Assessing the effectiveness of minimum legal drinking age and zero tolerance laws in the United States.
- Voas RB, Tippetts S and Fell JC. Accid Anal Prev 2003; 35(4): 579-587.
Correspondence: Robert B. Voas, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; (email: voas@pire.org).
The objective of this research was to determine the extent to which the decline in alcohol-related highway deaths among drivers younger than age 21 years can be attributed to raising the minimum legal drinking age (MLDA) and establishing zero tolerance (0.02% blood alcohol concentration (BAC) limit for drivers younger than age 21 years) laws. Data on all drivers younger than age 21 years involved in fatalities in the United States from 1982 to 1997 were used in the study. Quarterly ratios of BAC-positive to BAC-negative drivers in each of the 50 states where analyzed in a pooled cross-sectional time-series analysis. After accounting for differences among the 50 states in various background factors, changes in economic and demographic factors within states over time, and the effects of other related laws, results indicated substantial reductions in alcohol-positive involvement in fatal crashes were associated with the two youth-specific laws.
The policy of limiting youth access to alcohol through MLDA laws and reinforcing this action by making it illegal for underage drivers to have any alcohol in their system appears to have been effective in reducing the proportion of fatal crashes involving drinking drivers.
Feasibility of using an interactive laptop program in the emergency department to prevent alcohol misuse among adolescents.
- Gregor MA, Shope JT, Blow FC, Maio RF, Weber JE, Nypaver MM. Ann Emerg Med 2003; 42(2): 276-284.
Correspondence: Mary Ann Gregor, Department of Emergency Medicine, University of Michigan Injury Research Center, 300 N. Ingalls, Room 2D06, Ann Arbor, MI 48109-0437 USA; (email: magregor@umich.edu).
CONTEXT: Alcohol, the most commonly used substance among adolescents, is frequently associated with injury. Effective interventions to prevent adolescent alcohol use and misuse in acute care settings are lacking. A laptop-based alcohol prevention program could reinforce other prevention efforts that adolescents may receive.
OBJECTIVE: We determined the feasibility of using an interactive laptop program with adolescent emergency department (ED) patients to prevent alcohol use and misuse.
METHODS: We used the recruitment phase of a randomized controlled trial at an academic medical center and an urban teaching hospital. Patients were aged 14 to 18 years and presented within 24 hours of an acute injury. Measures included patient recruitment, mechanism of injury, injury severity score, alcohol use characteristics, and patients' opinion of the computer program.
FINDINGS: Of 843 eligible patients, 671 (79.6%) were enrolled and 655 (77.7%) completed the program. Parent or guardian reluctance was the most frequent reason for refusal. The participants averaged 16.0 years of age (range 14 to 18 years; SD 1.5 years), 66.9% were male, and 68.3% were white. Approximately 71% reported "ever" drinking. Recent alcohol use (past 3 months) by those "ever" drinking was as follows: 62.3% drank, 31.2% got drunk, and 37.4% binge drank. Seventy-four percent of recent drinkers reported that the program made them rethink their alcohol use. Ninety-four percent of participants liked the program. Only 5.3% required assistance with the program.
DISCUSSION: Use of an interactive computer program in the ED appears feasible. Further work is being done to evaluate the effectiveness of the program in reducing alcohol-related behaviors among adolescents.
A failed norms social marketing campaign.
- Clapp JD, Lange JE, Russell C, Shillington A, Voas RB. J Stud Alcohol 2003; 64(3): 409-414.
Correspondence: John Clapp, School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, California 92182-4119, USA; jdclapp@mail.sdsu.edu).
OBJECTIVE: In this article we test the efficacy of an intensive norms social marketing campaign to reduce heavy drinking among college students living in a residence hall.
METHOD: We employed a pretest-posttest nonequivalent comparison group design. The study was conducted in two (experimental and comparison) comparable residence halls located in a large urban public university. We attempted a census at each hall, and pre- and postintervention data were collected in public areas of each residence hall. Relative sample sizes were approximately 60% in the experimental hall (both waves) and 38% in the comparison hall.
FINDINGS: The campaign successfully corrected students' misperceptions of drinking norms but had no effects, or counterintuitive effects, on drinking behaviors.
COMMENTS: Despite the popularity of this approach, universities would be prudent to proceed with care before adopting this approach wholesale.
See Also Item 1 Under Transportation
Research, policy-making and intervention programming in injury prevention: a classic case of sub-optimization.
Correspondence: Ian R. Johnson, Accident Research Centre, Building 70, Monash University, Victoria, 3800, AUSTRALIA; (email: ian.johnston@general.monash.edu.au).
In most post-industrial countries injury is a leading cause of death, particularly premature death. In Australia, for example, over two thirds of all deaths among persons aged 15 to 24 years are the result of injury. Transport, particularly road transport, is the single most frequent setting for fatal injury. Despite these facts injury research is under-funded and uncoordinated. There is only a fledgling science and little underpinning theory. There is a plethora of unlinked data sets, each reflecting the institutional responsibility of the collecting agency. Even within transport there is little cross modal contact. While the complexities of service delivery demand institutional segregation no such case exits for the segregation of research.
True disaster readiness and preparedness are not really measured until put to the test of a real disaster. The attacks of Sept 11, 2001, put 1 community hospital and its disaster plan to the ultimate test. The process the hospital used to review, evaluate, and change its former disaster plan and then implement a new plan on the basis of the response to Sept 11 terrorists attacks is described. Specific challenges faced by this community hospital, the importance of participation in a regional response effort, and how the hospital has readied itself in a new threat environment are addressed. Disasters affect hospitals of all sizes and geographic locations. Health care facilities need a strong framework with which to function independently, if only for a short time, until additional resources can be implemented.
The discotheque fire in Gothenburg 1998: a tragedy among teenagers.
- Cassuto J, Tarnow P. Burns 2003; 29(5): 405-416.
Correspondence: Jean Cassuto, Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, SE-43180 , Mölndal, SWEDEN; (email: jean.cassuto@aniv.gu.se).
