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November 3, 2000

Part 2

See Part 1 for the category "General / Cross-Cutting".


  • Murray JA; Chen D; Velmahos GC; Alo K; Belzberg H; Asensio JA; Demetriades D; Berne TV. Pediatric falls: is height a predictor of injury and outcome? Am Surg 2000 Sep;66(9):863-5.

    Falls account for a significant proportion of pediatric injuries and deaths. A retrospective review of pediatric patients (age 0-14 years) was performed to determine whether patterns of injuries and outcomes could be predicted on the basis of the height of the fall. In addition we evaluated the triage criterion "fall greater than 15 feet" for transport of patients to a trauma center. Patients were stratified by the height of the fall: greater than or less than 15 feet. The end points for analysis were the associated injuries and survival. Patients who fell less than 15 feet had a higher incidence of intracranial injuries (and fewer extremity fractures than patients who fell more than 15 feet). Skull fractures were the most frequent injury and were associated with an increase in intracranial injuries in both subgroups. In conclusion low-level falls are associated with significant intracranial injuries. The evaluation of patients sustaining low-level falls should not be limited on the basis of the height of the fall. Using falls of greater than 15 feet as a triage criterion for transport to a trauma center needs to be prospectively evaluated to ensure that critically injured patients are triaged appropriately.

  • Benoit R; Watts DD; Dwyer K; Kaufmann C; Fakhry S. Windows 99: a source of suburban pediatric trauma. J Trauma 2000 Sep;49(3):477-81; discussion 481-2.

    BACKGROUND: Falls from windows in urban areas cause a significant number of pediatric injuries. Window falls have not been well described in the nonurban setting. We describe the epidemiology of window falls from residential homes among pediatric patients at a suburban Level I trauma center. METHODS: A review of patients admitted from January 1991 through November 1999 to a center serving a rapidly growing suburban area was performed. RESULTS: A total of 2,322 children, ages 0-14 years, were admitted during the study period. Falls comprised 41% of these admissions, and 11% of falls were from windows, greater than twice the national average. More than 39% of children who fell from windows were admitted directly to the intensive care unit. Overall mortality rate was 4%. Ages 0 to 4 years comprised the largest percentage (83%), and all children who died were in this age group. Children < or = 4 years were more likely to have an Abbreviated Injury Score> or = 2 (head injury) than those ages 10 to 14 years (p = 0.032). More than 31% of all children injured in window falls seen at the study institution between 1991 and 1999 were admitted in the last 2 years. CONCLUSION: Pediatric falls from windows in this suburban area appear to be increasing, with an incidence greater than the national average. Children at greatest risk are less than 4 years old. Further research in injury prevention at the national level aimed at suburban areas may be warranted.

  • Leistikow BN; Martin DC; Milano CE. Fire injuries, disasters, and costs from cigarettes and cigarette lights: a global overview. Prev Med 2000 Aug;31(2 Pt 1):91-9.

    BACKGROUND: Fires cause 1% of the global burden of disease. Fire (includes explosion) disasters have immense health, social, and environmental costs. We will provide initial estimates of overall U. S. and global fire tolls from smoking. METHODS: We tabulated and summarized smoking-related fire and disaster tolls from published documents. We compared those tolls to U.S. fire, burn, and fire death rates per billion cigarettes extrapolated globally. Smoking-attributable percentages of adult and child access to cigarette lighter and match ignitions (lights), and resultant fires, burns, and deaths ignited by young children, were estimated from likely smoking-attributable lights usage. Cigarette plus cigarette lights fire tolls were multiplied times published and estimated fire costs. RESULTS: Smoking is the leading cause of residential or total fire death in all eight countries with available statistics. Smoking is a leading cause of fires in many more countries. Cigarettes cause numerous fire disasters. Cigarette lights cause an estimated 100,000 U.S. and one million global, child-playing fires per year. Cigarette lights fire injuries likely rival U.S., and possibly global, cigarette fire injury numbers. Smoking causes an estimated 30% of U. S. and 10% of global fire death burdens. Smoking's estimated U.S. and global fire costs were $6.95 (sensitivity range $5.34-22.8) and $27.2 (sensitivity range $8.2-89.2) billion, respectively, in 1998 U. S. dollars. CONCLUSIONS: Smoking likely causes large global fire tolls. U.S. fire tolls have fallen when smoking decreased. Further reducing smoking can substantially reduce fire and disaster tolls. Copyright 2000 American Health Foundation and Academic Press.

