Correspondence: Mireille Jacobson, Department of Planning, Policy, & Design, School of Social Ecology, University of California, Irvine, CA 92697-7075, USA; (email: mireille@uci.edu).
This paper uses a set of "natural experiments," created by the passage of a U.S. Department of Transportation drug-testing mandate and 13 state testing laws, to examine the effects of testing truckers for illicit substances on highway safety. Since truckers do not bear the full costs of their driving and employers cannot contract on all aspects of their behavior, drug testing may be one means for companies to either screen or monitor employees and lower expected accident costs. Indeed, I find that testing led to a 910 percent reduction in truck accident fatalities. The social benefits of mandated testing appear to outweigh the costs of the program. However, the similarity between the effect of mandating testing and simply clarifying state law suggests that extending the right to perform drug tests may have been as effective at lower cost.
New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools.
- Ellickson PL, McCaffrey DF, Ghosh-Dastidar B, Longshore DL. Am J Public Health 2003; 93(11): 1830-1836.
Correspondence: Phyllis Ellickson, RAND, Santa Monica, CA 90407-2138, USA; (email: phyllis_ellickson@rand.org).
CONTEXT: We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities.
METHODS: Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline.
FINDINGS: The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use.
COMMENTS: School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.
CONTEXT: Alcohol-related crime is increasingly being recognized as a problem in cities and towns with popular entertainment districts. Crime and disorder linked to alcohol has been particularly connected with binge drinking or heavy sessional drinking. Research evidence indicates that it is the young adult age group who are most likely to be involved in crime and disorder and the most likely to binge drink. This paper examines the relationship between binge drinking and criminal and disorderly behavior among 18- to 24-year-olds.
METHODS: Secondary analysis was undertaken of the 1998/1999 Youth Lifestyles Survey, a large-scale, representative, household survey of 12- to 30-year-olds living in England and Wales.
FINDINGS: Binge drinking, and especially male binge drinking, among 18- to 24-year-olds is statistically related to offending behavior. In the 12 months prior to interview 39% of binge drinkers admitted to committing an offense and 60% admitted criminal and/or disorderly behavior during or after drinking alcohol. Multivariate analysis found that binge drinking remains strongly associated with criminal and disorderly behavior even after taking other relevant factors into account. Individuals who got drunk at least once a week had more than five times the odds of being involved in fighting or violent crime. For offenses or disorderly behavior that took place during or after drinking alcohol an individual had a seven times greater chance of breaking or damaging something and a five times greater chance of being involved in a fight if he/she got drunk at least once a week.
COMMENTS: These findings suggest that frequency of drunkenness is a better predictor of offending behavior than frequency of drinking per se. Using frequency of drunkenness as the basis for defining binge drinking reveals that a large minority of young adults who binge drink also become involved in offending or disorderly behavior. Binge drinking is particularly associated with crimes of violence. The relationship between binge drinking and crime and disorder is stronger among young males than females.
Child health indicators for Europe: a priority for a caring society.
- Rigby MJ, Kohler LI, Blair ME, Metchler R. Eur J Public Health 2003; 13(3 Suppl): 38-46.
Correspondence: Michael J. Rigby, CHILD Health Indicators Project/Centre for Health Planning and Management, Darwin Building, Keele University, Keele, Staffordshire, ST5 5BG, UK; (email: m.j.rigby@keele.ac.uk).
CONTEXT: Measurement of children's health is important for two reasons: first, because young people are citizens in their own right, yet largely unable to act as self-advocates, particularly at the population level; and second, because their health determines the health of the future population. Indicators based on measurements of child health are important for identifying progress, problems and priorities, changes over time, and newly emergent issues. The European Community Health Monitoring Programme (HMP) is a comprehensive program to develop and implement a set of national-level indicators. The Child Health Indicators of Life and Development (CHILD) project is the only population group-specific project, seeking to determine a holistic set of measures.
METHODS: The project endeavored to address all aspects of child health and its determinants, balancing positive and negative aspects. It undertook a structured search of published evidence to seek to identify, and validate, indicators of health and illness, health determinants and challenges to health, quality of healthcare support and health-promoting national policies. A systematic approach was used in identifying valid indicators, and in assembling a balanced composite list. All ages from infancy to adolescence were covered.
FINDINGS: The project's final report identifies 38 core desirable national indicators, citing purpose and evidence for each. Of equal importance, it also identifies 17 key child health topics on which further research work is needed in order to identify and validate indicators appropriate across different national settings. Issues of unintentional injuries, violence, and self-harm are addressed.
See item 2 under Risk Factor Prevalence, Injury Occurrence, and Costs
Correspondence: John Stoop, Delft University of Technology, Faculty of Technology, Policy and Management, Delft, THE NETHERLANDS; (email: johns@tbm.tudelft.nl).
Whenever a naval disaster occurs, a public outcry is heard to a full investigation into the causes of the event. Although the maritime industry has an outstanding reputation in accident investigation, such investigations are hardly conducted in inland shipping or leisure craft sailing. Due to a number of serious accidents in the maritime sector and increasing interest by public and media, the philosophy of independent investigations has gained interest at a policy making level in the European Union and with international NGO's, such as the International Maritime Organization IMO. The purpose of this paper is to discuss the application of this methodology in all segments of shipping. The paper elaborates a conceptual model, principle processes and available techniques as a common orientation to safety-focused investigations. Accident investigation reports of Dutch investigative agencies are benchmarked to this model assessing the potential of the approach to all segments of shipping. It shows the applicability to minor as well as major accidents and the importance of independence. Systemic deficiencies at all levels in safety of shipping are identified and a generic applicability is demonstrated. It is concluded that independent accident investigation provides a powerful diagnostic tool for reducing the peril of drowning.
Cougar attacks on humans are increasing. Presented is a case report of a nonfatal 2-year-old male cougar attack on an 8-year-old girl in British Columbia. Discussions of wound management, rabies post-exposure prophylaxis (RPEP), and the possible psychologic ramifications of such an attack are presented. Also reviewed are recommendations on actions that may be helpful in preventing an attack following a sudden encounter with a cougar. Humans must learn to coexist with cougars, which present a small but real threat to people.
Wilderness injury, illness, and evacuation: National Outdoor Leadership School's incident profiles, 1999-2002.
OBJECTIVES: This paper describes field injury, illness, near miss, and evacuation profiles of the National Outdoor Leadership School (NOLS).
METHODS: The NOLS incident database is used to record injuries, illnesses, near-miss incidents (close calls), evacuations, and nonmedical incidents. The database has been used continually since 1984.
FINDINGS: During the period September 1, 1998, through August 31, 2002, there were 630,937 program days on which 1940 incidents were reported involving 1679 students and 233 staff. Athletic injuries account for 50% of all injuries, and soft-tissue injuries account for 30%. Athletic injuries are most often sprains and strains of knees (35%), ankles (30%), and backs (13%). Falls and slips around camp or while hiking are the leading contributing factors. The most common illnesses are gastrointestinal symptoms such as nausea, vomiting, and diarrhea (26.4%) and all flu-like illness, including flu symptoms and respiratory symptoms (16.6%). Rock fall was the leading near-miss incident. Two hundred fifty-seven (53%) medical evacuees received treatment and were able to rejoin and finish their course. There was one fatality from 1999 to 2002. The fatality rate for this period is 0.002 per 1000 program days.