The fire disaster in Gothenburg, Sweden, 1998 killing 63 and wounding 213 teenagers was caused by arson committed by a youth from the same community. The fire was started in the basement of an overcrowded discotheque and made, due to unfortunate circumstances, devastating progress. The ensuing rescue work performed by other youth, fire fighters, police and medical staff was prompt and must be seen in the light of a very difficult situation. As a result of these orchestrated efforts and the fact that this disaster occurred in a major city with substantial resources, all the injured were able to be hospitalized within 2h. The load on four local hospitals was initially severe due to the large number of injured and the limited number of staff on night duty. The situation was contained by relocating patients from the intensive care units to ordinary wards and by transporting several of the most severe burn injuries by helicopter to burn units in other parts of Sweden and to Norway. Hundreds of relatives and friends gathered at the local hospitals. This was a new experience for the hospitals and staff, involving many positive aspects as well as some negative aspects such as violence, threats and rumors. As a result of the large number of injuries vast psychosocial rehabilitation program was initiated by health care staff, religious communions, schools and the community, has continued over the past years. Such a disaster emphasizes a requirement for extensive preparation not only in the rescue and medical services, but also in the ways and areas to rehabilitate patients in society.
Correspondence: T. Potokar, Welsh Regional Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales 5A6 6NL, UK ; (email: tpot64@hotmail.com).
The use of mobile phones has increased dramatically over the last 10 years and recently there has been increasing public interest in the health risks associated with their use. These can be categorized in the following way: 1) Risks due to exposure to radio waves of a certain frequency; 2) Behavior related risks (i.e. use of phone whilst driving); 3) Risks due to interference with electronic equipment; and 4) Potential ignition of flammable substances.
Although there have been media reports of fire caused by mobile phones and the theoretical potential for mobile phones to cause explosions if used in the vicinity of flammable or explosive substances we could find no reported cases in the scientific literature of this happening. Other reported risks have been more fully investigated although there is no consensus and opinion remains divided as to their potential.
We present an adult with minor burns sustained as a result of a flash explosion whilst working on the petrol tank of a car. There was no evidence of any factors precipitating this explosion except for his mobile phone ringing immediately prior to it. We discuss the theoretical risk of mobile phones causing explosions in petrol stations and summarize some of the other hazards associated with their use.
There are many accounts of the potential hazards of mobile phones in the literature, including an increased risk of road traffic accidents, brain tumors and interference with electrical equipment. Oil companies and mobile phone companies are aware of the potential risk of explosion due to the ignition of petrol vapors and all forecourts display signs informing people to turn off their phones. The exact mechanism of action seems to be uncertain and the risk non definable. This, however, is the first reported case in which we believe a mobile phone caused ignition of petrol fumes and subsequent flash burns to an individual. The risk may be minimal but the potential disastrous consequences of spontaneous ignition of petrol vapor by a mobile phone should be further investigated to ascertain what, if any, public health and safety measures need to be undertaken.
See item 1 under Psychological & Attentional Issues
CONTEXT: There has been concern regarding potential shock hazards for rescuers or bystanders when a defibrillator is used in a wet environment and the recommended safety procedure, moving the patient to a dry area, is not followed.
OBJECTIVE: To measure the electrical potentials associated with the use of an automated external defibrillator (AED) in a realistically modeled wet environment.
METHODS: A raw processed turkey was used as a patient surrogate. The turkey was placed on a cement floor while pool water was applied to the surrounding area. To simulate a rescuer or bystander in the vicinity of a patient, a custom sense probe was constructed. Defibrillation shocks were delivered to the turkey and the probe was used to measure the voltage an operator/bystander would receive at different points surrounding the surrogate. The test was repeated with salt water.
FINDINGS: The maximum voltage occurred approximately 15 cm from the simulated patient and measured 14 V peak (current 14 mA peak) in the case of pool water, and 30 V peak (current 30 mA peak) in the case of salt water.
DISCUSSION: Thirty volts may result in some minor sensation by the operator or bystander, but is considered unlikely to be hazardous under these circumstances. The maximum currents were lower than allowed by safety standards. Although defibrillation in a wet environment is not recommended practice, our simulation of a patient and a rescuer/bystander in a wet environment did not show significant risk should circumstances demand it.
Work-related burn injuries in Ontario, Canada: has anything changed in the last 10 years?
- Mandelcorn E, Gomez M, Cartotto RC. Burns 2003; 29(5): 469-472.
Correspondence: Robert C. Cartotto, Ross Tilley Burn Centre, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ont. M4N 3M5, CANADA; (email: robert.cartotto@swchsc.on.ca).
CONTEXT: Many burn injuries occur in the workplace. Previous research from this institution 10 years ago analyzed the incidence and nature of occupation-related burns admitted to our facility.
objectives: To compare the current incidence and patterns of work-related burn injuries treated at our adult regional burn center (Current group) with the findings of a similar study 10 years ago (Early group).
METHODS: Retrospective study of all burn center admissions between 5 December 1998 and 31 December 2000 was completed. The data from the Early and Current groups was analyzed using the Chi-square test of homogeneity.
FINDINGS: During the study period, 355 patients were hospitalized. After exclusions, 100 occupational burn cases were identified (28%). The mean age of patients was 39+/-12 years, 90% were male. The mean total body surface area (TBSA) burn was 11+/-13.7%. The most common mechanism of burn was electrical (32%), followed by flame (22%), scald (17%), tar (14%), contact (8%), and chemical (7%). Four patients (4%) died of their injuries. There were no significant differences between the Current group and the Early group in terms of incidence, age, gender, occupation, mechanism of burn, or mortality.
COMMENTS: In the past 10 years no change was found in the incidence or pattern of work-related burn injuries treated at this institution. This suggests that existing prevention strategies have not been effective.
Correspondence: David Nguyen-Tri, Psychophysics and Perception Laboratory, School of Optometry, University of Montreal, Montreal, Quebec, CANADA; (email: david.nguyen-tri@umontreal.ca).
