Alcohol involvement in burn, submersion, spinal cord, and brain injuries.
- Levy DT, Mallonee S, Miller TR, Smith GS, Spicer RS, Romano EO, Fisher DA. Med Sci Monit 2004; 10(1): CR17-24.
Correspondence: David Levy, University of Baltimore, Baltimore and Pacific Institute for Research and Evaluation, Beltsville, Maryland, USA; (email: levy@pire.org).
BACKGROUND: Alcohol is involved in many injuries, but estimates of this involvement vary considerably. Most information pertains to deaths although most injuries are nonfatal.
METHODS: The portion of fatal and nonfatal injuries involving alcohol was determined from a comprehensive Oklahoma surveillance system that tracks persons killed or hospitalized due to burns, submersions, spinal cord injuries (SCIs), and traumatic brain injuries (TBIs). Logistic regression was used to determine factors that explain the percentage of alcohol involvement in fatal versus nonfatal cases.
FINDINGS: The victim was alcohol involved in 17% of fire burns, 4% of scald burns, 24% of submersions, 34% of SCIs, and 41% of TBIs where involvement was known. Large differences existed in total alcohol involvement between age and gender groups and between fatal and nonfatal cases of fire burns (31% vs.11%) and submersions (33% vs. 6%). Large differences also existed in victim alcohol involvement between fatal and nonfatal cases of intentional SCIs (0% vs. 48%) and TBIs (38% vs. 70%). Those who imbibed during the day were not at excess risk of scald injury, but they were twice as likely to suffer a serious fire burn, 3 times as likely to suffer a spinal cord injury, 3.5 times as likely to suffer a submersion injury, and 2 to 4 times as likely to suffer a TBI. These excess risks persisted for all age groups between 15 and 64, with the excess risk especially high for underage drinkers aged 15 to 20. In contrast, people aged 65 and older did not appear to be at excess risk on days that they imbibed.
COMMENTS: A large percentage of fatal and nonfatal injuries as classified by diagnosis group involve alcohol. People who had been drinking were substantially more likely to suffer serious nonfatal and fatal injuries other than scald burns.
"Why is there such a fuss being made about bullying? Bullying is commonplace, normal, and part of growing up." This was a comment made with frustration and more than a bit of annoyance to me by an experienced and, as best I can judge, highly qualified 4th-grade teacher several years ago after the publication of an article by Nansel et al. That article received considerable media attention and press coverage, raising the issue of bullying to a more prominent level in violence prevention efforts. Interestingly, this teacher was unaware that I had, in fact, written a commentary for that article emphasizing the need to address bullying as part of a comprehensive approach to youth violence prevention. However, his sentiment has been repeated to me by many others, especially teachers, since then and reflects a concerning problem with respect to people's understanding of this issue and its importance. Yet, although the Nansel et al article was among the first studies to report on the prevalence of bullying and its associated psychosocial concerns in this country, there was already a considerable body of work on this subject from other countries that reflected the extent and seriousness of the problem as well as well-evaluated strategies for addressing it.
There clearly has been considerably more attention to bullying with respect to its consequences and implications in countries with lower rates of violence and violent injuries than this country.
The study reported in this issue of Pediatrics by Juvonen et al (see SafetyLit School Issues 19 January 2004) looks specifically at 6th graders primarily from Latino and African American communities by using self-, peer, and teacher reports in a more comprehensive data collection effort than many previous studies. It is an important contribution to our understanding of bullying and those involved in part because we still have relatively little data on the prevalence and associated findings of these children. Their findings are consistent with those of Nansel, with almost one fourth of those surveyed reporting some involvement with bullying and 6% reporting experiencing both bullying and being bullied. Additionally, the associated psychosocial problems reported are quite similar to those described in other studies with bullies displaying higher rates of conduct disorders (although they also experience high levels of social standing), those bullied displaying concerning rates of emotional distress and social isolation, and the bully/bullied being most concerning with respect to conduct, school, and peer relationship problems.
Furthermore, this and other studies that look at the short-term factors related to bullying must be put into the context of studies that reflect significant longer-term consequences. Olweus reported a fourfold increase in criminal behavior by their mid-twenties among individuals with a history of bullying, with a majority having at least one criminal conviction and more than one third having multiple convictions. The author also reported higher rates of depression and poor self-esteem in adults with histories of being bullied. Although there are few other studies that evaluate the long-term consequences related to bullying, a significant number of the high-profile school shootings over the past decade have involved individuals with histories of bullying or being bullied. These studies and the anecdotal reports relating to the circumstances of a number of school shootings must elevate our attention to the issue of bullying, strategies for prevention, and efforts to use the identification of those involved as a way of identifying and serving a high-risk group of children and youth.
We must be thoughtful and rigorous about our efforts to address this problem. Merely labeling bullies as trouble-makers and punishing them is far from a therapeutic approach, and the no-tolerance policies linked to suspension or expulsion that have been adopted by many schools create even more problems and represent serious, missed opportunities to help children in trouble. Not adequately addressing the social and emotional distress of those bullied because of lack of understanding of the problem or lack of mental health resources is yet another unfortunate missed opportunity to help. Those that experience both are particularly concerning and require special attention. What we cannot do is respond in a way that blames children for behaviors that develop as a result of social and environmental influences such as home environments, community circumstances, media images, and value systems that promote violence and aggression.
Maybe most important is the need to address the larger school environment that supports or condones bullying as reflected by the reported high social status that bullies enjoy among their school mates. We need to identify ways to shift the social norms and values in schools and communities to ones that promote healthy peer interactions and reject bullying, intimidation, and other forms of physical and verbal coercion as acceptable. Again, we have Olweus8 as a resource, because he has developed a very comprehensive approach to bullying prevention that deals with the individuals involved as well as all of the stake-holders in the school setting (students, teachers, parents, and administrators) to change the climate and value system of the school. His model has been well-evaluated with very impressive results in other countries and needs to be modified to settings in this country with appropriate evaluations to measure the outcomes. We must also incorporate a better understanding of this issue in teacher training but cannot load this solely on teachers who are already overburdened with other responsibilities. If our schools are to meet the needs of children better, physicians, mental health professionals, youth programs, and other parts of our human service system need to become more involved.
Last but of great importance is that we cannot lose sight of the fact that youth violence is a complex issue with many risk and resiliency factors. Addressing violence must include a broad vision that takes an issue such as bullying and integrates it into the bigger picture and the larger solutions. True and effective violence prevention requires a comprehensive response that brings all segments of the community into play. Health care, public health, mental health, youth development, education, family support, faith and religious, and criminal justice institutions and professionals have roles to play as do community groups, survivors, and others who live with the consequences of violence on a daily basis.
This paper describes the targeted intervention component of GREAT Schools and Families. The intervention-GREAT Families-is composed of 15 weekly multiple family group meetings (e.g., 4-6 families per group) and addresses parenting practices (discipline, monitoring), family relationship characteristics (communication, support, cohesion), parental involvement and investment in their child's schooling, parent and school relationship building, and planning for the future. High-risk youth and their families-students identified by teachers as aggressive and socially influential among their peers-were targeted for inclusion in the intervention. The paper describes the theoretical model and development of the intervention. Approaches to recruitment, engagement, staff training, and sociocultural sensitivity in work with families in predominantly poor and challenging settings are described. The data being collected throughout the program will aid in examining the theoretical and program processes that can potentially mediate and moderate effects on families. This work can inform us about necessary approaches and procedures to engage and support families in efforts to reduce individual and school grade-level violence and aggression.
One question that emerged following the 11 September attacks was how to categorize and classify the event within existing disaster and conflict-event research frameworks. A decade ago, Quarantelli (1993)compared findings on the similarities and differences between consensus- and conflict-type events by illustrating a conceptual distinction between the two. In this paper, this discussion is expanded to include terrorist attacks by offering comparisons from research findings following 11 September. We provide analyses of individual, organizational, and community-level behavior in crisis situations and suggest how 11 September is both similar to, and differs from, consensus- and conflict-type events as they were previously considered. Applications for emergency management are also suggested.
- Cohen HS, Wells J, Kimball KT, Owsley C. J Safety Res 2003; 34(4): 361-369.
