The driving performance is easily impaired as a consequence of the use of alcohol and/or licit and illicit drugs. However, the role of drugs other than alcohol in motor vehicle accidents has not been well established. The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation. A prospective observational case-control study was conducted in the Tilburg region of The Netherlands from May 2000 to August 2001. Cases were car or van drivers involved in road crashes needing hospitalisation. Demographic and trauma related data was collected from hospital and ambulance records. Urine and/or blood samples were collected on admission. Controls were drivers recruited at random while driving on public roads. Sampling was conducted by researchers, in close collaboration with the Tilburg police, covering different days of the week and times of the day. Respondents were interviewed and asked for a urine sample. If no urine sample could be collected, a blood sample was requested. All blood and urine samples were tested for alcohol and a number of licit and illicit drugs. The main outcome measures were odds ratios (OR) for injury crash associated with single or multiple use of several drugs by drivers. The risk for road trauma was increased for single use of benzodiazepines (adjusted OR 5.1 (95% Cl: 1.8-14.0)) and alcohol (blood alcohol concentrations of 0.50-0.79g/l, adjusted OR 5.5 (95% Cl: 1.3-23.2) and >/=0.8g/l, adjusted OR 15.5 (95% Cl: 7.1-33.9)). High relative risks were estimated for drivers using combinations of drugs (adjusted OR 6.1 (95% Cl: 2.6-14.1)) and those using a combination of drugs and alcohol (OR 112.2 (95% Cl: 14.1-892)). Increased risks, although not statistically significantly, were assessed for drivers using amphetamines, cocaine, or opiates. No increased risk for road trauma was found for drivers exposed to cannabis. The study concludes that drug use, especially alcohol, benzodiazepines and multiple drug use and drug-alcohol combinations, among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation.
Correspondence: Karen D. Liller, Department of Community and Family Health, University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd, Tampa, FL 33612, USA; (email: kliller@hsc.usf.edu).
(Published by PNG Publications)
Reducing the burden of injury is a national and international goal that requires interdisciplinary approaches. Behavioral and social sciences are an integral part of comprehensive and effective injury-prevention efforts,yet they have lagged behind other approaches.
We have only limited knowledge about how to change individual and population injury-risk behaviors, let alone how to sustain behavioral change. Interventions have often been based on simplistic assumptions that changing knowledge changes behavior. Many interventions have been developed using trial and error methods, rather than on theory driven health behavior change models. It is now widely accepted that behavioral and social sciences are an integral part of comprehensive and effective violence and unintentional injury-prevention efforts.
For every environmental or technological advance, there is usually a behavioral component that needs to be addressed. Children need to wear bike helmets, parents need to properly restrain a child in a child safety seat, tenants need to install smoke alarms, athletes need to wear protective gear, drivers need to use antilock brakes properly, and social and behavioral alternatives to violence must be found for youth and young adults.
Theory-based initiatives to prevent violence and injury have successfully demonstrated the application of behavioral science to injury prevention, but they are infrequently used. Behavioral and social science contributions to injury prevention are underrepresented in the literature, underdeveloped in their application, and sorely underfunded. To more effectively address the complexities of injury prevention, we need to integrate what is known in behavioral science and apply this knowledge to injury problems, research questions, and practices. Health promotion and safety promotion can help us accomplish this goal. Research should take an interdisciplinary focus and adapt existing theories to injury-risk behaviors and to the modification of risky environments. More emphasis is needed on behavioral and community intervention studies, evaluation, and the dissemination of programs with proven effectiveness. We have also observed that a mix of strategies is needed to address both unintentional and intentional injuries. For example, in the child abuse field, Peterson and Brown recommend addressing background factors and immediate contributors that can lead to both types of injuries.
These factors and contributors include sociocultural variables (ie, poverty, chaos, stress, isolation); caregiver-based variables (ie, history of abuse or risk taking, substance-abuse, supervision practices, unrealistic expectations of child, need for control); and child-based variables (ie, distractible, high-anxiety level, impulsivity, nonconformity). A mix of interventions focused on strengthening family and economic systems, developing linkages to social services, performing home visitations, building community networking, using therapy, and providing education and skill training for both parents
and children would be important in addressing the total injury problem. These strategies emphasize behavioral and sociocultural environmental changes and should involve a wide array of professionals, including educators, health professionals, and representatives from health and social agencies.
Injuries, injury prevention and public health.
- Sleet DA, Liller KD, White DD, Hopkins K. Am J Health Behav 2004; 28 Suppl 1: s6-s12.
Correspondence: David A. Sleet, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MSK63, Atlanta, GA 30341, USA; (email: dsleet@cdc.gov).
OBJECTIVES: To introduce the readers to the field of injury prevention and comprehensive public health intervention approaches.
