Inspired by the critical incident technique of McKnight et al. (1995) who analyzed 12,000 drivers' decisions leading to (or not to) DWI, and identified the influence of social, motivational, and economic factors, we have developed a social-sequential model of young drivers' DWI (driving while intoxicated) and RWDI (riding with a driver under influence) prevention. DWI or RWDI may be analyzed as a four-stage process: (1) the decision to drink and to associate leisure activities with drinking; (2) the management of alcohol consumption during the evening; (3) the decision to drive after drinking; and (4) the behavioral adaptation, once the decision to drive is taken (disinhibition of risk-taking or risk compensation). At each of these four stages, preventive action can reflect the intervention of two types of actors: (1) formal social control of behavior is influenced by professionals involved in accident prevention, and (2) informal social control of behavior is influenced by the proximal environment of the subject.
Evaluation of the Ngati Porou Community Injury Prevention Project.
- Brewin M, Coggan C. Ethn Health 2004; 9(1): 5-15.
Correspondence: Marilyn Brewin, Injury Prevention Research Centre, Faculty of Medicine and Health Sciences, University of Auckland, NEW ZEALAND; (email: m.brewin@auckland.ac.nz).
OBJECTIVE: To evaluate the Ngati Porou Community Injury Prevention Project based in a rural district in the North Island of New Zealand with an extensive indigenous population (Maori).
METHODS: The evaluation design was quasi-experimental and included process, impact and outcome measures.
FINDINGS: Process evaluation found that the Ngati Porou Community Injury Prevention Project was based on sound principles related to injury prevention, as well as addressing Maori aspirations. The main activities undertaken were: road safety campaigns; alcohol and drug programmes; family violence initiatives; and the development of a playground safety audit. A significant increase in awareness of injury prevention was found among Ngati Porou whanau (families) (pre 17% and post 25%, p < 0.05). Injury morbidity statistics for the period 1996-99 showed a significant decrease in injury rates for all age groups, compared with the comparison community (p < 0.05).
COMMENTS: The Ngati Porou Community Injury Prevention Project successfully applied the principles of role modelling, life span focus, accessibility, acceptability and active participation. This is a promising model that could be repeated in other indigenous communities.
Sleepiness, Sleep Disordered Breathing and Accident Risk Factors in Commercial Vehicle Drivers.
- Howard ME, Desai AV, Grunstein RR, Hukins C, Armstrong JG, Joffe D, Swann P, Campbell DA, Pierce RJ. Am J Respir Crit Care Med 2004; (Epub ahead of print).
Correspondence: Mark Howard, Institute of Breathing and Sleep, Austin Health and University of Melbourne, Heidelberg, Victoria, AUSTRALIA; (email: mark.howard@austin.org.au).
Sleep disordered breathing and excessive sleepiness may be more common in commercial vehicle drivers than the general population. The relative importance of factors causing excessive sleepiness and accidents in this population remains unclear. We measured the prevalence of excessive sleepiness and sleep disordered breathing and assessed accident risk factors in 2342 respondents to a questionnaire distributed to a random sample of 3268 Australian commercial vehicle drivers and another 161 drivers among 244 invited to undergo polysomnography. 59.6% of drivers had sleep disordered breathing and 15.8% had obstructive sleep apnea syndrome. 24% of drivers had excessive sleepiness. Increasing sleepiness was related to an increased accident risk. The sleepiest 5% of drivers on the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire had an increased risk of an accident (odds ratio 1.91, p=0.02 and 2.23, p<0.01 respectively) and multiple accidents (odds ratio 2.67, p<0.01 and 2.39, p=0.01), adjusted for established risk factors. There was an increased accident risk with narcotic analgesic use (odds ratio 2.40, p<0.01) and antihistamine use (odds ratio 3.44, p=0.04). Chronic excessive sleepiness and sleep disordered breathing are common in Australian commercial vehicle drivers. Accident risk was related to increasing chronic sleepiness and antihistamine and narcotic analgesic use.
OBJECTIVE: To identify determinants of mothers' home-safety practices for preventing six types of common injuries to children (burns, poisoning, drowning, cuts, strangulation/suffocation/choking, and falls).
METHODS: Home interviews were conducted with mothers of children 19-24 and 25-30 months old about home-safety practices. For each of 30 safety precautions to prevent these six types of injuries, mothers indicated whether or not they engaged in the practice, and explained why.
FINDINGS: Regression analyses revealed both common and unique determinants of mothers' home-safety practices to prevent these six types of home injuries. For burns, cuts, and falls, beliefs that child characteristics and parent characteristics elevated the child's risk of injury were the key determinants of the mother's engaging in precautionary measures. For drowning, poisoning, and suffocation/strangulation/choking, health beliefs also contributed to predict mothers' practices, including beliefs about potential injury severity and extent of effort required to implement precautionary measures.