Correspondence: Helen Cohen, Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA; (email: hcohen@bcm.tmc.edu).
BACKGROUND: People with dizziness caused by vestibular (i.e., inner ear) disorders complain of difficulty driving. Physicians occasionally warn their patients with vestibular disorders not to drive. Few studies have asked patients about their driving performance, so little data are available.
METHOD: Using the Driving Habits Questionnaire, the authors did structured interviews with people with several different vestibular disorders and with normal subjects. The self-reported crash rate and rate of citations for moving violations did not differ between the subject groups.
FINDINGS: Patients report reduced driving skills, particularly in situations when visual information is reduced, rapid head movements are used, and specific path integration or spatial navigation skills are needed.
Correspondence: Mary F. Lesch, Liberty Mutual Research Institute for Safety, 71 Frankland Road, 01748, Hopkinton, MA, USA; (email: mary.lesch@libertymutual.com).
BACKGROUND: Prior research indicates that many warning symbols are poorly understood, particularly by the elderly.
METHOD: The effectiveness of three different training conditions to improve comprehension and memory for warning symbols was assessed for younger (18-35 years of age) and older (50-67 years of age) participants. All three conditions paired the symbols with associated text during training; however they differed in the extent to which they further elaborated on the meanings of the symbols.
FINDINGS: Training substantially improved accuracy and speed of responding on a comprehension test; however there was little difference among conditions. Additionally, while the magnitude of the training effect was similar for both age groups, older participants performed much more poorly than younger participants, both before (37% vs. 52% correct) and after training (68% vs. 88% correct on the immediate post-test), and found it more difficult to reject incorrect meanings (55% vs. 68% correct).
COMMENTS: Relatively simple training conditions can dramatically improve accuracy and speed of responding to warning symbols. Training should be used to improve warning symbol comprehension since failures to adequately understand warning information may lead to injury or death. Furthermore, attempts should be made to address individual differences in warning processing such as those related to changes in cognitive processing across the lifespan.
Contact palm burns in toddlers from glass enclosed fireplaces.
- Dunst CM, Scott EC, Kraatz JJ, Anderson PM, Twomey JA, Peltier GL. J Burn Care Rehabil 2004; 25(1): 67-70.
Correspondence: George L. Peltier, Department of Surgery, Hennepin County Medical Center, 701 park Avenue 813B, Minneapolis, Minnesota, USA; (email: unavailable).
We have seen an alarming increase in the incidence of pediatric palm burns associated with gas fireplaces. The increasing popularity of these units places more children at risk. Medical records of patients under the age of 5 years who sustained hand burns from contact with the glass enclosure of gas fireplaces from 1996 through 2002 were reviewed. Thirty-nine patients were identified, with a mean age of 12.8 months. A 15-fold increase in incidence was observed. Thirty-three patients suffered superficial second-degree burns that were treated conservatively. Twenty-one percent of children developed significant wound complications requiring intensive therapy including extension splinting or surgery. Pediatric burns resulting from palmar contact with the glass enclosures of gas fireplaces have emerged as an avoidable new danger within the home. Although most of these injuries heal with conservative treatment alone, many require surgery or other intensive management to regain acceptable function.
Correspondence: Seth Ayim Gyekye, Department of Social Psychology, University of Helsinki, Neitsytsaarentie 8 D 22, 00960 96, Helsinki, FINLAND; (email: gyekye@sato.helsinki.fi).
BACKGROUND: Reports from the accident literature indicate that accident rates tend to vary with type of occupation. The mining industry has been recorded as the most dangerous with a high disabling injury rate. This observation has been attributed to the extremely stressful conditions under which miners work. Besides, the intimidating work environment in the mines has been insinuated to invoke a sense of helplessness, fatalism and hence defensive causal attributions for accident occurrences.
METHODS: This study compared causal attributions between accident victims in Ghana's mining industry with their counterparts in textile factories. T values and Chi-square were employed to test for statistically significant differences between the two groups of accident victims.
FINDINGS: Findings indicate that there is no difference between the causal attributions for miners and non-miners.
COMMENTS: Accident frequency and occupational type have no impact on causal attributions.
Developing an effective tool for teaching teens about workplace safety.
- Miara C, Gallagher S, Bush D, Dewer R. Am J Health Educ 203; 34(5 Suppl): s30-s34.
Correspondence: Christine Miara, Children's Safety Network, Education
Development Center, 55 Chapel Street, Newton, MA 02458, USA; (email: cmiara@edc.org).
Paid employment is an important feature of adolescent life. Too often, it has negative
health consequences, including more than 200,000 workplace injuries to 14 to 17 year
olds every year. Training teens about occupational safety is part of an overall strategy to
address this problem. When the project described in this article began, there were few
curricula for teaching teens basic occupational safety information, and there was little
research on the most effective way to deliver this information. Project staff sought to fill
these gaps in resources and knowledge. They conducted formative research to determine
teen knowledge and attitudes about workplace safety and about child labor laws, teens'
comfort with voicing concerns at work, and the type of training they received. Staff also
interviewed educators and pilot-tested a draft curriculum to determine format and content
appropriate to trainers' time constraints and levels of knowledge. In response to the
findings, project staff developed curricula with activities addressing hazards in
workplaces, prevention strategies, child labor laws, and how to communicate effectively
about workplace concerns. Activities were created to be interactive and fun, and
instructor guidance was present concisely but with sufficient background information for
someone with limited knowledge of occupational health and safety.
Deaths in construction related to personnel lifts, 1992-1999.
Correspondence: Michael McCann, The Center to Protect Workers' Rights, 8484 Georgia Avenue, Suite 1000, 20910, Silver Spring, MD, USA; (email: michael.mccann@att.net).
BACKGROUND: This study examined deaths of construction workers due to personnel lifts (boom-supported and scissor lifts, suspended scaffolds, and crane platforms).
METHODS: Deaths of construction workers for 1992-1999 were examined using data from the Census of Fatal Occupational Injuries, a Bureau of Labor Statistics database.
FINDINGS: The study identified 339 deaths: 42% from boom-supported lifts; 26% from suspended scaffolds; 19% from scissor lifts; 5% from crane platforms; and 7% from unapproved lifts (e.g., forklift platforms). The main causes of death were falls (36%), collapses/tipovers (29%), and electrocutions (21%).
COMMENTS: Recommendations include: following OSHA regulations, wearing personal fall protection equipment, adequate maintenance, inspection before use, and training on the model of lift used. Precautions are also needed to prevent contact with overhead power lines. The increasing popularity of boom-supported lifts and scissor lifts,both in construction and other industries, make their safety an important issue.
Evaluation of a safety training program in three food service companies.
- Sinclair RC, Smith R, Colligan M, Prince M, Nguyen T, Stayner L. J Safety Res 2003; 34(5): 547-558.
Correspondence: Raymond C. Sinclair, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway, MS C-10, 45226, Cincinnati, OH, USA; (email: Rsinclair@cdc.gov).
BACKGROUND: Outcome measures for safety training effectiveness research often do not include measures such as occupational injury experience. Effectiveness mediators also receive sparse attention.
METHODS: A new safety training curriculum was delivered to workers in a stratified random sample of food service facilities across three companies. A similar group of facilities received usual training. We collected post-test measures of demographic variables, safety knowledge, perceptions of transfer of training climate, and workers' compensation claim data for one year after the initial training activities.
FINDINGS: Knowledge test scores were apparently higher in the new-training units than in the usual-training units. Some demographic variables were inconsistently associated with these differences. Evidence for reduction of the injury rate associated with the new training was observed from two companies but only approached significance for one company. A second company revealed a similar but non-significant trend. Knowledge scores were not significantly associated with lower injury rates.
COMMENTS: We found evidence that safety training increases knowledge and reduces injuries. We found almost no evidence of effects of training effectiveness mediators, including no relationship between safety knowledge and injury experience. Methodological issues related to conducting a large study may have influenced these results. Although safety training leads to greater knowledge and, in some cases, reduced occupational injuries, the influence of mediating variables remains to be fully explained.
See item 2 under Risk Prevalence, Injury Occurrence, and Costs
Using theory to guide practice in children's pedestrian safety education.
