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• Rivara FP, editor. Translating Injury Prevention Research into Action: A Strategic Workshop. Feb 1-2, 2000, Dallas, TX. Seattle, WA: Harborview Injury Prevention and Research Center, 2000. (E.30.12 S)
  
  Abstract: The relationship between the science of injury prevention and the translation of this science into the practice of injury prevention was the basis for a workshop held in Dallas, TX on February 1-2, 2000. Invited to the workshop were 50 experts from around the country who had experience in successfully initiating interventions, policy, or both in one of three areas of injury control: bicycle helmet promotion; safe firearm storage; and graduated licensing of new drivers. The goal of the workshop was to discuss what has been shown to be effective, and how that research can best be implemented through interventions and policy. The report includes presentations and breakout session materials on each of those topics.



• Delnevo CD, Hausman AJ. Injury prevention counseling among residents of internal medicine. American Journal of Preventive Medicine 2000; 19(1):63-65. (E.47.02.02 S)
  
  Abstract: The US Preventive Service Task Force's Guide to Clinical Preventive Services and Healthy People 2000 recommend that physicians participate in various counseling activities, including injury prevention. Despite recommendations, rates of physician counseling, particularly injury prevention, are low. This study assessed clinical preventive services and attitudes among physicians. Furthermore, it illustrates how physicians prioritize injury prevention counseling relative to other prevention recommendations. Personal characteristics of the residents were collected by a self-administered survey. The authors performed a 12 month retrospective chart review of 184 new doctor-patient encounters to determine rates of clinical preventive services that included four injury prevention services: the use of seat belts; helmets; smoke detectors; and the safe storage of firearms. Overall, attitudes toward injury prevention in the context of other clinical preventive services were low. Seat belt counseling was the only injury prevention service documented in the charts, and was performed at only one of four clinic sites. Clinic site as a key predictor of preventive practice may be suggestive of the importance of organizational priorities and professional norms. Future injury prevention education efforts must aim at improving attitudes of current and future physicians to facilitate positive professional norms.

Residential/Supervised Care:

• Hodsoll K, Nayak USL. The perception of fire risk by older people and its impact on relevant fire safety education. International Journal for Consumer and Product Safety 1999; 6(3):159-168. (E.55.08 S)
  
  Abstract: Accidents due to fire and flames are second only to falls as the most important cause of accidental death in the homes of elderly individuals in the United Kingdom. This study aims to ascertain whether older people are receiving fire accident advice appropriate to their needs. A questionnaire addressing the issues of risk perception, fire preventive action, and access to fire safety information was distributed to 1100 randomly selected older people. Fire risk was perceived as far less of an immediate threat than the danger of a personal attack by an intruder in the home. Recognition of fire risk and the effectiveness of fire safety measures did not result directly in safety appliances being fitted. The majority of respondents had received no fire fighting training, yet more than half felt confident in tackling a small fire. Neither did experience of a fire in the home necessarily increase action towards safety precautions. The majority had not been exposed to a fire safety campaign in the past 12 months. On exposure to a campaign, the impact towards fire safety was positive. The educational process should aim to close the gap between the recognition of the need for fire safety precautions and the implementation of fire safety measures. The key to effective fire prevention among older people depends upon: information; training; and support in situ by trusted community figures.



• Liao CC, Rossignol AM. Landmarks in burn prevention. Burns 2000; 26(5):422-434. (E.55.08 S)
  
  Abstract: The objective of this paper is to highlight landmarks in burn prevention. Novel strategies in the areas of law and regulation, environmental and consumer product design, and educational programs are identified and discussed. Notwithstanding marked reductions in burn morbidity and mortality, especially in economically developed countries, burn injuries remain an important public health concern throughout the world. More, and more effective, burn prevention programs coupled with renewed efforts to reduce the social and environmental correlates of burn injuries (poverty, overcrowding, family stress, and educational deficits) are needed to further reduce burn incidence and its long-term sequelae



• Kemp JS, Unger B, Wilkins D, Psara RM, Ledbetter TL, Graham MA et al. Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: Results of a four-year, population-based, death-scene investigation study of Sudden Infant Death Syndrome and related deaths. Pediatrics 2000; 106(3):e41. (E.55.04 S)
  
