SafetyLit Update - 26 August 2002

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26 August 2002

We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.

See Report Under Rural Issues
Personal and situational influences on drink driving and sober driving among a cohort of young adults.

Morrison L, Begg DJ, Langley JD. Inj Prev 2002; 8(2): 111-115.

Correspondence: Dorothy Begg, Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, P.O. Box 913, Dunedin, NEW ZEALAND; (email: dorothy.begg@ipru.otago.ac.nz).

OBJECTIVES: To compare personal and situational influences on incidents involving drink driving with those involving sober driving.

METHODS: Information on a range of road safety practices was sought in face to face interviews conducted with 969 members of the Dunedin Multidisciplinary Health and Development Study cohort at age 26 years. A total of 750 study members reported an incident that involved the opportunity to consume alcohol and also travel by motor vehicle. Of these, 87 were classified as "drink drive incidents" and 663 as "sober drive incidents".

Findings: Study members who were male, of lower socioeconomic status, had no school qualifications, or were dependent on alcohol or marijuana at age 21 were significantly more likely to report a drink drive incident at age 26. Compared with the sober drive incidents, the drink drive incidents were more commonly associated with driving alone, drinking at bars, and no advanced planning. For drink drive incidents the amount of alcohol consumed was influenced by the conviviality of the occasion, whereas for sober drive incidents it was the need to drive. One quarter of those reporting drink drive incidents stated they had used marijuana and/or LSD at the event at which they drank.

DISCUSSION: Drink drive and sober drive incidents differed, particularly with regard to decisions made before the event. Prevention efforts could usefully be targeted toward these decisions. (Copyright BMJ Publications Group)
Local and state school-based substance use surveys. Availability, content, and quality.

Hallfors D, Iritani B. Eval Rev 2002; 26(4):418-437.

Correspondence:Denise D Hallfors, Department of Maternal & Child Health, School of Public Health, University of North Carolina at Chapel Hill, USA; (email: denise_hallfors@unc.edu).

School-based substance use surveys are an important data source for prevention and evaluation researchers, but access to students has become progressively restricted by schools. Because almost all states and many districts conduct their own regular surveys, archived data are a potential resource for informed policy and practice decisions. In this study, substance use survey data were successfully collected from 69 of 105 targeted school districts located in 12 states. Results indicate the availability and quality of extant data currently limit their usefulness. Recommendations are made regarding how schools could be assisted to improve the value of their substance use surveys.

See Abstract #1 under Transportation.

No reports this week

Relationships between some individual characteristics and occupational accidents in the construction industry: a case-control study on 880 victims of accidents occurring during a two-year period.

N Chau, JM Mur, L Benamghar, C Siegfried, JL Dangelzer, M Français, R Jacquin, A Sourdot. J Occup Health 2002; 44(3): 131-139.

Correspondence: Nearkasen Chau, INSERM Unit 420, Faculte de medecine, BP 184, 54505 Vandoeuvre-les-Nancy Cedex, FRANCE; (email: Nearkasen.Chau@nancy.inserm.fr).

This case-control study assessed the relationships between certain individual characteristics (age, body mass index, training, length of time in present job, sleep disorders, certain disabilities, smoking habits, sporting activities) and occupational accidents in construction male laborers: 880 cases with at least one occupational accident in 1995-1996, 880 controls with no occupational accident during the previous five years, matched to cases on the job. A standardized questionnaire, filled in by the occupational physician, was used. The statistical analyses were made by the conditional logistic regression method for paired data. The main causes of accidents were handling or carrying objects, falls to a lower level, construction machinery and devices, falls on the same level, moving objects, hand tools. For all accidents combined, the factors with significant adjusted odds-ratios (OR) were: age < 30 yrs (OR 1.30, 95%CI 1.01-1.68), sleep disorders (1.97, 1.42-2.73), and current smoker (1.27, 1.04-1.54). Sleep disorders were a significant factor in falls to a lower level (OR 2.25, 95%CI 1.14-4.44), age < 30 yrs and sleep disorders for accidents caused by moving objects (4.64, 1.48-14.5 and 13.11, 2.64-65.2 respectively), and no sporting activity for injuries by handling or carrying objects (1.70, 1.11-2.60). Sleep disorders were significant for accidents with sick leave lengths of >15 d, whereas age < 30 yrs and current smoker were significant for the others ( < 14 d). A relationship was observed between the severity of sleep disorders and accidents. Occupational accidents are mainly due to work conditions, but certain individual characteristics may also play a role; this should be confirmed by further studies. (Copyright © Japan Society for Occupational Health)
Prevention of falls on the level in occupational situations: a major issue, a risk to be managed.

Leclercq S. Int J Occup Saf Ergon 2002; 8(3):377-385.

Correspondence: Sylvie Leclercq, Man at Work Department, French National Research and Safety Institute (INRS), Vandoeuvre, FRANCE; (email: sylvie.leclercq@inrs.fr).

The terminology used to designate falls on the level is broadly based and the accidents concerned are only very rarely defined explicitly. A definition of falls on the level in occupational situations is therefore proposed. We attempt to define the issue represented by the prevention of such accidents on the basis of statistical data, prior to explaining the twin objectives focused on in the field of their prevention. We then propose a summary of unbalance risk factors in occupational situations. These factors are associated with different components of the occupational situation they concern: individuals, their tasks, the equipment used, or the working environment. The diversity of accident contexts and different in-company prevention possibilities are thereby highlighted. Finally, we discuss a number of consequences in prevention terms.

Evidential value of injuries useful for reconstruction of the pedestrian-vehicle location at the moment of collision.

