SafetyLit Update: 23 September 2002

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23 September 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.

The relationship between liquor outlet density and injury and violence in New Mexico.

Escobedo LG, Ortiz M. Accid Anal Prev 2002; 34(5): 689-694.

Correspondence: Luise G. Escobedo, New Mexico Department of Health, Las Cruces 88001, USA; (email: luise@doh.state.nm.us).

This study used an ecologic design based on data from 1990 to 1994 gathered from forensic, vital statistic, census, law enforcement and liquor licensing agencies to assess the relationship between liquor outlet density and alcohol-related health outcomes in New Mexico. Linear regression models show that suicide, alcohol-related crash, and alcohol-related crash fatality (adjusted for age, sex, and minority status) are significantly associated with liquor outlet density. Data also show that, compared with the first tertile, suicide and alcohol-related crash rates increase about 50% and the alcohol-related crash fatality rate two-fold with the third tertile of liquor outlet density. Greater availability of liquor outlets is associated with higher rates of suicide, alcohol-related crash, and alcohol-related crash fatality. (Copyright © 2002 Elsevier Science)

Epidemiology and socioeconomics.

Kuhn F, Morris R, Mester V, Witherspoon CD, Mann L, Maisiak R. Ophthalmol Clin North Am 2002; 15(2): 145-151.

Correspondence: Ferenc Kuhn, United States Eye Injury Registry, Helen Keller Foundation for Research and Education, 1201 11th Avenue South, Suite 300, Birmingham, AL 35205, USA; (email: fkuhn@mindspring.com).

Ophthalmologists should be responsible for a systemic collection of standardized data on the occurrence of eye injuries. Such a database is the key for designing prophylactic measures to successfully prevent ocular trauma. The USEIR model, whether reporting takes place over the Internet [www.USEIRonline.org www.WEIRonline.org (worldwide)] or on paper, has proved to be an efficient epidemiological tool. Use of this model in different countries has allowed making unbiased comparisons between regions or countries, highlighting injury patterns that may be different in different geographical areas, and pinpointing areas where prophylaxis (through legislation and public campaigns) appears most effective. Participation of all ophthalmologists who evaluate/treat patients with serious eye trauma is strongly encouraged. (Copyright © 2002 Elsevier Science)
Babywalkers: Delay development, cause injuries, and we should consider banning them.

Taylor B. BMJ 2002; 325: 612.

Brent Taylor, Royal Free and University College Medical School, London NW3 2PF, UK; (email: b.taylor@rfc.ucl.ac.uk)
.
Babywalkers (infant walkers, wheeled seats that allow infants to move around with their feet on the floor) are widely used, by 50% or more of infants. A recent short report in the BMJ showed that babywalkers delayed acquisition of crawling, standing alone, and walking alone. A brisk correspondence followed, with many respondents picking faults with the study, some supporting continued parental choice, and others welcoming this additional evidence that babywalkers are dangerous.

Previous reports have suggested that development is affected adversely by babywalkers. Along with that in the BMJ, these were observational or questionnaire based studies and not randomised control trials. Some inconsistencies exist regarding which milestones were affected, probably reflecting comparatively low numbers of children in the studies, but overall evidence shows significant developmental delays associated with babywalkers. Anecdotal reports note adverse effects from the use of babywalkers in a child with cerebral palsy and even the development of cerebral palsy-like symptoms in apparently normal children. No published data are available that imply that development may have benefited, although this is a common reason why parents choose to use babywalkers. Against an effect on development is a small controlled study in 15 pairs of twins, with one twin allocated to a babywalker and the other not, which found no difference in age at walking. An earlier study from one of the same authors showed apparently adverse electrophysiological changes in six babies allocated to a babywalker compared with their twin controls.

For injuries the evidence is even stronger. Injuries with babywalkers are common, if usually minor. However, deaths and serious injuries (skull fracture, concussion, intracranial haemorrhage, fractures of the cervical spine, and other fractures) occur. These are particularly associated with falls downstairs, which are the commonest cause of babywalker related injury. Poisoning and burns are other risks. A rate of 8.9 injuries needing attendance in emergency departments per 1000 children less than 1 year of age and 1.7/1000 for serious injuries has been reported.

Can preventive interventions help? Programmes to educate parents have proved disappointing. Uncontrolled mobilityup to one metre per secondis the major hazard. Most accidents occur while the child is under supervision, often with an adult in the same room.1 Recent voluntary standards introduced in the United States recommend that babywalkers be manufactured wide enough (more than 36 inches; 91 cm) not to pass through doors; it is hoped that this will prevent children tumbling down steps on to, for example, a concrete floor in the cellar. Braking systems designed to stop the walker toppling if one wheel loses contact with the ground (for example, over the edge of stairs) are also recommended, but evidence shows that they may not work.

What else can be done? Babywalkers have been banned in Canada, although many families still import them.11 The American Academy of Pediatrics recommends a ban on the manufacture and sale of the products. Stationary activity centres providing tilt, rotation, and bounce are suggested as an alternative to wheeled machines and are likely, if not confirmed, to be safer. The shown risk for injuries, together with apparent adverse effects on development and lack of other benefit, makes a very strong case for a general ban on babywalkers.

Injuries and illnesses among New York City Fire Department rescue workers after responding to the World Trade Center attacks.

Banauch G, McLaughlin M, Hirschhorn R, Corrigan M, Kelly K, Prezant D. MMWR 2002; 51(Special Issue): 1-5.

Full article, with tables, figures, and editorial comment, available on-line: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm51SPa1.htm.

Within minutes of the terrorist attacks on September 11, 2001, the Fire Department of New York City (FDNY) operated a continuous rescue/recovery effort at the World Trade Center (WTC) site. Medical officers of FDNY Bureau of Health Services (FDNY-BHS) responded to provide emergency medical services. The collapse of the WTC towers and several adjacent structures resulted in a vast, physically dangerous disaster zone. This report describes morbidity and mortality in FDNY rescue workers during the 11-month period after the WTC attacks and documents a substantial increase in respiratory and stress-related illness compared with the time period before the WTC attacks.

During the collapse, 343 FDNY rescue workers died and, during the next 24 hours, an additional 240 FDNY rescue workers sought emergency medical treatment. This report includes all reported injuries/illnesses during the 24 hours following the attacks. Traumatic injuries are reported for the 3 months after the attacks because many workers did not report their injuries initially so they could participate in the rescue effort.

At the time of the attacks, 11,336 firefighters and 2,908 EMS workers were employed by FDNY. During the collapse, 343 FDNY rescue workers died (341 firefighters and two paramedics). During the first 24 hours, 240 FDNY rescue workers (158 firefighters and 82 EMS workers) sought emergency medical treatment. Most (63%) were for eye irritation, respiratory tract irritation and exposure (any combination of mild exhaustion, dehydration, and eye and respiratory tract irritation) not requiring hospital admission. Of 28 FDNY rescue workers who required hospitalization, 24 had traumatic injuries including 17 with fractures, four with back trauma, two with knee meniscus tears, and one with facial burns. One firefighter suffered a cervical spine fracture requiring surgery for stabilization and recovered without neurologic sequelae. Three FDNY rescue workers required hospital admission for life-threatening inhalation injuries.

