Injury surveillance trends in career–technical education: New Jersey 1999–2018

Introduction: Adolescents engaging in school-sponsored work experiences may be at risk of injury due to factors such as inexperience. This article examines trends in 20 years of reported injuries among New Jersey (NJ) adolescents engaging in school-sponsored work experiences, and compares a transition from paper to online reporting format. Methods: New Jersey requires reporting of injuries occurring during school-sponsored work experiences to the NJ Department of Education. Injuries reported by NJ schools from 1999 to 2018 (n = 2,119) were examined; incidence rates for 2008 to 2018 (n = 743) were calculated using publicly available NJ Department of Education enrollment data for the denominator, including for specific groups of students: career and technical education; special healthcare needs. Results: A downward trend in reported injuries in NJ schools was observed. However, the year online reporting became required by code (2013), an increase of nearly 50% was seen from 2012 (59–89), followed by a decline in reported incidents 2014 to 2018 (mean = 65, range 76 down to 47). Injury rate trends over time paralleled those of reported incidents. Conclusions: This study suggested worker safety and public health benefits of improvements from State of NJ code required training programs and online injury surveillance report form. Practical Applications: One potential method to address the safety and health of adolescents engaging in work experiences is the use of online reporting forms, to aid in surveillance efforts, coupled with occupational safety and health training specifically geared toward teachers and administrators who both supervise young, relatively inexperienced and vulnerable workers and who make relatively frequent worksite visits. Incorporation of specific details of the instructions on the use of a reporting form into required trainings, in addition to providing a clear, accessible guidance manual online, could further help improve youth worker safety surveillance efforts.     

A survey of forest workers in New Zealand. Do hours of work, rest, and recovery play a role in accidents and injury?

PROBLEM: A number of structural and organizational changes have occurred recently within the New Zealand Forestry Industry, with concerns being raised about the impact of these changes on the forestry worker in terms of fatigue, sleepiness, and compromised safety. This study explored the relationship of fatigue, and some of its key determinants, with accidents and injuries in a group of forestry industry workers in New Zealand. METHOD: A total of 367 forestry workers responded to a self-administered questionnaire. RESULTS: Fatigue was found to be commonly experienced at work in the forest, with 78% of workers reporting that they experienced fatigue at least "sometimes." This study found that certain groups of workers reported long working hours, reduced sleep, compromised recovery time, and intensely paced work. The results of logistic regression analysis showed that recent sleep, number of breaks taken during the workday, and specific job/tasks were independently associated with reporting of high fatigue levels at work. Near-miss injury events were significantly more common among those reporting a high level of fatigue at work. Accidents and lost-time injury were associated with length of time at work, ethnicity, and having had near-miss injury events. DISCUSSION: Together, these results suggest that fatigue and aspects of work organization, which are likely to be fatiguing, may be associated with compromised safety for forest workers. IMPACT ON INDUSTRY: With an already slim margin of error present in forest operations, an impairment due to increased fatigue may constitute a significant risk factor for accidents and injuries in this workforce. The results indicate the need for further examination of shift and workload management among forestry workers, as well as a role for improving industry awareness about the causes and consequences of fatigue.     

General health status and functional disability following injury in traffic crashes

OBJECTIVE: With increasing rates of survival associated with traffic crashes, a shift to understand the consequences of injury has risen to prominence. This prospective cohort study set out to examine general health status and functional disability at 2 months and 6-8 months post-crash. METHODS: Participants were otherwise healthy adults aged 18-59 years admitted to hospitals, excluding those with moderate-severe head injury and spinal cord injury. Sixty-two adults completed interviews prior to discharge and at 2 months and 8 months post-discharge. RESULTS: By 8 months post-crash, 89 percent had resumed employment and or study, two thirds rated the resolution of their medical problems to be excellent (14.5 percent) or good (53 percent), and 82 percent were considered to be fully self-sufficient with respect to activities of daily living. Despite this, results from the SF-36 indicated significant reductions in health status at 2 and 8 months post-crash relative to pre-crash health, with domain scores up to 26 percent lower than pre-crash scores, while assessment of activities of daily living indicated residual functional disability at both follow-up times. Self-reported pain was higher for both males and females at both follow-up times compared with pre-crash self-reported pain. CONCLUSION: This study demonstrated significant, ongoing loss of health-related quality of life and impairment associated with injuries sustained in road crashes, highlighting the need for continuing care post-discharge to facilitate a rapid return to optimal health.     

