Correspondence: D. Gorman, Department of Epidemiology and Biostatistics, School of Rural Public Health, Suite 310, 3000 Briarcrest Drive, Bryan, Texas 77802, USA; (email: gorman@srph.tamushsc.edu).
OBJECTIVE: To examine the relationship between alcohol outlet density and violent crime controlling for neighbourhood sociostructural characteristics and the effects of spatially autocorrelated error.
DESIGN: The sample for this ecologic study comprised 188 census tracts from the City of Austin, Texas and 263 tracts from the City of San Antonio, Texas. Data pertaining to neighbourhood social structure, alcohol density and violent crime were collected from archival sources, and analysed using bivariate, multivariate and geospatial analyses.
FINDINGS: Using ordinary least squares analysis, the neighbourhood sociostructural covariates explained close to 59% of the variability in violent crime rates in Austin and close to 39% in San Antonio. Adding alcohol outlet density in the target and adjacent census tracts improved the explanatory power of both models. Alcohol outlet density in the target census tract remained a significant predictor of violent crime rates in both cities when the effects of autocorrelated error were controlled for. In Austin, the effects of alcohol outlet density in the adjacent census tracts also remained significant. The final model explains 71% of the variance in violent crime in Austin and 56% in San Antonio.
COMMENTS: The findings show a clear association between alcohol outlet density and violence, and suggest that the issues of alcohol availability and access are fundamental to the prevention of alcohol-related problems within communities.
Alcohol-related emergency department visits among people ages 13 to 25 years.
Correspondence: R.W. Elder, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., Mailstop K63, Atlanta, Georgia 30341, USA; (email: rfe3@cdc.gov).
OBJECTIVE: Data from a large, nationally representative sample of hospital emergency departments (EDs) were used to assess the prevalence and characteristics of alcohol-related ED visits among people ages 13 to 25 years in the United States.
METHOD: Emergency department visits recorded in the National Electronic Injury Surveillance System-All Injury Program were coded for alcohol involvement based on alcohol product codes and abstractions of chart narratives. National estimates and confidence intervals were calculated using SUDAAN statistical software.
FINDINGS: Based on these chart data, in the United States in 2001 there were an estimated 244,331 alcohol-related ED visits among people ages 13 to 25 (3.2% of total visits). Of these, an estimated 119,503 (49%) involved people below the legal drinking age of 21. The number of alcohol-related visits increased throughout adolescence and young adulthood to the age of 21, after which they decreased to levels similar to those seen for 18 to 20 year olds. Alcohol-related visits were most frequent on weekends and among males and were more strongly associated with visits related to assault or self-harm than to visits for unintentional injuries or injuries of unknown intent. In this population, 38% of alcohol-related visits involved no external cause of injury (e.g., drinking to excess only).
COMMENTS: These data highlight the need for stronger efforts to delay initiation of alcohol use among adolescents as long as possible and to limit access to alcohol for underage drinkers.
Correspondence: C. Mock, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA; (email: cmock@u.washington.edu).
The global burden of injuries is enormous, but has often been overlooked in attempts to improve health. We review measures that would strengthen existing efforts to prevent and treat injuries worldwide. Scientifically-based efforts to understand risk factors for the occurrence of injury are needed and they must be translated into prevention programmes that are well designed and assessed. Areas for potential intervention include environmental modification, improved engineering features of motor vehicle and other products, and promotion of safe behaviours through social marketing, legislation, and law enforcement. Treatment efforts need to better define the most high-yield services and to promote these in the form of essential health services. To achieve these changes, there is a need to strengthen the capacity of national institutions to do research on injury control; to design and implement countermeasures that address injury risk factors and deficiencies in injury treatment; and to assess the effectiveness of such countermeasures. Although much work remains to be done in high-income countries, even greater attention is needed in less-developed countries, where injury rates are higher, few injury control activities have been undertaken, and where most of the world's population lives. In almost all areas, injury rates are especially high in the most vulnerable sections of the community, including those of low socioeconomic status. Injury control activities should, therefore, be undertaken in a context of attention to human rights and other broad social issues.
Effective Trauma Center Partnerships to Address Firearm Injury: A New Paradigm.
BACKGROUND: Firearm violence is the second leading cause of injury-related death. This study examined the use of local trauma centers as lead organizations in their communities to address firearm injury.
METHODS: Three trauma centers in cities with populations less than 100,000 were linked with a university-based firearm injury research center. A trauma surgeon director and coordinator partnered with communities, recruited and directed advisory boards, established a local firearm injury surveillance system, and informed communities using community-specific profiles. Primary process and outcome measures included completeness of data, development of community-specific profiles, number of data-driven consumer media pieces, number of meetings to inform policy makers, and an analysis of problems encountered.
FINDINGS: Local trauma centers in smaller communities implemented a firearm injury surveillance system, produced community-specific injury profiles, and engaged community leaders and policy makers to address firearm injury. Community-specific profiles demonstrated consistent firearm suicide rates (6.58-6.82 per 100,000) but variation in firearm homicide rates (1.08-12.5 per 100,000) across sites. There were 63 data-driven media pieces and 18 forums to inform community leaders and policy makers. Completeness of data elements ranged from 57.1% to 100%. Problems experienced were disconnected data sources, multiple data owners, potential for political fallout, limited trauma center data, skills sets of medical professionals, and sustainability.
COMMENTS: Trauma centers, when provided resources and support, with the model described, can function as lead organizations in partnering with the community to acquire and use community-specific data for local firearm injury prevention.
BACKGROUND: Environmental exposures contribute to the global burden of disease. We have estimated the burden of disease attributable to outdoor and indoor air pollution, inadequate water and sanitation, lead exposure, and injury among European children and adolescents.
METHODS: Published studies and reports from international agencies were reviewed for calculation of risk-factor exposure in Europe. Disability-adjusted life years (DALYs) or deaths attributable to each factor, or both, were estimated by application of the potential impact fraction to the estimates of mortality and burden of disease from the WHO global database of burden of disease.
FINDINGS: Among children aged 0-4 years, between 1.8% and 6.4% of deaths from all causes were attributable to outdoor air pollution; acute lower-respiratory-tract infections attributable to indoor air pollution accounted for 4.6% of all deaths and 3.1% of DALYs; and mild mental retardation resulting from lead exposure accounted for 4.4% of DALYs. In the age-group 0-14 years, diarrhoea attributable to inadequate water and sanitation accounted for 5.3% of deaths and 3.5% of DALYs. In the age-group 0-19 years, injuries were the cause of 22.6% of all deaths and 19.0% of DALYs. The burden of disease was much higher in European subregions B and C than subregion A. There was substantial uncertainty around some of the estimates, especially for outdoor air pollution.