METHODS: A review of injury epidemiology, statistics, definitions, intervention approaches, and the importance of health promotion is provided.
FINDINGS: Behavioral, environmental, and technological solutions will be necessary to reduce or eliminate the factors that lead to injury.
COMMENTS: Reductions in injury and their costs will need the support, collaboration, and partnering of several disciplines. The use of sound behavioral and social science theories and methods will be an essential component of intervention effectiveness.
Correspondence: Hassan Soubhi, Department of Health Care & Epidemiology, University of British Columbia, British Columbia Injury Research and Prevention Unit, Centre for Community Child Health, Quebec, CANADA; (email: hassan.soubhi@umontreal.ca).
OBJECTIVE: To integrate findings from cross-sectional and longitudinal analyses of the relationships between childhood injury, child behavior, parenting, family functioning and neighborhood characteristics.
METHODS: Logistic modeling of cross-sectional (n = 12,666) and longitudinal (n = 9796) data from the National Longitudinal Survey of Children and Youth.
FINDINGS: Consistent correlates of childhood injury across designs included child's age, gender, difficult temperament, aggressive behavior, positive parenting, neighbors' cohesion, neighborhood problems, and socioeconomic disadvantage.
COMMENTS: Contextual influences on childhood injury vary by child's age, temperament and behavior. In early childhood, neighborhood processes of cohesion show protective effects. For older children, neighborhood disadvantage dominates the risk of injuries.
Correspondence: Aaron Rubin, Kaiser Permanente Sports Medicine Fellowship Program, 9985 Sierra Avenue, Fontana, CA 92335, USA; (email: aarib.l.rubin@kp.org).
There is a heightened awareness of terrorism in this country. There always remains the possibility of nonterrorist disasters at sporting venues. The team physician will be among the first medical responders to a disaster at a sporting venue. By being involved in the creation of an emergency action plan, learning the incident command system, understanding triage, and obtaining basic trauma life support skills, the team physician can be prepared to respond to mass casualty incidents at sporting events.
Colombia is a poor country that has been plagued by ongoing violence for more than 120 years. During the 1940s, subversive terrorist groups emerged in rural areas of the country when criminal groups came under the influence of Communism, and were later transformed into contemporary groups, such as the Ejercito de Liberacion Nacional (ELN) or National Liberation Army and Fuerzas Armadas Revolucionares de Colombia (FARC) or Revolutionary Armed Forces of Colombia). Paramilitary terrorist groups emerged in response to subversive groups and were later transformed into contemporary groups, such as the Autodefensas Unidas de Colombia (AUC) or United Self-Defense Forces of Colombia. Terrorism has placed an enormous burden on modern Colombia. From 1995 to 2002, 9,435 people were killed by terrorism-related events, of which 5,864 were killed by subversive terrorist activities and 3,571 were killed by paramilitary terrorist activities. In 2002, at least nineteen attacks produced 10 or more casualties, of which 18 were bombings. In 2002, terrorists killed at least 12 mayors, 71 legislators, and internally displaced 300,000 persons from their homes. Since terrorist groups in Colombia are typically supported by drug manufacturing and trafficking, it has been difficult at times to distinguish violence due to terrorism from violence due to illicit drug trafficking. Terrorism has also had a major adverse effect on the economy, with restricted travel, loss of economic resources, and lack of economic investment. In addition to political, military, and commercial targets, terrorists have specifically targeted healthcare infrastructure and personnel. At the national and local levels, much emergency planning and preparedness has taken place for terrorism-related events. The Centro Regulador de Urgencias (CRU) or Emergency Regulation Center in Bogota plays a major role in coordinating local prehospital and hospital emergency response in the capital city and the national level where necessary.
Sleep-related fatal vehicle accidents: characteristics of decisions made by multidisciplinary investigation teams.
- Radun I, Summala H. Sleep 2004; 27(2): 224-227.
Correspondence: Igor Radun, Department of Psychology, Traffic Research Unit, University of Helsinki, Helsinki, FINLAND; (email: igor.radun@helsinki.fi).
OBJECTIVES: To analyze factors that explain the attribution of crash causes as sleep-related by accident investigators.
DESIGN: Analysis of national database of fatal road accidents studied in depth. All nonprofessional nonintoxicated car drivers responsible for a fatal accident from 1991 to 2001 were included (N = 1464).
SETTING: Finland, with approximately 5.1 million inhabitants and 2.3 million motor vehicles. PARTICIPANTS: N/A.
INTERVENTIONS: N/A.
MEASUREMENTS: Comprehensive database recorded by multidisciplinary investigation teams, with specific emphasis on the availability of sleep-related driver variables and sleep-related causal decisions by teams.
