Showing papers in "Injury Prevention in 2000"

Risky business: safety regulations, risk compensation, and individual behavior

Abstract: Editors comment: We are proud to be able to bring to our readers this full text version of the Haddon Memorial Lecture delivered at the recent Fifth World Conference on Injury Prevention and Control in New Delhi, India. James Hedlund offers a brilliant review of one of the most important areas of debate in the entire field of injury control. This is the most complete, most perceptive, and well balanced appraisals of this complex issue I have ever read. Take the time to digest it completely. Our thanks to the Insurance Institute for Highway Safety for agreeing to permit us to publish it. Government regulations and industry practices constrain our behavior in many ways in an attempt to reduce injuries. Safety features are designed into products we use: cars now have airbags; medicine bottles have “childproof” caps. Laws require us to act in a safe manner: we must wear seat belts while driving and hard hats in construction areas. But do these measures influence our behavior in other ways? Risk compensation theory hypothesizes that they do, that we “use up” the additional safety though more risky actions. This paper surveys risk compensation by reviewing its history, discussing its theoretical foundations, outlining evidence for and against its claims, and providing the author's own views. It concludes by discussing the relevance of risk compensation for injury prevention workers who seek to reduce unintentional injuries. Injury prevention as a discipline began when injuries were understood to be both predictable and preventable. Most injuries are the unintended consequences of individual actions in a risky environment; they are not due to fate or to problem behavior. This understanding led to three fundamental injury prevention strategies, as described in the comprehensive report Injury in America 1:

Cost of illness studies: what is good about them?

Abstract: The article by Currie et al is highly critical of cost of injury studies, stating that “ . . . such studies are not helpful in the context of setting priorities for resource allocation and research activities”.1 The authors postulate that cost of injury studies add little to what is already known, such as deaths from motor vehicle crashes, hospital admissions, and emergency department visits. These routinely collected data, they say, provide direct and meaningful information about the size of the problem, if that is what is needed by decision makers for setting priorities for resource allocation and research activities. So, why spend additional resources and research time to describe the burden of motor vehicle crash injuries when the problem is adequately quantified? They conclude that research funds would be better spent by estimation of the effectiveness, costs, and benefits associated with different injury prevention strategies. Cost of illness studies abound in the US. Are they all useless, as suggested by the authors? What do they measure? How are they used? When choices are made about the allocation of resources, who is affected? On whose behalf are decisions made? The answers to these questions define the perspective of cost studies. For example, costs or losses to industry or business due to a disease focus on the impact of absenteeism and lost productivity2,3; costs to public programs are accountable for their beneficiaries4; and costs to society take a comprehensive approach to estimating direct and indirect health and other related costs associated with an illness, disease, or injury.5,6 Cost of illness studies are typically divided into two major categories: (1) core costs are those resulting directly from the illness and (2) other related costs include non-health costs of the illness. Within each category, there …

Social differences in traffic injury risks in childhood and youth--a literature review and a research agenda.

Abstract: Objectives —The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda. Method —A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries. Results —For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender. Conclusions —The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.

Socioeconomic differences in childhood injury: a population based epidemiologic study in Ontario, Canada

Abstract: Objective—To determine whether risks for childhood injury vary according to socioeconomic gradients. Design—Population based, retrospective study. The percentage of individuals living below the poverty line (described ecologically using census data) was the primary measure of socioeconomic status. Setting—Catchment area of a tertiary medical centre that provides emergency services to all area residents. Area residents aged 0–19 years during 1996 were included. Observations—Injuries that occurred during 1996 were identified by an emergency department based surveillance system. The study population was divided into socioeconomic grades based upon percentages of area residents living below the poverty line. Multiple Poisson regression analyses were used to quantify associations and assess the statistical significance of trends. Results—5894 childhood injuries were identified among 35 380 eligible children; 985 children with missing socioeconomic data were excluded. A consistent relation between poverty and injury was evident. Children in the highest grade (indicating higher poverty levels) experienced injury rates that were 1.67 (95% confidence interval 1.48 to 1.89) higher than those in the lowest grade (adjusted relative risk for grades 1-V: 1.00,1.10,1.22,1.42, 1.67; ptrend<0.001). These patterns were observed within age/sex strata; for home, recreational, and fall injuries; and for injuries of minor and moderate severities. Conclusions—Socioeconomic differences in childhood injury parallel mortality and morbidity gradients identified in adult populations. This study confirms that this health gradient is observable in a population of children using emergency department data. Given the population based nature of this study, these findings are likely to be reflected in other settings. The results suggest the need for targeted injury prevention efforts among children from economically disadvantaged populations, although the exact requirements of the optimal prevention approach remain elusive.