Data for the first month following the attacks include those injuries occurring in the first 24 hours that resulted in medical leave. Compared with monthly mean incidence rates for the 9 months before the attacks, the incidence of crush injuries, lacerations, and fractures during the month after the attacks increased by 200% (from three to nine), 35% (from 37 to 50), and 29% (from 21 to 27), respectively, but then returned to levels similar to those observed before the attacks. Compared with the 9 months before the WTC attacks, monthly mean incidence decreased for contusions (from 86 to 67 [29%]), sprains and strains (from 364 to 200 [41%]), other orthopedic injuries (from 96 to 61 [35%]), and burns (from 43 to three [95%]). As of August 28, 2002, a total of 90 FDNY rescue workers were on medical leave or light duty assignments because of orthopedic injuries reported during the 3 months of activity at the WTC site.

Getting answers: what can BLS data reveal about disabling injuries?

Courtney TK, Webster BS. Prof Saf 2002; 47(9): 24-30.

Correspondence: Theodore K. Courtney, Liberty Mutual Research Center for Safety and Health, 71 Frankland Road, Hopkinton, MA 01748, USA; (email: Theodore.Courtney@LibertyMutual.com).

The United States Bureau of Labor Statistics' (BLS) annual survey of occupational injuries and illnesses (SOII) is a frequently utilized sources of data on national occupational morbidity. In 1992 the BLS introduced an expanded survey method that collects more detailed data on cases with days-away-from-work (DAFW). While the new method provides detail on the body part, nature of injury, extent and certain antecedents of these cases, the published data are most often presented univariately. This makes it difficult to assess the extent of many common injuries.

Although the Internet offers expanded access to the SOII data, getting correct answers about injuries and illnesses from the data can still be a challenge. This how-to-oriented article introduces the BLS SOII DAFW system and identifies key considerations for using the data. Questions regarding the most frequent and severe types of occupational injury in the U.S. are used to illustrate three common approaches (publication-based, web-based, and specific data requests) to accessing the data. Limitations and common pitfalls in data interpretation are also discussed. In addition, guidance is provided on the most appropriate method to approach the data for a specific question. Internet links are provided to allow readers to further explore the topic. (Copyright © 2002 American Society of Safety Engineers)
Organizational safety: which management practices are most effective in reducing employee injury rates?

Vredenburgh AG. J Safety Res 2002; 33(2): 259-276.

Correspondence: Alison G. Vredenburgh, Vredenburgh and Associates, Inc., PMB 353, 2588 El Camino Real, Suite F, Carlsbad, CA 92008, USA; (email: alisonv@nethere.com).

PROBLEM: While several management practices have been cited as important components of safety programs, how much does each incrementally contribute to injury reduction? This study examined the degree to which six management practices frequently included in safety programs (management commitment, rewards, communication and feedback, selection, training, and participation) contributed to a safe work environment for hospital employees.

METHOD: Participants were solicited via telephone to participate in a research study concerning hospital risk management. Sixty-two hospitals provided data concerning management practices and employee injuries.

RESULTS: Overall, the management practices reliably predicted injury rates. A factor analysis performed on the management practices scale resulted in the development of six factor scales. A multiple regression performed on these factor scales found that proactive practices reliably predicted injury rates. Remedial measures acted as a suppressor variable.

DISCUSSION: While most of the participating hospitals implemented reactive practices (fixing problems once they have occurred), what differentiated the hospitals with low injury rates was that they also employed proactive measures to prevent accidents. The most effective step that hospitals can take is in the front-end hiring and training of new personnel. They should also ensure that the risk management position has a management-level classification. This study also demonstrated that training in itself is not adequate. (Copyright © 2002 Elsevier Science)

Pedestrian crashes in Washington, DC and Baltimore.

Preusser DF, Wells JK, Williams AF, Weinstein HB. Accid Anal Prev 2002; 34(5):703-710.

Correspondence: David E. Preusser, Preusser Research Group, Inc., Trumbull, CT 06611, USA; (email: preusser@worldnet.att.net).

Police crash reports were obtained for pedestrian-motor vehicle crashes in Washington, DC (N = 852) and Baltimore (N = 1234) for the year 1998. Reports were coded using procedures developed and applied in these two cities during the 1970s, including the determination of pedestrian crash type, primary precipitating factor, and culpability. Results indicated substantial differences between crash patterns observed during the 1970s and those observed during 1998. Midblock dart-dash crashes, which typically involve a precipitating factor or critical error by a child pedestrian, decreased (from 37% to 15% in Washington). Across all crashes in both cities, the number of drivers who made a critical error leading to the crash was nearly equivalent to the number of pedestrians who made a critical error. Overall, pedestrians were slightly more likely to be judged culpable (50% vs. 39%). Turning vehicle crashes, which typically involve a driver's failure to grant a pedestrian the right of way at a signalized intersection, increased (from 9% to 25% in Washington). Countermeasures to reduce the number of pedestrians hit by turning vehicles are discussed. (Copyright © 2002 Elsevier Science)
Outcomes of pediatric pedestrian injuries by locations of event.

Di Scala C, Sege R, Li G. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 241-250.

Correspondence: Carla Di Scala, Department of Pediatrics, Tufts/NEMC, Boston, Massachusetts, USA; (email: cdiscala_tra@opal.tufts.edu).

Data from the National Pediatric Trauma Registry October 1995-October 2000, containing medical records of children under 20 years old hospitalized for pedestrian injuries, were examined. Demographics and outcome measures (nature and severity of injury, utilization of resources, deaths, and disability at discharge) were compared by location of occurrence. Pediatric pedestrian injuries resulted in severe outcomes whether the events occurred in driveways, public places, or in the road. Off the road injuries accounted for a significant proportion (13.2%) of all serious pedestrian injuries and disproportionately affected the youngest children. Prevention should consider the child's age and the location of injury occurrence. (Copyright © 2001 Association for the Advancement of Automotive Medicine)

Recording acute poisoning deaths.

Flanagan R, Rooney C. Forensic Sci Int 2002; 128(1-2): 3-19.

Correspondence: Robert Flanagan, Medical Toxicology Unit, Guy's and St. Thomas' Hospital Trust, Avonley Road, SE14 5ER, London, UK; (email: robert.flanagan@gstt.sthames.nhs.uk).

Recording deaths from acute poisoning/substance abuse is not straightforward. The International Classification of Diseases (ICD), used to code mortality statistics, is aimed towards recording the underlying cause of death such as suicide or drug dependence rather than gathering data on poisoning per se.