FINDINGS: Injury severity, age, and marital status of the responsible car driver were related to the proportion of missing data in fatigue-related variables in the database (sleeping time, time awake, lifetime mileage). While there were differences between investigation teams and their activities, a series of logistic regression models showed that the lack of relevant variables in the database did not affect the proportion of accidents attributed to falling asleep (10% of cases) or as having fatigue-related causal factors (an additional 5% of the cases). The accident type (head-on and running-off versus other) and road conditions (dry or wet versus icy or snowy pavement) predicted the investigation teams' attribution of sleep-related causes in all models.
COMMENTS: Multidisciplinary teams' attribution of sleep-related causal factors were rather stable, comprising 10% to 15% of the cases investigated, independent of the availability of specific sleep-related information.
Treadmills are a burn risk for children. A child's hand can get trapped in the conveyor belt, causing friction burns to the underlying tissue. The purpose of this retrospective study was to review the characteristics and treatment of treadmill-related burns in children from 1998 to 2002. Ten patients, at a mean age of 3.4 years, sustained injuries associated with treadmill use. Trapping of the hand between the conveyor belt and the base was the most frequent injury mechanism. Burn location was predominantly on fingers and palms. Four patients required operative intervention. All patients required specialized wound care as well as scar management and occupational therapy. Treadmills pose a danger to children. Current safety devices are ineffective for preventing serious hand injuries in children. New design modifications and public awareness are needed to improve child safety.
Evaluation of a falls prevention program for independent elderly.
- Casteel C, Peek-Asa C, Lacsamana C, Vazquez L, Kraus JF. Am J Health Behav 2004; 28 Suppl 1: s51-s60.
Correspondence: Carri Casteel, Southern California Injury Prevention Research Center, UCLA School of Public Health, Los Angeles, CA, USA; ccasteel@email.unc.edu).
OBJECTIVE: To evaluate the effectiveness of an older adult falls-prevention program and describe compliance with the program.
METHODS: The No More Falls! program was evaluated by comparing outcomes of program participants and nonparticipants from the same health care system and by comparing outcomes in pre- and postintervention periods.
FINDINGS: Program participants were 20% less likely to fall than nonparticipants. Falls during the year after program participation decreased 53%, compared with a 21% decline among nonparticipants. Compliance was positively associated with program effectiveness.
COMMENTS: These findings suggest that the No More Falls! program was successful in reducing falls among older adults.
Work-related pilot fatalities in agriculture--United States, 1992-2001.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(15): 318-320.
Aircraft often are used in agriculture to apply pesticides, herbicides, or fertilizers. During 1992-2001, a total of 141 persons died in agriculture-related plane crashes. To characterize aviation fatalities in agriculture, CDC analyzed data on fatal injuries to pilots working in U.S. agriculture during 1992-2001. This report summarizes the results of that analysis, which indicated that agricultural pilots are at increased risk for fatal injury compared with pilots in all other industries. The agriculture aviation profession continues to work to reduce fatalities by recommending continual skill development and by offering training to aerial application pilots.
Geographic studies of the incidence and prevalence of child pedestrian injury collisions in different community environments have been primarily descriptive and idiosyncratic, reflecting one or another likely determinant of the places where these injuries occur. The current study maintains that multiple determinants of child pedestrian injury collisions must be considered in evaluating the unique contributions of any one community feature to injury rates. These features include local characteristics of populations, such as rates of unemployment, and places, such as locations of schools. Schools are one stable geographic feature associated with regular, often concentrated periods of complex and congested traffic patterns. The objective of the present study was to examine annual rates of child pedestrian injury in four California communities with a focus on the unique contribution of schools to injury risk. We predicted that annual numbers of child pedestrian injury collisions (both in-school and summer combined) would be greater in communities with higher youth population densities, more unemployment, fewer high-income households, and higher traffic flow. It was hypothesized that youth population density and its interaction with the number of schools in a given area would be related to greater rates of child pedestrian collisions during in-school months. An ecological approach was taken that divided the four communities into 102 geographic units with an average of 6321 people residing in each unit. Archival data on traffic flow, number of child pedestrian injury collisions and locations of schools were obtained from state agencies. Individual-level data were obtained from a general population survey conducted in the communities. The results showed that annual numbers of injuries were greater in areas with higher youth population densities, more unemployment, fewer high-income households, and greater traffic flow. Annual numbers of injuries during in-school months were greater in areas containing middle schools and greater population densities of youth.
Correspondence: Joseph Luftman, Kaiser Permanente, 4950 Sunset Boulevard, 4th Floor, Station B, Los Angeles, CA 90027, USA; (email: Joseph.P.Luftman@kp.org).
Football is reported to have one of the highest rates of injury among sports. Thus, it is becoming more commonplace for a physician to be present at the sideline to help manage injuries acutely. The team physician should be well equipped to provide game coverage by having the necessary equipment and knowledge of the injuries common in football. The physician should have an understanding of how to evaluate injuries at the sideline and when to send the player to the emergency room for further evaluation.
