Pooled Analysis of Two Swedish Case-Control Studies on the Use of Mobile and Cordless Telephones and the Risk of Brain Tumours Diagnosed During 1997–2003

Here we present the pooled analysis of 2 case–control studies on the association of brain tumours with mobile phone use. Use of analogue cellular phones increased the risk for acoustic neuroma by 5%, 95% confidence interval (CI) = 2-9% per 100 hrs of use. The risk increased for astrocytoma grade III—IV with latency period with highest estimates using >10-year time period from first use of these phone types. The risk increased per one year of use of analogue phones by 10%, 95% CI = 6-14%, digital phones by 11%, 95% CI = 6-16%, and cordless phones by 8%, 95% CI = 5-12%. For all studied phone types OR for brain tumours, mainly acoustic neuroma and malignant brain tumours, increased with latency period, especially for astrocytoma grade III—IV.     

The prevalence of seatbelt and mobile phone use among drivers in Riyadh,Saudi Arabia: An observational study

IntroductionRoad traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Numerous factors may increase the likelihood of RTIs. The prevalence of risk factors associated with RTIs may vary due to several reasons. Because little is known about these risk factors locally, we examined the prevalence of mobile phone and seatbelt use and their association with spatial locations.MethodsThis is an observational study conducted at major highways and inner intersections throughout Riyadh, the country's capital. Two observers captured seatbelt and mobile phone use among drivers. Logistic regression models were constructed to examine the association between real estate prices and mobile phone or seatbelt use. Observations were categorized as taken place in an affluent neighborhood if the average price per square meter was above 2500 Saudi Riyal.ResultsA total of 1700 drivers were observed in 13 sites citywide. 13.8% of drivers were seen using mobile while driving and only a third of drivers (34%) were wearing seatbelts. Being at an affluent neighborhood was associated with close to three times higher odds of wearing seatbelts (OR = 2.7, 95% CI = 1.9–3.7) and also associated with 42% lower odds of mobile phone use among drivers (OR = 0.58, 95% CI = 0.36–0.92).DiscussionThis study found a high prevalence of traffic violations among drivers in Riyadh. Based on our estimate, 660,000 drivers are roaming the street during daytime while using their phones and they are less likely to wear seatbelts. Unfortunately, this estimate might contribute to increasing RTIs. Despite existing regulations, seatbelt use among drivers is significantly lower than in developed countries (i.e. USA 94%).ConclusionOur study found a high prevalence of traffic violations represented by lack of compliance with seatbelt and mobile phone use laws. These findings provide a basis for their underlying prevalence in SA. Practical applications: Public health prevention programs may use these findings to facilitate support to increasing investment in awareness campaigns and further enforcement by the traffic police to reduce RITs and improve population health.     

Cell phones and driving: review of research

OBJECTIVE: The research literature on drivers' use of cell phones was reviewed to identify trends in drivers' phone use and to determine the state of knowledge about the safety consequences of such use. METHODS: Approximately 125 studies were reviewed with regard to the research questions, type and rigor of the methods, and findings. Reviewed studies included surveys of drivers, experiments, naturalistic studies (continuous recording of everyday driving by drivers in instrumented vehicles), studies of crash risk, and evaluations of laws limiting drivers' phone use. RESULTS: Observational surveys indicate drivers commonly use cell phones and that such use is increasing. Drivers report they usually use hand-held phones. Experimental studies have found that simulated or instrumented driving tasks, or driving while being observed, are compromised by tasks intended to replicate phone conversations, whether using hand-held or hands-free phones, and may be further compromised by the physical distraction of handling phones. Effects of phone use on driving performance when drivers are in their own vehicles are unknown. With representative samples of adequate size, naturalistic studies in the future may provide the means to document the patterns and circumstances of drivers' phone use and their effects on real-world driving. Currently, the best studies of crash risk used cell phone company billing records to verify phone use by crash-involved drivers. Two such studies found a fourfold increase in the risk of a property-damage-only crash and the risk of an injury crash associated with phone use; increased risk was similar for males and females, younger and older drivers, and hands-free and hand-held phones. A number of jurisdictions in the United States and around the world have made it illegal for drivers to use hand-held phones. Studies of these laws show only limited compliance and unclear effects on safety.CONCLUSIONS: Even if total compliance with bans on drivers' hand-held cell phone use can be achieved, crash risk will remain to the extent that drivers continue to use or switch to hands-free phones. Although the enactment of laws limiting drivers' use of all phones is consistent with research findings, it is unclear how such laws could be enforced. At least in the short term, it appears that drivers' phone use will continue to increase, despite the growing evidence of the risk it creates. More effective countermeasures are needed but are not known at this time.     