Teresinski G, Madro R. Forensic Sci Int 2002; 128(3):127-135.

Correspondence: Grzegorz Teresinski, Department of Forensic Medicine, Medical Academy in Lublin, ul. Jaczewskiego 8, 20-090, Lublin, POLAND; (email: grzdyl@asklepios.am.lublin.pl).

The paper presents final results of the studies concerning the usefulness of knee, ankle, hip, pelvis and neck injuries in reconstructing the circumstances of car-to-pedestrian accidents. Each type of injuries was evaluated with regard to possible reconstruction of the victim's position (upright or recumbent) at the moment of collision and in the upright hits-the side of the pedestrian's body hit. In each group, a chance of proper reconstruction of the pedestrian's location (which determined the frequency of injury pattern assumed as the typical one of a given position or impact side) and error risk (percentage of cases in which the injury pattern showed improper position or impact side) were calculated. These data were compared with similarly calculated possibilities of deducing based on the classical "bumper" injuries to soft tissues and "bending" fractures of the lower limb bone diaphyses. It was shown that the bone bruises within the knee epiphyses were very specific evidence for upright hits as they confirm the limb load by body mass at the moment of pathological dislocation of joint structures on impact. The evidential value of knee injuries was found to be similar to that of other "classical" methods based on bumper injuries or even higher in lateral and front hits. The injuries to the remaining structures were less frequently found and their correlation with the victim's position or impact side was lower. Nevertheless, once the whole complex of these injuries is taken into consideration the chances of proper reconstruction of the pedestrian-vehicle location increase and the risk of opinion error is minimized. (Copyright © 2002 Elsevier Science)

National Vehicle Emissions Policies and Practices and Declining US Carbon Monoxide-Related Mortality.

Mott JA, Wolfe MI, Alverson CJ, Macdonald SC, Bailey CR, Ball LB, Moorman JE, Somers JH, Mannino DM, Redd SC. JAMA 2002; 288(8): 988-995.

Correspondence: Joshua Mott, Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-17, Atlanta, GA 30333, USA; (email: zud9@cdc.gov).

BACKGROUND: Carbon monoxide (CO) has been reported to contribute to more than 2000 poisoning deaths per year in the United States.

OBJECTIVES: To evaluate the influence of national vehicle emissions policies and practices on CO-related mortality and to describe 31 years (1968-1998) of CO-related deaths in the United States.

DESIGN AND SETTING: Longitudinal trend analysis using computerized death data from the Centers for Disease Control and Prevention, US Census Bureau population data, and annual CO emissions estimates for light-duty vehicles provided by the US Environmental Protection Agency.

MAIN OUTCOME MEASURE: All deaths in the US for which non-fire-related CO poisoning was an underlying or contributing condition, classified by intent and mechanism of death. Negative binomial regression was used to incorporate every year of data into estimated percentage changes in CO emissions and mortality rates over time.

FINDINGS: During 1968-1998, CO-related mortality rates in the United States declined from 20.2 deaths to 8.8 deaths per 1 million person-years (an estimated decline of 57.8%; 95% confidence interval [CI], -62.4% to -52.6%). Following the introduction of the catalytic converter to automobiles in 1975, CO emissions from automobiles decreased by an estimated 76.3% of 1975 levels (95% CI, -82.0% to -70.4%) and unintentional motor vehicle-related CO death rates declined from 4.0 to 0.9 deaths per 1 million person-years (an estimated decline of 81.3%; 95% CI, -84.8% to -77.0%). Rates of motor vehicle-related CO suicides declined from 10.0 to 4.9 deaths per 1 million person-years (an estimated decline of 43.3%; 95% CI, -57.5% to -24.3%). During 1975-1996, an annual decrease of 10 g/mile of estimated CO emissions from automobiles was associated with a 21.3% decrease (95% CI, -24.2% to -18.4%) in the annual unintentional motor vehicle-related CO death rate and a 5.9% decrease (95%CI, -10.0% to -1.8%) in the annual rate of motor vehicle-related CO suicides.

DISCUSSION: If rates of unintentional CO-related deaths had remained at pre-1975 levels, an estimated additional 11 700 motor vehicle-related CO poisoning deaths might have occurred by 1998. This decline in death rates appears to be a public health benefit associated with the enforcement of standards set by the 1970 Clean Air Act. (Copyright © 2002 American Medical Association)

Nonfatal Sports- and Recreation-Related Injuries Treated in Emergency Departments --- United States, July 2000--June 2001

Gotsch K, Annest JL, Holmgreen P, Gilchrist J. MMWR 2002; 51(33): 736-740.

Correspondence: Karen Gotsch, Office of Statistics and Programming, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Mailstop K65, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA; (email: khg8@cdc.gov).

Complete report with editorial note, figures, tables, and references is available HERE.

Each year in the United States, an estimated 30 million children and adolescents participate in organized sports, and approximately 150 million adults participate in some type of nonwork-related physical activity. Engaging in these activities has numerous health benefits but involves a risk for injury. CDC analyzed data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) to characterize sports- and recreation-related injuries among the U.S. population. This report summarizes the results of that analysis, which indicate that during July 2000--June 2001 an estimated 4.3 million nonfatal sports- and recreation-related injuries were treated in U.S. hospital emergency departments (EDs). Injury rates varied by sex and age and were highest for boys aged 10--14 years. Effective prevention strategies, including those tailored to specific activities and those aimed at children, adolescents, and adults, are needed to reduce sports- and recreation-related injuries in the United States.