Increasing age and experience: are both protective against motorcycle injury? a case-control study

Abstract: Objectives—To assess the associations between age, experience, and motorcycle injury. Setting—Motorcycle riding on nonresidential roads between 6 am and midnight over a three year period from February 1993 in Auckland, New Zealand. Methods—A population based casecontrol study was conducted. Cases were 490 motorcycle drivers involved in a crash and controls were 1518 drivers identified at random roadside surveys. Crash involvement was defined in terms of a motorcycle crash resulting in either a driver or pillion passenger being killed, hospitalised, or presenting to a public hospital emergency department with an injury severity score >5. Results—There was a strong and consistent relationship between increasing driver age and decreasing risk of moderate to fatal injury. In multivariate analyses, drivers older than 25 years had more than 50% lower risk than those aged from 15‐19 years (odds ratio (OR) 0.46; 95% confidence interval (CI) 0.26 to 0.81). In univariate analyses, a protective eVect from riding more than five years compared with less than two years was observed. However, this protection was not sustained when driver age and other potential confounding variables were included in the analyses. Familiarity with the specific motorcycle was the only experience measure associated with a strong protective eVect (OR (>10 000 km experience) 0.52; 95% CI 0.35 to 0.79) in multivariate analyses. Conclusions—Current licensing regulations should continue to emphasise the importance of increased age and might consider restrictions that favour experience with a specific motorcycle. (Injury Prevention 2000;6:32‐35)

Equestrian injuries: a five year review of hospital admissions in British Columbia, Canada.

Abstract: Aim —To determine the demographics of hospital admissions and mortality associated with equestrian activities in the 33 000 riders in British Columbia (BC). Method —Analysis of admission data from the Ministry of Health for the years 1991–96, review of information obtained from the Office of the Chief Coroner, and comparison of data from Canadian Hospitals Injury Reporting and Prevention Program. Results —The mean number of admissions per year was 390. Head injury was the most common cause of admission to hospital (20%) in BC. Females most often required admission (62%). Teenagers and children have a higher incidence of head injuries than the general population. The injury rate was 0.49/1000 hours of riding. There were three deaths per year, 1/10 000 riders; 60% were caused by head injury and females predominated. Conclusion —Head injuries and other serious injuries occur with equestrian activities and it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including helmets, especially for children.

Seasonal variations in incidence of fractures among elderly people.

Abstract: Objective —To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older. Population and methods —A prospective, population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997, a total of 459 904 person years. Cases were identified through a prospective registration system. Results —There were 10 992 (2390 per 100 000 person years) fall related fractures. The risk was higher in the colder seasons (October through March) among people aged 65–79 years (relative risk (RR) = 1.39, 95% confidence interval (CI) 1.32 to 1.47) and in people aged 80 years and older (RR = 1.17, 95% CI 1.09 to 1.22). For arm fractures, the RR was 1.69 (95% CI 1.56 to 1.83) among people aged 65–79 years and 1.30 (95% CI 1.13 to 1.43) among those aged 80 years and older. The RR for hip fractures was 1.27 (95% CI 1.15 to 1.37) among people aged 65–79 years and 1.08 (95% CI 1.00 to 1.15) for people aged 80 years and older. Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months. Conclusion —Season affects the incidence of all types of fractures in elderly people. Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect. Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture, but the size of the effect is difficult to estimate with certainty.

Youth injury data in the Canadian Hospitals Injury Reporting and Prevention Program: do they represent the Canadian experience?

Abstract: Objective—Injuries to Canadian youth (11‐15 years) identified from a population based health survey (World Health Organization—Health Behaviour in School-Aged Children Survey, or WHOHBSC) were compared with youth injuries from a national, emergency department based surveillance system. Comparisons focused on external causes of injury, and examined whether similar rankings of injury patterns and hence priorities for intervention were identified by the diVerent systems.

Toddler drowning in domestic swimming pools

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

Effect of an older sibling and birth interval on the risk of childhood injury.

