Prevalence and demographic differences in microaccidents and safety behaviors among young workers in Canada

IntroductionThe present study examines the self-reported frequency of non-lost work time workplace injuries (“microaccidents”) and the frequency of three types of work-related safety behaviors (i.e., safety voice, safety compliance, and safety neglect) recalled over a four-week period.MethodWe analyzed data on microaccidents and safety behaviors from 19,547 young workers (aged 15–25 years, Mdn = 18 years; 55% male) from multiple Canadian provinces.ResultsApproximately one-third of all young workers recalled experiencing at least one microaccident at work in the last four weeks. Comparisons across three age groups revealed that younger workers, particularly between the ages of 15–18, reported more frequent microaccidents, less safety voice, less safety compliance, and more safety neglect than workers aged 19–22. This pattern of results also held for comparisons between workers in 19–22 and 23–25 age groups, except for safety voice which did not differ between these two older age groups. In terms of gender, males and females reported the same frequency of microaccidents, but males reported more safety voice, more safety compliance, and more safety neglect than females did. The results and limitations of the present study are discussed.ConclusionFrequency of microaccidents and safety behavior vary among young worker age sub-groups.     

Enabling youth to advocate for workplace safety

Work-related injury rates for Canadian youth (ages 15–24) are alarmingly high compared to adult workers even though youth are less likely to be performing hazardous jobs. This paper reports on a document analysis of youth workplace safety education initiatives sponsored by national and provincial/territorial governmental and non-governmental agencies. Web-based documents were analyzed through the theoretical lens of self-advocacy. The self-advocacy framework highlights how youth can be agentic in altering high-risk workplaces by publicly articulating their own interests, needs, and rights (Test et al., 2005); thus, self-advocacy is a critical component in studying educational programs for youth safety. The analysis revealed that instruction on workplace safety identifies safety issues to workers and tells youth to work safely but does little to promote self-advocacy in young workers.     

Foundational workplace safety and health competencies for the emerging workforce

IntroductionYoung workers (aged 15–24) suffer disproportionately from workplace injuries, with a nonfatal injury rate estimated to be two times higher than among workers age 25 or over. These workers make up approximately 9% of the U.S. workforce and studies have shown that nearly 80% of high school students work at some point during high school. Although young worker injuries are a pressing public health problem, the critical knowledge and skills needed to prepare youth for safe and healthy work are missing from most frameworks used to prepare the emerging U.S. workforce.MethodsA framework of foundational workplace safety and health knowledge and skills (the NIOSH 8 Core Competencies) was developed based on the Health Belief Model (HBM).ResultsThe proposed NIOSH Core Competencies utilize the HBM to provide a framework for foundational workplace safety and health knowledge and skills. An examination of how these competencies and the HBM apply to actions that workers take to protect themselves is provided. The social and physical environments that influence these actions are also discussed.ConclusionsThe NIOSH 8 Core Competencies, grounded in one of the most widely used health behavior theories, fill a critical gap in preparing the emerging U.S. workforce to be cognizant of workplace risks.Practical applicationsIntegration of the NIOSH 8 Core Competencies into school curricula is one way to ensure that every young person has the foundational workplace safety and health knowledge and skills to participate in, and benefit from, safe and healthy work.     

Alcohol-related deaths among young passengers: An analysis of national alcohol-related fatal crashes

Introduction: There is consensus that riding with an impaired driver (RWI) constitutes a major threat to public health. The aim of this study was to characterize the factors contributing to the motor-vehicle deaths of 15–20 year-old (y/o) passengers that RWI with a peer. Method: Secondary analyses of the 2010–2018 Fatality Analysis Reporting System. 5,673 passengers aged 15–20 y/o killed while riding in passenger cars with a driver aged 21 or older, 3,542 of these drivers also aged 15–20 y/o. Analyses were conducted between October 2019 and December 2020. Results: Sixty-three percent of the young passengers were killed while riding with a driver 15–20 y/o. Of these drivers, 26.8% had a blood alcohol concentration (BAC) >0.00 g/dL and 77.1% had a BAC ≥0.08 g/dL. Compared with those occurring during the day on weekdays, fatalities of young passengers who RWI with a peer driver with a BAC ≥ 0.08 g/dL often occurred on weekend nights (OR = 8.2) and weekday nights (OR = 5.2), and when the passenger and driver were both male (OR = 1.8). Race/ethnicity was not a significant contributor to RWI fatalities. Conclusions: Most 15–20 y/o RWI fatalities occurred on weekends, at night, when the driver was a young peer with a high BAC, and the passenger and driver were male. The high prevalence of fatalities in these high-risk situations suggests that young driver-passenger dynamics may contribute to alcohol-related fatalities. Practical Applications: To curb RWI fatalities among underage passengers, countermeasures should focus not only on underage drinking drivers and riders, but also on drinking drivers of all ages. Prevention should increase focus on situations in which both the young passenger and young driver are males.     