  • Mallonee S Evaluating injury prevention programs: the Oklahoma City Smoke Alarm Project. Future Child 2000 Spring-Summer;10(1):164-74.

    Evaluation of injury prevention programs is critical for measuring program effects on reducing injury-related morbidity and mortality or on increasing the adoption of safety practices. During the planning and implementation of injury prevention programs, evaluation data also can be used to test program strategies and to measure the program's penetration among the target population. The availability of this early data enables program managers to refine a program, increasing the likelihood of successful outcomes. The Oklahoma City Smoke Alarm Project illustrates how an evaluation was designed to inform program decisions by providing methodologically sound data on program processes and outcomes. This community intervention trial was instituted to reduce residential fire-related injuries and deaths in a geographic area of Oklahoma City that was disproportionately affected by this problem. The distribution of free smoke alarms in targeted neighborhoods was accompanied by written educational pamphlets and home-based follow-up to test whether the alarms were functioning correctly. Early evaluation during the planning and implementation phases of the program allowed for midcourse corrections that increased the program's impact on desired outcomes. During the six years following the project, the residential fire-related injury rate decreased 81% in the target population but only 7% in the rest of Oklahoma City. This dramatic decline in fire-related injuries in the target area is largely attributed to the free smoke alarm distribution as well as to educational efforts promoting awareness about residential fires and their prevention.

  • Watson W, Ozanne-Smith J, Begg S, Stathakis V. Bunk bed injuries in Australia: the case for a mandatory safety standard. International Journal for Consumer & Product Safety 1999; 6(2):87-96.

    Bunk beds have long been recognised as a potential source of injury to children. This study was undertaken to establish an evidence base for a proposed injury reduction program and to determine whether or not there is a case for a mandatory safety standard. Recent literature on bunk bed safety was reviewed to provide an overview of the injury issues involved. Major sources of relevant Australian and international data were identified and the available data summarized. An in-depth analysis of Victorian data was undertaken to identify the nature and severity of injuries sustained and any patterns or trends, including age profiles. It is estimated that, in Australia, in the under fifteen age-group, there are at least 2,100 bunk bed-related injuries treated annually by hospital emergency departments. This represents a rate of about 50 injuries per 100,000 age-specific population. The majority of these injuries (86%) occur in children under the age of 10 years with injuries peaking in the 5-9 year age-group. The main cause of non-fatal injury is falls from the top bunk resulting in a fracture (33%), mainly to the upper extremity (75%). There have been at least two deaths from asphyxia in Australia in the past 10 years, due to entrapment in the bunk structure. It is clear from the current evidence that bunk bed injuries are a significant problem in Australia and represent a life-threatening hazard to young children in particular. The existing voluntary Australian/New Zealand Standard adequately addresses the safety issues raised by the examination of the literature and the analysis of the injury data. It is also clear that, in Australia, voluntary standards and the market place have been ineffective in achieving compliance. It is therefore recommended that the Australian Standard be made mandatory in an effort to significantly improve the safety of bunk beds in Australia.


  • Floerchinger-Franks G; Machala M; Goodale K; Gerberding S. Evaluation of a pilot program in rural schools to increase bicycle and motor vehicle safety. J Community Health 2000 Apr;25(2):113-24.

    Concerned with high bicycle-and motor vehicle-related mortality rates among children, Idaho's South Central District Health Department provided a competition to increase use of 1) seat belts, 2) motor vehicle rear seating, and 3) bicycle helmets among children attending elementary schools in the eight rural counties it serves. Nine of the 44 elementary schools in the health district chose to participate in the contest. Eight schools addressed increasing helmet use, four schools also addressed increasing seat belt use and rear seating, and one school addressed safety in general. A $1,000 prize was awarded to each of four schools judged to have the highest levels of student and community involvement, outreach, creativity, and changes in safety behavior (based on perceptions of outside judges). In 1997, baseline observations were collected for 1) seat belt use and rear seating for children in 28 schools, and for 2) bicycle helmet use among children in 25 schools. In 1998, follow up data were collected for 1) seat belt and rear seating in 42 schools, and 2) bicycle helmet use in 35 schools. Data were analyzed using SAS. Adjusting for differences in baseline rates, regression analysis was used to compare 1997 and 1998 rates for seat belt use, rear seating, and bicycle helmet use for those schools having baseline data. Results showed that although there was no significant difference between participating and non-participating schools in rear-seating behaviors, there was an increase in seat belt and bicycle helmet use for participating schools. Since schools self-selected participation, it is unknown whether those schools were fundamentally different from nonparticipating schools.
  • Pelletier AR, Quinlan KP, Sacks JJ, Van Gilder TJ, Gilchrist J, Ahluwalia HK. Injury prevention practices as depicted in G-rated and PG-rated movies. Arch Pediatr Adolesc Med. 2000 Mar;154(3):283-6.