CONTEXT: It has been reported that greater age-related losses in sensitivity occur for short-wavelength visual stimuli than for medium- and long-wavelength visual stimuli.
OBJECTIVES: The purpose of the current experiment was to determine to what extent optical, receptoral, and postreceptoral factors contribute to these age-related changes in color vision.
METHODS: One hundred two observers (ages 18-87) completed a minimum motion task to determine isoluminance between red and green and between red and blue. A motion-nulling task was also performed to assess the L-M postreceptoral chromatic mechanism.
FINDINGS: No significant age-related changes occurred in red-green isoluminance values. Red-blue isoluminance values showed a significant and systematic decrease with age in observers with phakic eyes. Pseudophakic eyes in older subjects performed this task as well as phakic eyes in young subjects. The motion-nulling results demonstrated small age-related losses in the postreceptoral color mechanisms.
COMMENTS: The findings of this experiment, particularly those of the red-blue isoluminance task, indicate that the optical factor of lenticular senescence is the main contributor to the age-related changes observed in color vision. A model based on age-related changes in lenticular absorbance shows good fit with the experimental data of observers with phakic eyes, suggesting that optical factors are the main cause of the age-related changes in these color vision tasks.
398 children, 1 to 6 years of age, and the adults accompanying them in two supermarkets were exposed to one of four treatments. Two experimental treatments featured variations on a warning sign, prompting adults to prevent their children from standing while in the cart seat and basket portions of shopping carts. The two control treatments exposed the adults to advertisements rather than warning signs. No effect was observed of either warning on standing while in cart seats, standing while in baskets, climbing on carts, or standing on the ends or sides of carts; nor was any effect noted on three measures of adult supervision. This lack of effect is attributed to adults' perceptions of the low risk of serious injury to children in carts, their familiarity with carts, the costliness of ensuring compliance with the warnings, and the lack of natural contingencies supporting the prompts. Risky activities by children were related to the child's location in the cart, child's sex, and adult supervision.
Perception of risk to self: When a celebrity contracts a disease - the example of Earvin "Magic" Johnson's announcement that he was HIV positive.
- Casey MK, Allen M, Emmers-Sommer T, Sahlstein E, Degooyer D, Winters A, Wagner AE, Dun T. J Health Commun 2003; 8(3): 249-265.
Correspondence: Mary K. Casey, Department of Communication, University of Wisconsin--Milwaukee, 53201, USA; (email: mkcasey@uwm.edu).
This meta-analysis summarizes the available data concerning the impact that the public announcement that Earvin "Magic" Johnson, a National Basketball Association All-Star, had tested positive for HIV. The results demonstrate that the announcement increased the level of accurate knowledge in persons, the number of persons getting tested for HIV, and the desire to obtain more information about HIV and AIDS. For adults the impact of the announcement was to increase the perception of vulnerability while for children/adolescents the announcement diminished the perception of risk.
Evaluation of the Balloon Analogue Risk Task (BART) as a predictor of adolescent real-world risk-taking behaviors.
The Balloon Analogue Risk Task (BART) was administered to a sample of 26 high school-aged adolescents to test the utility of the BART as a behavioral measure of risk-taking propensity. Data indicate that riskiness on the BART was related to self-reported engagement in real-world risk-taking behaviors. These data replicate and uniquely extend past research to an adolescent sample, suggesting that the BART may be a useful addition to self-report batteries for the assessment of risk-taking behaviors in adolescents.
Parental monitoring, negotiated unsupervised time, and parental trust: the role of perceived parenting practices in adolescent health risk behaviors.
Correspondence: Elaine A. Borawski, Center for Health Promotion Research, Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio, USA; (email: eab@hal.cwru.edu)
To compare two different parenting practices (parental monitoring and negotiated unsupervised time) and perceived parental trust in the reporting of health risk behaviors among adolescents. Data were derived from 692 adolescents in 9th and 10th grades (mean = 15.7 years) enrolled in health education classes in six urban high schools. Students completed a self-administered paper-based survey that assessed adolescents' perceptions of the degree to which their parents monitor their whereabouts, are permitted to negotiate unsupervised time with their friends and trust them to make decisions. Using gender-specific multivariate logistic regression analyses, we examined the relative importance of parental monitoring, negotiated unsupervised time with peers, and parental trust in predicting reported sexual activity, sex-related protective actions (e.g., condom use, carrying protection) and substance use (alcohol, tobacco, and marijuana).For males and females, increased negotiated unsupervised time was strongly associated with increased risk behavior (e.g., sexual activity, alcohol and marijuana use) but also sex-related protective actions. In males, high parental monitoring was associated with less alcohol use and consistent condom use. Parental monitoring had no affect on female behavior. Perceived parental trust served as a protective factor against sexual activity, tobacco, and marijuana use in females, and alcohol use in males. Although monitoring is an important practice for parents of older adolescents, managing their behavior through negotiation of unsupervised time may have mixed results leading to increased experimentation with sexuality and substances, but perhaps in a more responsible way. Trust established between an adolescent female and her parents continues to be a strong deterrent for risky behaviors but appears to have little effect on behaviors of adolescent males.
CONTEXT: Equestrian activities are associated with a high rate of injury. Attempts to reduce the incidence and severity of injury require accurate characterization of risk factors and pattern of injury. The present study was performed to analyse the injuries seen at an Australian center where a large number of equestrian injuries present.
METHODS: Data were collected prospectively over a 3 year period on all equestrian injuries presenting to the Prince of Wales -Hospital complex. These data were compared against and combined with retrospectively collected data over the preceding 3 years at the same center.
FINDINGS: Two hundred and twenty-one injured equestrians presented (181 consented) in the prospective period of the study, and 208 presented in the retrospective period. Overall, 81% of riders were wearing a helmet at the time of their injury. Helmet use was associated with a significantly lower admission rate (27% vs 55%; P < 0.0001, from combined data). Recreational equestrians had a higher admission rate than professional equestrians, and had a significantly higher head and spine injury rate than the professional group. Rate of helmet use increased from 72% in the retrospective group to 91% in the more recent prospective group, and total admissions decreased from 43% to 14%.