Assessing disabling and non-disabling injuries and illnesses using accepted workers compensation claims data to prioritize industries of high risk for Oregon young workers

Introduction: Young workers are especially vulnerable to occupational injuries and illnesses. There is a continued need to investigate injury burden among young workers across demographics and industry to inform targeted interventions. Workers compensation (WC) claims are important for quantifying work-related injuries and illnesses, however published studies have focused on disabling claims. This study extended previous research on Oregon young workers by including the most recent WC claims data to identify patterns of injury and high risk industries. Methods: We obtained all accepted disabling claims (N = 13,360) and a significant portion of non-disabling claims (N = 24,660) on workers aged 24 years and under from 2013 to 2018. Claim count, rate and cost were calculated by year, age, gender, industry, and injury type. A prevention index (PI) method was used to rank industries in order to inform prevention efforts. Results: Average annual disabling and non-disabling claim rates were 111.6 and 401.3 per 10,000 young workers. Workers aged 19–21 (disabling: 119.0 per 10,000 and non-disabling: 429.3) and 22–24 years (115.7 and 396.4) and male workers (145.3 and 509.0) had higher claim rates than workers aged 14–18 (80.6 and 297.0) and female workers (79.8 and 282.9). The most frequent injury types were “struck by/against” (35.6%) and “work-related musculoskeletal disorders (WMSDs)” (19.5%). High risk industries included agriculture, construction, and manufacturing for both genders combined. For female young workers, the highest risk industry was healthcare. Conclusions: This study demonstrated the added value of non-disabling WC claims data. Using both disabling and non-disabling data and PI method, agriculture, construction, manufacturing and healthcare industries were identified as priority workplaces to prevent common and costly injuries among Oregon young workers. Practical Applications: While the industries identified are considered hazardous for all workers, findings in this study can guide targeted research and prevention efforts specific to young workers.     

Characteristics of vehicles driven by teens and adults killed in crashes, 2013–2017

Introduction: Teen drivers experience higher crash risk than their experienced adult counterparts. Legislative and community outreach methods have attempted to reduce this risk; results have been mixed. The increasing presence of vehicle safety features across the fleet has driven fatality numbers down in the past decades, but the disparity between young drivers and others remains. Method: We merged Fatality Analysis Reporting System (FARS) data on fatal crashes with vehicle characteristic data from the Highway Loss Data Institute (HLDI). The analysis compared the vehicle type, size, age, and the presence of select safety features in vehicles driven by teens (ages 15–17 years) and adult drivers (ages 35–50 years) who were killed in crashes from 2013 to 2017. Results were compared with a similar analysis conducted on data from 2007 to 2012. Results: Teen drivers were more likely than their adult counterparts to be killed while driving older, smaller vehicles that were less likely to have the option to be equipped with side airbags. Discussion: Teenage drivers remain more likely to be killed while driving older, smaller vehicles than adult drivers. Parents and guardians are mainly responsible for teen vehicle choice, and should keep vehicle size, weight, and safety features in mind when placing their teen in a vehicle. Practical Application: These findings can help guide safer vehicle choice for new teen drivers.     

Workplace violence: a study of Turkish workers

This research was conducted to address the experience of workplace violence of Turkish workers from different sectors and to investigate the impact of the exposed violence on their psychological well-being. Data were collected anonymously with printed questionnaires from the volunteer participants and depended on self-reporting. The response rate was 79.0% (1708/2161). The prevalence of workplace violence was found to be 44.8%. The most common type was verbal violence together with mobbing (bullying). Victims of physical violence were mostly males, whereas females were found to be victims of verbal, psychological and sexual violence. Most cases did not result in legal action and the victims remained silent. Psychological well-being of exposed workers in terms of depression, anxiety and stress seemed to deteriorate. Workplace violence remains a silent epidemic in Turkey. Preventive measures against workplace violence and social support for violated workers do not exist.     