COMMENTS: The number of injuries and, specifically, the number of athletic injuries have declined. The number and rate of near-miss incidents increased as a result of better reporting; the rate of nonmedical incidents held steady. Motivation continues to be our leading category of nonmedical incident. Efforts at collecting incident data provide a useful measurement from which we can gauge our risk-management performance.
Counter-terrorism planning using the Hazardous Substances Events Surveillance system.
Correspondence: Deana M. Manassaram, Division of Health Studies/Epidemiology and Surveillance Branch, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia 30333, USA; (email: dmanassaram@cdc.gov).
The Hazardous Substances Emergency Events Surveillance (HSEES) system was developed in 1990 and is maintained by the Agency for Toxic Substances and Disease Registry, a public health agency within the United States Department of Health and Human Services. HSEES data can be used for hazard vulnerability assessments. Baseline patterns of hazardous substance releases can be used by local emergency planning committees to (1) identify substances that cause serious injuries, (2) improve monitoring and control of access, and (3) assess the preparedness of responding agencies. HSEES is an active surveillance system that can be useful in the early detection of unusual occurrences involving hazardous substances.
The study sample consisted of 3,869 drivers, split approximately 50/50 between observed cell phone users and those observed not using cell phones (labeled "nonusers"). Cell phone use was determined by a snapshot observation made on city streets. The sample represented 54% of those originally observed, for whom a match was obtained for both vehicle license plate and for gender and estimated age group of the observed driver and that of the driver named in the vehicle policy. Data were obtained from records of insurance claims, police-reported collisions and violations, following a strict protocol to protect individual privacy. The dependent measures were at-fault crash claims and "inattention" violations. A logistic regression model controlled for age, gender, exposure (represented by not-at-fault crash claims), alcohol-related offenses, and aggressive driving offenses. The study also involved a comparison of the contributing factors and collision configurations of police-reported collisions involving the users and "nonusers" in the sample. Drivers observed using cell phones had a higher risk of an at-fault crash than did the "nonusers," although the difference was not significant for males. There was no apparent effect on "inattention" violations. The cell phone users also had a higher proportion of rear-end collisions. The violation pattern of cell phone users suggests that they are, in general, riskier drivers. These differences likely reflect lifestyle, attitude and personality factors. It is essential to control for these factors in assessing the direct risk attributable to cellular telephone use.
A randomized and controlled trial of a participative ergonomics intervention to reduce injuries associated with manual tasks: physical risk and legislative compliance.
A participative ergonomics approach to reducing injuries associated with manual tasks is widely promoted; however only limited evidence from uncontrolled trials has been available to support the efficacy of such an approach. This paper reports on a randomized and controlled trial of PErforM, a participative ergonomics intervention designed to reduce the risks of injury associated with manual tasks. One hundred and seventeen small to medium sized food, construction, and health workplaces were audited by government inspectors using a manual tasks risk assessment tool (ManTRA). Forty-eight volunteer workplaces were then randomly assigned to Experimental and Control groups with the Experimental group receiving the PErforM program. Inspectors audited the workplaces again, 9 months following the intervention. The results showed a significant decrease in estimates of manual task risk and suggested better legal compliance in the Experimental group.
The natural fire safety concept -- full-scale tests at Cardington.
- Lennon T, Moore D. Fire Safety J 2003; (38)7: 623-643.
Correspondence: Tom Lennon, Centre for Steel Construction, Building Research Establishment, Bucknalls Lane, Garston, Watford WS2 7JR, UK; (email: lennon@bre.co.uk).
As part of a European collaborative program of research, the UK's Building Research Establishment has carried out a series of eight full-scale fire tests in a purpose-built compartment at Cardington in the United Kingdom. The work is in support of the development of the ECSC program "Natural Fire Safety Concept, Full Scale Tests, Implementation in the Eurocodes, and Development of a Userfriendly Design Tool." This test program is distinct from the collaborative fire test program carried out on the steel-framed building at Cardington to study the structural response of a building to fire. The tests have been undertaken in a compartment with overall dimensions of 12 m × 12 m. The parameters considered in the tests have been defined from a consideration of the limitations of the current parametric approach adopted in Annex B of the ENV version of Eurocode 1.2 and from the requirement to validate the program OZONE developed in the scope of a complementary research project. The tests have investigated the influence of compartment linings, fire load type and through draft condition on the severity of fully developed, post-flashover fires. Fire development in the pre-flashover phase and smoke movement are not considered in this program although complementary tests carried out by the other partners to the research have investigated these aspects of fire behavior. The objectives of the research are to gather high-quality data on the behavior of post-flashover fires in realistic compartments and to use this information to validate the natural fire safety concept. This paper considers the predictive methods for determining the parametric temperature-time response in the Eurocode in the light of comparisons with the test results.
Prevention of drowning in home pools--lessons from Australia.
As an affluent and warm weather country, Australia faced an epidemic of drowning in children under five as the popularity of home pools increased in the late 1960s and early 1970s. In one state child drowning rose by 6.62 per 100,000 in the five years from 1968. Variation across jurisdictions in actions to regulate domestic pools has resulted in Australia representing an unfortunate natural experiment in interventions to prevent child drowning in pools. Mechanisms adopted by various authorities were analyzed in detail to identify factors that contributed to success and failure in regulating domestic pools. Despite early identification of the problem and development of what were later demonstrated to be effective interventions, best practice solutions were not established in any jurisdiction until 2002, 25 years after identification of the problem. Key failures in intervention were found to be: failure to act in a timely way, flawed regulation, blockage of timely action and repeal of effective state regulation under political pressure, and blockage of effective standards. Lessons are identified as: inherent weaknesses in the standard setting process, failure of interventions to address major risk categories, failure to act before the hazard grew, failure to consider lesser interventions for tactical reasons, failure to pay attention to advocates, and the need for continuing effort. The paper argues that analysis of the identification of the problem, development of interventions and implementation of mechanisms of prevention illustrate where systemic changes are required and indicate lessons that should be applied in developing and implementing future interventions.
See item 5 under Risk Factor Prevalence, Injury Occurrence & Costs
Correspondence: Carlos Augusto Vaz De Souza, Coordena o Geral de Vigil ncia Ambiental em Sa de, Centro Nacional de Epidemiologia, Funda o Nacional de Sa de, Minist rio da Sa de, Bras lia, DF, 70058-902, BRAZIL; (email: Carlos.augusto@funasa.gov.br).
Accidents in the chemical industry can have serious consequences for workers, communities, and the environment and are thus highly relevant to public health. This article is the result of an occupational surveillance project involving several public institutions. We analyze 800 work-related accidents that resulted in injuries, environmental damage, or loss of production in 1997 in an oil refinery located in Rio de Janeiro, Brazil. The methodology was based on managerial and organizational approaches to accident investigation, with the European Union reporting system as the reference. The results highlight various limitations in the process of reporting and investigating accidents, as well as a certain hierarchy of accidents, with more attention given to accidents involving loss of production and less to those resulting in injuries, particularly among outsourced workers.
Occupational health and safety legislation and implementation in China.
Correspondence: Zhisumoh Su, Department of Health Legislation and Inspection, Ministry of Health, Beijing, PEOPLE'S REPUBLIC OF CHINA; (email: zhisumoh@sina.com).