Outcomes in children and young adults who are hospitalized for firearms-related injuries.
- DiScala C, Sege R. Pediatrics 2004; 113(5): 1306-1312.
Correspondence: C. DiScala, Department of Pediatrics, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts 02111, USA; (email: cdiscala_tra@hotmail.com).
OBJECTIVES: To compare outcomes by intent of nonfatal firearms-related injuries in a hospitalized population, newborn to 19 years of age, and estimate the national incidence of ensuing disability.
METHODS: Descriptive statistics and comparative analysis using chi(2), odds ratio, and t test were applied to data from the National Pediatric Trauma Registry (NPTR) and the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Demographics, preinjury medical history, scene of injury, primary body part injured, severity of injury, utilization of resources, short-term and long-term disability, medical cause of disability, and disposition at discharge were studied.
FINDINGS: NPTR unintentional (n = 268) and assault-related firearms-related injuries (n = 506) were compared. In both groups, the majority of patients were male (80%). Compared with the unintentionally injured, the assaulted children were older and more frequently black (59.3% vs 32.5%). Approximately 17% in both groups had a preinjury history of medical/psychosocial problems. Unintentional injuries occurred mainly in private dwellings (75.7%), and assaults occurred in public places/street (53.8%). In both groups, injuries to multiple body regions were prevalent, and a substantial proportion sustained injuries of serious to critical level. Most children were transported by ambulance, but a significant proportion in the unintentional group were transported by helicopter. The rate of admission to the intensive care unit was approximately 40% for both groups. The unintentionally injured had a higher rate of surgical intervention (66.8% vs 50.8%) and stayed in the hospital longer than the assaulted ones (median: 5 days vs 3 days). Almost half of the children in both groups were discharged with disability, and approximately 87% returned to their home. Applying the NPTR disability rate to National Electronic Injury Surveillance System estimates of hospitalization suggests that approximately 3200 children nationwide develop disability from firearms-related injuries annually.
COMMENTS: Nonfatal firearms-related injuries in a pediatric population are associated with a high use of medical resources and lasting disability.Public policies should be developed and implemented to reduce the occurrence of these catastrophic events.
Interactions between child behavior patterns and parenting: implications for children's 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: Two factors were considered as predictors of children's risk for unintentional injury: (a) children's temperamentally difficult behavior patterns and (b) parenting. Along with hypotheses to replicate previous univariate effects, it was hypothesized that active, involved parents with sufficient time resources might reduce injury risk among temperamentally at-risk children.
METHODS: Study 1 used a retrospective design with a diverse sample of over 10,000 5-year-olds. Study 2 replicated Study 1 using a prospective design and behavioral data from a sample of over 1,000 children followed from 6 to 36 months of age.
FINDINGS: In Study 1, male gender, child hyperactivity, and family poverty predicted injury in a univariate manner. In Study 2, male gender and lack of positive parenting predicted injury in a univariate manner. Interaction effects also emerged: in Study 1 the interaction between child hyperactivity and parental time resources protected children from injury, and in Study 2 the interaction between child's difficult temperament and positive parenting protected children from injury.
COMMENTS: Children at increased risk for injury, i.e., those with hyperactive and difficult behavior patterns, might be protected in the environment of positive parenting. Theoretically, results suggest that researchers should consider Temperament x Environment interactions along with univariate predictors of outcome behavior. From an applied perspective, results have implications for the design of injury prevention campaigns: Parents who spend positive time with temperamentally difficult children might protect them from injury.
Parental beliefs regarding developmental benefits of childhood injuries.
- Lewis T, DiLillo D, Peterson L. Am J Health Behav 2004; 28 Suppl 1: s61-s68.
Correspondence: Terri Lewis, Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, 203 Bank of America Plaza, CB# 8030, Chapel Hill, NC 27599-8030, USA; (email: UCCTLL@MAIL.CSCC.UNC.EDU).
OBJECTIVE: To assess parental beliefs that minor childhood injuries play a beneficial role in the development of young children.
METHODS: Mothers and fathers of 159 children, ages 15 to 40 months, completed the Injury Attitudes Questionnaire (IAQ), designed to assess parental beliefs that children 'learn from' and 'toughen up' as a result of experiencing minor injuries.
FINDINGS: A main effect for parent gender was found such that fathers endorsed stronger beliefs than did mothers regarding the developmental benefits of injuries.
COMMENTS: The accuracy of these beliefs as well as their relevance to parental injury-prevention behaviors is discussed.
Correspondence: Pranab Kumar Nag, National Institute of Occupational health, Indian Council of Medical Research, Meghani Nagar, Ahmedabad 380016, INDIA; (email: pranabnag@yahoo.com).