Nursing student evaluation of NIOSH workplace violence prevention for nurses online course

Introduction: As primary targets of workplace violence in health care settings, nurses may suffer negative physical and psychological consequences. NIOSH created an online course to educate nurses about violence prevention techniques. Method: A mixed-methods approach assessed workplace violence awareness and knowledge among nursing students. A pre/post/post-test survey and focus group discussions evaluated participant awareness and knowledge, assessed course design, and solicited recommendations for increasing participation and strategies for improving message retention. Results: The mean awareness scores differed significantly between pre-course and both post-course time points (Wilk's λ = 0.319, F(2, 46) = 49.01, p < 0.001). Post hoc tests using the Bonferroni correction revealed that course participation increased awareness of workplace violence from pre-course scores (M = 0.75, SD = 0.438) to immediate post-course (M = 2.13, SD = 0.789) and four-week post-course (M = 1.96, SD = 0.771) scores on a 3-item measure. Similarly, mean knowledge scores increased between pre-course and both post-course time points (Wilk's λ = 0.495, F(1.57, 73.66) = 37.26, p < 0.001). Post hoc tests using the Bonferroni correction revealed that course participation increased knowledge of workplace violence from pre-course scores (M = 6.65, SD = 1.45) to immediate post-course (M = 8.56, SD = 1.32) and four-week post-course (M = 8.19, SD = 1.42) scores on a 10-item measure. Qualitative data from the focus groups reinforced the quantitative findings. Participants citing benefits from the content strongly recommended including the course in nursing curriculums. Incorporating the course early in the nursing educational experience will better prepare students to deal with workplace violence when they enter health care professions. Conclusions: The results indicate that NIOSH and its partners created an effective online workplace violence awareness and prevention course. Practical applications: Nursing students and professionals can be effectively educated about workplace violence using an online format.     

Communication in the workplace: Defining the conversations of supervisors

Background: Communications plays a central role in promoting the health and wellbeing of workers. Although much literature has shown the positive benefits of safety communication in the workplace, research has yet to explore the nature of these communication practices within supervisor–worker relationships. This study overcomes this gap in the literature through objectively monitoring communication within the daily working lives of work-group supervisors in one organization. Aims: The aims of the research were to: (a) categorize communication in the workplace into three categories, namely task-related communication, relationship-related communication, and safety-related communication; and (b) explore the frequency of these dialogs. Method: We periodically recorded brief snippets of ambient (acoustic) sounds in supervisors' workplace environment by using an Electronically Activated Recorder (EAR). The EAR was run on an Apple iPod, with an application downloaded for free on iTunes (i.e., iEAR). The EAR was programmed to record for 30 s every three minutes for eight working hours a day of a five-day working week. Results: A total of 12.38 h of acoustic sounds from five workgroup supervisors was useable for coding. The results found examples of task-related (productivity, efficiency, workflow, and human resources) communication, as well as relationship-related (greetings, personal life discussions, workplace relations), and safety-related communication. We also found that the majority of the communication recorded was task-related communication compared with relationship-related and safety-related communication. Practical applications: This research provides preliminary insights into communication practices in the workplace and avenues for future research.     

Occupational injury and psychological distress among U.S. workers: The National Health Interview Survey, 2004–2016

Introduction: Injuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (b) the association between injury status and SPD. Methods: Self-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004–2016). Psychological distress during the past 30 days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0–4, total score range: 0–24). SPD was defined as K6 ≥ 13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates. Results: The prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI = 7.71%, NOI = 6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR = 2.19, 95%CI: 1.62–2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR = 0.98, 95%CI: 0.65–1.48). Conclusion: The prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.     

