Many studies have suggested the importance of peer influence and personal attitudes (e.g., expectancies, resistance self-efficacy, and perceived harm) in predicting adolescent use of illegal substances. The present study examined these variables in relation to self-reported use of alcohol, cigarettes, and marijuana for 213 younger adolescents (12-15 years old) and 219 older adolescents (18-22 years old). A series of logistic regressions was performed to assess variables relating to use of each substance by age group and gender. Friends' use was significantly related to substance use for both age groups, both sexes, and all substances examined in this study. Perceived harm was not significantly related to use for any group. Finally, outcome expectancies and resistance self-efficacy were differentially related to use depending on age, gender, and substance. The implications of these findings for prevention programming and future research are also discussed.
Attitudinal and normative predictors of alcohol use by older adolescents and young adults.
- Kuther TL, Higgins-D'Alessandro A. J Drug Educ 2003; 33(1): 71-90.
Correspondence: Tara Kuther, Department of Psychology, Western Connecticut State University, Danbury 06810, USA; (email: kuther@wcsu.edu)
A model of alcohol use based on the theory of planned behavior, expectancy theory, and the developmental literature on the influence of parents and peers was examined with 87 eleventh grade students, 105 college freshmen, and 107 college juniors. Specifically, the influence of attitudes about the positive and negative consequences of drinking, perceived parental and peer norms about alcohol consumption, and perceived control over drinking predicted self-reported alcohol use. The results suggest that, during adolescence, decisions to consume alcohol are rational, based on the consideration of the positive consequences of alcohol use and perceptions of control over drinking; however, the negative consequences of alcohol use are discounted. While perceived peer norms predicted alcohol consumption in all three age groups
Alcohol availability as a predictor of youth drinking and driving: a hierarchical analysis of survey and archival data.
- Treno AJ, Grube JW, Martin SE. Alcohol Clin Exp Res 2003; 27(5): 835-840.
Correspondence: Andrew J. Treno, Prevention Research Center, 2150 Shattuck Ave., Ste. 900, Berkeley, CA 94704, USA; (email: andrew@prev.org).
BACKGROUND: Much attention has recently been directed toward developing preventive interventions to reduce drinking and driving through efforts to limit the numbers and locations of alcohol outlets at the community level. Although evaluations of these efforts have suggested linkages between alcohol outlets and problem outcomes, they have not addressed the linkage between outlets and drinking and driving among youth. The analysis reported here investigats the relationship between alcohol outlet densities and underage drinking and driving as self-reported on two telephone surveys conducted in California.
METHODS: These analyses were based on data obtained from two telephone surveys conducted by the Prevention Research Center and archival data collected by the California Department of Alcoholic Beverage Control and the US Census Bureau. The sample for the first survey consisted of 15- to 20-year-old adolescents and young adults contacted by telephone, using a random digit dialing of exchanges in the greater San Francisco Bay Area. A second set of survey data was similarly collected by a random sample of households throughout California, and the Bay Area subset was also used for this analysis.
FINDINGS: At the individual level, older respondents were more likely to report drinking and driving and riding with drinking drivers, whereas females and Asians were less so. At the aggregate or city-level, alcohol outlet density, as measured by the number of on- and off-premises establishments licensed to sell alcohol, was associated with both drinking and driving and riding with drinking drivers. These effects were moderated by a number of individual level effects, with younger respondents and females more likely to be affected by outlet densities.
DISCUSSION: The findings here provide support for the implementation of policies targeting alcohol outlet density reductions. Areas with large numbers of such outlets provide ample opportunities to youth for alcohol purchases.
Traffic-related injury prevention interventions for low-income countries.
Correspondence: Samuel Forjuoh, Texas A & M University System, Health Science Center, College of Medicine, Scott & White Memorial Hospital, Temple, TX, USA; (email: sforjuoh@swmail.sw.org).
