Children's behavioral traits and risk of injury: Analyses from a case-control study of agricultural households

Problem

Children on family agricultural operations have high risk of injury. The association between children's behavioral traits and their risk of injury is not well understood.

Method

Data from the Regional Rural Injury Study-II were used to assess behavioral risk factors for injury to children ages six to < 20 years. A total of 379 injury events (cases) and 1,562 randomly selected controls were identified. Adjusted odds ratios (OR) and 95% confidence intervals (CI), calculated using logistic regression, were used to estimate injury risk in reference to behavioral traits.

Results

Injury risks were greater for children with high levels of depressive symptoms (OR = 1.9, CI = 1.0-3.7) and aggression (OR = 1.6, CI = 0.9-2.7), and low levels of careful/cautious behavior (OR = 1.8, CI = 1.1-2.9). Children with low levels of self-regulation had reduced risks (OR = 0.4, CI = 0.2-0.8).

Discussion

Results suggest that children's behaviors affect their risk of agricultural injury. Additional research could elucidate mechanisms and inform interventions.

Impact on industry

The development of multifaceted, sustainable approaches for prevention is necessary for this unique population. These findings suggest a need for interventions that incorporate specific behavior-related risk factors in the context of family farms and ranches.     

The effects of airbags and seatbelts on occupant injury in longitudinal barrier crashes

Introduction

Longitudinal barriers, such as guardrails, are designed to prevent a vehicle that leaves the roadway from impacting a more dangerous object while minimizing the risk of injury to the vehicle occupants. Current full-scale test procedures for these devices do not consider the effect of occupant restraints such as seatbelts and airbags. The purpose of this study was to determine the extent to which restraints are used or deployed in longitudinal barrier collisions and their subsequent effect on occupant injury.

Methods

Binary logistic regression models were generated to predict occupant injury risk using data from the National Automotive Sampling System / Crashworthiness Data System from 1997 through 2007.

Results

In tow-away longitudinal barrier crashes, airbag deployment rates were 70% for airbag-equipped vehicles. Compared with unbelted occupants without an airbag available, seat belt restrained occupants with an airbag available had a dramatically decreased risk of receiving a serious (MAIS 3+) injury (odds-ratio (OR) = 0.03; 95% CI: 0.004-0.24). A similar decrease was observed among those restrained by seat belts, but without an airbag available (OR = 0.03; 95% CI: 0.001- 0.79). No significant differences in risk of serious injuries were observed between unbelted occupants with an airbag available compared with unbelted occupants without an airbag available (OR = 0.53; 95% CI = 0.10-2.68).

Impact on Industry

This study refutes the perception in the roadside safety community that airbags rarely deploy in frontal barrier crashes, and suggests that current longitudinal barrier occupant risk criteria may over-estimate injury potential for restrained occupants involved in a longitudinal barrier crash.     

An epidemiologic comparison of injuries presenting to a pediatric emergency department and local urgent care facilities

Problem

The objective of this study was to compare the epidemiology of injuries presenting to emergency department (ED) and urgent care (UC) facilities of a single, NEISS-affiliated hospital.

Method

Patient medical records (n = 36,811) were used to compare injury incidence, injury characteristics, and demographic characteristics between the ED, on-site UC, and off-site UC during 2006.

Results

ED presentations were more likely to be open wounds and motor vehicle-related compared to on-site UC presentations. ED presentations were more likely to be system wide/late effects, be made by an African American, or be paid through Medicaid compared to off-site UC presentations. On-site UC presentations were more likely to be made by an African American or be paid through Medicaid compared to off-site UC presentations.

Discussion

ED and UC injury characteristics and patient demographics differ. With no nationally-representative UC injury surveillance, current research likely underestimates injury incidence and presents skewed profiles. Impact on Industry: This article adds insight into the generalizability of ED-based injury surveillance to UC injuries.     

Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

Restraint use and seating position among children less than 13 years of age: Is it still a problem?

Introduction

The purpose of this study was to calculate national estimates and examine the extent to which children prematurely use adult seat belts and ride in the front seat of a vehicle during a 30 day period.

