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August 7-11, 2000


  • Morrison A, Stone DH, The EURORISC Working Group. Trends in injury mortality among young people in the European Union: A report from the EURORISC Working Group. Journal of Adolescent Health 2000; 27:130-135. (E.45.02 S)

    This study examines the trends in injury mortality among young people aged 15-24 years residing in the 15 current member states of the European Union between 1984 and 1993. Almost a quarter of a million young people died as a result of sustaining an externally caused physical injury (either intentional or unintentional). Injury accounted for 2/3 of all deaths in this age group. Over 3/4 (76%) of deaths were due to unintentional injury, a further 17% to self-inflicted injuries, and the remaining 7% to homicide and other violent causes. Motor vehicle traffic fatalities accounted for 84% of unintentional injury deaths. Although a decline in injury mortality was observed throughout Europe, rates of mortality owing to both unintentional injuries and suicide varied widely among study countries at both the beginning and end of the study period. Whereas injury mortality rates in young people in most European countries are lower than in other parts of the world (including the United States), injuries represent a major public health problem and are a cause for concern.

  • Simmes DR, Blaszcak MR, Kurtin PS, Bowen NL, Ross RK. Creating a community report card: The San Diego experience. Carefully selected statistics form an annual snapshot of community health and well-being. American Journal of Public Health 2000; 90(6):880-882. (E.30.02 S)

    San Diego County's population is the second largest in California and the fourth largest in the United States. Its 2.7 million people represent diverse racial and ethnic backgrounds and present many challenges to those providing public health and social services. Recent changes, such as welfare reform, the movement of Medicaid to managed care, and restructuring of the county's Health and Human Services Agency, further challenge the ability to improve outcomes for children and families. The County Board of Supervisors ordered the development of a monitoring system to determine what effects these changes may have on county residents. The resulting report card reflected a broad definition of health and well-being. The five domains - economics, health, safety, education, and access to services - are further defined by 29 scientifically based or consensus driven indicators. Data sources ranged from local health, education, and law enforcement entities to state and federal agencies. Included are 3-5 years of historical data, state and national comparative data, and race/ethnicity data.

  • Reason J. Safety paradoxes and safety culture. Injury Control and Safety Promotion 2000; 7(1):3-14. (E.45.02 S)

    This paper deals with four safety paradoxes: safety is defined and measured more by its absence than its presence; defences, barriers, and safeguards not only protect a system, they can also cause its catastrophic breakdown; many organizations seek to limit the variability of human action, primarily to minimize error, but it is this same variability - in the form of timely adjustments to unexpected events - that maintains safety in a dynamic and changing world; and an unquestioning belief in the attainability of absolute safety can seriously impede the achievement of realizable safety goals, while a preoccupation with failure can lead to high reliabiltiy. Drawing extensively on the study of high reliability organizations (HROs), the paper argues that a collective understanding of these paradoxes is essential for those organizations seeking to achieve an optimal safety culture. In concludes with a consideration of some practical implications.

  • Annual Review of Public Health. Fielding JE, Lave LB, Starfield B, editors. [21]. 2000. Palo Alto, CA, Annual Reviews. Annual Review of Public Health. (E.45.02 B)

    This edition of the Annual Review series contains a wide variety of articles on public health genetics, epidemiology and biostatistics, environmental and occupational health, public health practice, social environment and behavior, and health services.

  • Rogmans W. Injury cost analysis and ethics: At what costs? International Journal for Consumer and Product Safety 1999; 6(1):3-9. (E.45.06 S)

    Studies into the cost of illness or the burden of diseases are expanding in number and certainly also in quality and utility for policy makers. This paper focuses on the principle issues with respect to the utilization of cost analyses and seeks to provide guidance for more balanced decision making, taking into account public values as well. Current decision making in injury prevention can be improved by being more firmly rooted in sound science and thoughtful value judgements. Cost-benefit analysis has strong added value to decision making, but subjective factors are important as well. What is most important is that decision making is guided by the basic mission of public governance: the protection of the citizens. This implies a continuous debate on what level of known, preventable harm will be allowed to persist in the environment, workplaces, and homes. Interventions need justification in science, technology, and practice, but the moral unacceptability of certain risks still remains a major driving force for investing in prevention.