This article reviews the current statistics of employment and work-related injuries and illness in China, as well as the history of occupational health and safety legislation in the country. Comprehensive, newly promulgated workplace health and safety legislation is described, and the specific responsibilities of employers, government agencies, trade unions, and employees are detailed. The government's implementation plan for this and prior legislation is also outlined.
See item 4 under Risk Factor Prevalence, Injury Occurrence, and Costs
Correspondence: Robert J. Schneider, Department of City and Regional Planning, University of North Carolina at Chapel Hill, CB 3140 New East Bldg., 27599-3140, Chapel Hill, NC, USA; (email: rschneider@tooledesign.com).
There are about 75,000 pedestrian crashes in the United States each year. Approximately 5000 of these crashes are fatal, accounting for 12% of all roadway deaths. On college campuses, pedestrian exposure and crash-risk can be quite high. Therefore, we analyzed pedestrian crashes on the campus of the University of North Carolina at Chapel Hill (UNC) as a test case for our spatially-oriented prototype tool that combines perceived-risk (survey) data with police-reported crash data to obtain a more complete picture of pedestrian crash-risk. We use spatial analysis techniques combined with regression models to understand factors associated with risk. The spatial analysis is based on comparing two distributions, i.e. the locations of perceived-risk with police-reported crash locations. The differences between the two distributions are statistically significant, implying that certain locations on campus are perceived as dangerous, though pedestrian crashes have not yet occurred there, and there are actual locations of police-reported crashes that are not perceived to be dangerous by pedestrians or drivers. Furthermore, we estimate negative binomial regression models to combine pedestrian and automobile exposure with roadway characteristics and spatial/land use information. The models show that high exposure, incomplete sidewalks and high crosswalk density are associated with greater observed and perceived pedestrian crash-risk. Additionally, we found that people perceive a lower risk near university libraries, stadiums, and academic buildings, despite the occurrence of crashes.
- Elejalde JI, Louis CJ, Elcuaz R, Pinillos MA. Eur J Emerg Med 2003; 10(3): 252-253.
Correspondence: Jose I. Elejalde, Department of Emergency Medicine, Hospital of Navarra, Calle del lago 9 3° A, 31016 Pamplona, SPAIN; (email: jielejalde@yahoo.es).
Given the difficulty of obtaining traditionally illicit drugs, consumption is turning towards less restricted products. We report the case of an 18-year-old man, who after inhaling xylazine (a non-narcotic sedative used in veterinary medicine for analgesia, hypnosis and muscle relaxation) presented with an episode of chills and dizziness followed by sweating, gait instability, palpitations and two episodes of syncope with bradycardia and hypotension. Ten cases of toxicity caused by xylazine consumption by oral and parenteral administration (intramuscular, subcutaneous, and intravenous) have been documented in humans. In these cases, consumption was either involuntary or for suicidal or homicidal purposes, or used as an agent of drug abuse, occasionally resulting in death. We present the second documented case of toxic effects of drug abuse with inhaled xylazine.
Black widow spider and brown recluse spider bites in Texas from 1998 through 2002.
- Forrester MB, Stanley SK. Vet Hum Toxicol 2003; 45(5): 270-273.
Correspondence: Mathias B. Forrester, Texas Department of Health, 11 W 49th Street, Austin, Texas 78756, USA; (email: Mathias.Forrester@tdh.state.tx.us).
Black widow spiders and brown recluse spiders are of medical importance to humans in the US. However, these spiders differ in their habits, habitat, and the clinical effects and treatment of their bite. This study used data from human exposure calls to poison centers in Texas to compare the epidemiology of bites from these 2 spiders. During 1998-2002, 760 black widow spider bites and 1,369 brown recluse spider bites were reported. Black widow spider bite penetrance demonstrated no secular trend during this time period while the penetrance of brown recluse spider bites increased. A higher percentage of black widow spider bites occurred among males, while a higher proportion of brown recluse spider bites were reported for females. Black widow spider bites most frequently had mild outcomes while brown recluse spider bites most often had moderate outcomes. The majority of reported bites for both types of spider occurred at the patient's own residence, although the percentage was lower for black widow spiders. Seasonal trends were noted for both black widow and brown recluse spiders. The highest penetrance of black widow spider bites was observed in western Texas while the highest penetrance of brown recluse spider bites was observed in central Texas. This information is useful for identifying those populations at greatest risk for the respective spider bites.
The epidemiology of pepper spray exposures reported in Texas in 1998-2002.
- Forrester MB, Stanley SK. Vet Hum Toxicol 2003; 45(6): 327-330.
Correspondence: Mathias B. Forrester, Texas Department of Health, 11 W 49th Street, Austin, Texas 78756, USA; (email: Mathias.Forrester@tdh.state.tx.us).
Pepper spray is used as an incapacitant agent. Although now available for general use in the US, the health consequences of pepper spray exposures are poorly understood. This study used data from human exposure calls to poison centers in Texas to investigate the epidemiology of pepper spray exposures. During 1998-2002 there were 1,531 human exposures to pepper spray identified by the Texas poison centers. Pepper spray reports declined during the 5-y period of the study. The majority of exposures were unintentional (84%), occurred at home (68%), involved males (56%), and comprised children and adolescents (64%). Risk factors for pepper spray exposure varied by patient age. Although 85% of the pepper spray exposures were managed outside of health care facilities, 97% of exposures involved at least minimal notable clinical effects. Given the level of detectable clinical effects of this intervention and the widespread availability of these agents, there is a need for better education of the public regarding the proper use of pepper spray and the effects of its use.
OBJECTIVES: To evaluate injury patterns of snowbladers and compare them with those of skiers and snowboarders. To determine possible effects of helmet use in these sports on injury to the head and neck.
METHODS: This prospective case series observational study was conducted by collecting the injury reports from the ski patrol during the 1999-2000 season at Mont Tremblant ski resort, Quebec. All participants in downhill winter sports who presented themselves to the ski patrol with traumatic injury related to their sport were included. A concussion was defined as any loss of consciousness, amnesia, confusion, disorientation, vertigo, or headache that resulted from injury. The ski patroller reported helmet use on the accident report at the time of injury.
FINDINGS: Snowbladers present with a unique pattern of injury compared with skiers and snowboarders. The incidence of leg, knee, and ankle/foot injuries were 20.5%, 25.6%, and 10.3% respectively. Concussions represented 11% of all injuries. There was no increase in other injury, including neck injury, related to helmet use.
COMMENTS: Unique injury patterns in snowbladers warrant reconsideration of equipment design. Concussion is a common injury on the ski slope. Although the effects of helmet use on concussion rate are inconclusive based on this study, helmet use did not increase the rate of neck injury, even when adjusted for age.
How valid is a self reported 12 month sports injury history?
- Gabbe BJ, Finch CF, Bennell KL, Wajswelner H. Br J Sports Med 2003; 37(6): 545-547.
Correspondence: Belinda Gabbe, Department of Epidemiology and Preventive Medicine, Central and Eastern Clinical School, Alfred Hospital, Monash University, Commercial Road, Melbourne, Victoria, AUSTRALIA; (email: belinda.gabbe@med.monash.edu.au).
CONTEXT: A past injury history is one of the most commonly cited risk factors for sports injury. Often, injury history data are collected by self report surveys, with the potential for recall bias. OBJECTIVE: To assess the accuracy of a 12 month injury history recall in a population of 70 community level Australian football players.
