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Contribution of drinking patterns to differences in rates of alcohol related problems between three urban populations.
- Bobak M, Room R, Pikhart H, Kubinova R, Malyutina S, Pajak A, Kurilovitch S, Topor R, Nikitin Y, Marmot M. Epidemiol Community Health 2004; 58(3): 238-242.
Correspondence: Martin Bobak, International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; martinb@public-health.ucl.ac.uk).
OBJECTIVE: To examine, on empirical data, whether drinking patterns, in addition to overall alcohol consumption, contribute to differences in rates of alcohol related problems between populations.
DESIGN: Cross sectional survey.
SETTINGS: One Russian, one Polish, and one Czech city.
PARTICIPANTS: 1118 men and 1125 women randomly selected from population registers.
MAIN OUTCOME MEASURES: Problem drinking; negative social consequences of drinking; alcohol consumption and drinking pattern.
RESULTS: Rates of problem drinking and of negative consequences of drinking were much higher in Russian men (35% and 18%, respectively) than in Czechs (19% and 10%) or Poles (14% and 8%). This contrasts with substantially lower mean annual intake of alcohol reported by Russian men (4.6 litres) than by Czech men (8.5 litres), and with low mean drinking frequency in Russia (67 drinking sessions per year, compared with 179 sessions among Czech men). However, Russians consumed the highest dose of alcohol per drinking session (means 71 g in Russians, 46 g in Czechs, and 45 g in Poles), and had the highest prevalence of binge drinking. In women, the levels of alcohol related problems and of drinking were low in all countries. In ecological and individual level analyses, indicators of binge drinking explained a substantial part of differences in rates of problem drinking and negative consequences of drinking between the three countries.
COMMENTS: These empirical data confirm high levels of alcohol related problems in Russia despite low volume of drinking. The binge drinking pattern partly explains this paradoxical finding. Overall alcohol consumption does not suffice as an estimate of alcohol related problems at the population level.
See item 2 under Occupational Issues
See item 1 under Risk Factor Prevalence, Injury Occurrence & Costs
We write to draw your attention to the growing problem of the loss of access to internet citations.1-4 The internet has revolutionised access to information, and, not surprisingly, readers of medical journals are increasingly referred to the Internet for information unavailable elsewhere.2
Since recent research shows that more than one in eight Internet citations in high-impact medical and scientific journals become extinct in about 2 years,2 concern about whether referenced electronic information will be accessible in the future is justified. Furthermore, even if internet addresses yield information, a reader cannot be assured that the accessed electronic information is unchanged from the original referenced by the authors.
Although The Lancet does request inclusion of accession dates in internet references, additional measures are needed to better preserve electronic citations. Two additional guidelines would help fulfil this need: requiring authors to submit all referenced internet information to the Internet Archive (www.archive.org), and to keep hard copies of all such referenced information until available on this archive (about 6 months).
The Internet Archive, a non-profit Internet library that preserves digital information at no cost to the author, reader, journal, or publisher, provides a promising first step towards solving problems incurred by broken internet links and altered electronic information in scientific publications.5 Through use of the Alexa web crawler, the archive's WayBack Machine allows for the storage and retrieval of electronic information located at a given Internet address (uniform resource locator [URL]) as it appeared on a specific date. A collaborative effort by authors and journals to submit all cited article URLs to the Internet Archive will better ensure access to electronic references now and for years to come.
1 Spinellis D. The decay and failures of web references. Commun Assoc Computing Machinery 2003; 46: 71-77.
2 Dellavalle RP, Hester EJ, Heilig LF, et al. Information science. Going, going, gone: lost Internet references. Science 2003; 302: 787-88.
3 Hedstrom M. It's about time. Research challenges in digital archiving and long-term preservation. National Science Foundation and the Library of Congress, 2003. http://www.si.umich.edu/digarch/ Report.DFt.2.doc (accessed Jan 2, 2004).
4 Melnick A. New technology, new problems. Am Med Writers Assoc J 2003; 18: 28-29.
5 Kahle B. Preserving the Internet. Sci Am 1997; 276: 82-83. http:// www.hackvan.com/pub/stig/articles/trusted-systems/0397kahle.html (accessed Jan 2, 2004).
OBJECTIVES: The results and impact of the first phase of a Community Based Mental Health Model, developed in the South network by the Bogota Health authority and the Tunjuelito hospital during 2002 were evaluated. The first phase of the program included the formation of health community agents, communitary screening of mental health done through home visits, referrals to the services network and an increase in the nodes of the network of good treatment.
METHODS: The indicators of before (year 2001) and after (year 2002) the application of the model were compared, as well as the variations between the study groups (South network) and the control group (Central-Eastern network).
FINDINGS: The mental health model increased the notification of cases of family violence (23.8% in the study group vs. 15.3% in the control group), the followup of cases of family violence (80% vs. 25%) and the conectivity of the networks of good treatment. In the localities in which the mental health component of the Basic Attention Plan is strengthened, the mental health model showed a better performance.
COMMENTS: The results suggest that the implementation of a community based mental health model favors the notification of cases of family violence, their followup and a greater community composition in the social networks of good treatment.
Parents of fatally injured children discuss taking part in prevention campaigns: an exploratory study.
Correspondence: Deborah C. Girasek, Department of Preventive Medicine & Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; (email: dgirasek@usuhs.mil).
This qualitative study explores how a small group of parents who have lost children to accidental injuries feel about taking part in prevention campaigns. Prospective participants were identified through a state medical examiner's office. Six mothers and 5 fathers of children who had died 3-5 years earlier agreed to be interviewed. All participants thought that it was appropriate to approach bereaved parents about such opportunities, after the most disabling phase of grief had subsided. Yet they raised cognitive, emotional, and practical barriers to engaging in prevention work. The appealing aspects of becoming a safety advocate included preventing emotional and physical injuries to others, as well as advancing their own recovery. It is very possible that the volunteers we spoke with held more positive views on participation than the many mothers and fathers who chose not to participate in our study. Nonetheless, their comments give us our first insights into how collaborating on prevention may feel to those for whom prevention has failed.
BACKGROUND: Human exposure to cold outdoor and indoor temperatures below 10 degrees C may be associated with various cold-related sensations and symptoms. It is not possible to predict a person's survival ability only by assessing thermal environments; but individual screening is always required for good health care practice with regards to treatment and/or prevention.
METHODS: As part of a development project, a health-check questionnaire was developed for the workers exposed to cold. The completion of the development was carried out in the framework of a Nordic collaboration.
FINDINGS: This was three-level medical screening protocol for detecting individual cold-related health ailments. "The health-check questionnaire for subjects exposed to cold" comprises the first step of the screening protocol. The medical screening was harmonized with the assessment practices for cold-related health risks in the workplaces.
COMMENTS: A "health-check questionnaire for subjects exposed to cold" was developed as the first step of the three-level medical screening for the detection of cold-related health ailments of individuals. The analogical assessment practices for the cold-related health risks in the workplaces were developed in the same project. They both aim towards the establishment of an ISO standard for working in cold environments.
