SafetyLit - 2 March 2001

March 2, 2001

General Topics

A preschool program for safety and injury prevention delivered by home visitors. Johnston BD, Britt J, D'Ambrosio L, Mueller BA, Rivara FP. Inj Prev 2000; 6(4):305-9.

ABSTRACT: OBJECTIVE: To evaluate the feasibility, acceptability, and effectiveness of an injury prevention program delivered by school based home visitors to the families of low income children attending preschool enrichment programs in Washington State. STUDY SAMPLE: The families of children attending preschool Head Start programs in two regions were eligible. A total of 213 families (77.8% of those eligible) from intervention sites, and 149 families (71.9% of those eligible) from concurrent comparison sites, agreed to participate and completed the trial. INTERVENTION: Trained school personnel conducted home safety inspections as part of a planned home visit. Intervention families were offered educational materials as well as smoke detectors, batteries, ipecac, and age appropriate car safety restraints based on results of the home inspection. EVALUATION METHODS: At a repeat home visit three months later, the proportion of families with a positive change in injury prevention knowledge or behavior among those in the intervention group was compared with the proportion in the comparison group. Smoke detector presence and function were observed. RESULTS: Among families without a working smoke detector at baseline, the intervention was associated with an increased probability of having a working detector at follow up (relative risk (RR) 3.3, 95% confidence interval (CI) 1.3 to 8.6). Intervention families were also more likely to report the presence of ipecac in the home (RR 4.7, 95% CI 3.0 to 7.3) at follow up and to have obtained an age appropriate booster seat (RR 4.1, 95% CI 1.9 to 8.8). The program was acceptable to client families and to the home visitors who conducted the intervention. CONCLUSIONS: Among the families of low income children enrolled in preschool enrichment programs, home safety inspections and the distribution of safety supplies by school based home visitors appears to improve knowledge and behavior related to poisoning, smoke detector installation, and car safety seat use over three months of follow up.

Toddler drowning in domestic swimming pools. Blum C, Shield J. Inj Prev 2000; 6(4):288-90.

ABSTRACT: AIMS: To identify how toddlers who drowned gained access to private swimming pools; to recommend preventive strategies to reduce the incidence of toddler drowning and near drowning. METHOD: The study reviewed critically all completed investigations into the drowning deaths of toddlers aged 1-4 years reported to the state coroner (n=33) as a result of unintentional submersion incidents in domestic swimming pools in Victoria, Australia, from 1 January 1992 to 31 December 1997. RESULTS: There was a predominance of 1 year olds, and boys. Forty six per cent of the children drowned in the three summer months. The majority of pools were in-ground; most were located on the child's home property. Over half the pools lacked fencing of any kind; of those that did have fences, only three appear to have met Australian standards. CONCLUSIONS: More than half of the children studied drowned in unfenced pools and spas. In not one case did a child gain unaided access to a pool fitted with a fully functional gate and fence that met the Australian standard. Where children gained access to fenced pools, the majority did so via faulty or inadequate gates, or through gates that were propped open. This finding highlights the need for pool owners to install Australian standard approved fences and gates, and to maintain existing fences and gates regularly. Door locks and supervision were inadequate primary prevention strategies.

Decreasing incidence of burn injury in a rural state. Clark DE, Dainiak CN, Reeder S. Inj Prev 2000; 6(4):259-62.

ABSTRACT: OBJECTIVES: To determine changes in the incidence of burn injury since the regionalization of burn care and intensification of fire prevention initiatives that occurred in Maine during the 1970s. METHODS: Death certificate data from Maine and the United States for deaths due to fire or burns were obtained for 1960-98. Hospitalization and burn registry data were obtained for Maine from 1973-98. Frequencies and incidence rates were compared over time and, where possible, between Maine and the United States. RESULTS: During 1960-79, annual burn mortality in Maine averaged 5.1/100,000, with random variation. After this, the rate declined steadily to an average annual level of 1.4/100,000 during 1993-96. For the entire United States, average annual mortality declined from 4.2/100,000 during 1961-64 to 1.5/100,000 during 1993-96. Reduction in mortality has been principally due to prevention of dwelling fires. Hospitalization for burns in Maine was 34.8/100,000 during 1973-76 and declined to 10.6/100,000 during 1995-98. CONCLUSIONS: Burn prevention measures have dramatically reduced the incidence of death and hospitalization resulting from burns in Maine.