Methods

Data were obtained from a nationally representative cross-sectional random-digit-dial telephone survey that included child-specific questions on motor vehicle restraint use and seating position.

Results

Among children less than 13 years, parents reported an estimated 618,337 who rode unrestrained and more than one million who rode in the front seat of a vehicle at least some of the time in the past 30 days. During the same time period, close to 11 million children 8 years and younger reportedly used only adult seat belts.

Discussion

Our results highlight the need for continued outreach to parents regarding optimal restraint use and rear seating position for children every trip, every time.     

Comparison of risk factors for falls from height between commercial and residential roofers

Introduction

The purpose of this investigation was to compare commercial roofers and residential roofers in terms of their behaviors, beliefs, working conditions, and attitudes toward the use of fall protection devices, which could lead to fall accidents.

Methods

A cross-sectional sample of 252 roofers participated in the survey in the Midwest (Wisconsin, Illinois, Michigan, Indiana, and Iowa).

Results

Residential roofers were more likely to fall (adjusted prevalence ratio = 1.57, 95% CI = 0.86, 2.27) than commercial roofers. Existence of fall protection programs, enforcement of fall protection device use, actual use of fall protection devices, work type, company size, and race/ethnicity were significantly associated with fall accidents.

Impact on industry

This study adds insight into fall accidents from roofs in the construction industry and provides industry-specific cautions against fall accidents that can be reflected in regulatory agency implementation.     

Validity of police-reported alcohol involvement in fatal motor carrier crashes in the United States between 1982 and 2005

Objective

To examine the validity of police-reported alcohol data for drivers involved in fatal motor carrier crashes.

Material and Methods

We determined the availability of blood alcohol concentration (BAC) and police-reported alcohol data on 157,702 drivers involved in fatal motor carrier crashes between 1982 - 2005 using Fatality Analysis and Reporting System (FARS) data. Drivers were categorized as motor carrier drivers if they operated a vehicle with a gross vehicle weight rating of greater than 26,000 pounds. Otherwise, they were classified as non motor carrier drivers. The sensitivity and specificity of police-reported alcohol involvement were estimated for both driver types.

Results

Of the 157,702 drivers, 18% had no alcohol information, 15% had BAC results, 42% had police-reported alcohol data, and 25% had both. Alcohol information varied significantly by driver, crash, and vehicle characteristics. For example, motor carrier drivers were significantly more likely (51%) to have BAC testing results compared to non motor carrier drivers (31%) (p < 0.001). The sensitivity of police-reported alcohol involvement for a BAC level ≥ 0.08 was 83% (95% CI 79%, 86%) for motor carrier drivers and 90% (95% CI 89%, 90%) for non motor carrier drivers. The specificity rates were 96% (95% CI 95%, 96%) and 91% (95% CI 90%, 91%), respectively.

Conclusions

The sensitivity and specificity of police-reported alcohol involvement are reasonably high for drivers involved in fatal motor carrier crashes. Further research is needed to determine the extent to which the accuracy of police-reported alcohol involvement may be overestimated because of verification bias.

Impact on the Industry

Based on the results of this study, the federal government should continue to work with states to strengthen their strategies to increase chemical testing of all drivers involved in fatal crashes.     

The unrecognized danger of a new transportation mechanism of injury--pedicabs

Objective

Pedicabs are a new and controversial transportation innovation for tourists in congested areas in several U.S. cities. Scant literature on this trauma mechanism exists. The purpose of this study is to identify the incidence, demographics, morbidity, mortality, and potential for injury prevention of pedicab incidents amongst major trauma admissions at an urban, academic Level I Trauma Center.

Patients & Methods

Researchers conducted a retrospective review of the Trauma Registry from 2000 to 2009. All patients identified as being injured in a pedicab incident were reviewed. Demographics, diagnoses, toxicology, treatments, and injury severity scale (ISS) were collected. Outcomes included mortality, ICU, and hospital length of stay (LOS), discharge disposition, and hospital charges. A photographic survey of 50 local pedicabs was examined for the presence and use of safety equipment.

