Correspondence: Brian M. Quigley, Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, New York 14203, USA; (email: quigley@ria.buffalo.edu).
BACKGROUND: The present analysis is an attempt to examine the characteristics of bars in which violence occurs while accounting for the personalities of the clientele that frequent the bar. It is proposed that an explanation of why violence occurs at certain bars requires examining the characteristics of the bars, the personalities of the clientele, and how these two types of variables act together in order to give rise to aggressive behavior.
METHOD: We conducted interviews with frequent bar patrons (n = 327), assessing participants on a number of individual differences related to aggression and drinking behavior as well as on characteristics of the usual bar that they attend. Bars were categorized into violent bars (n = 256) or nonviolent bars (n = 71) based on participant responses.
FINDINGS: Participants' age, alcohol dependence and anger expression differentiated those who frequented violent bars from those who frequented nonviolent bars. The relationship of these individual differences to bar type was mediated by a number of characteristics of the bar itself, including noise, temperature, the presence of bouncers, the gender of the workers, the presence of billiards and illegal activities in the bar.
COMMENTS: The results indicate that individuals having certain personality characteristics are attracted to bar environments that promote antinormative behaviors such as violence. However, it seems to be the characteristics of the bars that are the strongest predictors of violence.
Legal prosecution of alcohol-impaired drivers admitted to a level I trauma center in Rhode Island.
BACKGROUND: Despite harsh legislation, driving under the influence of alcohol (DUI) is exceedingly common, and alcohol-related motor vehicle crashes (MVCs) account for significant morbidity, mortality, and economic loss. Legal sanctions can keep offenders off the road (protecting other drivers and pedestrians) and ensure compliance with treatment programs (reducing recidivism). However, even with clear evidence of a transgression, the law seems to be inconsistently enforced among trauma patients. The purpose of this study was to measure the rate of legal prosecution among impaired drivers admitted to a trauma center after MVCs, and to determine the recidivism rate among these individuals.
METHODS: Our trauma registry was queried to identify intoxicated drivers admitted during an 18-month period. Court records identified patients who had been charged with traffic offenses, including prior (2 years) and subsequent (1 year) charges.
FINDINGS: Blood alcohol concentration (BAC) was measured in 387 (74%) of 525 drivers, of whom 137 (35%) had BAC >/=100 mg/dL. Of 113 state residents, 22 (19%) were charged with an offense related to the MVC. Of 12 charged with DUI, 10 were convicted, for an overall DUI conviction rate of just 9%. Seven (32%) of those who were charged had prior or subsequent charges. Of 91 patients not charged for the index event, 31 (34%) had prior or subsequent charges.
COMMENTS: Alcohol is involved in a large percentage of MVCs in our region. The infrequency of prosecution for DUI despite property damage and/or personal injury, and the high recidivism rate, are significant social concerns. These data suggest the need for processes to facilitate legal prosecution-possibly including revision of legislation involving reporting of BACs.
Evaluation on intervening efficacy of health education on accidental suffocation and drowning of children aged 0 - 4 in countryside.
- Zhang PB, Chen RH, Denh JY, Xu BR, Hu YF. Zhonghua Er Ke Za Zhi 2003; 41(7): 497-500.
Correspondence: Children's Health Care Research Center in the Second Affiliated Hospital of Nanjing Medical University. Nanjing 210011, CHINA; (email: unavailable).
OBJECTIVE: The main causes of death in children aged 0 - 4 were accidental suffocation and drowning which had a significant relation with parents' lack of prevention knowledge and effective measures. By comparing parents' acknowledge and behavior in preventing accidental suffocation and drowning and the mortality rate of accidental suffocation and drowning after intervening with those before the intervening, evaluation was made on intervening efficacy of health education.
METHODS: Six counties in north Jiangsu were involved in the survey. Two townships drawn from each county were divided into the intervened group and the controlled group. Health education was carried out in the intervened group for one year in 2000. Twenty to 30 parents of infants and children aged 1 - 4 drawn randomly from every township in the intervened group were taken as investigation subjects before and after intervening, and a questionnaire was made for them to answer. Meanwhile, the mortality rates of accidental suffocation and drowning were measured.
FINDINGS: Followed by health education for a year, the parents' opinion about whether unintentional injury can be avoided or not has changed from 18.8% to 20.5% to 1.8% - 2.9%, and parents' knowledge about how to give first aid in spot has increased from 11.1% - 13.5% to 41.1% - 56.8%. The parents' behavior that not sleeping with their infants in the same beds and not tying infants in a candle with blanket, and setting up fence beside pools and rivers has increased by 75.7%, 61.5% and 61.2%, respectively, while their relative knowledge has increased by 212.7% and 194.3%. In the intervened group, the mortality rates of infants' accidental suffocation per 100 000 has fallen from 487.8 to 71.2, dropped by 85.4%; and the mortality rates of drowning in children aged 1 - 4 per 100 000 has fallen from 60.0 to 36.2, dropped by 39.7%. In comparison, in the controlled group, the mortality rates of infants' accidental suffocation per 100 000 has fallen from 344.1 to 276.4, dropped by 19.7%; and the mortality rates of drowning in children aged 1 - 4 per 100,000 has increased by 26.3%, from 51.7 to 65.3.
COMMENTS: Health education to parents is an effective intervening measure for prevention of accidental suffocation and drowning. The goal of health education should be to change inadequate behavior and dangerous environment in which unintentional injury is easily happened. The intervening measures that not sleeping with their infants in the same beds and not tying infants in a candle with blanket, and putting up fence beside pools and rivers are feasible and practicable.
Mass casualty terrorist bombings: A comparison of outcomes by bombing type.
- Arnold JL, Halpern P, Tsai MC, Smithline H. Ann Emerg Med 2004; 43(2): 263-273.
Correspondence: Jeffrey L. Arnold, Yale New Haven Center for Emergency and Terrorism Preparedness, 1 Church Street, 5th Floor, New Haven, CT 06510, USA; (email: arnoldmdcs@cs.com).
BACKGROUND: We compared the epidemiologic outcomes of terrorist bombings that produced 30 or more casualties and resulted in immediate structural collapse, occurred within a confined space, or occurred in open air.
METHODS: We identified eligible studies of bombings through a MEDLINE search of articles published between 1966 and August 2002 and a manual search of published references. Pooled and median rates of mortality, immediately injured survival, emergency department use, hospitalization, and injury were determined for each bombing type.
FINDINGS: We found 35 eligible articles describing 29 terrorist bombings, collectively producing 8,364 casualties, 903 immediate deaths, and 7,461 immediately surviving injured. Pooled immediate mortality rates were structural collapse 25% (95% confidence interval [CI] 6% to 44%), confined space 8% (95% CI 1% to 14%), and open air 4% (95% CI 0% to 9%). Biphasic distributions of mortality were identified in all bombing types. Pooled hospitalization rates were structural collapse 25% (95% CI 6% to 44%), confined space 36% (95% CI 27% to 46%), and open air 15% (95% CI 5% to 26%). Unique patterns of injury rates were found in all bombing types.
COMMENTS: Patterns of injury and health care system use vary with the type of terrorist bombing.
BACKGROUND: It is essential that driver licensing authorities have a valid and reliable system for evaluating older drivers' continuing competency; road tests are usually required as part of such a system. This study sought to find information about the nature of driving errors made during license review tests, and about relationships between error type and test outcome for older drivers.
METHODS: Data from licensing authority files from 533 road tests during a 12-month period were analyzed; medical and other referral information was included. Average driver age was 76 years. Performance scores were generated for intersection negotiation, lane changing, low speed manoeuvres, positioning and speed control, safety margin, and car control.
FINDINGS: Logistic regression analysis showed that test outcome was well predicted by a subset of driving performance scores; adding driver age to the model explained very little variance. Age alone was strongly associated with outcome. Relationships between referral information and test outcome are also reported.
COMMENTS: Results highlight several factors relevant to the development of more valid and reliable road tests for older drivers.
Recovery from perturbations during paced walking.
- Oddsson LI, Wall C, McPartland MD, Krebs DE, Tucker CA. Gait Posture 2004; 19(1):24-34.
Correspondence: Lars I. E. Oddsson, NeuroMuscular Research Center, Boston University, 19 Deerfield St., 4th floor, Boston, MA 02215, USA; (email: loddsson@bu.edu).