COMMENTS: Large proportions of deaths and DALYs in European children are attributable to outdoor and indoor air pollution, inadequate water and sanitation, lead exposure, and injuries. Interventions aimed at reducing children's exposure to environmental factors and injuries could result in substantial gains. The pronounced differences by subregion and age indicate the need for targeted action.
Correspondence: S. Folkard, Body Rhythms and Shiftwork Centre, Department of Psychology, University of Wales Swansea, Swansea, Wales, UK; (email: S.Folkard@Swansea.ac.uk).
Models based on measures of fatigue and performance make the implicit assumption that they will be successful in predicting risk. The present paper reviews the available literature on shiftwork safety in which real measures of accidents or injuries could be pinpointed in time and in which the a priori risk appeared to be constant. Three main problems for the models emerged from this review: 1) risk was significantly higher on the afternoon shift than on the morning shift; 2) the dominant peak in risk over the course of the night shift occurred at about midnight; and 3) risk increased substantially over spans of four successive nights. It is suggested that the relationship between risk and fatigue may be non-linear, that models may have overestimated the recovery during short sleeps, and that day sleeps between night shifts may be less recuperative than normally timed night sleeps of the same length.
My home is my castle! Or is it? Hospitalizations following home injury in Israel, 1997-2001.
- Sikron F, Giveon A, Aharonson-Daniel L, Peleg K. Isr Med Assoc J 2004; 6(6): 332-335.
Correspondence: Fabienne Sikron, Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, ISRAEL; (email: unavailable).
BACKGROUND: Although the home is perceived to be a safe haven, it is a scene of numerous injuries.
OBJECTIVES: To characterize home injury in Israel, the victims, injury circumstances and outcomes, and to identify groups at high risk for injury in order to focus future interventions and thus effectively prevent these injuries and their associated hospitalizations.
METHODS: We analyzed 5 year records (1997-2001) from the National Trauma Registry of all patients arriving at eight trauma centers following home injury and admitted to hospital, transferred to another medical center, or died in the emergency department.
FINDINGS: The study group included 26,921 patients, constituting 34% of all unintentional hospitalized trauma patients. Twenty-seven percent were children (0-4 years) and 37% were elderly (> or = 65 years), the two age groups whose home injury accounted for most of the trauma injuries. Among children more boys (59%) than girls (41%) were injured, but the opposite was true for the elderly (30% males and 70% females). The share of females among the home-injured increased with age. Falls caused 79% of all home injuries (97% among the elderly) and burns 9%, increasing to 18% among children (0-4 years). Among non-Jewish home-injured patients, infants predominated (50% compared to 20% among Jews). Moderate to critical injuries amounted for 42%, with 38% of the home-injured and 60% of the elderly requiring surgery. The clinical and economic consequences of home injuries differed according to the type of injury, with burns carrying the heaviest toll of prolonged intensive care and hospital stay. Overall, hospital stay averaged 6.2 days per patient (median 3 days).
COMMENTS: Falls among the elderly, burns among children, and a high prevalence of hospitalization among non-Jewish children define groups at high risk for home injuries. Prevention programs should be based on these findings and should focus on the more vulnerable groups.
The aim of this study was to investigate the relationship between psychosocial work characteristics and the risk for being injured in an occupational accident. We performed this study within the framework of the Maastricht Cohort Study of Fatigue at Work, a prospective cohort study on employees (n = 7051) from a wide range of companies and organizations. One hundred eight workers reported being injured in an occupational accident for which the subject consulted a physician or physiotherapist. Adjustments were made for work environment and demographic variables. High psychologic job demands were a risk factor for being injured in an occupational accident. Low decision latitude had a crude relative risk for being injured in an occupational accident of 2.02 (95% confidence interval [CI] = 1.23-3.39). This relationship almost completely disappeared after adjustment for the confounders mentioned here. Coworker and supervisor support were inversely related to the risk of being injured in an occupational accident but did not reach statistical significance. Other psychosocial work characteristics that had a significant effect on the risk for being injured in an occupational accident were conflicts with the supervisor (relative risk [RR] = 2.49; 95% CI = 1.42-4.37) or colleagues (RR = 2.62; 95% CI = 1.58-4.35), job satisfaction (RR = 1.43; 95% CI = 1.08-1.91), and high emotional demands (RR = 2.45; 95% CI = 1.52-3.94). We conclude that after adjustment for demographic variables, fatigue, and factors that describe the type of work environment that high psychologic job demands, emotional demands, and conflicts with the supervisor and/or colleagues are risk factors for being injured in an occupational accident.
Glove use and the relative risk of acute hand injury: a case-crossover study.
Correspondence: Gary Sorock, Department of Occupational and Environmental Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA; (email: gsorock@jhsph.edu).
The purpose of this study was to investigate the relationship between glove use and acute traumatic occupational hand injury. We used a case-crossover, within-subject study design to control for differences between individuals such as occupation, injury history, age, gender, risk-taking behavior, manual dexterity, and muscle strength. A total of 1166 hand-injured workers were interviewed regarding the use of gloves at the time of the injury. The self-reported average duration of glove use in the previous work month was the measure of expected exposure to wearing gloves. Nineteen percent of subjects reported wearing gloves at the time of the injury. The expected exposure to glove use in the past work month was 27.9%. Glove use was associated with a lower risk of lacerations and punctures but not crush, fractures, avulsions, amputations, dislocations; the risk of the former two injury types was estimated to be 60-70% lower while wearing gloves. Glove use is only one component of a comprehensive hand injury prevention approach that might include the identification and elimination of sharp hazards, engineering controls, safety warnings, training in high-risk situation awareness, and proper selection and timing of glove use.
Pediatric pedestrian trauma study: a pilot project.
- Hotz GA, Cohn SM, Nelson J, Mishkin D, Castelblanco A, Li P, Duncan R; Pediatric Pedestrian Injury Task Force. Traffic Inj Prev 2004; 5(2): 132-136.
Correspondence: Gillian A. Hotz, Department of Surgery, Division of Trauma and Surgical Critical Care, University of Miami School of Medicine, Miami, Florida, USA; (email: ghotz@med.miami.edu).
OBJECTIVE: To evaluate the implementation of the WalkSafe Program, a school based educational injury prevention program for children grades Kindergarten through 5.