Analysing workplace violence towards health care staff in public hospitals using alternative ordered response models: the case of north-eastern Turkey

The main objective of this article is to determine key factors that may have a significant effect on the verbal abuse, emotional abuse and physical assault of health care workers in north-eastern Turkey. A self-administered survey was completed by 450 health care workers in three well-established hospitals in Erzurum, Turkey. Because of the discrete and ordered nature of the dependent variable of the survey, the data were analysed using four distinctive ordered response models. Results revealed that several key variables were found to be a significant determinant of workplace violence, such as the type of health institution, occupational position, weekly working hours, weekly shift hours, number of daily patient contacts, age group of the respondents, experience in the health sector, training against workplace violence and current policies of the hospitals and the Turkish Ministry of Health.     

Temporary jobs and the severity of workplace accidents

Introduction. From the point of view of workplace safety, it is important to know whether having a temporary job has an effect on the severity of workplace accidents. We present an empirical analysis on the severity of workplace accidents by type of contract. Method. We used microdata collected by the Italian national institute managing the mandatory insurance against work related accidents. We estimated linear models for a measure of the severity of the workplace accident. We controlled for time-invariant fixed effects at worker and firm levels to disentangle the impact of the type of contract from the spurious one induced by unobservables at worker and firm levels. Results. Workers with a temporary contract, if subject to a workplace accident, were more likely to be confronted with severe injuries than permanent workers. When correcting the statistical analysis for injury under-reporting of temporary workers, we found that most of, but not all, the effect is driven by the under-reporting bias. Conclusions. The effect of temporary contracts on the injury severity survived the inclusion of worker and firm fixed effects and the correction for temporary workers' injury under-reporting. This, however, does not exclude the possibility that, within firms, the nature of the work may vary between different categories of workers. For example, temporary workers might be more likely to be assigned dangerous tasks because they might have less bargaining power. Practical implications. The findings will help in designing public policy effective in increasing temporary workers' safety at work and limiting their injury under-reporting.     

Values-in-action that support safe production

Introduction: Safe production is a sustainable approach to managing an organization’s operations that considers the interests of both management and workers as salient stakeholders in a productive and safe workplace. A supportive culture enacts values versus only espousing them. These values-in-action are beliefs shared by both management and workers that align what should happen in performing organizational routines to be safe and be productive with what actually is done. However, the operations and safety management literature provides little guidance on which values-in-action are most important to safe production and how they work together to create a supportive culture. Method: The researchers conducted exploratory case studies in 10 manufacturing plants of 9 firms. The researchers compared plant managers’ top-down perspectives on safety in the performance of work and workers’ bottom-up experiences of the safety climate and their rates of injury on the job. Each case study used data collected from interviewing multiple managers, the administration of a climate survey to workers and the examination of the plant’s injury rates over time as reported to its third party health and safety insurer. Results: The researchers found that plants with four values-in-action —a commitment to safety, discipline, prevention and participation—were capable of safe production, while plants without those values were neither safe nor productive. Where culture and climate aligned lower rates of injury were experienced. Discussion and conclusion: The four value-in-actions must all be present and work together in a self-reinforcing manner to engage workers and managers in achieving safe production. Practical application: Managers of both operations and safety functions do impact safety outcomes such as reducing injuries by creating a participatory environment that encourage learning that improves both safety and production routines.     

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004–2012

Introduction: Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers. Methods: Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004–2012. Participants were categorized as normal weight (BMI: 18.5–24.9 kg/m²), overweight (BMI: 25.0–29.9), obese I (BMI: 30.0–34.9), and obese II (BMI: 35 +). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software. Results: During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000 ± 1.2), fingers (11.5 ± 1.3), and knees (7.1 ± 0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR = 1.25 (95% CI = 1.04–1.52); obese I: 1.41 (1.14–1.74); obese II: 1.68 (1.32–2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR = 1.48, (95% CI = 1.03–2.13); obese I: 1.70 (1.13–2.55); obese II: 2.91 (1.91–4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR = 1.73 (95% CI = 1.29–2.31); obese I: PR = 2.24 (1.64–3.06); obese II: PR = 2.95 (2.04–4.26)]. Conclusions: Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers. Practical applications: Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.     