METHODS: The retrospective, self reported injury histories of 70 community level Australian football players were compared with prospective injury surveillance records for the same 12 month period. The accuracy of the players' recall of the number of injuries, injured body regions, and injury diagnosis was assessed.
FINDINGS: Recall accuracy declined as the level of detail requested increased. All players could recall whether or not they were injured during the previous year. Almost 80% were able to accurately recall the number of injuries and body regions injured, but not the diagnoses, whereas only 61% were able to record the exact number, body region, and diagnosis of each injury sustained.
COMMENTS: The findings of this study highlight the difficulty of using retrospectively collected injury data for research purposes. Any injury research relying on self reported injury history data to establish the relation between injury history and injury risk should consider the validity of the self report injury histories.
Swimming lessons, swimming ability, and the risk of drowning.
Correspondence: Ruth A. Brenner, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892, USA; (email: BrennerR@NIH.GOV).
Drowning is a leading cause of injury related death in many countries. Strategies to prevent these deaths depend upon characteristics of the victim and the specific circumstances surrounding the event. One preventive strategy that may be beneficial for persons of all ages and under nearly all circumstances is increased swimming ability, through some form of swimming instruction. However, a clear protective relationship between increased swimming ability and the risk of drowning has never been demonstrated. Studies focused on children, suggest that swimming ability may confer some protection, although the data are far from conclusive. This paper (1) reviews the current evidence regarding the relationship between swimming ability, swimming lessons and the risk of drowning, (2) reviews the past and present recommendations for swimming instruction and (3) outlines future research needs.
A qualitative assessment methodology for road safety policy strategies.
- Wong SC, Leung BS, Loo BP, Hung WT, Lo HK. Accid Anal Prev 2004; 36(2): 281-293.
Correspondence: Wong Sze Chun, Department of Civil Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong, PR CHINA; (email: hhecwsc@hkucc.hku.hk).
This paper proposes a qualitative assessment methodology that is comprised of a cluster analysis and an autoregression analysis that assess the effects of various road safety strategies implemented in Hong Kong over the last 10 years. The cluster analysis is first used to group over a hundred road safety projects and programs into a smaller set of meaningful road safety policy strategy clusters. These strategies, together with the trend factor, seasonal pattern, car crashworthiness and meteorological data are then used in the autoregression analysis to relate to the fatality and casualty rates of drivers, passengers, motorcyclists, and pedestrians. This method allows the evaluation of the overall effects of the road safety strategies, and the effects and relative significance of each individual strategy. The evaluation method is described, and the main findings of the study are discussed.
Community characteristics and demographic information as determinants for a hospital-based injury prevention outreach program.
- Chang D, Cornwell EE 3rd, Phillips J, Baker D, Yonas M, Campbell K. Arch Surg 2003; 138(12): 1344-1346.
Correspondence: David Chang, School of Public Health and The Johns Hopkins Medical Institution, Baltimore, MD, USA; (email: unavailable).
CONTEXT: To focus the efforts of a hospital-based injury prevention outreach program, information on patient demographics, community characteristics, and catchment area must be known.
DESIGN AND SETTING: Evaluation of prospectively collected data maintained in the Trauma Registry of a level I university-based trauma center.
MAIN OUTCOME MEASURES: Demographics, mechanism of injury, mortality, and home ZIP codes of patients admitted to the Adult Trauma Service, The Johns Hopkins Medical Institution, Baltimore, Maryland, were compared for 2 separate calendar years, at 2 years before (1995) and at 2 years after (2000) the implementation of a dedicated trauma program that includes an injury prevention outreach program.
FINDINGS: The list of common patient ZIP codes varied minimally from 1995 to 2000. The 18 most common ZIP codes represent (1) 80% of patients, (2) total area of 99 square miles (257.4 km2) (5.7-mile [9.1-km] radius), and (3) a region with a mean household income that is 67% of the statewide median. An increasingly disproportionate percentage of patients with gunshot wounds (GSWs) were the youngest patients (ages 15-24 years) treated by the Adult Trauma Service. While overall survival of trauma patients improved in 2000, no improvement was seen among patients with GSWs. Over half of the nonsurviving patients (37/65 [57%]) seen in 2000 and more than two thirds of patients with lethal GSWs (25/37 [67.6%]) were declared dead in the emergency department, suggesting nonpreventability from a clinical care standpoint.
COMMENTS: The catchment area represented by the bulk of patients admitted to a level I urban trauma center is compact and economically disadvantaged. While overall trauma mortality has decreased, GSWs are more lethal and prevalent in teenagers and young men. This identifies violence prevention as an area of emphasis.
See also item 1 under Disasters & Environmental Exposures
CONTEXT: Relatively little is known about patterns of injury at the community level in Vietnam and their economic consequences. This study sought to estimate the costs of various unintentional injuries in Bavi District during one year; to describe how costs depended on gender, age, circumstances, and severity of injury; and to describe how the economic burden of unintentional injuries was distributed between households, government, and health insurance agency.
METHODS: A cohort study was undertaken, which involved four cross-sectional household surveys among sampled communities in the Bavi District during the year 2000, each asking about injuries in the preceding three months. The costing system in public healthcare in Vietnam was applied as well as information from the victims.
FINDINGS: The total cost of injuries over one year in Bavi District was estimated to be D3,412,539,000 (Vietnamese dong) (US$235,347), equivalent to the annual income of 1,800 people. In total, 90% of this economic burden fell on households, only 8% on government, and 2% on the health insurance agency. The cost of a severe injury to the corresponded to approximately seven months of earned income. Home and traffic injuries together accounted for more than 80% of the total cost, 45% and 38% respectively. The highest unit cost was related to traffic injuries, followed by home, "other", work-related, and school injuries in descending order.
COMMENTS: The results can be considered as an economic baseline that can be used in evaluations of future interventions aimed at preventing injuries.
Violent causes of death in young people of 10 to 24 years old. Argentina 1991 - 2000.
- Serfaty EM, Foglia L, Masautis A, Negri G. Vertex 2003; XIV(Suppl 2): 40-48.
Correspondence: Edith M. Serfaty, Academia Nacional de Medicina de Buenos Aires, ARGENTINA; (email: serfaty@epidemiologos.org).
OBJECTIVE: To study the most frequent death causes between young people during 1991 to 2000. We worked at the Epidemiological Research Center of the Buenos Aires Academy of Medicine, with all the country's death dates certified by the Ministry of Health. Argentine young population (10 to 24 years old) was of about 10,000,000 people, after the increase of 15% during the studied period.
METHODS: The population studied were all violent causes of death of people between 10 to 24 years old, of Argentina, since 1991 to 2000. The violent causes of death studied were: Accident (other than traffic), traffic accidents, suicide, homicide, between 10-14 year old, 15-19 year old and 20-24 year old, male and female youngsters. Mortality rates were calculated on yearly basis per province and per country.
FINDINGS: Of 100% of death causes among 10-24 years old adolescents: 15% were accidents (non traffic), 14,6 traffic accidents, 10,1% homicides and 9,1% were suicides. Mortality rates were higher for males, in all ages and during all the period. We observed an increase in external causes of death during 1991 to 2000. Mortality rates of homicide and suicide increased for males between 1991 and 2000.