METHODS: A randomized comparative design was used for this study. The study was conducted in two high-risk urban school districts, which were chosen based on the geographic areas with the highest pedestrian injury and fatality rates. Four elementary schools (two in each district) were identified as potential study sites. Two intervention schools, one in each school district, were randomly chosen to receive the WalkSafe program; the other two schools served as controls, and received no intervention. The data was collected within the classroom setting for both the intervention and control schools. All elementary school children were administered the same pedestrian safety questionnaire as a pre-test, post-test and at three months following the intervention.
FINDINGS: A total of 2300 children participated in the WalkSafe program. The intervention (I) schools showed significant improvement in post-test scores then the control (C) schools (p = 0.012), and the (I) schools were able to maintain their test scores as reflected in a three-month follow-up evaluation (p = 0.47). Grades 3-5 of the (I) schools showed significant improvement in their test scores over grades K-2 (p < 0.0001).
COMMENTS: The WalkSafe program was shown to improve the pedestrian safety knowledge of elementary school children. Future research will include implementing the WalkSafe program at each elementary school within a single high-risk district.
Incidence rates and characterizations of occupational carbon monoxide (CO) poisoning in terms of sources of exposures, diagnosis, treatment, and health care utilization are critical for public health planning. We identified 182 CO poisoning cases occurring over a 6-year period (IR = 4.3/100,000 worker-years) in the West Virginia workers' compensation data. Frequent sources of poisoning were gas-powered engines (28%) and furnaces (20%). Minimum treatment duration ranged from 1 day to 8 years with significant differences in mental health comorbidities between cases treated within 1 year compared with cases treated for more than 1 year (OR = 20.75; 95% CI = 3.5-128.4). The average cost (medical and wage loss replacement) for CO claims was dollars 2130 and median lost time was 45 days. CO poisoning could lead to prolonged disability and treatment in patients with mental health comorbidities, suggesting a possible role for early intervention.
Correspondence: Travis Heggie, Department of Recreation, Park and Tourism Sciences, Texas A&M University, College Station, TX 77843-2261, USA; (email: heggie@tamu.edu).
OBJECTIVE: To report the injuries and illnesses encountered by wilderness hikers in Hawaii Volcanoes National Park attempting to hike to active lava flows and to investigate the roles that demographics, prior hiking experience, hiking behavior, and preparedness play in hiker vulnerability to injury and illness.
METHODS: During an 8-week period, daily on-site exit interviews of lava hikers were conducted by a uniformed park ranger and park volunteer. Information about the hiker's home residence, wilderness hiking experience, preparedness, health status, and health problems encountered during the hike was collected from a total of 804 hikers.
FINDINGS: A high rate of injury and illness was found among the study population. Scrapes and abrasions (59%), blisters (51%), and muscle strains and sprains (47%) were the most common injuries. Dehydration (77%) and respiratory irritation (46%) were the most common illnesses. Lower extremities were the most common site of injuries, and beginning hikers were the most vulnerable to injury and illness. Many hikers were inexperienced tourists willing to disregard warning signs and enter high-risk areas.
COMMENTS: Hawaii Volcanoes National Park is one of 22 US national park units with volcanic resources. The injuries and illnesses reported by the study group identify the impact that this type of environment can have on the safety of wilderness users in areas with similar resources. Recreating in remote and severe areas has inherent risks, but the high rate of injuries and illnesses sustained by the hikers of this study can potentially be reduced through the development of more direct risk management methods.
Physical activity interventions to prevent falls among older people: update of the evidence.
- Sherrington C, Lord SR, Finch CF. J Sci Med Sport 2004; 7(1 Suppl): 43-51.
Correspondence: Cathie Sherrington, Prince of Wales Medical Research Institute, The University of New South Wales, AUSTRALIA; (email: c.sherrington@unsw.edu.au).
Injuries resulting from falls are a significant public health issue, particularly for older people. This review provides an update of the evidence on the effects of various physical activity (PA) or exercise intervention strategies for the prevention of unintentional falls among older people. Six systematic reviews, and three randomised controlled trials not incorporated in previous reviews, were located with a literature search. There is clear evidence that a targeted supervised home exercise program of strength and balance exercise and walking practice, prescribed by a trained health professional, can prevent falls among older community dwellers. There is also an indication that untargeted group exercise (ie, not individually prescribed) can prevent falls among community dwellers, particularly if it involves Tai Chi or other exercises which challenge balance. There is some indication that individual prescription of PA is more important in frailer groups. Further investigation is required to establish the effects of PA in residential aged care, and the relative effects of different types of PA in different populations. In addition, multidisciplinary, multifactorial. health/environmental risk factor screening/intervention programs have been found to be effective in preventing falls. For many individuals with physical risk factors for falls (eg, impaired strength, balance or functional ability), PA alone is likely to reduce the risk of falls. For those with additional risk factors (eg, visual impairments, psychoactive medication use), other interventions may also be required.
Looking for the evidence: a systematic review of prevention strategies addressing sport and recreational injury among children and youth.
- MacKay M, Scanlan A, Olsen L, Reid D, Clark M, McKim K, Raina P. J Sci Med Sport 2004; 7(1): 58-73.
Correspondence: Morag MacKay, Children's Hospital of Eastern Ontario Research Institute, Ottawa, CANADA; (email: mmackay@cheo.on.ca).
OBJECTIVES: To examine evidence on the effectiveness of current injury prevention strategies in selected sport and recreational activities, determine the applicability of the evidence to children and youth and discuss the implications related to policy, programming and future research.
METHODS: Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches. Two independent assessors assessed articles for first relevance and then quality. Relevant articles were abstracted and synthesised for activities that had three or more relevant articles.
FINDINGS: A total of 21,499 articles identified through database and manual searching yielding 117 that met inclusion criteria. The majority of the studies (93 or 89%) involved eight activities: baseball, basketball, cycling, football, ice hockey, rugby, alpine skiing and soccer. Children and youth were identified as the specific target group in 45% of the studies and another 12% included children in their sample. Studies addressed a range of intervention strategies and varied on quality of evidence.
COMMENTS: Surprisingly few well-designed and controlled studies investigating strategies to prevent injuries were found and an even smaller number evaluated strategies to reduce injury in children and youth. As governments in developed countries continue to focus on increasing physical activity among children and youth, thought must be given to the issue of risk of injury and the relative lack of evidence of effective preventive measures.
Bridging between two standards for collecting information on race and ethnicity: an application to Census 2000 and vital rates.
- Parker JD, Schenker N, Ingram DD, Weed JA, Heck KE, Madans JH. Public Health Rep 2004; 119(2): 192-205.