Sports- and recreation-related injuries included those occurring during organized and unorganized activities, whether work-related or not. An injury was defined as bodily harm resulting from exposure to an external force or substance. Each case was classified into one of 39 mutually exclusive sports- and recreation-related groups based on an algorithm that considered both the consumer products involved (e.g., bicycles or accessories, swings or swing sets, or in-line skating [activity, apparel, or equipment]) and the narrative description of the incident. Cases were excluded if 1) the principal diagnosis was an illness, pain only, psychological harm only, contact dermatitis associated with consumer products or plants, or unknown; 2) the ED visit resulted from the adverse effects of therapeutic drugs or surgical care; or 3) the injury was violence-related, including intentional self-harm, assault, or legal intervention. Because deaths are not captured completely by NEISS-AIP, persons who were dead on arrival or who died in the ED also were excluded.

Each case was assigned a sample weight based on the inverse probability of selection; these weights were added to provide national estimates of sports- and recreation-related injuries. Estimates were based on weighted data for 70,060 sports- and recreation-related ED visits during July 2000--June 2001. Confidence intervals (CIs) were calculated by using a direct variance estimation procedure that accounted for the sample weights and complex sample design. Rates were calculated by using averaged 2000--2001 U.S. Census Bureau population data.

During July 2000--June 2001, an estimated 4.3 million (95% CI=3.7--4.8 million) sports- and recreation-related injuries were treated in U.S. hospital EDs, comprising 16% of all unintentional injury-related ED visits. The percentage of all unintentional injury-related ED visits that were sports- and recreation-related was highest for persons aged 10--14 years (51.5% for boys, 38.0% for girls), and lowest for persons aged >45 years (6.4% for men, 3.1% for women). The overall rate of sports- and recreation-related injuries was 15.4 per 1,000 population. Rates were highest among persons aged 10--14 years (75.4 for boys, 36.3 for girls), and lowest among persons aged 0--4 years (11.1 for boys, 6.8 for girls) and persons aged >45 years (4.3 for men, 2.2 for women). Among all ages, rates were higher for males than for females.

Types of sports- and recreation-related activities in which persons were engaged when injured varied by age and sex. For persons aged 0--9 years, the leading types were playground- and bicycle-related injuries. Both scooter- and trampoline-related injuries ranked among the top seven types of injuries for both boys and girls aged 0--9 years. For males aged 10--19 years, football-, basketball-, and bicycle-related injuries were most common. For females aged 10--19 years, basketball-related injuries ranked highest. For persons aged 20--24 years, basketball- and bicycle-related injuries ranked among the three leading types of injuries. Basketball-related injuries ranked highest for men aged 25--44 years. Exercise (e.g., weight lifting, aerobics, stretching, walking, jogging, and running) was the leading injury-related activity for women aged >20 years and ranked among the top four types of injuries for men aged >20 years.

The most frequent injury diagnoses were strains/sprains (29.1%; 95% CI=25.2%--33.0%), fractures (20.5%; 95% CI=16.5%--24.5%), contusions/abrasions (20.1%; 95% CI=17.5%--22.8%), and lacerations (13.8%; 95% CI=11.9%--15.8%). The body parts injured most commonly were ankles (12.1%; 95% CI=10.9%--13.4%), fingers (9.5%; 95% CI=8.2%--10.8%), face (9.2%; 95% CI=7.9%--10.5%), head (8.2%; 95% CI=6.4%--10.1%), and knees (8.1%; 95% CI=6.8%--9.4%). Of an estimated 350,734 (95% CI=270,417--431,051) persons with sports- and recreation-related head injuries, approximately 199,050 (95% CI=127,947--270,153) had a brain injury diagnosed (i.e., diagnosis of concussion or internal injury). Overall, 2.3% (95% CI=1.5%--3.0%) of persons with sports- and recreation-related injuries were hospitalized.

Application of hidden Markov models on residuals: an example using Canadian traffic accident data.

Laverty WH, Miket MJ, Kelly IW. Percept Mot Skills 2002; 94(3): 1151-1156.

Correspondence: William H. Laverty, Department of Educational Psychology and Special Education, University of Saskatchewan, Saskatoon, CANADA; (email: laverty@snoopy.usask.ca).

Laverty, Kelly, Rotton, and Flynn conducted a regression analysis in 1992 on 9 years of automobile accidents in Saskatchewan (a total of 200,545 accidents) to find a small linear trend, season effects, holiday, and day of the week effects. The application of a hidden Markov model to the residuals of this analysis uncovered two states which are likely to be related to the weather. These states can be described as low volatility' and 'high volatility'. The 'low volatility' state involves low variability compared to the 'high volatility' state (occurring during the colder months) during which the largest numbers of accidents occur. It is suggested that hidden Markov models are a useful method for uncovering hidden, underlying states in social science and health-related data.
Epilepsy and injury mortality in Sweden -- the importance of changes in coding practice.

Jansson B, Ahmed N. Seizure 2002; 11(6): 361-370.

Correspondence: Bjarne Jansson, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Norrbacka Building, S-171 76 Stockholm, Sweden. SWEDEN; (email: bjarne.jansson@phs.ki.se).