COMMENTS: Adolescents (15-19 year old) and male gender are risk factors for external causes of death (accidents, aggression and suicide). The results of this study showed that mortality by violent causes should be a priority problem for the Public Health and for all the community.
Frequency of burn-trauma patients in an urban setting.
- Varghese TK, Kim AW, Kowal-Vern A, Latenser BA. Arch Surg 2003; 138(12): 1292-1296.
Correspondence: Thomas K. Varghese, Department of Surgery, Northwestern University Medical Center, USA; (email: t-varghese@md.northwestern.edu).
CONTEXT: Burn-trauma patient encounters constitute 5% of the emergency department population.
HYPOTHESIS: A large urban hospital will treat twice as many (ie, 10%) burn-trauma patients. DESIGN: Retrospective 44-month study.
SETTING: Metropolitan county hospital.
PATIENTS: Population-based sample of burn-only (n = 1102), burn-trauma (n = 120), and assault burn-trauma (n = 43) patients.
MAIN OUTCOME MEASURES: Frequency and demographics.
FINDINGS: Just under 10% (n = 120) of the burn population had burn-trauma injuries. The mean +/- SD Injury Severity Score was 12 +/- 12 in these burn-trauma patients: 4 +/- 2 in outpatients and 14 +/- 13 in inpatients. The burn-only and burn-trauma groups had similar age ranges, ethnic distribution, frequency of inhalation injury, substance abuse, malnutrition, sepsis, pneumonia, diabetes mellitus, percentage total burn surface area, number of procedures, grafted areas, and mortality. Forty-three burn-trauma patients (35.8%) sustained injuries due to assault, compared with 123 (11.2%) in the burn-only group (P<.001). Burn-trauma patients who were assaulted had a mean +/- SD Injury Severity Score of 11 +/- 10. There was a significantly increased male-female ratio among the assault burn-trauma patients (6:1) compared with the burn-trauma (3:1) and burn-only (2.3:1) groups (P<.04). Most of these injuries were caused by an unknown assailant, in connection with an automobile, a motorcycle, a bicycle, or pedestrians intentionally struck by moving vehicles, or by child abuse. The main mechanism of injury was contact in 57 burn-trauma patients (47.5%), compared with 127 (11.5%) in the burn-only group (P<.001).
COMMENTS: A large urban population will have an increased frequency (2-fold in our center) of burn-trauma injuries. Assault and child abuse are significant contributory factors to burn-trauma injuries in this population.
The value of life: estimates with risks by occupation and industry.
The worker fatality risk variable constructed for this article uses BLS data on total worker deaths by both occupation and industry over the 1992-97 period rather than death risks by occupation or industry alone, as in past studies. The subsequent estimates using 1997 CPS data indicate a value of life of $4.7 million for the full sample, $7.0 million for blue-collar males, and $8.5 million for blue-collar females. Unlike previous estimates, these values account for the influence of clustering of the job risk variable and compensating differentials for both workers' compensation and nonfatal job risks.
Fatal falls from heights in and around Diyarbakir, Turkey.
- Goren S, Subasi M, Tyrasci Y, Gurkan F. Forensic Sci Int 2003; 137(1): 37-40.
Correspondence: Suleyman Goren, Department of Forensic Medicine, Faculty of Medicine, Dicle University, Diyarbakir, TURKEY; (email: sgoren@dicle.edu.tr).
Falls from high places, such as from a building, are frequently encountered in suicides, in some accidents, and sometimes in homicides. In this study, we evaluated the demographic data, mortality rates, fall causes, and post-mortem findings of individuals who fell from heights. Our cases were collected retrospectively from the files of the Branch of the Council of Forensic Medicine in Diyarbakir between 1996 and 2001. There were 431 accidental and 53 suicidal deaths due to blunt injury resulting from falls. Of the victims, 188 were female and 296 were male. The average age of the 484 victims was 27.05 years (range: 4 months-100 years). For buildings, the height ranged from 3 to 8 stories for suicides and from 1 to 8 stories for accidents. We proceeded to analyse the characteristics of accidental falls as follows. The majority of falls were from balconies or rooftops due to the tendency of people to sit and sleep on these places during the hotter months of the year. Some 54.5% of all falls occurred in May-August. The 53 suicidal jumps all occurred off buildings. The victims ranged in age from 15 to 70 years, and comprised 29 women and 24 men. One of the deceased jumped from the roof of a school in which he was boarding, and another from the seventh story of a hospital in which he was receiving treatment. The remaining 51 jumped from heights ranging from 3 to 8 stories. Psychiatric illness was reported in 18 (33.9%) of the suicide deaths, while 10 (18.8%) of the 53 suicides were single women. The results of this study were at variance with literature data with respect to the following: falls from heights were most common in the 0-5 year age group, females had a higher suicide rate than males, and the majority of accidental falls occurred at home rather than in the workplace.
Correspondence: Andrej Michalsen, Division of Peri-operative Care and Emergency Medicine, Utrecht University Medical Centre, Utrecht, THE NETHERLANDS; (email: A.Michalsen@azu.nl).
Injury prevention efforts often focus on reducing the risk of potentially dangerous activities, facilities or equipment, such as diving, swimming pools or flotation devices. This paper aims to clarify the concepts of risk assessment and risk perception. Statistically, risk denotes the probability of an untoward event, often expressed in terms of potential financial loss. Subjectively, though, risk denotes an individual's perception of the likelihood and the seriousness of an undesirable event. Individual perception appears to be strongly influenced by personal traits and socio-cultural parameters. Risk assessment helps to form the basis for public health interventions. The implementation and effectiveness of these are influenced by individual risk perception. Therefore, preventive efforts need to incorporate and hopefully influence the determinants of risk perception among the target populations. Considering drowning, both hazard and incidence of submersion injuries are underestimated, whereas treatment options are usually overestimated. Consequently, individual risk alertness needs to be improved--drowning remains a ubiquitous risk.
Correspondence: Khaled A. Abbas, Department of Urban and Regional Planning, College of Architecture and Planning, King Faisal University, P.O. Box 2397, 31451, Dammam, SAUDI ARABIA; (email: kaabbas13@yahoo.com).
This paper starts by presenting a conceptualization of indicators, criteria and accidents' causes that can be used to describe traffic safety. The paper provides an assessment of traffic safety conditions for rural roads in Egypt. This is done through a three-step procedure. First, deaths per million vehicle kilometers are obtained and compared for Egypt, three other Arab countries and six of the G-7 countries. Egypt stands as having a significantly high rate of deaths per 100 million vehicle kilometers. This is followed by compiling available traffic and accident data for five main rural roads in Egypt over a 10-year period (1990-1999). These are used to compute and compare 13 traffic safety indicators for these roads. The third step for assessing traffic safety for rural roads in Egypt is concerned with presenting a detailed analysis of accident causes. The paper moves on to develop a number of statistical models that can be used in the prediction of the expected number of accidents, injuries, fatalities and casualties on the rural roads in Egypt. Time series data of traffic and accidents, over a 10 years period for the considered roads, is utilized in the calibration of these predictive models. Several functional forms are explored and tested in the calibration process. Before proceeding to the development of these models three ANOVA statistical tests are conducted to establish whether there are any significant differences in the data used for models' calibration as a result of differences among the considered five roads.