Head injury and limb fracture in modern playgrounds.
- Norton C, Rolfe K, Morris S, Evans R, James R, Jones MD, Cory C, Dunstan F, Sibert JR. Arch Dis Child 2004; 89(2): 152-153.
Correspondence: J R Sibert, Department of Child Health, University of Wales College of Medicine, Llandough Hospital, Penarth CF64 2XX, UK; (email: sibert@cardiff.ac.uk).
There were no serious head injuries in modern Cardiff municipal playgrounds with safety surfaces over five years injury surveillance. The literature suggests serious head injuries did occur before the introduction of safety surfaces.
In order to explore the epidemiological characteristics and accident reasons of occupational injury, the data of Occupational injuries in the steel plant during employment from January 1988 to December 2001 were analysed. By retrospective analysis for the 14 year data of occupational injury, we found the decreasing trend of incidence of occupational injury in steel industry, male has greater incidence of occupational injury than female, the shorter of duration of employment means a greater incidence of occupational injury. The major body part of occupational injury are the head and extremity, the major nature of injury are burns and fracture. The most cause of injuries are violation of regulation and distraction of attention by the victim himself or herself, the next reasons are the limitation of equipments and the bad condition of production.
Do drug-free workplace programs prevent occupational injuries? Evidence from Washington State.
- Wickizer TM, Kopjar B, Franklin G, Joesch J. Health Serv Res 2004; 39(1): 91-110.
Correspondence: Thomas M. Wickizer, Department of Health Services, University of Washington, Seattle 98195-7660, USA; (email: tomwick@u.washington.edu).
OBJECTIVE: To evaluate the effect of a publicly sponsored drug-free workplace program on reducing the risk of occupational injuries.
DATA SOURCES: Workers' compensation claims data from the Washington State Department of Labor and Industries covering the period 1994 through 2000 and work-hours data reported by employers served as the data sources for the analysis.
STUDY DESIGN: We used a pre-post design with a nonequivalent comparison group to assess the impact of the intervention on injury risk, measured in terms of differences in injury incidence rates. Two hundred and sixty-one companies that enrolled in the drug-free workplace program during the latter half of 1996 were compared with approximately 20,500 nonintervention companies. We tested autoregressive, integrated moving-average (ARIMA) models to assess the robustness of our findings.
PRINCIPAL FINDINGS: The drug-free workplace intervention was associated (p < .05) with a statistically significant decrease in injury rates for three industry groups: construction, manufacturing, and services. It was associated (p < .05) with a reduction in the incidence rate of more serious injuries involving four or more days of lost work time for two industry groups: construction and services. The ARIMA analysis supported
COMMENTS: The drug-free workplace program we studied was associated with a selective,industry-specific preventive effect. The strongest evidence of an intervention effect was for the construction industry. Estimated net cost savings for this industry were positive though small in magnitude.
Epidemiology of work related injuries in young people: results of a survey carried out in Modena (Italy) between January and June 2000
- Righi E, Gatti G, Marcheselli R, Fantuzzi G, Aggazzotti G. Ann Ig 2003; 15(5): 735-745.
Correspondence: E. Righi, Dipartimento di Scienze Igienistiche, Microbiologiche e Biostatistiche, Universita degli studi di Modena e Reggio Emilia, ITALY; (email: e.righi@unimore.it).
Work related injuries, above all those involving young people, are an important health and social issue, even though up to now small attention has been deserved in spite of the presence of about 68 workers per 1000 young people and the occurrence of 27,400 injures in young people in 2000 in Italy. This study was aimed at improving the knowledge on work related injures occurring in Modena in 14-17 year old subjects in the period January-June 2000. A descriptive epidemiological study was cairried out. Information was collected at the two emergency departments operating in Modena by checking hospital and INAIL records. Injures were defined as events caused by a violent external cause producing one or more lesions. Injuries were defined as work related when occurring during working activities or "in itinere". Work related injures and other injures were compared using the different statistical methods. Work related injuries occurring in young people during January-June 2000 in Modena were 76 (6-month incidence: 1.5 per 100 subjects of the same age) and represent 8.5% of all injuries. The most involved subjects were 17 year old males working in the industrial field, and in most cases prognoses were lasting less than 8 days. A Cluster Analysis identified two types of injures: the "in itinere" ones which resulted similar to the road accidents, both for body sites involved and for the way of occurrence and the injuries occurring at the working place characterised by a high frequency of lesions concerning hand, head, above all eyes. The study showed a remarkable incidence of work related injuries among 14-17 year old subjects in Modena in the first 6 months of 2000. Nevertheless many difficulties in finding information raised during the survey: a higher accuracy and completeness in collecting and recording of the data is needed to better define the epidemiological aspects of this issue.
Correspondence: Rollin Nagel, Department of Pediatrics, Medical College of Ohio, 1015 Garden Lake Parkway, Toledo, OH 43614, USA; (email: rnagel@mco.edu).
BACKGROUND: Prevention is understudied in trauma care. Furthermore, the effectiveness of prevention outreach programs is not well documented. We attempted to verify that elementary school educational programs effectively create retained knowledge.
METHODS: Three hundred fifty-one students (grades 1-3) viewed a bicycle safety videotape and then listened to a structured discussion of bicycle safety rules. Coded pretests were given before and identical posttests were given immediately after the session. Tests were readministered 1 month later to evaluate retained knowledge. Two hundred fifty-one students completed all three tests.
FINDINGS: Students showed significant (p < 0.01) improvement in retained knowledge about riding with traffic, wearing a bicycle helmet, warning pedestrians when riding on sidewalks, and stopping before riding into the street.
COMMENTS: We conclude that prevention programs are effective and result in retained knowledge. Further analysis is recommended to evaluate retained knowledge at greater intervals after the original education.
Carbon monoxide poisoning: undetected by both patients and their doctors.
- Harper A, Croft-Baker J. Age Ageing 2004; 33(2): 105-109.
Correspondence: Adam Harper, Department of Elderly Medicine, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK; (email: adamharper@doctors.org.uk).
Carbon monoxide poisoning represents a potentially preventable and reversible cause of mortality and morbidity if sources and cases can be identified. The elderly have been shown to be particularly at risk. Concerns continue to be raised about potential unrecognised cases of carbon monoxide poisoning. These concerns arise from difficulties in knowing who to suspect as a potential victim of poisoning as well as how, when and what to test. In general carbon monoxide has no helpful unique clinical presentation and is known to mimic common illnesses as well as exacerbate established diseases. As a gas it is undetectable by the human senses and is potentially present in most households. This paper reviews the issues associated with carbon monoxide poisoning including pointers to early diagnosis and discussion of pathophysiology and management.
Prevention and treatment of ankle sprain in athletes.
- Osborne MD, Rizzo TD Jr. Sports Med 2003; 33(15): 1145-1150.
Correspondence: Michael D. Osborne, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; (email: unavailable).