- Cross D, Hall M, Howat P. Am J Health Educ 203; 34(5 Suppl): s42-s47.
Correspondence: Donna Cross, Western Australian Centre for Health Promotion Research, Curtin University of Technology, GPO Box U1987, Perth, WA, AUSTRALIA; (email: d.cross@curtain.edu.au).
Few pedestrian injury prevention programs appear to articulate the theory upon which
their design and evaluation are based. This article describes how theory was used to plan,
develop, implement, and evaluate the educational component of a comprehensive child
pedestrian intervention. Organizational and planning theories were used to guide the
conceptual development, implementation, and evaluation of the program, while
behavioral and child development theories were used to identify the content and
strategies to address the pedestrian behavior of seven to nine year old children. The
resultant program demonstrated improved road crossing and playing behaviors in the
intervention group children compared to the comparison group. The systematic use of
relevant theory in this program is likely to be associated with its positive impact on
children's pedestrian safety.
Parents as advocates for child pedestrian injury prevention: what do they
believe about the efficacy of prevention strategies and about how to create
change?
- DeFrancesco S, Gielen AC, Bishai D, Mahoney P, Ho S, Guyer B. Am J Health Educ 203; 34(5 Suppl): s48-s54.
Correspondence: Andrea Carlson Gielen, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA; (agielen@jhsph.edu).
This study describes the support of parents and other community members for child
pedestrian safety measures, their willingness to pay in terms of volunteer time and money
for efforts to make child pedestrian safety improvements in their neighborhood, and their
views on how to affect child pedestrian safety improvements in their communities. In
partnership with four city public elementary schools, data were collected through focus
groups of parents and other caregivers and through a written survey distributed to parents
and caregivers. The findings reveal that parents and caregivers are aware of a full range
of prevention measures for the child pedestrian injury problem but are especially
supportive of speed bumps, safety education for parents, and better traffic enforcement.
Parents and caregivers are uncertain about what kind of strategies would work well to get
changes made in their communities to protect child pedestrians. They also reveal that
they are willing to get involved in trying to get changes made. Parents and other
community members can be willing and effective partners in injury prevention, but they
can benefit from receiving more information about the value of environmental prevention
measures and from skill-building in injury prevention advocacy.
See item 1 Under Risk Factor Prevalence, Injury Occurrence, and Costs
OBJECTIVES: Wilderness Event Medicine (WEM), that is, the care of large groups of people participating in events in remote areas, is a rapidly growing subspecialty of wilderness medicine. Our goals are to report the injury rates from one wilderness event and to suggest ways to advance this emerging field.
METHODS: We describe a 1-day wilderness hike and compare the injury rates from this one event with rates from other urban and wilderness events.
FINDINGS: Of the total 350 hikers, 6 persons presented for medical evaluation (5 dehydration and 1 orthopedic), yielding a rate of 17 evaluations per 1000 person-days of exposure. Only 1 person (or 2.9 per 1000) required medical assistance beyond oral rehydration. These rates are comparable to rates reported for urban events and other wilderness activities.
COMMENTS: According to very limited reports, the rates of injuries in wilderness events are similar to those for urban events. We recommend defining a wilderness event as an event with more than 200 participants and where the time from injury to care at a medical facility is likely to be greater than 1 hour. We also suggest the creation of a database of wilderness events, including standardized terms for the descriptions of activities, terrain, injuries, and medical response. Such a database could be used to help event planners anticipate and perhaps prevent injuries and to prepare effectively for those injuries that do occur.
Risk for injury when playing in a national football (Soccer) team.
Correspondence: Jan Ekstrand, Department of Social Medicine and Public Health Science, Linkoping University, and the Sports Clinic, Linkoping, SWEDEN; (email: jan.ekstrand@telia.com).
The Swedish male senior national football team was followed prospectively between 1991 and 1997. During these 6 years, the team played 73 official matches and had three training camps. The senior author (J. E.) attended 57 of these matches and the three training camps and these matches and training camps, are included in the present study. Exposure to football was recorded individually for each player. The team physician examined all injuries. Total exposure was 7245 h (6235 training and 1010 match hours) and there were 71 injuries (40 training and 31 match injuries). Five (16%) of the match injuries were major, with more than 4 weeks of absence from football. The injury incidence during training was 6.5/1000 h and the injury risk during matchplay was 30.3/1000 h. A significantly higher injury incidence was found for matches lost compared to matches won or drawn (52.5 vs. 22.7/1000 h, P=0.026). No statistically significant difference for injury was found between competitive matches and friendly matches. No difference was found between home and away matches or matches on neutral ground. The risk for injury when playing in a national team compares with previously reported figures for professional football at a high level.
A pilot study of the attitudes of Australian rules footballers towards protective headgear.
- Finch CF, McIntosh AS, McCrory P, Zazryn T. J Sci Med Sport 2003; 6(4): 505-511.
Correspondence: Caroline F. Finch, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, AUSTRALIA; (email: caroline.finch@med.monash.edu.au).
Despite a relatively high risk of injury to participants of Australian Rules football, very few players report wearing protective equipment. The aim of this paper is to describe the results of a pilot survey of the attitudes of community-level Australian Rules football players towards protective headgear and the risk of head injury. Seventy players from four purposefully chosen clubs in metropolitan Melbourne completed a self-report questionnaire at the end of the 2000-playing season. Almost all players (91.4%) reported they did not wear protective headgear during the 2000 season. Non-headgear users said that headgear was too uncomfortable (47.4%) and they didn't like it (42.1%). However, 80.0% of non-users said they would wear it if it prevented injury. The major motivation for wearing headgear was to prevent injury. Players considered rugby, boxing and driving a car, to be associated with a higher-risk of head injury than Australian Rules football. As a group, the players perceived the risk of head injury in Australian Rules football to be low to moderate when compared to other sports and activities. This partially explains why so few players wore protective headgear. Repeat surveys on a larger sample should be conducted to further understand the attitudes towards protective headgear and perceptions of risk in community-level Australian football players.
BACKGROUND: Intentional and unintentional injury prevention efforts have traditionally been independent and non-integrated. Fostering collaboration between the sub-fields would enhance work within both sub-fields and advance injury prevention work as a whole.
METHODS: A systematic assessment of similarities and differences between the sub-fields was performed, including an examination of relevant definitions and norms, research methods and findings, key risk and resiliency factors, and prevention strategies that would promote collaboration and better advance current prevention efforts.
FINDINGS: Several areas exist in which injury prevention efforts could be coordinated or ideas and practices could be cross-applied, including training of practitioners, data collection and analysis, application of tools and methodologies, examination of risk and resiliency factors, and identification of funding sources and partners.
COMMENTS: This paper delineates how intentional and unintentional injury prevention practitioners can more effectively collaborate to promote safer environments and further reduce incidence of injury. An integrated injury prevention approach could significantly impact the underlying contributors to both types of injury, allowing practitioners within both sub-fields to achieve greater outcomes through increased credibility, reduced duplication of efforts, more efficient use of resources, and unified injury prevention messages.
Cost effectiveness of a bicycle - pedestrian trail development in health promotion.
- Wang G, Macera CA, Scudder-Soucie B, Schmid T, Pratt M, Buchner D. Prev Med 2004; 38(2): 237-242.
Correspondence: Guijing Wang, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 30341, Atlanta, GA, USA; (email: gbw9@cdc.gov).
BACKGROUND: A persistently low population level of physical activity is a challenge for public health. Data on cost effectiveness of environmental interventions are needed to inform the development and implementing of such interventions.
OBJECTIVE: To conduct cost-effectiveness analysis of bicycle/pedestrian trails.
DESIGN: The costs of trail development and number of users of four trails in Lincoln, NE, were obtained. The costs were adjusted to 2003 dollars. The physical activity-related outcomes/items are number of users who were more physically active since they began using the trails, number of users who were physically active for general health, and number of users who were physically active for weight loss. Cost-effectiveness measures were derived. Sensitivity analysis was performed.
FINDINGS: The annual trail development cost US$289,035, 73% of which was construction cost. Of the 3,986 trail users, 88% were active at least 3 days a week. The average annual cost for persons becoming more physically active was US$98 (range US$65-253); the cost was US$142 (range US$95-366) for persons who are active for general health, and US$884 (range US$590-2,287) for persons who are active for weight loss.