COMMENTS: Significant and serious injuries are associated with equestrian activities, with the higher risk group being recreational equestrians, and riders not using a helmet. The pattern of injury favors head and spine in recreational and non-helmeted riders, and extremities for professional and helmeted riders. Helmet use is still not universal among riders, although an increase in its use may be contributing to an overall reduction in admission rate. Facial and spinal injuries still occurred in helmeted patients.
Lacrosse stick entrapment injury to the thumb.
- Livingston LA, Forbes SL. Br J Sports Med 2003; 37(3): 272-273.
Correspondence: Lori A Livingston, School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, CANADA; (email: Lori.Livingston@dal.ca)
A case of injury to the left thumb following an errant stick check, and subsequent entrapment of the digit in the open sidewall of a lacrosse stick, is presented. A circumferential laceration, severe swelling, and bruising to the proximal phalanx resulted. This case report emphasizes the need to limit the dimensions of openings in the sidewalls of lacrosse sticks to prevent the occurrence of this and other preventable injuries.
Correspondence: Andrew W. Evans, Centre for Transport Studies, University College London, Gower Street, London WC1E 6BT, UK; (email: aevans@transport.ucl.ac.uk).
This paper examines the statistical properties of estimates of fatal accident rates, mean fatalities per accident, and fatality rates when these estimates are based on past accident data. The statistical properties are illustrated by two long-term transport fatal accident datasets from Great Britain, the principal one for railways and the other for roads, chosen to provide a statistical contrast. In both modes, the accident rates have fallen substantially over the long term. Two statistical estimates of current accident and fatality rates are presented for each dataset, one based only on recent data and the other based on estimates of long-term trends. The trend-based estimate is preferred for train accidents because this makes maximum use of the limited and variable data; the recent data are preferred for road accidents because this avoids unnecessary dependence on modeling the trends. For train accidents, the estimated fatality rate based on past accidents is compared with an estimate produced by the railway industry using a risk model. The statistical estimate is less than half the industry's estimate, and the paper concludes that the statistical estimate is to be preferred.
- Schalamon J, V Bismarck S, Schober PH, Hollwarth ME. Pediatr Surg Int 2003; (available online ahead of print).
Correspondence: Johannes Schalamon, Department of Pediatric Surgery, University of Graz, Auenbruggerplatz 34, 8036, Graz, AUSTRIA; (email: Johannes.Schalamon@kfunigraz.ac.at).
We analyzed the causes and diagnoses, the treatment, short and long-term outcome of a consecutive series of 70 pediatric polytrauma patients. From 1989 to 1996, 70 children (aged 10 months to 16 years, mean 7.4 years) presented with multiple trauma. A follow-up investigation was performed 4.2 years (mean) after the accident. Traffic accidents (68%) were the leading cause of injuries. Among all injuries (mean ISS 24.6 range 17-57), injuries of the head/neck area were most frequent (87%) followed by extremity fractures (76%) and 135 operations were performed on 55 children, mostly for fracture stabilization. All multiple injured children survived. At discharge 25 children were still impaired (36% of 70). At follow-up 58 patients were revisited, 11 (19% of 58) presented with impairments, 8 of those (73% of 11) following severe head trauma. This study showed a 10% rate of late impairment due to the severity of the primary head trauma.
Accident profile of older people in Antalya City Center, Turkey.
Correspondence: L. Donmez, Akdeniz University Medical Faculty, Department of Public Health, 07070, Campus, Antalya, TURKEY; (email: donmez@med.akdeniz.edu.tr).
Accidents are major health problems leading to deaths and injuries among older people. The present study was performed to investigate the characteristics of the accidents experienced within the last 1 year in people aged 60 years and older living in Antalya City Center. The study was planned as a cross-sectional research. A total of 840 individuals selected from the study population with cluster-sampling method were used in questionnaires. A number of 163 (19.4%) individuals had at least one accident in the last year. A total of 178 accidents were reported within the last 1-year; 124 (69.7%) falls, 22 (12.4%) traffic accidents and 12 (6.7%) dropping of objects to head. The accidents occurred mostly at home (40.4%), at avenue-street etc. (31.5%), and in garden (8.4%). The result of logistic regression analysis revealed that accident frequency was positively related with female gender (odds=1.79, P<0.05), disability of lower extremities (odds=1.63, P<0.05) and hearing impairment (odds=2.01, P<0.05) whereas it was negatively related with living in detached house (odds=0.41, P<0.05). It was found that accidents caused health (82.0%) and financial (38.2%) problems in elderly and also the disabilities in daily activities (66.3%). Average numbers of days with disability in daily activities were 21.1 in 1 year per accident and 5.7 in 1 year per individual. Occurrence of health problems and disability in daily activities were more frequent among women compared to men (P<0.05). Methods like environmental measures or educational programs to prevent accidents and accident-related injuries must be focused on defined risk groups and places where the accidents occur more frequently. Future researches about the effectiveness of prevention in elderly on accident frequency, mortality and morbidity are needed to deal with this current problem.
Surveillance for health behaviors of American Indians and Alaska Natives: findings from the Behavioral Risk Factor Surveillance System, 1997-2000.
CONTEXT: In the United States, disparities in risks for chronic disease (e.g., diabetes, cardiovascular disease, and cancer) and human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are evident among American Indians and Alaska Natives (AI/ANs) and other groups. This report summarizes findings from the 1997-2000 Behavioral Risk Factor Surveillance System (BRFSS) for health-status indicators, health-risk behaviors, and HIV testing and perceived risk for HIV infection among AI/ANs, compared with other racial/ethnic groups in five regions of the United States.
REPORTING PERIOD: 1997-2000.