Correspondence: Bruce Hall, University of South Florida - Lakeland, College of Education, 3433 Winter Lake Road, Lakeland, FL 33803, USA; (email: bhall@tempest.coedu.usf.edu).
This study looks at existing aspects of written school violence policies (Codes of Student Conduct) across large, mid-size, and small school districts in Florida. The aim was to provide a clearer picture of how weapons are defined, and the consequences of their possession, use, or display. Two research areas were addressed: 1. What constitutes a weapon in Florida's public school districts? 2. What consequences of weapons violations are dictated by Florida school districts' Codes of Student Conduct? The school districts' written Codes of Student Conduct were examined to discover patterns among the districts in their definition of a weapon, and the consequences of weapons violations. Using the Composite Weapons Classification Matrix, actual samples defined by Florida schools were identified and categorized by the researchers. These categories included blunt objects, chemical weapons, destructive devices, electrical weapons, firearms and projectiles, knives and sharp instruments, martial arts weapons, and other objects. Most of the districts classify infractions in terms of their seriousness, using a three, four, or five categorical system, with the gravest offenses reserved for the highest (most severe) category. In every district, weapons violations (possession, use or sale of firearms, explosive devices or other weapons) were listed within the highest (most severe) infraction category. The most common consequences were out of school suspension, expulsion, confiscation of the weapon, and referral to law enforcement authorities.
Bullying and Evolutionary Psychology: The Dominance Hierarchy Among Students and Implications for School Personnel.
Correspondence: Jered B. Kolbert, Slippery Rock University, Department of Counseling and Educational Psychology, 008A McKay Education Building, 1 Morrow Way, Slippery Rock, PA,16057, USA; (email: jered.kolbert@sru.edu).
The phenomenon of childhood bullying is conceptualized from an evolutionary psychological perspective. In this manuscript, the research literature is examined regarding the role of the relationship between aggression, testosterone, and social status in the development and maintenance of dominance hierarchies, which involves a reciprocal relationship between physical, social, and psychological variables. The evolutionary advantage of the dominance hierarchy is explored, and it is contrasted with eminence, an alternative form of establishing social status. Childhood bullying is suggested to be one of the central mechanisms in the establishment of dominance hierarchies in school systems. Implications for prevention of and intervention in bullying for school personnel are discussed.
Correspondence: James D. Unnever, Department of Sociology and Anthropology, Radford University, Box 6948, Young Hall 210, Radford, VA 24142, USA; (email: junnever@runet.edu).
The purpose of this study was to assess the nature and extent of student attitudes toward bullying. We investigated the consistency and prevalence of student attitudes across gender, race, socioeconomic status, and grade level. We also assessed whether students with positive attitudes toward peer aggression and students with higher trait anger were especially prone to support a normative structure that encourages bullying. Based on a data set including 6 middle schools and over 2,400 students, our results indicate that a culture of bullying is a pervasive phenomenon among middle school students and should be an important consideration in bullying prevention efforts.
- Ruppertsberg AI, Wuerger SM, Bertamini M. Vis Neurosci 2003; 20(4): 421-428.
Correspondence: Alexa I. Ruppertsberg, Eleanor Rathbone Building, Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK; (email: air@liv.ac.uk).
For over 30 years there has been a controversy over whether color-defined motion can be perceived by the human visual system. Some results suggest that there is no chromatic motion mechanism at all, whereas others do find evidence for a purely chromatic motion mechanism. Here we examine the chromatic input to global motion processing for a range of color directions in the photopic luminance range. We measure contrast thresholds for global motion identification and simple detection using sparse random-dot kinematograms. The results show a discrepancy between the two chromatic axes: whereas it is possible for observers to perform the global motion task for stimuli modulated along the red-green axis, we could not assess the contrast threshold required for stimuli modulated along the yellowish-violet axis. The contrast required for detection for both axes, however, are well below the contrasts required for global motion identification. We conclude that there is a significant red-green input to global motion processing providing further evidence for the involvement of the parvocellular pathway. The lack of S-cone input to global motion processing suggests that the koniocellular pathway mediates the detection but not the processing of complex motion for our parameter range.
No effects of acute exposure to the electromagnetic field emitted by mobile phones on brainstem auditory potentials in young volunteers.
- Bak M, Sliwinska-Kowalska M, Zmyslony M, Dudarewicz A. Int J Occup Med Environ Health 2003; 16(3): 201-208.
Correspondence: Mariola Sliwinska-Kowalska, Department of Physical Hazards, Nofer Institute of Occupational Medicine, Lodz, POLAND; (email: marsliw@imp.lodz.pl).
OBJECTIVES: A widespread use of mobile phones evokes a growing concern for their possible adverse effects on the human central nervous system. This study was aimed at evaluating the effects of EMF generated by mobile phones, at all standard wavelengths: 450, 935 and 1800 MHz used in Poland, on the auditory brainstem-evoked responses (ABR) during and after the exposure.
MATERIALS AND METHODS: The effects of acute exposure to electromagnetic fields (EMF) on ABR were evaluated in 45 young, healthy volunteers of both genders. The electromagnetic impulses were generated with the antenna of mobile phone. The exposure was induced by repeated phone activation for 20 min. The ABR evaluation was performed before, during and immediately after the exposure, and the latencies of waves I, III and V, and inter-waves I-V were analyzed.
FINDINGS: Prior test calibration on a phantom did not show the influence of the external EMF generated by the mobile phone on the ABR equipment. For neither EMF frequency, differences were observed in wave and inter-wave latencies during and after exposure to EMF compared to the initial ABR pattern, in both men and woman.
COMMENTS: This implies that commonly used mobile phones do not affect propagation of electrical stimuli along the auditory nerve to auditory brainstem centers.
Suicidal cognition is defined here as the combination of thinking about committing suicide and engaging in self-harm and is considered to indicate maladjustment following an extreme internalized reaction to negative life events. Victimization at home and at school might lead some youth to suicidal cognition. The present study aimed to examine cross-sectional predictors of suicidal cognition focusing on the unique influence of 'direct victimization' at school by peers and at home by parents, over and above that of vicarious victimization (i.e. exposure to domestic violence). Participants were 998 adolescents randomly recruited from high schools in Italy who had to fill in a cross-sectional survey measuring different dimensions associated with suicidal cognition. Thoughts about committing suicide and self-harming in the previous 6 months were reported by almost a fourth of the whole sample, with girls having these thoughts more frequently than boys. A high prevalence rate was reported also for direct victimization at school (over half of the sample), and at home (a third of the sample) and for vicarious victimization at home (reported by a fifth of the entire sample).Multiple hierarchical regressions showed that a significant proportion of the total variance of suicidal cognition was explained by gender and age, meaning that older girls are more at risk of suicidal cognition than boys; relational victimization at school is also a risk factor. Direct victimization at home by the father for boys and by the father and the mother for girls significantly predicted suicidal cognition after controlling for exposure to domestic violence.
Correlates of motives for suicide.
- Lester D, Wood P, Williams C, Haines J. Psychol Rep 2003; 93(2): 378.
Correspondence: David Lester, Psychology Program, The Richard Stockton College of New Jersey, Pomona 08240-0195, USA; (email: David.Lester@Stockton.edu).