COMMENTS: This analysis provides basic cost-effectiveness measures of bicycle/pedestrian trails. Policymakers can use this information in making resource allocation decisions.
An Estimate of the U.S. Government's Undercount of Nonfatal Occupational Injuries.
Correspondence: J. Paul Leigh, Department of Epidemiology and Preventive Medicine, Medicine School, TB 168, University of California at Davis, Davis, CA 95616, USA; (email: jpleigh@epm.ucdavis.edu).
Debate surrounds the size of the underestimate of nonfatal occupational injuries produced by the U.S. Bureau of Labor Statistics (BLS). We developed models that separated categories of injuries: BLS Annual Survey, federal government, agriculture, state and local government, self-employed outside agriculture, and all other. The models generated varying estimates depending on the assumptions for each category pertaining to job risks and amount of underreporting. We offered justification for the assumptions based on published studies as well as our own analyses of BLS data. The models suggested the Annual Survey missed from 0% to 70% of the number of injuries (from private firms, excluding the self-employed) it was designed to capture. However, when we included firms and governments the Annual Survey was not designed to capture, and considered reasonable assumptions regarding underreporting, we estimated the BLS missed between 33% and 69% of all injuries. We concluded that there was substantial undercapture in the BLS Annual Survey, some due to the excluded categories of government workers and the self-employed, as well as some due to underreporting.
Pediatric traumatic brain injuries in Taiwan: an 8-year study.
BACKGROUND: This study is intended to determine the causes of pediatric traumatic brain injuries (PTBI) in children aged 14 years or less, and to identify various types of craniocerebral damage resulting from different mechanisms of injury.
METHODS: From July 1, 1993 to June 30, 2001, a survey on PTBI was conducted in Taiwan. The data of patients used in this study were collected from 56 major hospitals among the age group of 0-14 years. The items in the traumatic brain injury survey included sex, age, causes of injuries, severity, and the eventual outcome.
RESULTS: A total of 5349 cases were identified. The male-to-female ratio was 1.69: 1. The incidence rate was higher in the age groups of 4-9 years and 10-14 years. The main cause of PTBI was traffic injury, which accounted for 2537 of the cases (47.3%), followed by falls, 2160 (40.3%). Of all traffic injuries, motorcycle-related injury had the highest incidence, followed by the pedestrian and bicycle-related injury. This study also showed that 83.2% of the patients had mild injury, 9.8% had moderate injury, and 7.0%, severe injury.
COMMENTS: The results of this study suggest that it is important to decrease all the risk factors in the environment of homes and public areas as much as possible. Helmet wearing and the development of public transportation are essential for the prevention of head injury.
The 2002 annual report of the Regional Infant and Child Mortality Review Committee.
- Randall B, Wilson A. S D J Med 2003; 56(12): 505-509.
The annual report of the Regional Infant and Child Mortality Review Committee (RICMRC) is attached. This Committee has as its mission the review of infant and child death so that information can be transformed into action to protect young lives. The 2002 review area includes South Dakota's Minnehaha, Turner, Lincoln, Moody, Lake, McCook, and Union counties. In 2002 there was one death in this region due to SIDS, plus one infant death due to positional asphyxia that illustrates the hazards of soft bedding and prone sleeping. These data reflect the need to remain vigilant in the public campaign to promote "back to sleep" and safe sleeping environments for infants. There were four other deaths due to accidental injury, mostly representing immaturity in driving various vehicles. In 2002 there were two child abuse homicides, and three teenage suicides. The RICMRC invites other communities to join in its efforts to review deaths to prevent potential life-threatening hazards to children in their local environs.
BACKGROUND: Research suggests that people who engage in risk-taking behaviors often hold specific beliefs that can mitigate or reduce their perceptions of risk associated with those behaviors.
METHODS: A scale was developed (Speeding Risk Belief Scale (SRBS)) to assess beliefs about speeding-related risk and predict self-reported speeding in a random-digit telephone survey of 800 South Australian drivers between the ages of 16 and 50.
FINDINGS: The scale was internally consistent, and path analyses showed it to be associated with self-reported speeding, both directly and indirectly through participants' estimates of speeding-related risk.
COMMENTS: Origins of risk-mitigating beliefs and the extent to which they may be causally linked with speeding are discussed, and recommendations are made for future research. This research has strong implications for the conduct of countermeasure campaigns that disseminate information on speeding-related risk.
Correspondence: Allan F. Williams, Insurance Institute for Highway Safety, 1005 North Glebe Road, 22201-4751, Arlington, VA, USA; (email: research@iihs.org).
BACKGROUND: To assess how drivers view dangers on the highway, what motivates them to drive safely, how they say they reduce their crash and injury risk, and how they rate their own driving skills.
FINDINGS: Most drivers rated their skills as better than average. The biggest motivating factor for safe driving was concern for safety of others in their vehicle, followed by negative outcomes such as being in a crash, increased insurance costs, and fines. The greatest threats to their safety were thought to be other drivers' actions that increase crash risk such as alcohol impairment or running red lights. In terms of reducing crashes and injuries, drivers tended to focus on actions they could take such as driving defensively or using seat belts. There was less recognition of the role of vehicles and vehicle features in crash or injury prevention.
COMMENTS: Knowing how drivers view themselves and others, their concerns, and their motivations and techniques for staying out of trouble on the roads provides insight into the difficulty of changing driving practices.
Case reports of on-site investigations of auger-related farm injuries.
- Ingram MW, Crowe TG, Wassermann J, Hagel LM, Dosman JA. J Agric Saf Health 2003; 9(2): 133-142.
Correspondence: Mark Ingram, Institute of Agricultural Rural and Environmental Health, University of Saskatchewan, 103 Hospital Drive, P.O. Box 120, Royal University Hospital, Saskatoon, SK S7N 0W8, CANADA; (email: mark.ingram@usask.ca).
Previous reports have indicated that injuries involving augers (screw conveyors) are a serious problem in agriculture, but to date on-site engineering inspections linking injuries to mechanical and procedural aspects have not been available. This article details four events involving injuries as the result of being entangled in auger flighting. In each report, the circumstances surrounding the injury event are outlined, and the machinery involved is evaluated in terms of its compliance with current safety standards. In three of the four instances, the machinery did not conform to current guarding standards or to safety sign standards. In these three cases, injuries were preventable with improved guarding according to ASAE Standards. In the other case, the machine complied with ASAE Standards, but the injury could have been prevented with improved guarding of the auger flighting.
This paper describes the theoretical basis and content of the universal student component of the Guiding Responsibility and Expectations for Adolescents for Today and Tomorrow (GREAT) Schools and Families' middle school violence prevention program for changing school climate. The GREAT Student Program builds on and extends the content of the sixth grade Responding In Peaceful and Positive Ways (RIPP-6) social-cognitive violence prevention program through an expanded conceptual framework that focuses on changing school norms and explicitly incorporates cultural and contextual goals. The program consists of twenty 40-minute lessons taught by a trained facilitator on a weekly basis during the school day.
Correspondence: C.A. Emery, University of Alberta, Department of Public Health Science (Epidemiology), Faculty of Medicine, Alberta, CANADA; (email: unavailable).
The aims of this review paper are (1) to discuss the relevance of proprioception and standing balance in rehabilitation and prevention of sports injuries, (2) to examine the evidence supporting decreased balance as a risk factor and balance training as a prevention strategy for injury in sport, (3) to review the evidence in the literature supporting the reliability and validity of clinical balance measurements, (4) to examine factors potentially influencing lower extremity balance and (5) to discuss the implications for future research in identifying clinical balance measurement tools appropriate for use in rehabilitation and injury prevention in sports medicine. Laboratory measurement techniques for balance (using costly, highly technical, and often non-portable equipment) are often not appropriate for use in a clinical setting or for research in a large field based clinical trial. Many of the clinical tools for balance measurement are not appropriate for use in the healthy active population, as they are not challenging enough or they are static balance measures. Evidence from original research suggests that static unipedal timed balance is a reliable measurement in both children and adults. There is little evidence to support the reliability and validity of dynamic clinical measurements of balance developed. It is impaired dynamic unipedal balance in sport which may be a significant risk factor for re-injury following rehabilitation or injury in sport. Dynamic standing balance measurement tools appropriate for use in the clinical setting need to be developed and assessed for reliability and validity.