Results

During the period of January 2000 to July 2009 there were 15 major trauma victims from identified pedicab incidents. Falling from the pedicab was the mechanism of injury in 14 of 15 cases. There were two fatalities in victims following severe traumatic brain injury. Traumatic brain injury, skull fracture, or loss of consciousness was seen in 11/15 victims. Ethanol ingestion was detected in blood tests of 10 of the 14 adult victims. Median charges of hospitalization due to a pedicab related injury was US$29,956 ± 77,482. A photographic survey of 50 local pedicabs reveals very limited use of safety belts by passengers despite existing city ordinances.

Conclusions

Major trauma victims of pedicab incidents in the United States suffer significant injuries and death. Most cases occurred in passengers falling from the pedicab at night after alcohol ingestion. There is an opportunity for implementation of strategies toward improved injury prevention with this new form of transport.     

A comparison of web-based and telephone surveys for assessing traffic safety concerns, beliefs, and behaviors

Introduction

The purpose of this investigation was to compare the results of a web-based and a telephone interview survey measuring driver concerns about a variety of traffic safety issues, their beliefs, and specific driving behaviors.

Method

State-wide, annual random digit-dial telephone surveys and web-based surveys were conducted in Maryland. A total of 1,700 drivers were surveyed by telephone and 6,806 took a web survey.

Results

Telephone respondents were more likely to be female and older. Web respondents were more likely to be white and not Latino/Hispanic. After controlling for demographic differences, telephone survey respondents were more likely to be concerned about traffic safety. They were more likely to believe that sobriety checkpoints reduce drunk driving (OR = 2.18, 95% CI 1.94, 2.45), they would be ticketed for not wearing a seat belt (OR = 1.26, 95% CI 1.12, 1.43), and they would be stopped by the police if they drove after drinking too much (OR = 1.17, 95% CI 1.03, 1.32). They were less likely to report a variety of risky behaviors including using a cell phone while driving (OR = .54, 95% CI .48, .61) and driving 10+ mph over the speed limit (OR = .81, 95% CI .72, .91), but were more likely to report having been ticketed for a moving violation in the last month (OR = 2.22, 95% CI 1.70, 2.90). Suggestions are offered for overcoming potential sources of sampling bias.

Impact on Industry

Web-based surveys produce substantially different results than random-digit-dial telephone surveys, when used for public assessments of traffic safety concerns and behaviors.     

Continued progress in the prevention of nail gun injuries among apprentice carpenters: What will it take to see wider spread injury reductions?

Problem

Nail guns are a common source of acute, and potentially serious, injury in residential construction.

Method

Data on nail gun injuries, hours worked and hours of tool use were collected in 2008 from union apprentice carpenters (n = 464) through classroom surveys; this completed four years of serial cross-sectional data collection from apprentices. A predictive model of injury risk was constructed using Poisson regression.

Results

Injury rates declined 55% from baseline measures in 2005 with early training and increased use of tools with sequential actuation. Injury rates declined among users of tools with both actuation systems, but the rates of injury were consistently twice as high among those using tools with contact trip triggers.

Discussion and impact

Nail gun injuries can be reduced markedly through early training and use of tools with sequential actuation. These successful efforts need to be diffused broadly, including to the non-union sector.     

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety

Problem

Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety.

Methods

A 31-item self-administered survey was mailed to pediatricians.

Results

160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash.

Conclusions

A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. Impact on Industry: Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.     

Assessing public opinion regarding potential ATV-related policies

Problem

States with laws regarding ATV use and safety have lower mortality and injury rates than states with few or no restrictions. Our objective was to assess the attitudes of registered Ohio voters concerning potential legislation regarding ATV use and safety to determine the feasibility of its enactment.

Method

A statewide telephone survey of 838 registered Ohio voters was conducted and results were weighted by region to accurately represent all Ohio voters.