Evolution of road risk disparities at small-scale level: example of Belgium

PROBLEM: Road accident outcomes are traditionally analyzed at state or road network level due to a lack of aggregated data and suitable analytical methods. The aim of this paper is to demonstrate usefulness of a simple spatiotemporal modeling of road accident outcomes at small-scale geographical level. METHOD: Small-area spatiotemporal Bayesian models commonly used in epidemiological studies reveal the existence of spatial correlation in accident data and provide a mechanism to quantify its effect. The models were run for Belgium data for the period 2000-2005. Two different scale levels and two different exposure variables were considered under Bayesian hierarchical models of annual accident and fatal injury counts. The use of the conditional autoregressive (CAR) formulation of area specific relative risk and trend terms leads to more distinctive patterns of risk and its evolution. The Pearson correlation tests for relative risk rates and temporal trends allows researchers to determine the development of risk disparities in time. RESULTS: Analysis of spatial effects allowed the identification of clusters with similar risk outcomes pointing toward spatial structure in road accident outcomes and their background mechanisms. From the analysis of temporal trends, different developments in road accident and fatality rates in the three federated regions of Belgium came into light. Increasing spatial disparities in terms of fatal injury risk and decreasing spatial disparities in terms of accident risk with time were further identified. IMPACT ON INDUSTRY: The application of a space-time model to accident and fatal injury counts at a small-scale level in Belgium allowed identification of several areas with outstandingly high accident (injury) records. This could allow more efficient redistribution of resources and more efficient road safety management in Belgium.     

Youth on racial minority operated U.S. farms, 2008: Demographics and injuries

IntroductionTo obtain injury surveillance data for youth on racial minority operated farms, the National Institute for Occupational Safety and Health developed the Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS) in collaboration with the U.S. Department of Agriculture.MethodsUsing a regionally stratified telephone survey of U.S. minority operated farm households, M-CAIS data were collected for youth less than 20 years of age.ResultsThere were an estimated 37,443 youth living on racial minority operated U.S. farms in 2008, almost half (46%) of these youth worked on the farm. Racial minority farm operators hired 6,443 youth, and reported an estimated 775,991 youth relative and other visitors on the farm. These youth suffered an estimated 516 injuries (5.9 injuries/1000 farms).ConclusionsHousehold youth had an injury rate of 7.8 injuries/1000 household youth and a work-related injury rate of 6.9 injuries/1000 working household youth.Practical applicationsThe research enables agricultural safety and health researchers, practitioners, and educators to identify priorities and design trainings and interventions to minimize the risk of farm hazards to youth on racial minority farm operations in the United States.     

Ecology of player-to-player contact in boys' youth soccer play

INTRODUCTION: Youth soccer (football) injuries occur for a wide range of reasons, but the most frequent cause of injury is via player-to-player contact. This study was designed to study the ecology of collisions between players during youth soccer play. METHOD: Six teams of 11- and 12-year-old male players were followed over the course of a full season. Games were videotaped and reviewed to address three primary questions: how frequently do player-to-player collisions occur; when and where on the field do those collisions occur; and what is the rate of falls and injuries as a result of player-to-player contact. RESULTS: A total of 1,279 player-to-player collisions was observed, or an average of 65.59 collisions per game. Nearly half of the observed collisions resulted in one or both players falling to the ground, and about one-tenth resulted in the referee calling a foul, but very few of the collisions (less than 1%) resulted in an injury. Collisions occurred relatively consistently throughout the games, no matter what the score was. They occurred most frequently in the midfield area, when the ball was on or near the ground, and when players were attempting to retrieve a loose, uncontrolled ball. CONCLUSIONS: Results are discussed with respect to implications for injury prevention.     