The Indian farming employs 225 million workforce to cover 140 million hectares of total cultivated land. In spite of rapid farm mechanization (e.g., 149 million farm machinery), the vast resource-poor family farming has primary dependence on traditional methods (e.g., 520 million hand tools and 37 million animal-drawn implements are in operation). The work drudgery, the traumatic accidents and injuries are the major concerns to examine options for ergonomics intervention and betterment of work in crop production activities. This review summarizes human energy expenditure in crop production activities, to assess the job severity, tools and machinery, and formulate the basis to reorganize work and work methods. While the farm mechanization is more in the northern India, the accidents were more in the villages in southern India. On average of the four regions, the tractor incidents (overturning, falling from the tractor, etc.) were highest (27.7%), followed by thresher (14.6%), sprayer/duster (12.2%), sugarcane crusher (8.1%) and chaff cutter (7.8%) accidents. Most of the fatal accidents resulted from the powered machinery, with the annual fatality rate estimated as 22 per 100,000 farmers. The hand tools related injuries (8% of the total accidents) were non-fatal in nature. In spite of the enactment of legislation, the shortcomings in production and monitoring of the machinery in field use may be responsible for the high rate of accidents (e.g., 42 thresher accidents/1,000 mechanical threshers/year in southern India). Due to the lack of technical capability of the local artisans, adhering to safety and design standards is impractical to the implements fabricated in the rural areas. The analysis emphasizes that the effective safety and health management may be possible through legislative enabling of the local infra-structure, such as block development authority and primary health services, to permeate occupational health and safe work practices in the farming sector.
Assessing the long-term effects of the Safe Dates program and a booster in preventing and reducing adolescent dating violence victimization and perpetration.
- Foshee VA, Bauman KE, Ennett ST, Linder GF, Benefield T, Suchindran C. Am J Public Health 2004; 94(4): 619-624.
Correspondence: Vangie Foshee, Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill, 27599-7440, USA; (email: foshee@email.unc.edu).
OBJECTIVES: This study determined 4-year postintervention effects of Safe Dates on dating violence, booster effects, and moderators of the program effects.
METHODS: We gathered baseline data in 10 schools that were randomly allocated to a treatment condition. We collected follow-up data 1 month after the program and then yearly thereafter for 4 years. Between the 2- and 3-year follow-ups, a randomly selected half of treatment adolescents received a booster.
FINDINGS: Compared with controls, adolescents receiving Safe Dates reported significantly less physical, serious physical, and sexual dating violence perpetration and victimization 4 years after the program. The booster did not improve the effectiveness of Safe Dates.
COMMENTS: Safe Dates shows promise for preventing dating violence but the booster should not be used.
Some previous investigations indicated that economic crisis (inflation in Serbia 1993/94) have great influence on increasing suicide rates in Serbia. After that suicide decreased, despite the war and bombing in 1999, specially among the elderly people. A total of 453 suicides were registered on the territory of south-eastern Serbia during 1995-2001 years. Of them 295 (65.1%) were aged over 60 years. Generally linear trends of suicide among both genders from 1995 to 2001 decreased, but the slope of decreasing was grater among males than among females. The highest rates among the both genders were registered in the years with the maximum number of suicides, but the linear trends of rates have statistically important correlation with time (r>0.5). Average annual suicide rate among males was 42.5, and among women it was 18.7. The highest average annual suicide rate among men was observed in the age group 75 years and over (93.3), and the lowest in the age group 65-69 (20.6). Among males, in the all age group linear trends of suicide rates decreased, with the highest slope among 75 years and over and the lowest among 65-69 years. The highest suicide rate among females was registered in age group 75 years and over (25.6), the lowest in the age group 65-69 (13.5). The linear trends are similar as among males: downward trend was observed among all aged groups, with the highest slope among women 75 years and over. The most common way of suicide among men was hanging up (63%), poisoning and by firearms. There were no statistical differences between way of suicide and age groups. The most frequent way of suicide among females was hanging up (55%), poisoning (25%) and drowning (12%). There were statistically significant differences in drowning between age groups, 70-74 and 75 and over (p<0.05), and between poisoning and age groups 60-64 years and 75 years and over. Poisoning and drowning are statistically more frequent among women than among men.
An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents.
Data from 390 high school students were collected to examine potential differences between adolescents who had attempted suicide and those who engaged in self-injurious behavior on measures of depression, suicidal ideation, and attitudes toward life and death. Significant differences were found between controls and the self-harm groups on all dependent variables. A significant difference on attitudes toward life was found between the self-injury and suicide attempt groups. Post-hoc regression analyses showed that measures of depression, suicide ideation, and attitudes towards life predicted participants' self-harm categorization. These findings provide preliminary evidence that self-injurious behavior is different from attempted suicide among a community sample of adolescents.