Correspondence: J. Parker, Office of Analysis, Epidemiology, and Health Promotion, National Center for Health Statistics, 3311 Toledo Rd., Rm. 6415, Hyattsville, MD 20782, USA; (email: jdparker@cdc.gov).
OBJECTIVES: The 2000 Census, which provides denominators used in calculating vital statistics and other rates, allowed multiple-race responses. Many other data systems that provide numerators used in calculating rates collect only single-race data. Bridging is needed to make the numerators and denominators comparable. This report describes and evaluates the method used by the National Center for Health Statistics to bridge multiple-race responses obtained from Census 2000 to single-race categories, creating single-race population estimates that are available to the public.
METHODS: The authors fitted logistic regression models to multiple-race data from the National Health Interview Survey (NHIS) for 1997-2000. These fitted models, and two bridging methods previously suggested by the Office of Management and Budget, were applied to the public-use Census Modified Race Data Summary file to create single-race population estimates for the U.S. The authors also compared death rates for single-race groups calculated using these three approaches.
FINDINGS: Parameter estimates differed between the NHIS models for the multiple-race groups. For example, as the percentage of multiple-race respondents in a county increased, the likelihood of stating black as a primary race increased among black/white respondents but decreased among American Indian or Alaska Native/black respondents. The inclusion of county-level contextual variables in the regression models as well as the underlying demographic differences across states led to variation in allocation percentages; for example, the allocation of black/white respondents to single-race white ranged from nearly zero to more than 50% across states. Death rates calculated using bridging via the NHIS models were similar to those calculated using other methods, except for the American Indian/Alaska Native group, which included a large proportion of multiple-race reporters.
COMMENTS: Many data systems do not currently allow multiple-race reporting. When such data systems are used with Census counts to produce race-specific rates, bridging methods that incorporate geographic and demographic factors may lead to better rates than methods that do not consider such factors.
- Anderson RN, Minino AM, Fingerhut LA, Warner M, Heinen MA. Natl Vital Stat Rep 2004; 52(21): 1-86.
Correspondence: Robert N. Anderson, Division of Vital Statistics, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Hyattsville, Maryland 20782, USA; (email: unavailable).
OBJECTIVES: This report presents injury mortality data for 2001 using the external cause of injury mortality matrix for the International Classification of Diseases, Tenth Revision (ICD-10), a detailed and comprehensive framework for tabulating and presenting injury deaths by mechanism and intent of death. Data are presented by age, sex, race, Hispanic origin, and State. This report also presents data on injury deaths classified according to the nature of the injury sustained. Deaths resulting from the terrorist attacks on September 11, 2001, are presented and the impact of these deaths on the trends in injury mortality is discussed. This report supplements the annual report of final mortality statistics.
METHODS: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2001. Causes of death and nature of injury are processed and coded in accordance with the ICD-10.
FINDINGS: In 2001, 157,078 resident deaths occurred as the result of injuries. Of these injury deaths, 64.6 percent were classified as unintentional, 19.5 percent were suicides, 12.9 percent were homicides, 2.7 percent were of undetermined intent, and 0.3 percent involved legal intervention or operations of war. The five leading mechanisms of injury death were motor vehicle traffic, firearm, poisoning, falls, and suffocation, accounting for 78 percent of all injury deaths. A head injury was mentioned in 32 percent of injury deaths and was the most commonly mentioned injury condition resulting in death. Poisoning and toxic effects were the second most common, mentioned in 16 percent of injury deaths and were the underlying cause of 14 percent of injury deaths. In 2001, 36,753 deaths (1.6 percent of deaths) had a natural underlying cause of death but included one or more mentions of an external cause on the death certificate.
COMMENTS: Injury mortality data presented in this report using the external cause of injury mortality matrix for ICD-10 provide detail on the mechanism of death needed for research and other activities related to injury prevention. This report also highlights the importance of multiple causes of death when analyzing injury mortality data. The Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) is involved in several ongoing projects related to the study of injury and injury mortality.
A biomechanical analysis of the causes of traumatic brain injury in infants and children.
Correspondence: W. Goldsmith, Graduate School, Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, California, USA; (email: goldsmth@me.berkeley.edu).
There is significant disagreement among medical professionals regarding the mechanisms for infant brain injury. This disagreement is due in part to the failure by some to acknowledge and incorporate known biomechanical data and models into hypotheses regarding causes. A proper biomechanical understanding of the mechanisms of traumatic brain injury (TBI) challenges many published and testified assumptions regarding TBI in infants and children. This paper analyzes the biomechanical relationship between the causes of TBI in infants and children, and their physiological consequences. Loading characteristics, injury parameters and criteria, scaling, failure characteristics, differences between infants and adults, and impact due to falls are described and discussed in the context of the laws of mechanics. Recent studies are critiqued with reference to their contribution to an understanding of brain injury mechanisms. Finally, methods for improving our currently incomplete knowledge of infant head injuries, and their mechanisms, consequences and tolerances are proposed. There is an urgent need for close collaboration between physicians and biomechanicians to objectively and scientifically evaluate infant head injuries to further define their mechanical bases, and to assist in their diagnosis and treatment.
A checklist for assessing the risk of falls among the elderly.
The purpose of this study was to estimate the risk of falls among elderly citizens by using a checklist. This checklist was initially developed using the Delphi technique, then refined on the basis of research findings. Cross-sectional design and a purposive sample were used, with the sample selected from three sheltered housing projects (n = 302) and from Win-san district (n = 103) in Taipei, comprising 405 participants. On the basis of their experiences of falling in the previous year, participants were classified into two groups: fall (n = 202) and non-fall (n = 203). Participants in the fall group had lower scores on an SPMSQ (Short Portable Mental Status Questionnaire), took longer to complete the Get-up and Go test and were more afraid of falling. Participants who took longer than one second to complete the Get-up and Go test or had urinary frequency or incontinence problems were found to be at greater risks for falls. The elderly who lived in homes with dimly lit kitchens and clutters at entryways (or backyards) were found to be at a considerably greater risk, by 22 or 13 times respectively. This checklist can be used by care providers to identify those providing care to the elderly, those at high risk of falls, and to prevent such falls or, at least lessen the risks of falls.