DESCRIPTION OF SYSTEM: BRFSS is a state-based telephone survey of the civilian, noninstitutionalized, adult (i.e., persons aged > 18 years) population. For this report, responses from the 36 states covered by the Indian Health Service administrative areas were analyzed.
FINDINGS: Region and sex-specific variations occurred in the prevalence of high-risk behaviors and health-status indicators. For example, the prevalence of current cigarette smoking ranged from 21.2% in the Southwest to 44.1% in the Northern Plains, and the awareness of diabetes was lower in Alaska than in other regions. Men were more likely than women to report binge drinking and drinking and driving. For the majority of health behaviors and status measures, AI/ANs were more likely than respondents of other racial/ethnic groups to be at increased risk. For example, AI/ANs were more likely than respondents of other racial/ethnic groups to report obesity (23.9% versus 18.7%) and no leisure-time physical activity (32.5% versus 27.5%).
COMMENTS: The 1997-2000 BRFSS data demonstrate that health behaviors vary regionally among AI/ANs and by sex. The data also reveal disparities in health behaviors between AI/ANs and other racial/ethnic groups. The reasons for these differences by region and sex, and for the racial/ethnic disparities, are subjects for further study. However, such patterns should be monitored through continued surveillance, and the data should be used to guide prevention and research activities. For example, states with substantial AI/AN populations, and certain tribes, have successfully used BRFSS data to develop and monitor diabetes and tobacco prevention and control programs.
Federal and state agencies, tribes, Indian health boards, and urban Indian health centers will continue to use BRFSS data to develop and guide public health programs and policies. The BRFSS data will also be used to monitor progress in eliminating racial and ethnic health disparities. Regional Indian health boards, tribal epidemiology centers, and Indian Health Service Area Offices can use the findings of this report to prioritize interventions to prevent specific health problems in their geographic areas. Moreover, tribes and other institutions that promote AI/AN health care can use the report to document health needs when applying for resources.
Association between course of study at university and cause-specific mortality.
- McCarron P, Okasha M, McEwen J, Smith GD. J R Soc Med 2003; 96(8): 384-388.
Correspondence: Peter McCarron, Unit of Descriptive Epidemiology, International Agency for Research on Cancer, 150 Cours Albert-Thomas, 69372 Lyon Cedex 08, FRANCE; (email: peter.mccarron@qub.ac.uk).
Although socioeconomic position is clearly related to mortality and one measure of this is length of education, it is not known whether the choice of course at university determines future health. We therefore investigated the association between faculty of study and all-cause and cause-specific mortality in a prospective follow-up of male students who underwent health examinations while attending Glasgow University from 1948 to 1968. Among the 9887 (84%) alumni traced by means of the NHS Central Register, 8367 (85%) had full data on important potential confounding variables; 939 of these men had died. Physiological variables differed little between students from the various faculties. Medical students were most likely to come from affluent social backgrounds and, after law students, were most likely to be smokers. Compared with former medical students, former arts and law students had excess all-cause and cardiovascular disease mortality, while science and engineering alumni had similar risks. Former medical students had lower lung cancer mortality than other alumni but higher mortality from alcohol-related causes including accidents, suicide and violence. The lower mortality risks observed among former medical and engineering students may be due to their better employment prospects and healthier lifestyle behaviors, although the high mortality from alcohol-related causes among former medical students underscores the complexity of choice of health behavior. The findings point to the potential for disease prevention among the large proportion of the population who now have third-level education.
OBJECTIVE: To provide preliminary psychometric data on the Children's Aggression Scale-Teacher Version (CAS-T), which was designed to assess severity and frequency of aggressive, as distinct from nonaggressive, disruptive behaviors.
METHODS: The CAS-T has 23 items representing five domains: Verbal aggression, Aggression against objects and animals, Provoked physical aggression, Unprovoked physical aggression, and Use of weapons. The CAS-T was completed for 273 nonreferred boys and 67 clinically referred children (60 boys; 7 girls). Coefficient alpha was assessed separately in clinical and nonreferred groups. Validity was evaluated by comparing CAS-T scores of children with different disruptive behavior disorder diagnoses and by examining the relationship of CAS-T scores to other parent and teacher ratings.
FINDINGS: The scale as a whole had excellent reliability as measured by coefficient alpha. Children with conduct disorder were rated significantly higher than those with oppositional defiant disorder, attention-deficit/hyperactivity disorder, and no disruptive behavior disorder diagnosis. Further, patterns of correlations with other rating scales provide strong support for the convergent and discriminant validity of the CAS-T.
COMMENTS: The CAS-T may fill a gap in that it distinguishes among various types and severity of aggression, as distinct from oppositional-defiant behaviors.
Correspondence: Diego De Leo, Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, Queensland, AUSTRALIA; (email: D.DeLeo@mailbox.gu.edu.au).
This study examined the increase in the rate of suicide by hanging and an apparently simultaneous decrease in the rate of suicide by firearm as hypothetical evidence that Australian males have substituted one method of suicide for another. Trends in hanging and firearm suicide rates were examined from 1975 to 1998 for all Australian males and from 1971 to 1998 for a subset of Australian male youth, as well as a group of Australian males aged over 64 years at the time of their death. When the firearm suicide rate for Australian males declined the hanging rate increased simultaneously, with no statistical difference in the rate of change of the two methods. A similar pattern of simultaneous divergence in hanging and firearm suicide rates of a 15- to 24-year-old subgroup occurred at a not dissimilar rate over a longer time period. Rates of suicide by hanging were found to have begun increasing prior to the decline in firearm suicide. The declining rate of firearm suicide in the 15- to 24-year-old subgroup coincided with an increase in the overall suicide rate. Relationships between trends in hanging and firearm suicide differed between states and between urban and non-urban areas within Queensland, with the firearm suicide rate falling more rapidly in urban areas, especially following the introductions of restrictions to weapon purchases. Individual suicide method choice may be related to independent changes in the social acceptability of each method, as well as to an increasing prevalence of suicide in younger males, who are more likely to use the hanging method. The functioning and effect of social acceptability remains unclear, however. Intervention and prevention strategies should focus on challenging the social acceptability of hanging, especially among males aged 15 to 24 years.