Traffic-related injuries have become a major public health concern worldwide. However, unlike developed or high-income countries (HICs), many developing or low-income countries (LICs) have made very little progress towards addressing this problem. Lack of the progress in LICs is attributable, in part, to their economic situation in terms of their governments' lack of resources to invest in traffic safety, cultural beliefs regarding the fatalism of injuries, competing health problems particularly with the emergence of HIV/AIDS, distinctive traffic mixes comprising a substantial number of vulnerable road users for whom less research has been done, low literacy rates precluding motorists to read and understand road signs, and peculiar political situations occasionally predominated by dictatorship and non-democratic governments. How then can LICs tackle the challenge of traffic safety from the experiences of HICs without reinventing the wheel? This paper reviews selected interventions and strategies that have been developed to counter traffic-related injuries in HICs in terms of their effectiveness and their applicability to LICs. Proven and promising interventions or strategies such as seat belt and helmet use, legislation and enforcement of seat belt use, sidewalks, roadway barriers, selected traffic-calming designs (e.g., speed ramps/bumps), pedestrian crossing signs combined with clearly marked crosswalks, and public education and behavior modification targeted at motorists are all feasible and useable in LICs as evidenced by data from many LICs. While numerous traffic-related injury policy interventions and strategies developed largely in HICs are potentially transferable to LICs, it is important to consider country-specific factors such as costs, feasibility, sustainability, and barriers, all of which must be factored into the assessment of effectiveness in specific LIC settings. Almost all interventions and strategies that have been proven effective in HICs will need to be evaluated in LICs and particular attention paid to the effectiveness of enforcement measures. It behooves LIC governments, however, to ensure that only standard, approved safety devices like helmets are imported into their countries. Additionally, LICs may need to improvise and innovate in the traffic safety technology transfer.
Correspondence: Carlo Campobass, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare, Policlinico, 70124 Bari, ITALY; (email: cpcarlo@yahoo.com).
We describe the investigation of the 1999 collapse of an apartment building in Foggia, Italy. Sixty-one victims were recovered in the rubble of the building, and five people were unaccounted for. All the bodies were well preserved except for two who had been burned. The majority of the victims were identified visually or by comparing body features, clothing, or personal effects with information collected from relatives or friends. Positive identifications of the two victims who were burned were obtained by dental comparison and DNA analysis. Approximately half of the victims (51.6%) sustained fatal injuires, while the remainder died from asphyxia. The injuries were characterized using the Abbreviated Injury Scale (AIS) and the New Injury Severity Score (NISS) systems. Injury severity associated with the location of victims inside the apartment may provide useful information for those involved in building design and/or search and rescue operations. Engineers determined that the collapse was the result of the use of inappropriate foundation material.
Correspondence: Brenda J. Brouwer, Motor Performance Laboratory, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, CANADA; (email: brouwerb@post.queensu.ca).
OBJECTIVES: To determine the relative effect of education and activity programs on fear of falling, balance, strength, and health status.
DESIGN: A randomized intervention trial with two groups (education and activity); evaluators were blind to group allocation.
SETTING:Motor performance laboratory at Queen's University.
PARTICIPANTS: Thirty-eight community-dwelling seniors who reported a fear of falling and activity restriction but were free of neurological and mobility-limiting orthopedic conditions.
INTERVENTIONS: Programs designed to reduce fear of falling were delivered weekly to groups of three to five seniors for 8 weeks, each session lasting 1 hour. The activity program included low-resistance exercises and weight-shifting activities. Education focused on identifying and reducing risk factors for falls.
MEASUREMENTS: Balance confidence, activity level, limits of stability (LOS), isokinetic strength, and health status were measured twice preintervention (baseline), postintervention, and 6 weeks later.
FINDINGS: Both programs reduced fear of falling (P < .006) as ascertained from the balance confidence scores. Differential effects were observed in LOS (P < .05); activity improved balance, whereas education led to modest declines. Gains in perception of health status were limited to physical health for the activity group and mental health for the education group. Benefits were generally sustained at follow-up.
DISCUSSION: Improved balance confidence is not intervention-specific, but associated changes in physical ability and health status are a function of the composition of the intervention program.
Fall-related upper body injuries in the older adult: a review of the biomechanical issues.
- DeGoede KM, Ashton-Miller JA, Schultz AB. J Biomech 2003; 36(7): 1043-1053.
Correspondence: James A. Ashton-Miller, Department of Biomechanical Engineering, University of Michigan, G.G. Brown 3208, Ann Arbor, MI, USA; (email: jaam@umich.edu).