Despite the inherent difficulties, clear trends can be observed from the data available for England and Wales. There have been marked changes in the compounds featuring in suicidal poisoning in the last 35 years reflecting changes in the availability of poisons, notably carbon monoxide and prescription barbiturates. However, although the number of poisoning suicides has decreased in the recent years, suicides from other means have increased in males (suicides in 1999, 75% male), hence there has been little change in the annual total of suicides. There are also striking differences in drug abuse- and volatile substance abuse (VSA)-related deaths between males and females. Drug abuse-related fatal poisoning (83% male, 1979-1999, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) definition which does not include suicide), largely attributable to heroin and methadone, increased markedly during the 1990s, with a sharp rise in deaths attributed to accidental poisoning, although deaths involving methadone are now declining. VSA-related deaths (90% male, 1971-1999, almost entirely accidental deaths), nowadays predominantly from abuse of fuel gases (liquefied petroleum gas, LPG) from, for example, cigarette lighter refills, have declined from a peak in the early 1990s and are now becoming manifest in an older age group. These two latter instances especially provide examples where ICD-derived fatal poisoning data are inadequate and a 'poisons oriented' approach to data collection and analysis is necessary. (Copyright © 2002 Elsevier Science)

Survey of the injury rate for children in community sports.

Radelet MA, Lephart SM, Rubinstein EN, Myers JB. Pediatrics 2002; 110(3): e28.

Correspondence: Scott M. Lephart, Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania 15203, USA; (email: lephart@pitt.edu).

OBJECTIVE: To determine the baseline injury rate for children ages 7 to 13 participating in community organized baseball, softball, soccer, and football.

METHODS: In this observational cohort study, 1659 children were observed during 2 seasons of sports participation in an urban area. Data were collected by coaches using an injury survey tool designed for the study. A reportable injury was defined as one requiring on-field evaluation by coaching staff, or causing a player to stop participation for any period of time, or requiring first aid during an event. Logistic regression analyses were done within and across sports for injury rates, game versus practice injury frequencies, and gender differences where appropriate.

RESULTS: The injury rates, calculated per 100 athlete exposures during total events (games plus practices), were: baseball, 1.7; softball, 1.0; soccer, 2.1; and football, 1.5. The injury rates for baseball and football were not significantly different. Across sports, contusions were the most frequent type of injury. Contact with equipment was the most frequent method of injury, except in football where contact with another player was the most frequent method. In baseball, 3% of all injuries reported were considered serious (fracture, dislocation, concussion); in soccer, 1% were considered serious; and in football, 14% were considered serious. The frequency of injury per team per season (FITS), an estimation of injury risk, was 3 for baseball and soccer, 2 for softball, and 14 for football for total events. For all sports, there were more game than practice injuries; this difference was significant except for softball. There were no significant gender differences in soccer for injury rates during total events.

CONCLUSIONS: Given the classification of football as a collision sport, the high number of exposures per player, the FITS score, and the percentage of injuries considered serious, youth football should be a priority for injury studies. Health professionals should establish uniform medical coverage policies for football even at this age level.

RECOMMENDATIONS: Injury surveillance for youth sports is gaining momentum as an important step toward formulating injury prevention methods. However, establishing patterns of injuries, taking preventive measures, and evaluating equipment and coaching modifications may take years. In addition to the objective findings of this study, our direct observations of community sports through 2 seasons showed areas where immediate modifications could reduce injury risk. The first recommendation is that youth sports leagues provide and require first aid training for coaches. Training could be done by sports medicine professionals and include recognition and immediate response to head, neck, and spine injuries, as well as heat-related illnesses. The second recommendation is that youth sports leagues have clear, enforceable return to play guidelines for concussions, neck and back injuries, fractures, and dislocations. The third recommendation is that baseball and softball leagues consider the injury prevention potential of face guards on batting helmets. (Copyright © 2002 American Academy of Pediatrics)
A changing pattern of injuries to horse riders.

Moss PS, Wan A, Whitlock MR. Emerg Med J 2002; 19(5): 412-414.

Correspondence: P. S. Moss, Accident and Emergency Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, UK; (email: philmoss1@btopenworld.com).

OBJECTIVES: To describe the demographics and nature of injuries occurring on or around horses, to examine the nature of protective clothing in relation to these injuries, and to compare our data with previously published work in this area.

METHODS: Patients were identified using the term "sports injury-horse riding" from the departmental database for one calendar year from February 2000. Data were collected regarding demographics, injuries, protective clothing, and outcome. The data were then analysed and compared with the previously published literature.

RESULTS: 260 patients' records were analysed. The patients were mostly young (median age 26) and female (84.6%). The majority of patients had a single injury (88.8%). Seventeen per cent had an isolated head injury, all of which proved to be minor. Multiple injuries including the head accounted for 8.5% of all injuries. These again proved minor, bar one fatality where the helmet came off before impact. Upper limb injuries accounted for 29.2% of all injuries of which 61.8% sustained a fracture of which 36.2% were to the wrist. When compared with previous work the incidence and severity of head injury continues to decline while the relative number and severity of upper limb injuries increases.

CONCLUSIONS: The majority of head injured riders are wearing approved helmets and sustaining only minor injury. There is currently no protective gear recommended for the upper limb and more specifically the wrist. This paper identifies the potential need for research and development of such protection. (Copyright © 2002 Emergency Medicine Journal)
Are squash players protecting their eyes?

Eime RM, Finch CF, Sherman CA, Garnham AP. Inj Prev 2002; 8(3): 239-241.

Correspondence: Caroline Finch, Sports Injury Prevention Research Unit, Department of Epidemiology and Preventive Medicine, Central and Eastern Clinical School, Alfred Hospital, Prahran, Victoria 3181, AUSTRALIA; (email: caroline.finch@med.monash.edu.au).

OBJECTIVE: To determine factors associated with adult squash players' protective eyewear behaviours.

METHODS: A survey of 303 players (aged >/=18 years) was conducted at three squash venues in Melbourne, Australia over a three week period in June 2000 to obtain information about protective eyewear use.

RESULTS: Of 303 participants the response rate was 98.1%; 66.1% were males, with a mean age of 40.5 years. The majority (68.4%) had played squash for 10 years or more. Although 18.8% of players reported using protective eyewear, only 8.9% reported wearing approved eyewear. Both age group (p < 0.05) and years of squash experience (p < 0.01) were significantly associated with any eyewear use. The two main influences were personal experience of eye injuries (50.0%) and knowledge of eye injury risk (33.9%). A commonly reported barrier was restriction of vision (34.2%).

CONCLUSION: These findings demonstrate a low prevalence of voluntary use of appropriate protective eyewear. Future prevention strategies incorporating education campaigns should focus on increasing players' knowledge of risks. The barriers to use and misconceptions about which types of eyewear is most protective need to be addressed as a priority. (Copyright © 2002 BMJ Publications Group)

Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99.

Nguyen MH, Annest JL, Mercy JA, Ryan GW, Fingerhut LA. Inj Prev 2002; 8(3): 185-191.

Correspondence: Lee Annest, Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy (MS-K59), Atlanta, GA 30341–3724, USA; (email: lannest@cdc.gov).