Driver hand-held cellular phone use: a four-year analysis

INTRODUCTION: The use of hand-held cellular (mobile) phones while driving has stirred more debate, passion, and research than perhaps any other traffic safety issue in the past several years. There is ample research showing that the use of either hand-held or hands-free cellular phones can lead to unsafe driving patterns. Whether or not these performance deficits increase the risk of crash is difficult to establish, but recent studies are beginning to suggest that cellular phone use elevates crash risk. METHODS: The purpose of this study was to assess changes in the rate of hand-held cellular phone use by motor-vehicle drivers on a statewide level in Michigan. This study presents the results of 13 statewide surveys of cellular phone use over a 4-year period. Hand-held cellular phone use data were collected through direct observation while vehicles were stopped at intersections and freeway exit ramps. Data were weighted to be representative of all drivers traveling during daylight hours in Michigan. RESULTS: The study found that driver hand-held cellular phone use has more than doubled between 2001 and 2005, from 2.7% to 5.8%. This change represents an average increase of 0.78 percentage points per year. The 5.8% use rate observed in 2005 means that at any given daylight hour, around 36,550 drivers were conversing on cellular phones while driving on Michigan roadways. The trend line fitted to these data predicts that by the year 2010, driver hand-held cellular phone use will be around 8.6%, or 55,000 drivers at any given daylight hour. CONCLUSIONS: These results make it clear that cellular phone use while driving will continue to be an important traffic safety issue, and highlight the importance of continued attempts to generate new ways of alleviating this potential hazard.     

Calling,texting, and searching for information while riding a motorcycle: A study of university students in Vietnam

Objective: The objective of this study was to investigate the prevalence of calling, texting, and searching for information while riding a motorcycle among university students and the influences of sociodemographic characteristics, social norms, and risk perceptions on these behaviors.

Methods: Students at 2 university campuses in Hanoi and Ho Chi Minh City, the 2 largest cities in Vietnam, were invited to participate in an anonymous online survey. Data collection was conducted during March and May 2016.

Results: There were 741 respondents, of whom nearly 90% of students (665) were motorcycle riders. Overall prevalence of mobile phone use while riding is 80.9% (95% confidence interval [CI], 77.9–83.9%) with calling having a higher level of prevalence than texting or searching for information while riding: 74% (95% CI, 70.7–77.3%) vs. 51.7% (95% CI, 47.9–55.5%) and 49.9% (95% CI, 46.1–53.7%), respectively. Random parameter ordered probit modeling results indicate that mobile phone use while riding is associated with gender, motorcycle license duration, perceived crash risk, perceived risk of mobile phone snatching, and perceptions of friends' mobile phone use while riding.

Conclusions: Mobile phone use while riding a motorcycle is highly prevalent among university students. Educational programs should focus on the crash and economic risk of all types of mobile phone use while riding, including calling, texting, and searching for information. In addition, they should consider targeting the influence of social norms and peers on mobile phone use while riding.     

Driving and telephoning: Relative accident risk when using hand-held and hands-free mobile phones

Experimental research shows that using mobile phones while driving leads to impaired driving, and it has been suggested that this driving impairment to a large extent is a result of cognitive, rather than physical, distractions. This notion is partly supported by empirical data showing that use of hands-free phones is associated with impaired driving in much the same way as use of hand-held phones. In the present study, accident risk when using hand-held and hands-free phones was investigated in a sample of 4307 drivers who were involved in accidents in 2007. In addition, data from a similar survey from 1997 (N = 5007) were used in order to get more observations. Relative risk was estimated using “quasi-induced exposure” in multiple-vehicle accidents. Results from the two surveys combined showed a significant increase in accident risk for hand-held mobiles and for hand-held and hands-free phones together. A non-significant tendency towards increased risk for hands-free mobiles was also detected. However, analyses of data from 2007 separately did not result in statistically significant relative risk estimates for any of the mobile types. Hand-held users were more inclined to attribute the accident to mobile phone use than were hands-free users.     