Description of Missouri children who suffer burn injuries. Quayle KS, Wick NA, Gnauck KA, Schootman M, Jaffe DM. Inj Prev 2000; 6(4):255-8.

ABSTRACT: OBJECTIVE: This study uses Missouri's inpatient and outpatient E code data system to describe the demographic characteristics of Missouri children who suffered burn injuries during 1994 and 1995. METHODS: Retrospective review of Missouri E code data. RESULTS: Altogether 8,404 children aged 0-14 years were treated for burn injuries in Missouri hospitals during 1994 and 1995. The rate of burn injury in Missouri children was 339 per 100,000/year. African-American boys 0-4 years living in urban counties were at increased risk. In addition, African-American girls ages 0-4 years living in counties with a high poverty rate had raised burn injury rates. Burns from hot objects and scalds from hot liquids caused more than half of the burns. CONCLUSIONS: Hospital based E coding has proven an invaluable tool for the study of burns and will, no doubt, prove equally useful for other injuries.

Urban residential fire and flame injuries: a population based study. DiGuiseppi C, Edwards P, Godward C, Roberts I, Wade A. Inj Prev 2000; 6(4):250-4.

ABSTRACT: BACKGROUND: Fires are a leading cause of death, but non-fatal injuries from residential fires have not been well characterised. METHODS: To identify residential fire injuries that resulted in an emergency department visit, hospitalisation, or death, computerised databases from emergency departments, hospitals, ambulance and helicopter services, the fire department, and the health department, and paper records from the local coroner and fire stations were screened in a deprived urban area between June 1996 and May 1997. RESULT: There were 131 fire related injuries, primarily smoke inhalation (76%), an incidence of 36 (95% confidence interval (CI) 30 to 42)/100,000 person years. Forty one patients (32%) were hospitalised (11 (95% CI 8 to 15)/100,000 person years) and three people (2%) died (0.8 (95% CI 0.2 to 2.4)/100,000 person years). Injury rates were highest in those 0-4 (68 (95% CI 39 to 112)/100,000 person years) and > or = 85 years (90 (95% CI 29 to 213)/100,000 person years). Rates did not vary by sex. Leading causes of injury were unintentional house fires (63%), assault (8%), clothing and nightwear ignition (6%), and controlled fires (for example, gas burners) (4%). Cooking (31%) and smoker's materials (18%) were leading fire sources. CONCLUSIONS: Because of the varied causes of fire and flame injuries, it is likely that diverse interventions, targeted to those at highest risk, that is, the elderly, young children, and the poor, may be required to address this important public health problem.

Cycling safety: injury prevention in Oxford cyclists. McGuire L, Smith N. Inj Prev 2000; 6(4):285-7.

ABSTRACT: OBJECTIVE: To assess injury prevention measures used by cyclists in Oxford and to detect any differences between wearers and non-wearers of cycling helmets. METHOD: A prospective observational survey of a series of cyclists passing a single point on a busy city road in reduced lighting. Two observers jointly recorded four measures of injury prevention: use of front or rear light, high visibility (reflective or fluorescent) clothing, and cycling helmet. The use of the first three interventions was analysed in relation to helmet use/non-use. RESULTS: A total of 392 cyclists were observed over one hour. Fourteen (3.6%) were observed to use all four studied measures, while 137 (34.9%) used none of them. The frequency of measures observed was: lit front light 190 (48.5%), lit rear light 197 (50.2%), both lights on 163 (41.6%), helmet on 104 (26.5%), and high visibility clothing 39 (9.9%). Despite the helmet using group's smaller size, it contained a significantly higher proportion of cyclists with lit front light (60.6% v 44.1%), lit rear light (61.5% v 46.2%), and high visibility clothing (27.9% v 3.5%), than the non-helmet group (p < or = 0.01). Whereas only 22% of the helmet users had no other observed measures, 47.2% of non-users did so. CONCLUSION: Cycling helmet users were significantly more likely to use collision prevention measures in conditions of reduced visibility. Explanations may include higher levels of risk awareness and greater knowledge of safe cycling practices in the smaller, helmet using group. However, current measures by cyclists in a major cycling centre may be insufficient to prevent collisions and consequent serious injury or death.