The aim of the current study was to develop a safe, standardized, stability test and to explore a set of metrics to characterize the recovery of gait stability in healthy individuals following a single mechanical perturbation during steady locomotion. Balance perturbations were mechanically applied to the right foot of 12 healthy subjects during paced walking by translating a platform embedded in a 12 m walkway diagonally (+45/-135�) relative to the direction of travel approximately 200 ms after heel strike. We examined the medio-lateral (ML) displacement of the sternum before, during and after the platform translation. Measurements of ML position of the right and left shanks in relation to the position of the sternum were used as step-by-step estimates of the moment arm controlling ML motion of the body. We hypothesized that when gait is perturbed in the single stance phase of the step cycle via a translation of the support surface, a series of steps after the perturbation input will be altered reflecting an effort by the CNS to maintain the center of mass (COM) within the base of support and to stabilize the upper body for continued gait. Specifically, if the foot is perturbed laterally during mid-stance a widening of the upcoming step will occur and if the foot is perturbed medially a narrowing of the upcoming step will occur. This behavior was frequent for most subjects. Recovery of non-perturbation behavior was achieved on the third step after the platform translation. An additional strategy was seen for some subjects during lateral perturbation inputs. Instead of widening the upcoming step, these subjects acquired the support to stabilize the body by putting their left foot down very quickly with minimal change in stance width. The recovery profiles of the sternum, though directionally asymmetric, were similar in shape among subjects and roughly proportional to the magnitude of the platform translation. Five to six steps were required for complete recovery in the subjects tested in this study.
The aim was to highlight the role of childcare products as causes for mild brain injury (concussion)in small children (0-4 years of age) and to determine the most dangerous products. By childcare products this report means the following items: child and baby furniture, nursing tables, baby walkers,toys, baby carriages, sport equipment for children, playground equipment and security equipment for children. The data were derived from the EHLASS (European Home and Leisure Accident Surveillance System) for 1998 and 1999 and covered a restricted population of Sweden (approximately 5 per cent). According to this register 182 mild brain injuries (concussions) were recorded following a fall, an accident or a blow to the head among children (0-4 years of age) during 1998 and 158 for 1999. Of those injuries, childcare products were the cause of the accident in 84 (46 per cent) and 76 (48 per cent) cases respectively for 1998 and 1999. The number of children admitted for hospital care was 68 (57/84) and 74 (56/76) per cent respectively. The home was the most common place of the accident and play and leisure activity were the most common activities. More than 50 per cent of these accidents took place during daytime. The product type that caused most accidents was nursery furniture and, in this category, the baby walker was the most dangerous. The product type that caused the second most frequent accidents was playground equipment.
The role of fathers in toddlers' unintentional injury risk.
Correspondence: David C. Schwebel, Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, Alabama 35294, USA; (email: schwebel@uab.edu).
OBJECTIVES: Previous work suggests that maternal parenting and supervision reduces risk for children's unintentional injuries, but very little research has examined the role of fathers in children's unintentional injury risk. The role of fathers in protecting children from unintentional injury was considered.
METHODS: A prospective longitudinal design predicted injury risk in 181 toddlers from the ages of 6 to 36 months. Predictor variables included child gender and temperament, individual difference factors of the mother and father, and parenting factors of the mother and father.
FINDINGS: Hierarchical regression models suggested that fathers' report of gains to the family from their employment was the strongest predictor of risk of children's unintentional injury. Several other paternal and maternal factors were also modestly related to injury risk.
COMMENTS: Data indicate the need to consider the role of fathers in protecting children from unintentional injuries.
Almost 2 million workdays and millions of dollars are lost annually because of non-fatal assaults suffered at the workplace (NIOSH, 1996). Twenty workers, on average, are murdered each week in the United States and an estimated 18,000 workers per week are victims of non-fatal assault (NIOSH, 2001). Violence and stress are two interrelated issues that affect the work force. In-depth studies of these issues have not been conducted with long haul truckers in general, or with women in non-traditional, male dominated fields such as the long haul trucking industry. Epidemiological data related to violence and stress experienced by these under-studied populations are needed to plan effective interventions to reduce occupational risks. Studies employing both qualitative and quantitative methods are needed to articulate risk and protective factors related to violence against workers (Runyan, 2001). Occupational health nurses are qualified to participate in the development and implementation of research and intervention studies to improve worker safety related to violence at the workplace for men and women in both traditional and non-traditional occupational roles.
Review of the Federal Child Labor Regulations: Updating hazardous and prohibited occupations.
- Miller ME, Bush D. Am J Ind Med 2004; 45(2): 218-221.
Correspondence: Mary E. Miller, Washington State Department of Labor and Industries, Employment Standards Program, Olympia, Washington, USA; (email: mmar235@lni.wa.gov).
BACKGROUND: Child labor regulations are intended to protect our young and most vulnerable workers. While regulations are not the only strategy for providing a safe and healthy work environment for young workers, they are the first step in setting the community standard to protect them. The world of work has changed since the first child labor laws were issued in 1939. The U.S. Department of Labor (DOL) enlisted assistance from the National Institute for Occupational Safety and Health (NIOSH) to evaluate the current list of hazardous and prohibited occupations and to make recommendations for changes to the regulations.
METHODS: A group of national experts reviewed the recommendations made by NIOSH. The consensus review process identified areas of agreement, disagreement, and priorities for the DOL's Wage and Hour Division. Gaps in the hazardous orders not addressed in the recommendations were also identified.
FINDINGS: This commentary describes the background of the Hazardous Orders under the Fair Labor Standards Act, the evaluation by NIOSH, the process used to review it, and recommendations for further action.
COMMENTS: The NIOSH report is a valuable resource for anyone working to prevent occupational injuries-among adult and young workers alike. It is crucial that the DOL use the guidance provided by NIOSH and the Young Workers Safety and Health Network to improve the protections for young workers.
Effectiveness of the HomeSafe pilot program in reducing injury rates among residential construction workers, 1994-1998.
- Darragh AR, Stallones L, Bigelow PL, Keefe TJ. Am J Ind Med 2004; 45(2): 210-217.
Correspondence: Amy Rowntree Darragh, Graduate Program in Occupational Therapy, Sacred Heart University, Fairfield, Connecticut 06432, USA;(email: darragha@sacredheart.edu).
BACKGROUND: The construction industry typically has one of the highest fatal and non-fatal injury rates compared with other industries. Residential construction workers are at particular risk of injury (work is in remote sites with small crews, there are often many subcontractors, and they have limited access to safety programs). Difficulty accessing information specific to this group has made research more challenging, therefore, there are few studies. This study evaluated the effectiveness of the HomeSafe Pilot Program, a safety education and training program designed to reduce injuries among residential construction workers.
METHODS: Researchers evaluated whether overall and severe injury incidence rates declined during the intervention period. Data were analyzed using incidence rates and Poisson regression to control for the effect of antecedent secular trend.
FINDINGS: Injury incidence rates declined significantly following HomeSafe; however, this effect was not statistically significant once temporal variation was controlled.
COMMENTS: The decline in injury rates following HomeSafe cannot be attributed solely to HomeSafe, however, programmatic and methodologic limitations contributed to the inconclusive results. Further research into the hazards faced by residential construction workers is needed.
Heat stress while wearing long pants or shorts under firefighting protective clothing.
Correspondence: Tom M McLellan, Operational Medicine Section Defence R&D Canada - Toronto, 1133 Sheppard Avenue West, Toronto ON M3M 3B9, CANADA; (email: unavailable).
It was the purpose of this study to examine whether replacing long pants (P) with shorts (S) would reduce the heat stress of wearing firefighting protective clothing during exercise in a warm environment. Twenty-four Toronto Firefighters were allocated to one of four groups that performed heavy (H, 4.8 km�hm1, 5% grade), moderate (M, 4.5 km�hm1, 2.5% grade), light (L, 4.5 km�hm1) or very light (VL, 2.5 km�hm1) exercise while wearing their full protective ensemble and self-contained breathing apparatus. Participants performed a familiarization trial followed by two experimental trials at 35�C and 50% relative humidity wearing either P or S under their protective overpants. Replacing P with S had no impact on the rectal temperature (Tre) or heart rate response during heavy or moderate exercise where exposure times were less than 1 h (40.8v-v5.8 and 53.5v-v9.2 min for H and M, respectively while wearing P, and 43.5v-v5.3 and 54.2v-v8.4 min, respectively while wearing S). In contrast, as exposure times were extended during lighter exercise Tre was reduced by as much as 0.4�C after 80 min of exercise while wearing S. Exposure times were significantly increased from 65.8v-v9.6 and 83.5v-v11.6 min during L and VL, respectively while wearing P to 73.3v-v8.4 and 97.0v-v12.5 min, respectively while wearing S. It was concluded that replacing P with S under the firefighting protective clothing reduced the heat stress associated with wearing the protective ensemble and extended exposure times approximately 10v-v15% during light exercise. However, during heavier exercise where exposure times were less than 1 h replacing P with S was of little benefit.