Measurement of driving patterns of older adults using data logging devices with and without global positioning system capability

BACKGROUND: Methods to study driving patterns and exposure of older drivers have typically relied on surveys or driving diaries. Electronic data logging devices may offer a reliable, alternative method of measuring driving exposure, and global positioning system (GPS) technology may be able to provide further information about driving patterns. OBJECTIVES: The aim of this study was to compare a driving diary with two electronic data logging devices, one of which had GPS capability, in order to identify which method best assesses the driving exposure and habits of older drivers as well as the method most acceptable to study participants. METHOD: In this prospective cohort study we recruited 20 participants aged 70 years or more (mean 78; range 70-85) (15 men and 5 women). The participants' driving patterns were recorded for one week with an electronic data logging device with GPS (FleetPulse), followed by recording for a further week with an electronic data logging device without GPS (CarChip). During both time periods the subjects also completed a standard driving diary. RESULTS: More comprehensive information, including braking and acceleration patterns, duration of driving time, time of day, and maximum speeds, was collected with the electronic devices than with the driving diary. There was excellent correlation between the driving diary data and those obtained with the CarChip (r = 0.9; p < 0.01). The correlation between the driving diary data and the FleetPulse data was moderate (r = 0.56; p = 0.02). The subjects clearly preferred the electronic monitoring devices over the driving diary. GPS data were able to demonstrate driving routes. CONCLUSIONS: Electronic data logging devices are a valid method for recording the driving patterns of older adults. These devices also reduce burden and improve the completeness of data.     

Effect of a nurse back injury prevention intervention on the rate of injury compensation claims

Problem

This study evaluated the effect of introducing a No Lifting policy on back injuries to nurses, across an entire health care system.

Methods

Methods included: analysis of the data for all public health agencies in the Australian state of Victoria; compensation data from the Victorian Workcover Authority; data about workforce and program implementation from a retrospective survey of agencies; longitudinal analysis of standardized workers compensation claim rates for back injuries before, during and after the intervention.

Results

A statistically significant decline in back injury claim rates during implementation contrasted with no statistically significant trends within the periods before and after the intervention. A statistically significant reduction occurred in mean quarterly standard back injury claim incidence rates per 1,000 equivalent fulltime nursing staff (EFTNS), representing a 24% reduction in standard back injury claims/1000 EFTNS.

Discussion

Ergonomics principles encourage changing the work environment to suit the worker. This approach delivered a significant improvement in the immediate term.

Impact of industry

The substantial decline in back injury rates signifies a major improvement in the safety of a critical aspect of the work environment for nurses.     

Long-term crash trends at single- and double-lane roundabouts in Washington State

Introduction: Despite the proven safety benefits, crashes still occur at roundabouts. This study examined long-term trends in total crash counts, crash severity, and crashes involving common driver errors (failing to yield the right-of-way and speeding) in the period following the completion of single- and double-lane roundabouts in Washington state. Method: Crashes occurring during 2010–2016 at single- and double-lane roundabouts completed between 2009 and 2015 in Washington state were included. Poisson regression examined changes in annual total crash counts over time. Logistic regression estimated average annual changes in the odds that a crash involved an evident/incapacitating/fatal injury and that a crash involved a driver error. Regression models were estimated for single- and double-lane roundabouts separately. Results: Annual total crash counts declined significantly by 8.8% over time at double-lane roundabouts and increased nonsignificantly over time at single-lane roundabouts. The study estimated a significant 32.1% annual reduction in the odds that a crash involved an evident or incapacitating injury at double-lane roundabouts and a nonsignificant 18.9% reduction at single-lane roundabouts. There was a significant 10.6% annual decline in the odds that a crash was right-of-way related at double-lane roundabouts and a significant 19.1% annual decline in the odds that a crash was speeding-related at single-lane roundabouts. Conclusions: The current study demonstrates that safety can improve over time at double-lane roundabouts as drivers gain experience navigating them. At the same time, it is important that roundabouts include design elements that will prevent right-of-way mistakes and reduce speeds. Practical applications: Communities installing double-lane roundabouts may find that their benefits will increase the longer they are in place, even if initial changes in crashes and injuries are underwhelming.     

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000–2016

Introduction: Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. Methods: Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. Results: Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39–49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14–19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04–1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65–85 years) passengers were less likely to be unrestrained than those aged 20–64 years. Conclusions: Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.     