The authors in the Pediatric Emergency Unit of a university hospital in Turkey prospectively investigated cost factors in pediatric trauma and attempted to identify cost predictors. They reviewed the charts of and sent out questionnaires to 91 children (50 boys, 41 girls) less than 16 years (mean, 6 years) who were admitted consecutively with multiple trauma to their emergency unit October 1998 to September 1999. They obtained data on age, gender, date, mechanism of injury, site of injury, type of treatment, and length of hospital stay. They also studied physical findings, Pediatric Trauma Score (PTS), Revised Trauma Score (RES), and Pediatric Glasgow Trauma Score (GCS). Motor vehicle crashes (MVA) accounted for 45% of injuries, falls, 41%, and bicycle accidents, 14%. Sites of injury were head (74%), abdomen (57%), and extremity (37%). Seventeen patients (19%) required major and 27 (30%) minor surgical treatment, whereas 44 (48%) were treated conservatively. There were 3 deaths. Mean duration of hospital stay was 4 days. Mean total cost of care was US $376 ($20 to $1,995), reflecting the significantly lower health care cost in Turkey. There was no correlation between cost and age. The cost associated with MVA was higher than for other injuries. Forty-eight percent of patients were referred from another hospital, and here the cost of care was significantly higher. Total cost correlated directly with duration of hospital stay and distance of referring hospital but inversely with the PTS, RETS, and GCS.
Correspondence: Kenneth Beck, Department of Public and Community Health, University of Maryland, College Park, Maryland 20742-2611, USA; (email: kbeck1@umd.edu).
OBJECTIVES: To compare drivers who were: (1) exposed to Maryland's sobriety "Checkpoint Strikeforce" campaign; (2) not exposed but were aware of it; and (3) neither exposed nor aware of it. This six-month campaign involved periodic road-side sobriety checkpoints, in which police attempted to detect and arrest drunk drivers and a series of radio Public Service Announcements (PSAs) that promoted public awareness.
METHODS: A statewide sample of 1725 drivers were interviewed by telephone to determine their exposure to and awareness of this campaign, as well as their beliefs and behaviors concerning drunk driving and seat belt usage.
FINDINGS: Relatively few people (9.6%) were exposed in any way to the campaign; however almost 30% were aware of it. Significant increases in perceived vulnerability to arrest for drinking and driving were found among those who were exposed. There were no differences in reported drinking and driving, but seat belt usage in the last 30 days was higher among those who were exposed. There were no differences among those people who had been directly exposed to the campaign (i.e., personally gone through a sobriety checkpoint) and those who were indirectly exposed (i.e., knew a family member or someone else who went through a checkpoint).
COMMENTS: Exposure to a sobriety checkpoint was associated with increased perceptions of drink-driving risk (i.e., likelihood of getting caught by the police), which was not dependent upon having personally experienced it. Awareness without exposure appears to be insufficient to change perceived risk. The need to increase the reach and frequency of the sobriety "Checkpoint Strikeforce" campaign is indicated.
Nonfatal occupational injury among California farm operators.
- McCurdy SA, Farrar JA, Beaumont JJ, Samuels SJ, Green RS, Scott LC, Schenker MB. J Agric Saf Health 2004; 10(2): 103-119.
Correspondence: Sam McCurdy, Department of Epidemiology and Preventive Medicine, University of California, Davis, California, USA; (email: samccurdy@ucdavis.edu).
We conducted a population-based telephone survey addressing farm-work-related (FWR) injuries among California farm operators. Of 1947 participants (80.4% response), 135 farm operators reported 160 FWR injuries in the preceding year, yielding a one-year cumulative incidence for any FWR injury of 6.9% (95% CI 5.8%-8.2%), or a mean 8.2 FWR injuries per 100 farmers in the preceding year (95% CI 6.8-9.7). Multiple injury events in the same individual occurred more frequently than predicted by chance. Sprains and strains (29.4%) were the most frequently reported injury and predominantly involved the back. Overexertion represented the most frequent external cause (24.2%), followed by machinery (14.3%), falls (13.0%), and animals (12.4%). Factors associated with FWR injury included white ethnicity (OR 3.19; 95% CI 1.38-7.36), increased annual hours worked on the farm, low levels of administrative work, and increased percentage of time working with livestock. FWR injury experience of California farm operators is comparable with that reported for other agricultural populations. Above-expected frequency of multiple injuries supports involvement of personal or environmental risk factors. Preventive efforts should focus on higher-risk groups and preventing overexertion and muscle strain and injury related to machinery, falls, and animals, especially livestock.
BACKGROUND: The association of bullying victimisation by siblings with a) involvement in bullying at school and b) behaviour problems among lower secondary school children in Israel was investigated.
METHOD: Self-report questionnaires of sibling victimisation, peer bullying experiences and behaviour problems were completed by 921 pupils aged 12-15 (mean age 13.7 years).
FINDINGS: Of the sample, 16.2% were directly bullied by their siblings at home and 11.9% were direct victims of bullying by peers at school every week. More than half of victims of bullying by siblings (50.7%) were also involved in bullying behaviour at school compared to only 12.4% of those not victimised by siblings, indicating a strong link between intrafamilial and extrafamilial peer relationships. Children with poor sibling and peer relationships were at a highly increased risk for behaviour problems. Ethnic (Israeli Jewish vs. Arab) and sex differences were small compared to the effects of sibling relationship on behaviour problems.
COMMENTS: Intervention strategies directed at reducing bullying in school should take into account pupils' experiences of victimisation by siblings at home.
The purpose of this study was to determine the prevalence of suicide attempts, and to identify the risk factors for suicide attempts in Turkish children and adolescents between the ages 10 and 20 years. Multi-step, stratified, cluster sampling was used. A stratified sample of 4256 students was selected as representative of the city's school children population. Data was obtained with a pair of structured questionnaires designed to evaluate the presence and risk factors of suicide attempts, both in the children and adolescents and their parents. These questionnaires investigated family environment, subject characteristics, and various risk factors for suicide attempts. Child Beck Depression Inventory (CBDI) was administered to all children and adolescents. After the data quality control process, the study sample was reduced to 4143 children and adolescents. Children and adolescents were divided two groups according to the experience or non-experience of suicide attempts: group 1 (n=80) and group 2 (n=4063), respectively. Three categories of independent variables were assessed: adolescent, family, and socioeconomic characteristics. Logistic regression models were based on the children and adolescents and on parent reports. The prevalence of suicide attempts as reported by the children and adolescents was 1.93% (n=80).The mean age of group 1 was higher than that of group 2 (p=0.002, t=-3.172), as was the mean score of CBDI (p=0.000, t=-9.083). Logistic regression analysis indicated that having problems with parents, using illicit drugs, and psychiatric problems in relatives best predicted suicide attempts in Turkish children and adolescents.
Asian/Pacific islander adolescent sexual orientation and suicide risk in Guam.
OBJECTIVES: We examined the effects of same-sex orientation on suicide risks for Guam's Asian/Pacific Islander adolescents.
METHODS: We used a probability sample and logistic regression analysis to identify suicide risk factors.