Helmet use protects against head injury. Our objective was to assess whether parental knowledge of helmet safety is associated with helmet use in children, and whether a relationship exists between helmet ownership and other safety behaviors. Three hundred forty-one surveys were distributed to parents of third through fifth graders; 97% of parents believed that a helmet confers protection; 49% of parents reported that their child owns a helmet. Of the helmet owners, 27% reported that the child wears it more than 75% of the time. Seat belt usage was associated with helmet ownership (p=0.02) and frequency of wearing a helmet (p=0.04). Although parents are aware of the benefits, a barrier between helmet ownership and usage exists.
This study examined age-specific trends in the annual incidence rates of poisoning exposures reported to a regional poison control center over a 5-y period. Data from the poison control center's 1997-2001 computerized case records were combined with age-specific population estimates from the US Census Bureau. Incidence rates of reported poisoning exposures were calculated and evaluated for the following age groups: < 6 y; 6 to 12 y; 13 to 19 y; 20 to 35 y; 36 to 65 y; and > 65 years. Ordinary linear regression analysis revealed a statistically significant decreasing trend in the annual crude incidence rate of poisoning exposures/1.000 population (r2 = .87, slope = -.33 p = .02). Different patterns were observed in the rates of reported poisoning exposures between the 6 age groups. While there was a significant decrease in the rate of reported poisoning exposures in children < 6 y of age or less, and for adults 20-35 and 36-65 y-old, the incidence rate among children 6-12 y, adolescents, and people > 65 y-old showed no significant decreasing trend.
The circle of safety: a campfire burn prevention campaign expanding nationwide.
- Maguina P, Palmieri TL, Curri T, Nelson K, Greenhalgh DG. J Burn Care Rehabil 2004; 25(1): 124-127.
Correspondence: Stephen E. Morris, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Room 3B312, Salt Lake City, Utah 84132, USA; (email: morris@tulip.med.utah.edu).
Camping is a popular family activity, especially during the spring and summer months. Campfires are a common activity among campers. They offer a source of recreation but also pose a risk for severe burns. The rising number of children with campfire burns seen at our institution triggered a quest for a campaign for the prevention of these injuries. A chart review was performed to study the characteristics and the circumstances of burn injuries of all children treated for campfire-related injuries over a 4-year period between 1997 and 2001. Thirty-two children sustained campfire-related burn injuries, with 88% being under the age of 7. The children had either fallen into the campfire or walked into simmering coals. All accidents would have been prevented if the children had kept a safe distance from the campfire. Normal growth charts were used to determine the average height of 7-year-old children as being 48 inches. A campaign was started to encourage families to keep a safe distance of 4 feet from their campfires by drawing a "circle of safety" with a stick on the ground 4 feet away from the fire.
Correspondence: Margot Putukian, Department of Athletic Medicine, Princeton University, McCosh Health Center, Princeton, NJ 08544-1004, USA; (email: putukian@princeton.edu).
Soccer is the world's game, played by 120 million people around the world and 16 million in the United States. It is unique in that it forbids the use of the upper extremity, other than by the goalkeeper or when throwing the ball into play from the sideline. It is also unique in that it is the only sport in which the head is purposefully used to strike the ball. As sports medicine has evolved, so has our curiosity about how certain sport-specific skills or protective equipment might change the injury profile of a sport. For soccer, there has been some concern that heading may be associated with the development of cumulative traumatic brain encephalopathy, or the "punch drunk" syndrome described in boxers. This article discusses this question in detail, with a critical look at the literature and an emphasis on the prospective data.
Correspondence: Seow-Yian Tay, Department of Emergency Medicine, Tan Tock Seng Hospital, Moulmein Road, 387980 SINGAPORE; (email: seow_yian_tay@ttsh.com.sg).
BACKGROUND: The New Injury Severity Score (NISS) was proposed in 1997 to replace the Injury Severity Score (ISS) because it is more sensitive for mortality. We aim to test whether this is true in our patients.
METHODS: This study was a retrospective review of data from 6,231 consecutive patients over 3 years in the trauma registry of a Level I trauma center studying outcome, ISS, and NISS.
FINDINGS: Misclassification rates were 3.97% for the NISS and 4.35% for the ISS. The receiver operating characteristic curve areas were 0.936 and 0.94, respectively. Neither the ISS nor the NISS were well calibrated (Hosmer-Lemeshow statistic, 36.11 and 49.28, respectively; p < 0.001).
COMMENTS: The NISS should not replace the ISS, as they share similar accuracy and calibration.
Correspondence: Vanessa Newburn, University of Wisconsin Medical School, Department of Population Health Sciences, Madison 53726, USA; (email: vnewburn@students.wisc.edu).
BACKGROUND: To assess trends in mortality among children ages 1-14 in Wisconsin over the last 2 decades and prompt policymakers to include annual monitoring of childhood mortality in the state Health Plan for 2010.
METHODS: Data for all-cause and cause-specific (intentional-, unintentional-, non-injury related) mortality for 1980-1999 were obtained from WONDER, the Centers for Disease Control and Prevention's mortality database, and stratified by black/white race and gender. Trends were assessed using the 5-year moving average method and projected to 2010 to estimate future mortality.
FINDINGS: Childhood mortality rates in Wisconsin decreased 26% from 1980-1999 to 23.7/100,000 population, representing 87 lives saved annually. Throughout this period, Wisconsin's mortality rate was lower than the national average; however, disparities have increased. Boys and blacks experienced the highest death rates and the greatest increases in rates from homicide and suicide. If trends continue, Wisconsin is predicted to have the same overall rate as the United States in 2010.
COMMENTS: Wisconsin has experienced slower rates of decline in childhood mortality than the United States over the past 20 years, due, in part, to increasing disparities by race and gender. To halt this phenomenon, policymakers should include annual monitoring of childhood mortality rates in the state health plan and support appropriate interventions for children at risk.
Reducing mortality in adolescents and young adults in Wisconsin: are we making progress?
Correspondence: David Todem, Department of Biostatistics & Medical Informatics, University of Wisconsin Medical School, Madison 53726-2397, USA; (email: todem@biostat.wisc.edu).
BACKGROUND: Has there been progress in the reduction of adolescent and young adult mortality in Wisconsin over the last 20 years? This paper addresses this question by examining the mortality trends--and disparities by race and gender--of adolescents and young adults in Wisconsin, ages 15-24.
METHODS: Mortality data for blacks and whites from 1980-1999 for Wisconsin and the United States were accessed from the Centers for Disease Control and Prevention's Web-based database system CDC WONDER. Mean death rates were calculated for the 5-year spans 1980-1984 and 1995-1999. A Poisson model for rates was used to summarize the death rates and perform predictions.
FINDINGS: Wisconsin and the United States have reduced mortality in the age group 15-24 by about 17% and 16%, respectively, between 1980-1984 and 1995-1999. In spite of this overall progress, significant disparities still exist between white and black older adolescents and young adults. When compared to 1980-1984, Wisconsin mortality rates for 1995-1999 were 24% lower among whites, but 73% higher among blacks. Disparities still exist when rates are analyzed by the leading causes of deaths. Deaths due to motor vehicle injuries have decreased for whites by about 31% compared to an increase of 19% for blacks.
COMMENTS: Wisconsin has made progress in reducing death rates in adolescents and young adults, especially in fatal motor vehicle injuries. However, significant disparities still exist between whites and blacks, males and females, and leading causes of deaths. Wisconsin should work to reduce the mortality rate in adolescents and young adults and to eliminate disparities by 2010.
Has there been progress in reducing mortality among Wisconsin adults ages 25 to 44?
- Dranger EA, Hoffman JM. WMJ 2003; 102(8): 42-46.
Correspondence: Elizabeth Dranger, Department of Population Health Sciences, University of Wisconsin-Madison, 53726, USA; (email: eadranger@students.wisc.edu).