    BACKGROUND: Previous studies on alcohol, tobacco, and violence suggest that children's behavior can be influenced by mass media; however, little is known about the effect of media on unintentional injuries, the leading cause of death among young persons in the United States. OBJECTIVE: To determine how injury prevention practices are depicted in G-rated (general audience) and PG-rated (parental guidance recommended) movies. DESIGN: Observational study. SETTING: The 25 movies with the highest domestic box-office grosses and a rating of G or PG for each year from 1995 through 1997. Movies that were predominantly animated or not set in the present day were excluded from analysis. SUBJECTS: Movie characters with speaking roles. MAIN OUTCOME MEASURES: Safety belt use by motor vehicle occupants, use of a crosswalk and looking both ways by pedestrians crossing a street, helmet use by bicyclists, personal flotation device use by boaters, and selected other injury prevention practices. RESULTS: Fifty nonanimated movies set in the present day were included in the study. A total of 753 person-scenes involving riding in a motor vehicle, crossing the street, bicycling, and boating were shown (median, 13.5 person-scenes per movie). Forty-two person-scenes (6%) involved falls or crashes, which resulted in 4 injuries and 2 deaths. Overall, 119 (27%) of 447 motor vehicle occupants wore safety belts, 20 (18%) of 109 pedestrians looked both ways before crossing the street and 25 (16%) of 160 used a crosswalk, 4 (6%) of 64 bicyclists wore helmets, and 14 (17%) of 82 boaters wore personal flotation devices. CONCLUSIONS: In scenes depicting everyday life in popular movies likely to be seen by children, characters were infrequently portrayed practicing recommended safe behaviors. The consequences of unsafe behaviors were rarely shown. The entertainment industry should improve its depiction of injury prevention practices in G-rated and PG-rated movies.
  • Powell JW, Barber-Foss KD. Sex-related injury patterns among selected high school sports. Am J Sports Med. 2000 May-Jun;28(3):385-91.

    This cohort observational study was undertaken to test the hypothesis that the incidence of injuries for girls participating in high school sports is greater than that for boys. From 1995 through 1997, players were included in our study if they were listed on the school's varsity team roster for boys' or girls' basketball, boys' or girls' soccer, boys' baseball, or girls' softball. Injuries and opportunities for injury were recorded daily. Certified athletic trainers reported injury and exposure data. Based on 39,032 player-seasons and 8988 reported injuries, the injury rates per 100 players for softball (16.7) and for girls' soccer (26.7) were higher than for baseball (13.2) and boys' soccer (23.4). The knee injury rates per 100 players for girls' basketball (4.5) and girls' soccer (5.2) were higher than for their male counterparts. Major injuries occurred more often in girls' basketball (12.4%) and soccer (12.1%) than in boys' basketball (9.9%) and soccer (10.4%). Baseball players (12.5%) had more major injuries than softball players (7.8%). There was a higher number of surgeries, particularly knee and anterior cruciate ligament surgeries, for female basketball and soccer players than for boys or girls in other sports.


  • Brent DA; Baugher M; Birmaher B; Kolko DJ; Bridge J. Compliance with recommendations to remove firearms in families participating in a clinical trial for adolescent depression. J Am Acad Child Adolesc Psychiatry 2000 Oct;39(10):1220-6.