Analysis of a large sample of suicide notes from 262 suicides in Australia showed separated/divorced suicides and suicides who abused alcohol were more likely to give love/romance as a precipitant for suicide while those who used gas (natural or car exhaust) were more likely to give depression and guilt as a motive.
Suicide in Hong Kong: epidemiological profile and burden analysis, 1981 to 2001.
- Yip PS, Law CK, Law YW. Hong Kong Med J 2003; 9(6): 419-426.
Correspondence: Paul S F Yip, The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, HONG KONG; (email: sfpyip@hku.hk).
OBJECTIVES: To describe changes of the epidemiological profile of suicides in Hong Kong, and the burden of suicides in terms of years of life lost between 1981 and 2001.
DESIGN. Retrospective study.
SETTING: Hong Kong.
PARTICIPANTS: Data on registered deaths of the Hong Kong population from 1981 to 2001 were retrieved from records of the Census and Statistics Department of the Government of the Hong Kong Special Administrative Region.
MAIN OUTCOME MEASURES: Crude, standardized, age- and sex-standardized suicide rates; years of life lost; suicide method used; and rank among leading causes of death.
FINDINGS: Suicide ranked sixth in the leading cause of deaths and represented about 3% of all deaths each year. The suicide rate has increased from 9.6 per 100 000 to 15 per 100 000 between 1981 and 2001. The total years of life lost due to suicide increased by 96.0%, from about 9900 years in 1981 to 19 400 years in 2001, whereas the figure for all causes of death decreased by 14.0%, from 274 600 years to 236 700 years. The total share of years of life lost attributable to suicide deaths has increased from 3.6% to 8.1% and is still increasing, especially among the middle age-groups (30-59 years). The use of charcoal burning as a suicide method has increased from 6.0% before 1998 to more than 28.0% in 2001.
COMMENTS: The burden on the years of life lost due to suicide is underestimated and overlooked. The increase of suicides in recent years has had a significant impact on the years of life lost and can be used as a useful indicator of performance in Hong Kong.
Risk of suicide and related adverse outcomes after exposure to a suicide prevention program in the US Air Force: cohort study.
Correspondence: Kerry L Knox, University of Rochester Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY 14642, USA; (email: Kerry_knox@urmc.rochester.edu).
OBJECTIVES: To evaluate the impact of the US Air Force suicide prevention program on risk of suicide and other outcomes that share underlying risk factors.
METHODS: Design- Cohort study with quasi-experimental design and analysis of cohorts before (1990-6) and after (1997-2002) the intervention. Participants- 5,260,292 US Air Force personnel (around 84% were men). Intervention- A multilayered intervention targeted at reducing risk factors and enhancing factors considered protective. The intervention consisted of removing the stigma of seeking help for a mental health or psychosocial problem, enhancing understanding of mental health, and changing policies and social norms.
Main outcome measures- Relative risk reductions (the prevented fraction) for suicide and other outcomes hypothesized to be sensitive to broadly based community prevention efforts, (family violence, accidental death, homicide). Additional outcomes not exclusively associated with suicide were included because of the comprehensiveness of the program.
FINDINGS: Implementation of the program was associated with a sustained decline in the rate of suicide and other adverse outcomes. A 33% relative risk reduction was observed for suicide after the intervention; reductions for other outcomes ranged from 18-54%.
COMMENTS: A systemic intervention aimed at changing social norms about seeking help and incorporating training in suicide prevention has a considerable impact on promotion of mental health. The impact on adverse outcomes in addition to suicide strengthens the conclusion that the program was responsible for these reductions in risk.
See item 5 under Risk Factor Prevalence, Injury Occurrence & Costs
Recently, several states and Canadian provinces have begun experimenting with centerline rumble strips. Modeled after shoulder rumble strips, centerline rumble strips are placed in the center of the roadway between opposing lanes of traffic to alert drivers that they have crossed over into the path of oncoming traffic. At the current time there does not appear to be a standard for the patterns and dimensions of the centerline rumble strips being installed. Therefore, this research attempts to determine the optimal pattern and dimensions for installation on Kansas highways based on decibel levels and steering wheel vibration generated by traveling over the rumble strips. Twelve patterns were generated based on the installations of other states and these were installed at an isolated location for testing. Seven vehicles of various sizes negotiated these rumble strips at varying speeds and the decibel levels at the driver's location, as well as steering wheel vibration, were recorded and analyzed. From this data, two patterns were selected for further testing in an actual highway setting in Kansas in 2003.
Boarding and alighting injury experience with different station platform and car entranceway designs on US commuter railroads.
- Morlok EK, Nitzberg BF, Lai L. Accid Anal Prev 2004; 36(2): 261-271.
Correspondence: Edward K. Morlok, Electrical and Systems Engineering Department, University of Pennsylvania, Room 229, Towne Building, 220 S. 33rd Street, 19104-6315, Philadelphia, PA, USA; (email: morlok@seas.upenn.edu).
Commuter railroad systems in the US employ three combinations of station platforms and car entranceways. These are high-level platforms with remotely controlled doors and level entranceway (HL-RC), low-level platforms (just above the rail) with steps and remotely controlled doors (LL-RC), and a mixture of the two platform types with a correspondingly more complex, partly manual, door and entranceway arrangement (ML-MO). Much controversy exists over which type of platform/entranceway is better. This seemingly small feature significantly impacts many performance characteristics of these systems, including cost, speed, and boarding and alighting accidents. Northeastern systems are generally moving toward the mixed platform design or all high-level platforms, while systems elsewhere are generally selecting the low-level design. Data on actual accident experience for 1995-2000 are analyzed to determine the effect of platform/entranceway type on passenger and employee injuries. Passenger injury rates on systems with the HL-RC design are lowest, with LL-RC systems next, and ML-MO systems having the highest rates. Employee injury rates are the least on LL-RC systems, but higher on ML-MO and HL-RC systems. Systems with a mixture of high and low platforms (ML-MO) experience a higher overall (combined passenger and employee) injury rate than the other two designs. The implications of these results for both the modernization of existing systems and the design of new systems, in the US and abroad, are discussed.
Improving older driver knowledge and self-awareness through self-assessment: the driving decisions workbook.
Correspondence: David W. Eby, Transportation Research Institute, University of Michigan, 2901 Baxter Road,Ann Arbor, MI 48109-2150, USA; (email: eby@umich.edu).
OBJECTIVES: This study aims to assess whether the Driving Decisions Workbook, a self-assessment instrument for older drivers, increased self-awareness and general knowledge. This study also assessed perceptions regarding its usefulness, particularly as a tool for facilitating discussions within families of older drivers. A secondary purpose of the study was to determine if problems identified by drivers in the workbook related to problems they had with actual driving.
DESIGN AND METHODS: The Driving Decisions Workbook was administered along with a questionnaire and a road test. A convenience sample of 99 licensed drivers aged 65 and above was used.
FINDINGS: After completing the workbook, about three fourths of the participants reported being more aware of changes that could affect driving. Fourteen percent reported that they had discovered a change in themselves of which they had not been previously aware. All respondents found the workbook to be at least a little useful and thought the workbook could help facilitate family discussions. Workbook responses were positively correlated with overall road test scores. Significant correlations were also noted between the road test and a majority of workbook subsection responses. COMMENTS: This study indicates that the workbook may be a useful first-tier assessment instrument and educational tool for the older driver. It may encourage an older driver to drive more safely and/or to seek clinical assessment, and help in facilitating discussions about driving within their families.