Wisconsin residents age 25-44 years represent an important life stage and a relatively large portion of the Wisconsin population. Focusing on the most common causes of death among Wisconsin adults 25-44 years old, we assess progress in reducing mortality, describe disparities between subgroups of this age group, and identify areas for improvement. Mortality trends and leading causes of death were examined from 1980-1999 by querying the Centers for Disease Control and Prevention's WONDER database using the methods established by the National Vital Statistics System. Mortality rates in Wisconsin declined slightly (5%) during this time, and are consistently lower than the national rates. Mortality due to unintentional injury, cancer, and coronary heart disease declined in this age group. However, this decline was in contrast to increases in mortality due to suicide, homicide, and HIV--all preventable causes of death. Finally, disparities in mortality rates increased between black and white Wisconsin residents. In order to make progress in this age group, public health efforts need to focus on effective strategies to prevent HIV and violence.
A decline in adult mortality, ages 45-64, in Wisconsin over the last 20 years: is it enough?
Correspondence: A. Said, Section of Gastroenterology and Hepatology and Department of Population Health Sciences, University of Wisconsin-Madison, 53792, USA; (email: a.said@hosp.wisc.edu).
BACKGROUND: Decreasing mortality is an important objective of health improvement. We examined the progress in reducing overall mortality in Wisconsin over the last 2 decades in the age group spanning 45-64 years. Goals for reducing mortality and disparities in mortality by 2010 were addressed.
METHODS: We examined trends in all cause mortality for Wisconsin from 1980-1999 for ages 45-64. Mortality data was also examined by subgroups (race and gender) and cause. Mortality data was abstracted from Centers for Disease Control and Prevention's WONDER.
FINDINGS: From 1980-99, adults aged 45-64 experienced a 22% decline in mortality and, consequently, over 1720 lives were "saved" annually in Wisconsin in this age group between 1995-1999. Mortality in black men and women declined 8% and 10% respectively in this interval as compared to 27% for white males and 19% for white females (P<0.05 for all groups for temporal change in death rates). Significant declines in cardiovascular and cancer mortality were achieved. Deaths from injuries increased slightly. The black to white mortality ratio is projected to increase by 2010.
COMMENTS: Wisconsin has done well in reducing overall mortality in persons 45-64 years of age over the last 2 decades. Future challenges include reducing health disparities between blacks and whites.
The epidemiology of serious and fatal injury in San Diego county over an 11-year period.
- Potenza BM, Hoyt DB, Coimbra R, Fortlage D, Holbrook T, Hollingsworth-Fridlund P; And the Trauma Research and Education Foundation. J Trauma 2004; 56(1): 68-75.
Correspondence: Bruce M. Potenza, MD, FACS, UCSD Medical Center, Division of Trauma, 8896, 200 West Arbor Drive, San Diego, CA 92103-8896, USA; (email: bpotenza@ucsd.edu).
BACKGROUND: Analysis of the mechanism and severity of injury over time may permit a more focused planning of acute care and trauma prevention programs.
METHODS: A retrospective, population-based study examining severe traumatic injury in a single county was undertaken. Three overlapping data sets were used to form a composite injury data set.
FINDINGS: There were 55,664 patients included in the study. A total of 40,897 (73.5%) patients survived and 14,767 (26.5%) died. Of those patients who died, 8,910 (60.3%) died in the field and were not transported to a trauma center. There was an increase in the mean age of all trauma victims (3 years) and an increase of 5 years in fatally injured patients. The mean Injury Severity Score decreased from 14.7 to 11.6 (p < 0.01); however, Injury Severity Score for fatal patients remained constant (39.7). The overall injury rate remained unchanged (195 per 105), whereas the fatal injury rate decreased by 22% (45.9 per 105) over the 11-year study period. The leading cause of injury was motor vehicle crash, followed by assault. The leading cause of fatal injury was suicide, followed by homicide.
COMMENTS: A combination of three independent injury data sources generated a composite data set of serious and fatal injury. This regional injury analysis was the most comprehensive overview of injury in our region. Important observations included the following: there has been no change in the overall incidence of severe injury within our county; the incidence of fatal traumatic injury has significantly decreased; the leading causes of nonfatal injury do not correlate with the rank order of fatal injury; intentional injury was the leading cause of injury deaths; and scene fatalities represent a poorly studied group of patients who may benefit from primary prevention and injury control research.
Traumatic dental injuries in Brazilian preschool children.
The purpose of this study was to determine the prevalence and distribution of traumatic injuries to primary anterior teeth in children from zero to 6 years old, all attendees in 28 public nursery schools in Canoas (Brazil). A total of 1545 boys and girls participated in the study. The children were clinically examined for signs of trauma according to Andreasen's classification. Traumatic injuries were identified in 35.5% of children. The largest percentage of injuries was demonstrated by 3-4-year-old child, with no significant difference between boys and girls. The maxillary central incisor was the most vulnerable to injury, without differences between the right and the left side. Single tooth injury was predominant in all age groups. Crown fractures represented 83% of all traumatic injuries. Our findings emphasize the importance of encouraging parents to visit the dentist with their child at an early stage. Furthermore, parents and educators should be advised about prevention of traumatic injuries and actions to be taken in case of an accident.
The role of the helmet in the prevention of traumatic brain injuries.
Correspondence: John W. Powell, Athletic Training Education, 105 IM Sports Circle, Michigan State University, East Lansing, MI 48824, USA; (email: powellj4@msu.edu).
Today, traumatic brain injuries (TBIs) exceed 1 million cases per year. Tens of thousands of people die and hundreds of thousands of people are hospitalized. The health care costs exceed $50 billion. The Centers for Disease Control and Prevention estimate that people with mild TBIs who are not hospitalized add another $17 billion to the total dollars spent on care. These high frequencies and costs place a high priority on programs and procedures to minimize the number of injuries and to reduce the severity of those that occur. One of these programs focuses on the protective devices worn by the people that work and play in environments where there is an identified risk of TBI. Because these environments cover a wide variety of activities, the design and effectiveness of these protective devices must be specific to the nature of the activity and the person they are designed to protect.
Distribution and determinants of health and work status in a comprehensive population of injury patients.
Correspondence: Willem Jan Meerding, Department of Public Health, Erasmus MC, University Medical Center-Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, THE NETHERLANDS; (email: w.meerding@erasmusmc.nl).
BACKGROUND: Insight into the distribution and determinants of both short- and long-term disability can be used to prioritize the development of prevention policies and to improve trauma care. We report on a large follow-up study in a comprehensive population of injury patients.
METHODS: We fielded a postal questionnaire in a stratified sample of 4,639 nonhospitalized and hospitalized injury patients aged 15 years and older, at 2, 5, and 9 months after injury. We gathered sociodemographic information, data on functional outcome with a generic instrument for health status measurement (EuroQol EQ-5D+) and data on work absence.
FINDINGS: The response rates were 39%, 75%, and 68% after 2, 5, and 9 months, respectively. The reported data were adjusted for response bias and stratification. The 2-month health status of nonhospitalized patients was comparable to the general population's health when measured by the EQ-5D summary score, although considerable prevalence of restrictions in usual activities (24.0%) and pain and discomfort (34.8%) were reported. Hospitalized patients reported higher prevalences of disability in all health domains. Their mean EQ-5D summary score increased from 0.62 at 2 months to 0.74 at 5 months but remained below the population norm at 9 months, particularly for patients with a long hospital stay. Patients with injuries of the spinal cord and vertebral column, hip fracture, and other lower extremity fractures reported the worst health status, also when adjusted for age, sex, and educational level. Age, sex, type of injury, length of stay, educational level, motor vehicle injury, medical operation, intensive care unit admission, and number of injuries were all significant predictors of functioning. Nonhospitalized and hospitalized injury patients lost on average 5.2 and 72.1 work days, respectively. Of nonhospitalized patients, 5% had not yet returned to work after 2 months, and 39%, 20%, and 10% of hospitalized patients had not yet returned to work after 2, 5, and 9 months, respectively. In a multivariate regression analysis, length of stay, type of injury, level of education, and intensive care unit admission appeared to be significant predictors of absence duration and return to work.
COMMENTS: Injury is a major source of disease burden and work absence. Both hospitalized and nonhospitalized patients contribute significantly to this burden.
Resilience to risk-taking behaviors in impoverished African American girls: The role of mother-daughter connectedness.