Respiratory Impairment in Cotton-Ginning Workers Exposed to Cotton Dust

Dust generated during the handling and processing of cotton causes ill health of ginning workers. The purpose of this study was to determine the prevalence of respiratory symptoms among cotton-ginning workers. This study involved 188 workers of 10 cotton-ginning factories. Forced vital capacity (FVC), peak expiratory flow rate (PEFR), and forced expiratory volume in 1 s (FEV1) declined significantly with increasing duration of exposure (p < .001) of the cotton-ginning workers. Results of a standard respirator medical evaluation questionnaire indicated that, depending on duration of exposure, 51%–71% of cotton-ginning workers suffered from chest tightness, 55%–62% experienced chest pain, while 33%–42% of the workers reported frequent cough. Blood tests of the workers showed higher values of erythrocyte sedimentation rate, eosinophils, and white blood cells when exposure was longer. Byssinosis symptoms were observed among the workers. We recommend regular periodical medical check-ups, compulsory use of personal protective equipment, and proper ventilation at the workplace.     

An application of a modified theory of planned behavior model to investigate adolescents’ job safety knowledge,norms, attitude and intention to enact workplace safety and health skills

Introduction: For many reasons, including a lack of adequate safety training and education, U.S. adolescents experience a higher rate of job-related injury compared to adult workers. Widely used social-psychological theories in public health research and practice, such as the theory of planned behavior, may provide guidance for developing and evaluating school-based interventions to prepare adolescents for workplace hazards and risks. Method: Using a structural equation modeling approach, the current study explores whether a modified theory of planned behavior model provides insight on 1,748 eighth graders’ occupational safety and health (OSH) attitude, subjective norm, self-efficacy and behavioral intention, before and after receiving instruction on a free, national young worker safety and health curriculum. Reliability estimates for the measures were produced and direct and indirect associations between knowledge and other model constructs assessed. Results: Overall, the findings align with the theory of planned behavior. The structural equation model adequately fit the data; most path coefficients are statistically significant and knowledge has indirect effects on behavioral intention. Confirmatory factor analyses suggest that the knowledge, attitude, self-efficacy, and behavioral intention measures each reflect a unique dimension (reliability estimates ≥0.86), while the subjective norm measure did not perform adequately. Conclusion: The findings presented provide support for using behavioral theory (specifically a modified theory of planned behavior) to investigate adolescents’ knowledge, perceptions, and behavioral intention to engage in safe and healthful activities at work, an understanding of which may contribute to reducing the downstream burden of injury on this vulnerable population—the future workforce. Practical application: Health behavior theories, commonly used in the social and behavioral sciences, have utility and provide guidance for developing and evaluating OSH interventions, including those aimed at preventing injuries and promoting the health and safety of adolescent workers in the U.S., who are injured at higher rates than are adults.     

A qualitative investigation of factors affecting school district administrators’ decision to adopt a national young worker curriculum

Introduction: Even though the majority of youth in the U.S. work, and workers under the age of 18 are seriously injured on the job at higher rates when compared to adults, most adolescents lack instruction on workplace safety and health. Method: This qualitative study examines the extent to which selected U.S. school districts provide workplace safety and health instruction to students and explores the factors that influence districts’ decision to adopt a free, foundational occupational safety and health (OSH) curriculum. Results: Results from key informant interviews conducted with a purposive sample of 34 school administrators revealed that only a third of the districts have at least 75% of their students receive some instruction on workplace safety and health, while 15% indicated they provide no instruction on this topic. District staff who indicated that they provide OSH instruction stated that it is most often taught through career and technical education (CTE; 65%) and/or health classes (26%). They believed the benefits of providing this instruction include assisting students to get jobs (38%) and helping students learn about safety (32%), while competing demands (44%) and time constraints (41%) were identified as barriers to providing OSH education to students. Conclusions: Given the importance of work to teens and their increased risk of work injury, interested stakeholders—including parents, teachers, employers, and the public health community—should promote the inclusion of workplace safety and health instruction in U.S. secondary schools. Practical Applications: This research fills a gap in current knowledge about the extent to which OSH is currently taught within U.S. secondary schools, enumerates barriers and facilitators to the inclusion of workplace safety and health instruction in schools, presents a free, foundational curriculum in workplace safety and health, and provides directions for future research on the vital role schools can play in preparing the future workforce for safe and healthy employment.     