Adolescent noncompliance with age-specific versus universal US motorcycle helmet laws: Systematic review and meta-analysis

Introduction: The U.S. experience with motorcycle helmets affords an important insight into the responses of adolescents to age-specific laws. Political contention has led to a number of U.S. state law changes back and forth between universal and age-specific laws. Because both kinds of law require adolescent motorcyclists to wear helmets, relatively few studies have focused on how the law type affects their behavior. Method: Differential behavior is tested by a systematic review of literature, leading to a meta-analysis, in relation to the experience of various states’ motorcycle helmet laws. An electronic search was conducted for before-and-after studies in U.S. states that include data on adolescent helmet usage – both with a universally applicable motorcycle helmet law, and with an age-restricted law (usually, under-21 or under-18) – from observational, injury or fatality records for a certain period (e.g., 12 months) pre and post the state law change. Results: The search yielded ten studies, including two that compared a set of age-specific law states with a set of universal law states over the same time period. Heterogeneity analysis of seven single-state studies with raw data revealed an acceptable fit for a random-effects model. Additional noncompliance with age-restricted laws was indicated by an attributable percentage among exposed of over 65% and odds ratio exceeding 4. Conclusions: About two-thirds of adolescent noncompliance with age-restricted motorcycle helmet usage laws disappears with universal applicability. Evidence from numerous international studies of youth reaction to helmet laws suggests that a large part of the greater compliance with universal laws is due to their conveying a more convincing message that helmets afford protection against injury. Practical Applications: The meta-analysis provides fresh, young-rider perspective on the continuing debate over motorcycle-helmet laws. Broader insight into adolescent psychology suggests considering alternatives to age-restricted laws more widely in safety and health policy.     

Time allocation between work and recreation and the associated injury risks among young people

PROBLEM: The purpose of this study was to examine the relationship between overall risk of injury and time use patterns between work and active recreation among adolescents and young adults. METHODS: Using a representative sample of 9,795 Canadians aged 15-24 years, a multivariate logistic regression on the likelihood of any medically attended injury was conducted, including sociodemographic, individual, and time factors. RESULTS: Young people who engaged in a combination of high work and high activity hours were twice as likely to sustain a medically attended injury compared to those who worked low hours, but did not participate in any recreational activity. Those respondents who were not in school had a 43% increase in injury risk compared to full-time students. SUMMARY: Our findings suggest that injury risk was not a simple function of fatigue and cumulative exposure time. Our findings suggest the importance of considering time use and the associated injury risk tradeoffs. IMPACT ON INDUSTRY: Relevant to state and federal work safety policy makers, our findings suggest the importance of understanding where youth might otherwise spend their time if constraint were placed on their employment opportunities, and the associated injury risk tradeoffs must be taken into consideration.     

CDC's efforts to improve traumatic brain injury surveillance

IntroductionYouth sports concussion has become a prominent public health issue due to growing concern about the risk of long-term health effects.MethodA broad spectrum of stakeholders has convened to propose solutions, including a committee of the National Academy of Sciences (NAS) who systematically examined the issue and, in a 2014 report, made a series of recommendations to better address this public health problem.ResultsAmong these recommendations, the NAS committee called for CDC to develop a plan for a comprehensive surveillance system to better quantify the incidence and outcomes of youth sports concussion among children 5 to 21 years of age. Since the release of the NAS report, CDC has taken action to address this recommendation and, in the process, develop strategies to improve traumatic brain injury (TBI) surveillance more broadly. The challenges outlined by the NAS committee with respect to producing comprehensive incidence estimates of youth sports concussion are not exclusive to youth sports concussion, but also apply to TBI surveillance overall. In this commentary, we will discuss these challenges, the process CDC has undertaken to address them and describe our plan for improving TBI and youth sports concussion surveillance.     

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.     