OBJECTIVE: To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts.

SETTING: The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually.

METHODS: National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS.

RESULTS: BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881-17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments.

CONCLUSIONS: BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations. (Copyright © 2002 BMJ Publications Group)

See abstract under Poisoning
Registry based trauma outcome: perspective of a developing country.

Zafar H, Rehmani R, Raja AJ, Ali A, Ahmed M. Emerg Med J 2002; 19(5): 391-394.

Correspondence: Hasan Zafar, Department of Surgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi 74800, PAKISTAN; (email: hasnain.zafar@aku.edu).

OBJECTIVE: To report trauma outcome from a developing country based on the Trauma and Injury Severity Scoring (TRISS) method and compare the outcome with the registry data from Major Trauma Outcome Study (MTOS).

DESIGN: Registry based audit of all trauma patients over two years.

SETTING: Emergency room of a teaching university hospital.

SUBJECTS: 279 injured patients meeting trauma team activation criteria including all deaths in the emergency room.

OUTCOME MEASURES: TRISS methodology to compare expected and observed outcome. Statistical analysis: W, M, and Z statistics and comparison with MTOS data.

RESULTS: 279 patients meeting the trauma triage criteria presented to the emergency room, 235 (84.2%) were men and 44 (15.8%) women. Blunt injury accounted for 204 (73.1%) and penetrating for 75 (26.9%) patients. Seventy two patients had injury severity score of more than 15. Only 18 (6.4%) patients were transported in an ambulance. A total of 142 (50.9%) patients were transferred from other hospitals with a mean prehospital delay of 7.1 hours. M statistic of our study subset was 0.97, indicating a good match between our patients and MTOS cohort. There were 18 deaths with only one unexpected survivor. The expected number of deaths based on MTOS dataset should have been 12.

CONCLUSIONS: Present injury severity instruments using MTOS coefficients do not accurately correlate with observed survival rates in a developing country. (Copyright © 2002 BMJ Publications Group)
The Interchangeability of Homicide Data Sources: A Spatial Analytical Perspective.

Baller RD, Messner SF, Anselin L. Homicide Stud 2002, 6(3): 211-227.

Correspondence: Robert D. Baller, Department of Sociology, The University of Iowa, W140 Seashore Hall, Iowa City, Iowa 52242-1401, USA; (email: robert-baller@uiowa.edu).

The authors extend the work of Wiersema, Loftin and McDowall (2000) by assessing the interchangeability of Supplemental Homicide Report (SHR) and National Center for Health Statistics (NCHS) homicide rates in the context of spatial analysis. Conclusions drawn from spatial analyses may be affected by the choice of data source if the underrecording of homicide tends to cluster in geographic space more strongly in one data source than the other. Such a situation could alter indications of homicide rate clustering and substantive conclusions drawn from multivariate spatial regression models. Results indicate that although these data sources are interchangeable for urban counties, spatial effects and the effects of social structural factors vary by data source for rural counties. (Coopyright 2002 Sage Publications)
Underestimates of unintentional firearm fatalities: comparing Supplementary Homicide Report data with the National Vital Statistics System.

Barber C, Hemenway D, Hochstadt J, Azrael D. Inj Prev 2002; 8(3): 252-256.

Correspondence: Catherine Barber, Harvard Injury Control Research Center, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (email: cbarber@hsph.harvard.edu).

OBJECTIVE: A growing body of evidence suggests that the nation's vital statistics system undercounts unintentional firearm deaths that are not self inflicted. This issue was examined by comparing how unintentional firearm injuries identified in police Supplementary Homicide Report (SHR) data were coded in the National Vital Statistics System.

METHODS: National Vital Statistics System data are based on death certificates and divide firearm fatalities into six subcategories: homicide, suicide, accident, legal intervention, war operations, and undetermined. SHRs are completed by local police departments as part of the FBI's Uniform Crime Reports program. The SHR divides homicides into two categories: "murder and non-negligent manslaughter" (type A) and "negligent manslaughter" (type B). Type B shooting deaths are those that are inflicted by another person and that a police investigation determined were inflicted unintentionally, as in a child killing a playmate after mistaking a gun for a toy. In 1997, the SHR classified 168 shooting victims this way. Using probabilistic matching, 140 of these victims were linked to their death certificate records.

RESULTS: Among the 140 linked cases, 75% were recorded on the death certificate as homicides and only 23% as accidents.

CONCLUSION: Official data from the National Vital Statistics System almost certainly undercount firearm accidents when the victim is shot by another person. (Copyright © 2002 BMJ Publications Group)
Recording of community violence by medical and police services.

Sutherland I, Sivarajasingam V, Shepherd JP. Inj Prev 2002; 8(3): 246-247.

Correspondence: Ian Sutherland, Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine, Heath Park, Cardiff, CF14 4XN, UK; (email: sutherlandi3@cardiff.ac.uk).

OBJECTIVES: To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police.

METHODS: Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located.

RESULTS: Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0).

CONCLUSIONS: Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0-10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection. (Copyright © 2002 BMJ Publications Group)

Study of the effectiveness of the US safety standard for child resistant cigarette lighters.

Smith LE, Greene MA, Singh HA. Inj Prev 2002; 8(3): 192-196.

Correspondence: Linda E. Smith, Hazard Analysis Division, Directorate for Epidemiology, US Consumer Product Safety Commission, 4330 East West Highway, Bethesda, MD 20814–4408, USA; (email: lsmith@cpsc.gov).

OBJECTIVE: The purpose of this research is to evaluate the effectiveness of the US Consumer Product Safety Commission's (CPSC) Safety Standard for Cigarette Lighters, which requires that disposable cigarette lighters be resistant to operation by children younger than age 5.

METHODS: Fire data on children playing with lighters were solicited from selected US fire departments for incidents occurring from 1997-99, to identify the proportion of such fires caused by children younger than age 5 playing with cigarette lighters. These data were compared with similar data from 1985-87. An odds ratio was used to determine if there was a significant decrease in cigarette lighter fires caused by children younger than age 5 compared to children ages 5 and older. To estimate fires that would have occurred without the standard, the odds ratio, adjusted for population, was applied to 1998 national estimates of fires occurring. National estimates of 1998 fire losses were based on data from the National Fire Incident Reporting System and the National Fire Protection Association to which the 1997-99 age and lighter type distributions were applied. The difference between the fire losses that would have occurred and those that did occur represented fire losses prevented.

RESULTS: In the post-standard study, 48% of the cigarette lighter fires were started by children younger than age 5, compared with 71% in the pre-standard study. The odds ratio of 0.42 was statistically significant (p < 0.01). This represented a 58% reduction in fires caused by the younger age group compared to the older age group. When applied to national fire loss data, an estimated 3300 fires, 100 deaths, 660 injuries, and $52.5 million in property loss were prevented by the standard in 1998, totaling $566.8 million in 1998 societal savings.