Clinic and prevention of suicide in elderly: a literature review.
In almost all countries where reliable statistics researches are conducted, the rate of suicide among elderly people rises in people over 65 years old, reaching its highest point at 85 years old. Nevertheless, it seems that this phenomena is tended to be ignored. Although the evidence given by the epidemiology, many physicians and even of psychiatrist claim that the suicide among elderly is rare.
Suicide attempts in elderly people. Data from the Hospital Italiano de Buenos Aires.
OBJECTIVE: The aim of this paper is to analyze some characteristics of 25 patients, over 60, who attempted suicide and were hospitalized in the Department of Psychiatry of a general hospital in Buenos Aires.
METHODS: This is a retrospective study using data from the medical records of patients (1999 to 2002); based on a protocol comprising an analysis of attempted suicides, demographic and clinical variables. Patients were diagnosed following the DSM-IV criteria by two trained GPs and were confirmed by MMPI and Rorschach.
FINDINGS: 72% were women. The average age was 73,8 % were divorced, 20% never married, 32% widowed and 32% married. The most frequent diagnosis was Major Depressive Disorder of late onset followed by Personality Disorder ( 96%; 48%). The most frequent method was intoxication, (68.75% BDZ). Almost half of the attempts were highly severe.
COMMENTS: We may infer that the elderly person who attempts suicide: is female, 68-78 years old, does not have a partner, lives with someone, has Major Depressive Disorder (at least half of them had Personality Disorder) and a clinical disease. This is her first attempt, is alone at home, and she does not advise others. Reduced hearing is a very frequent co-morbidity.
Unemployment and suicide. Evidence for a causal association?
Correspondence: Tony A. Blakely, Department of Public Health, Wellington School of Medicine, University of Otago, Wellington, NEW ZEALAND; (email: tblakely@wnmeds.ac.nz).
OBJECTIVES: To determine the independent associations of labor force status and socioeconomic position with death by suicide.
DESIGN: Cohort study assembled by anonymous and probabilistic record linkage of census and mortality records.
PARTICIPANTS: 2.04 million respondents to the New Zealand 1991 census aged 18-64 years.
MAIN OUTCOME MEASURE: Suicide in the three years after census night.
FINDINGS: The age adjusted odds ratios (95% confidence intervals) of death by suicide among 25 to 64 year olds who were unemployed compared with employed were 2.46 (1.10 to 5.49) for women and 2.63 (1.87 to 3.70) for men. Similarly increased odds ratios were observed for the non-active labor force compared with the employed. Strong age only adjusted associations of suicide death with the socioeconomic factors of education (men only), car access, and household income were observed. Compared with those who were married on census night, the non-married had odds ratios of suicide of 1.81 (1.22 to 2.69) for women and 2.08 (1.66 to 2.61) for men. In a multivariable model the association of socioeconomic factors with suicide reduced to the null. However, marital status and labor force status remained strong predictors of suicide death. Unemployment was also strongly associated with suicide death among 18-24 year old men. Sensitivity analyses suggested that confounding by mental illness might explain about half, but not all, of the association between unemployment and suicide.
COMMENTS: Being unemployed was associated with a twofold to threefold increased relative risk of death by suicide, compared with being employed. About half of this association might be attributable to confounding by mental illness.
Graduate training and the treatment of suicidal clients: the students' perspective.
Correspondence: Elizabeth T. Dexter-Mazza, School of Professional Psychology, Pacific University, Forest Grove, Oregon 97116, USA, (email: dext0951@pacificu.edu).
Existing literature suggests that graduate programs may not provide adequate training in working with suicidal clients. Therefore, we surveyed 238 predoctoral psychology interns and assessed the prevalence of clients engaging in suicidal behaviors and the amount of formal training in managing suicidal clients received. Results showed approximately 5% of participants indicated a client suicide and 99% indicated they had treated at least one suicidal client during their graduate training. In contrast, results demonstrated only 50% of the participants reported attending programs where formal training was offered. These findings suggest a continued need for increased formal training in managing suicidal clients in graduate psychology programs.
A suicide peak after weekends and holidays in patients with alcohol dependence.
This paper analyzes the variation of suicide by day of the week in alcohol dependence, with public holidays taken into consideration. From 1949 through 1969, 1,312 patients with alcohol dependence were admitted to the Department of Psychiatry in Lund. By 1997, a total of 102 (99 men) alcoholic patients had taken their own life. Suicide victims with severe depression and other diagnoses were compared. There was a suicide peak on the first two days after weekends and holidays in patients with alcohol dependence (p < .05). Alcohol withdrawal is proposed as a contributor to the suicide peak.
Correspondence: Bo Bjerre, M.D., Traffic Medicine Advisory Board, Swedish National Road Administration, SE-781 87
Borlänge, SWEDEN; (email: bo.bjerre@vv.se).
The Swedish alcohol ignition interlock program for driving while intoxicated (DWI) offenders, both first-time as well as multiple offenders, was launched as a pilot project in 1999. It is a volunteer program and differs in some respects from other programs: It covers a period of 2 years, it includes very strict medical regulations entailing regular checkups by a physician, it does not require a prior period of hard suspension, and it focuses strongly on changes in alcohol habits. Records from the 5 years prior to the offense showed that DWI offenders are generally in a high-risk category long before their offense, with a four to five times higher accident rate (road accidents reported by the police) and a three to four times higher rate of hospitalization due to a road accident. Only 12% of the eligible DWI offenders took part in the program and, of these, 60% could be diagnosed as alcohol dependent or alcohol abusers. During the program, alcohol consumption is monitored through self-esteem questionnaires (AUDIT) and five different biological markers. Our data show a noticeable reduction in alcohol consumption among the interlock users. This, combined with the high rate of compliance with the regulations, probably accounts for the fact that there was no case of recidivism during the program. Preliminary findings also suggest a reduction in the annual accident rate for interlock users while in the program. It still is too early to draw any conclusions concerning the rate of recidivism after completion of the program due to an insufficient amount of data for analysis. Nevertheless, the preliminary results are so promising that the program will now be expanded to cover all of Sweden as well as to include all driver's license categories.