- Aronowitz T, Morrison-Beedy D. Res Nurs Health 2004; 27(1): 29-39.
Correspondence: Teri Aronowitz, School of Nursing, College of Human Services & Health Professions, Syracuse University, Syracuse, NY, USA; (email: tbaronow@syr.edu).
Rates of risk behaviors (e.g., violence, substance use) for impoverished girls are exceedingly high. Some view their future pessimistically, decreasing their resilience to avoid risky behaviors. Others resist such behaviors. Connectedness with an adult promotes this resilience, but how is unclear. The purpose of this secondary analysis was to investigate the relationships among connectedness to mother, time perspective, and resilience to risk-taking behaviors in impoverished African American girls ages 11-15. Structural equation modeling was used to cross-validate this model. In contrast to the results found in earlier studies, no direct relationship emerged between maternal connectedness and resilience. Instead, future time perspective was the key mediator between connectedness and resilience. These findings suggest that an important aspect of interventions to foster resilience to risk behaviors in young girls could be to assist their mothers in developing a connected relationship with their daughters that would promote a future time perspective.
Impact of impulsiveness, venturesomeness, and empathy on driving by older adults.
- Owsley C, McGwin G Jr, McNeal SF. J Safety Res 2003; 34(4): 353-359.
Correspondence: Cynthia Owsley, Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th Street, Suite 609, Birmingham, AL 35294-0009, USA; (email: owsley@uab.edu).
PROBLEM: Although personality characteristics such as impulsiveness have been linked to the driving safety and driving habits of young and middle-aged adults, little research has focused on the role of personality in older driver behavior.
METHOD: Using the IVE questionnaire in an exploratory study, three personality dimensions (impulsiveness, venturesomeness, and empathy) were measured in 305 older drivers (ages 57-87 years old). In addition, the Driving Habits Questionnaire was used to estimate driving exposure, and the Driver Behavior Questionnaire (DBQ) was used to estimate driving errors and violations. State-recorded crash data were made available by the state public safety agency.
FINDINGS: Subjects who reported four or more driving errors had higher impulsivity and empathy scores and lower venturesomeness scores. Subjects reporting driving violations were more likely to have high impulsivity scores. Driving six or more places per week was associated with lower levels of impulsivity.
COMMENTS: These results suggest that a comprehensive understanding of driving problems among older adults should also include a consideration of personality dimensions. In doing so, the challenges faced in the interpretation of self-report instruments on driving behaviors must be acknowledged, with a move in research toward greater reliance on more objective measures of driving behavior when assessing the impact of personality variables.
Fatal and non-fatal machine-related injuries suffered by children in Alberta, Canada, 1990-1997.
- Lim GW, Belton KL, Pickett W, Schopflocher DP, Voaklander DC. Am J Ind Med 2004; 45(2): 177-185.
Correspondence: Donald C. Voaklander, BC Rural and Remote Health Research Institute, University of Northern British Columbia, 3333 University Drive, Prince George, British Columbia, V2N 4Z9, CANADA; (email: voakland@unbc.ca).
BACKGROUND: Children raised on farms are exposed to many hazardous types of machinery. The objective of this study was to describe the magnitude of non-fatal and fatal farm machinery injuries in Alberta children and adolescents (0-17 years) for the years 1990-1997. To date, there have been no published studies of pediatric farm injuries in Western Canada.
METHODS: Data were collected through the Canadian Agricultural Injury Surveillance Program (CAISP). Death certificates and hospital charts were audited to provide enhanced information about the circumstances of injuries related to farm machinery for farm persons aged 17 years and younger.
FINDINGS: A total of 302 farm machinery injuries were recorded for the years 1990-1997. Of these, 14 resulted in death. All-terrain vehicles (ATVs) were the most common cause of injury (n = 76), followed by tractors (n = 72), and power take-offs (n = 15). The predominant injury mechanism was entanglement (n = 69), followed by falls from machines (n = 57), and being pinned/struck by a machine (n = 49). The median length of hospital stay for injuries was 2.0 days. Males (median = 2.0 days) had significantly longer hospital stays than females (median = 1.0 days). There were significantly more injuries reported during the summer and autumn than during the winter and spring. Those injured in the autumn were significantly older (median = 13.0 years) than children injured in the spring (median = 9.0 years). Injury rates dropped significantly during the study period from 119.9/100,000 per year in 1990 to 50.7/100,000 in 1997.
COMMENTS: While injury rates have dropped, the number of injuries occurring to children on Alberta farms is of concern. The large number of ATV related injuries suggests that preventative strategies need to be focused in this area.
A teacher-focused approach to prevent and reduce students' aggressive behavior.
- Orpinas P, Horne AM, Multisite Violence Prevention Project. Am J Prev Med 2004; 26(1 Suppl): 29-38.
Correspondence: Pamela Orpinas, PhD, Department of Health Promotion and Behavior, 319 Ramsey Center, The University of Georgia, Athens GA 30602, USA; (email: porpinas@coe.uga.edu).
The purpose of this article is to describe the GREAT (Guiding Responsibility and Expectations for Adolescents for Today and Tomorrow) Teacher Program, a prevention program for middle school teachers to deter students' aggressive behavior. It was developed on the basis of an ecologic understanding of aggression and on specific constructs of Social Cognitive Theory. The goals of the program were (1) to increase teacher awareness of different types of aggression, risk factors, role of the classroom teacher, and influence of the school climate on the child's behavior; (2) to develop strategies that will prevent aggression; (3) to improve teacher management skills to reduce power struggles and aggression; and (4) to enhance skills to assist students who are the targets of aggression. To accomplish these goals, teachers participated in a 12-hour workshop and 10 support group sessions. Training, manuals, and supervision were provided to maintain program integrity and to assure the quality of implementation.
Supporting violence prevention at the school site: Issues and lessons in state administration.
- Nichols C. Am J Prev Med 2004; 26(1 Suppl): 29-38.
Correspondence: Chuck Nichols, California Department of Education, Safe and Healthy Kids Program Office,1430 N Street, , Sacramento CA 95814, USA; (email: cnichols@cde.ca.gov).
Violence against children on the school site -- in its many forms, from social ostracism to physical bullying to schoolyard fights to gang violence -- has a direct impact on the ability of school systems to prepare youth to be successful citizens. This fact, along with our society's universal distress at the thought of a child in pain, means that a primary goal of school administrators at every level is to provide for students an environment that is physically safe and emotionally secure. For the California Department of Education (CDE), the strategy for the achievement of this goal is to lead local education agencies (LEAs) toward the implementation of research-validated prevention programs such as those described in this supplement.
In a large state such as California, where there are 1300 LEAs and over 8000 individual schools, leading and supporting the implementation of new programs is a very large task. The elements of this task include funding, capacity building and technical assistance, evaluation and program improvement, and program auditing. For over 20 years, CDE has had an explicit school violence-prevention mission and has learned valuable lessons regarding each of these support elements, particularly during the past 8 years when violence-prevention funding has steadily and dramatically increased.
Funding from the state that is intended for a specific use such as violence prevention is allocated to LEAs in one of two ways -- as an "entitlement" or as an award from a competitive grant process. Entitlement funds are given to all qualifying LEAs (e.g., all LEAs serving grades 9-12) based on school enrollment or on average daily attendance. In general, grant programs include more requirements about the manner in which funds may be used.
The key to successful program implementation with either funding mechanism lies in minimizing the disadvantages of that mechanism. In the case of grant funding, the major disadvantage is that the program staff may be contractors or may be in temporarily funded positions sitting outside the mainstream of LEA management. One way to minimize this situation is to provide long-term grants, for which annual refunding is contingent on periodic self-evaluation reports. In the case of entitlements, the problem of small funding amounts may be minimized by encouraging the formation of consortia of LEAs that pool funding. The problems of program commitment and capacity will be helped by statewide capacity-building efforts, although this is by no means a quick solution in a large state.
Prevention programs are exceptionally susceptible to variation in effectiveness related to issues such as: (1) differing circumstances at individual school sites, (2) fidelity of implementation, and (3) the skill of practitioners. For these reasons and others it is impossible to be certain that a given program will work in a given situation and over an extended time period. Ongoing evaluation of prevention programs is therefore essential to the continued success of any prevention program. However, it is an unfortunate fact that scientifically valid evaluation is beyond the resources of the vast majority of school sites.