Deconstructing a gender difference: driving cessation and personal driving history of older women.
- Hakamies-Blomqvist L, Siren A. J Safety Res 2003; 34(4): 383-388.
Correspondence: Liisa Hakamies-Blomqvist, Department of Psychology, University of Helsinki, P.O. Box 9, Helsinki 00014, FINLAND; (email: liisa.hakamies-blomqvist@hvti.se).
OBJECTIVES: The purpose of this study is to understand the reasons behind older women's driving cessation by comparing the driving histories of Finnish women who either gave up or renewed their drivers license at the age of 70.
METHODS: A mail survey was sent to all Finnish women born in 1927 who gave up their license in 1997 (N=1,476) and to a corresponding random sample of women who renewed their license (N=1,494). The total response rate was 42.1%.
FINDINGS: The length and level of activity of personal driving history were strongly associated with driving cessation and continuation. Ex-drivers tended to have an inactive driving career behind them, whereas drivers had a more active personal driving history. In addition, those women with an active, "male-like" driving history who had decided to stop driving gave reasons for driving cessation that were similar to what is known about older men's reasons to give up driving.
COMMENTS: The results suggest that the decision to stop driving is related to driving habits rather than gender.
High school students' attitudes about firearms policies.
- Vittes KA, Sorenson SB, Gilbert D. J Adolesc Health 2003; 33(6): 471-478.
Correspondence: Katherine Vittes, School of Public Health, University of California, Los Angeles, (K.A.V., S.B.S.), Los Angeles, California, USA; (email: kavittes@ucla.edu).
To examine high school students' attitudes about firearm policies and to compare their attitudes with those of adults. The Hamilton Youth and Guns Poll is the first national survey of high school students about their attitudes concerning firearm policies. Questions were asked of 1005 sophomores, juniors, and seniors about their actual (i.e., direct) exposure (e.g., presence of a gun in the home) and about their social (i.e., indirect) exposure (e.g., whether the student could get a gun) to firearms and related violence. Population weights were applied, and multivariate logistic regression was used to examine the relationship between demographic and exposure variables and opinions about firearm policies. Most high school students supported more restrictive firearm policies. Opinions varied little by demographic variables with the exception of gender. Females were significantly more supportive of most firearm policies. Actual exposure was a more consistent predictor than social exposure. Students living in a home with a gun, particularly a handgun, were less likely to support most restrictive gun policies. Most high school students in the United States favor stringent policies governing firearms. Adolescents' attitudes about firearm policies parallel those of adults.
Legal and policy responses to children exposed to domestic violence: the need to evaluate intended and unintended consequences.
Correspondence: Peter G. Jaffe, Centre for Children and Families in the Justice System of the London Family Court Clinic, Ontario, CANADA; (email: peter@lfcc.on.ca).
Greater training and specialization in working with children exposed to domestic violence has resulted in new policies, interagency protocols, and legislation in many states. This paper examines court-related responses in criminal, child protection, and family court custody proceedings, which highlight legislative changes and resulting systemic change. Although this legislation originated with the best of intentions to assist and protect children, some of the most striking outcomes have been negative and unintended. Laws that mandate reporting of children exposed to domestic violence can clash with inadequate training and resources, or inadvertently revictimize abused women. Similarly, child custody legislation that raises a refutable presumption that a violent spouse will not receive custody or joint custody of children after parental separation has resulted in greater skepticism about abuse allegations We propose that efforts at law reform can be enhanced by a more thoughtful analysis of potential intended and unintended consequences, and should be accompanied by a comprehensive evaluation plan to monitor implementation effects.
Intervention for children exposed to interparental violence (IPV): assessment of needs and research priorities.
Correspondence: Sandra A. Graham-Bermann, Department of Psychology, University of Michigan, Ann Arbor, Michigan 48109-1109, USA; (email: sandragb@umich.edu).
In this paper we review the development of interventions for children who have been exposed to interparental violence (IPV), assess current needs in the evaluation of interventions, and provide suggestions for research priorities in this area. Interventions for negative outcomes associated with exposure to IPV only recently have been carefully designed and evaluated, thus knowledge regarding program effectiveness is minimal. Three of the most comprehensive interventions that have been evaluated are presented. Each has demonstrated effectiveness, and focuses on children with different levels of symptoms and distress. However, many questions remain regarding which interventions are beneficial for diverse children with different kinds and intensities of problems. A number of research priorities and suggestions for further improvements in the evaluation of effectiveness of interventions are identified.
Neighborhood disadvantage and the nature of violence.
Correspondence: Eric Baumer, Department of Criminology, University of Missouri-St. Louis, 8001 Natural Bridge Road, St. Louis, MO 63121, USA; (email: baumer@umsl.edu).
Although numerous studies have examined the influence of neighborhood socioeconomic disadvantage on the quantity of violence, little attention has been devoted to whether such conditions also shape the quality of violence. Drawing on Anderson's (1999) influential ethnography, we derive several hypotheses about how the nature of violence differs across neighborhoods with varying socioeconomic conditions. Using data on assaults and robberies from the area-identified National Crime Victimization Survey (NCVS), our analyses reveal support for Anderson's description of the nature of violence in different neighborhood contexts, but only mixed support for his argument that those differences are due to neighborhood effects.
Strain and violence: Testing a general strain theory model of community violence.
Correspondence: Barbara D. Warner, Department of Criminal Justice and Police Studies, Eastern Kentucky University, 467 Stratton Building 521 Lancaster Avenue, Richmond, KY 40475 3102, USA; (email: barbara.warner@eku.edu).
Agnew's General Strain Theory (GST) has come to be recognized as an increasingly important explanation for violence at the individual level. Drawing on this individual level theory, Agnew [Journal of Research in Crime and Delinquency 36 (1999) 123] recently suggested that GST might also be applicable to explaining variations in community crime rates. This macro level General Strain Theory (MST) has, however, rarely been empirically examined. This article provides an examination of some of the central ideas in Agnew's MST using data from sixty-six neighborhoods in a southern state. The findings suggest that neighborhood disadvantage and stability significantly affect neighborhood levels of strain. In turn, strain significantly affects levels of violence. The extent to which the effects of strain on violence are conditioned by levels of informal social control and social support/capital are also examined in this article. The results are partially supportive of MST.
The portrayal of crime and justice in the comic book superhero mythos.
Correspondence: Scott A. Vollum, College of Criminal Justice, Sam Houston State University, 208-A Graham Road, Huntsville, TX 77340, USA; (email: STDSAV12@shsu.edu).
This article examines the representation of crime and justice in the worlds and lives of two of the most popular and pervasive comic book superheroes: Batman and Superman. The messages conveyed in the stories of these two superheroes are identified and discussed in relation to three different contexts: (1) the structure of the society in which the superhero resides, (2) the crime and criminals they come up against, and (3) the crime-fighting superheroes themselves. The perspectives of crime and justice conveyed by the predominant images and messages are then examined in accordance with Sutherland's tripartite framework of criminological inquiry: The representation of law, the breaking of law, and the reaction to the breaking of law are considered. Finally, the hegemonic messages implicit in the comic book superhero mythos are discussed.
See item 3 under Alcohol and Drugs
See item 2 under Risk Factor Prevalence, Injury Occurrence, and Costs