CONCLUSIONS: The CPSC standard requiring child resistant cigarette lighters has reduced fire deaths, injuries, and property loss caused by children playing with cigarette lighters and can be expected to prevent additional fire losses in subsequent years. (Copyright © 2002 BMJ Publications Group)
Hot iron burns in children.

Simons M, Brady D, McGrady M, Plaza A, Kimble R. Burns 2002; 28(6): 587-590.

Correspondence: Roy Kimble, Queens University, Ireland, Belfast, UK; (email: royk@mailbox.uq.edu.au).

BACKGROUND: Burns for contact with irons are an important preventable cause of burns in children. The objective of this study, was to document and describe these burns. The report describes 50 children with iron burns who were treated at our Burns Unit between 1997 and 2001.

METHODS: Prospective data collection demographics, nature of contact with iron, site, body surface area (BSA), medical and surgical interventions and complications and hand preference were examined.

RESULTS: The median of age patients was 17 months. The majority of burns were caused by touching the iron (44%) or by pulling the cord (38%). Most of the children were supervised (74%) and the iron was switched off in 34% of the injuries. Seventy-six percent of children sustained hand burns. Although, burn areas were relatively small, 36% required grafting. Residual scarring occurred in 42% and contractures in 10%. Surgical release of contractures was required in 4%.

CONCLUSION: There is clearly a wide scope for prevention of hot iron burns. A public education campaign is now planned including: leaflets distributed at the point of purchase of the iron, public education via media outlets and lobbying of iron manufacturers to improve safety features. (Copyright © 2002 Elsevier Science)
Predisposing and precipitating factors for falls among older people in residential care.

Kallin K, Lundin-Olsson L, Jensen J, Nyberg L, Gustafson Y. Public Health 2002; 116(5): 263-71.

Correspondence: Kristina Kallin, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umea University, Umea, SWEDEN; (email: kristina.kallin@germed.umu.se).

Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures.Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures.We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise. (Copyright © 2002 Royal Institute of Public Health, published by Nature Publications Group)

Children's injuries in agriculture related events: the effect of supervision on the injury experience.

Pryor SK, Caruth AK, McCoy CA. Issues Compr Pediatr Nurs 2002; 25(3): 189-205.

Correspondence: Susan K. Pryor College of Nursing and Health Sciences, Southeastern Louisiana University, Baton Rouge, Louisiana, USA; (email: spryor@selu.edu).

BACKGROUND: An international health problem and the leading cause of death and disability among children in the United States are unintentional injuries. Children in rural areas in the United States have the highest death rate related to unintentional injuries regardless of age (Crawley, 1996).

METHODS: Using Haddon's Injury Model as the theoretical framework, the purpose of this study is threefold. First the study describes actual injuries that were sustained by farm children. Second, the research identifies the type of supervision the farm children and adolescents were receiving at the time of the injury, and finally the study examines injury risk in relation to supervision. Descriptive and categorical data analysis methods were used to examine the associations between farm-related injury and supervision type.

RESULTS: Out of 177 children living in the home under 18 years of age, 32 children sustained at least one injury and eight sustained two injuries within one year from the time of the survey. The majority of children needed medical attention because of their injuries (n = 37). Children were more likely to sustain farm-related injury when they were supervised by a caregiver engaged in farm work versus supervised at home (p =.007).

DISCUSSION: The findings of this study support Haddon's Injury Model, which suggests injuries occur because of an uncontrolled interaction between a host, an agent, and the environment. Examining the children's role within the framework of Haddon's Injury Model, will assist researchers in designing evidenced-based research that addresses the interaction between the host, agent, and environmental factors. Results from these studies will be useful in identifying effective interventions in the pre-event phase, as well as maximizing quality of life in the postevent phase. (Copyright © 2002 Taylor & Francis Health Sciences)
Health and safety hazards in Northwest agriculture: Setting an occupational research agenda.

Fenske RA, Hidy A, Morris SL, Harrington MJ, Keifer MC. Am J Ind Med 2002; Suppl 2: 62-67.

Correspondence: Richard A. Fenske Department of Environmental Health, Box 357234, University of Washington, Seattle, WA 98195, USA; (email: rfenske@u.washington.edu).

BACKGROUND: Agriculture is among the most hazardous occupations in the United States. Research can provide new insights about disease and injury and serve as the foundation for occupational health and safety policies. The determination of research priorities can be problematic. Public participation approaches offer opportunities to identify and integrate various perspectives.

METHODS: The agenda process was modeled on the NIOSH National Occupational Research Agenda. Center staff contacted representatives of producer groups, labor, health care, academia, and public agencies to participate in telephone interviews and a daylong workshop.

RESULTS: Twelve research priorities were identified: musculoskeletal disorders; respiratory disease; skin disease; traumatic injuries; chemical exposures; special populations at risk; social and economic foundations of workplace safety; risk communication barriers; diagnostic approaches; hazard control technology; intervention effectiveness; and surveillance research methods.

CONCLUSIONS: The agenda process engaged stakeholders in priority setting. The resulting document is a useful guide for occupational safety and health in agriculture. Am. J. Ind. Med. Suppl. 2:62-67, 2002. (Copyright 2002 Wiley-Liss)

Preservice teachers' perceived confidence in teaching school violence prevention.

Kandakai TL, King KA. Am J Health Behav 2002; 26(5): 342-353.

Correspondence: Tina L. Kandakai, Department of Adult, Counseling, Health, and Vocational Education, Kent State University, OH 44242-0001, USA; (email: tkandaka@kent.edu).

OBJECTIVE: To examine preservice teachers' perceived confidence in teaching violence prevention and the potential effect of violence-prevention training on preservice teachers' confidence in teaching violence prevention.

METHODS: Six Ohio universities participated in the study. More than 800 undergraduate and graduate students completed surveys.

RESULTS: Violence-prevention training, area of certification, and location of student- teaching placement significantly influenced preservice teachers' perceived confidence in teaching violence prevention.

CONCLUSION: Violence-prevention training positively influences preservice teachers' confidence in teaching violence prevention. The results suggest that such training should be considered as a requirement for teacher preparation programs. (Ciopyright © 2002 PNG Publications)

A review of interventions to reduce the prevalence of parasuicide.

Comtois KA. Psychiatr Serv 2002; 53(9): 1138-1144.

Correspondence: Katherine Anne Comtois, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359911, Seattle, Washington 98104 (e-mail: comtois@u.washington.edu).

OBJECTIVE: The author reviewed studies of treatments for parasuicide in order to assist health services planners, administrators, and clinicians develop and improve interventions for parasuicide and decrease its prevalence.

METHODS: Parasuicide, which is a major risk factor for completed suicide, was defined as any nonfatal self-injury, including suicide attempts and self-mutilation. The literature from 1970 to 2001 was searched using MEDLINE and PsycINFO. Only experimental and quasi-experimental controlled trials of treatment for parasuicidal individuals were selected for review.