    OBJECTIVE: To assess the rate and correlates of compliance with clinicians' recommendations to remove firearms from the homes of depressed adolescents participating in a clinical trial. METHOD: The parents of 106 adolescents with major depression who participated in a randomized psychotherapy clinical trial were asked systematically about firearms in the home. Those who answered affirmatively were given information about the suicide risk conveyed by guns in the home and urged to remove them. The rates of gun removal and acquisition were assessed at the end of the treatment and over the subsequent 2-year naturalistic follow-up. RESULTS: Of those who had guns at intake, 26.9% reported removing them by the end of the acute trial. Retention was associated with urban origin, marital dissatisfaction, and paternal psychopathology. Of those who did not have guns at intake, 17.1% reported acquiring them over 2-year follow-up. Living in a 2-parent household and marital dissatisfaction were associated with gun acquisition. CONCLUSIONS: Families of depressed adolescents may frequently be noncompliant with recommendations to remove guns from the home despite compliance with other aspects of treatment. More efficacious interventions to reduce access to guns in the homes of at-risk youths are needed.

  • Christoffel KK. When counseling parents on guns doesn't work: why don't they get it? J Am Acad Child Adolesc Psychiatry. 2000 Oct;39(10):1226-8.


    Christoffel provides commentary on the DA Brent et al. report on the low compliance with counseling parents to remove firearms from the homes of depressed adolescents. She explores the implications of this report and provides suggestions for more effective counseling.

  • Squires T, Gorman D, Arrundale J, Platt S, Fineron. Reduction in drug-related suicide in Scotland 1990-1996: an artefactual explanation. J Epidemiol Community Health 1999;53:436-437.

    Deaths in Scotland are coded according to the International Classification of Diseases Revision 9 by the Registrar general for Scotland and published annually. This paper highlights the effect on the drug related suicide rate (E950) cause by drug overdose deaths coded to ICD9 304, "drug dependence".


  • Leden L; Garder P; Pulkkinen U. An expert judgment model applied to estimating the safety effect of a bicycle facility. Accid Anal Prev 2000 Jul;32(4):589-99.

    This paper presents a risk index model that can be used for assessing the safety effect of countermeasures. The model estimates risk in a multiplicative way, which makes it possible to analyze the impact of different factors separately. Expert judgments are incorporated through a Bayesian error model. The variance of the risk estimate is determined by Monte-Carlo simulation. The model was applied to assess the safety effect of a new design of a bicycle crossing. The intent was to gain safety by raising the crossings to reduce vehicle speeds and by making the crossings more visible by painting them in a bright color. Before the implementations, bicyclists were riding on bicycle crossings of conventional Swedish type, i.e. similar to crosswalks but delineated by white squares rather than solid lines or zebra markings. Automobile speeds were reduced as anticipated. However, it seems as if the positive effect of this was more or less canceled out by increased bicycle speeds. The safety per bicyclist was still improved by approximately 20%. This improvement was primarily caused by an increase in bicycle flow, since the data show that more bicyclists at a given location seem to benefit their safety. The increase in bicycle flow was probably caused by the new layout of the crossings since bicyclists perceived them as safer and causing less delay. Some future development work is suggested. Pros and cons with the used methodology are discussed. The most crucial parameter to be added is probably a model describing the interaction between motorists and bicyclists, for example, how risk is influenced by the lateral position of the bicyclist in relation to the motorist. It is concluded that the interaction seems to be optimal when both groups share the roadway.

  • Segui-Gomez M. Driver air bag effectiveness by severity of the crash. Am J Public Health 2000 Oct;90(10):1575-81.

    This analysis provided effectiveness estimates of the driver-side air bag while controlling for severity of the crash and other potential confounders.
    METHODS: Data were from the National Automotive Sampling System (1993-1996). Injury severity was described on the basis of the Abbreviated Injury Scale, Injury Severity Score, Functional Capacity Index, and survival. Ordinal, linear, and logistic multivariate regression methods were used.
    RESULTS: Air bag deployment in frontal or near-frontal crashes decreases the probability of having severe and fatal injuries (e.g., Abbreviated Injury Scale score of 4-6), including those causing a long-lasting high degree of functional limitation. However, air bag deployment in low-severity crashes increases the probability that a driver (particularly a woman) will sustain injuries of Abbreviated Injury Scale level 1 to 3. Air bag deployment exerts a net injurious effect in low-severity crashes and a net protective effect in high-severity crashes. The level of crash severity at which air bags are protective is higher for female than for male drivers.
    CONCLUSIONS: Air bag improvement should minimize the injuries induced by their deployment. One possibility is to raise their deployment level so that they deploy only in more severe crashes.

  • Li G; Shahpar C; Soderstrom CA; Baker SP. Alcohol use in relation to driving records among injured bicyclists. Accid Anal Prev 2000 Jul;32(4):583-7.