The frequent nature of ankle sprains and persistent disability that often ensues has lead to considerable medical costs. As prevention of disease and injury becomes an increasingly important part of the practice of medicine today, we strive to understand and identify interventions that optimally reduce the frequency of ankle sprain and re-injury. In doing so, considerable morbidity and unnecessary medical expenditures may potentially be averted. The prophylactic use of ankle braces is fairly common. Recent critical evaluation of their effectiveness supports their use for at least 6 months following injury in athletes who have sustained a moderate or severe sprain; however, their role in primary prevention of ankle sprain is less evident. Functional ankle rehabilitation is the mainstay of acute ankle sprain treatment and in recent reviews has been deemed preferable to immobilisation or early surgery for initial treatment of acutely injured ankles. Furthermore, certain components of ankle rehabilitation, such as proprioceptive exercises, have been found to protect the joint from re-injury. Multifaceted ankle sprain prevention programmes that incorporate a variety of strategies for injury reduction are also effective in sprain prevention, although the relative importance of each component of such programmes warrants further investigation. Surgery for ankle sprain is principally reserved for patients who fail a comprehensive non-operative treatment programme and can be highly successful in treating chronic functional instability. This paper examines the current literature regarding common ankle sprain prevention strategies and provides a review of appropriate treatment schemes.
Snowboarding injuries: current trends and future directions.
- Bladin C, McCrory P, Pogorzelski A. Sports Med 2004; 34(2): 133-139.
Snowboarding has become one of the premier alpine sports. The past decade has seen the popularity of snowboarding increase dramatically and the recent Winter Olympic Games at Salt Lake City, USA, showcased the strong visual appeal of the sport and the youth-oriented lifestyle and culture that accompanies it.The injury profile of the sport has also undergone change along with technological advances in boot and binding systems and the changing demographics of the sports participants. Central to the development of injury-prevention strategies is knowledge of the profile of injuries that occur, understanding those who are at particular risk and, if possible, the biomechanical factors involved in each injury type.Snowboarding was initially considered a dangerous, uncontrolled, alpine sport - an opinion based on little or no scientific evidence. That evidence has rapidly grown over the past decade and we now know that snowboard injury rates are no different to those in skiing; however, the injury profile is different. The purpose of this review is to give some perspective to the current snowboard injury literature. It discusses not only the demographic profile of those injured and the type of injuries that occur, but also gives some insight into the progress that has occurred in determining the impact of specific prevention strategies, such as splints to prevent injuries to the wrist/forearm.The next decade will also see a greater understanding of the biomechanical forces involved in snowboard injuries, which may well impact on future technological advances. As the literature indicates, however, some things will not change, e.g. injuries are more likely to occur in beginners and lessons need to be reinforced as a fundamental aspect of any injury-prevention strategy.
The potential of emergency department injury surveillance data: an illustration using descriptive analysis of data in 0-4 year olds from the Bath injury surveillance system.
- Brownscombe J, Simpson N, Lenton S, Davis R, Barby T. Child Care Health Dev 2004; 30(2): 161-166.
Correspondence: Neil Simpson, Child Health Department, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK;
(email: neil.simpson@banes-pct.nhs.uk).
OBJECTIVES: To illustrate the potential of injury surveillance data from an emergency department surveillance system.
SETTING: Bath clinical area.
METHODS: Data for children (0-4 years old) resident in Bath city in UK were recoded and analysed.
FINDINGS: There were a total of 3144 attendances and 2300 unintentional injuries - equivalent to an attendance rate of 131/1000. There were 91 thermal injuries and 162 poisoning/ingestions. Descriptive information is presented on the circumstances and consequences.
COMMENTS: The majority of unintentional injuries in 0-4 year olds occur in the home, which is a modifiable environment. Detailed information around the circumstances available from the Bath injury surveillance system allows better focus for prevention messages and priority setting.
Body piercing and high-risk behavior in adolescents.
- Roberts TA, Auinger P, Ryan SA. J Adolesc Health 2004; 34(3): 224-229.
Correspondence: Timothy A. Roberts, Division of Adolescent Medicine, Department of Pediatrics, Strong Children's Research Center, Golisano Children's Hospital at Strong, University of Rochester School of Medicine, USA; (email: timothy_roberts@urmc.rochester.edu).
OBJECTIVE: To evaluate the association of body piercing with sociodemographic factors, peer substance use, and high-risk behaviors.
METHODS: Cross-sectional analysis using Wave II of the National Longitudinal Study of Adolescent Health (Add Health) Public Use Dataset, a nationally representative, school-based sample of 4337 adolescents, aged 13-18 years, surveyed in 1996. The major predictor variable was body piercing at locations other than the ears. The outcome variables were selected from five areas of high-risk behaviors including sexual intercourse, substance use (problem drinking, smoking, and marijuana use), violent behavior (fighting and inflicting injuries), antisocial behavior (truancy, shoplifting, and running away), and mood problems (depression, suicidal ideation and suicide attempts). The association between body piercing and peer substance use was also examined.
FINDINGS: Females (7.2% vs. 1.5%) and older adolescents were more likely to report piercing (all p's <.01) In linear regression analysis, controlling for sociodemographic factors, body piercing was significantly associated with higher levels of peer substance use (beta = 1.40 [99% CI.57-2.23]). In logistic regression analyses, controlling for sociodemographic factors, piercing was associated with sexual intercourse (OR = 4.5 [99% CI 2.1-10.0]), smoking (3.1 [1.6-5.9]), marijuana use (3.0 [1.6-5.9]), truancy (2.6 [1.3-5.3]), running away from home (3.0 [1.2-7.2]), suicidal ideation (2.5 [1.2-4.9]), and suicide attempts (3.0 [1.2-7.5]).
COMMENTS: Clinically, body piercing may serve as a marker for higher levels of peer substance use and potential problem behavior.
The epidemiology of unintentional non-fatal injuries among children in the South Plains/Panhandle region of Texas.
- Arif AA, Patterson PJ, Borders TF, Shah SM. Texas J Rural Health 2003; 21(2): 31-41.
Correspondence: Ahmed A. Arif, Texas Tech Health Sciences Center, 3601 4th St. MS 8161, Lubbock, Texas 79430, USA; (email: ahmed.arif@ttuhsc.edu).
The purpose of this study was to estimate and characterize the burden of unintentional injuries among children under 16 years of age in the South Plains/Panhandle region of Texas. A total of 1,500 households were selected through a cross-sectional survey in 42 counties in the fall of 2001. Telephone interviews with parents were conducted to identify the nature and place of injury among children. The age-adjusted prevalence of parent-reported childhood injury was 15.9%. Out of 228 children injured, the majority (88%) needed medical attention. The majority of injuries occurred while the child was engaged in sports or other related recreational activity, followed by unintentional falls, and accidents at home. Compared to younger children (< 6 years), older children (11 to 16 years) were more likely to sustain injuries. A total of 35 (17.6%) children required hospital admission following their injuries. Those in the lower level socioeconomic group (as determined by the responding parents' educational status) were more likely to seek admission to the hospital following injury. In the South Plains/Panhandle region, the occurrence of unintentional injuries is a significant health problem resulting in hospitalization and loss of routine activity. Further analytical studies are needed to identify more specific risk factors that can serve as a basis for prevention efforts.