  • Mulder S, van Beeck E, Meerding WJ. New directions in injury surveillance: Development of a model for continuous monitoring of direct medical costs. International Journal for Consumer and Product Safety 1999; 6(1):11-23. (E.45.06 S)

    Information on the costs of injuries is an important additional instrument in setting priorities for injury prevention. The objective of this study was to develop a model which continuously monitors the direct medical costs of injuries in The Netherlands. The model should provide information on the direct medical costs of injuries at any time and for any selection of injury categories. It is an incidence based model according to the "bottom up" principle. Homogeneous patient groupings with respect to health care use are defined. The groupings are based on existing classifications from the literature and are defined by means of 7 criteria: nature of care provided; body region of the injury; type of injury; severity of injury; age; complications; and sex of the patient. Several cost elements are distinguished. For each cost element, relevant patient groupings are determined. This article presents the design of the model as adopted by the Working Group on the Costs of Injuries of the European Consumer Safety Association (ECOSA).


  • Eilert-Petersson E, Laflamme L. Product related injuries at home. International Journal for Consumer and Product Safety 1998; 5(4):203-214. (E.55 S)

    This study highlights the most typical circumstances and products related to home injuries and establishes the extent to which any patterns found in domestic injuries are age or gender related. Injury data were taken from a community based injury surveillance register built up over a one year period in a Swedish county. Injury incidence by age and gender was calculated, and typical injury patterns were identified through multivariate analysis of 9 characteristics of the injuries. Home injury incidence was found to be highest for males in all younger age categories excpet 7-15 years, and for females in the oldest age category (65+). The patterns demonstrate that injuries in home settings are simultaneously product, age, and gender related, which points to a combination of risk groups and safety planning problems.

  • Lindqvist K, Timpka T, Schelp L, Ahlgren M. Evaluation of a home injury prevention program in a WHO Safe Community. International Journal for Consumer and Product Safety 1999; 6(1):25-32. (E.55 S)

    The objective of this study was to evaluate the effect of a community based injury prevention program on home injuries. A quasi-experimental design was used, with cross sectional pre- and post-implementation measurements in the program area and in a neighboring control community. Children and the elderly were two main target groups of the intervention program, which was based on a participative strategy for community involvment. The total relative risk for home injury occurrence decreased in the study area, whereas it increased in the control area. Regarding age and gender, there was a decrease for females and males in the study area and a slight increase in the control area. For males, the youngest and oldest age groups showed no decrease, whereas females showed a decrease among the youngest and those aged 60-79. No decrease was observed in the control area. The study showed that the Safe Community approach had a general effect on the incidence of home injuries.


  • Durbin DR. Preventing motor vehicle injuries. Current Opinion in Pediatrics 1999; 11:583-587. (E.52.02 S)

    Prevention of injuries to child passengers is a significant public health priority, as motor vehicle related injuries remain a leading cause of death for children. Improvements in child restraint use have contributed to significant declines in child occupant mortality rates over the past 20 years. However, although overall restraint use has improved, many children are not optimally restrained for their age. Errors in installing and using child safety seats, as well as the premature graduation of children to vehicle safety belts, contribute to reducing the effectiveness of restraints for children. Further prevention of motor vehicle occupant injuries to children will require the combined approaches of engineering, education, and enforcement. This review presents current information regarding inappropriate restraint of children and highlights current engineering, education, and legislative efforts to improve child occupant protection.

  • Peterson TD, Tilman Jolly B, Runge JW, Hunt RC. Motor vehicle safety: Current concepts and challenges for emergency physicians. Annals of Emergency Medicine 1999; 34:384-393. (E.52.02 S)

    Motor vehicle crashes are the leading cause of death for the young and contribute to a high degree of morbidity and mortality for all ages. Motor vehicle crashes produce an enormous burden for society in terms of suffering, disability, death, and costs. Motor vehicle crash injury prevention is developing as a focused discipline to implement proven interventions involving technology and behavior known to prevent or reduce the severity of motor vehicle crash injury. Emergency physicians have an important role in advancing motor vehicle safety and injury prevention, both in the emergency department and within the community. This article reviews safety issues and interventions for emergency physicians, including motor vehicle crash injury biomechanics, effectiveness of occupant protection systems, benefits versus risks of air bags, correct use of child restraints, motorcycle helmet use, safety restraint and helmet use laws, and challenges for emergency physicians.