We analyzed national mortality trends of injuries and poisoning in patients with epilepsy to establish the importance of changes in coding practice. Patients where epilepsy was a syndrome, either as an underlying or contributing cause-of-death at any time of life, throughout Sweden during 1975¯1995 were included. All conditions mentioned on each death certificate were examined, and epilepsy and injury diagnoses were separated according to underlying, contributing or multiple cause-of-death. Annual mortality rates, case-fatality rates, and linear regression coefficients were computed. The most common underlying cause-of-death (UCD) was diseases of the circulatory system (34.4%) followed by epilepsy (31.7%). Injury and poisoning were coded as UCDs for 5.8% of the patients. Injury and poisoning as a contributory cause-of-death increased significantly, but not as an underlying cause during the study period. The proportion of each diagnostic group as an underlying cause decreased by 35% for epilepsy and 18% for injury from 1981 and onwards. These changes should be interpreted with caution since changes of coding practice are more likely to be the cause of these apparent changes. The most frequent specific external causes of injury deaths in epileptic patients were falls and drowning. Intracranial fatal injuries in connection with fall accidents predominated, especially among elderly persons. Deaths related to accidental poisoning were caused by the toxic effect of non-medicinal substances. Cause-of-death statistics from different countries must be interpreted with caution when making international comparisons. Both underlying and contributing cause-of-death statistics should be considered in analyses of mortality trends. Copyright © 2002 BEA Trading)

See Report Under Recreation & Sports

The added value of the registration of home accidents in general practice.

Devroey D, Van Casteren V, Walckiers D. Scand J Prim Health Care 2002; 20(2): 113-117.

Correspondence: Dirk DeVroey, Unit of Epidemiology, Scientific Institute Public Health, Brussels, BELGIUM; (email: dirk.devroey@iph.fgov.be).

OBJECTIVES: To determine the number, the nature and the circumstances of home accidents managed in general practices, and to compare the results with the European Home and Leisure Accidents Surveillance System (EHLASS) data. DESIGN: A prospective population survey of all domestic accidents managed in 138 sentinel general practices during 1995/96. SETTING: Primary health care. SUBJECTS: In total, 4481 patients were included, of which 58% were female. MAIN OUTCOME MEASURES: The incidence of domestic accidents managed in general practices; the nature and place of the accident; the nature of the injury; the predisposing factors and related products. RESULTS: The highest incidence of home accidents was measured among children and the elderly. The median age was significantly lower for men (36 years) than for women (54 years). Among women, 74% of all home accidents were the result of a fall. The lesion is often a contusion or wound. Fractures were recorded in 20% of all home accidents. Three-quarters of all fractures involved women, especially older women. Most accidents among women (80%) occurred during motion and housework. Among men, 65% of all home injuries occurred during motion and do-it-yourself jobs. CONCLUSION: Because of the close relation with most patients and a knowledge of their living conditions, the GP is able to provide more reliable information on the circumstances of accidents than are health care providers in hospitals. The prevention of home accidents should at least partly be based on the results provided by general practitioners. (Copyright © 2002 Taylor & Francis)

Suicidal and drug-related behaviors of rural seventh and eighth grade students.

Light H. Percept Mot Skills 2002; 94(3 Pt 2):1196-1198.

Correspondence: Harriett Light, Child Development and Family Science, College of Human Development and Education, North Dakota State University, Fargo, ND 58105, USA; (email: Harriett.Light@ndsu.nodak.edu).

This journal, Perceptual and Motor Skills, is not available online. The mailing address is: C.H. & R.B. Ammons, Box 9229, Missoula MT 59807, USA.

Among 1,641 rural students in Grades 7 and 8, tobacco, alcohol, and inhalants were the most commonly used drugs; 281 reported suicidal thoughts, and 175 stated they made a plan to kill themselves during the past year. (Copyright © 2002 Perceptual and Motor Skills)

See Report Under Alcohol & Other Drugs

See Report Under Rural Issues
Drug use and suicide attempts: The role of personality factors.

Bolognini M, Laget J, Plancherel B, Stephan P, Corcos M, Halfon O. Subst Use Misuse 2002; 37(3): 337-356

Correspondence: Monique Bolognini, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Lausanne, SWITZERLAND; (email: mbologni@inst.hospvd.ch).

This study on suicide attempts is part of a large research project on dependent behavior in adolescents and young adults. 228 subjects aged 14-25 (107 "drug abusers," 121 controls) from the French speaking part of Switzerland were evaluated on the basis of a semi-structured interview (Mini International Neuropsychiatric Interview), enabling a DSM-IV diagnosis, and self-reports (SSS by Zuckermann, MMPI-2, IDI by Hirschfeld). 31.5% of "drug abuser" males and 41.2% of "drug abuser" females committed one or more suicide attempts. The results of a logistic regression show that the significant factor explaining suicide attempts in drug users is emotional reliance for males and experience-seeking for females. (Copyright © 2002 Marcel Dekker)
Cultural stereotypes of women from South Asian communities: mental health care professionals' explanations for patterns of suicide and depression.

Burr J. Soc Sci Med 2002; 55(5): 835-845.

Jennifer Burr, School of Health & Related Research, University of Sheffiled, UK; (email: j.a.burr@sheffiled.ac.uk).

Low rates of treated depression and high rates of suicide in women from some South Asian communities are evident in epidemiological studies in the UK. It is argued here that explanations for these apparent differences are likely to be located in stereotypes of repressive South Asian cultures. This small scale study, utilizing focus groups and individual interviews, sought to explore the construction of cultural stereotypes within mental health discourse with specific reference to stereotypes of women from South Asian communities. Mental health careers from a UK inner city area of relatively high social deprivation were targeted. Focus groups were conducted with a range of mental health care professionals who worked in both inpatient and outpatient mental health care services. In addition, individual interviews were conducted with consultant psychiatrists and General Practitioners. Extensive reference is made in this paper to the content of focus groups and interviews and how health carer's knowledge about and experience of South Asian cultures and caring for women from these communities was contextualised. Mental health care professionals constructed cultural difference in terms of fixed and immutable categories which operated to inferiorize Britain's South Asian communities. It is argued that their knowledge is constructed upon stereotypes of western culture as superior to a construction of eastern cultures as repressive, patriarchal and inferior to a western cultural ideal. Ultimately, it is argued that these stereotypes become incorporated as 'fact' and have the potential to misdirect diagnosis and therefore, also misdirect treatment pathways. (Copyright © 2002 Elsevier Science)
Risk factors for suicide in later life.