Effect of motor vehicle crashes on adverse fetal outcomes.
- Hyde LK, Cook LJ, Olson LM, Weiss HB, Dean JM. Obstet Gynecol 2003; 102(2): 279-286.
Correspondence: Lisa K. Hyde, 615 Arapeen Drive, Suite 202, University of Utah, , Salt Lake City, UT 84108, , USA, (email: lisa.hyde@hsc.utah.edu).
OBJECTIVES: To assess the effect of maternal involvement in motor vehicle crashes on the likelihood of adverse pregnancy outcomes and to estimate the effect of seatbelt use in reducing the occurrence of those outcomes.
METHODS: Statewide motor vehicle crash, birth, and fetal death records from 1992 to 1999 were probabilistically linked. Logistic regression was used to compare the likelihood of adverse birth and fetal outcomes including low birth weight, prematurity, placental abruption, fetal distress, excessive bleeding, fetal death, and other complications among pregnant women in crashes and those not in crashes.
FINDINGS: Of 322,704 single live resident births, 8938 mothers (2.8%) experienced a crash during pregnancy. Pregnant women using seatbelts were not significantly more at risk for adverse fetal outcomes than pregnant women not in crashes. However, pregnant women who did not wear seatbelts during a crash were 1.3 times more likely to have a low birth weight infant than pregnant women not in a crash (95% confidence interval [CI] 1.0, 1.6) and twice as likely to experience excessive maternal bleeding than belted pregnant women in a crash (95% CI 1.0, 4.2). Forty-five of 2645 fetal deaths were linked to a motor vehicle crash, with unbelted pregnant women 2.8 times more likely to experience a fetal death than belted pregnant women in crashes (95% CI 1.4, 5.6).
COMMENTS: Pregnant women should be counseled to wear seatbelts throughout pregnancy and reduce crash risk.
Air bag effectiveness as function of impact speed.
- Nusholtz GS, Famili F, Di Domenico L, Shi Y, Ben Aoun Z, Hongsakaphadana Y. Traffic Inj Prev 2003; 4(2): 128-135.
Correspondence: Guy S. Nusholtz, DaimlerChrysler, CIMS 483-05-10, 800 Chrysler Dr., Auburn Hills, MI 48326, USA; (email: GSN@DaimlerChrysler.com).
An investigation was conducted to estimate the effectiveness of air bags as a function of velocity. The study consisted of three parts: a theoretical idealization, an analysis of National Automotive Sampling System/Crashworthiness Data System (NASS/CDS), and a reanalysis of previously published Fatality Analysis Reporting System (FARS) data. The theoretical analysis looked at idealized risk curves as a function of velocity; assuming that the air bag offers a benefit for both belted and unbelted occupants. Analysis of the NASS/CDS data looked at the effectiveness of air bags as a function of velocity for Maximum Abbreviated Injury Scale (MAIS) 3+ injuries. The reanalysis of the previously published FARS data looked at the effectiveness of the air bag as a function of velocity for fatalities. The theoretical analysis indicates that the air bag effectiveness should be greatest at the low velocities. The field data analysis of both NASS/CDS and FARS were consistent with the theoretical analysis, indicating that air bags are most effective at the lower velocities, below 40 kph (25 mph), for both belted and unbelted occupants. Although it was not possible to estimate a different effect for belted and unbelted for fatalities using FARS, it was possible for MAIS 3+ using NASS/CDS. For unbelted occupants the effectiveness goes to zero or becomes negative above 40 kph (25 mph) for MAIS 3+, and for belted occupants the effectiveness stays positive but with significantly lower magnitude for speeds above 40 kph (25 mph).
Overall injury risk to different drivers: combining exposure, frequency, and severity models.
Correspondence: Kara M. Kockelman, The University of Texas at Austin, 6.9 E. Cockrell Jr. Hall, Austin, TX 78712-1076, USA; (email: kkockelm@mail.utexas.edu).
Traffic crash risk assessments should incorporate appropriate exposure data. However, existing US nationwide crash data sets, the NASS General Estimates System (GES) and the Fatality Analysis Reporting System (FARS), do not contain information on driver or vehicle exposure. In order to obtain appropriate exposure data, this work estimates vehicle miles driven (VMD) by different drivers using the Nationwide Personal Transportation Survey (NPTS). These results are combined with annual crash rates and injury severity information from the GES for a comprehensive assessment of overall risk to different drivers across vehicle classes.
Data are distinguished by driver age, gender, vehicle type, crash type (rollover versus non-rollover), and injury severity. After correcting for drivers' crash exposure, results indicate that young drivers are far more crash prone than other drivers (per VMD) and that drivers of sports utility vehicles (SUVs) and pickups (PUs) are more likely to be involved in rollover crashes than those driving passenger cars. Although, the results suggest that drivers of SUVs are generally much less crash prone than drivers of passenger cars, the rollover propensity of SUVs and the severity of that crash type offset many of the incident benefits for SUV drivers.
The effect of cell phone type on drivers subjective workload during concurrent driving and conversing.
- Matthews R, Legg S and Charlton S. Accid Anal Prev 2003; 35(4): 451-457.
Correspondence: Roland Matthews, Ergonomics Research Group, Department of Human Resources, Health and Workplace Management, Massey University, Palmerston North, NEW ZEALAND; (email: r.m@ihug.co.nz).