It is clear that the prevention community, with strong leadership from researchers, is moving in a direction that will lead us to our goal of school environments that are physically safe and emotionally secure. Although there is much work to be done, the research community is devoting tremendous resources to the development of demonstrably effective programs in all aspects of prevention. There is, however, a developing issue at the grass-roots level of prevention. Working-level practitioners who have recently become aware of the need to use research-validated prevention methods are beginning to look for help in the implementation of those programs. A practitioner from San Diego, for example, might read in the literature of a successful violence-prevention program that operated in Texas. How does the San Diego practitioner find out the information needed to implement the program effectively? Among the questions that practitioner might ask are the following:
Is training available?
Does detailed program documentation exist?
Can a full-time teacher/part-time prevention practitioner effectively deliver the program?
What adaptations can be made to suit local circumstances without reducing program effectiveness?
Can the program be operated effectively at a large scale? (Many school districts contain over 5000 students, and a significant number serve over 25,000 students.)
Will the program work with varying target populations?
Are materials that were used to deliver the program available? Do they include session-by-session activity plans or curricula?
What is the cost of the training and materials?
Is ongoing technical assistance in program implementation available?
What low-cost self-review methods can be used to help assure program effectiveness?
A research-validated prevention program cannot be successfully implemented at the school site unless these issues of fidelity, adaptation, and scalability are carefully addressed by the program developer. Valuable work is being done in this area already, but it is the opinion of the CDE that the prevention community would benefit if researchers and program developers shifted more of their resources from basic research to the study of program replication at the school site. Only when a successful basic research project is followed by a project on the replication and scalability of the program can the youth of our country benefit from that research.
School Bullying: Changing the Problem by Changing the School.
- Orpinas P, Horne AM, Staniszewski D. School Psychol Rev 2003; 32(3): 431-444.
Correspondence: Pamela Orpinas, PhD, Department of Health Promotion and Behavior, 319 Ramsey Center, The University of Georgia, Athens GA 30602, USA; (email: porpinas@coe.uga.edu).
This article describes the development and evaluation of a bullying prevention
program in one large, public elementary school. The program, which was
developed based on a collaborative model between school personnel and university
consultants, included modification of the school environment, education of
students, and training of teachers. To evaluate the program, all students completed
an anonymous survey in the spring of 1998 (n = 541) and the spring of 1999 (n =
520). Among the younger children, a 40% reduction in the mean self-reported
aggression and a 19% reduction in mean self-reported victimization were found.
Among children in third through fifth grade, a 23% reduction in the mean reported
victimization was observed, but no significant differences in aggression were found.
This article proposes a model of translating theory and research of violence prevention
into action.
Studying change in dominance and bullying with linear mixed models.
Correspondence: Jeffrey D. Long, University of Minnesota, Department
of Educational Psychology, 206 Burton Hall/178 Pillsbury Drive SE, Minneapolis, MN 55455, USA; (email: longj@tc.umn.edu).
It is argued that studies of early adolescent peer victimization and bullying
should be longitudinal because of the dynamism of this developmental period.
Traditional methods for analyzing longitudinal data are inadequate because of the
strict data requirements and inflexibility of models. A better alternative is linear
mixed models (LMMs) for repeated measures. LMMs have less restrictive data
requirements and much flexibility in the type of models that may be specified.
Using empirical data from middle school students, it is shown how LMMs can be
used to examine three major aspects of change in dominance and bullying. The
first is unconditional change, which involves treating the sample as an entire group
and modeling the mean trajectories of dominance and bullying over time. The
second is conditional change, which involves examining gender differences in
mean change of dominance and bullying over time. The third is dynamic change,
which involves examining the longitudinal covariation between bullying and dominance
controlling for trajectory effects. The algebra of the LMMs is presented
from a multilevel perspective assuming a random effects model. The results are
discussed in terms of dominance theory and highlight the advantages of the LMM
approach to data analysis in the study of adolescent peer victimization and bullying.
State laws and policies to address bullying in schools.
Correspondence: Susan P. Limber, Institute on Family and Neighborhood Life, Clemson University, 158 Poole Agricultural Center, Clemson, SC 29634, USA; (email: slimber@clemson.edu).
This article focuses on the recent flurry of legislation in states to address
bullying among school children. The primary purpose is to describe, compare, and
contrast current state laws about bullying. Specifically, a description is provided
of legislators' definitions of bullying and legislative findings about the nature and
seriousness of bullying. Next, an analysis is conducted of the stated purposes of
these laws and their likely consequences. Following is a brief review of several
states' efforts to develop model policies about bullying. Finally, recommendations
are made about actions that legislators and other policy makers can take to best
support educators in the development of effective bullying prevention policies and
programs.
Perceptions of the frequency and importance of social support by students classified as victims, bullies, and bully/victims in an urban middle school.
This study examined the perceptions of the frequency and importance
of social support for students classified as bullies, victims, bully-victims,
and comparison students (nonbully/nonvictim). The sample included 499 sixth- through
eighth-grade students from a predominantly Hispanic urban middle school.
Students completed an anonymous survey that included 18 questions on both the
receipt and provision of bullying behavior and were categorized into four groups
(bully, victim, bully/victim, and comparison). Perceptions of both the frequency
and importance of social support from parents, teachers, classmates, close friends,
and the school were assessed via the Child and Adolescent Social Support Scale
-Revised (CASSS-R; Malecki, Demaray, & Elliott, 2000). The goals of the current
study were to (a) present descriptive data on bullying behavior; (b) investigate
differences in the frequency and importance ratings of perceived social support by
bully status (bully, victim, bully/victim, and comparison); and (c) investigate what
sources of support were most related to victim, bully, bully/victim, and comparison
students' scores. Significant differences were found among the four groups on
both the frequency and importance of total social support and support from the
various sources. Results and implications are discussed.
Bullies and victims in the peer ecology: four questions for psychologists and school professionals.
Correspondence: Ernest Hodges, Department of Psychology, St. John's University, 8000 Utopia Parkway, Jamaica, NY 11439, USA; (email: hodgese@stjohns.edu); or to Philip C. Rodkin, 220B Education Building, Mail Code 708, Department of Educational Psychology, University of Illinois at Urbana-Champaign, 1310 S. 6 St., Champaign, IL 61820, USA; (email: rodkin@uiuc.edu).
The purpose of this article is to synthesize recent work on aggression
and victimization in educational settings from an ecological perspective. Four questions
directed towards school psychologists and bullying researchers guide this
review: (a) How do bullies fit into their peer ecologies? (b) How do victims fit into
their peer ecologies? (c) How can teachers impact bullying and victimization? (d)
How can parents impact bullying and victimization? Our goal is to encourage
school service professionals, prevention and intervention researchers, developers
of antibullying curricula, and child development researchers to consider the implications
of these questions as part of their effort to confront victimization and understand
its contextual roots.
Assessing the climate of the playground and lunchroom: implications for bullying prevention programming.
- Leff SS, Power TJ, Costigan TE, Manz PH. School Psychol Rev 2003; 32(3): 418-430.
Correspondence: Stephen S. Leff, Children's Seashore House of The Children's Hospital of Philadelphia, Department of Pediatric Psychology, 3405 Civic Center Blvd., Philadelphia, PA 19104, USA; (email: leff@email.chop.edu).
A considerable number of bullying prevention and intervention programs
are being implemented in elementary schools across the United States and worldwide.
However, although the majority of aggressive interchanges between students
occur in the playground and lunchroom contexts, many well-known outcome
measures of bullying are not particularly sensitive to those unstructured settings.
The authors used a participatory action research framework to partner with
playground and lunchroom personnel and community members to conduct an extensive
scale development study, which resulted in the creation of the Playground
and Lunchroom Climate Questionnaire (PLCQ). An initial psychometric study of
the PLCQ was conducted to assess school climate variables that may affect
children's social and behavioral functioning at school from the perspective of playground
and lunchroom personnel. Results from the study suggest that the PLCQ
measures two school context variables: (a) structure for activities and monitoring,
and (b) staff collaboration. Suggestions for combining the PLCQ with more traditional
measures to guide bullying prevention and intervention programming are
discussed.
Bullies and victims among polish school-aged children.
- Mazur J, Malkowska A. Med Wieku Rozwoj 2003; VII(1 Pt 2): 121-134.
Correspondence: J. Mazur, Zaklad Epidemiologii, Instytut Matki i Dziecka, ul. Kasprzaka 17a, 01-211 Warszawa, POLAND; (email: epid@imid.med.pl).