Although the epidemiology of fall-related injuries is well established for the elderly population over 65 years of age, the biomechanics of how, when and why injuries do and do not occur when arresting a fall have received relatively little attention. This paper reviews the epidemiological literature in the MEDLINE data base pertinent to the biomechanics of fall-related injuries, including data on fall rates, fall-related injury rates, fall directions and types of injuries available. It also covers primary sources not listed on MEDLINE, along with the pertinent biomechanics literature. Many falls in older adults are in a forward direction, and as a result the upper extremities are one of the most commonly injured structures, presumably in protecting the head and torso. In this review emphasis is placed on what is, and what is not, known of the biomechanical factors that determine the impact forces and injury risk associated with upper extremity injuries in forward falls. While decreased bone mineral density may be contributory, it is not a reliable predictor of fracture risk. Evidence is presented that fall-related impact forces can be reduced by appropriate volitional arrest strategies. Further theoretical and experimental research is needed to identify appropriate fall-arrest strategies for the elderly, as well as the physical capacities and skills required to do so. Inexpensive interventions might then be developed to teach safe fall-arrest techniques to older individuals.
Correspondence: Martha Hijar, National Institute of Public Health of Mexico, Av. Universidad 655 Col Sta Ma. Ahuacatitlan, Cuernavaca Morelos, MEXICO; (email: mhijar@correo.insp.mx).
Road traffic injuries in general and pedestrian injuries in particular are a major public health problem in Mexico, especially in large urban areas. Analysis of mortality and road crashes at the national level was done using routine data recorded on death certificates. Fatality rates for different age groups were estimated by region for the year 2000. These data were supplemented by a cross-sectional study of pedestrian injuries in Mexico City based on death certificates information for pedestrians who lived and died in Mexico City between 1994 and 1997. Participant observation of physical spaces where crashes occurred was carried out. The spaces were filmed and in-depth interviews of survivors conducted. Road traffic crashes were responsible for approximately 17,500 deaths in Mexico during 2000. The mean age of the victims was 37 years. Mexico lost an average of 30 years of productive life for each individual who died in a traffic crash--525,000 years in 2000. An estimated 9500 (54.3%) of all fatalities were pedestrians, and for every pedestrian death there were 13 others who sustained nonfatal injuries requiring medical care. The overall crude mortality rate for pedestrian injuries in Mexico City was 7.14 per 100,000 (CI 6.85-7.42). A concentration of deaths was observed in 10 neighborhoods at specific types of street environments. The underlying factors included dangerous crossings and the absence or inadequacy of pedestrian bridges, as well as negative perceptions of road safety by pedestrians. In conclusion, this study demonstrates the importance of elucidating the underlying contextual determinants of pedestrian injuries.
Road traffic injuries in Colombia.
- Rodriguez DY, Fernandez FJ, Acero Velasquez H. Inj Control Saf Promot 2003; 10(1-2): 29-35
Correspondence: Deysi Yasmin Rodriguez, Research Program on Traffic and Transport, National University of Colombia, Ciudad Universitaria, Edificio 214 (Antonio Narino) oficina 418, Bogota D.C., COLOMBIA; (email: p293149@ing.unal.edu.co).
Road traffic injuries are a leading public health problem in Colombia. Pedestrians are the most vulnerable road users, especially in the main urban centers of Bogota, Medellin and Cali. Data analyzed in this report include official statistics from the National Police and the National Institute of Legal Medicine and Forensic Sciences for 1996-2000, and results of a study conducted at the National University of Colombia in 2000. Methods from the Highway Capacity Manual were used for determining physical and technical variables, and a Geographical Information System tool was used for the location and spatial analysis of the road traffic crashes. Pedestrians accounted for close to 32% of injuries and 40% of the deaths from road traffic crashes. The problem of road traffic crashes existed predominately in urban areas. In the main urban centers, pedestrians constituted nearly 68% of road traffic crash victims. The high level of risky road use behaviors demonstrated by pedestrians and drivers, and inadequate infrastructure for safe mobility of pedestrians in some sections of the road network were the main contributing factors. Major improvements were achieved in Bogota following enhancements to the municipal transport system and other policies introduced since 1995. In conclusion, policies and programs for improving road safety, in particular pedestrian safety, and strengthening urban planning are top priority.
- Ogmen H, Breitmeyer BG, Melvin R. Vision Res 2003; 43(12): 1337-1350.
Correspondence:Haluk Ogmen, Department of Electrical and Computer Engineering, University of Houston, N308 Engineering Building 1, 77204-4005, Houston, TX, USA; (email: ogmen@uh.edu).