The effect of three types of cell phones (hand held, hands free with an external speaker and personal hands free) on total subjective workload (including its constituent components; mental demand, physical demand, temporal demand, performance, effort and frustration) and intelligibility was measured using the NASA-task load index (TLX) and the modified rhyme test (MRT), respectively in 13 experienced drivers (nine male, four female, age range 28 to 65 years), whilst driving on a rural highway. The drivers rated all components of workload for each type of cell phone to be significantly higher than for a control condition in which no cell phone was used. The mean (standard deviation) total workload was lowest for the personal hands free cell phone (7.1(3.65)) and highest for the hands free speaker phone (10.8 (3.63)) (P<0.001). The mean (standard deviation) intelligibility score was highest for the personal hands free cell phone (74.1 (7.9)) and lowest for the hands free speaker phone (55.0 (10.4)) (P<0.001). Frustration was significantly correlated with total workload (0.60, P<0.001) and intelligibility was significantly correlated with frustration (-0.35, P<0.05). Physical demand was not a high contributor to total workload. It is concluded that a personal hands free cell phone would interfere least with the cognitive demands of driving.
Effect of cellular telephone conversations and other potential interference on reaction time in a braking response.
- Consiglio W, Driscoll P, Witte M and Berg WP. Accid Anal Prev 2003; 35(4): 495-500.
Correspondence: William P. Berg, Department of Physical Education, Health and Sport Studies, Miami University, 202G Phillips Hall, Oxford, OH 45056, USA; (email: bergwp@muohio.edu).
This experiment studied the effect of phone conversations and other potential interference on reaction time (RT) in a braking response. Using a laboratory station which simulated the foot activity in driving, 22 research participants were requested to release the accelerator pedal and depress the brake pedal as quickly as possible following the activation of a red brake lamp. Mean reaction time was determined for five conditions: (a) control, (b) listening to a radio, (c) conversing with a passenger, (d) conversing using a hand-held phone, and (e) conversing using a hands-free phone. Results indicated that conversation, whether conducted in-person or via a cellular phone caused RT to slow, whereas listening to music on the radio did not.
Mobile telephone use among Melbourne drivers: a preventable exposure to injury risk.
- Taylor DM, Bennett DM, Carter M, Garewal D. Med J Aust 2003; 179(3): 140-142.
Correspondence: David Taylor, Emergency Department, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, AUSTRALIA; (email: david.taylor@mh.org.au).
OBJECTIVE: To determine the rate of handheld mobile telephone use among motor vehicle drivers.
DESIGN AND SETTING: Observational study of motor vehicle drivers at three times (10: 00-11: 00; 14: 00-15: 00; 17: 00-18: 00) on three consecutive Fridays in October 2002 at 12 highway sites in metropolitan Melbourne.
MAIN OUTCOME MEASURES: Rates of mobile phone use overall and by sex and age group, highway site (major metropolitan road, central business district, freeway exit ramp) and time of day (morning, afternoon, evening).
FINDINGS: 315 of 17 023 drivers were observed using mobile phones (18.5 users/1000 drivers; 95% CI, 16.5-20.6). Men had a slightly higher rate of use (19.0; 95% CI, 16.5-21.6) than women (17.5; 95% CI, 14.1-20.9), but the difference was not significant. Older drivers (50 years or more) had a significantly lower rate (4.8; 95% CI, 2.5-7.0) than middle-aged (21.9; 95% CI, 18.8-25.1) or young drivers (23.2; 95% CI, 18.9-27.5). Central business district drivers had a slightly, but not significantly, higher rate (20.5; 95% CI, 16.8-24.3) compared with those on major metropolitan roads (16.7; 95% CI, 13.3-20.2) or freeway exit ramps (18.2; 95% CI, 14.8-21.6). The rate of mobile phone use was significantly higher in the evening (23.5; 95% CI, 19.8-27.3) compared with the morning (16.0; 95% CI, 12.6-19.4) and afternoon (15.2; 95% CI, 11.9-18.4).
DISCUSSION: Mobile phone use is common among Melbourne metropolitan drivers despite restrictive legislation. This issue needs to be further addressed by Victoria Police and public health and education agencies. Similar research is indicated to determine the extent of mobile phone use in other states.
To examine midwives' perceptions and experiences of routine enquiry for domestic violence. Focus groups and semi-structured interviews. The study was conducted in the maternity services of Guy's and St Thomas' NHS Hospital Trust, an inner London teaching hospital. Twenty-eight midwives were interviewed. One hundred and sixteen out of 145 (80%) midwives were trained to screen routinely pregnant women for domestic violence at booking, at 34 weeks of gestation and postpartum. Twenty midwives attended one of four focus groups and eight semi-structured interviews were conducted. Interviews were transcribed and analyzed using content analysis. Midwives' views of routine enquiry for domestic violence. Midwives felt that domestic violence was an important issue to be addressed. However, practical and personal difficulties were encountered during the study. These included: time constraints, lack of confidential time, safety issues, staff shortages, low staff morale and midwives' personal experiences of domestic violence. The study produced a raised awareness about domestic violence within the maternity unit. There was considerable support for the idea of a specialist domestic violence midwife. Routine enquiry for domestic violence cannot be implemented effectively without ensuring that in-depth training, resources, staff support and policies to ensure that screening can be conducted safely and confidentially are in place.
Gunshot fatalities in children and adolescents in New York City.
- Gill JR, Lenz KA, Amolat MJ. J Forensic Sci 2003; 48(4): 832-835.
New York City Office of Chief Medical Examiner, and Department of Forensic Medicine, New York University School of Medicine, New York, NY 10016, USA; (email unavailable).
We reviewed the case records of all fatalities due to gunshot wounds in children and adolescents under 19 years of age in New York City from 1996 to 2000. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 263 deaths: 242 homicides, 17 suicides, and 4 accidents. Among the homicides, 96% involved Black or Hispanic and 68% involved 17 and 18-year-old decedents. There were 11 times as many male as female homicides. The detection of ethanol and/or illicit drugs was 56% in the homicide and 53% in the suicide groups. Suicide notes were found in 18% of suicides, and an additional 35% verbally expressed a plan to commit suicide. Most suicides (77%) were in the home and half of the homicides occurred on the street.