Population preventable fraction of bicycle related head injuries. Kopjar B. Inj Prev 2000 Sep;6(3):235-8.

ABSTRACT: OBJECTIVE: This study analyzes the population attributable fraction (PAF) of bicycle head injuries due to non-helmet use. METHODS: The concept of the PAF and Levin's formula for its calculation were used to develop mathematical models for estimation of: (i) attributable fraction of bicycle related head injuries in the population due to non-helmet use, (ii) expected proportion of helmeted cases among all head injuries, and (iii) estimate of the helmet use rate in the population based on patient case information. The PAF was calculated for a sample of injuries from Stavanger, Norway. RESULTS: Levin's formula was used to calculate the PAF. Two additional mathematical models were developed for calculating the expected proportion of helmeted cases and the estimation of the helmet use rate in the population. The P calculation examples for all models were is shown. It was estimated that 133 out of 210 injuries could have been avoided in Stavanger between 1990 and 1996 if all children aged 0-14 had used helmets. CONCLUSIONS: If applied correctly, the PAF is a valid and useful indicator for the population effects of bicycle helmets. The models developed in this study may help to better interpret and predict the population effects of helmet promotion interventions.

Use of Alcohol as a Risk Factor for Bicycling Injury. Li G, Baker SP, Smialek JE, Soderstrom CA. JAMA. 2001; 285:893-896.

ABSTRACT: Context- Bicycling is one of the leading causes of recreational injuries. Elevated blood alcohol concentrations (BACs) are found in about one third of fatally injured bicyclists aged 15 years or older. Objective- To assess the relative risk of fatal and serious bicycling injury according to BAC. Design- Matched case-control study. Setting and Subjects- Bicyclists aged 15 years or older who were fatally or seriously injured while riding a bicycle during the day in Maryland in 1985-1997 (cases, n = 124) and bicyclists aged 15 years or older who were interviewed and given a breath test for estimated BAC during roadside surveys that took place in June 1996 through May 1998 at the same site, time of day, day of week, and month of year in which a case bicyclist was injured (controls, n = 342). Main Outcome Measure- Odds ratio of bicycling injury according to estimated BAC. Results- An estimated positive BAC (0.02 g/dL) was detected in 12.9% of the case bicyclists (23.5% of the 34 fatally injured and 8.9% of the 90 seriously injured) compared with 2.9% of the control bicyclists (P <.001). Relative to an estimated BAC of less than 0.02 g/dL, the adjusted odds ratio of bicycling injury was 5.6 (95% confidence interval [CI], 2.2-14.0) for a BAC of 0.02 g/dL or higher and was 20.2 (95% CI, 4.2-96.3) for a BAC of 0.08 g/dL or higher. Rates of helmet use at the time of injury or interview were 5% and 35%, respectively, for those with and without a positive BAC (P = .007). Conclusion- Alcohol use while bicycle riding is associated with a substantially increased risk of fatal or serious injury.

Relationship of parent driving records to the driving records of their children. Ferguson SA, Williams AF, Chapline JF, Reinfurt DW, De Leonardis DM. Accid Anal Prev 2001; 33(2):229-34.

ABSTRACT: Many studies have shown that young driver crash rates can be influenced by such factors as lifestyle characteristics and licensing systems. However, the influence of parents on their teenage children's crash and violation rates has not received much attention. The present study used data from the North Carolina driver history file to match the crash and violation records of young drivers between the ages of 18 and 21 with those of their parents. Results indicate that children's driving records in the first few years of licensure are related to the driving records of their parents. Children whose parents had three or more crashes on their record were 22% more likely to have had at least one crash compared with children whose parents had no crashes. Likewise, children whose parents had three or more violations were 38% more likely to have had a violation compared with children whose parents had none. Logistic regression models showed that these relationships held when controlling for household type and child gender.

Misuse of booster seats. Morris SD, Arbogast KB, Durbin DR, Winston FK. Inj Prev 2000 Dec;6(4):281-4.