Fun ride or risky transport: Golf cart-related injuries treated in U.S. emergency departments from 2007 through 2017

Introduction: Golf cart-related injuries constitute a substantial source of morbidity, most notably in pediatric populations. Despite the high rate of injuries, there have been no meaningful changes in golf cart design or legislation to reduce the overall burden of these injuries. This study sought to characterize the epidemiology of golf cart-related injuries treated in United States hospital emergency departments. Method: A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for patients of all ages who were treated in emergency departments (EDs) (2007–2017) for a golf cart-related injury. Results: From 2007 through 2017, an estimated 156,040 (95% CI = 102,402–209,679) patients were treated in U.S. EDs for golf cart-related injuries. The average rate of traumatic brain injuries (TBIs) in children (1.62 per 100,000 children) was more than three times that of TBIs in adults (0.52 per 100,000 adults; rate ratio = 2.38; 95% CI = 2.36–2.41) and nearly twice that of TBIs in seniors (1.11 per 100,000 seniors; rate ratio = 1.21; 95% CI = 1.19–1.22). The rate of injuries in seniors increased significantly by 67.6% from 4.81 per 100,000 seniors in 2007 to 8.06 per 100,000 seniors in 2017 (slope = 0.096; p = 0.041). Conclusions: Golf cart use remains an important source of injury for people of all ages, especially in children. As use continues to increase, it is unlikely that golf cart-related injuries will decrease without substantial changes to product design, regulation, and/or legislation. Practical Applications: Use of golf carts pose a considerable risk of injury and morbidity; safety recommendations should be followed.     

Motor vehicle restraint system use and risk of spine injury

OBJECTIVE: Motor vehicle collision (MVC)-related spinal injury is a severe and often permanently disabling injury. In addition, strain injuries have been reported as a common outcome of MVCs. Although advances in automobile crashworthiness have reduced both fatalities and severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on thoracolumbar spine injuries is unknown. This study examined the relationship between the occurrence of mild to severe cervical and thoracolumbar spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs. METHODS: A retrospective cohort study was conducted among subjects obtained from the 1995-2004 National Automotive Sampling System. Cases were identified based on having sustained a spine injury of >/=1 on the Abbreviated Injury Scale (AIS), 1990 Revision. Risk risks (RRs) and 95% confidence intervals (CIs) were computed comparing occupant restraint systems with unrestrained occupants. RESULTS: We found an overall incidence of AIS1 cervical (11.8%) and thoracolumbar (3.7%) spinal injury. Seatbelt only restraints were associated with increased cervical AIS1 injury (RR = 1.40, 95% CI 1.04-1.88). However, seatbelt only restraints showed the greatest risk reduction for AIS2 spinal injuries. Airbag only restraints reduced thoracolumbar AIS1 injuries (RR = 0.29, 95% CI 0.08-1.04). Seatbelt combined with airbag use was protective for cervical AIS3+ injury overall (RR = 0.29, 95% CI 0.14-0.58), cervical neurological injury (RR = 0.19, 95% CI 0.05-0.81), and thoracolumbar AIS3+ injury overall (RR = 0.20, 95% CI 0.05-0.70). CONCLUSIONS: The results of this study suggest that seatbelts alone or in combination with an airbag increased the incidence of AIS1 spinal injuries, but provide protection against more severe injury to all regions of the spine. Airbag deployment without seatbelt use did not show increased protection relative to unrestrained occupants.     

Driver mortality in frontal crashes: comparison of newer and older airbag designs

In 1997, the National Highway Traffic Safety Administration amended its requirements for frontal crash performance under Federal Motor Vehicle Safety Standard 208 to temporarily allow 30 mi/h (48 km/h) sled tests with unbelted dummies as an alternative to 30 mi/h head-on rigid-barrier vehicle tests. This change permitted automakers to reduce airbag inflation forces so that they would be less likely to injure occupants who are close to airbags when they first deploy. Most vehicle models were sled-certified starting in model year 1998. Airbag-related deaths have decreased since 1997; however, controversy persists about whether reduced inflation forces might be decreasing protection for some occupants in high-severity frontal crashes. To examine the effects of the regulatory changes, this study computed rate ratios (RR) and 95% confidence intervals (95% CI) for passenger vehicle driver deaths per vehicle registration during 2000-2002 at principal impact points of 12 o'clock for 1998-99 model year vehicles relative to 1997 models. Passenger vehicles included in the study had both driver and passenger front airbags, had the same essential designs during the 1997-1999 model years, and had been sled-certified for drivers throughout model years 1998 and 1999. An adjustment was made for the higher annual mileage of newer vehicles. Findings were that the effect of the regulatory change varied by vehicle type. For cars, sport utility vehicles, and minivans combined, there was an 11 percent decrease in fatality risk in frontal crashes after changing to sled certification (RR = 0.89; 95% CI = 0.82-0.96). Among pickups, however, estimated frontal fatality risk increased 35 percent (RR = 1.35; 95% CI = 1.12-1.62). For a broad range of frontal crashes (11, 12, and 1 o'clock combined), the results indicated a modest net benefit of the regulatory change across all vehicle types and driver characteristics. However, the contrary finding for pickups needs to be researched further.     