A metacontrast mask suppresses the visibility of, without influencing the reaction time (RT) to, the target. We investigated whether this dissociation results from a sensori-motor pathway immune to masking effects or from the characteristics of stimulus timing in mutually inhibitory sustained and transient channels. For target visibility, para- and metacontrast yielded the usual U-shaped functions. Peak paracontrast occurred at stimulus onset asynchronies (SOAs) of -150 to -100 ms. RTs were relatively low for metacontrast and did not show a systematic change as a function of SOA. The RT contribution from contour-masking was greatest at an SOA of -150 ms (paracontrast) and declined to near zero in the metacontrast regime. The dissociation between visibility and RT seen in metacontrast did not occur in paracontrast, rejecting the theory that RTs are elicited by a single sensori-motor pathway immune to masking. The dependence of the dissociation on stimulus timing can be explained by RECOD, a dual-pathway model wherein fast and slow activities interact.
Effect of exposure duration, contrast and base blur on coding and discrimination of edges.
- Purushothaman G, Lacassagne D, Bedell HE, Ogmen H. Spat Vis 2002; 15(3): 341-376.
Correspondence: Gopathy Purushothaman, Department of Electrical and Computer Engineering, University of Houston, TX 77204-4005, USA; (email: gopathy@uchicago.edu.
We extend a neural network model, developed to examine neural correlates for the dynamic synthesis of edges from luminance gradients (Ogmen, 1993), to account for the effects of exposure duration, base blur and contrast on the perceived sharpness of edges. This model of REtino-COrtical Dynamics (RECOD) predicts that (i) a decrease in exposure duration causes an increase in the perceived blur and the blur discrimination threshold for edges, (ii) this increase in perceived blur is more pronounced for sharper edges than for blurred edges, (iii) perceived blur is independent of contrast while the blur discrimination threshold decreases with contrast, (iv) perceived blur increases with increasing base blur while the blur discrimination threshold has a nonmonotonic U-shaped dependence on base blur, (v) the perceived location of an edge shifts progressively towards the low-luminance side of the edge with increasing contrast, and (vi) perceived contrast of suprathreshold stimuli is essentially independent of spatial frequency over a wide range of contrast values. These predictions are shown to be in quantitative agreement with existing psychophysical data from the literature and with data collected on three observers to quantify the effect of exposure duration on perceived blur.
This study examines how credibility affects the way people process information and how they subsequently perceive risk. Three conceptual areas are brought together in this analysis: the psychometric model of risk perception, Eagly and Chaiken's heuristic-systematic information processing model, and Meyer's credibility index. Data come from a study of risk communication in the circumstance of state health department investigations of suspected cancer clusters (five cases, N = 696). Credibility is assessed for three information sources: state health departments, citizen groups, and industries involved in each case. Higher credibility for industry and the state directly predicts lower risk perception, whereas high credibility for citizen groups predicts greater risk perception. A path model shows that perceiving high credibility for industry and state-and perceiving low credibility for citizen groups-promotes heuristic processing, which in turn is a strong predictor of lower risk perception. Alternately, perceiving industry and the state to have low credibility also promotes greater systematic processing, which consistently leads to perception of greater risk. Between a one-fifth and one-third of the effect of credibility on risk perception is shown to be indirectly transmitted through information processing.
Case-control study to investigate risk factors for horse falls in hurdle racing in England and Wales.
- Pinchbeck GL, Clegg PD, Proudman CJ, Morgan KL, French NP. Vet Rec 2003; 152(19): 583-587.
Correspondence: Gina L. Pinchbeck, Epidemiology Group, Department of Veterinary Clinical Science and Animal Husbandry, University of Liverpool, Leahurst, Neston CH64 7TE, UK; (email: unavailable).
Between March 1, 2000 and August 31, 2001, a case-control study was conducted on 12 racecourses in England and Wales to identify and quantify the risk factors associated with horse falls in hurdle races. The cases and controls were defined so that variables relating to the horse, the jockey, the race and racecourse, and the jump could be considered. The cases were defined as a jumping effort at a hurdle flight that resulted in a fall, and the controls were defined as a successful jump over a hurdle at any of the 12 racecourses within 14 days before or after the case fall. Conditional logistic regression was used to examine the univariable and multivariable relationships between the predictor variables and the risk of falling. The risk of falling was significantly associated with the position of the jump in the race, and with the distance and speed of the race. A horse's previous racing experience and history were also significantly associated with the risk of falling and horses participating in their first hurdle race were at almost five times greater risk of falling than horses that had hurdled before.
Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes.
- Field M, Collins MW, Lovell MR, Maroon J. J Pediatr 2003; 142(5): 546-553.
Melvin Field, Department of Neurological Surgery, University of Pittsburgh School of Medicine, PUH Suite B-400, 200 Lothrop St, Pittsburgh, PA 15213, USA; (email: fieldm@msx.upmc.edu).
OBJECTIVE: To evaluate symptoms and neurocognitive recovery patterns after sports-related concussion in high school and college athletes.Study design College athletes (n = 371) and high school athletes (n = 183) underwent baseline neuropsychological evaluation between 1997 and 2000. Individuals who received a concussion during athletic competition (n = 54) underwent serial neuropsychologic evaluation after injury and were compared with a noninjured within-sample control group (n = 38). Main outcome measures included structured interview, four memory measures, and Concussion Symptom Scale ratings. Baseline to postinjury change scores and multiple analyses of variance were used to compare recovery curves within and between groups. RESULTS: High school athletes with concussion had prolonged memory dysfunction compared with college athletes with concussion. High school athletes performed significantly worse than age-matched control subjects at 7 days after injury (F = 2.90; P < .005). College athletes, despite having more severe in-season concussions, displayed commensurate performance with matched control subjects by day 3 after concussion. Self-report of postconcussion symptoms by student athletes was not predictive of poor performance on neuropsychologic testing. CONCLUSIONS: Caution and systematic evaluation should be undertaken before returning athletes with concussion to competition. Sole reliance on the self-report of the athlete may be inadequate. Preliminary data may suggest a more protracted recovery from concussion in high school athletes.
Regional variations in homicide mortality in Jalisco, Mexico
- Vega-Lopez MG, Gonzolez-Perez GJ, Munoz De La Torre A, Valle Barbosa A, Cabrera Pivaral C, Quintero-Vega PP. Cad Saude Publica 2003; 19(2): 613-623.
Correspondence: Guillermo J. Gonz�lez-P�rez, Centro de Estudios en Salud, Poblaci�n y Desarrollo Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara. Modena 1134, Col. Providencia, CP 44630, Guadalajara, Jalisco, MEXICO; (email: ggonzal@udgserv.cencar.udg.mx).
The present study describes regional variations in homicide rates in Jalisco State, Mexico, in 1989-1991, 1994-1996, and 1999-2000, analyzing the trends by gender and socioeconomic stratum. Using mortality data generated by the National Institute for Statistics, Geography, and Information Technology, homicide rates adjusted by age and gender were calculated, along with rate/female rate ratios; rate ratios by socioeconomic stratum and 95% confidence intervals were also calculated. According to the results, the homicide rate showed: a downward trend in the 1990s; a regional homicide mortality pattern, with the highest rates in peripheral regions, considered among the poorest areas in the State; municipalities with the lowest socioeconomic conditions also presenting a statistically significant excess homicide mortality; and an evident over-mortality from homicide among males. The results point to tasks and challenges for public health and law enforcement institutions, including the need to implement different inter-institutional policies that take into consideration the characteristics of homicide and violent crime in Jalisco.
This paper presents an analysis of 44 case records of suicide occurring between 1990 and 1997 in the State of Victoria, Australia, in which the State Coroner identified the presence of a putative gambling problem. Analysis of demographic data revealed that the majority of suicidal gamblers were male with a mean age of 40 years with 84% of the sample being either unemployed or from lower socioeconomic backgrounds. The most common method of suicide was carbon monoxide poisoning. A quarter of the victims left a suicide note. Evidence was found indicating that almost a third (31.8%) of cases had previously attempted suicide and one in four had sought some form of mental health assistance for their gambling problem. A number of putative risk factors were identified including comorbid depression, large financial debts and relationship difficulties. The relationship between crime, suicide and gambling and gender differences among suicidal gamblers was also examined.
Suicide in children and adolescents at a province in Turkey.
Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.