Death obsession in Kuwaiti and American college students.
- Abdel-Khalek AM, Lester D. Death Stud 2003; 27(6): 541-553.
Correspondence: Ahmed M. Abdel-Khalek, College of Social Sciences, Kuwait University, KUWAIT; (email: jss@kuc01kuniv.edu.kw).
Two samples of Kuwaiti (n = 460) and American (n = 273) male and female undergraduates responded to the Death Obsession Scale (DOS) in Arabic and English, respectively. Cronbach's alpha reliability statistics were .96 and .91, respectively, denoting high internal consistency. In the same vein, all the item-remainder correlations in both samples were significant denoting item validity and content validity. A general factor of death obsession was disclosed in the Kuwaiti sample, whereas two salient factors (death rumination, and death dominance and repetition) were extracted in the American sample. Gender-related differences were significant in the Kuwaiti sample, that is, females attained higher mean score than their male counterparts, whereas there were no significant gender differences in the American sample. Kuwaiti students attained significantly higher mean DOS score than their American counterparts in the total and all the individual items of the DOS.
Self-reported quality of life after electrical and thermal injury.
- Cochran A, Edelman LS, Saffle JR, Morris SE. J Burn Care Rehabil 2004; 25(1): 61-66.
Correspondence: Stephen Morris, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Room 3B312, Salt Lake City, Utah 84132, USA; (email: unavailable).
Electrical injury patients (EI) often require more procedures and longer hospital stays than their thermal injury counterparts. We hypothesized that postinjury quality of life might be better in thermal injury patients (TIs) than in EI. Each EI recorded in our institution's TRACS trade mark /ABA registry between 1995 and 2000 was matched with a TI for age and TBSA involvement. We compared SF-36 scores of EI and TIs to evaluate quality of life. Age and TBSA injury were similar between groups. SF-36 results demonstrated no significant differences in self-reported quality of life indices. Return to full-time employment did not differ significantly between groups. EI and TIs do not differ significantly in quality of life after their burn injuries. Self-evaluated function for EI and TIs is comparable. Quality of life in both EI and TIs are above population means on many dimensions.
The 'Prevention Paradox' applies when low-risk individuals in a population contribute the most cases of a condition or problem behaviour by virtue of their being in the majority, thereby recommending a universal or whole of population approach to prevention. The applicability of a universal as opposed to a targeted high-risk approach to the prevention of youth substance use was examined in two studies of children and adolescents conducted in Victoria, Australia. These studies were reanalysed by recombining developmental, social and individual measures to form cumulative risk indices for substance use. In Study 1, a cross-sectional survey of students, most regular tobacco, alcohol and cannabis use by 15/16-year-olds occurred in the moderate and low-risk groups, recommending a universal prevention strategy. However, the majority of illicit drug use occurred in the highest-risk group (top 15%). Furthermore, in younger age groups both legal and illegal drug use was concentrated mainly in the highest risk group. Study 2 used data from a major longitudinal study where risk factors at around age 11/12 years were used to predict substance use at age 17/18 years. Most students who admitted involvement in frequent smoking, heavy drinking and, although to a lesser degree, cannabis were classified as low or average risk. It is concluded that universal prevention strategies are needed for late adolescent alcohol, tobacco and cannabis use and more targeted strategies for addressing harm related to early age drug use, frequent cannabis use and illegal drug use.
Reckless driving and gender: an examination of a terror management theory explanation.
- Taubman-Ben-Ari O, Findler L. Death Stud 2003; 27(7): 603-618.
Correspondence: Orit Taubman - Ben-Ari, School of Social Work, Bar-Ilan University, Ramat-Gan 52900, ISRAEL; (email: taubman@mail.biu.ac.il).
A study, based on Terror Management Theory, examined the effects of mortality salience on young men's and women's behavioral intentions to drive recklessly. Participants (N = 206) reported on the relevance of driving to their self-esteem. Half of them were exposed to a mortality salience induction and the remaining to a control condition. Then they were asked about their willingness to drive recklessly in various scenarios. Findings showed that mortality salience led to higher intentions to drive recklessly than the control condition only among men who perceived driving as relevant to their self-esteem. No such differences were found among women. Results are discussed in light of the self-enhancing and cultural-world views-validating mechanisms proposed by the Terror Management Theory.
Correspondence: Douglas M. Kingman, Department of Agriculture, Illinois State University, Campus Box 5020, Normal, IL, 61790-5020, USA; (email: dkingma@ilstu.edu).
Since 1978 Purdue University has maintained a national database of agriculture-related engulfment cases that have occurred in loose agricultural material in both commercial and on-farm facilities. The database presently contains 502 documented cases of fatal and non-fatal engulfments from the U.S. and Canada. A review of the more recent on-farm fatal and non-fatal engulfment cases, those occurring in 1980 through 2001, was conducted in order to characterize engulfments and identify contributing factors that would be relevant to future intervention strategy development including the implementation of design standards for on-farm structures. From 1980 through 2001, 197 cases were identified that occurred in on-farm grain bins, 156 of which were fatal and 41 were non-fatal. A rate of approximately seven fatal and two non-fatal cases per year were identified from 1980 through 2001. The magnitude of the engulfment problem is continuing, based on six and seven fatal cases reported in the years 2000 and 2001, respectively. Sixteen percent of fatal and six percent of non-fatal victims were children and adolescents under the age of 16. Fifty percent of the survivors were 60 years of age or older. Engulfments were generally reported more often in the top corn-producing states and involved corn in 76% of the fatal cases when product was known. Seventy-seven percent of the fatal victims were unloading the bin at the time of engulfment in cases where activity at the time of engulfment was known. Forty-one percent of the fatality cases involved corn that was out-of-condition where the condition of the grain was known. In survival cases where information about the presence of co-workers at the time of engulfment was known, it was found that a co-worker was present at the time of engulfment in 86% of the cases. In four cases, a survivor was rescued from a bin after being completely engulfed in grain. In all four cases, a co-worker was present at the time of engulfment and out-of-condition grain was involved. Findings are being used to design new injury prevention strategies, including educational materials and recommendations for engineering controls that focus on primary causative factors.
See item 2 under Risk Factor Prevalence, Injury Occurrence & Costs
What we can--and cannot--expect from school-based drug prevention.
- Caulkins J, Pacula RL, Paddock S, Chiesa J. Drug Alcohol Rev 2004; 23(1): 79-87.
Correspondence: Jonathan P Caulkins, H. John Heinz III School of Public Policy and Management Carnegie Mellon University, USA; (email: caulkins@andrew.cmu.edu).