  • Greening L, Stoppelbein L. Young drivers' health attitudes and intentions to drink and drive. Journal of Adolescent Health 2000; 27:94-101. (E.52.06.02 S)

    This study evaluated young drivers' intentions to drink and drive in the context of a health attitude model, the Protection Motivation Theory (PMT). Licensed drivers attending college and ranging in age from 17-20 years completed questionnaires assessing PMT variables. The PMT model was found to predict intentions to drink and drive. Young drivers who perceived rewards for drinking and driving and who felt vulnerable to the risks of drinking and driving were significantly more likely to report intentions to drink and drive. Attitudes about alternative adaptive responses to drinking and driving, including perceived low self-efficacy for implementing alternative responses and perceiving personal costs for engaing in alternative options, also contributed to drivers' intentions to drink and drive. Although teenaged drivers are well informed of the dangers of drinking and driving, they still put themselves and others at risk by driving after consuming alcohol. Health professionals promoting safer alternatives might consider how young drivers' attitudes about both drinking and driving and alternative adaptive responses contribute to their intentions to drink and drive.

  • Jelalian E, Alday S, Spirito A, Rasile D, Nobile C. Adolescent motor vehicle crashes: The relationship between behavioral factors and self-reported injury. Journal of Adolescent Health 2000; 27:84-93. (E.52.04 S)
    This study examines the relative importance of demographic and behavioral factors, as well as alcohol use, in motor vehicle crash (MVC) related injuries in an adolescent sample. Data were collected from two samples of adolescents. In Study 1, students in grades 9-12 from 3 high schools were surveyed regarding risk taking behavior and injuries experienced during the previous 6 months. Study 2 involved adolescent males from an all-boys parochial school who were asked about risk taking, attention and behavior problems, alcohol use, driving behavior, and self-reported injury. Rates of self-reported MVC injuries were consistent across the two studies, ranging from 10% in the mixed gender sample to 16% in the all male sample. Males reported more frequent MVC injuries and higher rates of risk taking behavior. In Study 1, age and risk taking behaviors were predictive of injuries while riding or driving in a car. In the all male sample, risk taking behaviors and conduct problems were significant predictors of MVC injuries. Interventions with adolescents may be targeted at increasing safe driving strategies as well as decreasing risk taking behaviors.

  • Ekman R, Welander G. The results of 10 years' experience with the Skaraborg bicycle helmet program in Sweden. International Journal for Consumer and Product Safety 1998; 5(1):23-39. (E.51.02.02 S)

    This study describes a bicycle helmet program in Skaraborg County, Sweden (the SBIHP) that was first embarked upon, specifically for young children, in just one of the County's municipalities. It then evolved into a long-term, systematic, county-wide program for preschool children. At a later stage, it was supplemented by "ad hoc campaigns" for older school children, senior citizens, and other adult groups. As the process continued, the SBIHP was adapted and changed in accordance with new findings, evaluations, and experiences. The process described shows a sequence of events in which both "top down" and "bottom up" experiences have been utilized, refined, and adapted to the local situation and its environment.


  • Cantor J. Media violence. Journal of Adolescent Health 2000; 27S:30-34. (E.78.06 S)

    Research on the effects of media violence is not well understood by the general public. Despite this fact, there is overwhelming consensus in the scientific literature about the unhealthy effects of media violence. Meta-analyses show that media violence viewing consistently is associated with higher levels of antisocial behavior. Desensitization is another well-documented effect of viewing violence. Although there is evidence that youth who are already violent are more likely to seek out violent entertainment, there is strong evidence that the relationship between violence viewing and antisocial behavior is bidirectional. There is growing evidence that media violence also engenders intense fear in children which often lasts days, months, and even years. The media's potential role in solutions to these problems is only beginning to be explored, in investigations examining the uses and effects of movie ratings, television ratings, and the V-chip, and the effects of media literacy programs and public education efforts. Future research should explore important individual differences in responses to media violence and effective ways to intervene in the negative effects.

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