The relationship of occupational injury and use of mental health care

Introduction: Symptoms of depression and anxiety are a common consequence of occupational injury regardless of its cause and type. Nevertheless, mental health care is rarely covered by workers’ compensation systems. The aim of this study was to assess the use of mental health care post-injury. Methods: We used a subsample of patient-care workers from the Boston Hospital Workers Health Study (BHWHS). We matched one injured worker with three uninjured workers during the period of 2012–2014 based on age and job title (nurse or patient-care associate) and looked at their mental health care use pre- and post-injury using medical claims data from the employer sponsored health plan. We used logistic regression analysis to assess the likelihood of mental health care use three and six months post-injury controlling for any pre-injury visits. Analyses were repeated separately by job title. Results: There were 556 injured workers between 2012 and 2014 that were matched with three uninjured workers at the time of injury (n = 1,649). Injured workers had a higher likelihood of seeking mental health care services than their uninjured counterparts during the six months after injury (OR = 1.646, 95% CI: 1.23–2.20), but not three months post-injury (OR = 0.825, 95% CI: 0.57–1.19). Patient-care associates had a higher likelihood to seek mental health care post-injury, than nurses (OR: 2.133 vs OR: 1.556) during the six months period. Conclusions: Injured workers have a higher likelihood to experience symptoms of depression and anxiety based on their use of mental health care post-injury and use is more predominant among patient-care associates; however, our sample has a small number of patient-care associates. Practical Applications: Treating depression and anxiety as part of the workers’ compensation system has the potential of preventing further physical ailment and improving the return to work process regardless of nature of injury.     

Workplace violence intervention effectiveness: A systematic literature review

This is a systematic review of literature published since 1992, to determine the effectiveness of interventions in preventing workplace violence and to suggest interventions that need further evaluation research. The health care industry is the topic of 54% of the papers, the retail industry is the topic of 11% of the papers, and the remaining papers address the workplace in general or other situations. This finding drives the organization of this review: the first group of papers discussed in this review evaluates interventions to prevent workplace violence in the retail industry – mostly to prevent robbery and violence to retail workers. Singly or in combination, environmental designs in the retail industry, such as increased lighting to improve visibility and a limited cash-handling policy, can make workers safer, but more research is needed to overcome the barriers to implementation of environmental designs, especially in small businesses. The second group of papers in this review is about interventions to prevent violence to health care workers – mostly training and techniques of dealing with combative patients. Training health care workers to better cope with violent patients and to avoid injury is becoming standard practice, but research is needed to identify specific aspects of training and patient management programs that are most effective.     

Young drivers' determinants of driving under the influence of cannabis: Findings from the Youth Cannabis and Driving Survey (YouCanDS)

Introduction: Driving under the influence of cannabis (DUIC) is proven to increase the risk of collisions and is most common among young drivers (ages 16 to 24). However, little is known about the specific determinants of DUIC behavior among youth, which limits the capacity to develop evidence-based prevention and intervention efforts. This study developed and evaluated a youth DUIC questionnaire, which was used to establish the DUIC determinants of young drivers. Method: The questionnaire was based on the theoretical framework of general deterrence and general prevention. Data obtained included: demographics, past cannabis use and DUIC experiences, DUIC intention, experiences riding as a passenger with someone DUIC, knowledge and credibility of the law, attitudes towards DUIC, and social controls. The resulting questionnaire was validated for a sample of 426 young drivers in the province of Ontario, Canada. An ordinal regression was conducted to examine the relationships between questionnaire items and DUIC intention. Results: The questionnaire displayed good construct validity and internal consistency across four out of five domains (KMO and Cronbach α values ≥ 0.70). Of the 426 respondents (52.6% female), 356 (83.6%) reported previous cannabis use, with 296 (69.5%) doing so in the past year, and 142 (33.3%) reporting DUIC. Furthermore, 179 (42%) study participants indicated at least a slight chance of DUIC in the next year. The regression analysis identified six variables predictive of DUIC intention: past DUIC incidence, perceived percent of those convicted that receive the penalty, moral awareness, perceived dangerousness, minor accident risk, and vicarious punishment avoidance. Conclusions: Preventive efforts should emphasize these determinants when designing targeted strategies and interventions. Practical Applications: These efforts should focus on educating the dangers and risk of a vehicle collision, that law enforcement has the capacity to apprehend and appropriately punish individuals DUIC, and that DUIC is wrong and socially unacceptable.