FINDINGS: Same-sex orientation was associated with a greater risk of suicide attempt, especially for boys. Adolescents who reported suffering physical abuse in the context of a romantic relationship, engaging in binge drinking, and experiencing feelings of hopelessness were at greater risk for suicidal ideation and attempts. Race/ethnicity was associated with suicide risk for both boys and girls, and patterns suggest that membership in the same racial/ethnic group decreased suicide risk for girls and increased risk of suicide for boys.
COMMENTS: Gay, lesbian, and bisexual Asian/Pacific Islander adolescents in Guam deserve intervention and counseling programs to reduce suicide risk.
Self-inflicted burns: an eight year retrospective study in Finland.
- Palmu R, Isometsa E, Suominen K, Vuola J, Leppavuori A, Lonnqvist J. Burns 2004; 30(5): 443-447.
Correspondence: Raimo Palmu, National Public Health Institute, Department of Mental Health and Alcohol Research, Helsinki, FINLAND; (email: raimo.palmu@hel.fi).
The aim of this study was to investigate differences in characteristics of burn patients who had attempted suicide, as compared with other burn patients admitted to the Helsinki Burn Centre during 1989-97. Burn patients were first drawn from a computerised register, after which a psychiatrist examined their medical records and ascertained the suicide attempters. Of the total of 811 burn patients, 46 (5.7%) had attempted suicide. The median total body surface area (TBSA) of suicide attempters (24.0%) was markedly higher than in the other patients (6.0%, [Formula: see text] ). Flame was a much more common cause of burns among suicide attempters (82.1%) than among the remainder (44.5%, [Formula: see text] ). Suicide attempters were also more often unemployed (28.2 versus 12.9%) or on disability pension (30.8 versus 7.1%) before the injury ( [Formula: see text] ). Although the proportion with self-inflicted burns among all burn patients was not high, the markedly higher severity of their burns makes them an important clinical subgroup for further study.
Because death from suffocation in traffic fatalities has not been well described, we delineated the clinical, circumstantial, and autopsy findings associated with suffocation in a series of motor vehicle crashes. Medical examiner case files from a 5-year period were reviewed. Scene investigation, autopsy, toxicology, and first-responder reports were examined. Crash descriptions were reviewed, including vehicle type, mechanism of crash, response time, restraint use, occupant ejection, and victim position in cabins of vehicles. Mechanisms of suffocation, including torso compression, inversion, neck flexion, facial occlusion, and blood aspiration, were determined for each case. The files were searched for factors relevant to the diagnosis of suffocation, namely, cerebral concussion, alcohol intoxication, obesity, petechiae, lung weights as a proxy for livor, natural disease, and impact wounds. Twenty-nine traffic fatality cases were identified in which suffocation caused death. In 26, suffocation mechanisms were solely responsible for death. In 3, death was caused by suffocation in combination with other mechanisms. Twenty-five subjects were occupants of vehicles with cabins and 4 were motorcycle riders. The most common mechanism of suffocation was torso compression. Most subjects had either multiple mechanisms of suffocation or a single mechanism acting in concert with concussion or alcohol intoxication. Concussion and intoxication were common, with one or both present in 20 subjects, including all of those with blood aspiration. Petechiae were frequent but were found consistently only among those with inversion. Cutaneous chest petechiae were associated with inversion and torso compression. Lung weights were highest among those with blood aspiration and lowest among those with inversion. Body mass index was highest among those with inversion, suggesting that obesity could be a risk factor for this mechanism.
Elderly licensure laws and motor vehicle fatalities.
Correspondence: David C. Grabowski, Lister Hill Center for Health Policy, School of Public Health, University of Alabama, Birmingham, USA, (email: grabowsk@uab.edu).
BACKGROUND: Little is known about how state-level driver licensure laws, such as in-person renewal, vision tests, road tests, and the frequency of license renewal relate to the older driver traffic fatality rate.
OBJECTIVE: To determine whether state driver's license renewal policies are associated with the fatality rate among elderly drivers.
METHODS: Retrospective, longitudinal study conducted January 1990 through December 2000 of all fatal crashes in the contiguous United States identified in the Fatality Analysis Reporting System, which involved either an older (ages 65-74 years, 75-84 years, and > or =85 years) or middle-aged (ages 25-64 years) driver. Two regression approaches were used to study the effect of state laws mandating in-person renewal, vision tests, road tests, and frequency of license renewal on driver fatalities, controlling for state-level factors including the number of licensed elderly drivers, primary and secondary seatbelt laws, maximum speed limit laws, blood alcohol level of 0.08, and administrative license revocation drinking and driving laws, per capita income, and unemployment rate. The first regression approach examined only elderly driver fatalities and the second approach examined daytime elderly driver fatalities and used daytime fatalities among middle-aged drivers as a general control for unobserved variation across states and over time.
MAIN OUTCOME MEASURES: Older driver fatalities and older and middle-aged daytime driver fatalities.
FINDINGS: Among individuals aged 85 years or older, there were a total of 4605 driver fatalities and 4179 daytime driver fatalities during the study period. For this age cohort, after controlling for middle-aged daytime driver deaths, states with in-person license renewal were associated with a lower driver fatality rate (incident rate ratio [RR], 0.83; 95% confidence interval [CI], 0.72-0.96). This was the only policy related to older drivers that was significantly associated with a lower fatality risk across both regression models. Thus, state-mandated vision tests, road tests, more frequent license renewal, and in-person renewal (for individuals aged 65-74 years and 75-84 years) were not found to be independently associated with the fatality rate among older drivers in the 2 models.
COMMENTS: In-person license renewal was related to a significantly lower fatality rate among the oldest old drivers. More stringent state licensure policies such as vision tests, road tests, and more frequent license renewal cycles were not independently associated with additional benefits.
A research agenda for increasing safety belt use in the United States.
On November 13-14, 2003, a symposium on high-visibility safety belt use enforcement in Raleigh, NC: (a) celebrated the 10th anniversary of North Carolina's Click It or Ticket program; (b) documented current knowledge regarding safety belt use; (c) proposed strategies to increase use further; and (d) discussed research to support these strategies.
Ninety five percent: An evaluation of law, policy, and programs to promote seat belt use in Washington state.
- Salzberg PM, Moffat JM. J Safety Res 2004; 35(2): 215-220.
Correspondence: Philip M. Salzberg, Washington Traffic Safety Commission, 1000 S. Cherry Street, PO Box 40944, Olympia, Washington 98504, USA; (email: psalzberg@wtsc.wa.gov).