ABSTRACT: OBJECTIVE: To describe several aspects of booster seat use and misuse in a sample of children attending child safety seat clinics. METHODS: Booster seat practices were assessed at 76 child safety seat clinics held between April 1997 and January 1999 in Pennsylvania and southern New Jersey. At each assessment, a child passenger safety team evaluated the booster seat and identified modes of misuse. RESULTS: Altogether 227 booster seats were observed. Sixty eight per cent (68%) of shield boosters and 20% of belt positioning boosters were misused. Thirty two per cent of the children using a shield booster weighed more than 40 lb (18.1 kg); 68% of children in shield boosters and 63% in belt positioning boosters weighed less than 40 lb. CONCLUSION: This study identified a relatively high rate of booster seat misuse. Shield boosters were more likely to be misused than belt positioning booster seats. Significant numbers of children weighing more than 40 lb were using possibly dangerous shield boosters. The majority of children in this study were less than 40 lb. In this weight range, a convertible child restraint system provides better protection than a booster seat. Booster seat use should only be initiated once the child has completely outgrown their convertible child restraint system.

Novice drink drivers, recidivism and crash involvement. Ferrante AM, Rosman DL, Marom Y. Accid Anal Prev 2001; 33(2):221-7.

ABSTRACT: A group of drink drivers with no prior arrest for drink driving was selected from drink driving arrest records originating in Western Australia between 1987 and 1995. These drink-driving records were linked to road crash records for the same period. The analysis of these combined records focussed on the sequence of driving events (i.e., arrests, crashes and arrests resulting from crashes) and the present article explores the relationship in time between known drink driving incidents and crash involvement. Using multi-variate survival analysis, it was found that if a driver's first drink driving offence resulted from a road crash, especially if this occurred at a younger age, he/she was significantly more likely to drink, drive and crash again.

A linkage study of Western Australian drink driving arrests and road crash records. Rosman DL, Ferrante AM, Marom Y. Accid Anal Prev 2001; 33(2):211-20.

ABSTRACT: Records of drivers in all reported road crashes occurring in Western Australia between 1987 and 1995 were linked with records of all drink driving arrests in the same period. About 7% of all drink driving arrests occurred because of a road crash. Differences were observed between these drink-driving crashes and other types of road crashes. Drink driving crashes tended to be more severe than those not involving alcohol. Serious crashes (involving fatalities or hospitalisations) accounted for 20% of alcohol-related crashes, but only 6% of all crashes reported over the study period. From another perspective, crash-related drink-driving arrests were more likely than routine enforcement arrests to involve younger (18-35 years) and older (65 years and over) drink drivers. Routine enforcement arrests, on the other hand, were likely to involve a greater proportion of Aboriginal drivers.

Factors associated with parental safe road behaviour as a pedestrian with young children in metropolitan New South Wales, Australia. Lam LT. Accid Anal Prev 2001; 33(2):203-10.

ABSTRACT: A cross-sectional population-based randomised telephone survey of parents with children aged between 5 and 12 years was conducted to investigate factors associated with safe road behaviour of parents as pedestrians with their young children in Sydney metropolitan and near by cities in New South Wales, Australia. Parental perception of the road environment as hazardous associated significantly with their safe road behaviour as pedestrian while with their children. This held true even after adjusting for the non-English speaking background and the age of the child. Knowledge of road rules, on the other hand, was not associated with parental safe road behaviour. The results of this study suggested that parental safe road behaviour require much attention in future research and in programme development. The perception of the road environment is a very important factor in motivating safe road behaviour. This should be taken into consideration in designing road safety campaigns.

Fatal traffic accidents among trailer truck drivers and accident causes as viewed by other truck drivers. Hakkanen H, Summala H. Accid Anal Prev 2001; 33(2):187-96.