COMMENTS: The factors that motivated mothers to engage in precautionary measures at home varied depending on the type of injury. Intervention programs to enhance maternal home-safety practices will need to target different factors depending on the type of injury to be addressed.
Correspondence: Maria J Brunette, Department of Work Environment, University of Massachusetts-Lowell, One University Avenue, Lowell, MA 01854, USA; (email: Maria_Brunette@uml.edu).
While it is known that Hispanics have a continuous growing participation in the construction workforce and that their fatal and non-fatal occupational injuries are higher than any other ethnic group, very little construction safety and health research has been conducted in the United States. Research that focuses on safety and health of Hispanic workers employed in the construction industry might prove beneficial in reducing injuries and promoting safe and decent workplaces for all.The purpose of this article was twofold. First, to propose a research agenda where topics such as surveillance, intervention research on high risk occupations, intervention effectiveness evaluation, design and development of effective and appropriate safety training and educational materials, and the socioeconomic impact of injuries and illnesses, are investigated among the Hispanic construction workforce. Second, to present relevant aspects inherent to this particular population that need to be incorporated into the design and development stages of any safety and health research initiative. They include the occupational, social, economic, and cultural background of Hispanic workers; use of a participatory approach, proper selection and use of translation methods; and conducting collaborative research. Certain limitations and challenges related to the availability of resources for conducting safety and health research on Hispanic workers are further discussed.
Work related injuries in small scale commercial fishing.
Correspondence: Stephen W Marshall, CB#7435, Department of Epidemiology, McGarvan-Greenberg Hall, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA; (email: Smarshall@unc.edu).
OBJECTIVE: To describe the epidemiology of work related injury in a group of small scale, independent commercial fishers.
DESIGN: Cross sectional survey (baseline instrument of a prospective cohort study).Setting and SUBJECTS: Commercial fishers in eastern North Carolina.
RESULTS: A cohort of 219 commercial fishers was established and 215 subjects completed an injury questionnaire. The main types of fishing conducted by the cohort were finfishing (159/215) and crabbing (154/215). Of the 215 fishers, 83 reported that they had suffered an injury event in the previous 12 months, a retrospective recall incidence proportion of 38.6 per 100 workers (95% confidence interval 32.1 to 45.1). The 83 injury events resulted in 94 injuries; 47% were penetrating wounds and 24% were strains/sprains. Half of injuries were to the hand/wrist/digits and 13% were to the back. Of the penetrating wounds, 87% were to the hand/wrist/digits, 32% became infected, and 80% were caused by contact with finfish, shellfish, or other marine animal. Of the strains/sprains, 48% were to the back and 26% were to the shoulder. Seventy percent of strains/sprains were caused by moving heavy objects, mainly either while hauling in nets, pots, or lines or loading/unloading the boat.
CONCLUSION: In this group of small scale, independent fishers, the most common reported injuries were penetrating wounds to the hand/wrist/digits from marine animals and strains/sprains to the back while moving heavy objects.
Pedestrians injured by automobiles: Relationship of age to injury type and severity.
- Demetriades D, Murray J, Martin M, Velmahos G, Salim A, Alo K, Rhee P. J Am Coll Surg 2004; 199(3): 382-387.
Correspondence: Demetrios Demetriades, Division of Trauma and SICU, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA; (email: unavailable).
BACKGROUND: There is little research on the effect of age on the nature and severity of injuries to pedestrians struck by automobiles.
METHODS: Trauma registry study included all auto versus pedestrian trauma admissions of pedestrians injured by automobiles at an academic Level I trauma center over 10 years and 4 months. Injury Severity Score, severe body area (head, chest, abdomen, extremities) trauma with Abbreviated Injury Score >3, specific organ injuries, and mortality were calculated according to age groups (<==14 years, 15 to 55 years, 56 to 65 years, >65 years).
FINDINGS: During the study period 5,838 admissions were reviewed. There were 1,136 patients (19.4%) 14 years old or less, 3,741 (64.1%) who were 15 to 55 years, 420 (7.2%) 56 to 65 years, and 541 (9.3%) older than 65 years. Overall mortality was 7.7% and ranged from 3.2% in the age group 14 years or less to 25.1% in patients over 65 years. The incidences of severe trauma (Injury Severity Score >15) in the four age groups were 11.2%, 18.7%, 23.6%, and 36.8%, respectively. The incidences of critical trauma (Injury Severity Score >30) were 2.3%, 3.9%, 5.7%, and 13.9%, respectively. The incidence of severe head and chest trauma (Abbreviated Injury Score >3) increased with age. The incidence of solid organ and hollow viscus injuries was similar in all age groups. Spinal injuries increased significantly with age and ranged from 0.4% in the pediatric group to 8.5% in the elderly group. Pelvic and tibial fractures were significantly more common in adults; femur fractures were significantly more common in the pediatric group.