Abstract: Objective —Certain family structures have been identified as putting children at high risk for injury. To further define children at highest risk, we set out to explore the effect of an older sibling and birth interval on the risk of injury related hospital admission or death. Methods —Data were analyzed using a case-control design. Cases and controls were identified by linking longitudinal birth data from Washington state (1989–96) to death certificate records and hospital discharge data obtained from the Washington State Comprehensive Hospital Abstract Reporting System and frequency matched in a 1:2 ratio on year of birth. Cases consisted of singleton children 6 years of age or younger who were hospitalized or died as a result of injury during the years 1989–96. Multivariate logistic regression was used to identify and adjust for confounding variables. Results —There were 3145 cases and 8371 controls. The adjusted odds ratio for injury in children with an older sibling was 1.50 (95% confidence interval 1.37 to 1.65). The effect was greatest in children under 2 years of age, and in those with a birth interval of less than two years. As the number of older siblings increased, so did the risk of injury, with the highest risk in children with three or more older siblings. Conclusion —These data suggest that the presence of an older sibling is associated with an increased risk of injury. The risk is highest in those with very short birth intervals. Potential mechanisms for this increased risk may relate to inadequate parental supervision. Pediatricians and other care providers need to be alert to these identifiable risk factors and then direct preventive strategies, such as home visits and educational programs, toward these families.

Effects of recent 0.08% legal blood alcohol limits on fatal crash involvement

Abstract: Objectives —This study assessed whether states that lowered legal blood alcohol limits from 0.10% to 0.08% in 1993 and 1994 experienced post-law reductions in alcohol related fatal crashes. Methods —Six states that adopted 0.08% as the legal blood alcohol limit in 1993 and 1994 were paired with six nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of pre-law and post-law years. Results —States adopting 0.08% laws experienced a 6% greater post-law decline in the proportion of drivers in fatal crashes with blood alcohol levels at 0.10% or higher and a 5% greater decline in the proportion of fatal crashes that were alcohol related at 0.10% or higher. Conclusions —If all states adopted the 0.08% legal blood alcohol level, 400–500 fewer traffic fatalities would occur annually.

Urban residential fire and flame injuries: a population based study

Abstract: Background —Fires are a leading cause of death, but non-fatal injuries from residential fires have not been well characterised. Methods —To identify residential fire injuries that resulted in an emergency department visit, hospitalisation, or death, computerised databases from emergency departments, hospitals, ambulance and helicopter services, the fire department, and the health department, and paper records from the local coroner and fire stations were screened in a deprived urban area between June 1996 and May 1997. Result —There were 131 fire related injuries, primarily smoke inhalation (76%), an incidence of 36 (95% confidence interval (CI) 30 to 42)/100 000 person years. Forty one patients (32%) were hospitalised (11 (95% CI 8 to 15)/100 000 person years) and three people (2%) died (0.8 (95% CI 0.2 to 2.4)/100 000 person years). Injury rates were highest in those 0–4 (68 (95% CI 39 to 112)/100 000 person years) and ≥85 years (90 (95% CI 29 to 213)/100 000 person years). Rates did not vary by sex. Leading causes of injury were unintentional house fires (63%), assault (8%), clothing and nightwear ignition (6%), and controlled fires (for example, gas burners) (4%). Cooking (31%) and smoker9s materials (18%) were leading fire sources. Conclusions —Because of the varied causes of fire and flame injuries, it is likely that diverse interventions, targeted to those at highest risk, that is, the elderly, young children, and the poor, may be required to address this important public health problem.

Injury death excesses in smokers: a 1990-95 United States national cohort study

Abstract: Objectives—Assess injury death relative risks (RR), dose-response, and attributable fractions for current cigarette smokers (smokers) in a recent representative sample of the United States population without and with adjustment for (a) demographic and (b) additional behavioral risk factors. Setting—United States. Methods—National Health Interview Survey (NHIS) adult (ages 18+ years) interviewees from 1990 or 1991 were followed through 1995. Referents had never smoked a total of 100 cigarettes. Relative risks were estimated with Stata software's Cox proportional hazard regressions, using NHIS final weights and primary sampling units. The resulting RR and published data were used to estimate population smoking attributable fractions of injury deaths in the United States. Results—The crude, age-race-gender adjusted, and fully (demographic plus educational attainment, marital status, alcohol use level, and seat belt use) adjusted RRs for injury death in smokers were 1.86 (95% confidence interval (CI) 1.30 to 2.66), 1.60 (CI 1.12 to 2.29), and 1.42 (CI 0.99 to 2.05) respectively. Those RRs correspond to United States injury death smoking attributable fractions of 18%, 13%, and 9%, respectively. Those smoker/injury death RRs each showed a significant dose response relationship (p<0.030). Smokers' unadjusted unintentional injury, motor vehicle crash, and suicide RRs were 1.87 (CI 1.22 to 2.86), 2.14 (CI 1.12 to 4.11), and 2.17 (CI 1.02 to 4.62), respectively. Conclusions—Smokers in the United States have significant dose-response excesses of injury death, independent of age, race, gender, alcohol use, seat belt use, education, and marital status. This supports earlier studies suggesting that smoking may be a leading contributor to injuries and injury may be a leading burden from smoking, both nationally and globally.