Familial transmission of suicidal ideation and suicide attempts: evidence from a general population sample.
Correspondence: R.D. Goodwin, Department of Epidemiology, Mailman School of Public Health, Columbia University, 1051 Riverside Drive, Unit #43, New York, NY 10032, USA; (email: rdg66@columbia.edu).
The goals of the study were (1) to determine the association between parental and offspring suicidal ideation and suicide attempts among adult offspring in a general community sample, and (2) to examine the extent to which this association can be explained by mediating processes of mental disorders. Data were drawn from the National Comorbidity Survey (n=8098), a representative household sample of adults aged 15-54 in the United States. The relationships between suicidal ideation and suicide attempts among adult offspring and suicidal ideation and suicide attempt in their parents, compared with those in parents not characterized by suicidal ideation or suicide attempts, were calculated using multiple logistic regression analyses. Analyses were adjusted for differences in sociodemographic characteristics and for mental disorders. Results showed that parental suicidal ideation was associated with a significantly increased likelihood of suicidal ideation [OR=1.7 (1.2, 2.5)] and suicide attempt [OR=1.4 (0.9, 2.1)] among offspring. Parental suicide attempt was associated with increased odds of suicidal ideation [OR=2.0 (1.4, 2.9)] and suicide attempt [OR=2.2 (1.4, 3.4)] among offspring. Comorbid mental disorders contributed to the strength of these associations, but with the exception of the link between parental suicidal ideation and offspring suicide attempt, all remained statistically significant even after adjustment. These data provide initial evidence of familial linkages (parent-offspring) of suicidal ideation and behavior among a sample of adults representative of the US population. The data suggest that comorbid mental disorders contribute to these associations but do not completely account for them. The findings are consistent with and extend results from family, clinical, and high-risk studies suggesting that a familial risk of suicidal ideation and suicide behavior occurs in the general population. Implications for prevention and future research are discussed.
Correspondence: Kelvin K. W. Yau, Department of Management Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, PR CHINA; (email: mskyau@cityu.edu.hk).
A population-based case-control study was conducted to examine factors affecting the severity of single vehicle traffic accidents in Hong Kong. In particular, single vehicle accident data of three major vehicle types, namely private vehicles, goods vehicles and motorcycles, which contributed to over 80% of all single vehicle accidents during the 2-year-period 1999-2000, were considered. Data were obtained from the newly implemented traffic accident data system (TRADS), which was developed jointly by the Transport Department, Police Force and Information Technology Services Department, Hong Kong. The effect of district, human, vehicle, safety, environmental and site factors on injury severity of an accident was examined. Unique risk factors associated with each of the vehicle types were identified by means of stepwise logistic regression models. For private vehicles, district board, gender of driver, age of vehicle, time of the accident and street light conditions are significant factors determining injury severity. For goods vehicles, seat-belt usage and weekday occurrence are the only two significant factors associated with injury severity. For motorcycles, age of vehicle, weekday and time of the accident were determined to be important factors affecting the injury severity. Identification of potential risk factors pertinent to the particular vehicle type has important implications to relevant official organisations in modifying safety measures in order to reduce the occurrence of severe traffic accidents, which would help to promote a safe road environment.
The mixed effects of precipitation on traffic crashes.
OBJECTIVE: This paper investigates the relationship between precipitation and traffic crashes in the US during the period 1975-2000. Traffic crashes represent the leading cause of death and injury for young adults in the US, and the ninth leading cause of death for the overall population. Prior studies have found that precipitation raises the risk of traffic crashes significantly.
METHODS: A negative binomial regression approach is employed. Two different units of analysis are examined: state-months and state-days. The sample includes all 48 contiguous states.
FINDINGS: A surprising negative and significant relationship between monthly precipitation and monthly fatal crashes is found. However, in the daily level analysis, a strong positive relationship is estimated, as in prior studies. The source of the contrasting results appears to be a substantial negative lagged effect of precipitation across days within a state-month. In other words, if it rained a lot yesterday, then on average, today there are fewer crashes. Additional analysis shows that the risk imposed by precipitation increases dramatically as the time since last precipitation increases. For example, 1cm of precipitation increases the fatal crash rate for a state-day by about 3% if exactly 2 days have passed since the last precipitation and by about 9% if more than 20 days have passed. This basic pattern holds for non-fatal crashes as well.
COMMENTS: The lagged effects of precipitation across days may be explained by the clearing of oil that accumulates on roads during dry periods or by the conditioning of people to drive more safely in wet conditions. Either way, policy interventions that prepare drivers more adequately for the risks of precipitation following dry periods are likely to be beneficial.
An evaluation of the effectiveness of forward facing child restraint systems.