COMMENTS: Age plays an important role in the anatomic distribution and severity of injuries and survival outcomes after pedestrian injuries.
Bites attributed to the brown recluse spider, Loxosceles reclusa Gertsch & Mulaik, are frequently reported by medical personnel throughout Florida, whereas the extensive arachnological evidence contradicts the alleged widespread occurrence of Loxosceles spiders in the state. We compared reports of brown recluse spider bites made by medical personnel from a 6-yr Florida poison control center database to the known verifications of Loxosceles spiders from 100 yr of Florida arachnological data. Medical personnel diagnosed 124 brown recluse spider bites from 31 of Florida's 67 counties in 6 yr. In contrast, only 11 finds of approximately 70 Loxosceles spiders have been made in 10 Florida counties in 100 yr. Florida does not have sufficient widespread populations of Loxosceles spiders to warrant consideration of brown recluse spider envenomation as a probable etiology of dermonecrosis. Florida health care would improve if medical personnel would consider the multitude of other etiologies that manifest in dermonecrosis.
Case-control investigation of the factors affecting the risk of horses falling during steeplechase racing in the UK.
- Pinchbeck GL, Clegg PD, Proudman CJ, Morgan KL, French NP. Vet Rec 2004; 155(1): 11-15.
Correspondence: Gina Pinchbeck, Department of Veterinary Clinical Science, University of Liverpool, Leahurst, Neston CH64 7TE, UK; (email: unavailable).
A concurrent case-control study of 12 UK racecourses was made between March 1, 2000, and August 31, 2001, to identify and quantify the factors associated with the risk of horses falling in steeplechase races. Cases were defined as a jumping effort at a steeplechase fence that resulted in a fall and controls were defined as a successful jumping effort over any steeplechase fence at any of the 12 racecourses within 14 days before or after the case fall. Information on the horse, the jockey and the race were collected and all the fences on all the courses were surveyed. Conditional logistic regression was used to examine the relationships between the predictor variables and the risk of falling. There was one fall per 254 jumping efforts. The risk of a horse falling decreased the more times it had raced on a particular racecourse. The number of fences, the distance from the previous fence and the nature of the previous fence also affected the risk of falling. If the previous fence was a water jump the risk of falling increased; fences that were sited on flat or slight uphill gradients (up to approximately 1 in 25) were associated with a lower risk of horses falling than downhill fences, and higher takeoff boards were associated with a higher risk of falling.
Viewing lava safely: an epidemiology of hiker injury and illness in Hawaii Volcanoes National Park.
Correspondence: Travis Heggie, Department of Recreation, Park and Tourism Sciences, Texas A&M University, College Station, TX 77843-2261, USA; (email: heggie@tamu.edu).
OBJECTIVE: To report the injuries and illnesses encountered by wilderness hikers in Hawaii Volcanoes National Park attempting to hike to active lava flows and to investigate the roles that demographics, prior hiking experience, hiking behavior, and preparedness play in hiker vulnerability to injury and illness.
METHODS: During an 8-week period, daily on-site exit interviews of lava hikers were conducted by a uniformed park ranger and park volunteer. Information about the hiker's home residence, wilderness hiking experience, preparedness, health status, and health problems encountered during the hike was collected from a total of 804 hikers.
FINDINGS: A high rate of injury and illness was found among the study population. Scrapes and abrasions (59%), blisters (51%), and muscle strains and sprains (47%) were the most common injuries. Dehydration (77%) and respiratory irritation (46%) were the most common illnesses. Lower extremities were the most common site of injuries, and beginning hikers were the most vulnerable to injury and illness. Many hikers were inexperienced tourists willing to disregard warning signs and enter high-risk areas.
COMMENTS: Hawaii Volcanoes National Park is one of 22 US national park units with volcanic resources. The injuries and illnesses reported by the study group identify the impact that this type of environment can have on the safety of wilderness users in areas with similar resources. Recreating in remote and severe areas has inherent risks, but the high rate of injuries and illnesses sustained by the hikers of this study can potentially be reduced through the development of more direct risk management methods.
A comparison of data sources for the surveillance of work-related carpal tunnel syndrome in Massachusetts.
- Davis L, Wellman H, Hart J, Cleary R, Gardstein BM, Sciuchetti P. Am J Ind Med 2004; 46(3): 284-296.