The objective of the study was to determine the prevalence of bullying in Polish schools and to evaluate the relationship between bullying and substances abuse. Data obtained through HBSC (Health Behaviour in School-Aged Children. A WHO Cross-National Study) conducted in Poland in 2002 were used. The representative sample comprised 6383 students 11, 13 and 15 years of age. The indicators of total and frequent bullying were defined and five main ways of bullying were described. Relationship between bullying and substance abuse was evaluated by logistic regression models adjusted for age and gender with frequent (at least 2-3 times a month) bullying as dependent variable. Results showed that 20% of students were involved in frequent bullying; 10% as perpetrator, 8% as victim and 2% as both. More boys than girls reported being involved in bullying both as victims and perpetrators. The prevalence of victimization decreased with age while the prevalence of bullying increased. Verbal bullying was the main way of bullying reported by students. 10% of students suffered from physical violence and 16% reported bullying others in physical ways. The difference between boys and girls was higher for physical bullying. Frequent episodes of drunkenness (more than 10 times in the lifetime) increased the risk of bullying about 7 times (OR=6.8; CI=4.9-9.4). Every day tobacco smoking and frequent marihuana use resulted in three fold increase in the risk of bullying. The positive results of the Norwegian anti-bullying programme provided by D. Olweus as well as other examples of anti-bullying strategies developed recently within the European Community and model approaches from Australia are described.
The concept of degraded images applied to hazard recognition training in mining for reduction of lost-time injuries.
- Kowalski-Trakofler KM, Barrett EA. J Safety Res 2003; 34(5): 515-525.
Correspondence: Kathleen M. Kowalski-Trakofler, National Institute for Occupational Safety and Health (NIOSH), Pittsburgh Research Laboratory, 626 Cochrans Mill Road, 15236, Pittsburgh, PA, USA; (email: kkowalski@cdc.gov).
BACKGROUND: This paper discusses the application of a training intervention that uses degraded images for improving the hazard recognition skills of miners.
METHODS: NIOSH researchers, in an extensive literature review, identified fundamental psychological principles on perception that may be employed to enhance the ability of miners to recognize and respond to hazards in their dangerous work environment. Three studies were conducted to evaluate the effectiveness of the degraded image training intervention. A model of hazard recognition was developed to guide the study.
FINDINGS: In the first study, miners from Pennsylvania, West Virginia and Alabama, who were taught with the aid of degraded images, scored significantly better on follow-up hazard recognition performance measures than those trained using traditional instructional methodologies. The second and third studies investigated the effectiveness of the training intervention at two mining companies. Data collected over a 3-year period showed that lost-time injuries at mines in Alabama and Illinois declined soon after the training intervention was instituted.
COMMENTS: Further exploration of the hazard recognition model and the development of other interventions based on the model could support the validity of the steps in the hazard recognition model.
- Partonen T, Haukka J, Pirkola S, Isometsa E, Lonnqvist J. Acta Psychiatr Scand 2004; 109(2): 110-115.
Correspondence: Timo Partonen, Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, FINLAND; (email: timo.partonen@ktl.fi).
OBJECTIVE: Physical time-givers may have a modifying effect on the time patterns of death from suicide.
METHOD: Data on a total of 1397 suicides in Finland over a year were collected using the method of psychological autopsy. We linked versatile information on each individual to meteorological data adjusted for local weather conditions, and to the universal astronomic data.
FINDINGS: The number of suicides with seasonal mismatch was greater than the expected in the northernmost region of the country (P = 0.03). The northern location was the most significant predictor of such suicides (P = 0.001). They were associated with the changes in ambient temperature during the preceding day (P < 0.00001), the changes to colder preceding suicides in the spring.
COMMENTS: Our findings show that mismatch between the changes in ambient temperature and those in the length of day may precede death from suicide in some individuals.
Estimation of reporting delay and suicide incidence in Hong Kong.
- Cui JS, Yip PS, Chau PH. Stat Med 2004; 23(3): 467-476.
Correspondence: Jisheng S. Cui, Department of Public Health, The University of Melbourne, Parkville, Vic. 3010, AUSTRALIA; (email: j.cui@unimelb.edu.au).
This paper uses a semi-parametric method to examine the reporting delay distribution in suicides in Hong Kong reporting system. The data arise from a rightly truncated situation in which only suicide cases registered before a specific time are known to have occurred; otherwise they are not recorded in the known death files even if they have occurred. It is shown that the poisoning-related suicide deaths have a longer reporting delay than other suicide methods. By modelling the reporting delay function, a Horvitz-Thompson-type estimator is suggested to adjust for reporting delay and to provide a more timely estimate of the suicide incidences for monitoring the suicide problem in Hong Kong. Based on these analyses, we recommended a suitable cut-off date to collect suicide cases occurring in the previous year and reported before this date in Hong Kong.
BACKGROUND: This study evaluates how the traffic behaviors of young drivers and their attitudes toward traffic regulations have changed over the last 23 years, and particularly, whether the differences in attitudes and behavior between male and female drivers have changed.
METHOD: The study was conducted in 2001, and it replicated a traffic attitude survey administered in 1978. The same survey was used, enabling comparison between the years. The number of respondents was 3,158 in 1978 and 2,759 in 2001.
FINDINGS: The comparison revealed several differences regarding the background factors, attitudes, and driving style of novice drivers. Most obvious changes in the drivers' background were the changes in education level (higher today), driver training (more private training today), and exposure/experience in terms of kilometers (more today). The summary variable measured that the young drivers showed more negative attitudes toward traffic rules and safe driving in 2001 compared to 1978. Female drivers drove less than males and evaluated their driving skill lower. Female drivers were less involved in accidents and they committed less traffic offenses than males (kilometrage controlled). Female drivers showed a more positive attitude toward traffic safety and rules than males. The difference in traffic attitudes and behavior between males and females in 1978 compared to 2001 remained the same or even increased somewhat.
Differences in relative risks for fatal occupational highway transportation accidents.
Correspondence: Christopher A. Janicak, Department of Safety Sciences, Indiana University of Pennsylvania, 136 Johnson Hall, 15705, Indiana, PA, USA; (email: cjanicak@iup.edu).
BACKGROUND: This study examined the trends in the relative risks for being involved in fatal occupational highway transportation accidents based upon the age and gender of the victim.
FINDINGS: Significant differences in relative risks were identified based upon age; however, there were no significant differences in relative risks based upon gender. The trend analysis of relative risks for all motor-vehicle accidents based upon age showed that males exhibited a significant cubic trend while females exhibited a significant linear trend. The trend analysis of relative risks for fatal motor-vehicle accidents specifically involving vehicle operators based upon age yielded a significant quadratic trend for males and no significant trends for females. Examining the relative risks for fatalities involving only motor-vehicle operators controlled, to a certain extent, the differences in job exposure to motor-vehicle accidents based upon age.
COMMENTS: Prevention measures are identified as most crucial for older male workers in the transportation and agriculture industries.
Responsibility of drivers, by age and gender, for motor-vehicle crash deaths.
- Williams AF, Shabanova VI. J Safety Res 2003; 34(5): 527-531.
Correspondence: Allan F. Williams, Insurance Institute for Highway Safety, 1005 North Glebe Road, 22201, Arlington, VA, USA; (email: research@iihs.org).
BACKGROUND: Motor-vehicle crash rate comparisons by age and gender usually are based on the extent to which drivers in a particular age/gender category are themselves injured or involved in crashes (e.g., the number of 20-year-old females in crashes). Basing comparisons instead on the extent to which drivers in various age/gender groups are responsible for deaths (including themselves) in their crashes is more revealing of their overall contribution to the problem.
METHODS: Data from the Fatality Analysis Reporting System (FARS, 1996-2000) were used in the analysis, which was based on crashes that involved one or two vehicles only. Drivers in fatal single-vehicle crashes were assumed to have responsibility for the crash. In fatal two-vehicle crashes, driver operator errors reported by police were used to assign crash responsibility.
FINDINGS: When all crashes were considered, both the youngest and oldest drivers were most likely to be responsible for deaths in their crashes. In two-vehicle crashes, the oldest drivers were more likely than young drivers to be responsible. Young males were more likely than young females to be responsible for crash deaths, whereas females in their 50s and older were more likely than same-age males to be responsible. In terms of responsibility for deaths per licensed driver, young drivers, especially males, had the highest rates because of their high involvement rates and high responsibility rates. The majority of deaths for which young drivers were responsible occurred to people other than themselves, especially passengers in their vehicles, whereas the bulk of the deaths for which older drivers were responsible were their own.