Managing suicide risk in late life: access to firearms as a public health risk.
- Oslin DW, Zubritsky C, Brown G, Mullahy M, Puliafico A, Ten Have T. Am J Geriatr Psychiatry 2004; 12(1): 30-36.
Correspondence: David Oslin, University of Pennsylvania, 3600 Chestnut Street, Room 790, Philadelphia, PA 19104, USA; (email: oslin@mail.med.upenn.edu).
OBJECTIVE: The authors assessed the prevalence of gun availability for elderly patients to determine whether gun availability is related to the presence of suicidal or depressive symptoms.
METHODS: This is a cross-sectional epidemiologic survey of firearm availability and safety practices. A random sample of older adults with a scheduled primary-care clinic appointment was selected and screened with the General Health Questionnaire and questions about suicidality and alcohol use. Participants were also asked about the availability of firearms in their home and about safe gun practices.
FINDINGS: Of 1,023 patients screened, 285 (27.9%) reported having some type of firearm in the home, and 202 (19.7%) reported having a handgun in the home. Patients with suicidal ideation or high levels of depression or psychological distress were not significantly more or less likely to have a gun in the home than those without these emotional stressors. The strongest predictors of firearm availability were being male and being married.
COMMENTS: These preliminary data suggest that a significant proportion of elderly people have firearms available to them in their homes. Those patients with emotional distress did not differ from those without distress with respect to having firearms available to them. These data strongly suggest the need for screening for firearm availability and education about the safe storage of firearms as a potential means of prevention of suicide among elderly patients suffering from emotional distress or suicidal ideation.
Holocaust experience and suicidal ideation in high-risk older adults.
- Clarke DE, Colantonio A, Heslegrave R, Rhodes A, Links P, Conn D.Am J Geriatr Psychiatry 2004; 12(1): 65-74.
Correspondence: Diana Clarke, Department of Psychiatry, Room 4W04, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, Ontario, M6A 2E1, CANADA; (email: unavailable).
OBJECTIVE: Depression is an identified risk factor for suicidal ideation, a precursor for more serious suicidal behaviors. This risk might be further compounded in individuals who experience negative life events, including traumatic experiences, and those who might have co-morbid illnesses. The authors examined the impact of past exposure to the Nazi Holocaust on the development of suicidal ideation in a sample of depressed older adults.
METHODS: Authors conducted a retrospective cross-sectional study. The study sample comprised data on 530 consecutive eligible first admissions of Jewish patients who were referred and admitted to a geriatric psychiatry day hospital program between September 1986 and December 2000.
FINDINGS: Multiple logistic-regression analyses, controlling for social support, history of suicide attempts, and other negative life events, showed that severity of depression and exposure to the Holocaust were independently associated with suicidal ideation. Those not showing suicidal ideation were slightly more likely to have reported having a confidant.
COMMENTS: This is the first empirical study to demonstrate an increased likelihood for suicidal ideation in survivors of the Nazi Holocaust. The chronic stress produced by these traumatic events may have predisposed survivors to cope ineffectively as they age, thus resulting in suicidal ideation. Authors highlight the importance of a multifaceted approach when assessing suicidal behaviors in high-risk groups.
Aggression in suicide among adults age 50 and over.
- Conner KR, Conwell Y, Duberstein PR, Eberly S. Am J Geriatr Psychiatry 2004; 12(1): 37-42.
Correspondence: Kenneth R. Conner, Assistant Professor, Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA; (email: kenneth_conner@urmc.rochester.edu).
OBJECTIVE: Aggression confers risk for suicide in younger adults, but there is a paucity of research in middle and older adults. The authors examined the link between aggression and suicide in individuals age 50 and over.
METHODS: Scores on general aggression and aggression in the past month were compared in 85 cases and 85 community-comparison subjects matched on age, gender, race, and county of residence. Bivariate and multivariate tests controlling for mood disorders were conducted, along with analyses to examine age- or gender-related patterns.
FINDINGS: General aggression distinguished Suicide from Control subjects in men and women and in younger (50-64 years) and older (65-plus) subjects. General aggression was more strongly related to suicide in individuals under age 65. Aggression in the past month was also higher in Suicide than in Control subjects from the total sample but was not consistently higher across age and gender strata. General aggression and past-month aggression were not associated with suicide after controlling for mood disorders.
COMMENTS: The association of general aggression and suicide extends to middle and older adulthood, and aggression may serve as a marker for suicide risk before the onset of depression.
Inception rates of deliberate self-harm among adolescents in West London.
- Bhugra D, Thompson N, Singh J, Fellow-Smith E. Int J Soc Psychiatry 2003; 49(4): 247-250.
Correspondence: Dinesh Bhugra, HSRD, Institute of Psychiatry, London, UK; (email: unavailable).
BACKGROUND: Studies have suggested that inception rates of deliberate self-harm among different ethnic group adolescents are broadly similar.
OBJECTIVE: We set out to study the rates of adolescent self-harm over a calendar year in Ealing--part of West London.
METHODS: All cases of deliberate self-harm presenting to the A&E department and pediatrics were identified and socio-cultural factors studied. Ethnicity was obtained using self-ascription.
FINDINGS: A total of 76 cases were identified over one year. Using the at risk population as denominator, no differences in inception rates were noted according to ethnicity. Overdoses were the commonest method used for deliberate self-harm.
COMMENTS: The similarities between the Asian and white adolescents suggest that some common etiological factors may be at play. The risk factors may be related to gender rather than ethnicity in this age group.
Relationship of childhood trauma to age of first suicide attempt and number of attempts in substance dependent patients.
OBJECTIVE: To examine whether childhood trauma effect the age of first attempting suicide and the number of attempts.
METHOD: One thousand twelve hundred and eighty substance dependent patients were interviewed about whether or not they had ever attempted suicide, the age of first attempt and the number of attempts. Patients completed the Childhood Trauma Questionnaire - 34 item version.
FINDINGS: Five hundred and thirty-eight patients (42%) had attempted suicide. Significantly more of the patients who had attempted suicide were female. Patients who had made three or more attempts had significantly higher childhood trauma scores than patients who had made two attempts, who had higher scores than patients who had made one attempt, who had higher scores than patients who had never attempted. Patients who first attempted suicide before the age of 20 years had significantly higher childhood trauma scores than patients who first attempted after 20 years of age.
COMMENTS: Childhood trauma may be a determinant of the age of onset of suicidal behavior and of the number of suicide attempts.
If suicide is a public health problem, what are we doing to prevent it?
Correspondence: Kerry L. Knox, Department of Community and Preventive Medicine, University of Rochester, Box 644, Rochester, NY 11642, USA; (email: kerry_knox@urmc.rochester.edu).
Although not a disease, suicide is a tragic endpoint of complex etiology and a leading cause of death worldwide. Just as preventing heart disease once meant that specialists treated myocardial infarctions in emergency care settings, in the past decade, suicide prevention has been viewed as the responsibility of mental health professionals within clinical settings. By contrast, over the past 50 years, population-based risk reduction approaches have been used with varying levels of effectiveness to prevent morbidity and mortality associated with heart disease. We examined whether the current urgency to develop effective interventions for suicide prevention can benefit from an understanding of the evolution of population-based strategies to prevent heart disease.
Suicide and friendships among American adolescents.
Correspondence: Peter S. Bearman, Institute for Social and Economic Research and Policy, Columbia University, 420 West 18th Street, Suite 814-IAB, New York, NY, USA; (email: psb17@columbia.edu).