Correspondence: Letitia Davis, Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, Massachusetts, USA; (email: Letitia.Davis@state.ma.us).
BACKGROUND: This study examined whether a state surveillance system for work-related carpal tunnel syndrome (WR-CTS) based on workers' compensation claims (Sentinel Event Notification System for Occupational Risks, SENSOR) and the Annual Survey of Occupational Injuries and Illnesses (SOII) identified the same industries, occupations, sources of injury, and populations for intervention.
METHODS: Trends in counts, rates, and female/male ratios of WR-CTS during 1994-1997, and age distributions were compared across three data sources: SENSOR, Massachusetts SOII, and National SOII. SENSOR and National SOII data on WR-CTS were compared by industry, occupation, and injury source.
FINDINGS: Due to small sample size and subsequent gaps in available information, state SOII data on WR-CTS were of little use in identifying specific industries and occupations for intervention. SENSOR and National SOII data on the frequency of WR-CTS cases identified many similar occupations and industries, and both surveillance systems pointed to computer use as a risk factor for WR-CTS. Some high rate industries identified by SENSOR were not identified using National SOII rates even when national findings were restricted to take into account the distribution of the Massachusetts workforce.
COMMENTS: Use of national SOII data on rates of WR-CTS for identifying state industry priorities for WR-CTS prevention should be undertaken with caution. Options for improving state SOII data and use of other state data systems should be pursued.
Effects of data limitations when modeling fatal occupational injury rates.
- Bena JF, Bailer AJ, Loomis D, Richardson D, Marshall S. Am J Ind Med 2004; 46(3): 284-296.
Correspondence: James Bena, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA; (email:jbena@bio.ri.ccf.org).
BACKGROUND: Occupational fatal injury rate studies are often based upon uncertain and variable data. The numerator in rate calculations is often obtained from surveillance systems that can understate the true number of deaths. Worker-years, the denominator in many occupational rate calculations, are frequently estimated from sources that exhibit different amounts of variability.
METHODS: Effects of these data limitations on analyses of trends in occupational fatal injuries were studied using computer simulation. Fatality counts were generated assuming an undercount. Employment estimates were produced using two different strategies, reflecting either frequent but variable measurements or infrequent, precise estimates with interpolated estimates for intervening years. Poisson regression models were fit to the generated data. A range of empirically motivated fatality rate and employment parameters were studied.
FINDINGS: Undercounting fatalities resulted in biased estimation of the intercept in the Poisson regression model. Relative bias in the trend estimate was near zero for most situations, but increased when a change in fatality undercounting over time was present. Biases for both the intercept and trend were larger when small employment populations were present. Denominator options resulted in similar rate and trend estimates, except where the interpolated method did not capture true trends in employment.
COMMENTS: Data quality issues such as consistency of conditions throughout the study period and the size of population being studied affect the size of the bias in parameter estimation.
Since the early 1980s, external causes have been the second greatest cause of death in Brazil. They also place a growing demand on health care services. The current study analyzes morbidity and mortality from external causes in Brazil. The study material consists of 118,367 deaths and 652,249 hospitalizations due to external causes during the year 2000. The data are from the National Mortality Information System and Hospital Information System. The mortality coefficient from external causes was 69.7/ 100 thousand (119.0/100 thousand for males and 21.8/100 thousand for women). Homicides were the leading cause of death (38.3% of the total), with a high coefficient of 26.7/100 thousand, while falls were the leading cause of hospitalizations (42.8% of the total). Motor vehicle accidents were a major cause of both morbidity and mortality. Fractures, mostly occurring in the upper and lower limbs, accounted for 42.6% of hospitalizations. Based on the findings, preventive programs should aim to decrease both mortality and morbidity, with special emphasis on homicides, traffic accidents, and falls.
Pediatric electrical injuries: a review of 38 consecutive patients.
- Celik A, Ergun O, Ozok G. J Pediatr Surg 2004; 39(8): 1233-1237.
Correspondence: Ahmet Celik, Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, TURKEY; (email: unavailable).
BACKGROUND: The aim of this study was to explore the mechanisms, complications, morbidity, and mortality associated with electrical injuries in children.
METHODS: The charts of pediatric patients who had been admitted to the authors' center with electrical burn injuries (EBI) between January 1993 and October 2002 were reviewed retrospectively.