Conwell Y, Duberstein P, Caine E. Biol Psychiatry 2002; 52(3): 193

Correspondence: Yeates Conwell, Conwell, University of Rochester Medical Center, Department of Psychiatry, Center Study/Prevention of Suicide, 300 Crittenden Boulevard, Rochester NY 14642, USA; (email: yeates_conwell@urmc.rochester.edu ).

Suicide rates are higher in later life than in any other age group. The design of effective suicide prevention strategies hinges on the identification of specific, quantifiable risk factors. Methodological challenges include the lack of systematically applied terminology in suicide and risk factor research, the low base rate of suicide, and its complex, multidetermined nature. Although variables in mental, physical, and social domains have been correlated with completed suicide in older adults, controlled studies are necessary to test hypothesized risk factors. Prospective cohort and retrospective case control studies indicate that affective disorder is a powerful independent risk factor for suicide in elders. Other mental illnesses play less of a role. Physical illness and functional impairment increase risk, but their influence appears to be mediated by depression. Social ties and their disruption are significantly and independently associated with risk for suicide in later life, relationships between which may be moderated by a rigid, anxious, and obsessional personality style. Affective illness is a highly potent risk factor for suicide in later life with clear implications for the design of prevention strategies. Additional research is needed to define more precisely the interactions between emotional, physical, and social factors that determine risk for suicide in the older adult. (Copyright © 2002 Society of Biological Psychiatry)
Neighborhood predictors of hopelessness among adolescent suicide attempters: preliminary investigation.

Perez-Smith A, Spirito A, Boergers J. Suicide Life Threat Behav 2002; 32(2):139-145.

Correspondence: Anthony Spirito, Child and Family Psychiatry, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA; (email: anthony_spirito@brown.edu).

The role of neighborhood factors in predicting hopelessness among adolescent suicide attempters was examined in this study. Forty-eight adolescents who attempted suicide were administered measures of hopelessness and depression. Family socioeconomic status (SES) was calculated based on family demographics and characteristics of neighborhood context were examined using a geocoding software package. Adolescents who lived in neighborhoods with weak social networks reported higher levels of hopelessness, even after controlling for SES and depression. These preliminary findings suggest that environmental context may play a role in the emotional status of adolescents who attempt suicide. (Copyright © 2002 American Association of Suicidology)
Burden of illness and suicide in elderly people: Physical disease and depression are prevalent in elderly Finnish suicide victims (letter).

Timonen M, Viilo K, Väisänen E, Räsänen P, Hakko H, Särkioja T. BMJ 2002; 325(7361): 441.

Correspondence: Markku Timonen, Oulu Health Center, Box 8, 90015 City of Oulu, FINLAND; (email: markku.timonen@oulu.fi).

Finland has one of the world's highest death rates from suicide. The national Finnish hospital discharge register makes it possible to investigate reliably all hospital admissions for any physical diseases and mental disorders of each person living in Finland. We explored comorbid depression in the main categories of physical diseases as they appear in ICD-8 and ICD-9 in people aged 65 years and over who committed suicide.

We used data on all suicides (1296 males, 289 females) committed during 1988-2000 in northern Finland in the province of Oulu. The lifetime diagnoses of the suicide victims, based on psychiatric and somatic admissions and relevant codes from the International Classification of Diseases, were extracted from the hospital discharge register until the end of 1999. Depression was defined to be present if any of the following ICD codes was found in the register: ICD-8, 2960, 2980, 3004; ICD-9, 2961, 2968, 3004; ICD-10, F32-F34.

The table shows that heart and vascular diseases and gastrointestinal, musculoskeletal, and neurological disorders were the most common physical diseases among male suicide victims, the prevalence varying from 24% to 56%. In comparison with disease free subjects in each physical disease category, male suicide victims with heart and vascular or neurological diseases had a significantly higher prevalence of any comorbid mental disorder as well as comorbid depression. Among women no association between any comorbid mental disorder or depression and physical diseases reached significance, although in most physical disease categories (except respiratory diseases) over half of the female suicide victims were found to have the given disease. However, this was probably because of the small number of female suicide victims in our data, which easily leads to type II error in statistical analyses.

In conclusion, our results are in line with the findings of Waern et al (SafetyLit Update 10 June 2002) on neurological disorders, but they also highlight the importance of detecting comorbid depression among geriatric patients with heart and vascular diseases to prevent suicide among elderly people. The physical diseases of suicide victims in our data were extracted from the reliable national hospital discharge register, which means that only the information on diseases serious enough for hospital treatment were used in statistical analyses. Thus, the memory bias linked with personal interviews was avoided in our study. (Copyright © 2002 British Medical Journal)
The mediating roles of perceived social support and resources in the self-efficacy-suicide attempts relation among African American abused women.

Thompson MP, Kaslow NJ, Short LM, Wyckoff S. J Consult Clin Psychol 2002; 70(4): 942-949.

Correspondence: Martie P. Thompson, Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA; (email: mpthomp@clemson.edu).