Seat belt use in Washington state was 83% in 2001. In 2002, a series of law, policy, and program initiatives coalesced to produce a dramatic increase in seat belt use. Washington enacted a primary enforcement seat belt, the Chief of the Washington State Patrol made safety belt enforcement one of the core missions of that agency, and Washington participated in the national Memorial Day Click It or Ticket program during May 2002 and continued the program into 2003. Evaluation of these initiatives was accomplished through observation surveys of seat belt use, analysis of seat belt violation data, and analysis of data on traffic deaths of motor vehicle occupants. The major findings were that there was a two- to three-fold increase in enforcement of the seat belt law, belt use rates increased to 93% in 2002 and again to 95% in 2003, and motor-vehicle occupant fatalities decreased by 13%. Impact on Practice and Policy: The primary seat belt law and Click It or Ticket program activities were critical factors in increasing belt use in Washington state. Media and enforcement programs targeting seat belt use can be very effective in raising the belt use rate, but a long-term commitment to continuation of these program activities is essential. Other states implementing new primary seat belt laws should consider delivering a Click It or Ticket campaign prior to the effective date of the primary law and continuing these activities during subsequent months and years.
Epidemiological study on traffic accident in Shanghai from 2000 to 2002.
- Zhang SN, Lu W, Zhou SF, Chen SM, Yang BJ, Li Q, Lu JG, Wu JP, Bao Q, Song GX, Yuan D, Li YH, Zhou F. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(3): 199-203.
Correspondence: S. Zhang, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, CHINA; (email: unavailable).
OBJECTIVE: Data on traffic accident from year 2000 to 2002 were collected and testified. Epidemiological study was carried out to find the main risk fctors of traffic accident.
METHODS: The spatial distribution was conducted by means of Geographic Information System (GIS) and were marked on Shanghai digitalized map with different layers by different colors.
FINDINGS: Results showed that during 2000, 2001 and 2002, 69 669, 68 894, and 47 088 traffic accident episodes occurred in Shanghai, resulting in 1747, 1724, 1557 deaths respectively with direct economic lost: 2.1, 2.4, 3.0 billion RMB. The main risk factors causing traffic accident deaths would include drinking alcohol before driving, fatigue and speeding. The leading causes of death were head injury and complex injury of body. GIS showed that there was a homocentric circle with more traffic accidents in downtown city, but more deaths in the urban city. Disease burden caused by traffic accident was very heavy.
COMMENTS: In Shanghai, traffic accident has great impact on social and economic issues thus should be controlled effectively. Focus should be layed on control of traffic accident in downtown area and to decrease the number of deaths related to traffic accident in the urban area.
Arkansas and the motorcyle helmet law.
- Bledsoe GH. J Ark Med Soc 2004; 100(12): 430-433.
Correspondence: Gregory Bledsoe, Department of Emergency Medicine, The Johns Hopkins Medical Institute, Baltimore, USA; (email: unavailable).
Motorcycle helmet laws have a long and colorful history dating back to the original work of Britain's Dr. Hugh Cairns during World War II. In Arkansas, the state's mandatory motorcycle helmet law was repealed in 1997 and replaced by a law requiring only those under the age of 21 to wear helmets. Recent work by researchers at the University of Arkansas for Medical Sciences has highlighted the impact of the helmet law repeal and demonstrated an increase in nonhelmeted motorcycle crash admissions, head injury severity, ICU length of stay and financial loss at this institution. In February of 2003, House Bill 1024 was submitted to the Arkansas House Committee on Public Transportation to reinstate the mandatory motorcycle helmet law for all motorcycle riders but was killed in committee. This article is a review of motorcycle helmet laws with particular emphasis on the arguments pro and con and the history of these laws in the state of Arkansas.
Elder abuse is a societal problem that influences all members of the community. By 1993 each state had enacted laws addressing elder abuse in domestic and institutional settings (Tatara, 1995). These laws take many different forms, and in 44 states and the District of Columbia, contain sections regarding the designation of mandatory reporters of elder abuse and neglect. Health care professionals and law enforcement personnel frequently are listed as mandatory reporters. Iowa is the only state that requires education for its mandatory reporters. The purpose of this paper is to compare the investigation and substantiation rates for elder abuse allegations before and after July 1988 when Iowa statute (� 235B.1 IA CO) was revised to ensure training of mandatory reporters. The investigation and substantiation rates were analyzed using two-sample t-tests for comparisons of four time periods and compared to investigation rates for Texas and Wisconsin. There were no significant differences in investigation rates for the four time periods and no significant increase in investigation rates over time for Iowa. Many different state agencies are involved in implementing and enforcing this expensive and complicated endeavor of required education for mandatory reporters. Unfortunately, this education has not impacted investigation or substantiation rates for elder abuse.
History of childhood abuse in Portuguese parents.
- Figueiredo B, Bifulco A, Paiva C, Maia A, Fernandes E, Matos R. Child Abuse Negl 2004; 28(6): 671-684.
Correspondence: Barbara Figueiredo, Department of Psychology, University of Minho, Braga, PORTUGAL; (email: unavailable).
OBJECTIVE: The study examines the self-reported prevalence of childhood physical and sexual abuse in a large sample of Portuguese parents. METHODS: Nearly 1,000 parents (506 mothers and 426 fathers) were selected through public primary schools from the Northern area of Portugal. All completed the Portuguese version of the Childhood History Questionnaire (CHQ) [Journal of Family Violence 5 (1990) 15]. FINDINGS: Results show that the prevalence of abuse was 73%, but more severe physical abuse involving sequelae/injury was reported by 9.5%. Most physical abuses began prior to age 13, with half continuing after age 13. No gender differences were found for rates of physical abuse. However, among the milder physical abuse without sequelae/injury, those women who experienced "whipping" or "slapping/kicking" were more likely to do so from their mothers than fathers. Among men who were "slapped/kicked" this was more likely to be from their fathers. Low rates of sexual abuse were found at 2.6% with no gender or age differences. Lack of a supportive adult in childhood related to the more severe abuses, but only in adolescence. Portuguese rates of abuse were consistently lower than those reported in USA and Spanish studies using the CHQ. COMMENTS: This is the first retrospective, self-report study of childhood abuse in a large sample of Portuguese parents and, even with a participation rate of 69%, shows lower rates than in US and Spanish samples.
Development, utilisation, and importance of accident and emergency department derived assault data in violence management.
Correspondence: J.P. Shepherd, Department of Oral Surgery, Medicine and Pathology, Dental School, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XY, UK; (email: shepherdjp@cf.ac.uk).