School-based drug prevention is a central component of drug control strategies. This paper assesses quantitatively its contributions in the United States from a social policy perspective. The social benefits per participant stemming from reduced drug use ( approximately $840 from tobacco, alcohol, cocaine and marijuana) appear to exceed the economic costs of running the programs ( approximately $150 per participant); while the benefits associated with reduced cocaine use alone ( approximately $300) exceed the costs, the corresponding figure for marijuana ( approximately $20) is small. Even if prevention reduced the use of other illicit drugs (e.g. heroin) by as much as it reduced use of cocaine, the majority of benefits would still stem from reductions in use of tobacco and alcohol, which has implications for how school-based drug prevention is funded and whether it is perceived more as a weapon in the war on illicit drugs or as a public health measure. Specific numeric results are subject to considerable uncertainty, but the basic character of the conclusions appears to be robust with respect to parameter uncertainty. The greatest uncertainties concern the permanence of prevention's effects and how to value instances of initiation being deferred but not completely prevented.
Using participatory research to develop a playground-based prevention program.
- Leff SS, Costigan T, Power TJ. J School Psychol 2004; 42(1): 3-21.
Correspondence: Stephen S. Leff, Department of Pediatrics, School of Medicine, The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; (email: Leff@email.chop.edu).
Low level acts of aggression in school are associated with a host of emotional arousal, social problem-solving, peer relationship, and academic difficulties. School-wide interventions may decrease aggressive interactions and promote cooperative play and social skills among students. In the current study, the authors used a participatory-action research model to co-construct a playground-based recess program in a relatively large urban elementary school. The manuscript illustrates the partnership process and how data was used to inform intervention implementation procedures. The role of psychologists working at the whole-school level is highlighted.
OBJECTIVE: To investigate the relationship between smoking and suicidality among adolescent psychiatric patients in Finland.
METHODS: Data from 157 patients (aged 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and July 2002 were collected. Logistic regression analyses were used to examine the association between regular daily smoking and suicidality. The data were adjusted for several sociodemographic and clinical characteristics.
FINDINGS: The results showed over four-fold risk for definite and/or life-threatening suicide attempts among smoking adolescents in inpatient psychiatric facility compared with nonsmoking ones (OR 4.33, 95% CI 1.23-15.20). Also, the smoking adolescents had three times greater risk for occasional (OR 3.32, 95% CI 1.09-10.10) or frequent (OR 3.00, 95% CI 1.08-10.10) self-mutilation. Suicidality was more common among girls than boys and among those adolescents who suffered from depression.
COMMENTS: Among teens hospitalized for psychiatric illnesses, daily smoking was significantly related to suicide attempts and self-mutilation, even after controlling for several confounding factors, including psychiatric diagnosis.
Suicide, high-risk behaviors, and coping style in homeless adolescent males' adjustment.
OBJECTIVE: To evaluate the association among suicide behaviors, high-risk behaviors, coping style, and psychological adjustment (i.e., depressive symptomatology, internalizing and externalizing behavior problems) in homeless and non-homeless adolescent males (aged 16 to 19 years).
METHODS: Data were obtained from 100 homeless youth accessing an emergency shelter (Ottawa, ON). The comparison group was comprised of 70 youth accessing local community drop-in centers that lived with their parent(s)/guardian(s) and had never stayed in a shelter. Data were analyzed using Chi-square, Student's t-tests, and regression statistics.
FINDINGS: Relative to non-homeless youth, homeless youth were more likely to report drug, alcohol, and tobacco use, legal problems, academic difficulties, and mental health problems. Homeless youth presented with a higher prevalence of suicidal ideation, past suicide attempts, depressive symptomatology, and internalizing and externalizing behavior problems. Disengagement coping was a predictor of suicidal ideation, past attempts, depressive symptoms and both internalizing and externalizing behavior problems in homeless youth.
COMMENTS: Relative to non-homeless youth, findings indicate that homeless youth reported greater use of a disengaging coping style and are at greater risk for high-risk behaviors, past suicide attempts, and clinically elevated levels of depressive symptoms and behavior problems.
Risk for suicide may have heritable contributions. Evidence supporting this hypothesis includes strong and consistent findings from more than 20 controlled family studies indicating nearly 5-fold greater relative risk of suicidal acts among relatives of index cases with suicidal behavior compared to relatives of nonsuicidal controls. Relative risk was greater for completed suicide than for attempts. Contributions of genetic instead of environmental factors are indicated by a higher average concordance for suicidal behavior among co-twins of suicidal identical twins compared to fraternal twins or to relatives of other suicidal subjects, in at least seven studies. Three studies indicate significantly greater suicidal risk, particularly for completed suicide, among biological versus adoptive relatives of suicidal or mentally ill persons adopted early in life. Molecular genetics studies have searched inconclusively for associations of suicidal behavior with genes mainly for proteins required for central serotonergic neurotransmission. Complex interactions of environmental with heritable risk and protective factors for suicide and psychiatric illnesses or vulnerability traits are suspected, but specific intervening mechanisms remain elusive. Familial or genetic risks for psychiatric factors strongly associated with suicide, such as major affective illnesses and alcohol abuse, as well as impulsive or aggressive traits, have not consistently been separated from suicidal risk itself.
Comparative study of suicide potential among Pakistani and American psychiatric patients.
This study compared suicide potential and suicide attempts in 50 Pakistani and 50 American psychiatric patients all of whom reported a positive history of suicide attempts during the past 1-5 years. It further explored the role of nationality, gender, diagnosis, and marital status in respondents' potential for suicide and suicide attempts. The American sample reported a higher degree of suicide potential on the Firestone Assessment of Self-Destructive Thoughts (FAST), more suicide attempts, and a larger number of suicide precipitants (family conflicts, work pressure, wish for death, loneliness, financial problems, and mental disorders/drug withdrawal) than did the Pakistani sample. For suicide attempts, effects of 3-way interaction for gender, marital status and nationality were found significant. However, these effects were non-significant for respondent's potential for suicide. In addition, the FAST was found to have a significantly high correlation with suicide attempts. Thus, it may be inferred that the FAST can be used as a valuable screening instrument for the identification of patients at risk for suicide in diverse cultural settings. However, more prospective validity studies are needed to enhance our cross-cultural understanding of suicide; identification of psychiatric patients at risk for suicide by the FAST; and for effective treatment and prevention programs for Eastern and Western societies.
OBJECTIVES: To determine the prevalence and patterns of foot injuries following motorcycle trauma.
DESIGN Prospective.
SETTING: Yorkshire Region Trauma Units (Level 1 trauma centers with trauma research).
PATIENTS: Individuals injured in motorcycle road traffic accidents between January 1993 and December 1999.
OUTCOME MEASUREMENTS Patient demographics, protective devices (helmet) use, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), clinical details, therapeutic interventions, resuscitation requirements, duration of hospital stay, mortality, and type of foot injuries sustained.