Automobile insurance claims were examined to determine the rates of neck injuries in rear-end crashes for vehicles with and without redesigned head restraints, redesigned seats, or both. Results indicate that the improved geometric fit of head restraints observed in many newer vehicle models are reducing the risk of whiplash injury substantially among female drivers (about 37% in the Ford Taurus and Mercury Sable), but have very little effect among male drivers. New seat designs, such as active head restraints that move upward and closer to drivers' heads during a rear impact, give added benefit, producing about a 43% reduction in whiplash injury claims (55% reduction among female drivers). Estimated effects of Volvo's Whiplash Injury Prevention System and Toyota's Whiplash Injury Lessening design were based on smaller samples and were not statistically significant.
Specific and Long-Term Effects of Nova Scotia's Graduated Licensing Program
BACKGROUND: A graduated licensing (GL) program was introduced in Nova Scotia, Canada, in October 1994. Previous research has shown that it reduced collisions in the short term.
OBJECTIVES: The present study examined the relative contribution of each stage of the program (i.e., learner and intermediate levels) and the program's impact after beginning drivers graduated to full licensure.
METHODS: The research focused on teenage beginning drivers (age 16-17), but the effects on older beginners also was examined. Per-driver crash rates of two groups of novices selected from driver records in Nova Scotia were compared. One group (pre-GL) received their learner's permits during the 2 years before the program was implemented, and the second group (GL) received their learner's permits during the 2 years after implementation.
FINDINGS: The findings clearly establish that most of the collision reduction in Nova Scotia's program occurred during the first year of the program, particularly during the first 6 months when the majority of novices were driving under supervision. The collision rate for 16 to 17-year-old GL novices was 50% lower than the rate for pre-GL novices during the 6 months after they received their learner's permits, and about 10% lower during their first 2 years of licensure when unsupervised driving from midnight to 5 A.M. was prohibited. Much of this improvement for 16 to 17-year-olds occurred during restricted night hours. Collision rates also were lower during nonrestricted hours in the initial 6 months of licensure. The 3-month "time discount" for driver education provided no safety benefit, and GL novices with driver education had collision rates that were not lower than pre-GL novices. There was no long-term effect found for the program after 16 to 17-year-olds graduated to full licensure. For older beginning drivers, crash rates during the first year after obtaining a learner's permit showed a 31% reduction. This effect diminished rapidly. There was only a 2% reduction during the first year of licensure, and crash rates increased during the following 2 years.
DISCUSSION: Overall the data indicate substantial benefits of graduated licensing for 16 to 17-year-old beginners, but no benefits beyond the learner stage for older beginners.
A contemporary analysis of road traffic crashes, fatalities and injuries in Trinidad and Tobago.
Sir Arthur Lewis Institute of Social and Economic Studies, University of the West Indies, St. Augustine, Trinidad and Tobago, WI; (email: gstbiser@tstt.net.tt).
Road safety, in particular pedestrian safety, is a problem in Trinidad and Tobago. Data were derived from the database of the Traffic and Highway Patrol Unit of the Trinidad and Tobago Police Service. Road traffic crashes in Trinidad and Tobago are largely an urban problem. Four urban areas accounted for nearly three-quarters of reported road traffic crashes, fatalities and injuries. Pedestrians, passengers and drivers accounted for 93% of fatalities and 95% of injuries due to road traffic crashes in 2000. Pedestrians alone accounted for 42% of fatalities and 34% of injuries in 2000. Trends over time show that there has been a decline in fatality rates from 17 deaths per 100,000 population in 1960 to 10 deaths per 100,000 population in 2000, despite rapid motorization. Motorization increased four-fold from 63 registered vehicles per 1000 population in 1960 to 250 vehicles per 1000 population in 2000. In conclusion, effort should be intensified to ensure safety for all road users and, in particular, pedestrians, passengers and drivers. Improved data collection and operational research would improve monitoring and evaluation of policy interventions.
Pattern of road traffic injuries in Ghana: implications for control.