In-car cell phone use and hazards following hands free legislation

OBJECTIVE: A new law took effect in Finland at the beginning of 2003 which prohibits the handheld use of mobile phones while driving a motor vehicle. The purpose of this study was to assess the impact of the law on phone usage and self-reported safety during the first few months and 16 months later to determine whether the initial level of compliance with the law had been sustained. METHODS: Data were collected by Gallup home poll before (spring 2002) and after legislation took effect (spring 2003 and 2004). A representative sample of drivers who owned a cell phone (n = 836 to 966) was interviewed each time. On-road observations were also collected in four cities for 2003 and 2004. RESULTS: Just after the law, 97% of drivers were aware of the new hands free legislation. In sharp contrast to the pre-law rate of 16%, 43% reported not using the phone while driving immediately after the law and 41% one year later. The occasional users especially reduced their use of phones while driving. The law was correlated to reductions in self-reported handheld use of cell phones while driving, from 55.6% pre-law to 15.2% immediately after passage. In spite of this change, however, the hands free legislation did not reduce self-reported involvement of Finnish drivers in phone-related hazards. Handheld usage was still lower in 2004 than pre-law (20.0%), but the 32% increase from 2003 was significant. Observational data collected in Finland in 2003 and 2004 showed an even higher upward trend in handheld use (87% increase, from 3.1% to 5.8%; pre-law data were not available), and matched a similar increase reported by McCartt and Geary (2004) in their observational evaluation of New York's handheld mobile phone law. CONCLUSION: The self-reports indicate that the hands-free law reduced handheld phone use, among occasional users especially, but did not reduce phone-related hazards. The effect of the law on phone use substantially declined within one year.     

Driver personality characteristics related to self-reported accident involvement and mobile phone use while driving

A causal model was developed in this study to clarify the effect of mobile phone use on driving safety. Based on the model, a series of questionnaires were developed, and 194 car drivers were interviewed based on these questionnaires. Results showed that perceived risk and mobile phone usage habits varied with different individual traits. Drivers who were prone to accidents revealed a lower perception of safety risks and a higher self-reported accident rate resulting from mobile phone use than those who were not accident-prone. Aggressive drivers were found to use mobile phones more frequently while driving but had a similar accident rate to non-aggressive drivers. Frequency in mobile phone use while driving significantly increased among aggressive male drivers regardless of accident proneness. Findings from this study imply that the perceived risk of drivers might be an ignored but important factor in the relationship between mobile phone use and driving safety. Because of the difficulty in practically identifying who is accident-prone or not, this study suggests that overall prohibition in mobile phone use while driving is needed to reduce the corresponding number of traffic accidents.     

Collision and violation involvement of drivers who use cellular telephones

The study sample consisted of 3,869 drivers, split approximately 50/50 between observed cell phone users and those observed not using cell phones (labeled "nonusers"). Cell phone use was determined by a snapshot observation made on city streets. The sample represented 54% of those originally observed, for whom a match was obtained for both vehicle license plate and for gender and estimated age group of the observed driver and that of the driver named in the vehicle policy. Data were obtained from records of insurance claims, police-reported collisions and violations, following a strict protocol to protect individual privacy. The dependent measures were at-fault crash claims and "inattention" violations. A logistic regression model controlled for age, gender, exposure (represented by not-at-fault crash claims), alcohol-related offenses, and aggressive driving offenses. The study also involved a comparison of the contributing factors and collision configurations of police-reported collisions involving the users and "nonusers" in the sample. Drivers observed using cell phones had a higher risk of an at-fault crash than did the "nonusers," although the difference was not significant for males. There was no apparent effect on "inattention" violations. The cell phone users also had a higher proportion of rear-end collisions. The violation pattern of cell phone users suggests that they are, in general, riskier drivers. These differences likely reflect lifestyle, attitude and personality factors. It is essential to control for these factors in assessing the direct risk attributable to cellular telephone use.     

Quantifying driver cell phone use at signalized intersections using software-defined radio

Objective: This article outlines a data collection process that quantifies driver cell phone use using a software-defined radio (SDR) at a signalized intersection. Cell phone use while driving has been shown to be factor that increases the risk of a crash incident. Both operational and enforcement strategies can be applied at locations where high driver cell phone use is identified.