Correspondence: Kristy B. Arbogast, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., 3535 TraumaLink, 10th Floor, Philadelphia, PA 19104, USA; (email: arbogast@email.chop.edu).
The objective of this study was to determine the effectiveness of forward facing child restraint systems (FFCRS) in preventing serious injury and hospitalization to children 12-47 months of age as compared with similar age children in seat belts. Data were obtained from a cross-sectional study of children aged 12-47 months in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. Effectiveness estimates were limited to those children between 12 and 47 months of age seated in the back row(s) of vehicles, restrained in FFCRS, regardless of misuse, or seat belts of all types and usage. Completed survey information was obtained on 1207 children, representing 12,632 children in 11,619 crashes between 1 December 1998 and 31 May 2002. Serious injuries occurred to 0.47% of all 12-47-month olds studied, including 1.72% of those in seat belts and 0.39% of those in child restraint systems. The risk of serious injury was 78% lower for children in FFCRS than in seat belts (odds ratio, 95% confidence interval -0.45,). The risk of hospitalization was 79% lower for children in FFCRS than in seat belts, 95% -0.50. There was no difference between the restraint types in preventing minor injuries. As compared with seat belts, CRS are very highly effective in preventing serious injuries and hospitalization, respectively. This effectiveness estimate is substantially higher than older estimates, demonstrating the benefits of current CRS designs. These results provide those educating parents and caregivers population-based data on the importance of child restraint use.
Scenario analysis of freight vehicle accident risks in Taiwan.
Correspondence: Ming-Chih Tsai, Department of Marketing, National ChungHsing University, No. 250 Kuo-Kung Road, Taichung City 402, TAIWAN; (email: mctsai@dragon.nchu.edu.tw).
This study develops a quantitative risk model by utilizing Generalized Linear Interactive Model (GLIM) to analyze the major freight vehicle accidents in Taiwan. Eight scenarios are established by interacting three categorical variables of driver ages, vehicle types and road types, each of which contains two levels. The database that consists of 2043 major accidents occurring between 1994 and 1998 in Taiwan is utilized to fit and calibrate the model parameters. The empirical results indicate that accident rates of freight vehicles in Taiwan were high in the scenarios involving trucks and non-freeway systems, while; accident consequences were severe in the scenarios involving mature drivers or non-freeway systems. Empirical evidences also show that there is no significant relationship between accident rates and accident consequences. This is to stress that safety studies that describe risk merely as accident rates rather than the combination of accident rates and consequences by definition might lead to biased risk perceptions. Finally, the study recommends using number of vehicle as an alternative of traffic exposure in commercial vehicle risk analysis. The merits of this would be that it is simple and thus reliable; meanwhile, the resulted risk that is termed as fatalities per vehicle could provide clear and direct policy implications for insurance practices and safety regulations.
See item under Alcohol and Other Drugs
See item under Risk Factor Prevalence, Injury Occurrence and Costs
Despite an epidemic of intimate-partner violence against women, and general agreement that women should be screened for it, few assessment and intervention protocols have been evaluated in controlled studies. To test a telephone intervention intended to increase the "safety-promoting behavior" of abused women, 75 women received six telephone calls over a period of eight weeks in which safety-promoting behaviors were discussed. A control group of 75 women received usual care. Women in both groups received follow-up calls to assess safety-promoting behaviors at three, six, 12, and 18 months after intake. Analysis showed that the women in the intervention group practiced significantly (P < 0.01) more safety-promoting behaviors than women in the control group at each assessment. On average, women in the intervention group practiced almost two more safety-promoting behaviors than they had at time of intake and nearly two more than women in the control group; the additional behaviors were practiced for 18 months. This nursing intervention requires only 54 minutes to complete (six nine-minute telephone calls) and can be integrated into any health care setting. Because less than one hour of professional nursing time is involved, the cost of the intervention is minimal. Future research should determine whether the adoption of safety-promoting behaviors by abused women averts trauma and its subsequent health care costs.
The effect of nondiscretionary concealed weapon carrying laws on homicide.
- Hepburn L, Miller M, Azrael D, Hemenway D. J Trauma 2004; 56(3): 676-681.
Correspondence: Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115, USA; (email: ).
BACKGROUND: Historically, the carrying of concealed firearms has been either substantially restricted or prohibited outright. Over the past two decades, laws making it easier for civilians to obtain permits allowing them to carry concealed weapons legally have proliferated throughout the United States. This study investigates the effect of such changes in state laws on state homicide rates.
METHODS: Pooled cross-sectional time-series data (1979-1998) for 50 states and Poisson regression methods were used to estimate the effect of changes in state laws on homicide rates.
FINDINGS: No statistically significant association exists between changes in concealed weapon laws and state homicide rates. This finding is consistent across all models.