    To prevent alcohol-related occupational mishaps, employers often conduct background checks on prospective employees for history of driving while intoxicated (DWI) and driving under the influence of alcohol (DUI) to screen out candidates with drinking problems. Few studies, however, have examined the pervasive nature of drinking behavior across activity domains. Based on trauma registry data, we constructed a historical cohort of 120 Maryland residents ages 18 years or older who were injured while riding a bicycle between 1990 and 1997. Driving records for the 120 bicyclists for the 3 years between May 6, 1995 and May 5, 1998 were obtained from the state motor vehicle administration and were analyzed in relation to BAC-positive status at the time of injury. Bicyclists with positive BACs at the time of admission to the trauma center were significantly more likely than those with negative BACs to have a record of license suspension/revocation (52% vs 14%, P < 0.01) and to have DWI/DUI convictions (30% vs 3%, P < 0.01). Despite the modest sample size, this study provides compelling evidence of the pervasive nature of risky drinking between bicycling and driving activities.

  • Scuffham P; Alsop J; Cryer C; Langley JD. Head injuries to bicyclists and the New Zealand bicycle helmet law. Accid Anal Prev 2000 Jul;32(4):565-73.

    The purpose of this study was to examine the effect of helmet wearing and the New Zealand helmet wearing law on serious head injury for cyclists involved in on-road motor vehicle and non-motor vehicle crashes. The study population consisted of three age groups of cyclists (primary school children (ages 5-12 years), secondary school children (ages 13-18 years), and adults (19+ years)) admitted to public hospitals between 1988 and 1996. Data were disaggregated by diagnosis and analyzed using negative binomial regression models. Results indicated that there was a positive effect of helmet wearing upon head injury and this effect was relatively consistent across age groups and head injury (diagnosis) types. We conclude that the helmet law has been an effective road safety intervention that has lead to a 19% (90% CI: 14, 23%) reduction in head injury to cyclists over its first 3 years.

  • Yuan W. The effectiveness of the 'ride-bright' legislation for motorcycles in Singapore. Accid Anal Prev 2000 Jul;32(4):559-63.

    This paper examines the effectiveness of the 'ride-bright' legislation implemented in Singapore in November 1995. The odds ratio test is used to investigate if there is any significant difference in the number of daytime motorcycle accidents by severity before and after the implementation of the legislation. The findings indicate that although there is insignificant change in the number of slight injury accidents, the legislation is effective in reducing the number of fatal and serious injury accidents.

  • Martin PG; Crandall JR; Pilkey WD. Injury trends of passenger car drivers in frontal crashes in the USA. Accid Anal Prev 2000 Jul;32(4):541-57.

    Injuries trends of passenger car drivers in head-on collisions are identified based on crash data extracted from the National Automotive Sampling System. Annual injury incidence levels are estimated for years 1990-2007. Over that period, the number of crashes is predicted to rise by 71%. However, the number of serious injuries to drivers is expected to rise by only 41% and driver fatalities are anticipated to decrease by 9%. Meantime, the types of injuries suffered by drivers are changing. Year-to-year shifts in injury patterns result from changes in vehicle size classes within the US vehicle fleet population and increases in seat belt use and air bag availability. The effectiveness of air bags in saving lives is estimated to be 30%, and with more air bag-equipped cars on the road, the probability of sustaining a life-threatening head or a torso injury is reduced. Air bags, however, are not as effective in preventing upper and lower extremity injuries, and thus arm and leg injuries will become more prevalent in years to come.

  • Select Committee of the house of Lords on the Prevention of Road Accidents. Report of Proceedings, pp. 1-663. London: His Majesty's Stationary Office, 1938.

    An early discussion of issues of sharing traffic ways with pedestrians and bicycles; street and highway design to accommodate a mix of users; speed limits, failure to yield, driving under the influence of alcohol and other drugs, and physically impaired drivers. At a time when some in the United States were still arguing that alcohol may improve performance for some drivers this body was discussing license revocation and vehicle confiscation.

  • Chen G; Wilson J; Meckle W; Cooper P. Evaluation of photo radar program in British Columbia. Accid Anal Prev 2000 Jul;32(4):517-26.

