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November 10, 2000


  • O'Connor TG, Davies L, Dunn J, Golding J, The ALSPAC Study Team. Distribution of accidents, injuries, and illnesses by family type. Pediatrics 2000; 106(5):e68. (E.40.04S)

    The purpose of this study was to investigate whether family type and psychosocial risks indexed by family type were systematically associated with differences in health outcomes in children. The study is based on a longitudinal, prospective study of a large community sample of families, the Avon Longitudinal Study of Pregnancy and Childhood. At 2 years of age, children in single-parent and stepfamilies were disproportionately likely to experience accidents and receive medical treatment for physical illnesses. In addition, children in single-parent families and stepfamilies were more likely to be hospitalized or receive attention from a hospital doctor for an injury or illness. Exposure to psychosocial risks also were elevated in single-parent families and stepfamilies, compared with intact or nonstepfamilies, and these factors primarily accounted for the connection between family type and children's physical health. The consequences of family transitions on children's health extend beyond traditional mental health and behavioral outcomes and include accident proneness, illness, and receipt of medical attention. The mediating processes are not entirely attributable to social class differences connected to family type and may instead be associated with a range of psychosocial risks that are more frequently found in single-parent families and stepfamilies, compared with intact or nonstepfamilies. Prevention and intervention efforts directed toward children at risk for poor behavioral and mental health adjustment secondary to family disruption should consider children's physical health and health-related behaviors.

  • Da Pozzo S, Pensiero S, Perissutti P. Ocular injuries by elastic cords in children. Pediatrics 2000; 106(5):e65. (E.74.06S)

    Elastic cords hitting the eyeball as high-speed projectiles can severely damage ocular structures and can produce permanent visual function impairment. This study was conducted to evaluate the frequency, mechanics, and severity of eye injuries caused by elastic cords in children to adopt the most appropriate prevention measures. A retrospective medical records review of hospital admissions secondary to ocular trauma between 1991-1997 in a pediatric opthamology unit at an urban tertiary care pediatric hospital was performed to select all children admitted for ocular injury caused by an elastic cord. Eight children fulfilled the inclusion criteria; the prevalence ratio was 2% of all pediatric trauma admissions. In all cases, the mechanics of trauma was a combination of blunt and high-speed projectile injury. The mechanism of trauma in younger patients was typically a cord that was misused during unsupervised playtime, whereas cord slipping from car roof racks was noted in older patients. One patient suffered a severe permanent visual impairment caused by retinal detachment. All other children regained full visual acuity. Circumstances of injury in younger children are different from those found in older children, the latter being similar to those reported for adults. Prevention is the primary measure to be taken to reduce the prevalence of this injury and to lower the risk for ocular severe anatomic damage as much as possible. This can be achieved primarily by modifying the design of the hooks, intensifying educational campaigns, and keeping elastic cords out of children's reach.


  • American Academy of Pediatrics, Committee on Injury and Poison Prevention. Snowmobiling hazards. Pediatrics 2000; 106(5):1142-1144. (E.60.02S)

    Snowmobiles continue to pose a significant risk to children younger than 15 years and adolescents and young adults 15-24 years of age. Head injuries remain the leading cause of mortality and serious morbidity, arising largely from snowmobilers colliding, falling, or overturning during operation. Children also were injured while being towed in a variety of conveyances by snowmobiles. No uniform code of state laws governs the use of snowmobiles by children and youth. Because evidence is lacking to support the effectiveness of operator safety certification and because many children and adolescents do not have the required strength and skills to operate a snowmobile safely, the recreational operation of snowmobiles by persons younger than 16 years is not recommended. Snowmobiles should not be used to tow persons on a tube, tire, sled, or saucer. Furthermore, a graduated licensing program is advised for snowmobilers 16 years and older. Both active and passive snowmobile injury prevention strategies are suggested, as well as recommendations for manufacturers to make safer equipment for snowmobilers of all ages.


  • Bull MJ, Sheese J. Update for the pediatrician on child passenger safety: Five principles for safer travel. Pediatrics 2000; 106(5):1113-1116. (E.52.02.06S)

    By understanding a few basic principles, pediatricians can positively impact major issues affecting the safety of children during travel. Parents may not routinely consider the full implications of safe travel, but pediatricians can raise awareness with parents by asking them to carefully read their child safety seat instructions and vehicle owner's manual and informing parents of the 5 basic principles of child passenger safety: 1. Air bags can be dangerous to children; 2. Infants must ride rear-facing until they are at least 1 year old and weigh at least 20 pounds; 3. Adjustments must be made when convertible seats are changed from rear to forward-facing; 4. Safety seats must be secure in the vehicle, and the child must be secure in the seat; 5. Children are safer in child safety seats as long as they fit.