FINDINGS: The parent population of 1239 contained 53 (4.3%) foot-injured motorcyclists (49 men) with a mean age of 31.7 years (range 18-79 years). Fifty-two were drivers and one was a rear-seat passenger. Mean ISS was 6.9 (range 4-33), significantly lower than the parent population mean of 34.98 (range 9-75) (P = 0.001). Mean GCS was 14.7 (range 13-15). The motorcyclists' injuries included 26 metatarsal fractures (49.1%), 14 talar fractures (26.4%), 7 os calcis fractures (13.2%), and 6 toe fractures (11.3%). Associated foot injuries included three partial foot amputations, four Lisfranc dislocations, three cases of foot compartment syndrome (two crush injuries with no fracture, one open fourth metatarsal fracture with associated Lisfranc dislocation). Forty-six motorcyclists had more than one foot injury. Associated injuries included 22 ankle fractures (41.5%), 15 tibial fractures (28.3%), 6 femoral fractures (11.3%), 5 pelvic ring fractures (9.4%), 23 upper limb injuries (43.4%), and 3 cases of chest trauma (5.7%). No one sustained abdominal trauma or head injury compared with the parent population. All patients required operative stabilization of foot fractures, including their associated injuries. Mean hospital stay was 10.9 days (range 1-35 days). In the parent population, there were 71 deaths (6.0%), whereas there was only 1 death (1.9%) in the foot-injured group (with fractures including open book pelvic, T6-8, unilateral open femur, tibial, ankle, and metatarsal) with an ISS 33, who died of multiorgan dysfunction syndrome. At final follow-up, all patients underwent radiologic and clinical assessment of foot injuries. Forty-three patients returned to their previous occupation and level of mobility. Ten of the more significantly injured patients had to modify their occupation from manual to sedentary-type jobs due to their foot injuries. We noted a pattern of complex ipsilateral foot and limb injury in nine patients, which we postulate was due to the actual mechanism of contact with the road surface.
COMMENTS: Motorcycle accidents continue to be a source of severe injury, especially to the foot. The most common foot injury is a metatarsal fracture; however, there must be a high index of suspicion for associated injuries. Although these injuries are associated with a low mortality rate, they require prompt assessment and treatment to limit long-term morbidity and disability. The difference in foot injury pattern and mortality between the parent population and our series, among other factors, potentially may be influenced by the actual mechanism of contact with the road surface and the modifying action of the foot during the accident.
The effectiveness of ESP (Electronic Stability Program) in reducing real life accidents.
- Lie A, Tingvall C, Krafft M, Kullgren A. Traffic Inj Prev 2004; 5(1): 37-41.
Correspondence: Anders Lie, Swedish National Road Administration, Borlange, SWEDEN; (email: anders.lie@vv.se).
ESP (Electronic Stability Program) has recently been introduced onto the market in an effort to reduce the number and severity of loss-of-control automobile accidents. This reduction is expected to be particularly evident for accidents on roads with low friction (e.g., wet or icy conditions). This study aimed to evaluate the statistical effectiveness of ESP using data from accidents that occurred in Sweden during 2000 to 2002. To control for exposure, induced exposure methods were used, where ESP-sensitive to ESP-insensitive accidents and road conditions were matched in relation to cars equipped with and without ESP. Cars of similar, or in some cases identical, make and model were used to isolate the role of ESP. As predicted, the study showed a positive effect of ESP in circumstances where road surfaces have low friction. The overall effectiveness was 22.1 (+/-21) percent, while for accidents on wet roads, the effectiveness increased to 31.5 (+/-23.4) percent. On roads covered with ice and snow, the corresponding effectiveness was 38.2 (+/-26.1) percent. In addition, ESP was found to be effective for three different types of cars: small front-wheel drive; large front-wheel drive; and large rear-wheel drive.
Motor vehicle driver injury and marital status: a cohort study with prospective and retrospective driver injuries.
- Whitlock G, Norton R, Clark T, Jackson R, MacMahon S. Inj Prev 2004; 10(1): 33-56.
Correspondence: G Whitlock, Clinical Trial Service Unit and Epidemiology Studies Unit, Harkness Building, Radcliffe Infirmary, Oxford OX2 6HE, UK; (email: gary.whitlock@ctsu.ox.ac.uk).
OBJECTIVE: To investigate the association of marital status with risk of motor vehicle driver injury.
DESIGN: A cohort study with prospective and retrospective outcomes.
SETTING: New Zealand.
PARTICIPANTS: A total of 10 525 adults (a volunteer sample of a multi-industry workforce, n = 8008; and a random sample of urban electoral rolls, n = 2517). Exposure variable: Self reported marital status, assessed from a questionnaire administered in 1992-93 (baseline).
MAIN OUTCOME MEASURE: Motor vehicle driver injury resulting in admission of the driver to hospital and/or the driver's death, during the period 1988-98; hospitalisation and mortality data were obtained by record linkage to national health databases.
FINDINGS: During 108 741 person-years of follow up, 139 driver injury cases occurred (85 before baseline, 54 after). After adjustment for age, sex, and study cohort, never married participants had twice the risk of driver injury (hazard ratio [HR] 2.06, 95% confidence interval [CI] 1.35 to 3.16) as married participants (HR 1.00). The relative risk for never married participants was slightly higher (HR 2.29), though less precise (95% CI 1.39 to 3.76), after further adjustment for alcohol intake, driving exposure, area of residence, body mass index, and occupational status.
COMMENTS: After taking age, sex, and other variables into account, never married people had a substantially higher risk of driver injury than married people. While requiring corroboration, these findings imply that it may be appropriate for driver injury countermeasures to be targeted to never married people.
Are older drivers actually at higher risk of involvement in collisions resulting in deaths or non-fatal injuries among their passengers and other road users?
- Braver ER, Trempel RE. Inj Prev 2004; 10(1): 27-32.
Correspondence: Elisa Braver, Insurance Institute for Highway Safety, 1005 N Glebe Road, Arlington, VA 22201, USA; (email: ebraver@iihs.org).
OBJECTIVES: With more older drivers on the road, public concern has been expressed about their impact on traffic safety. This study revisited the question of driver age in relation to the risks of older drivers and others sharing the road with them, including pedestrians, passengers in the same vehicle, and occupants of other vehicles.
METHODS: Using United States federal data on fatal and non-fatal crashes, injury rates per driver were calculated for different types of road users. In addition, using data supplied by nine insurers, insurance claims per insured vehicle year were examined by driver age. The reference drivers were aged 30-59.
FINDINGS: For fatal crashes, older drivers' major impact on road users other than themselves was an increase in death rates among their passengers, who also tended to be elderly and thus more vulnerable to injuries (rate ratio (RR) for drivers aged 75+ 2.52; 95% confidence interval (CI) 2.39 to 2.66). For non-fatal crashes, drivers aged 75+ had a RR of 1.10 (95% CI 0.98 to 1.24) for involvement in collisions resulting in injuries to other passenger vehicles' occupants compared with 30-59 year old drivers. The oldest drivers (aged 85+) had significant increases in insurance claims for injuries to other road users in crashes in which they were deemed at fault (RR 1.8; 95% CI 1.71 to 1.89).
COMMENTS: These findings suggest that the oldest drivers, a group with low average annual mileage, do pose some increased risks to occupants of other vehicles, and pose the most serious risks to themselves and their passengers.