RESULTS AND CONCLUSIONS: Epidemiological research shows that parasuicide is a prevalent problem afflicting 4 to 5 percent of individuals in the United States. Parasuicide is a significant predictor of completed suicide, which is the ninth leading cause of death in the United States and accounts for 50 percent more deaths than homicide. Although research on treatments for parasuicide is limited, several treatments have received empirical support. Studies of usual care indicate that empirically supported treatments are rarely used and that standard treatments, particularly hospitalization, are very expensive. The author suggests eight practical steps, based on the literature and established health services strategies, for improving services to parasuicidal individuals. These steps are establishing case registries, evaluating the quality of care for parasuicidal persons, evaluating training in empirically supported treatments for parasuicide, ensuring fidelity to treatment models, evaluating treatment outcomes, identifying local programs for evaluation, providing infrastructural supports to treating clinicians, and implementing quality improvement projects. (Copyright © 2002 American Psychiatric Association)
Characteristics of suicidal adolescents and young adults presenting to primary care with non-suicidal (indeed non-psychological) complaints.

Joiner TE Jr., Jon J. Pfaff JJ, Acres JG. Eur J Public Health 2002; 12(3): 177-179.

Correspondence: Thomas E. Joiner, Jr., Department of Psychology, Florida State University, Tallahassee, Florida, USA; (email: joiner@psy.fsu.edu).

BACKGROUND: Some young people presenting to primary care experience suicidal symptoms that they do not report.

METHODS: We conducted a survey of suicidal ideation among 15-24-year-old patients presenting to Australian general practitioners.

FINDINGS: Patients who experienced substantial, but unstated, suicidal symptoms tended to be female and somewhat younger; their depression and distress levels, while not as high as suicidal patients with psychological complaints, were nonetheless elevated.

DISCUSSION: Young patients who evince any signs of depression or distress, particularly but not only young females, should be evaluated regarding psychological symptoms, including suicidal ideation. (Copyright © 2002 European Journal of Public Health)

Driving performance of drivers with impaired central visual field acuity.

Lamble D, Summala H, Hyvarinen L. Accid Anal Prev 2002; 34(5): 711-716.

Correspondence: Heikki Summala, Department of Psychology, University of Helsinki, P.O. Box 13, FIN-00014 Helsinki, FINLAND; (email: heikki.summala@helsinki.fi).

OBJECTIVES: This study investigated the performance of drivers with impairment to their central field of vision but with normal peripheral vision, due to retinoschisis, in a safety critical driving tasks.

METHODS: The performance of five male drivers with impaired vision (VA 0.2), aged between 40 and 50 years, all with more than 250,000 km life-time driving experience and a good safety record, and five normal vision controls, matched by gender, age, driving experience and safety record, were tested in 40 km/h city traffic and in a motorway car following situation.

FINDINGS: All participants displayed appropriate driving ability in city traffic and all were able to detect and respond adequately to a conflicting 'stunt pedestrian' and 'stunt cyclist' situation. There were no apparent differences between the drivers with impaired vision and those with normal vision. In the car following situation, the participants drove at 80 km/h, 50 m behind a lead car, on a 30 km section of motorway in normal traffic. During each trial, the lead car started to decelerate at an average of 0.53 m/s2 while the participant either looked at the car in front (control) or performed a memory and addition task (non-visual attention) while looking at the car in front. The participants were required to press the brake pedal when they noticed a decrease in headway. The participant's brake reaction time to the onset of the lead car's brake lights was also tested. The drivers with impaired vision were significantly slower, by 0.2 s, in detecting the onset of brake lights than the normal vision drivers. Their headway closure detection was 0.7 s slower than normal vision drivers, but this difference was not statistically significant in this small data.

DISCUSSION: In spite of some impairment in car following (central vision task), the results together with the clean record of these drivers with retinoschisis support the idea that visual acuity of 0.5 (the European Union norm) is not a necessary prerequisite for safe driving. (Copyright © 2002 Elsevier Science)
Is Road Rage a Serious Traffic Problem?

Smart RG, Mann RE. Traf Inj Prev 2002; 3(3): 183-189.

Correspondence: Reginald G. Smart, Centre for Addiction and Mental Health, Toronto, Ontario, CANADA; (email: reg_smart@camh.net).

In the past few years, one aspect of traffic safety, "road rage," has increasingly caught the attention of the media. There have been suggestions that road rage is a common occurrence on our roads, and that it is increasing as a result of the increasing pressures of modern society. There is no scientific basis for these suggestions. The topic is inconsistently defined, with little scientific evidence available. However, there are indications that road rage does occur, that it may not be a rare event or experience, and that it may have the potential to account for an important, if small, portion of road safety problems experienced in modern societies. Research needs are outlined. (Copyright © 2002 Taylor & Francis)
Hospital Cost Is Reduced by Motorcycle Helmet Use.

Brandt M-M, Ahrns KS, Corpron CA, Franklin GA, Wahl WL. J Trauma 2002; 53(3): 469-471.

Correspondence: Mary-Margaret Brandt, MD, 1C421 University Hospital, Box 0033, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0033, USA; (email: mmbrandt@med.umich.edu).

BACKGROUND: The purpose of this study was to identify the impact of motorcycle helmet use on patient outcomes and cost of hospitalization, in a state with a mandatory helmet law.

METHODS: Patients admitted after motorcycle crashes from July 1996 to October 2000 were reviewed, including demographics, Injury Severity Score, length of stay, injuries, outcome, helmet use, hospital cost data, and insurance information. Statistical analysis was performed comparing helmeted to unhelmeted patients using analysis of variance, Student's t test, and regression analysis.

FINDINGS: We admitted 216 patients: 174 wore helmets and 42 did not. Injury Severity Score correlated with both length of stay and cost of hospitalization. Mortality was not significantly different in either group. Failure to wear a helmet significantly increased incidence of head injuries (Student's t test, p < 0.02), but not other injuries. Helmet use decreased mean cost of hospitalization by more than $6,000 per patient.

DISCUSSION: Failure to wear a helmet adds to the financial burden created by motorcycle-related injuries. Therefore, individuals who do not wear helmets should pay higher insurance premiums. (Copyright © 2002, Lippincott Williams & Wilkins)
Booster seats: a community based study of installation and use by parents and caregivers.

Stepanski BM, Ray LU, Nichols L. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 37-48.

Correspondence: Barbara M. Stephanski, Division of Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, California, USA; (email: bstepahe@co.san-diego.ca.us).

This paper describes characteristics of child safety seat misuse among attendees at 41 inspections held between February 1999-April 2001 in San Diego County, CA. Standardized criteria were assessed by certified technicians. These 41 events consisted of 988 inspections for proper installation and adjustment. 963 had a determined seat type (rear-facing, forward facing, belt positioning boosters, shield boosters, other restraint, vehicle safety belts). Each seat type had specific criteria for misuse ranging from 3 to 15 measures. 95.6% had at least one error, which could reduce the seat's protection of its occupant from injury in a crash. (Copyright © 2001 Association for the Advancement of Automotive Medicine)
Benefits and Costs of Ultraviolet Fluorescent Lighting

Lestina DC, Miller TR, Langston EA, Knoblauch R, Nitzburg M. Traf Inj Prev 2002; 3(3): 209-215.