Effectiveness of toughened glassware in terms of reducing injury in bars: a randomised controlled trial

Abstract: Objective—To evaluate the effectiveness, in terms of injury prevention, of toughened pint glassware in bars. Design—Randomised controlled trial. Setting—A random sample of 57 bars in South Wales, West Midlands, and West of England. Subjects—A total of 1229 bar workers. Intervention—Complete replacement of pint glasses with annealed (control) or toughened (intervention) glassware. Main outcome measures—Bar staff injuries recorded monthly: number, site, and severity (lifestyle impact; treatment need) of injuries. Results—Ninety eight bar staff experienced 115 injuries: 43 in the control group, 72 in the intervention group. Adjusting for people at risk gave a relative risk (RR) of 1.48 (confidence interval (CI) 1.02 to 2.15). Similarly, adjusting for hours worked gave RR 1.57 (CI 1.08 to 2.29). Thus, injury rate was 60% higher in the intervention group (p Conclusions—Glass with lower impact resistance caused more injuries. “Toughened” glassware had lower impact resistance. Standards for toughening need to be developed.

A preschool program for safety and injury prevention delivered by home visitors

Abstract: Objective—To evaluate the feasibility, acceptability, and eVectiveness of an injury prevention program delivered by school based home visitors to the families of low income children attending preschool enrichment programs in Washington State. Study sample—The families of children attending preschool Head Start programs in two regions were eligible. A total of 213 families (77.8% of those eligible) from intervention sites, and 149 families (71.9% of those eligible) from concurrent comparison sites, agreed to participate and completed the trial. Intervention—Trained school personnel conducted home safety inspections as part of a planned home visit. Intervention families were oVered educational materials as well as smoke detectors, batteries, ipecac, and age appropriate car safety restraints based on results of the home inspection. Evaluation methods—At a repeat home visit three months later, the proportion of families with a positive change in injury prevention knowledge or behavior among those in the intervention group was compared with the proportion in the comparison group. Smoke detector presence and function were observed. Results—Among families without a working smoke detector at baseline, the intervention was associated with an increased probability of having a working detector at follow up (relative risk (RR) 3.3, 95% confidence interval (CI) 1.3 to 8.6). Intervention families were also more likely to report the presence of ipecac in the home (RR 4.7, 95% CI 3.0 to 7.3) at follow up and to have obtained an age appropriate booster seat (RR 4.1, 95% CI 1.9 to 8.8). The program was acceptable to client families and to the home visitors who conducted the intervention. Conclusions—Among the families of low income children enrolled in preschool enrichment programs, home safety inspections and the distribution of safety supplies by school based home visitors appears to improve knowledge and behavior related to poisoning, smoke detector installation, and car safety seat use over three months of follow up. (Injury Prevention 2000;6:305‐309)

Are cost of injury studies useful

Abstract: Studies from the USA and Canada have attempted to estimate the economic costs associated with injury.1–3 The rationale for these studies is often to provide data for priority setting (both research and policy). In other words, the expression of the cost of injury in monetary terms is thought to illustrate the importance of the problem and, therefore, its high priority for research and health services resources. For example, some authors have suggested that policy makers identify “high cost” injuries (compared with other injuries) and make these injuries a priority for treatment and prevention programs.1,3 Cost of injury studies may be useful in the “political” sense, for example, by raising public and political awareness of the burden of injury. Our argument, however, is that such studies are not helpful in the context of setting priorities for resource allocation and research activities. Furthermore, concentration on cost of injury studies may divert policy makers from what they need to know in order to maximise societal benefits from resource allocation. In this paper, we briefly describe the cost of injury method, explain why cost of injury studies have limited usefulness, and explain how, in our view, health economics can better contribute to the field of injury prevention. Cost of injury studies usually include both direct and indirect costs. Direct costs are those resources used to prevent, detect, and treat injury and its complications. The resource use in each of these categories is measured, valued, and summed. The most common method involves combining data on health care utilisation and costs; for example, the length of hospital stay for a specific injury is multiplied by an estimate of the cost per day for that injury. Indirect costs relate to the loss of productive output in the economy because of …

Impact of a helmet law on two wheel motor vehicle crash mortality in a southern European urban area.