OBJECTIVES: We investigated the relationship between friendships and suicidality among male and female adolescents. METHODS: We analyzed friendship data on 13 465 adolescents from the National Longitudinal Survey of Adolescent Health to explore the relationship between friendship and suicidal ideation and suicide attempts. We controlled for known factors associated with suicidality. RESULTS: Having had a friend who committed suicide increased the likelihood of suicidal ideation and attempts for both boys and girls. Socially isolated females were more likely to have suicidal thoughts, as were females whose friends were not friends with each other. Among adolescents thinking about suicide, suicide attempts appear largely stochastic, with few consistent risk factors between boys and girls. CONCLUSIONS: The friendship environment affects suicidality for both boys and girls. Female adolescents' suicidal thoughts are significantly increased by social isolation and friendship patterns in which friends were not friends with each other.
Improving the effectiveness of countermeasures to prevent motor vehicle crashes
among young drivers.
- Simons-Morton BG, Hartos JL. Am J Health Educ 203; 34(5 Suppl): s48-s54.
Correspondence: Bruce G. Simons-Morton, Prevention research Branch, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, 6100 Executive Blvd - 7B05, Bethesda, MD 20892-7510, USA; (email: mortonb@mail.nih.gov).
Motor vehicle crashes (MVCs) are the leading cause of injury and death among
adolescents 16 to 19 years of age. Three areas of countermeasures for decreasing young
driver risk are driver education, licensing policies, and parental management. Driver
education is an essential part of teaching adolescents the rules of the road and operating a
vehicle; however, it has not proven to prevent MVCs among young drivers. Graduate
Driver Licensing (GDL) is a policy innovation accepted widely in the U.S. that delays
licensure and restricts driving among novices under the most dangerous conditions. GDL
programs have effectively reduced motor vehicle crashes where adopted; however,
adoption and effectiveness of these policies vary. Parental management of teen driving
has not been systematically studied until recently and may be an important part of
reducing teen driving risk. Research indicates that parents place modest restrictions on
their teens' driving and that restrictions are related to fewer risky driving behaviors,
tickets, and MVCs. The Checkpoints Program aims to increase parental management of
teen driving and has been shown to do so in short-term follow-ups in several randomized
trials. Each countermeasure is important to teen safety and may need improvements;
however, the greatest protection against MVCs among young drivers would be to provide
better integration among, and wider implementation of, countermeasures.
Burn injuries resulting from (accidental) airbag inflation.
BACKGROUND: Airbags are intended to minimize facial injuries, alone and when used in combination with seatbelts in high-velocity motor-vehicle accidents. They may occasionally perforate, resulting in the release of sodium azide or sodium hydroxide, which result in chemical burns when in contact with skin. The force of deployment may itself result in significant blunt trauma, and there is a temperature rise during the inflation causing thermal burns, possibly as a separate and unnecessary consequence of a relatively minor accident.
METHOD: A case report is presented. The literature on such injuries was reviewed and the mechanism of airbag deployment commented.
COMMENTS: Alternative designs and mechanisms of linking the activation of the device to the velocity of travel or to add a switch which is activated when accessing a motorway are recommended.
Analysis of driver injury severity levels at multiple locations using ordered probit models.
Correspondence: Mohamed Abdel-Aty, Department of Civil & Environmental Engineering, University of Central Florida, 32816, Orlando, FL, USA; (email: mabdel@mail.ucf.edu).
BACKGROUND: The occurrence and outcome of traffic crashes have long been recognized as complex events involving interactions between many factors, including the roadway, driver, traffic characteristics, and the environment. This study is concerned with the outcome of the crash.
METHOD: Driver injury severity levels are analyzed using the ordered probit modeling methodology. Models were developed for roadway sections, signalized intersections, and toll plazas in Central Florida. All models showed the significance of driver's age, gender, seat belt use, point of impact, speed, and vehicle type on the injury severity level. Other variables were found significant only in specific cases.
FINDINGS: A driver's violation was significant in the case of signalized intersections. Alcohol, lighting conditions, and the existence of a horizontal curve affected the likelihood of injuries in the roadway sections' model. A variable specific to toll plazas, vehicles equipped with Electronic Toll Collection (ETC), had a positive effect on the probability of higher injury severity at toll plazas. Other variables that entered into some of the models were weather condition, area type, and some interaction factors. This study illustrates the similarities and the differences in the factors that affect injury severity between different locations.
Analysis of motor-vehicle crashes at stop signs in four U.S. cities.
Correspondence: Richard A. Retting, Insurance Institute for Highway Safety, 1005 North Glebe Road, 22201, Arlington, VA, USA; (email: research@iihs.org).
BACKGROUND: Nearly 700,000 police-reported motor vehicle crashes occur annually at stop signs, and approximately one-third of these crashes involve injuries. The purpose of this study was to develop a better understanding of the crashes that occur at stop signs and to identify potential countermeasures.
METHODS: Police reports of crashes at stop sign-controlled intersections during 1996-2000 in four U.S. cities were examined in detail. At total of 1,788 crash reports for intersections with two-way stop signs were included in the study.
FINDINGS: Stop sign violations accounted for about 70% of all crashes. Typically these crashes were angular collisions. Among crashes not involving stop violations, rear-end crashes were most common, accounting for about 12% of all crashes. Stop sign violation crashes were classified into several subtypes - driver stopped,driver did not stop, snow/wet/ice, and other/unknown. In about two-thirds of stop sign violation crashes, drivers said they had first come to a stop. In these cases, inability or failure to see approaching traffic often was cited as the cause of the crash. Drivers younger than 18 as well as drivers 65 and older were disproportionately found to be at fault in crashes at stop signs.
COMMENTS: Potential countermeasures include changing traffic control and intersection design, improving intersection sight distance, and increasing conspicuity of stop signs through supplemental pavement markings and other devices.
See items 1 and 2 under Risk Perception and Communication
Correspondence: Rosario Ceballo, Department of Psychology, University of Michigan, 525 East University, Ann Arbor, MI 48109, USA; (email: rosarioc@umich.edu).
Poor, inner-city children are exposed to inordinately high rates of community violence. Although the link between exposure to violence and adverse mental health outcomes is well documented, less attention has focused on factors that may buffer children from negative outcomes. Using a sample of 163 4th- and 5th-grade children, this study investigated whether children's perceptions of parental monitoring moderate the relation between children's violence exposure and their psychological well-being, as assessed by depression and hopelessness. Greater exposure to community violence was associated with more symptoms of depression and feelings of hopelessness. Moreover, parental monitoring buffered to a certain extent the relation between violence exposure and psychological functioning. Increased monitoring had a positive impact on the psychological well-being of children who were less exposed to violence; however, as violence exposure increased, the impact of parental monitoring was attenuated.
Homicide and suicide risks associated with firearms in the home: a national case-control study (letter to the editor and reply).
Correspondence: David A. Fritz, Department of Emergency Medicine, Scott and White Memorial Hospital and Clinic, 2401 South 31st Street, Temple, TX 76508, USA; (email: fritz423@pol.net).
It was with deep concern that I read the epidemiological study by Wiebe, "Homicide and Suicide Risks Associated With Firearms in the Home: A National Case-Control Study," in the June 2003 issue of Annals of Emergency Medicine.
I doubt the Annals' editorial board would have published without commentary an article by a pro-gun organization purporting to defend gun ownership. A submission from that organization would be considered biased in favor of gun ownership. The author's affiliations with anti-gun "research" groups are no less compelling an argument for bias.
Dr. Wiebe uses an implicitly biased structure for his study, which assures the outcome. If homicide and suicide frequently involve firearms, it is to be assumed that victims of these acts will have been exposed to an environment in which firearms are found more frequently than nonvictims. This is methodologically akin to performing a study in which you compare automobile fatalities in car owners versus non-car owners.
More to the point, if a different methodology had been used and the outcome favored gun ownership, would that manuscript have been submitted? Research organizations with political agendas might be tempted to withhold data that do not advance those same agendas.
The true issue, as always, is our willingness to accept the risks of human nature (and its aberrations) in return for the benefits of autonomy, self-reliance, and our constitutional rights.
The use of epidemiologic studies to advance political philosophy is certainly not a recent development. Mark Twain's quote, "There are lies, damned lies, and statistics," should give us pause.
Correspondence: Douglas J. Wiebe, Firearm & Injury Center at Penn, Leonard Davis Institute of Health Economics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA; (email: unavailable).