FINDINGS: Of the 764 acute burn admissions over a 9-year period, 5% (38 patients) had EBI. Mean age was 9.6 +/- 4.4 years (range, 1 to 16 years). Seventy-six percent of the EBI patients were boys (M to F, 29:9), and the extent of the burn wounds ranged from 1% to 50% of total body surface area (TBSA; mean, 18.6% +/- 14.7%). High-voltage (HV) electricity accounted for 63% of the EBI (1 lightning), and 37% were caused by low-voltage (LV) current. In 19 children, serious high-voltage injuries occurred by direct contact with outlet electrical transfer wires with a metal from a balcony or with manual contact while climbing to the pole. A total of 153 surgical procedures were performed on the EBI patients, and 26% of the cases (10 of 38) required amputations. Patients who sustained HV electrical injuries had associated major complications. All of the patients underwent close cardiac monitoring, and none had cardiac complications. The average hospital stay was 23.8 +/- 14.2 (range, 2 to 48) days. One patient died of wound sepsis.
COMMENTS: Although not frequent, EBI remain a serious problem, particularly in adolescent boys, and short- and long-term morbidity are significant. HV injuries occur mainly in the adolescent population and require more aggressive care. Balcony injury is a specific etiology for EBI, and special consideration is required to prevent this type of injury in our country.
Collaboration between nurses and agricultural teachers to prevent adolescent agricultural injuries: the agricultural disability awareness and risk education model.
Nearly 2 million children live or work on America's farms and ranches. Despite the increasing mechanization of production agriculture in the United States, children still constitute a considerable portion of the work force on farms and ranches. When adjusted for actual work exposure time, adolescent injury rates on agricultural establishments surpass those of adults (Castillo, D. N., Landen, D. D., & Layne, L. A. (1994). American Journal of Public Health, 84, 646-649). This project, headed by two public health nurses, developed and tested an agricultural safety curriculum [Agricultural Disability Awareness and Risk Education (AgDARE)] for use in high school agriculture classes. Students who participated in AgDARE scored significantly higher in farm safety attitude and intent to change work behavior than the control group. School and public health nurses, working together with agriculture teachers, may make an effective team in reducing injuries among teen agricultural workers.
OBJECTIVE: This study investigated the impact of safety beliefs on safe behavior and the effect of age, gender, class standing, and geographic region on these beliefs and behaviors. It also compares the level of safety beliefs and safe behavior of Midwestern college students in 1993 to those in 2002.
METHODS: A total of 1,059 undergraduate students at four Midwestern universities completed the 33-item questionnaire developed by Crowe (J. Saf. Res. 26 (1995) 187) during the spring semester of 2002.
FINDINGS: Significant main effects for gender and age on safety beliefs and safe behavior were found as well as a significant interaction between gender and age for both outcome variables. The regression model with the independent variables of personal responsibility and gender yielded a multiple R of.58, which explained 34% of the variance of the self-reported safe behavior. Midwestern college students in 2002 were found less safety-conscious in terms of self-reported safety beliefs and safe behavior than those in 1993.
COMMENTS: The findings indicate that safety education of adolescents and young adults in the United States has not been effective, at least for the last decade, or today's social and school environment is less conducive to the students' safe behavior and beliefs than a decade ago.
IMPACT ON INDUSTRY: Proactive multidisciplinary approaches to enhance safe behavior and beliefs of young adults should be made based on critical evaluation of current approaches.
Follow-up study of a school-based scalds prevention programme.
- Moore J, Morath K, Harre N. Health Educ Res 2004; 19(4): 430-439.
Correspondence: N.Harre, Department of Psychology, University of Auckland, Private Bag 92019, Auckland, NEW ZEALAND; (email: n.harre@auckland.ac.nz).
This paper describes the follow-up evaluation of a school-based scalds prevention programme designed to teach children about scalds hazards and encourage safe family practices. It involved two classroom sessions and a homework exercise that targeted five safety practices. The programme was taught to 28 classes in 14 schools in Waitakere City, New Zealand by Public Health Nurses (PHNs). Children (n = 116) aged 10-11 years from three of the schools in ethnically diverse, low/middle-income areas were assessed for their knowledge of scalds hazards 1 year after the programme. They recalled a mean of 7.46 out of 10 hazards, which was almost equivalent to children in an earlier evaluation who recalled 7.62 hazards immediately after the teaching. Altogether, 65-79% of children reported that each of the four safety items provided were at least temporarily used as intended, with 29-55% reporting that they were still in use 1 year later. Interviews with children's parents (n = 18) indicated that the majority of their hot water practices were not optimally safe prior to the programme and that many had adopted the suggested practices. While the PHNs were positive about the programme, they suggested teachers could deliver it as part of the school curriculum.
The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial.
- Verhagen E, Van Der Beek A, Twisk J, Bouter L, Bahr R, Van Mechelen W. Am J Sports Med 2004; 32(6): 1385-1393.
Correspondence: Willem van Mechelen, EMGO-Institute, VU Medisch Centrum, Van der Boechorststraat 7, 1081 BT Amsterdam, THE NETHERLANDS; (email: w.vanmechelen@vumc.nl).