Abstract: Background—In Spain, a federal road safety law went into effect in the fall of 1992 extending to urban areas the unrestricted use of safety helmets by all two wheel motor vehicle occupants. Objectives—To assess the effect of the law in reducing fatal motorcycle crash injuries; to estimate the number of lives saved; and to determine changes in the distribution of severity and anatomical location of injuries. Methods—Pre-test/post-test design of all deaths of two wheel motor vehicle occupants from 1990–92 (pre-law period) and from 1993–95 (post-law period) detected by the Barcelona Forensic Institute and the city police department. Injuries were coded using the 1990 version of the abbreviated injury scale. Poisson regression methods were used to model trends in mortality ratios and to provide estimates of the number of lives saved. Results—Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants were spared, representing a decrease of 25% in the observed motorcycle crash mortality in the post-law period when compared with what would be expected if no such law had gone into effect. The proportion of deaths with severe head injuries was also reduced from 76% to 67% in the post-law period. Conclusions—This study offers the first evaluation of a helmet law using combined forensic and police data in a large south European urban area where there is widespread use of motorcycles. Our results confirm the effectiveness of the helmet law, as measured by the reduction in the number of deaths and mortality ratios after the law implementation. The findings reinforce the public health benefits of mandatory non-restricted motorcycle and moped helmet use, even in urban areas with lower traffic speeds.

Motor vehicle crashes in Pakistan: the emerging epidemic

Abstract: Setting —Motor vehicle injuries are increasingly being recognized as a growing public health issue in the developing world. Pakistan is a developing country in South Asia where motor vehicle use has increased since independence in 1947. Objective —This paper explores the magnitude and impact of injuries from motor vehicle crashes in Pakistan. Methods —An exhaustive review of published and gray literature, together with a detailed analysis of government data from 1956. Results —The data indicate a persistent increase in the numbers of motor vehicle crashes, injuries, and fatalities. Changes in the reporting of rates are important to note in evaluating the data. Commercial vehicles contribute disproportionately to these motor vehicle injuries. Conclusions —There is a need to further the recognition of injuries as a public health issue in this country. Specific exploration of the epidemiological data; intersectoral collaboration between health, law, police and transport; and the development of appropriate information systems, will contribute to an appropriate response by Pakistan.

Maternal reports of child injuries in Canada: trends and patterns by age and gender

Abstract: Objectives—This study examines gender and age differences in maternal reports of injuries in a cross sectional group of children aged 0–11 years. The cause, nature, body part injured, and location of injury are explored, as are the associations with family socioeconomic indicators and associations with limitations in activities. Methods—Data for 22 831 children and their families come from cycle 1 of the Canadian National Longitudinal Survey of Children and Youth collected in 1995. Descriptive analyses and χ2 tests for trends are used to examine injury variations by child gender and age. Logistic regressions are used to examine the relationship between socioeconomic indicators and injury and the associations between injury and limitations in activities. Results—Consistent with findings from hospital data, boys experience more injuries than girls, and injuries increase with child age. Falls are the most common sources of maternally reported injuries, followed by scalds/poisonings for young children and sports injuries for school aged children. The majority of injuries occur in or around the home for young children, but at school for older children. For maternal reports of childhood injuries, single marital status is a risk factor for boys. Conclusions—Maternally reported injuries occur in 10% of Canadian children and many of these are associated with limitations in activities. Preventative strategies should take both child age and gender into consideration.