  Abstract: Prone sleep and unsafe sleep surfaces increase the risk of sudden infant death. Recent epidemiologic studies also suggest that when an infant's head or face is covered by bedding, or when a sleep surface is shared with others, the risk of dying increases. The inference of a causal role for these risk factors is supported by physiologic studies and by the consistent finding that fewer infants die when risk factors are reduced. The prevalence of most of these risk factors in infant deaths in the US is uncertain. This study sought to describe the prevalence of several important risk factors related to sleep practices among a defined population of infants dying suddenly and unexpectedly. In this population-based study, the authors retrospectively reviewed death-scene information and medical examiners' investigations of deaths in the city of St. Louis and St. Louis County between Jan 1, 1994 and Dec 31, 1997. The deaths of 119 infants were studied. Their mean age was 109.3 days. The diagnoses were SIDS in 88 deaths, accidental suffocation in 16, and undetermined in 15. Infants were found prone in 61.1% of cases and were found on a sleep surface not designed for infants in 75.9%. The head or face was covered by bedding in 29.4%. A shared sleep surface was the site of death in 47.1%. Only 8.4% of deaths involved infants found nonprone and alone, with head and face uncovered. Similar unsafe sleeping practices occurred in the large majority of cases diagnosed as SIDS, accidental suffocation, and cause undetermined. Regardless of the diagnosis, recommendations that infants sleep supine on firm sleep surfaces that lessen the risk of entrapment or head covering have the potential to save many lives. Campaigns are needed to heighten awareness of these messages and of the risks of dangerous bedsharing.



• Moon RY, Biliter WM. Infant sleep positions in licensed child care center after Back to Sleep Campaign. Pediatrics 2000; 106(3):576-580. (E.55.04 S)
  
  Abstract: Since the Back to Sleep (BTS) campaign was initiated in 1994, the rate of prone sleeping has decreased to approximately 20%. However, child care centers may have an increased rate of prone sleeping in infants. In 1996, a study of licensed child care centers demonstrated that 43% were unaware of the associated between sudden infant death syndrome (SIDS) and prone sleeping and that 49% positioned infants prone. This study was conducted to determine the effectiveness of a mailing from the BTS campaign to licensed child care centers by assessing the following: child care center awareness of the recommendations of the American Academy of Pediatrics regarding infant sleep position; and implementation of the recommendations in child care center practice. All licensed child care centers caring for infants <6 months old in Washington, DC, and Montgomery, Prince Georges, Howard, Anne Arundel, Frederick, and Charles Counties in Maryland were recruited for the study. 75% of the centers were aware of the recommendations regarding infant sleep position. Infants were placed prone in 27.9% of centers, although only 2.9% placed infants exclusively in the prone position. The most common reasons for avoiding prone position entirely were SIDS risk reduction and licensing regulations. Half of the centers had a written policy regarding sleep position. Twenty centers who wre aware of the dangers of prone sleeping continued to place infants prone at least some of the time, largely because of parental request. Only 56.9% of the centers had heard of the BTS campaign despite the mass mailing. The mailing resulted in a policy change for 14 centers. Since 1996, the percentage of licensed child care centers in the greater Washington, DC area that are aware of the association between SIDS and infant sleep position has increased from 57% to 75%. In addition, the rate of placing infants prone has declined from 49% in 1996 to 27.9% inthis study. Additional educational efforts toward child care providers and parents remain necessary.

Transportation:

• Wesson D, Spence L, Hu X, Parkin P. Trends in bicycling-related head injuries in children after implementation of a community-based bike helmet campaign. Journal of Pediatric Surgery 2000; 35(5):688-689. (E.51.02.02 S)
  
  Abstract: The aim of this study was to determine the effect of a community-based bike helmet promotion campaign on bike helmet use and related head injuries in children (0 to 14 years of age) in a large North American city. The authors established a multifaceted, multidisciplined, community-based campaign to promote bike helmet use by children in 1989. The goals were to increase helmet use by 100% per year, to reduce fatal bike-related head injuries by 50% overall, and to explore the feasibility of legislation mandating helmet use. Helmet use was measured by standardized field observations repeated annually in a single borough within the metropolitan area. To estimate head injury incidence, the number of admissions to hospital for the treatment of bike-related head injuries in a regional trauma registry, which included all residents in the target population was used. The authors were unable to control for changes in exposure to bicycling or in the criteria for admissions to hospital for the treatment of head injuries during the study period. The bike helmet use rate rose from 4% in 1990 to 67% in 1996. The number of head injury admissions fell from 46 in 1990 to 24 in 1996. Legislation requiring helmet use by all children went into effect in October 1995. Bike helmet use increased significantly during the first 4 years of the campaign and again after the helmet law was implemented. The total number of bike-related head injury admissions declined by more than 50%. The campaign achieved all of its goals except for a 50% reduction in fatal head injuries, which were too infrequent for analysis