A cornerstone of public health research is to fully understand the risks for death and disease, including those brought on by injuries. The case-control design is a rigorous and well-accepted methodology to examine these risks. Dr. Fritz asks whether the manuscript would have been submitted if a different conclusion had been reached. Absolutely. Studies that identify means of protection are important to publish and discuss in terms of methods, biases, and implications for public health policy. The findings of my study with which Dr. Fritz takes issue are consistent with findings from previous case-control studies,eg, cohort studies,eg, and studies using ecologic methods,eg, each of which have methodologic advantages. The consistency of this body of research -- which indicates that being exposed to firearms makes people more instead of less likely to be killed -- nullifies Dr. Fritz's argument that the findings of my study could be the result of bias.
Rather than offering constructive methodologic or scientific suggestions in his letter, Dr. Fritz chooses to dismiss the study outright, citing a priori "political agendas" as a motivation for the study's results. This accusation is misguided and bears no accompanying evidence. Moreover, his political indictment extends past my authorship to the universities where I have had and/or currently have appointments. These comments do nothing to further scientific dialogue, bypassing the central purpose of letters to the editor.
I am pleased that Dr. Fritz highlights motor vehicles as an analogy, because our ability to build our knowledge of risk and subsequently reduce fatalities despite an increase in miles driven is one of the great public health successes of the 20th century. We can only hope that by fully understanding risks for firearm injury, we can similarly reduce gun-related injury and death.
Selling crime: a study of gun stores with over 200 gun crime traces.
- Kessler J, Hill E. Washington, DC: Americans for Gun Safety Foundation, 2004.
A small number of the nation's 80,000 gun dealers are flooding America's streets with crime guns -- yet Washington rarely investigates, shuts down or prosecutes most of these high-crime dealers.
In the past, the Bureau of Alcohol, Tobacco and Firearms (ATF) has shown that approximately 1% of the nation's gun stores are the source of 57% of the firearms traced to crimes. Yet ATF has never released the names of the most egregious stores -- the stores that habitually sell guns that are later used in crimes. This report is the first ever to identify the nation's high crime gun stores, disclosing the top 120 high crime gun dealers across 22 states -- using ATF data from 1996-2000, the most recent data available. It also reveals, for the first time publicly, the ATF's track record in auditing these dealers (from 2000 to 2003) and details the violations committed by these high crime dealers.
Americans for Gun Safety Foundation believes that the public has a right to know if there are high crime gun dealers operating in their community -- and what steps the Department of Justice/ATF is taking to regulate, shut down and/or prosecute these potentially dirty dealers. Moreover, the vast majority of gun dealers, who are honest and follow the law, should not be tarred by a few dealers who sell an inordinate number of crime guns.
Consider the same situation in another consumer industry: If the Food and Drug Administration determined that 57% of the e coli bacteria cases were caused by 1% of the nation's fast food restaurants, consumers would have a right to know the names of the businesses associated with the problem. A restaurant with zero cases should not be tarred by the poor performance of others; a restaurant with many cases should not be protected by anonymity.
Yet the secrecy around these dealers has had exactly the opposite effect, with many of them still open for business and selling crime guns. Of the top 35 high crime dealers, with 500 or more crime guns traced to their store, all but three are operating today. Consider the case of Chuck's Guns, in Riverdale, Illinois, the largest source of crime guns in America. Undercover detectives visited Chuck's Guns to make undercover straw purchases 17 times -- so often that they were on a first name basis with the store clerks; a gun traced to this dealer was even used to kill a Chicago police officer. Yet the store remains open and no one from the store has served a day in prison.
Finally, the report demonstrates, using Department of Justice data, that not only are these dealers investigated inadequately, but the federal laws designed to crack down on corrupt gun stores are almost never enforced, with a 25% decline in prosecutions under the Bush Administration.
Background on Methodology:
Between 1996 and 2000, the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF) successfully completed 373,006 crime gun traces for police. A trace provides law enforcement with three important pieces of information: the name of the store that first sold the gun, the person who purchased it, and the date it was sold. As a single piece of information, a crime gun trace can sometimes provide a critical lead in a case. In the aggregate, this information can illustrate gun trafficking patterns and highlight high crime and potentially corrupt gun stores.
Using information obtained by the National Association for the Advancement of Colored People and analyzed by the National Economic Research Associates (NERA) for the NAACP's lawsuit against the firearm industry, this is the first report to ever identify the nation's high crime gun stores by name.1 Although the data contains all dealers with at least 25 firearm traces, for purposes of this report, Americans for Gun Safety Foundation has narrowed the list down to only those dealers with at least 200 suspicious traces. These suspicious traces are defined by ATF as a handgun or assault rifle recovered from a criminal or in a crime that has at least one of the following trafficking indicators: 1) an obliterated serial number (between 5% and 10% of crime guns have had their serial numbers defaced); 2) was recovered in a crime within 3 years of first being sold (about 35% of all crime guns are three years of age or younger); 3) was part of a multiple purchase in which more than one handgun was sold to one individual (a handgun bought in a multiple purchase is 4 times more likely to be used in a crime than other guns); 4) was recovered in a state other than where it was bought (about 35% of all crime guns crossed state lines before being recovered by police in a crime); 5) was one of several firearms recovered in a crime that was traced to the same buyer; 6) was sold by a dealer who is habitually unhelpful to police in completing crime gun traces; or 7) was traced back to a store that repeatedly reports firearm thefts.
In addition, Americans for Gun Safety Foundation has obtained data from the Department of Justice through the Freedom of Information Act which shows whether these high crime gun stores have been audited by ATF and whether they were found to have violations. These violations range from failing to keep the records required by the Brady Law on each firearm sale to willfully selling guns to persons prohibited by law from possessing firearms.
In 1998, ATF issued a directive to focus its investigative resources on precisely the same high crime dealers that are revealed in this report. The data obtained by Americans for Gun Safety Foundation will determine whether this directive has been followed. Are high crime dealers being investigated more frequently? Do they have more violations than other stores? Are they being shut down or prosecuted when they break the law?
As a note of caution, just because a store is on the list of high crime gun stores does not mean the store is engaging in illegal behavior. It is possible that some of these stores do such a high volume of business that it is inevitable that some firearms will be used in crimes. However, the analysis conducted by NERA takes into account the number of firearms sold by the dealer, recognizing that dealers with a high sales volume may have high crime gun trace numbers. The analysis revealed that the size of the dealer alone does not account for high numbers of crime gun sales. The NERA analysis disclosed that 14% of dealers were responsible for all traces of handguns for 1995 through 2000, and 7% of dealers were responsible for all traces of handguns recovered in crimes committed less than three years after the original sale of the gun.
In some cases, stores are located near high crime areas and the likelihood that their guns will be used in a crime is greater than for stores in remote areas. However, to be sure, many stores that are located in high crime areas are not among the top crime gun dealers.
In at least one case, a California store was the victim of a theft in which more than 1,000 firearms were stolen during the Los Angeles riots. These stolen firearms continue to show up in crimes.
But there are more than 80,000 individuals and businesses that are licensed to sell firearms in this country, and these high crime stores represent the tiny sliver that habitually sell firearms that are recovered in crimes. In addition, they sell handguns that are later recovered by law enforcement and these guns exhibit indicators that lead federal agents to believe that they were trafficked. These 120 of the highest crime gun stores represent slightly more than one-tenth of one percent of all licensed dealers, but are the source of 15% of the nation's crime guns.
Results in Brief:
Finding #1 - A very small number of gun stores are the source of a large number of crime guns.
120 gun stores were the source of at least 54,694 guns traced to crimes committed between 1996 and 2000.
These stores, representing slightly more than one-tenth of one percent of the nation's gun stores,were the source of 15% of crime gun traces over this period.
Each of these 120 stores had a minimum of 200 crime gun traces, while 6 stores had more than one thousand and two stores had more than two thousand crime gun traces.
These 120 stores were spread out among twenty-two states with Indiana (14 stores), Illinois (13 stores), Georgia (13 stores), Virginia (13 stores), and Maryland (11 stores) being home to the most high crime gun stores.
Finding #2 - Most high crime gun stores remain open and they are rarely inspected by federal agents.
96 of these high crime stores remain open and some that have shut down have reopened with virtually the same ownership.