  • U.S.Department of Transportation, National Highway Traffic Safety Administration. Getting to School Safely Community Action Kit. DOT HS 809 078. 2000. Washington, DC: National Highway Traffic Safety Administration. (E.50S)

    Children travel to school in many different ways - walking, bicycling, and riding in school buses, public transportation, and private cars. Getting to School Safely is a program launched by the National Highway Traffic Safety Administration and a broad range of national organizations committed to child safety to address the full range of school transportation safety issues. This planner was designed to help teachers, administrators, school transportation directors, parents, and concerned citizens plan activities at the community level to ensure that all students get to school safely during the school year and beyond. The packet includes materials to help implement activities: state and regional contacts, national organizations, fact sheets, and talking points. It also includes materials to help publicize activities and draw attention to school transportation issues.

  • Hoxie RE, Rubenstein LZ, Hoenig H, Gallagher BR. The older pedestrian. Journal of the American Geriatrics Society 1994; 42:444-450. (E.51.04S)

    Most persons must be able to walk to maintain an independent lifestyle. Yet relatively little is known about the abilities, requirements, and problems of older pedestrians. In this paper, the authors present a case that illustrates the dangers elderly pedestrians can experience. This is followed by discussions of the walking requirements and problems encountered by elderly persons as they perform their daily activities, and the relationship between walking speeds and pedestrian safety. It concludes with a discussion by a city traffic engineer who suggests how the special needs of elderly pedestrians can be addressed.

  • Way to Go! School Program. "Small Steps Towards a Big Difference". 1-89. 1998. British Columbia, Canada: ICBC. (E.50S)

    The Way to Go! manual and resource kit are designed to help parent, teacher, and student groups devise and implement school based traffic reduction programs in their communities. The Way to Go! Program provides a step-by-step guide to developing and implementing a school traffic reduction program in your school community. The Way to Go! Toolkit includes model forms to help organize the project and communicate ideas to the school community. The Way to Go! Resources lists a wide variety of sources for information and resources that support a traffic reduction program.

  • Safe Crossings: Guidelines for School Crossings Programs. 1-27. 1998. North Vancouver, BC, Canada: ICBC Road Safety. (E.51.04S)

    This booklet on School Crossing Programs was developed by a committee for pedestrian control crossings organized by the British Columbia Ministry of Transportation and Highways, Highway Safety Branch. Programs described include: Safe Routes to School; School Patrol; and Adult Crossing Guard. Appendices include a school master map; sample parent involvement letter; counting forms; program consent form; infraction report form; recognition of patrol service certificate; efficiency award for patrol service certificate; pedestrian count form; and vehicle count form.

  • Shipp MD, Daum KM, Weaver JL, Nakagawara VB, Bailey IL, Good GW et al. Motorist vision policy. Optometry 2000; 71(7):449-453. (E.52S)

    The primary purpose of public policy requiring vision testing for driver license renewal is to identify individuals with functional vision impairments and, when necessary, to restrict their driving. This is based on the presumption that poor vision is causally related to poor driving and traffic crashes. The ADA Environmental and Occupational Vision Committee performed a synthesis of relevant empirical literature on policy based research and developed potential options for enhancing traffic safety. Presently, some states require vision testing for driver's license renewal and some do not. Regional and nationwide studies report that vision related license renewal policies are associated with enhanced traffic safety. However, contemporary vision screening tests may be of limited value in identifying individuals with functional vision impairments. The most cost effective and valid method for identifying, treating, and counseling visually impaired drivers is to require a comprehensive eye examination as a condition for driver license renewal for those with a high prevalence or high probability of vision impairment.

  • Adler G. Driving and dementia: Dilemmas and decisions. Geriatrics 1997; 52(Suppl. 2):S26-S29. (E.50S)

    Dementia may compromise the competence and safety of an older driver. Persons with dementing diseases frequently experience disturbances in memory, language, orientation, visual spatial skills, and the ability to perform complex tasks. Safety cannot be increased by training or modifications to the vehicle, nor can those afflicted be expected to exercise sound judgment. Individuals may become lost on familiar streets, fail to follow directional signs, and drive at inappropriate speeds. This paper provides an overview of state licensing provisions, physician responsibilities, and a clinical approach to address and manage the driver with dementia.


  • McManus J, Dorfman L. Youth and violence in California newspapers. Issue 9, 1-15. 2000. Berkeley, CA, Berkeley Media Studies Group. (E.80.06S)

    This study examined reporting on youth issues in three California newspapers, the Los Angeles Times, the San Francisco Chronicle, and the Sacramento Bee, from June 1998 through May 1999. In the yearlong study, the newspapers devoted about 16% of their section fronts, sidebars, and editorial page stories to articles with a significant focus on youth. Only two topics dominate the coverage, however: education and violence. Stories about education from kindergarten through 12th grade comprised 26% of all youth stories, with another 8% concerning higher education. Violence stories comprised 25% of all youth stories. But only 3 young people in 100 perpetrate or become victims of serious violence in a given year. Treating violence and education nearly equally exaggerates the frequency of violence. Less than 2% of the papers' youth stories concerned child care. Similarly neglected were stories about youth and drugs or alcohol or sex, or unintentional injuries. Parenting and health received only 6% and 5% respectively. In the yearlong sample, about half of youth stories focused on a problem, many fewer described a solution. If policy makers and the public are to make well-informed decisions about preventing violence among youth, they will need a more accurate picture than what newspapers are currently providing. This report concludes with a list of recommendations for journalists and prevention advocates who want to ensure that the picture of youth and violence is comprehensive.