• Cook LJ, Knight S, Olson LM, Nechodom PJ, Dean JM. Motor vehicle crash characteristics and medical outcomes among older drivers in Utah, 1992-1995. Annals of Emergency Medicine 2000; 35(6):585-591. (E.50 S)
  
  Abstract: This study sought to compare the characteristics and medical outcomes of motor vehicle crashes for drivers 70 years and older with those of drivers between the ages of 30 and 39 years. The authors probabilistically linked statewide motor vehicle crash and hospital discharge data between the years of 1992 and 1995 for the state of Utah. They calculated the odds of older drivers exhibiting certain motor vehicle crash characteristics compared with younger drivers. Adjusting for nighttime crash, high-speed crash, and seatbelt use, they calculated the odds of an older driver being killed or hospitalized compared with those of a younger driver. During the study years, there were 14,466 drivers older than 69 years and 68,706 drivers between the ages of 30 and 39 years involved in motor vehicle crashes in Utah. Older drivers were less likely to have crashes involving drug or alcohol use and less likely to have crashes at high speed. Although older drivers were no more likely to have a crash involving a right-hand turn than younger drivers, they were over twice as likely to have a crash involving a left-hand turn. Also, older drivers were more likely to be killed or hospitalized than younger drivers. Among belted drivers, an older driver was nearly 7 times more likely to be killed or hospitalized than a younger driver. Older drivers do have distinctive motor vehicle crash patterns. Interventions must be taken to reduce the number of left-hand turn crashes involving older drivers. In addition, further research is needed to design, implement, and evaluate countermeasures that may enable older drivers to continue driving while keeping public safety in the forefront



• Grisoni ER, Pillai SB, Volsko TA, Mutabagani K, Garcia V, Haley K et al. Pediatric airbag injuries: the Ohio experience. Journal of Pediatric Surgery 2000; 35(2):160-162. (E.52.02.04 S)
  
  Abstract: This study sought to determine if properly restrained children, less than 13 years of age, placed in the front passenger seat are at greater risk for trauma from airbag deployment than unrestrained children. The charts of children treated at any of 3 regional pediatric trauma centers in Ohio were reviewed for airbag injuries sustained in motor vehicle crashes between January 1995 and September 1998. Injury Severity Scores (ISS) were compared with Mann-Whitney Rank Sum Test and outcome data with Fisher's Exact Tests. Twenty-seven children aged 1 month to 12 years sustained airbag-related injuries. Sixty-one percent were girls. ISS ranged from 1 to 75 with a mean score (+/- SD) of 10 (14.5). All crashes were at reported speeds of less than 45 mph, and 64% were head-on collisions. No significant differences in the mean ISS occurred between groups. Both groups had similar closed head, ocular and facial injuries, extremity fractures, and number of deaths (P = 1.0). Abdominal organ injury was exclusive to the restrained group. Decapitation only occurred among unrestrained children. These data showed that airbags, with or without proper safety restraints, can lead to mortality or serious morbidity in children

Alcohol/Drug use:

• McLeod R, Stockwell T, Stevens M, Phillips M. The relationship between alcohol consumption patterns and injury. Addiction 1999; 94(11):1719-1734. (E.40.02 S)
  
  Abstract: This study used a case-control design to quantify the risk of injury after the recent consumption of alcohol. A total of 797 cases and 797 controls were interviewed throughout 1997. Cases and controls were questioned about the injury event and alcohol and other drug use consumed in the 6 hours prior to the injury. They were breath-tested and medical records were checked for validation purposes. Logistic regression analysis produced an odds ratio of 3.4 for the risk of sustaining an injury after consuming more than 60g of alcohol in a 6 hour period, after controlling for demographic variables. The risk of injury at different levels of alcohol use was substantially higher for females with a significant odds ratio of 9.6 at greater than 60g of alcohol compared to 2.1 for men. These results need to be interpreted cautiously, but provide additional support that the risk of injury increases with the quantity of alcohol consumed and that the risk of injury is significantly higher for women.

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