BACKGROUND: Ankle sprains are the most common injuries in a variety of sports.
HYPOTHESIS: A proprioceptive balance board program is effective for prevention of ankle sprains in volleyball players. STUDY DESIGN: Prospective controlled study.
METHODS: There were 116 male and female volleyball teams followed prospectively during the 2001-2002 season. Teams were randomized by 4 geographical regions to an intervention group (66 teams, 641 players) and control group (50 teams, 486 players). Intervention teams followed a prescribed balance board training program; control teams followed their normal training routine. The coaches recorded exposure on a weekly basis for each player. Injuries were registered by the players within 1 week after onset.
FINDINGS: Significantly fewer ankle sprains in the intervention group were found compared to the control group (risk difference = 0.4/1000 playing hours; 95% confidence interval, 0.1-0.7). A significant reduction in ankle sprain risk was found only for players with a history of ankle sprains. The incidence of overuse knee injuries for players with history of knee injury was increased in the intervention group. History of knee injury may be a contraindication for proprioceptive balance board training.
COMMENTS: Use of proprioceptive balance board program is effective for prevention of ankle sprain recurrences.
Suicide rate after the 1991-1995 War in Southwestern Croatia.
- Bosnar A, Stemberga V, Cuculic D, Zamolo G, Stifter S, Coklo M. Arch Med Res 2004; 35(4): 344-347.
Correspondence: Alan Bosnar, Department of Forensic Medicine, Faculty of Medicine, Institute of Forensic Medicine of Rijeka, University of Rijeka, CROATIA; (email: alanbosnar@yahoo.com).
BACKGROUND: The paper analyzed the impact of war, the most pernicious of social evils, taking into consideration intensity of change in rate of suicide in the southwestern region of Croatia during the war and including three distinctly specific intervals, two peacetime-one pre-war (1986-1990) and one post-war (1996-2000) as well as the period of the war itself (1991-1995).
METHODS: From 853 cases of suicide committed during the period under review, age and gender of suicide victims, level of alcohol intoxication at suicide, means used in committing suicide, and suicide rate in years under review were analyzed. Quantitative characteristics of suicides were compared with other types of violent deaths, e.g., homicides and accidents. Frequencies of different features are shown graphically. Statistica 4.0 for Windows 98 was used in data processing.
FINDINGS: Of a total of 2,925 violent deaths in the period under review (1986-2000), 29.16% or 853 suicides (29.1%) were recorded. A total of 513 suicides were committed in the peace-time period-262 prior to the war (1986-1990) and 251 after the war (1996-2000)-while 340 suicides were recorded during the war (1991-1995). Means of committing suicide also changed drastically during the war, when 64 cases of firearm use were recorded compared with 18 cases during the pre-war interval and 36 cases in the post-war interval.
COMMENTS: Three parameters, namely, suicide rate, use of firearms, and intoxication, suffered the greatest changes in the war compared with the pre- and post-war period in the region under review.
Depressive symptoms and suicidal behaviour: changes with time in an adolescent clinic cohort.
OBJECTIVE: There are suggestions of a secular increase in the prevalence of depression, self-harm and suicidal behaviour in young people. This study aims to examine changes in prevalence of psychological disturbance over time in adolescents referred for treatment.
METHODS: Data on the type and severity of emotional and behavioural problems was measured using the Youth Self-Report and Child Behaviour Checklist in 4495 clinic-referred adolescents aged 12-17 years, born in a 21-year period (1966-1986).
FINDINGS: After taking into account the confounding effects of age and gender, there were significant increases in reports of self-harm and suicidal ideation (5% and 4% increase in odds per year, respectively) according to parents, but there was no change in parental ratings of depression (anxious/depressed scale). There were no changes in ratings of self-harm, suicidal ideation or anxiety/depression when adolescent reports were considered. The mean age at the time of referral decreased with increasing year of birth, from 14.6 years in those born in 1966-1971, to 13.1 years in those born in 1981-1986.
COMMENTS: Parents of referred adolescents reported increasing self-harm and suicidal behaviour with increasing year of birth. In contrast, there were no changes over time in the adolescents' reports. Neither parents nor children reported an increase in depressive symptoms. Perceptions of a secular increase may reflect increasing parental awareness of some behaviours, particularly self-harm and suicidal ideation. Interpretation of these results needs to be cautious given the clinical origin of the sample.
Teenagers' Attitudes About Coping Strategies and Help-Seeking Behavior for Suicidality.
Correspondence: Madelyn Gould, Division of Child Psychiatry and Department of Epidemiology and the New York State Psychiatric Institute, Columbia University, NY, USA; (email: gouldm@child.cpmc.columbia.edu).
