize the incident in 122 (57%) cases. All but 6 fell into 1 or more of 3 broad categories of causation: Child access (14%), mishandling (74%), and/or deficiencies in firearm design (32%).
DISCUSSION: Many unintentional shootings could be prevented by promoting safe storage of guns in the home, promoting safe handling of firearms, and requiring that all new handguns incorporate basic safety features.
Effect of current federal regulations on handgun safety features.
Milne JS, Hargarten SW, Kellermann AL, Wintemute GJ. Ann Emerg Med 2003; 41(1): 1-9.
Correspondence: Stephen Hargarten, Firearm Injury Center, Department of Emergency Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, FMLH East, Milwaukee, WI 53226, USA; (email: hargart@mcw.edu).
OBJECTIVE: In the late 1960s, the Bureau of Alcohol, Tobacco, and Firearms implemented the "factoring criteria," a set of minimum size and safety standards required for any handgun imported into the United States. These standards, however, were not applied to guns manufactured domestically. We determine whether extending the factoring criteria to all handguns sold in the United States, as has been proposed in Congress, would increase the likelihood that safety devices would be included in new handgun designs.
METHODS: Imported and domestic handgun models produced in 1996 were examined to determine the prevalence of 4 passively acting safety devices on pistols and 1 passive safety device on revolvers. Domestic models were also scored against the factoring criteria.
FINDINGS: Compared with domestic pistol models, imported pistols were more likely to include a firing pin block (odds ratio [OR] 2.43; 95% confidence interval [CI] 1.54 to 3.85) and a loaded chamber indicator (OR 1.59; 95% CI 0.98 to 2.56). Domestic pistol models that already met the factoring criteria were more likely to include a loaded chamber indicator (OR 12.05; 95% CI 2.74 to 53.02), a grip safety (OR 24.12; 95% CI 7.8 to 74.33), and a firing pin block (OR 4.92; 95% CI 2.35 to 10.29) than domestic models that did not meet the criteria.
DISCUSSION: Although pistol models that meet the factoring criteria are more likely to contain safety devices than those that do not, the net effect is modest. Thus, the factoring criteria alone are insufficient to ensure consistent incorporation of safety features into new handgun designs.
The prevention of child and adolescent violence: a review.
Violence among youth in the United States has surged in the past two decades. Numerous treatment programs exist to help treat the after-effects of violence, but by comparison, too few attempts are made to prevent violence from occurring. Primary and secondary violence prevention programs from the past 20 years have shown promising preliminary results. In general, secondary prevention efforts, or interventions with youth at-risk have shown more promise than primary prevention efforts, or intervention for the general population of youth. Furthermore, secondary prevention efforts tend to be more experimental in nature and effect sizes or clinical significance are reported more often when results are analyzed. Although numerous theories exist on the cause of violence among youth, no one theoretical stance appears to be dominant in terms of efficacy for prevention programs. Prevention research needs to be more rigorous and scientific in nature if it is to make any lasting impact on the types of interventions that will continue. A concerted effort on the part of federal and state-funded agencies needs to be made so that violence prevention work can become less redundant and more effective.
Injured elderly victims of bag-snatching treated at Odense University Hospital 1996-2000.
Faergemann C, Mikkelsen JB, Wedderkopp N, Skov O. Ugeskr Laeger 2002; 164(21):2768-2771.
Correspondence: Christian Faergemann, Odense Universitetshospital, ortopaedkirurgisk afdeling O, Ulykkes Analyse Gruppen, DK-5000 Odense, DENMARK; (email: c.faergemann@dadlnet.dk).
BACKGROUND: In recent years, a number of elderly patients have been treated at the Odense University Hospital following injuries caused by bag-snatching. The aim of this study was to discover how many of elderly patients sustained such injuries.
MATERIAL AND METHODS: The study comprised all inhabitants in the Odense Municipality aged 60 years or more treated at Odense University Hospital in 1996-2000 for injuries caused by bag-snatching.
FINDINGS: We registered 95 patients. The annual number rose significantly from 1996 to 1999 and from 1999 to 2000 it declined. The mean age was 78 years and 95% were women. Most of the injuries occurred during the daytime. Many patients were injured, because of falls as the bag-snatcher grabbed the bag and got away (74%). Fewer patients were beaten or kicked (26%). The patients were generally pedestrians (86%), and the bag-snatchers mostly pedestrians (47%) or cyclists (29%). The injuries were commonly contusions/sprains (45%) and fractures/dislocations (37%). Twenty-seven per cent were admitted to hospital with a median stay of 15 days (1-54 days). One patient died as a result of the injury. Most patients sustained minor injuries (Maximal abbreviated injury scale-score = 1) (62%).
DISCUSSION: Over a period of years we have observed an increasing number of injuries in the elderly caused by bag snatching. The victims often fell and fractured or dislocated a limb. More than a quarter of the victims were hospitalized.
Correspondence: Louise Dixon, Centre for Forensic and Family Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; (email: lxd036@bham.ac.uk)
Recent research suggests that spouse abusers are not a homogeneous group. Holtzworth-Munroe and Stuart [Psychol. Bull. 116 (1994) 476] propose three types of domestic violent men: family only, generally violent/antisocial, and dysphoric/borderline personality. This theoretical classification is compared to nine empirical research studies and two hypothetical studies, which can be found in the literature dated from 1994 onwards. The review provides support for the threefold typology. The total averages of offenders classified by Holtzworth-Munroe and Stuart's typology across the studies were 50%, 30%, and 20%, respectively. However, when sample type was considered, a significant difference between court referrals and volunteers was found for the men's distribution across the three types, with court-referred men being less likely to be categorized into the family-only group. All research to date is criticised for its narrow focus on the offender and its lack of a scientific profiling approach. Other factors such as the context, triggers for violence, and the behavioral actions of the victim need to be considered. A more holistic family-focused typology is suggested to be more appropriate for those victims who do not want to separate from their violent spouse.