Measuring Road Traffic Safety Performance: Monitoring Trends in Nonfatal Injury

Traditional indicators used to monitor trends in nonfatal injury are influenced by a range of factors other than the incidence of injury. Indicators based on threat-to-life scales offer a means of addressing this problem. The aim of the research described in this article was to compare trends in the official indicators with trends in selected threat-to-life indicators. We compared indicators based on the New Injury Severity Score and the International Classification of Diseases–based Injury Severity Score with the official New Zealand indicators; namely, (1) reported injuries, (2) reported injuries per 10,000 vehicles, (3) reported injuries per 100,000 people, and (4) number hospitalized (discharges). All the official indicators suggest that there has been a substantive decline in nonfatal Motor Vehicle Traffic Crashes (MVTCs) for the period 1988–2000, but a notable increase in 2001. The latter appear to be artifactual increases due to changes in patterns of data collection and do not reflect any real changes in incidence. Further support for this is provided by the results for the two threat-to-life indicators, which suggest that the decline observed for 1988–98 may have been attributable to a decline in the ascertainment or occurrence of minor injuries since those injuries, which represent a significant threat to life, have not declined to the same degree. Given the prominence of motor vehicle crashes as a cause of unnecessary morbidity, more thought needs to be given to deriving valid indicators for measuring trends in serious nonfatal injury.     

Measuring road traffic safety performance: monitoring trends in nonfatal injury

Traditional indicators used to monitor trends in nonfatal injury are influenced by a range of factors other than the incidence of injury. Indicators based on threat-to-life scales offer a means of addressing this problem. The aim of the research described in this article was to compare trends in the official indicators with trends in selected threat-to-life indicators. We compared indicators based on the New Injury Severity Score and the International Classification of Diseases-based Injury Severity Score with the official New Zealand indicators; namely, (1) reported injuries, (2) reported injuries per 10,000 vehicles, (3) reported injuries per 100,000 people, and (4) number hospitalized (discharges). All the official indicators suggest that there has been a substantive decline in nonfatal Motor Vehicle Traffic Crashes (MVTCs) for the period 1988-2000, but a notable increase in 2001. The latter appear to be artifactual increases due to changes in patterns of data collection and do not reflect any real changes in incidence. Further support for this is provided by the results for the two threat-to-life indicators, which suggest that the decline observed for 1988-98 may have been attributable to a decline in the ascertainment or occurrence of minor injuries since those injuries, which represent a significant threat to life, have not declined to the same degree. Given the prominence of motor vehicle crashes as a cause of unnecessary morbidity, more thought needs to be given to deriving valid indicators for measuring trends in serious nonfatal injury.     

Worker-fatigue contributing to workplace incidents in New Zealand Forestry

ProblemReports of incidents in dangerous work environments can be analysed to identify common hazards, in turn aiding in the prevention of future accidents. Whilst studies exist that do this, most focus on causes that involve physical risks. In this paper we propose an alternative approach, and illustrate causes of forestry incidents from the perspective of worker-failure and fatigue. Method This paper outlines the analysis of eight years’ worth of New Zealand forestry incident data, with a focus on the cause of, and time that, incidents occur. Results This has resulted in two main findings. First, 70% of incidents can be attributed, at least in part, to worker-failures. Second, 78% of worker-failure based causes show indications of fatigue. This indicates that a significant number of forestry incidents are caused by worker-fatigue. Finally, this dataset showed inconsistencies in data quality, similar to those that exist in other datasets. This did not affect our analysis. However, these types of errors have the potential to affect the data quality in the national reporting system. Impact on industry The results from this study will be used in a larger project on detecting fatigue in forestry workers for injury and incident prevention. It is also our hope that other researchers may find these results of interest for further fatigue prevention research in hazardous industries.     

Official reporting and newspaper coverage of road crashes: A case study

This paper describes a case study in Flanders–Belgium on the reporting rate of road crashes. Crash data from three sources were compared: official crash data, data retrieved from an insurance company and newspaper articles. A sample of 140 injury crashes with motorcyclists from an insurance company was used as the reference category. The purpose was to explore factors that contribute to the likelihood of crashes (not) to be reported in official statistics and newspapers. Logistic regression analyses and chi-square tests were used to reveal differences in reporting rate according to some variables. About 80% of the crashes with severe injuries were reported in the official statistics whereas the reporting rate for crashes with slightly injured was about 55%. Newspapers covered about 50% of crashes with severe injuries. The reporting rate in both official statistics and newspapers increased with the severity of the crash.