Having a large number of suspicious crime gun traces seems to have no bearing on whether the store will be inspected by agents. Of the 96 high crime stores that remain open, only 24 (25%) have been audited during the last three and one-half years.
When they are inspected, high crime gun stores are three times as likely to have committed violations than other stores. Of the 24 high crime stores that were audited, 18 were found to have one or more violations ranging from failure to keep proper records to selling firearms
to prohibited individuals. Seven stores had more than 5 violations.
Finding #3 - Federal laws to crack down on corrupt gun stores are almost never enforced.
The number of federal cases brought against corrupt dealers has declined by 25% from the last year of the Clinton Administration -- from 36 cases in FY2000 to 27 in FY2002.
Federal prosecutors in 22 states that are home to 29,418 dealers filed zero cases against gun stores in 2002.
58 of the 120 high crime dealers reside in the twenty-two states that had zero dealer prosecutions in FY2002.
The Multisite Violence Prevention Project: background and overview.
- Multisite Violence Prevention Project. Am J Prev Med 2004; 26(1 Suppl): 3-11.
Correspondence: Arthur M. Horne, Department of Counseling and Human Development Services, 402 Aderhold Hall, The University of Georgia, Athens GA 30602, USA; (email: ahorne@coe.uga.edu).
This paper provides an overview of the Multisite Violence Prevention Project, a 5-year project to compare the effects of a universal intervention (all students and teachers) and a targeted intervention (family program for high-risk children) on reducing aggression and violence among sixth graders. First, the paper describes the role of the Centers for Disease Control and Prevention in developing the project. Second, it details the background of researchers at the four participating universities (Duke University, The University of Georgia, University of Illinois at Chicago, and Virginia Commonwealth University) and examines the characteristics of the selected schools (n=37). Finally, the paper summarizes the theoretical perspectives guiding the work, the development of interventions based on promising strategies, the decision to intervene at the school level, the research questions guiding the project, the research design, and the measurement process for evaluating the results of the program.
Lessons learned in the Multisite Violence Prevention Project collaboration. Big questions require large efforts.
- Multisite Violence Prevention Project. Am J Prev Med 2004; 26(1 Suppl): 62-71.
Correspondence: Patrick H. Tolan, Institute for Juvenile Research, Department of Psychiatry, Families and Community Research Group, 840 S. Wood Street, Chicago IL 60612-7347, USA; (email: ptolan@psych.uic.edu).
This paper summarizes some organizational, scientific, and policy lessons that have emerged in the formation and conducting of the collaboration of the Multisite Violence Prevention Project. We contend that these lessons are valuable for other collaborations and are important for furthering the utility of scientific efforts. A central contention is that large-scale efforts such as this collaboration are underused but are essential for efficient advancement of knowledge about preventing youth violence.
The study designed by a committee. Design of the Multisite Violence Prevention Project.
- Henry DB, Farrell AD. Am J Prev Med 2004; 26(1 Suppl): 12-19.
Correspondence: David B. Henry, University of Illinois at Chicago, Chicago, Illinois, USA; (email: dhenry@psych.uic.edu).
This article describes the research design of the Multisite Violence Prevention Project (MVPP), organized and funded by the National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC). CDC's objectives, refined in the course of collaboration among investigators, were to evaluate the efficacy of universal and targeted interventions designed to produce change at the school level. The project's design was developed collaboratively, and is a 2 x 2 cluster-randomized true experimental design in which schools within four separate sites were assigned randomly to four conditions: (1) no-intervention control group, (2) universal intervention, (3) targeted intervention, and (4) combined universal and targeted interventions. A total of 37 schools are participating in this study with 8-12 schools per site. The impact of the interventions on two successive cohorts of sixth-grade students will be assessed based on multiple waves of data from multiple sources of information, including teachers, students, parents, and archival data. The nesting of students within teachers, families, schools and sites created a number of challenges for designing and implementing the study. The final design represents both resolution and compromise on a number of creative tensions existing in large-scale prevention trials, including tensions between cost and statistical power, and between internal and external validity. Strengths and limitations of the final design are discussed.
Implications of the Multisite Violence Prevention Project for violence prevention at state and local health departments.
Correspondence: Melvin Kohn, Office of Disease Prevention and Epidemiology, Oregon Department of Human Services, 800 NE Oregon, Suite 772, Portland OR 97232, USA; (email: melvin.a.kohn@state.or.us).
What is the relevance of the Multisite Violence Prevention Project (MVPP) for public health practitioners at state and local health departments?
The public health approach to violence prevention begins with describing the problem, then moves to identifying risk factors, devising interventions, and finally, evaluating how well they have worked. This progression fulfills the core public health functions of assessment, policy development and assurance. State and local health departments have a particular niche within the public health world: performing these core functions in a way that meets the specific needs of populations in their jurisdiction.
For violence-prevention practitioners at the state and local level, fulfilling their assessment role means becoming a source of information about the scope of the violence problem and the distribution of risk factors within their state or locality. Because of their familiarity with their community as well as their statutory role in disease control and their experience with public health surveillance in other areas, state and local health departments are well suited for this role. For example, a state or local health department could help answer the question of which schools have the biggest violence problems, or which schools have a risk-factor profile that is likely to be addressed by a particular intervention. In order to be effective, violence-prevention programs must be matched to meet the specific conditions and needs of a school.
Injury prevention at the state and local level requires partnerships with other agencies and organizations outside of the health department. Health departments are experts in the application of research data from epidemiologic studies to fit the specific needs of their communities. However, the fact that youth violence is a public health problem does not mean that public health will be the only, or even the primary, locus for prevention efforts. Departments of Education, local schools and school boards, as well as law enforcement are likely to be key partners for violence-prevention work in schools, and might be most likely to run such programs. So while the health department might not run a school violence prevention program directly, it can help its partners from education or law enforcement do so as effectively as possible.
The investigators involved with the MVPP are to be commended for framing their research questions in a way that is likely to yield useful information for public health practitioners at health departments. The MVPP focuses on the role of the school environment on the school population, rather than just focusing on individual behaviors and motivation. Health departments are likely to be asked: What can my school do to prevent violence? The MVPP should help provide answers to that question.
Schools also may look to the health department for advice about whether they should be focusing primarily on high-risk children or whether a more universal approach that targets all students is more likely to be successful. Undoubtedly, each approach has some value, and the MVPP should help elucidate how and where each is likely to be successful. The diverse nature of youth violence suggests that no single approach will "fix" the problem. Experience in other areas of complex health behavior, such as tobacco control, has indicated that changing that behavior requires a comprehensive approach that addresses the problem in multiple ways.[3] While each component of such an approach may be moderately effective alone, when applied together there is considerable synergy. The MVPP should help quantify the synergy between the "targeted" and "universal" approaches to this problem.
The usefulness of the MVPP for state and local public health practitioners will depend in large part on how generalizable the MVPP is to the specific conditions in that jurisdiction. Fortunately, the findings of the MVPP are likely to be robust because of its multisite design. Even so, the spectrum of sites included in the MVPP will not allow for immediate generalizability to all communities. For example, Oregon is a largely rural state in the Pacific Northwest with a small African-American population, while the communities included in the MVPP are in large part urban and from the Southeast and Midwest, with substantial African-American populations. Therefore, before an Oregon community would undertake the intervention used in the MVPP, that intervention would need to be modified to fit the racial and cultural makeup of schools in Oregon. However, those modifications might influence the effectiveness of the program, which suggests another role for the state or local health department as part of its assurance function: evaluating the effectiveness of the program as implemented on the ground. While this evaluation is likely to be substantially less extensive than what was used in the MVPP, it nevertheless would be critical.
The "big science" described in these articles -- that is, expensive studies with multiple sites, complex designs, and relatively long follow-up time -- has been very fruitfully practiced in other areas of public health. For example, longitudinal studies of cardiovascular disease have helped define risk factors for disease and the effectiveness of clinical interventions. Compared to other areas of public health practice, violence prevention is a young discipline. Just as "big science" has provided critical information for public health practice in other areas, studies like the Multisite Violence Prevention Project will help generate the knowledge base on which the practice of violence prevention will be built in the future.