Road traffic injuries and fatalities are increasing in Ghana. Police-collected crash and injury data for the period 1994-1998 were aggregated and analyzed using the MAAP5 accident analysis package developed by the Transport Research Laboratory, U.K. Published results of recent transport-related epidemiological and other surveys provided an additional data source. According to the 1994-1998 police data, road traffic crashes were a leading cause of death and injuries in Ghana. The other leading causes of death and injuries are occupational injuries which involve non-mechanized farming and tribal conflicts. The majority of road traffic fatalities (61.2%) and injuries (52.3%) occurred on roads in rural areas. About 58% more people died on roads in the rural areas than in urban areas, and generally more severe crashes occurred on rural roads compared with urban areas. Pedestrians accounted for 46.2% of all road traffic fatalities. The majority of these (66.8%) occurred in urban areas. The second leading population of road users affected was riders in passenger-ferrying buses, minibuses and trucks. The majority of these (42.8%) were killed on roads that pass through rural areas. Pedestrian casualties were overrepresented (nearly 90%) in five regions located in the southern half of the country. Efforts to tackle pedestrian safety should focus on the five regions of the country where most pedestrian fatalities occur in urban areas. Policies are also needed to protect passengers in commercially operated passenger-ferrying buses, minibuses and trucks because these vehicles carry a higher risk of being involved in fatal crashes.
Road traffic injuries in Kenya: magnitude, causes and status of intervention.
Road traffic crashes exert a huge burden on Kenya's economy and health care services. Current interventions are sporadic, uncoordinated and ineffective. This report offers a descriptive analysis of secondary data obtained from a variety of published literature and unpublished reports. Over three thousand people are killed annually on Kenyan roads. A four-fold increase in road fatalities has been experienced over the last 30 years. More than 75% of road traffic casualties are economically productive young adults. Pedestrians and passengers are the most vulnerable; they account for 80% of the deaths. Buses and matatus are the vehicles most frequently involved in fatal crashes. Characteristics of crashes vary considerably between urban and rural settings: pedestrians are more likely to be killed in urban areas, whereas passengers are the majority killed on intercity highways that transverse rural settings. Road safety interventions have not made any measurable impact in reducing the numbers, rates and consequences of road crashes. Despite the marked increase in road crashes in Kenya, little effort has been made to develop and implement effective interventions. Impediments to road traffic injury prevention and control include ineffective coordination, inadequate resources and qualified personnel, and limited capacity to implement and monitor interventions. There is need to improve the collection and availability of accurate data to help in recognising traffic injury as a priority public health problem, raising awareness of policymakers on existing effective countermeasures and mobilizing resources for implementation. Establishment of an effective lead agency and development of stakeholder coalitions to address the problem are desirable.
Correspondence: Douglas J. Wiebe, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania, 933 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA; (email dwiebe@cceb.med.upenn.edu).
OBJECTIVES: I test the hypothesis that having a gun in the home is a risk factor for adults to be killed (homicide) or to commit suicide.
METHODS: Two case-control analyses were based on national samples of subjects 18 years of age or older. Homicide and suicide case subjects were drawn from the 1993 National Mortality Followback Survey. Living control subjects were drawn from the 1994 National Health Interview Survey. Ten control subjects matched by sex, race, and age group were sought for each case subject.
FINDINGS: The homicide sample consisted of 1,720 case subjects and 8,084 control subjects. Compared with adults in homes with no guns, the adjusted odds ratio (OR) for homicide was 1.41 (95% confidence interval [CI] 1.20 to 1.65) for adults with a gun at home and was particularly high among women (adjusted OR 2.72; 95% CI 1.89 to 3.90) compared with men (adjusted OR 1.23; 95% CI 1.01 to 1.49) and among nonwhite subjects (adjusted OR 1.74; 95% CI 1.37 to 2.21) compared with white subjects (adjusted OR 1.27; 95% CI 1.03 to 1.56). Further analyses revealed that a gun in the home was a risk factor for homicide by firearm means (adjusted OR 1.72; 95% CI 1.40 to 2.12) but not by nonfirearm means (OR 0.83; 95% CI 0.62 to 1.11). The suicide sample consisted of 1,959 case subjects and 13,535 control subjects. The adjusted OR for suicide was 3.44 (95% CI 3.06 to 3.86) for persons with a gun at home. However, further analysis revealed that having a firearm in the home was a risk factor for suicide by firearm (adjusted OR 16.89; 95% CI 13.26 to 21.52) but was inversely associated with suicide by other means (adjusted OR 0.68; 95% CI 0.55 to 0.84).
DISCUSSION: Having a gun at home is a risk factor for adults to be shot fatally (gun homicide) or commit suicide with a firearm. Physicians should continue to discuss with patients the implications of keeping guns at home. Additional studies are warranted to address study limitations and to better understand the implications of firearm ownership.