OBJECTIVE: To identify youths' attitudes about coping and help-seeking strategies for suicidal ideation/behavior and examine their demographic and clinical correlates.
METHODS: A self-report survey was completed by high school students (N = 2,419) in six New York State schools from 1998 through 2001. The relationship between suicide attitudes and gender, depression, substance problems, serious suicidal ideation/behavior, and first-hand experience with a suicidal peer was examined.
FINDINGS: Two factors that approximate avoidance and approach coping responses, maladaptive coping strategies and help-seeking strategies, respectively, were identified. Boys scored higher than girls (t = 7.96, df = 2341, p <.001), and depressed youths (t = 15.56, df = 2323, p <.001), students with substance problems (t = 11.07, df = 2340, p <.001), and suicidal youths (t = 15.14, df = 2341, p <.001) scored significantly higher than their healthy counterparts on the maladaptive coping strategies factor. Students with first-hand experience with a suicidal peer scored significantly higher on the maladaptive coping strategies factor than those without this experience (t = 7.95, df = 2321, p <.001). Lower risk groups scored significantly higher on an adaptive help-seeking strategies factor.
COMMENTS: High-risk adolescents' attitudes are characterized by core beliefs that support the use of maladaptive coping strategies in response to depression and suicidal thoughts and behaviors. Targeting such attitudes is a recommended component of youth suicide prevention efforts.
A Supplementary Road Safety Package (SRSP) was developed in New Zealand in 1995/1996 to supplement the compulsory breath test (CBT) and speed camera programmes introduced in 1993. A major feature of the package was the use of emotion and shock advertising campaigns not only to affect high risk driving attitudes and behaviours towards speeding and drink-driving but also to encourage the use of safety belts. Furthermore, the SRSP also emphasised targeting enforcement to these three areas. This package continued for 5 years. This paper estimates the effect of the package on road trauma. The analysis shows that the Package made substantial impact on road safety and saved over 285 lives over the 5-year period.
Investigation of the driving experience of a sample of Victorian learner drivers.
This paper presents the results of an investigation of the driving experience of a small sample of learner drivers in Victoria, Australia. Participants (n = 110) kept a continuous logbook of their driving experience over the 2 years of the learner-driver period, including information about the distance and time of each driving trip, their level of confidence, and monthly data concerning the number of crashes, near misses, and unpleasant emotional interactions with their supervising driver. The analysis of these data suggests that learner drivers accrue relatively little driving experience and that they tend to obtain this experience in daytime, fair-weather driving. The implications of these results are discussed.
Bivariate ordered-response probit model of driver's and passenger's injury severities in collisions with fixed objects.
Correspondence: Toshiyuki Yamamoto, Department of Civil Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, JAPAN; (email: yamamoto@civil.nagoya-u.ac.jp).
A bivariate ordered-response probit model of driver's and most severely injured passenger's severity (IS) in collisions with fixed objects is developed in this study. Exact passenger's IS is not necessarily observed, especially when only most severe injury of the accident and driver's injury are recorded in the police reports. To accommodate passenger IS as well, we explicitly develop a partial observability model of passenger IS in multi-occupant vehicle (HOV). The model has consistent coefficients for the driver IS between single-occupant vehicle (SOV) and multiple-occupant vehicle accidents, and provides more efficient coefficient estimates by taking into account the common unobserved factors between driver and passenger IS. The results of the empirical analysis using 4-year statewide accident data in Washington State reveal the effects of driver's characteristics, vehicle attributes, types of objects, and environmental conditions on both driver and passenger IS, and that their IS have different elasticities to some of the risk factors.
How much visual road information is needed to drive safely and comfortably?
- de Waard D, Steyvers FJJM, Brookhuis KA. Safety Science 2004; 42(7): 639-655.
Correspondence: Dick De Waard, Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, THE NETHERLANDS; (email: d.de.waard@ppsw.rug.nl).
The questions "how much visual information from the road is required for proper driving?", and "how do people cope with a visually ambiguous road configuration?", were explored in an advanced driving simulator.Sixteen young and 16 elderly drivers completed two test rides on a rural road that was divided into five sections of 2 km, at each section a road element (e.g., delineation, roadside marker) was added or removed. During the rides, performance (lateral position, speed) and heart rate were recorded continuously, and before transition to a new section drivers gave a rating on invested effort and on visibility of the (previous) road course. The experiment's goal was to determine whether a shift in driving behaviour could be noticed at a certain amount of visual information.