Mechanical analysis of survival in falls from heights of fifty to one hundred and fifty feet

Abstract: During the interval of velocity change in aircraft and automobile accidents many typical crash injuries are caused by structures and objects which can be altered in placement or design so as to modify the large number of severe and constantly recurring patterns of injury in these accidents. In order conscientiously to approach some of the engineering problems encountered in reduction of the potential injury hazards of windshield structures, seats, instrument panels, safety belts, etc, it was necessary to have some understanding of the limits of mechanical strength of the human body. The objective in studying the physiologic results of rapid deceleration in the following instances of extraordinary survival—after free fall and impact with relatively solid structures—was to establish a working knowledge of the force and tolerance limits of the body. On the basis of these data certain engineering improvements can be considered for aircraft and automotive design. Loss of pilots through injury due to the increased landing speeds of military planes has become more and more frequent; this loss and the ever present toll by accident in the automotive field are matters of grave national concern. Injuries in these fields are mechanical results stemming from localized pressures induced by force and applied to the body through the medium of structure. It is an axiom in the mechanical arts that modification of cause will change results, but the nature and the degree of structural alteration to modify injury to human beings effectively depend on the reactions of the body to abrupt pressure and its distribution. The strength of human anatomic structure and its tolerance of pressure increase are centrally important elements in any proposed increase of safety factors through engineering effort. Obviously, if the body could tolerate pressure within only narrow limits, few improvements would be worth consideration, since the force …

Acceptability of baseball face guards and reduction of oculofacial injury in receptive youth league players.

Abstract: Goals —To assess the relative injury reduction effect and acceptability of face guards on batter's helmets. Methods —A non-randomized prospective cohort study among 238 youth league baseball teams in Central and Southern Indiana during the 1997 season. Coaches, parents, and players were asked to respond to pre-season and post-season questionnaires. Approximately one half of the teams were supplied with face guard helmets (intervention); all others used this protection at their discretion (comparison). Results —Parents, players, and coaches on the intervention teams reported a reduction in the incidence of oculofacial injuries compared with comparison team respondents (p=0.04). There was no reported adverse effect of face guard use on player performance. Conclusions —Helmet face guards should be required for batters to prevent facial injuries in baseball.

An evaluation of the effectiveness of the Injury Minimization Programme for Schools (IMPS).

Abstract: Objective—To evaluate the effect of an injury prevention programme (Injury Minimization Programme for Schools, IMPS) on children9s primary and secondary prevention, and basic life support, knowledge, attitudes, skills, and behaviour Design—Prospective non-randomised matched control Setting—Radcliffe NHS Trust and primary and middle schools in Oxfordshire, UK Subjects—1200 year 6 children (10 and 11 years old); 600 received IMPS, a primary and secondary injury prevention programme taught in the school and hospital environments; 600 children in the control group received no planned intervention Main outcome measures—Safety knowledge, measured using a quiz Resuscitation skills and behaviour observed and assessed using a simulated emergency scenario Attitude and hypothetical behaviour towards safety assessed by the “draw and write” technique Results—Before intervention, both groups had similar levels of knowledge Five months after the intervention, significantly more IMPS trained children demonstrated a greater increase in knowledge in administering first aid and the correct procedure for making a call to the emergency services They also demonstrated better basic life support techniques—for example, mouth-to-mouth and cardiac compressions They identified more subtle dangers, were more likely to seek help, and tell others that their behaviour was dangerous Conclusion—The results demonstrate the benefits of the IMPS programme on injury prevention knowledge, attitudes, and behaviours

Description of Missouri children who suffer burn injuries.

Abstract: Objective—This study uses Missouri's inpatient and outpatient E code data system to describe the demographic characteristics of Missouri children who suffered burn injuries during 1994 and 1995. Methods—Retrospective review of Missouri E code data. Results—Altogether 8404 children aged 0–14 years were treated for burn injuries in Missouri hospitals during 1994 and 1995. The rate of burn injury in Missouri children was 339 per 100 000/year. African-American boys 0–4 years living in urban counties were at increased risk. In addition, African-American girls ages 0–4 years living in counties with a high poverty rate had raised burn injury rates. Burns from hot objects and scalds from hot liquids caused more than half of the burns. Conclusions—Hospital based E coding has proven an invaluable tool for the study of burns and will, no doubt, prove equally useful for other injuries.