The authors examined whether self-efficacy among African American abused women decreased their risk of suicide attempts through the mediating influences of perceived social support from friends, perceived social support from family, and perceived effectiveness for obtaining material resources. The sample consisted of 100 women who presented to a hospital following a suicide attempt and 100 women who presented to the same hospital for nonemergency medical problems. Results revealed that the association between self-efficacy and suicide attempt status was partially accounted for by the mediating roles of perceived social support from friends and family, and perceived effectiveness at obtaining resources. Findings suggest that interventions to increase abused women's self-efficacy should focus on increasing their capacity to obtain social and material resources. (Copyright © 2002 American Psychological Association)

Socioeconomic differences in road traffic injuries.

Hyder AA, Ghaffar A. J Epidemiol Community Health 2002; 56(9): 719.

Correspondence: Adnan Hyder, Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, 615 N Wolfe Street, Suite E-8132, Baltimore, Maryland 21205, USA; (email: ahyder@jhsph.edu).

Road traffic injuries are estimated to be the ninth leading cause of death for all ages globally and are expected to become the third leading cause by 2020. The loss of healthy life from injuries (measured in terms of disability adjusted life years per 100 000 people) is four times greater in low to middle income countries than in high income nations. Moreover, fatality rates from road traffic injuries are highest in the developing world, especially Africa.

Empirical work is now being done in the developing world to understand the burden of road traffic injuries and its distribution related to population characteristics. Our work at national level in Pakistan has demonstrated that injuries are the fifth leading cause of loss of healthy life, and the second leading cause of disability. A 40 year analysis of public sector data in Pakistan demonstrates the public health impact—mortality, morbidity, and costs—to society in the developing nation. While a national health survey in Pakistan demonstrated the overlapping frequencies of childhood injuries and diarrhea in children for the first time in the early 1990s.

We have conducted one of the first nationally representative injury surveys in Pakistan focusing on this neglected public health issue.8 Highlights of this sample of nearly 29 000 people interviewed in rural and urban areas will soon be published in a peer reviewed journal. The survey indicates that 70% of childhood injuries occurred to children whose mothers had no education, and this variable was used to reflect some measure of social and economic status. In addition, the relative risk of transport injuries was three time higher in those with manual labor as a profession, compared with those in the service sector. These findings reflect the beginnings of the type of inequality analysis proposed by Hasselberg et al, which is a challenge in resource poor settings.

Such work from the developing world indicates the great need for better data on road traffic injuries, and especially disaggregated data that permit subanalysis. It is therefore critical that researchers in developing countries ensure that their study designs include aspects of equity analysis. (Copyright © 2002 Journal of Epidemiology and Community Health)
Impact of cataract surgery on motor vehicle crash involvement by older adults.

Owsley C, McGwin G Jr, Sloane M, Wells J, Stalvey BT, Gauthreaux S. JAMA 2002; 288(7): 841-849.

Correspondence: Cynthia Owsley, Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S 18th St, Suite 609, Birmingham, AL 35294-0009, USA; (email: owsley@eyes.uab.edu).

BACKGROUND: Motor vehicle crash risk in older drivers is elevated in those with cataract, a condition that impairs vision and is present in half of adults aged 65 years or older.

OBJECTIVE: To determine the impact of cataract surgery on the crash risk for older adults in the years following surgery, compared with that of older adults who have cataract but who elect to not have surgery.

DESIGN, SETTING, AND PATIENTS: Prospective cohort study of 277 patients with cataract, aged 55 to 84 years at enrollment, who were recruited from 12 eye clinics in Alabama from October 1994 through March 1996, with 4 to 6 years of follow-up (to March 1999).

MAIN OUTCOME MEASURE: Police-reported motor vehicle crash occurrence involving patients who elected to have surgery compared with those who did not.

FINDINGS: Comparing the cataract surgery group (n = 174) with the no surgery group (n = 103), the rate ratio for crash involvement was 0.47 (95% confidence interval, 0.23-0.94), adjusting for race and baseline visual acuity and contrast sensitivity. The absolute rate reduction associated with cataract surgery was 4.74 crashes per million miles of travel.

DISCUSSION: In our sample, patients with cataract who underwent cataract surgery and intraocular lens implantation had half the rate of crash involvement during the follow-up period compared with cataract patients who did not undergo surgery. Cataract surgery thus may have a previously undocumented benefit for older driver safety, reducing subsequent crash rate. (Copyright © 2002 American Medical Association)
Risk-taking attitudes among young drivers: the psychometric qualities and dimensionality of an instrument to measure young drivers' risk-taking attitudes.

Ulleberg P, Rundmo T. Scand J Psychol 2002 Jul;43(3):227-237.

Correspondence: Pal Ulleberg, Department of Psychology, Norwegian University of Science and Technology, Trondheim, NORWAY; (email: Pal.ulleberg@svt.ntnu.no).

Adolescents are proportionately more frequently involved in traffic accidents than are other age groups. A strategy for promoting road safety is to change the attitudes likely to influence driving behavior. However, the lack of valid and reliable instruments to measure risk-taking attitudes makes it difficult to evaluate the effects of measures aimed at changing attitudes among young drivers and their passengers. The present study tested the psychometric qualities of a scale intended to measure adolescents' risk-taking attitudes to driving. The results are based on a self-completion questionnaire survey carried out among 3,942 adolescents and young adults, aged 16-23 years, in Norway in 1998/1999. Using both exploratory and confirmatory factor analyses, 11 dimensions of risk-taking attitudes were identified. Parametric as well as nonparametric methods were applied to test the homogeneity of items within each attitude dimension. The reliability and validity of the dimensions were satisfactory. The attitude dimensions were significantly correlated with self-reported driving behavior, as well as accident frequency. The application of the new measurement instrument in studies aimed at evaluating safety campaigns is discussed. (Copyright © 2002 Blackwell Publishers)
Traffic safety among older adults: Recommendations for California.