Methods: A baseline driver cell phone use observation was made at the intersection, where 9,699 vehicles were observed at the intersection of Carlton Road and State Route 31 (Pennington Road) in Ewing, New Jersey. An SDR cell phone detection device created as part of this study was then deployed at the same intersection to determine whether the SDR device could detect an active cell phone signal. The identification of vehicle cell phone activity using the SDR was conducted a sample of 4,000 vehicles. A visual observation, along with a motion detection camera, was made alongside the SDR to visually confirm cell phones use.

Results: Of the 4,000 vehicles sampled using the SDR cell phone detection device, 6.1% of the a.m. peak travel time and 7.6% of the p.m. peak travel time had an active cellular device. A concurrent visual field verification of driver cell phone use showed that approximately 57% (a.m. peak) and 67% (p.m. peak) of the SDR-detected cell phones were visually confirmed to be associated with distracted cell phone use.

Conclusions: Once characterized, the frequency of driver cell phone use can be used to justify changes to signal timing protocols. These adjustments could include extending the signal’s “all-red time” or holding “yellow time” longer in order to properly clear the intersection. These data can also be used to identify locations that may require more enforcement measures to dissuade driver cell phone use. Furthermore, the impact of anti–cell phone campaigns or new laws can be quantified by measuring before and after cell phone use in the near term rather than waiting for crash studies at intersections to be completed and analyzed.     

Distracted walking: cell phones increase injury risk for college pedestrians

Introduction

Distraction on cell phones jeopardizes motor-vehicle driver safety, but few studies examine distracted walking. At particular risk are college students, who walk frequently in and near traffic, have increased pedestrian injury rates compared to other age groups, and frequently use cell phones. Method: Using an interactive and immersive virtual environment, two experiments studied the effect of cell phone conversation on distraction of college student pedestrians. In the first, we examined whether pedestrians would display riskier behavior when distracted by a naturalistic cell phone conversation than when undistracted. We also considered whether individual difference factors would moderate the effect of the distraction. In a second experiment, we examined the impact of three forms of distraction on pedestrian safety: (a) engaging in a cell phone conversation, (b) engaging in a cognitively challenging spatial task by phone, and (c) engaging in a cognitively challenging mental arithmetic task by phone. Results: Results revealed that cell phone conversations distracted college pedestrians considerably across all pedestrian safety variables measured, with just one exception. Attention to traffic was not affected by the naturalistic phone conversation in Experiment 1, but was altered by the cognitively-demanding content of some types of conversation in Experiment 2. The content of the conversation did not play a major role in distraction across other variables; both mundane and cognitively complex conversations distracted participants. Moreover, no significant associations between individual difference factors and susceptibility to distraction emerged. Impact on Industry: Results may inform researchers, policy makers, and pedestrians themselves. Educational campaigns might discourage telephone conversations in pedestrian environments.     

Self-reported wrist and finger symptoms associated with other physical/mental symptoms and use of computers/mobile phones

Recently, computer, mobile phone and Internet use has increased. This study aimed to determine the possible relation between self-reported wrist and finger symptoms (aches, pain or numbness) and using computers/mobile phones, and to analyze how the symptoms are specifically associated with utilizing desktop computers, portable computers or mini-computers and mobile phones. A questionnaire was sent to 15,000 working-age Finns (age 18–65). Via a questionnaire, 723 persons reported wrist and finger symptoms often or more with use. Over 80% use mobile phones daily and less than 30% use desktop computers or the Internet daily at leisure, e.g., over 89.8% quite often or often experienced pain, numbness or aches in the neck, and 61.3% had aches in the hips and the lower back. Only 33.7% connected their symptoms to computer use. In the future, the development of new devices and Internet services should incorporate the ergonomics of the hands and wrists.     

Traumatic brain injury mortality among U.S. children and adolescents ages 0–19 years, 1999–2017

IntroductionTo examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0–19 years by sex, age, urbanicity, state, and intent/causes of injury. Method: TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models. Results: Age-adjusted TBI mortality among Americans aged 0–19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = −4.8%, 95%CI: −6.3%, −3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15–19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10–14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15–19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states. Conclusions: Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10–19 years.     