  • Saltzman LE, Fingerhut LA, Rand MR, Visher C. Building data systems for monitoring and responding to violence against women: Recommendations from a workshop. Morbidity and Mortality Weekly Report 2000; 49(RR11):1-18. (E.82.02S)

    This report provides recommendations regarding public health surveillance and research on violence against women developed during a workshop, "Building Data Systems for Monitoring and Responding to Violence Against Women." The workshop, which was convened October 29-30, 1998, was co-sponsored by the US Department of Health and Human Services and the US Department of Justice. The goals of the workshop were to: develop information and make recommendations enabling researchers to better describe and track VAW; share information about data collection for VAW, with emphasis on intimate partner violence and sexual violence; and identify gaps and limitations of existing systems for ongoing data collection regarding VAW.

  • Ertem IO, Leventhal JM, Dobbs S. Intergenerational continuity of child physical abuse: how good is the evidence? The Lancet 2000; 356(9232):814-819. (E.80.02S)

    There is widespread belief that individuals who were physically abused during childhood are more likely to abuse their own children than those who were not abused, but the empirical studies examining this belief have not been systematically reviewed. The aim of this study was to evaluate systematically, based on eight methodological standards derived from a hypothetical randomised controlled trial, the design of studies investigating the intergenerational transmission of child physical abuse. The authors reviewed studies published between 1965 and 2000 in English that provided information about physical maltreatment in two generations and included a comparison group. Two investigators independently assessed whether each study met the methodological standards. In the ten studies identified (four cohort, one cross-sectional, and five case- control), the relative risks of maltreatment in the children of parents who were abused during childhood were significantly increased in four studies (relative risks 4.75-37.8), but in three other studies the relative risks were less than 2. Most study reports provided a clear description of abuse of parents during childhood and abuse of their children. Five studies failed to avoid recall and detection bias; five did not ensure that controls were not themselves maltreated; eight did not provide adequate follow-up; and in six the report did not state whether the enrolled parent was responsible for the maltreatment. Most studies did not control for intervening factors, such as sociodemographic characteristics during the time of abuse of the parent generation and at the time their children were abused. Only one study met all eight criteria (relative risk of abuse transmission 12.6 [95% CI 1.82-87.2]) and one met six (1.05 [0.53-2.06]). The one study that met all eight methodological standards provided evidence for the intergenerational continuity of child physical abuse, but that which met six standards did not support the hypothesis. Use of our model and methodological standards should improve the scientific quality of studies examining the effects of risk factors for adverse outcomes that may continue across generations.

  • State Child Death Review Council. Child Deaths in California Related to Abuse & Neglect, 1996-1998. 1-72. 2000. Sacramento, CA, California Attorney General's Office. (E.10.08S)

    An overview of child deaths in California provides the initial framework in which to view the magnitude of the problem of child abuse and neglect fatalities, as well as the scope of work of the State Child Death Review Council (SCDRC) and local child death review teams (CDRTs). Following the tables on child deaths, this report presents and discusses the 1997 State Pilot Data Collection Project. Additional chapters discuss Child Death Review Teams, the State Child Death Review Council, and the Additional Impact of Child Death Review Teams. Additional data are presented in the appendices.

Alcohol use:

  • Case Histories in Alcohol Policy. San Francisco, CA: Trauma Foundation, 2000. (E.40.02B)

    This book presents the case histories of seven organizations that have worked to reduce alcohol related problems - in particular, alcohol and violence - in their communities. The case histories provide practical knowledge from diverse community organizations with experience addressing these problems. The organizations profiled include: Salinas, CA: Preventing Alcohol Related Trauma in Salinas (PARTS); San Antonio, TX: San Antonio Fighting Back's Bi-Cultural Organization for Leadership Development (BOLD); Pomona, CA: The Community Wellness Partnership (CWP); Minnesota: Action on Alchol and Teens (AAT); Maryland: Maryland Underage Drinking Prevention Coalition (MUDPC); Gallup, NM; and Chicago, IL: The Vote-Dry Movement. Taken together, these case histories present a cross section of American society along several dimensions (urban/rural; geographic; racial/ethnic diversity; and a range of environmental strategies). Taken together, the case histories provide practical knowledge on building and sustaining an organization, responding to opposition, mobilizing constituents, using the media effectively, working with other organizations, and lobbying lawmakers.

  • Holder HD, Gruenewald PJ, Ponicki WR, Treno AJ, Grube JW, Saltz RF et al. Effect of Community-Based Interventions on High-Risk Drinking and Alcohol-Related Injuries. Journal of the American Medical Association 2000; 284(18):2341-2347. (E.40.02S)

    High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. The purpose of this study was to determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. Interventions included: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. Main outcome measures included: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1.29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0.77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults.

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