    This article presents the results of an evaluation of the speed and traffic safety effects of the photo radar program in British Columbia (BC) after 1 year of full operation. Traffic speed data were collected from the photo radar units and from induction loops installed across the province. Traffic collision and injury data were obtained from police investigation reports and from BC ambulance services records. The study employed a number of analytical frameworks, including simple before and after comparison, time-series cross-sectional analysis, and interrupted time series analysis. The study revealed a dramatic reduction of speed at photo radar deployment sites. A reduction of 2.4 km/h in mean speed was also observed at selected monitoring sites where enforcement was not likely to be present. The reduction of speed was accompanied by a decrease in collisions, injuries and fatalities. The analysis found a 25% reduction in daytime unsafe speed related collisions, an 11% reduction in daytime traffic collision victims carried by ambulances and a 17%, reduction in daytime traffic collision fatalities.

  • Holland AJ; Liang RW; Singh SJ; Schell DN; Ross FI; Cass DT. Driveway motor vehicle injuries in children. Med J Aust 2000 Aug 21;173(4):192-5 ABSTRACT:
    OBJECTIVES: To describe the frequency, nature and outcome of driveway injuries in children. DESIGN: Retrospective case series of driveway-related injuries in children under 16 years of age admitted to the New Children's Hospital (NCH), New South Wales, from November 1995 to February 2000, and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999.
    MAIN OUTCOME MEASURES: Circumstances of injury; type and number of injuries identified.
    RESULTS: 42 children were admitted to our institution with driveway-related injuries over four years and four months. These represent 12% of all children admitted with pedestrian motor vehicle injuries. Fourteen deaths (including one of the children admitted to NCH) were reported to the NPTD Registry over 12 years, accounting for 8% of all paediatric pedestrian motor vehicle deaths reported to the registry. Typically, the injury involved a parent or relative reversing a motor vehicle in the home driveway over a toddler or preschool-age child in the late afternoon or early evening. Four-wheel-drive or light commercial vehicles were involved in 42% of all injuries, although they accounted for just 30.4% of registered vehicles in NSW. These vehicles were associated with a 2.5-times increased risk of fatality. In 13 of the 14 deaths, the cause was a severe head injury not amenable to medical intervention.
    CONCLUSIONS: Driveway injuries in children account for a significant proportion of paediatric pedestrian motor vehicle injuries and deaths in NSW. Prevention represents the only effective approach to reducing deaths from this cause.


  • Miller M, Azrael D, Hemenway D. Community firearms, community fear. Epidemiology. 2000 Nov;11(6):709-14.

    To examine how perceptions of safety are influenced as more people i a community acquire firearms, we conducted a nationally representative random-digit-dial survey of 2,500 adults and asked whether respondents would feel more safe, less safe, or equally safe if more people in their community were to acquire guns. We used multivariate logistic regression to explore correlates of perceived safety while taking into account various confounders. Fifty percent of respondents reported that they would feel less safe if more people in their community were to own guns; 14 percent reported they would feel more safe. Women and minorities were more likely than were men and whites to feel less safe as others acquire guns, with odds ratios of 1.7 and 1.5 respectively. Our findings suggest that most Americans are not impervious to the psychological effects of guns in their community, and that, by a margin of more than 3 to 1, more guns make others in the community feel less safe rather than more safe.


  • McCurdy SA; Carroll DJ. Agricultural injury. Am J Ind Med 2000 Oct;38(4):463-80.


    BACKGROUND: Agriculture is one of the most hazardous industries in the US.
    METHODS: We reviewed MEDLINE and NIOSHTIC to identify English-language studies addressing occupational injury among agricultural populations, focusing on North America. Additional references were identified from the reference lists of identified studies and from contacts with experts in the field.
    RESULTS: U.S. data indicate up to approximately 780 deaths and 140,000 cases of nonfatal disabling injuries in 1998. Risk of agricultural injuries is approximately 5-10/100 persons per year, but is higher in certain risk groups, such as males and cattle workers. Falls, machinery, and animals are among the most common causes. Unique features of the agricultural workplace and exposed population combine to increase risk and hinder accurate measurement. These features include a wide range of activities, hazards, and dispersed work places in agriculture; a seasonal hired work force that often has brief tenure, poor English skills, and a distrust of officialdom; and a history of exemption regarding occupational health and safety regulations.
    CONCLUSIONS: Research in agricultural injury should include epidemiologic study of risk factors and evaluation of interventions. Although only limited data are available documenting efficacy of specific preventive approaches, prevention should focus on engineering controls, regulatory approaches, and education.

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