California Task Force on Older Adults and Traffic Safety. San Diego, California: Center for Injury Prevention Policy and Practice, 2002.

Available online: HERE.

The California Task Force on Older Adults and Traffic Safety, convened by the California Office of Traffic Safety, developed recommendations to prevent traffic crashes among older adults in California and to prepare for the growing senior population. This report lays the groundwork for a coordinated, comprehensive, and lasting approach to improving traffic safety for older Californians.

The Task Force incorporated numerous critical concerns in the development of the recommendations, including: the increase in the number of older adults in California; the increase in the number of older drivers; the increase in the number of trips and mileage traveled by older drivers; variability among older adults (as people age they actually become more different from one another); the need for individualized assessment; older adults vulnerability to injury and mortality from crashes; improving traffic safety for older adults should improve traffic safety for people of all ages; and the need to address the multifaceted issues of individuals, vehicles and the traffic environment.

The Task Force recommendations provide a strategic framework to improve traffic safety for older Californian’s. The report details the nature and scope of the problem, goals, action items, timeframes and recommended partners for each recommendation. The Task Force recommendations are: A) Institutionalize a statewide system for the prevention of traffic-related injuries among older adults; B) Institutionalize effective and equitable driver assessment and licensing practices within the California Department of Motor Vehicles; C) Facilitate older adult risk identification and risk reduction practices; D) Improve the ability of health care and service providers to assess traffic safety risk and minimize the impact of health impairments on safe mobility; E) Establish roadway infrastructure and land use practices that promote safety; F) Promote safer motor vehicle designs; and G) Expand the existing research and knowledge base about older adult traffic safety.
Human factors analysis of accidents involving visual flight rules flight into adverse weather.

Goh J, Wiegmann D. Aviat Space Environ Med 2002; 73(8):817-822.

Correspondence: Juliana Joo Hong Goh, University of Illinois at Urbana-Champaign, Aviation Human Factors Division, USA; (email: goh@uiuc.edu).

BACKGROUND: General aviation (GA) accident statistics indicate that visual flight rules (VFR) flight into instrument meteorological conditions (IMC) is a major safety hazard. However, little research has been conducted to identify the factors that influence VFR pilots' decisions to risk flying into deteriorating weather. The purpose of the present study was to further examine the causes of GA accidents associated with VFR flight into IMC. METHOD: A comprehensive review of GA accident reports maintained by the National Transportation Safety Board (NTSB) was conducted to identify accidents involving VFR flight into IMC between January 1990 and December 1997. These accidents were compared with other GA accidents that occurred during the same time period. FINDINGS: Analyses of these accidents revealed that VFR flight into IMC accidents were more likely to involve less-experienced pilots and to have passengers aboard the accident aircraft compared with the other GA accidents. In addition, most VFR flight into IMC accidents were considered by the NTSB to have involved intentional flight into adverse weather by the pilot. DISCUSSION: These findings are interpreted in terms of their implications for the underlying causes of VFR flight into IMC, including situation assessment, risk perception, and social pressure. Intervention programs that address all of these factors are needed. (Copyright © 2002 Aerospace Medical Association)

Social aetiology of violent deaths in Swedish children and youth.

Hjern A, Bremberg S. J Epidemiol Community Health 2002; 56(9): 688-692.

Correspondence: Sven Bremberg, Department of Public Health Sciences, Karolinska Institute, National Institute of Public Health, SE-10352 Stockholm, Sweden , SWEDEN; (email: sven.bremberg@telia.com).

OBJECTIVE: To describe the contribution of social conditions for the main causes of injury deaths in Swedish children and youth aged 5-25 years.

METHODS: Cohort study. All children below 15 years of age that resided in Sweden 1985 were followed up during 1991-1995. Injury deaths were recorded from The National Cause of Death Register. Information on parental social determinants were collected from various national registers. Connections between the social determinants and an injury death outcome were analyzed in multivariate Cox regression models.

FINDINGS: In total 1474 injury deaths were recorded during approximately 8 million person years. In a regression model, with control for sex, year of birth, and residency (urban/rural), the etiological fraction for parental SES, maternal country of birth, family situation, parental risk factors, and all these factors combined were 13%, 6%, 1.4%, 1.3%, and 19%, respectively. Similar regression models were studied separately for each of the main causes of injury death. The parental social determinants explained 58% of all homicides, 47% of all motor traffic injuries, and 30% of all other traffic injuries while the suicide rate was not affected by these determinants. Parental socioeconomic status was the single most important parental determinant for all major causes of injury.

DISCUSSION: There was a wide variation of the etiological fractions of parental social determinants for different causes of injury death. This variation might be used to further investigate the social etiology of injuries. (Copyright © 2002 Journal of Epidemiology and Community Health)
Violence in adolescents' romantic relationships: findings from a survey amongst school-going youth in a South African community.

Swart L, Seedat M, Stevens G, Ricardo I. J Adolesc 2002; 25(4):385-395.

Correspondence: Lu-Anne Swart, Institute for Social and Health Sciences, University of South Africa, 1087, Lenasia, 1820, SOUTH AFRICA; (email: swartl@unisa.ac.za).