Correspondence: Ted R. Miller, Pacific Institute for Research and Evaluation, Calverton, Maryland, USA; (email: miller@pire.org).

Ultraviolet (UVA) headlights are potentially a cost-effective way of reducing nighttime motor vehicle crashes and pedestrian crashes. A field study comparing UVA headlights to standard low beam headlights found significant improvements in detection and recognition distances for pedestrian scenarios, ranging from 34% to 117%. A cost analysis of using UVA headlights, along with fluorescent roadway paint, found that a 19.5% reduction in nighttime motor vehicle crashes involving pedestrians or pedal-cyclists will pay for the additional UVA headlight costs if headlights cost $100. Alternatively, given the same assumption, a 5.5% reduction in all relevant nighttime crashes will pay for the additional costs of UVA headlights and fluorescent highway paint combined. If the increased detection and recognition distances resulting from using UVA-fluorescent technology observed in this field study moderately reduce relevant crashes, the benefit cost ratios will exceed 1.0. Thus, the UVA-flourescent technology is potentially cost-effective and merits further consideration. (Copyright © 2002 Taylor & Francis)
Characteristics of pregnant women in motor vehicle crashes.

Weiss HB, Strotmeyer S. Inj Prev 2002; 8(3):207-210.

Correspondence: Harold B Weiss, Center for Injury Research and Control, University of Pittsburgh, 200 Lothrop St, Suite B400, Pittsburgh 15213, PA, USA; (email: hweiss@injurycontrol.com).

OBJECTIVES: Motor vehicle crashes are the leading cause of hospitalized trauma during pregnancy. Maternal injury puts the fetus at great risk, yet little is known about the incidence, risks, and characteristics of pregnant women in crashes.

METHODS: Police reported crashes were analyzed from the National Automotive Sampling System Crashworthiness Data System. Since 1995, this system recorded pregnancy/trimester status. Pregnant and non-pregnant women 15-39 years of age were compared by age, driver status, seat belt use, and treatment. Belt use and seating position were examined by trimester.

RESULTS: There were 427 pregnant occupants identified (weighted n=32 810, 2.6%, SE 12 585, rate 13/1000 person years). The mean age was 24.9 compared with 24.8 years (pregnant v non-pregnant). Cases were distributed by trimester as follows: first 29.8%, second 36.4%, and third 33.8%. Pregnant women were drivers 70% of the time compared with 71% for non-pregnant women. No belt use was 14% compared with 13% (pregnant v non-pregnant). Mean injury severity was lower for pregnant women but they were more likely to transported or hospitalized. Improper belt use decreased after the first trimester and there was little change in driver proportion by trimester. Third trimester hospitalization rates increased.

CONCLUSIONS: Pregnant occupants in crashes have similar profiles of restraint use, driver status, and seat position but different treatment indicators compared to non-pregnant occupants. Trimester status has relatively little impact on crash risk, seating position or restraint use. Undercounting of pregnant cases was possible, even so, 1% of all births were reported to be involved in utero in crashes. Little research has focused on developmental outcomes to infants and children previously involved in exposure to these crashes. (Copyright © 2002 BMJ Publications Group)
Exploring the Effects of a Road Safety Advertising Campaign on the Perceptions and Intentions of the Target and Nontarget Audiences to Drink and Drive.

Tay R. Traf Inj Prev 2002; 3(3): 195-200.

Correspondence: Richard Tay, Centre for Accident Research and Road Safety, Queensland University of Technology, Carseldine, AUSTRALIA; (email: r.tay@qut.edu.au).

This commentary explores the efficacy of a road safety advertising campaign in changing drivers' perceptions and intentions to drink and drive. Using data collected via a survey on a sample of students at Lincoln University in New Zealand in October 1999, this study found that the campaign appeared to be successful in increasing the perceived apprehension and crash risks associated with drunk driving and decreasing the intentions of the drivers to drink and drive. However, contrary to expectation, the campaign did not elicit a stronger change in the target audience relative to the nontarget audience. There was partial evidence to support the publicity campaign, but some refinements could be made to increase its efficacy among the target audience. In particular, the level of fear arousal should be moderated and the audience should be provided with effective and viable coping strategies to address the threat associated with drunk driving. (Copyright © 2002 Taylor & Francis)
Relationship between crash rate and hourly traffic flow on interurban motorways.

Martin JL. Accid Anal Prev 2002; 34(5): 619-629.

Correspondence: Jean-Louis Martin, Institut National de Recherche sur les Transports et leur Securite, Bron, FRANCE; (email: jean-louis.martin@inrets.fr).

This report describes the relationship between crash incidence rates and hourly traffic volume and discusses the influence of traffic on crash severity, based on observations made on 2000 km of French interurban motorways over 2 years. Incidence rates involving property damage-only crashes and injury-crashes are highest when traffic is lightest (under 400 vehicles/h). These incidence rates are at their lowest when traffic flows at a rate of 1000-1500 vehicles/h. For heavier traffic flows, crash incidence rates increase steadily as traffic increases on 2- and 3-lane motorways and inflect on 2-lane motorways when traffic increases to a level of 3000 vehicles/h. For an equivalent light traffic level, the number of crashes is higher on three-lane than on 2-lane motorways and higher at weekends (when truck traffic is restricted) than on weekdays. In heavy traffic, the number of crashes is higher on weekdays. We found no significant difference between the number of daytime and night-time crashes, whatever the traffic. No difference was observed in crash severity by number of lanes or period in the week for a given level of traffic. However, severity is greater at night and when hourly traffic is light. Compared to the number of vehicles on the road, light traffic is a safety problem in terms of frequency and severity, and road safety campaigns targeting motorway users to influence their behavior in these driving conditions should be introduced.
The effect of seating position on risk of injury for children in side impact collisions.

Durbin DR, Elliott M, Arbogast KB, Anderko RL, Winston FK. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 61-72.

Correspondence: Dennis R. Durbin, Department of Pediatrics, Children's Hospital of Philadelphia, USA; (email: ddurbin@cceb.med.upenn.edu).

The objective of this study was to evaluate the effect of seating position on risk of injury to children in side impact crashes. 5,632 children under age 16 in side impact crashes were enrolled as part of an on-going crash surveillance system which links insurance claims data to telephone survey and crash investigation data. Children seated in the front seat were at higher risk of significant injury than children seated in the rear (OR = 2.2 95% CI (1.2-3.8)). After adjusting for age, restraint use, and vehicle damage, children in the front seat were more likely to be injured (OR 2.6 95% CI (1.1-6.2)) than children seated in the rear when the child was sitting near the side of the impact. These results highlight the importance of evaluating the safety performance of both vehicles and restraint systems for children in side impact crashes.
Motor vehicle occupant crashes among teens: impact of the graduated licensing law in San Diego.