Results

Registered voters were in favor of restricting the use of ATVs by children < 16 years (81%), prohibiting passengers on ATVs (81%), requiring helmets (78%), and requiring all ATV owners and users to take a safety class (77%). ATV riders indicated that a mandatory helmet law would increase helmet use.

Impact on Industry

Assessing public opinion regarding public health and safety laws is a critical first step when considering legislation to improve ATV safety.     

Time trends and predictive factors for safety perceptions among incoming South Australian university students

Problem

Young workers are over-represented in injury statistics. In order to develop injury prevention strategies, this study investigated time trends and predictive factors relating to safety skills, confidence, and attitudes.

Method

Annual surveys were conducted from 2006-2009 among incoming students at the University of Adelaide. The questions addressed safety training, injury experience, and health and safety perceptions.

Results

Time trends in training, perceived safety skills, confidence, and attitudes were not significant. In terms of skills and confidence, the most important correlate was safety training outside of high school (odds ratio = 1.6), especially when repeated, assessed, or in face to face mode. Feeling strongly about safety issues was best predicted by injury experience (OR = 1.7) and gender.

Discussion

These results emphasize the value of assessed training, but they are also consistent with published U.S. data, indicating no improvement over time. It is suggested that there be a more integrated approach in safety education, involving schools and workplaces.

Impact on industry

By developing an understanding of student safety perceptions and experiences, this research aims to target strategies to reduce the excess injury rate for young workers. Workplaces should be more aware of the limitations of school-based safety education and a more integrated and evidence-based approach should be developed, involving schools and workplaces.     

Enhancing older driver safety: A driving survey and evaluation of the CarFit program

Objective

To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle.

Methods

A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n = 195) were assigned randomly to CarFit intervention (n = 83, M age = 78.1) or Comparison (n = 112, M age = 79.6) groups. After 6 months, participants completed a post-test of driving activity and CarFit recommendations.

Results

Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up.

Conclusion

CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers.

Impact on industry

CarFit recommendations may need stronger reinforcement in order to be enacted by a participant.     

Nonfatal bathroom injuries among persons aged ≥15 years--United States, 2008

Problem

Information about where nonfatal unintentional injuries occur is limited, but bathrooms commonly are believed to be a hazardous location.

Methods

Data from a nationally representative sample of hospital emergency departments (ED) was used to quantify and characterize nonfatal unintentional bathroom injuries among people aged ≥ 15 years.

Results

In 2008, an estimated 234,094 nonfatal bathroom injuries were treated in EDs. Most injuries (81.1%) were caused by falls and 37.3% of injuries occurred when bathing, showering, or getting out of the tub or shower. Both injury and hospitalization rates increased with age.

Summary

These results suggest that bathrooms tend to be most hazardous for persons in the oldest age groups.

Impact on Industry

Bathroom injuries among all household members might be reduced by increasing awareness about potentially hazardous activities in the bathroom combined with simple environmental changes such as adding grab bars inside and outside the tub or shower.     

Required hours of practice for learner drivers: A comparison between two Australian jurisdictions

Problem

This study considers whether requiring learner drivers to complete a set number of hours while on a learner license affects the amount of hours of supervised practice that they undertake. It compares the amount of practice that learners in Queensland and New South Wales report undertaking. At the time the study was conducted, learner drivers in New South Wales were required to complete 50 hours of supervised practice while those from Queensland were not.

Method

Participants were approached outside driver licensing centers after they had just completed their practical driving test to obtain their provisional (intermediate) license. Those agreeing to participate were interviewed over the phone later and asked a range of questions to obtain information including socio-demographic details and amount of supervised practice completed.

Results

There was a significant difference in the amount of practice that learners reported undertaking. Participants from New South Wales reported completing a significantly greater amount of practice (M = 73.3 hours, sd = 29.12 hours) on their learner license than those from Queensland (M = 64.1 hours, sd = 51.05 hours). However, the distribution of hours of practice among the Queensland participants was bimodal in nature. Participants from Queensland reported either completing much less or much more practice than the New South Wales average.