Older driver involvement in injury crashes in Texas, 1975-1999.
- Griffin LI III. Washington, DC: AAA Foundation for Traffic Safety; 80 pages; 2004.
Correspondence: Lindsay I. Griffin, III, Center for Transportation Safety, Texas Transportation Institute, Texas A & M University, College Station, TX 77843, USA; (email: l-griffin@tamu.edu).
(Copyright 2004, AAA Foundation for Traffic Safety)
According to the National Highway Traffic Safety Administration, older drivers are more likely than drivers in their thirties, forties, or fifties to be involved in traffic crashes, and they are more likely to be killed in traffic crashes. The number of Americans 65 years of age and older is expected to double between 2000 and 2030. Americans are living longer and driving longer. Together these trends suggest that the number of older drivers killed on U.S. streets and highways will grow.
The literature suggests that older drivers are more fragile than younger drivers -- that is, in crashes of comparable severity, older drivers are more likely than younger drivers to be seriously injured or killed. Medical conditions and use of medications have also been associated with the involvement of older drivers in crashes. With advancing age, sensory and motor capabilities decline and perceptual/cognitive and attentional impairment become more common, and the relative likelihood of traffic crashes increases. Although many older drivers may attempt to adjust to functional difficulties by driving less and avoiding difficult driving conditions, such as driving at night, in rainy weather, or in heavy traffic, older drivers still have a heightened risk of being involved in traffic crashes.
In this study, 25 years of police-level crash data from nearly 4 million injury crashes in the state of Texas were analyzed to determine the association between driver age and four factors: fragility -- the likelihood of death among drivers involved in injury crashes; illness -- the likelihood that drivers were ill or suffering from some other physical defect at the time of their crashes; perceptual lapses -- the likelihood that drivers involved in crashes failed to yield the right of way or disregarded traffic signs or signals; and left turns -- the likelihood that left turns were involved in injury crashes. The purpose of the study was to further understand these four factors and other variables and to portray in graphical format their association with crashes involving older drivers.
The control variables used in the analyses included whether drivers were involved in single-vehicle or multiple-vehicle crashes; whether the crash occurred in an urban or a rural setting; the driver's sex; the light conditions at the time of the crash (daylight or darkness); and whether or not the crash was related to an intersection. Additional analyses examined two-vehicle, intersection-related crashes
in which the vehicles approached one another from opposite directions or approached one another at an angle.
Because older drivers do not constitute a homogeneous population, three different age thresholds were used in defining this group: 65 and older, 75 and older, and 85 and older. Drivers aged 55 to 64, those nearing traditional retirement age, constituted the comparison group in the analyses.
When the analyses controlled for crash type (single-vehicle vs. multiple-vehicle), population density (rural vs. urban), driver sex (male vs. female), light condition (daylight vs. darkness), and intersection relatedness, drivers in the three older age categories, compared with drivers aged 55-64, were found to be more likely to die in injury crashes:
Drivers 65+ years of age were 1.78 times as likely to die
Drivers 75+ years of age were 2.59 times as likely to die
Drivers 85+ years of age were 3.72 times as likely to die
Other analyses that controlled for crash type, population density, driver sex, light condition, and intersection relatedness showed that when compared to 55-64 year old drivers, the three older age groups became progressively more likely to (1) have been ill or suffering some other physical defect at the time of their crashes, (2) have suffered perceptual lapses that contributed to their crashes (such as failure to yield the right of way or disregarding signs or signals), and (3) have been involved in left-turn crashes.
Unintentional injuries, in particular those resulting from motor vehicle crashes, are a major public health problem in the United States. Persons living in rural areas are at greater risk for injury than urban residents due in part to the fact that motor vehicle occupant restraint usage is lower in those areas. This article describes the results of an annual observational survey of child passenger and driver occupant restraint usage in Iowa and compares rates in rural and urban locations. It also addresses the child's location in the vehicle (front seat versus rear seat) and relates placement trends to the increasing awareness of dangers involving children and air bag safety devices.
Preparing dental students to recognize and respond to domestic violence: the impact of a brief tutorial.
- Danley D, Gansky SA, Chow D, Gerbert B. J Am Dent Assoc 2004; 135(1): 67-73.
Correspondence: Dale Danley, Department of Preventive and Restorative Dentistry, School of Dentistry, University of California San Francisco, 94117, USA; (email: danley@itsa.ucsf.edu).
BACKGROUND: The purpose of this study was to evaluate the impact of a brief, interactive multimedia tutorial designed to prepare dentists to recognize and respond to domestic violence.
METHODS: The authors randomly assigned dentists and dental students to one of three groups: a control group or one of two experimental groups in a modified Solomon four-group design.
FINDINGS: One hundred sixty-one dental students and 13 dentists completed the multimedia tutorial. At the posttest, subjects in both experimental groups demonstrated significantly better scores than did subjects in the control group on most items. The two experimental groups (pretest and posttest, posttest only) did not differ significantly from each other.
COMMENTS: An engaging, interactive tutorial presenting a simplified model for ways in which dental professionals can recognize and respond to domestic violence significantly improved dental students' knowledge of, and attitudes toward, the topic.
CLINICAL IMPLICATIONS: Clinicians may improve the care they provide to patients by accessing this brief tutorial and following the lessons contained in it.
Hostility among adolescents in Switzerland? multivariate relations between excessive media use and forms of violence.
Correspondence: Emmanuel N. Kuntsche, Research Department of the Swiss Institute for the Prevention of Alcohol and Drug Problems in Lausanne, Lausanne, SWITZERLAND; (email: ekuntsche@sfa-ispa.ch).
OBJECTIVE: To determine what kind of violence-related behavior or opinion is directly related to excessive media use among adolescents in Switzerland.
METHODS: A national representative sample of 4222 school children (7th- and 8th-graders; mean age 13.9 years) answered questions on the frequency of television-viewing, electronic game-playing, feeling unsafe at school, bullying others, hitting others, and fighting with others, as part of the Health Behaviour in School-Aged Children (HBSC) international collaborative study protocol. The Chi-square tests and multiple logistic regression analyses were applied to high-risk groups of adolescents.
FINDINGS: For the total sample, all bivariate relationships between television-viewing/electronic game-playing and each violence-related variable are significant. In the multivariate comparison, physical violence among boys ceases to be significant. For girls, only television-viewing is linked to indirect violence. Against the hypothesis, females' electronic game-playing only had a bearing on hitting others.
COMMENTS: Experimental designs are needed that take into account gender, different forms of media, and violence to answer the question of whether excessive media use leads to violent behavior. With the exception of excessive electronic game-playing among girls, this study found that electronic media are not thought to lead directly to real-life violence but to hostility and indirect violence.
Caught in the Crossfire: the effects of a peer-based intervention program for violently injured youth.
- Becker MG, Hall JS, Ursic CM, Jain S, Calhoun D. J Adolesc Health 2004; 34(3): 177-183.