Smith AM, Pierce J, Ray LU, Murrin PA. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 379-385.

Correspondence: Alan M. Smith, County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, USA; (email: asmit1he@co.san-diego.ca.us).

To assess the effect of California's graduated driver's license (GDL) law in San Diego County, we compared motor vehicle crash and passenger injury rates involving 16-year-old drivers for 1999 and 2000, the first two years of the law, against 1997, using data from a statewide database of all injury crashes. While the crash rate per 1,000 drivers did not change following GDL, a significant decline in the percentage of 16-year-olds with a driver's license corresponded with large decreases in population-based crash and injury rates.

See abstract under Reports of Injury Occurrence
See abstracts under Research Methods
Children Who Witness Violence, and Parent Report of Children's Behavior.

Augustyn M, Frank DA, Posner M, Zuckerman B. Arch Pediatr Adolesc Med 2002; 156(8):800-803.

Correspondence: Marilyn C. Augustyn, Boston University Medical Center, Maternity 5, One BMC Pl, Boston, MA 02118, USA; (email: augustyn@bu.edu).

OBJECTIVES: To examine how much distress children report in response to violence that they have witnessed and how this is associated with parental reports of children's behavior.

METHODS: As part of a study of in utero exposure to cocaine, children completed the Levonn interview for assessing children's symptoms of distress in response to witnessing violence. The children's caregivers completed the Exposure to Violence Interview (EVI), a caretaker-report measure of the child's exposure to violent events during the last 12 months. The EVI was analyzed as a 3-level variable: no exposure, low exposure, and high exposure. The caregivers also completed the Children's Behavior Checklist (CBCL).

RESULTS: Of 94 six-year-old children, 58% had no exposure to violence, 36% had low exposure to violence, and 6% had high exposure to violence, according to caretaker reports. The children's median+/-SD Levonn score was 64 (SD +/- 19.3). The mean SD +/- CBCL total T-score was 53 (SD +/- 10.2). In multiple regression analyses with gender, low and high exposure on EVI, Levonn, and prenatal cocaine exposure status as predictors, the Levonn score explained 4.8% of total variance in children's CBCL internalizing scores, 9.1% of the total variance in CBCL externalizing score, and 12.2% of the total variance in CBCL total score (P =.04, P =.004, and P <.001, respectively).

CONCLUSIONS: After accounting for the caretaker's report of the level of the child's exposure to violence, the child's own report significantly increased the amount of variance in predicting child behavior problems with the CBCL. These findings indicate that clinicians and researchers should elicit children's own accounts of exposure to violence in addition to the caretakers' when attempting to understand children's behavior. (Copyright © 2002 American Medical Association)
Effect of abuse on health: results of a national survey.

Diaz A, Simantov E, Rickert VI. Arch Pediatr Adolesc Med 2002; 156(8):811-817.

Correspondence: Angela Diaz, Mount Sinai Adolescent Health Center, 320 E 94th St, New York, NY 10128, USA; (email: angela.diaz@msnyuhealth.org).

HYPOTHESIS: The magnitude of risk would be highest for those reporting both types of abuse compared with those reporting 1 type or none.

OBJECTIVE: To examine the independent associations between physical or sexual abuse or both and self-reported health status, mental health, and health-risk behaviors among a national school-based sample of adolescent girls.

DESIGN: A secondary data analysis of a cross-sectional survey.

SETTING: A nationally representative sample of 3015 girls in grades 5 through 12 from 265 public, private, and parochial schools (with an oversampling of urban schools) completed an anonymous survey conducted by the Commonwealth Fund Adolescent Health Survey.

PATIENTS OR OTHER PARTICIPANTS: Girls were eligible for this study if they responded to 2 questions assessing past physical and sexual abuse.

RESULTS: Among the respondents, 246 (8%) reported a history of physical abuse; 140 (5%), sexual abuse; and 160 (5%), both. Logistic regression controlling for grade, ethnicity, family structure, and socioeconomic status found that those who reported both types of abuse compared with those who did not report any were significantly more likely to experience moderate to severe depressive symptoms (adjusted odds ratio [AOR], 5.10), moderate to high levels of life stress (AOR, 3.28), regular smoking (AOR, 5.90), regular alcohol consumption (AOR, 3.76), use of other illicit drugs in the past 30 days (AOR, 3.44), and fair to poor health status (AOR, 1.74). Finally, girls who reported both types of abuse were 2.07 times more likely to report moderate to high depressive symptoms compared with those reporting only sexual abuse (95% confidence interval, 1.14-3.74).

CONCLUSIONS: The magnitude of risk for adolescents reporting both types of abuse compared with no abuse is much greater than that for either abuse type alone. However, compared with both types, no significant increase in risk was detected in those reporting physical abuse only, and only depressive symptoms increased in those reporting sexual abuse only. (Copyright © 2002 American Medical Association)
What distinguishes unintentional injuries from injuries due to intimate partner violence: a study in Greek ambulatory care settings.
Petridou E, Browne A, Lichter E, Dedoukou X, Alexe D, Dessypris N. Inj Prev 2002; 8(3):197-201.

Correspondence: Eleni Petridou, Associate Professor of Epidemiology, Department of Epidemiology, Athens University Medical School, 75 Mikras Asias Str, Athens 11527, GREECE; (email: epetrid@med.uoa.gr). OBJECTIVES: Intimate partner violence (IPV) is an important sociocultural and public health problem. This study aims to assess sociodemographic and injury characteristics of IPV victims among adults in a traditional southern European population.

SETTING: Accident and emergency departments of three sentinel hospitals in Greece participating in the Emergency Department Injury Surveillance System (EDISS).

METHODS: Data on sociodemographic variables, as well as event and injury characteristics were retrieved from the EDISS database during the three year period 1996-98. Out of a total of 27 319 injured women aged 19 years or more, 312 (1.1%) were reported as IPV related and were compared with 26 466 women with unintentional injuries. Among the 35 174 men with injuries 39 (0.1%) were reported as IPV related and were compared with 34 049 men with unintentional injuries. The data were analyzed through simple cross tabulations and multiple logistic regression. Positive predicted values for selected injury characteristics were also calculated.

RESULTS: IPV is more common in rural than in urban areas of Greece. Women are 10 times more frequently IPV victims but men are also IPV victims; younger women and older men are disproportionately affected by IPV. The relative frequency of the phenomenon increases during the late evening and night hours. Certain types of injuries, notably multiple facial injuries, and presentation of the injured person on his/her own at the emergency department or combinations of predictive characteristics are strongly indicative of IPV.

CONCLUSIONS: Injuries due to IPV are not uncommon in Greece, not withstanding the traditional structure of the society and the tendency of under-reporting. Certain injury characteristics have high positive predictive values and could be used in screening protocols aiming at the correct identification of the underlying external cause in injuries that may be caused by IPV. (Copyright © 2002 BMJ Publications Group)

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