Probability of arrest while driving under the influence of alcohol

Abstract: Summary The probability of arrest while driving at a blood alcohol level over 0.10% was 0.0058 (about one in 200). There is considerable interest in defining the relationship between the probability of being arrested for driving under the influence of intoxicants (DUI) and blood alcohol concentration (BAC)*. Such information, if accurately known, could be put to a variety of uses, including public information, police patrol management information, DUI patrol evaluation, and estimation of the number of drunken drivers on the road. In surveys associated with the Alcohol Safety Action Projects (ASAP), thousands of persons have been interviewed and asked, among other questions, what they thought their chances were of being stopped by the police after having had too much to drink. The object of such a question is to measure the level of public awareness of enforcement of the DUI laws. Even those who pose the question do not know the answer, however; and such a question has no single answer unless the level of intoxication, or BAC, is specified. There have been no detailed studies to establish such probabilities. Previous estimates suggest that the probability of being arrested while staking a 10 mile trip with a BAC above 0.10% is about 0.0015†.1 Accurate knowledge of the probabilities of being arrested for DUI is necessary if a public education campaign against drunken driving is to retain the trust and confidence of the public. This kind of knowledge could also prove to be a valuable police patrol management tool. The officer in charge of DUI patrols would have a standard against which to measure the performance of his unit. In addition, if the probability of arrest for DUI under specific patrol conditions can be established with confidence, it should be possible—by patrolling a particular area and obtaining …

Children are not goldfish—mark/recapture techniques and their application to injury data

Abstract: Objectives—Mark/recapture (or capture-recapture) is a simple technique commonly applied to estimate the hypothetical total (including undercount) in a register composed of cases from two or more independent and separately incomplete case lists. This paper seeks to illustrate serious drawbacks in the use of the mark/recapture technique when applied to injuries. Setting and subjects—Northumbrian children under 15 years of age who were seriously injured in motor vehicle accidents (MVAs) over a five year period ascertained from two data sources: police reports and hospital inpatient records. Methods—Individuals (n) appearing in both police (S) and hospital (H) case lists are identified using various matching criteria. The separate and combined influence of age, sex, and casualty class (cyclist, passengers, pedestrians) on the probability of such matching is estimated using multivariate techniques. The hypothetical total incidence of child MVA victims (N) is calculated from N = (S × H)/n. Main outcomes—Estimates of the incidences of “serious” injuries in MVAs under various conditions of stratification and matching. The overall procedure is tested for conformity with accepted criteria for valid use of mark/recapture. Results—About one third of the 1009 police and 836 hospital records could be exactly matched. There were significant variations in matching proportions by class of accident (pedestrian v passenger v cyclist). This selective recapture or “heterogeneity” was not affected by sex, but was independently influenced by the age of the child. Further uncertainty was introduced when matching criteria were slightly relaxed. Estimates of the total population of children with serious injuries vary accordingly from 1729 to 2743. A number of plausible reasons why these two data sources might not be unbiased or mutually independent samples of the total target population are proposed as explanations for this heterogeneity. Conclusion—This typical example of two sample mark/recapture estimation in an epidemiological setting can be shown to violate virtually all the requirements for valid use of the technique. Very little can be deduced accurately about the scale or characteristics of an unobserved group by the use of mark/recapture applied to two overlapping health event registers.

Injuries associated with falls from beds

Abstract: Objectives—To assess the severity of injuries due to falls from upper bunks and lower beds and cots, and to ascertain the age group most at risk of such injuries. Setting—The accident and emergency (A&E) department in the Royal Aberdeen Children's Hospital which has the only paediatric A&E department in the north east of Scotland, serving a catchment area of over half a million people. Methods—All children attending with an injury sustained due to a fall from a bed or top bunk over five months had their case notes reviewed by the author. Results—Eighty five children were identified, a majority of whom were reported to have fallen out of bed while sleeping. Twenty five sustained a fracture, 27 a head injury, 12 a laceration requiring treatment, and 21 sustained a soft tissue injury to a limb. Fourteen (16%) required admission. Sixty six (78%) of the injuries occurred in children under the age of 6 years. Conclusion—These results show a higher incidence of significant injury than previously reported, and demonstrate the inadvisability of letting children under the age of 6 years sleep in upper bunks. In an attempt to make parents more aware of the risks it is recommended that these dangers should be brought to public attention.

Capture-recapture: a useful methodological tool for counting traffic related injuries?