ABSTRACT: Causality factors, the responsibility of the driver and driver fatigue-related factors were studied in fatal two-vehicle accidents where a trailer truck driver was involved during the period of 1991-1997 (n = 337). In addition, 251 long-haul truck drivers were surveyed in order to study their views regarding contributing factors in accidents involving trucks and the development of possible countermeasure against driver fatigue. Trailer truck drivers were principally responsible for 16% of all the accidents. Younger driver age and driving during evening hours were significant predictors of being principally responsible. In addition, the probability of being principally responsible for the accident increased by a factor of over three if the driver had a chronic illness. Prolonged driving preceding the accident, accident history or traffic offence history did not have a significant effect. Only 2% of the drivers were estimated to have fallen asleep while driving just prior to the accident, and altogether 4% of the drivers had been tired prior to the accident. Of the drivers 13% had however, been driving over 10 h preceding the accident (which has been criminally punishably in Finland since 1995 under the EC regulation) but no individual factors had a significant effect in predicting prolonged driving. The surveyed views regarding causes of truck accidents correspond well with the accident analysis. Accidents were viewed as being most often caused by other road users and driver fatigue was viewed to be no more than the fifth (out of eight) common cause of accidents. The probability of viewing fatigue as a more common cause increased significantly if the driver had experienced fatigue-related problems while driving. However, nearly half of the surveyed truck drivers expressed a negative view towards developing a technological countermeasure against driver fatigue. The negative view was not related to personal experiences of fatigue-related problems while driving.

Pedestrian fatalities and alcohol. Ostrom M, Eriksson A. Accid Anal Prev 2001; 33(2):173-80.

ABSTRACT: Since the share of alcohol-positive victims has been reported not to show the same reduction in pedestrian fatalities as in other 'road users', this study analysed pedestrian fatalities with special emphasis on the presence of alcohol. Autopsied pedestrian fatalities (286 victims) in northern Sweden from 1977 to 1995 were investigated, using autopsy and police reports. Blood alcohol was detected in 19% of the fatalities, with a median concentration of 1.6 g/l. The proportion of test-positive victims did not change significantly during the period of study. Males more often tested positive for alcohol than females (24 vs. 11%). Further, the test-positive victims had a lower mean age (49 vs. 59 years) and the proportion of test-positive victims was higher during weekends and nights. Pedestrian fatalities testing positive for alcohol differ from those testing negative in several respects. The public should be enlightened of the fact that drinking is a risk not only among users of motor vehicles, but also among pedestrians. Separation of pedestrians from motor vehicles by, e.g. fences, is of greatest importance.

Age and gender patterns in motor vehicle crash injuries: importance of type of crash and occupant role. Tavris DR, Kuhn EM, Layde PM. Accid Anal Prev 2001; 33(2):167-72.

ABSTRACT: To evaluate the interaction of gender, age, type of crash, and occupant role in motor vehicle crash injuries leading to hospitalization, we analyzed 1997 Wisconsin hospital discharge data for patients with primary E-code diagnoses of motor vehicle injuries. The overall ratio of males to females (M/F ratio) hospitalized for motor vehicle crash injuries was 1.33 (95% confidence interval (CI): 1.26-1.41). The M/F ratio varied by type of crash and differed for passengers and drivers. For injuries sustained in collisions between vehicles, the M/F ratio was 0.96 (95% CI: 0.87-1.05); in loss of control accidents the M/F ratio was 1.95 (95% CI: 1.76-2.17). Within each type of crash, the M/F ratio for drivers was similar to that for the entire type; the M/F ratio for passengers was about half of the type total. Expressed as rates of hospitalization per 100,000 people in the general population, hospitalizations of drivers in collisions with another motor vehicle increased steeply in males, but not in females, beginning at about age 70. For drivers in loss of control crashes, male rates exceeded female rates in all age groups, with peaks in the groups 15-24 and 85-89. For passengers, injury rates from collisions with other motor vehicles were greater for females, especially in the elderly, and injury rates from loss of control crashes were similar for both genders, with peaks at 15-24 and 85-94. The higher fatality of men in loss of control motor vehicle crashes, compared to women, suggests an important area for further investigation.

Drink driving and traffic accidents in young people. Horwood LJ, Fergusson DM. Accid Anal Prev 2000; 32(6):805-14.

ABSTRACT: The relationship between drink driving behaviours and rates of traffic accidents was analysed in a birth cohort of 907 New Zealand young people studied to the age of 21. Drink driving was significantly (P < 0.0001) related to active traffic accidents in which the driver's behaviour contributed to the accident but was not related to passive accidents in which driver behaviours did not contribute to the accident (P > 0.15). Those engaging in high rates of drink driving had rates of active traffic accidents that were 2.6 times higher than those who did not drink and drive. Further analysis suggested that much of this association was explained by confounding factors (and notably driver behaviour) that were associated with both drink driving and accident rates. After adjustment for confounding factors, those engaging in high rates of drink driving had rates of active accidents that were 1.5 (P < 0.01) times higher than those who did not drink and drive. It is concluded that although the study findings support the view that the regulation of drink driving behaviour amongst young people is likely to contribute to a reduction in traffic accidents, to be fully effective attempts at regulation of drink driving also need to be accompanied by a similar level of investment in regulating other aspects of risky or illegal driving behaviour amongst young people.