This paper reports on a study of heterosexual adolescent dating violence among secondary school students in a South African community. Approximately half of the surveyed males, and just over half of the surveyed females reported involvement in a physically violent dating relationship either as a perpetrator and/or victim. The study found significant associations between the beliefs about violence in a romantic relationship, the witnessing of physical violence in friendship contexts, the use of alcohol and adolescent dating violence. A significant association between familial variables and adolescent dating violence was only found for male participants. No significant association was found between religious participation and adolescent dating violence. The implications for prevention are discussed in an attempt to demonstrate the potential of local information that identifies risk factors for the development of appropriate community- and schools-based intervention programs. (Copyright © 2002 The Association for Professionals in Services for Adolescents, Published by Elsevier Science)
Medical consequences of violence: a two-year prospective study from a primary care accident and emergency department in Norway.

Steen K, Hunskaar S. Scand J Prim Health Care 2002 Jun;20(2):108-112.

Correspondence: Knut Steen, Department of Surgery, University of Bergen, NORWAY; (email: knut.steen@kir.uib.no).

OBJECTIVE: To assess the medical consequences of violence from the perspective of a primary care accident and emergency department. DESIGN: Prospective observational study. SETTING: Bergen Legevakt (AED).

METHODS: SUBJECTS- All assault victims treated at the AED 1994-96. MAIN OUTCOME MEASURES- Diagnoses, treatments, number of consultations at the AED, sickness certificates, rates of admittances to hospitals, referrals to specialists and injury severity ratings using Abbreviated Injury Scale (AIS) and Shepherd's injury severity scale.

FINDINGS: 1803 assault victims were registered, 433 (24%) females and 1370 (76%) males. Most injuries were of slight severity, corresponding to AIS 0 to 1 (82%) or Shepherd's scale 0 to 1 (74%). Bruises/contusions and cuts/lacerations dominated. The majority of patients did not receive any specific treatment at the AED and they were not given sickness certificates, but 11% were admitted to hospitals and 30% were referred to specialists. Males were more likely to be seriously injured than females.

DISCUSSION: Most physical injuries caused by violence and treated at a primary care accident and emergency department are minor. (Copyright © 2002 Taylor & Francis)
Firearm-related death and injury among children and adolescents.

Fingerhut LA, Christoffel KK. Future Child 2002; 12(2): 25-37.

Correspondence: Lois Fingerhut, Office of Analysis, Epidemiology, and Health Promotion, at the National Center for Health Statistics, Centers for Disease Control, Hyattsville, MD 20782, USA; (email: laf4@cdc.gov).

Available online: HERE

As the articles in this journal issue show (SafetyLit will publish abstracts of other reports from this journal in future weekly updates), gun violence affects children and youth in many ways: psychologically, emotionally, financially, and legally. But first and foremost, gun violence affects children's physical safety. Therefore, this issue opens with an overview of the physical toll that firearms exact upon children and youth, reviewing the incidence of firearm-related injury and death among Americans under age 20.

This article analyzes trends and current status in firearm death and injury, based on nationwide data collected by the federal government. Several key findings emerge from the data:

Firearm death rates among children and youth in the United States have declined dramatically since 1993, but remain high compared with historical rates in this country and rates in other developed nations. A majority of these deaths are homicides.

Certain groups of children and youth, especially adolescents, boys, minority youth, and those residing outside the Northeast, are particularly at risk for firearm death. The problem is most acute among black teenage males.

Firearm injuries are much more likely to result in death than are other injuries for which children and youth visit emergency departments—a reflection of the extreme lethality of firearms.

Given these findings, the authors call for a concerted effort to reduce youth firearm deaths to levels comparable to those of other industrialized nations, using a wide variety of approaches that span the public health, criminal justice, and educational spheres. They also recommend improved data systems to track firearm injury and death, so that researchers can better analyze these incidents and evaluate intervention strategies. (The Future of Children is a publication of the David and Lucile Packard Foundation.)
Youth, guns, and violent crime.

Blumstein A. Future Child 2002; 12(2): 25-37.

Correspondence: Alfred Blumstein, School of Public Policy and Management at Carnegie Mellon University,5000 Forbes Avenue, Pittsburgh, PA 15213, USA; (email: ab0q@andrew.cmu.edu).

Available online: HERE

Young people are over-represented as both victims and perpetrators of violence. Indeed, some commentators have suggested that recent cohorts of youth have been composed of "superpredators" who have little regard for human life. The evidence, however, suggests that other factors are responsible for recent increases in youth gun violence.

This article analyzes the extent and causes of youth violence in the United States, paying particular attention to the late 1980s and early 1990s, when rates of homicide and robbery committed by youth rose to extremely high levels. Examination of trends for these crimes shows that:

The increase in violence in the United States during the late 1980s and early 1990s was due primarily to an increase in violent acts committed by people under age 20. Similarly, dramatic declines in homicide and robbery in recent years are attributable primarily to a decline in youth violence.

The increase in youth homicide was predominantly due to a significant increase in the use of handguns, which converted ordinary teenage fights and other violent encounters into homicides.

Several other interrelated factors also fueled the rise in youth violence, including the rise of illegal drug markets, particularly for crack cocaine, the recruitment of youth into those markets, and an increase in gun carrying among young people.

The author points out that youth violence diminished as the crack markets shrank, law enforcement increased efforts to control youth access to guns, youth gun carrying declined, and the robust economy provided legitimate jobs for young people. (The Future of Children is a publication of the David and Lucile Packard Foundation.)

The criteria for selecting report for inclusion are simple. If the answer to any of the following questions is "yes", then the report is likely to be included: 1. Do the SafetyLit reviewers find the report interesting? 2. Are SafetyLit readers likely to hear of a report from a colleague? 3. Are SafetyLit readers likely to be questioned about the report from a member of the population they serve? 4. Does the report contain findings that are likely to be used by an adversary to oppose the actions or recommendations of a SafetyLit reader?

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Rev. 24-Aug-2002.