The main threshold found, for both age groups, lies between roads with �no delineation on the road surface at all' and �a centre-line'. Elderly drivers, however, appeared to need the visual aid of the centre-line to a greater extent than young drivers, and in general they drove slower and regulated their information input in this way. A visually ambiguous road situation concluded the experiment. The participants drove on a centre-lined road towards a junction where the road forked to the left and right. The left-hand road was a road without delineation but with lampposts, the right-hand road was a continuation of the centre-lined road without lampposts. In particular elderly drivers were confused by this situation and chose the road with lampposts more often. This finding supports the assumption that with increasing age people are more easily confused by ambiguous cues.
Prevalence of partner violence in same-sex romantic and sexual relationships in a national sample of adolescents.
- Halpern CT, Young ML, Waller MW, Martin SL, Kupper LL. J Adolesc Health 2004; 35(2): 124-131.
Correspondence: Carolyn Tucker Halpern, Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; (email: carolyn_halpern@unc.edu).
OBJECTIVE: To present the first national prevalence estimates of psychological and physical intimate partner violence between adolescents in same-sex relationships.
METHODS: Analyses focus on 117 adolescents aged 12-21 years (50% female) from Wave II of the National Longitudinal Study of Adolescent Health who reported exclusively same-sex romantic or sexual relationships in the 18 months before interview. Items from the Conflict Tactics Scale were used to measure partner violence victimization. Data analysis included computation of prevalence estimates and a logistic regression analysis to assess associations between sociodemographic characteristics and violence victimization.
FINDINGS: Almost one-quarter of adolescents with same-sex romantic or sexual partners reported some type of partner violence victimization; about 1 in 10 reported physical victimization. Significant sex differences were found (OR =.29, CI = 0.08, 1.00), with males being less likely than females to report "any violence." Of six other sociodemographic characteristics examined, importance of religion (OR =.27, CI = 0.07-1.07) and school size (OR =.32, CI = 0.09-1.11) were associated with victimization at the p <.10 level. Adolescents who reported that religion was important to them and adolescents who attended larger schools were at lower risk of "any violence."
COMMENTS: As with opposite-sex relationships, psychological and minor physical violence victimization is common among adolescents involved in same-sex intimate relationships. Males reporting exclusively same-sex relationships were less likely than females to report experiencing the violence behaviors examined.
Pilot educational outreach project on partner violence.
- Edwardsen EA, Pless NA, Fiscella KA, Horwitz SH, Meldrum SC. Prev Med 2004; 39(3): 536-542.
Correspondence: Elizabeth A. Edwardsen, Department of Emergency Medicine, University of Rochester, Rochester, NY 14642, USA; (email: Elizabeth_Edwardsen@urmc.rochester.edu).
BACKGROUND: To assess the impact of a multimodal educational outreach on physician screening and documentation of intimate partner violence (IPV) in primary care.
METHODS: Pre- and post-intervention assessment of physician screening and chart documentation of IPV. Physician screening was assessed by post-visit survey of patients and documentation was assessed by medical record review.
SETTING: Three medical offices in an urban community of approximately 1 million.
PARTICIPANTS: Three primary care physicians (one internist, one obstetrician, and one family physician) and 100 patients from each of these practices.
INTERVENTIONS: Multimodal educational outreach to physicians and their office staff regarding appropriate screening and management of IPV. A trained IPV educator made periodic office visits in 2002 to educate the physician and office staff regarding appropriate screening and management of IPV.
FINDINGS: Before the intervention, 36/150 (24%) of sample patients reported having been previously asked about IPV and 24/150 (16%) reported being asked in a written format. After the intervention, 100/149 (67%) and 41/108(28%) reported being asked verbally or in writing, respectively.
COMMENTS: This pilot study of three physicians suggests educational outreach represents a promising and feasible means of improving physician screening and documentation of IPV in primary care.
Violence-related behaviors among high school students--United States, 1991-2003.
- Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2004; 53(29): 651-655.
Homicide and suicide are responsible for approximately one fourth of deaths among persons aged 10-24 years in the United States. Two of the national health objectives for 2010 are to reduce the prevalence of physical fighting among adolescents to < or =32% and to reduce the prevalence of carrying a weapon by adolescents on school property to < or =4.9%. To examine changes in violence-related behaviors among high school students in the United States during 1991-2003, CDC analyzed data from the national Youth Risk Behavior Survey (YRBS). This report summarizes the results of that analysis, which indicated that most violence-related behaviors decreased during 1991-2003; however, students increasingly were likely to miss school because they felt too unsafe to attend. In addition, in 2003, nearly one in 10 high school students reported being threatened or injured with a weapon on school property during the preceding 12 months. Schools and communities should continue efforts to establish physical and social environments that prevent violence and promote actual and perceived safety in schools.