Summary

While it appears that the requirement that learner drivers complete a set number of hours may increase the average amount of hours of practice obtained, it may also serve to discourage drivers from obtaining additional practice, over and above the required hours.

Impact on Industry

The results of this study suggest that the implications of requiring learner drivers to complete a set number of hours of supervised practice are complex. In some cases, policy makers may inadvertently limit the amount of hours learners obtain to the mandated amount rather than encouraging them to obtain as much practice as possible.     

The relationship between recruitment processes, familiarity, trust, perceived risk and safety

Introduction and Method

Participants′ perceptions of the safety-related aspects of their organization′s recruitment processes were examined, as were their perceptions of safety aspects associated with new recruits.

Results

One hundred and fifty-four professional fire fighters indicated the trust they held in the safety-related aspects of their organizations′ selection and pre-start training. Perceived trust in pre-start training was negatively correlated (r = -.24, p < .01) with the risk associated with new recruits, and positively correlated (r = .50, p < .01) with ratings of trust in recruits to immediately work safely. Furthermore, trust in recruits to immediately work safely was negatively correlated (r = -.21, p < .01) with crews′ safety behavior toward recruits.

Conclusions

These results are interpreted as particularly dangerous for workers, as new recruits lack familiarity with aspects of their new workplace that cannot be addressed by either selection or pre-start training, making them a risk.

Impact on Industry

Organizations should actively identify new recruits, and encourage existing team members not to immediately trust new recruits to work safely.     

Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors

Introduction

Children ages 5-14 years have the highest rate of bicycle-related injuries in the country. Bicycle helmets can prevent head and brain injuries, which represent the most serious type of bicycle-related injury.

Objectives

This paper compares children's bicycle helmet use to that estimated from an earlier study, and explores regional differences in helmet use by existing helmet legislation.

Methods

This study was a cross-sectional, list-assisted random-digit-dial telephone survey. Interviews were completed by 9,684 respondents during 2001-2003. The subset with at least one child in the household age 5-14 years (2,409 respondents) answered questions about bicycle helmet use for a randomly selected child in their household.

Results

Almost half (48%) of the children always wore their helmet, 23% sometimes wore their helmet, and 29% never wore their helmet. Helmet wearing was significantly associated with race, ethnicity, and child age but was not associated with the sex of the child. Other significant predictors of use included household income, household education, census region, and bicycle helmet law status. Statewide laws were more effective than laws covering smaller areas. The proportion of children who always wore a helmet increased from 25% in 1994 to 48% in 2001-2002. Significant increases in helmet use from 20% to 26% were seen among both sexes, younger (5-9 years) and older (10-14 years) children, and in all four regions of the country.

Conclusions

While there has been substantial progress in the number of children who always wear their helmets, more than half do not. Further progress will require using a combination of methods that have been shown to successfully promote consistent helmet use. Impact on industry: minimal.     

The development and validation of a psychological contract of safety scale

Introduction

This paper builds on previous research by the author and describes the development and validation of a new measure of the psychological contract of safety. The psychological contract of safety is defined as the beliefs of individuals about reciprocal safety obligations inferred from implicit and explicit promises.

Method

A psychological contract is established when an individual believes that perceived employer and employee safety obligations are contingent on each other. A pilot test of the measure is first undertaken with participants from three different occupations: nurses, construction workers, and meat processing workers (N = 99). Item analysis is used to refine the measure and provide initial validation of the scale. A larger validation study is then conducted with a participant sample of health care workers (N = 424) to further refine the measure and to determine the psychometric properties of the scale.

Results

Item and correlational analyses produced the final employer and employee obligations scales, consisting of 21 and 17 items, respectively. Factor analyses identified two underlying dimensions in each scale comparable to that previously established in the organizational literature. These transactional and relational-type obligations provided construct validity of the scale. Internal consistency ratings using Cronbach's alpha found the components of the psychological contract of safety measure to be reliable.

Impact on Industry

The refined and validated psychological contract of safety measure will allow investigation of the positive and negative outcomes associated with fulfilment and breach of the psychological contract of safety in future research.