COMMENTS: The results highlight the contribution of young drivers to the motor-vehicle crash problem, the need for measures such as passenger restrictions in graduated licensing systems, and the need for vehicle modifications to better protect older occupants.
Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes.
- Lee HC, Lee AH, Cameron D, Li-Tsang C. J Safety Res 2003; 34(4): 453-459.
Correspondence: Andy Lee, Curtin University Driving Assessment and Consultancy, Perth, AUSTRALIA; (email: andy.lee@curtin.edu.au).
BACKGROUND: To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator, and to determine which measures were associated with the occurrence of motor-vehicle crash.
METHOD: One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study. Using the driving simulator, appropriate driving tasks were devised to test the older drivers, whose performances were assessed by 10 reliable assessment criteria. Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome.
FINDINGS: As expected, driving skill of older drivers was found to decline with age. Over 60% of the sample participants reported having at least one motor-vehicle crash during the past year. Adjusting for age in a logistic regression analysis, the cognitive abilities associated with the crash occurrence were working memory, decision making under pressure of time, and confidence in driving at high speed.
COMMENTS: The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator. Prospective studies need to be undertaken to determine whether the driving simulator can predict future crash events. This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered.
Effect of vehicle and crash factors on older occupants.
Correspondence: Rory A. Austin, National Highway Traffic Safety Administration, U.S. Department of Transportation, Room 5320, 400 7th Street, Southwest, Washington, DC 20590, USA; (email: raustin@nhtsa.dot.gov).
BACKGROUND: The expected substantial increase in people aged 65 or older is important for those concerned about transportation injuries. However, much of the previous research concentrates on older drivers and overlooks the fact that vehicle and crash factors may provide significant explanations of older occupant injury rates.
METHODS: Differences across age groups are explored using two nationwide travel surveys, crash involvement, fatalities, and injuries from crash databases and an ordered probit model of injury severity.
FINDINGS: Two noticeable differences that help explain injury risk are that older people are more likely to travel in passenger cars than younger people who frequently use light trucks, and that seriously injured older occupants are more likely to be involved in side-impact crashes than their younger counterparts.
COMMENTS: Increased attention to vehicle engagement in side-impact crashes and to vehicle technologies that can help drivers avoid side collisions would be particularly helpful for older occupants.
On-road driving evaluations: a potential tool for helping older adults drive safely longer.
Correspondence: Jane Stutts, Highway Safety Research Center, University of North Carolina, 730 Airport Road, Campus Box 3430 Chapel Hill, NC 27599-3430, USA; (email: jane_stutts@unc.edu).
BACKGROUND: This paper explores the potential use of on-road driving evaluations as a tool for helping older adults extend their safe driving years.
METHODS: Three separate research activities were carried out. The first was a national telephone survey of current and former older drivers. The results of this survey provide information relevant to the potential market for on-road driving evaluations. The second was a series of focus groups with potential stakeholders in the process: driver educators, occupational therapists, and physicians. These groups explored the feasibility and requirements of offering on-road driving evaluations to the wider public. Supplemental data were also collected from a mail survey of driving schools nationwide.
FINDINGS: Based on the results of these efforts, a number of recommendations are presented for expanding the availability of on-road driving evaluations, specifically to help older adults make more responsible decisions about continuing or stopping driving,and more generally to help them drive safely longer.
Correspondence: Paramjit T. Joshi, Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, District of Columbia 20010-2970, USA; (email: pjoshi@cnmc.org).
Acts of war and terrorism are increasingly prevalent in contemporary society. Throughout history, weaponry has become more efficient, accurate, and powerful, resulting in more devastation and loss of human life. Children are often overlooked as victims of such violence. Around the world, children are exposed to violence in multiple forms, frequently developing traumatic stress reactions. Such reactions are best understood within the context of social-emotional and cognitive development, as children respond differently to the stress of violence depending on their developmental level. Furthermore, the violence of war and terrorism often results in a multitiered cascade of negative life events including loss of loved ones, displacement, lack of educational structure, and drastic changes in daily routine and community values. These numerous losses, challenges, and stresses affect children's brains, minds, and bodies in an orchestrated whole-organism response. This paper describes these effects, synthesizing the current state of research on childhood traumatic stress reactions from the fields of neuroscience, clinical psychology, and pediatric diagnostic epidemiology.
Consequences of children's exposure to community violence.
Correspondence: Michael Lynch, Department of Psychology, State University of New York, College at Geneseo, 1 College Circle, Geneseo, New York 14454, USA; (email: mlynch@geneseo.edu).
Much has been learned over the past decade about the way children respond to experiences of violence in their community. The goal of this paper is to review what is known about the effects of community violence on children's development. In addition to main effects, factors that mediate these effects, as well as factors that moderate children's response to community violence are discussed. Special attention is paid to developmental differences in children's responses to community violence and the factors that may promote resilient functioning.
Prevalence of child and adolescent exposure to community violence.
Emerging as one of the most significant health issues facing American youth today, child and adolescent exposure to community violence has generated much interest across multiple disciplines. Most research to date has focused on documenting the prevalence of community violence and the emotional and behavioral ramifications. This paper provides an overview of the current literature regarding prevalence of youth exposure to community violence, and identifies those areas where further research is warranted. In addition to examining overall rates of community violence exposure, this paper reviews the prevalence of different types of community violence, such as weapon use, physical aggression, and crime-related events. Predictors of community violence exposure, including gender, age,race, socioeconomic status, behavior patterns, and geography, are discussed.
Community violence as it affects child development: issues of definition.
Correspondence: Penny Trickett, School of Social Work, University of Southern California, Los Angeles, California 90089-0411, USA; (email: pennyt@usc.edu).
The state of the art of definition of community violence as it relates to child development was examined in terms of the definitions used in 23 empirical studies. In all cases community violence was defined in terms of what were assumed to be measurements obtained as linear combinations of a priori numerical weighting of responses to questions--asked either of a child or of the parent of a child--about experiencing and/or witnessing and/or hearing about instances of violence. Thus, the definitions can be seen to represent the perspectives of 2 kinds of observers--the child or the child's parent--and 3 levels of closeness to violence--experiencing, witnessing, or hearing about violence. Combining these perspectives and levels, the following 8 different definitions could be seen to be used in the practice of 1 or more of the 23 empirical studies: Child Self-Report (perception) of either (1) experiencing, or (2) witnessing, or (3) experiencing and witnessing, and hearing about violence; or Parent Report (perception) of the Child (4) experiencing, or (5) witnessing, or (6) experiencing and witnessing and hearing about violence, or (7) = (1) + (4), or (8) = (3) + (6). In almost all the examples of research definitions it was assumed implicitly and without test of the assumption that different violent events were interchangeable, and usually it was assumed (again without test) that the magnitudes of different violence events were equal. Usually, an unstated theory of stress appeared to guide the measurement definition, but in one study definitions were developed and tested in terms of a clearly-stated theory of learning. It was concluded that definition of community violence is a measurement problem; that very likely it is multidimensional; that it could be more nearly solved if better attention were given to specifying it in terms of theory that can be put to test and by attending to basic assumptions and principles of measurement.
Evaluating the impact of interventions in the Multisite Violence Prevention Study.
- Miller-Johnson S, Sullivan TN, Simon TR, Multisite Violence Prevention Project. Am J Prev Med 2004; 26(1 Suppl): 48-61.
Correspondence: Shari Miller-Johnson, PhD, Center for Child and Family Policy, Duke University, Box 90545, Durham NC 27708-0545, USA; (email: sharimj@pps.duke.edu).
This paper discusses the procedures and measures that were developed and utilized to evaluate the impact of the GREAT (Guiding Responsibility and Expectations in Adolescents Today and Tomorrow) programs in the Multisite Violence Prevention Project (MVPP). First, we describe the three different samples used to examine the impact of the programs, and the different sources of data used to assess these samples. Next, we outline procedures used to collect and manage the data. In the last section, we summarize the final set of measures selected for use in this study. Throughout the paper, we highlight ways in which the participating institutions collaborated to develop consistent procedures for use across the four sites. Overall, the paper provides important information related to the evaluation of violence prevention efforts, particularly for working effectively in multisite collaborative studies.