Correspondence: Marla G. Becker, Department of Surgery, University of California San Francisco - East Bay, Oakland, California, USA; (email: mbecker@youthalive.org).
OBJECTIVE: To assess the effect of a hospital-based peer intervention program serving youth who have been hospitalized for violent injuries on participant involvement in the criminal justice system and violent reinjury and death after hospital discharge.
METHODS: A total of 112 violently injured youth (ages 12-20 years; 80% male; predominantly African-American [60%] and Latino [26%]) hospitalized in Oakland, California participated in a retrospective case-control study. Clients were matched by age and injury severity. Treatment and control youth were followed for 6 months after their individual dates of injury. The outcome variables of rate of entry/reentry into the criminal justice system, rate of rehospitalization for violent injuries and rate of violence-related deaths were compared for treatment and control groups using an odds ratio analysis.
FINDINGS: Intervention youth were 70% less likely to be arrested for any offense (odds ratio [OR] = 0.257) and 60% less likely to have any criminal involvement (OR = 0.356) when compared with controls. No statistically significant differences were found for rates of reinjury or death.
COMMENTS: A peer-based program that intervenes immediately after, or very soon after, youth are violently injured can directly reduce at-risk youth involvement in the criminal justice system.
Navigating between cultures: the role of culture in youth violence.
- Soriano FI, Rivera LM, Williams KJ, Daley SP, Reznik VM. J Adolesc Health 2004; 34(3): 169-176.
Correspondence: Vivian M. Reznik, Academic Center of Excellence on Youth Violence Prevention, University of California, San Diego, California, USA; (email: vreznik@ucsd.edu).
The purpose of this paper is to review three cultural concepts (acculturation, ethnic identity, bicultural self-efficacy) and their relationship to the known risk and protective factors associated with youth violence. We conducted a review of the relevant literature that addresses these three cultural concepts and the relationship among culture, violent behavior, and associated cognition. The available literature suggests that ethnic identity and bicultural self-efficacy can be best thought of as protective factors, whereas acculturation can be a potential risk factor for youth violence. We examine the connection between these cultural concepts and the risk and protective factors described in the 2001 Surgeon General's Report on Youth Violence, and present a summary table with cultural risk and protective factors for violence prevention. These concepts can assist physicians in identifying risk and protective factors for youth violence when working with multicultural adolescents and their families. Physicians are more effective at providing appropriate referrals if they are aware that navigating among different cultures influences adolescent behavior.
Neighbourhoods and homicide mortality: an analysis of race/ethnic differences.
OBJECTIVE: To examine whether measures of neighbourhood economic deprivation, social disorganisation, and acculturation explain homicide mortality differentials between Mexican Americans, non-Hispanic black Americans, and non-Hispanic white Americans, net of individual factors.
DESIGN: Prospective study, National Health Interview Survey (1986-1994) linked to subsequent mortality in the National Death Index (1986-1997).
SETTING: United States of America.
PARTICIPANTS: A nationally representative sample of non-institutionalised Mexican Americans, non-Hispanic black Americans, and non-Hispanic white Americans, aged 18-50 at the point of interview.
ANALYSIS: Cox proportional hazard models estimate the risk of death associated with various neighbourhood and individual factors.
RESULTS: Both individual and neighbourhood risk factors partially account for race/ethnic disparities in homicide. Homicide mortality risks are between 20% and 50% higher for residents of areas that have economic inequality of 0.50 or greater based on the coefficient of variation, or where 4% or more of the residents are Mexican American, 10% or more of the residents are non-Hispanic black, or 20% or more of the households are headed by single parents (p</=.05). But residents of areas where 10% or more of their neighbours are foreign born have 35% lower mortality risks than people living in areas with fewer foreign born people (p</=0.05). These differences persist even after controlling for individual level risk factors.
COMMENTS: The findings support economic deprivation, social disorganisation, and acculturation theories, and suggest that both neighbourhood and individual risk factors affect race/ethnic differences in homicide mortality. Public health policies must focus on both individual and neighbourhood factors to reduce homicide risks in vulnerable populations.
Content and ratings of teen-rated video games.
- Haninger KM, Thompson KM. JAMA 2004; 291(7): 856-865.
Correspondence: Kimberly M. Thompson, Department of Health Policy and Management, Kresge, 3rd Floor, 677 Huntington Avenue, Boston, MA 02115, USA; (email: kimt@hsph.harvard.edu).
CONTEXT: Children's exposure to violence, blood, sexual themes, profanity, substances, and gambling in the media remains a source of public health concern. However, content in video games played by older children and adolescents has not been quantified or compared with the rating information provided to consumers by the Entertainment Software Rating Board (ESRB).
OBJECTIVES: To quantify and characterize the content in video games rated T (for "Teen") and to measure the agreement between the content observed in game play and the ESRB-assigned content descriptors displayed on the game box.
DESIGN AND SETTING: We created a database of all 396 T-rated video game titles released on the major video game consoles in the United States by April 1, 2001, to identify the distribution of games by genre and to characterize the distribution of ESRB-assigned content descriptors. We randomly sampled 80 video game titles (which included 81 games because 1 title included 2 separate games), played each game for at least 1 hour, quantitatively assessed the content, and compared the content we observed with the content descriptors assigned by the ESRB.
MAIN OUTCOME MEASURES: Depictions of violence, blood, sexual themes, gambling, and alcohol, tobacco, or other drugs; whether injuring or killing characters is rewarded or is required to advance in the game; characterization of gender associated with sexual themes; and use of profanity in dialogue, lyrics, or gestures.
FINDINGS: Analysis of all content descriptors assigned to the 396 T-rated video game titles showed 373 (94%) received content descriptors for violence, 102 (26%) for blood, 60 (15%) for sexual themes, 57 (14%) for profanity, 26 (7%) for comic mischief, 6 (2%) for substances, and none for gambling. In the random sample of 81 games we played, we found that 79 (98%) involved intentional violence for an average of 36% of game play, 73 (90%) rewarded or required the player to injure characters, 56 (69%) rewarded or required the player to kill, 34 (42%) depicted blood, 22 (27%) depicted sexual themes, 22 (27%) contained profanity, 12 (15%) depicted substances, and 1 (1%) involved gambling. Our observations of 81 games match the ESRB content descriptors for violence in 77 games (95%), for blood in 22 (27%), for sexual themes in 16 (20%), for profanity in 14 (17%), and for substances in 1 (1%). Games were significantly more likely to depict females partially nude or engaged in sexual behaviors than males. Overall, we identified 51 observations of content that could warrant a content descriptor in 39 games (48%) in which the ESRB had not assigned a content descriptor. We found that the ESRB assigned 7 content descriptors for 7 games (9%) in which we did not observe the content indicated within 1 hour of game play.
COMMENTS: Content analysis suggests a significant amount of content in T-rated video games that might surprise adolescent players and their parents given the presence of this content in games without ESRB content descriptors. Physicians and parents should be aware that popular T-rated video games may be a source of exposure to a wide range of unexpected content.
See item 1 under Risk Factor Prevalence, Injury Occurrence & Costs