Motorcycle engine size and risk of moderate to fatal injury from a motorcycle crash. Langley J, Mullin B, Jackson R, Norton R. Accid Anal Prev 2000; 32(5):659-63.

ABSTRACT: Current New Zealand law requires that motorcyclists with a learner or restricted licence ride a motorcycle with an engine capacity of 250 cc or less. Previous research has reported inconsistent findings regarding the relationship between cubic-capacity and risk of a crash. We sought to determine: (1) compliance with the law; (2) if the risk of an injury crash is increased for learner/restricted licence holders who do not comply with the cubic capacity regulations; and (3) whether the risk of an injury crash increases with increasing capacity of the motorcycle. A population-based case-control study was conducted in the Auckland region over a 3 year period from February 1993. Among the controls, 66% were riding motorcycles with a capacity greater than 250 cc. The percentages for those with: full, learner and restricted, and no licence were 82, 29 and 60%, respectively. There was no evidence that learner and restricted licence holders who did not comply with the cubic capacity requirement were at increased risk. It should be noted however, that 75% of those who were complying were doing so on motorcycles of 250 cc or less. Relative to motorcycles of less than 250 cc the risk of an injury crash was elevated by at least 50% for all cubic capacity categories, with the exception of the 251-499 group. There was, however, no consistent pattern of increasing risk as cubic capacity increased. The findings of this study coupled with the fact that cubic capacity is a poor measure of power suggest that, if cubic capacity was to remain the sole basis for restricting learner and restricted licence holders, consideration should be given to having a substantially lower cubic capacity than 250 cc. An analysis of risk in terms of power to weight ratio and style of motorcycle may provide a more useful insight into the benefits of motorcycle design restrictions for novice riders.

Subsequent Criminal Activity Among Violent Misdemeanants Who Seek to Purchase Handguns Risk Factors and Effectiveness of Denying Handgun Purchase. Wintemute GJ, Wright MA, Drake CM, Beaumont JJ. JAMA. 2001; 285:1019-1026.

ABSTRACT: Context- Some states prohibit the purchase of handguns by persons convicted of selected misdemeanor crimes, but most do not. California has denied handgun purchases by violent misdemeanants since 1991; the effectiveness of these policies is unknown. Objective- To determine the risk factors for new criminal activity among violent misdemeanants who seek to purchase handguns and whether denial of handgun purchase by violent misdemeanants affects their risk of arrest for new crimes, particularly gun and/or violent crimes. Design- Retrospective, population-based cohort study. Setting and Subjects- Persons aged 21 to 34 years who sought to purchase a handgun through a licensed dealer in California during 1989-1991 and who had at least 1 violent misdemeanor conviction in the preceding 10 years. The study cohorts consisted of 986 persons whose purchase applications were made in 1991 and were denied (denied persons) and 787 persons whose purchase applications were made in 1989-1990 and were approved (purchasers). Main Outcome Measures- Incidence and relative risk of first arrest in California for new gun and/or violent crimes and for nongun, nonviolent crimes during a 3-year follow-up after actual or attempted handgun purchase. Results- During the 3-year follow-up, 546 (33.0%) of 1654 subjects with follow-up information were arrested for a new crime, including 296 (31.9%) of 927 denied persons and 250 (34.4%) of 727 purchasers. After adjusting for differences in age, sex, and prior criminal history, purchasers were more likely than denied persons to be arrested for new gun and/or violent crimes (relative hazard [RH], 1.29; 95% confidence interval [CI], 1.04-1.60), but not for nongun, nonviolent crimes (RH, 0.96; 95% CI, 0.78-1.19). In both groups, risk of arrest was strongly related to age and number of convictions accrued prior to actual or attempted handgun purchase. Conclusion- Our results indicate that denial of handgun purchase to violent misdemeanants is associated with a specific decrease in risk of arrest for new gun and/or violent crimes.

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