OBJECTIVES: To develop formal processes for the collection, disclosure, and effective use of accident and emergency (A&E) department derived assault injury data for city violence reduction.
METHODS: Over a four year period, managed by a multi-agency steering group, A&E data collection, collation, and disclosure processes were developed, instituted, and refined. Consultations and negotiations between agencies identified the most effective and ethical methods, appropriate recipients, and the nature of the information of most use.
FINDINGS: Disclosure of A&E data to city authorities, the police, and local media drew substantial attention and crime prevention resources to the locations of violence. As a result, a police task force responsible for targeting city street crime was funded, which analysed both A&E and police information. Monthly, electronic transfer of raw, anonymous data to the task force crime analyst informed and prompted violence prevention initiatives by several agencies. Police mounted overt and covert interventions targeted at violence hotspot licensed premises and used the data to oppose, on injury grounds, drinks/entertainment licence applications. Transport authorities established new half hourly night time city centre bus services. The local authority mounted an assault awareness campaign in schools and public libraries, and licensing magistrates used the data to measure, for example, the impact of continuous 36 hour drinks licensing on public safety.
COMMENTS: The principal finding of this evaluation was that judicious sharing of unique information about locations and times of violence derived from A&E patients was a powerful and effective means of targeting police and other local resource to bring about violence reduction.
Violence in Teen-Rated Video Games.
- Haninger K, Ryan MS, Thompson MS ScD KM. MedGenMed 2004; 6(1): 1.
Correspondence: Kevin Haninger, Center on Media and Child Health, Children's Hospital Boston and Kids Risk Project, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA; (email: haninger@fas.harvard.edu).
BACKGROUND: Children's exposure to violence in the media remains a source of public health concern; however, violence in video games rated T (for "Teen") by the Entertainment Software Rating Board (ESRB) has not been quantified.
OBJECTIVE: To quantify and characterize the depiction of violence and blood in T-rated video games. According to the ESRB, T-rated video games may be suitable for persons aged 13 years and older and may contain violence, mild or strong language, and/or suggestive themes.
METHODS: 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 content descriptors for violence and blood assigned to these games. We randomly sampled 80 game titles (which included 81 games because 1 title included 2 separate games), played each game for at least 1 hour, and quantitatively assessed the content. Given the release of 2 new video game consoles, Microsoft Xbox and Nintendo GameCube, and a significant number of T-rated video games released after we drew our random sample, we played and assessed 9 additional games for these consoles. Finally, we assessed the content of 2 R-rated films, The Matrix and The Matrix: Reloaded, associated with the T-rated video game Enter the Matrix.
MAIN OUTCOME MEASURES: Game genre; percentage of game play depicting violence; depiction of injury; depiction of blood; number of human and nonhuman fatalities; types of weapons used; whether injuring characters, killing characters, or destroying objects is rewarded or is required to advance in the game; and content that may raise concerns about marketing T-rated video games to children.
FINDINGS: Based on analysis of the 396 T-rated video game titles, 93 game titles (23%) received content descriptors for both violence and blood, 280 game titles (71%) received only a content descriptor for violence, 9 game titles (2%) received only a content descriptor for blood, and 14 game titles (4%) received no content descriptors for violence or blood. In the random sample of 81 T-rated video games we played, 79 games (98%) involved intentional violence for an average of 36% of game play time, and 34 games (42%) contained blood. More than half of the games (51%) depicted 5 or more types of weapons, with players able to select weapons in 48 games (59%). We observed 37 games (46%) that rewarded or required the player to destroy objects, 73 games (90%) that rewarded or required the player to injure characters, and 56 games (69%) that rewarded or required the player to kill. We observed a total of 11,499 character deaths in the 81 games, occurring at an average rate of 122 deaths per hour of game play (range 0 to 1310). This included 5,689 human deaths, occurring at an average rate of 61 human deaths per hour of game play (range 0 to 1291). Overall, we identified 44 games (54%) that depicted deaths to nonhuman characters and 51 games (63%) that depicted deaths to human characters, including the player.
COMMENTS: Content analysis suggests a significant amount of violence, injury, and death in T-rated video games. Given the large amount of violence involving guns and knives, the relative lack of blood suggests that many T-rated video games do not realistically portray the consequences of violence. Physicians and parents should appreciate that T-rated video games may be a source of exposure to violence and some unexpected content for children and adolescents, and that the majority of T-rated video games provide incentives to the players to commit simulated acts of violence.
A cross-national study of violence-related behaviors in adolescents.
- Smith-Khuri E, Iachan R, Scheidt PC, Overpeck MD, Gabhainn SN, Pickett W, Harel Y. Arch Pediatr Adolesc Med 2004; 158(6): 539-544.
Correspondence: Peter C. Scheidt, Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, 6100 Executive Blvd, MSC 7510, Bethesda, MD 20892-7510, USA; (email: Scheidtp@nih.gov).
BACKGROUND: Violent behavior among adolescents is a significant problem worldwide, and a cross-national comparison of adolescent violent behaviors can provide information about the development and pattern of physical violence in young adolescents.
OBJECTIVES: To determine and compare frequencies of adolescent violence-related behaviors in 5 countries and to examine associations between violence-related behaviors and potential explanatory characteristics.Design, Setting, and
PARTICIPANTS: Cross-sectional, school-based nationally representative survey at ages 11.5, 13.5, and 15.5 years in 5 countries (Ireland, Israel, Portugal, Sweden, and the United States).
MAIN OUTCOME MEASURES: Frequency of physical fighting, bullying, weapon carrying, and fighting injuries in relation to other risk behaviors and characteristics in home and school settings.
RESULTS: Fighting frequency among US youth was similar to that of all 5 countries (nonfighters: US, 60.2%; mean frequency of 5 countries, 60.2%), as were the frequencies of weapon carrying (noncarriers: US, 89.6%; mean frequency of 5 countries, 89.6%) and fighting injury (noninjured: US, 84.5%; mean frequency of 5 countries, 84.6%). Bullying frequency varied widely cross-nationally (nonbullies: from 57.0% for Israel to 85.2% for Sweden). Fighting was most highly associated with smoking, drinking, feeling irritable or bad tempered, and having been bullied.
COMMENTS: Adolescents in 5 countries behaved similarly in their expression of violence-related behaviors. Occasional fighting and bullying were common, whereas frequent fighting, frequent bullying, any weapon carrying, or any fighting injury were infrequent behaviors. These findings were consistent across countries, with little cross-national variation except for bullying rates. Traditional risk-taking behaviors (smoking and drinking) and being bullied were highly associated with the expression of violence-related behavior.