COMMENTS: The current findings are consistent with those of other published studies indicating that nondiscretionary concealed weapon laws are not associated with significant increases or decreases in homicide.
Implications of educating the public on mental illness, violence, and stigma.
Correspondence: Patrick Corrigan, University of Chicago Center for Psychiatric Rehabilitation, Tinley Park, IL 60477, USA; (email: p-corrigan@uchicago.edu).
This study examined how two types of public education programs influenced how the public perceived persons with mental illness, their potential for violence, and the stigma of mental illness. A total of 161 participants were randomly assigned to one of three programs: one that aimed to combat stigma, one that highlighted the association between violence and psychiatric disorders, and a control group. Participants who completed the education-about-violence program were significantly more likely to report attitudes related to fear and dangerousness, to endorse services that coerced persons into treatment and treated them in segregated areas, to avoid persons with mental illness in social situations, and to be reluctant to help persons with mental illness.
Ending intimate partner violence: an application of the transtheoretical model.
- Burke JG, Denison JA, Gielen AC, McDonnell KA, O'Campo P. Am J Health Behav 2004; 28(2): 122-133.
Correspondence: Jessica G. Burke, Johns Hopkins University School of Public Health, Department of Population Family Health Sciences, 615 N. Wolfe Street, 4th Floor, Baltimore, MD 21205, USA; (email: jburke@jhsph.edu).
OBJECTIVE: To examine the application of the transtheoretical model (TM) to women's experiences of ending intimate partner violence (IPV).
METHODS: Qualitative interviews were conducted with 23 abused women.
FINDINGS: Women use 7 traditional processes of change. Women in early stages of change use cognitive processes. Women in later stages use behavioral processes. Consciousness-raising and social liberation appear in both early and later stages. Helping relationships are critical throughout. Decisional balance and self-efficacy are also related.
COMMENTS: Women ending IPV do use the TM processes and constructs of change. These findings support the development and evaluation of a TM stage-based IPV intervention.
Prediction of violence perpetration among high-risk youth.
- Sussman S, Skara S, Weiner MD, Dent CW. Am J Health Behav 2004; 28(2): 134-144.
Correspondence: Steve Sussman, Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Alhambra, CA 91803, USA; (email: ssussma@usc.edu).
OBJECTIVES: To prospectively examine demographic background, personality, perceived environment, and behavior as violence perpetration predictors in emerging adulthood among high-risk adolescents using problem-behavior theory as a conceptual perspective.
METHODS: Self-report questionnaires were administered 5 years apart to 676 participants.
FINDINGS: Hard drug use, belief that hurting another's property while drunk was acceptable, and high-risk group self-identification predicted later violence perpetration independent of baseline violence perpetration.
COMMENTS: Consistent with problem-behavior theory, personality, perceived environment, and behavior variables, beyond baseline violent behavior, predict risk for future violence perpetration in emerging adulthood, whereas demographic background may exert indirect effects.
Is adolescent sibling violence a precursor to college dating violence?
- Noland VJ, Liller KD, McDermott RJ, Coulter ML, Seraphine AE. Am J Health Behav 2004; 28 Suppl 1: s13-s23.
Correspondence: Virginia J. Noland, University of Florida, College of Health and Human Performance, Department of Health Science Education, P.O. Box 118210, FLG 5, Gainesville, FL 32611-8210, USA; (email: vnoland@hhp.ufl.edu).
OBJECTIVE: To determine whether experiencing sibling violence in adolescence is a significant predictor for later dating violence. The influence of parent-to-child and parent-to-parent violence is also explored.
METHODS: A modified version of the CTS2 was administered to community college students. The survey instrument used the CTS2 psychological and physical assault subscales.
FINDINGS: Adolescent sibling violence was a predictor for college dating violence. Males reported experiencing more sibling violence than females did, but females reported experiencing more dating violence, both as perpetrators and victims.
COMMENTS: Further research is needed to improve understanding of the reasons for and the long-term consequences of sibling violence.
Violence prevention among African American adolescent males.
- Ngwe JE, Liu LC, Flay BR, Segawa E, Aban A. Am J Health Behav 2004; 28 Suppl 1: s24-s37.
Correspondence: Job E. Ngwe, Northeastern Illinois University, Chicago, IL, USA.
OBJECTIVE: To test psychosocial mediators of the effects of an intervention in reducing the rate of growth of violence among adolescents.
METHOD: Five hundred and seventy-one African American adolescent males participated in this randomized trial. Multilevel modeling techniques were used to ascertain both intervention and mediated effects.
RESULTS: Intervention significantly reduced rate of growth of violence and 5 social and psychological factors in the treatment group relative to the control group. Four of these social and psychological factors were found to be complete mediators between the intervention and its preventive effects.
CONCLUSION: Changing psychological mediating variables is central to reducing youth violence.