Abstract: Introduction—Although the capture-recapture technique is increasingly employed in studies of human populations to correct for under-ascertainment in traditional epidemiological surveillance, it has rarely been used in injury research. Objectives—To estimate the completeness of official data sources on traffic related injuries (TRIs) by using the capture-recapture technique and to calculate an ascertainment corrected number of fatal and serious TRIs among Scottish young people aged 15–24 years. The appropriateness of the approach in this context is also assessed. Method—A two sample capture-recapture technique was applied to two official sources of TRI data. Data on TRIs were obtained from the Scottish Health Service and the STATS19 dataset at the University of Essex Data Archive for 1995. Four standards (A-D) of matching were applied to fatalities and serious TRIs to allow plausible relaxation of matching standards within the context of the data collection setting. The completeness of each data source was assessed, and an ascertainment corrected number of fatalities and serious TRIs calculated. Results—The ascertainment corrected number of TRI fatalities among 15–24 year olds using standard D was 104. This represents only a small increase in the number of fatalities using capture-recapture than when using each individual dataset. The completeness of the Scottish Health Service database for TRI fatalities was 93%. The STATS19 database was 95% complete. The ascertainment corrected number of TRI hospital admissions was 1969. The STATS19 and the Scottish Health Service databases were approximately two thirds and three quarters complete respectively for non-fatal TRIs requiring hospitalisation. Conclusions—Injury researchers have advocated the linkage of major datasets to supplement and improve the quality of injury data. Using capture-recapture we found that routine databases enumerate TRI fatalities accurately, in contrast to injury morbidity databases that do not. Capture-recapture is a potentially useful method of evaluating the completeness of data sources and identifying biases within datasets. However, ascertainment corrected rates should be viewed with caution. A number of requirements of the capture-recapture technique are unachieved in this study of injury in the human population.

Demonstrating Your Program's Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury.

Abstract: This book comes with a comment form so that readers can evaluate its worth. I found this a very useful starting point when reviewing the text and would encourage everyone else to use it too. As a researcher and practitioner who has had experience of evaluating injury prevention programmes, I was interested to see what this United States text has to offer, and how applicable it is to the UK. The purpose of the book is to help those working in injury prevention understand (1) why evaluation is worth the resources and effort involved, (2) how evaluation is conducted, and (3) how to incorporate evaluation into programmes. The book is divided into three main sections as outlined above. Section one is brief but covers important issues such as why evaluate, what …

Evaluation of the Waitakere Community Injury Prevention Project

Abstract: Objective—To evaluate the Waitakere Community Injury Prevention Project (WCIPP). Methods—Process and outcome evaluations were conducted over a three year period. Process activities included analysis of project documentation, participant observation, key informant interviews, and two post-implementation case studies. A quasiexperimental design was used for the outcome evaluation. Three primary sources of data were collected and analysed: injury statistics; a pre-post telephone survey (n=4000); and a pre-post organisation survey (n=144). Results—Process evaluation provided a comprehensive account of the operation and activities of the WCIPP. Findings stress the pivotal role of the coordinators and highlight the value of incorporating a multicultural approach. A positive impact on changes to Waitakere City Council safety policies and practices was also evident. Outcome evaluation findings demonstrated significant reductions in rates of Waitakere child injury hospitalisations (p<0.05), while comparison communities showed an increase in child hospitalisation rates. In addition, compared with pre-intervention and comparison data, significantly more Waitakere residents were aware of injury prevention safety messages (p=0.0001) and had acquired appropriate child safety items (p=0.0001). Conclusion—The community injury prevention model appears to be an effective strategy for injury prevention. The support provided by the council for the WCIPP has provided a benchmark for the role of local governments in injury prevention.

Gun use in the United States: results from two national surveys

Abstract: Objectives—To determine the relative incidence of gun victimization versus self defense gun use by civilians in the United States, and the circumstances and probable legality of the self defense uses. Methods—National random digit dial telephone surveys of the adult population were conducted in 1996 and 1999. The Harvard surveys appear unique among private surveys in two respects: asking (1) open ended questions about defensive gun use incidents and (2) detailed questions about both gun victimization and self defense gun use. Five criminal court judges were asked to assess whether the self reported defensive gun uses were likely to have been legal. Results—Even after excluding many reported firearm victimizations, far more survey respondents report having been threatened or intimidated with a gun than having used a gun to protect themselves. A majority of the reported self defense gun uses were rated as probably illegal by a majority of judges. This was so even under the assumption that the respondent had a permit to own and carry the gun, and that the respondent had described the event honestly. Conclusions—Guns are used to threaten and intimidate far more often than they are used in self defense. Most self reported self defense gun uses may well be illegal and against the interests of society.