Cell phone users, reported crash risk, unsafe driving behaviors and dispositions: a survey of motorists in Maryland

INTRODUCTION: The purpose of this investigation was to identify risky driving behaviors and dispositions that distinguish drivers who use a cell phone while operating a motor vehicle from non-cell phone using drivers. METHOD: Annual telephone surveys were used to identify drivers who reported using a cell phone while driving in the last month (n=1803) and were compared to those who said they did not use cell phones while driving (n=1578). RESULTS: Cell phone using drivers were more likely to report driving while drowsy, going 20 mph over the speed limit, driving aggressively, running a stop sign or red light, and driving after having had several drinks. They were also more likely to have had a prior history of citation and crash involvement than non-cell phone using drivers. Cell phone using drivers also reported they were less careful and more in a hurry when they drive than non-cell phone using drivers. CONCLUSION: Cell phone using drivers report engaging in many behaviors that place them at risk for a traffic crash, independent of the specific driving impairments that cell phone usage may produce. Strategies that combine coordinated and sustained enforcement activities along with widespread public awareness campaigns hold promise as effective countermeasures for these drivers, who resemble aggressive drivers in many respects.     

Effects of Washington, D.C. law on drivers' hand-held cell phone use

OBJECTIVE: To assess the effects of Washington, D.C. law prohibiting drivers' use of hand-held cell phones on such use. METHODS: Daytime observations of drivers were conducted at signalized intersections in D.C. in March 2004, several months before the law took effect on July 1, 2004, and again in October 2004. As a comparison, observations also were conducted in areas of Virginia and Maryland located close to the D.C. border. Maryland and Virginia placed no limitations on drivers' phone use. Use was observed for 36,091 vehicles in D.C., 25,151 vehicles in Maryland, and 28,483 vehicles in Virginia. RESULTS: The rate of talking on hand-held cell phones among drivers in D.C. declined significantly from 6.1% before the law to 3.5% after. Phone use declined slightly in Maryland and increased significantly in Virginia so that, relative to the patterns of hand-held phone use in the two states, phone use in D.C. declined 50%. Hand-held phone use in D.C. declined comparably among drivers of vehicles registered in all three jurisdictions. D.C. police issued 2,556 citations and 1,232 warnings for cell phone violations during July-November 2004. There were spates of media coverage when the law was passed and when it took effect. CONCLUSIONS: D.C.'s law prohibiting drivers' hand-held phone use had a strong effect on such use among drivers in D.C. Without ongoing publicized enforcement of the law, long-term compliance may be difficult to achieve.     

Parent driver characteristics associated with sub-optimal restraint of child passengers

OBJECTIVES: To identify parent driver demographic and socioeconomic characteristics associated with the use of sub-optimal restraints for child passengers under nine years. METHODS: Cross-sectional study using in-depth, validated telephone interviews with parent drivers in a probability sample of 3,818 vehicle crashes involving 5,146 children. Sub-optimal restraint was defined as use of forward-facing child safety seats for infants under one or weighing under 20 lbs, and any seat-belt use for children under 9. RESULTS: Sub-optimal restraint was more common among children under one and between four and eight years than among children aged one to three years (18%, 65%, and 5%, respectively). For children under nine, independent risk factors for sub-optimal restraint were: non-Hispanic black parent drivers (with non-Hispanic white parents as reference, adjusted relative risk, adjusted RR = 1.24, 95% CI: 1.09-1.41); less educated parents (with college graduate or above as reference: high school, adjusted RR = 1.27, 95% CI: 1.12-1.44; less than high school graduate, adjusted RR = 1.36, 95% CI: 1.13-1.63); and lower family income (with $50,000 or more as reference: <$20,000, adjusted RR = 1.23, 95% CI: 1.07-1.40). Multivariate analysis revealed the following independent risk factors for sub-optimal restraint among four-to-eight-year-olds: older parent age, limited education, black race, and income below $20,000. CONCLUSIONS: Parents with low educational levels or of non-Hispanic black background may require additional anticipatory guidance regarding child passenger safety. The importance of poverty in predicting sub-optimal restraint underscores the importance of child restraint and booster seat disbursement and education programs, potentially through Medicaid.     

Boating-related drowning in Australia: Epidemiology,risk factors and the regulatory environment

Objective: Recreational boating is a popular pastime in many high income countries, and is a leading activity prior to drowning. This study reports on unintentional fatal drowning associated with boating-related incidents in Australia. Methods: A total population, retrospective, cross sectional design examined all boating-related unintentional drowning deaths between July 1, 2005 and June 30, 2015. Variables examined included age, sex, location of drowning incident, vessel type, activity, presence of alcohol/drugs, and lifejacket wear. Relative risk (with a 95% confidence interval) was calculated using fatal drowning rates per 100,000 population and rates per 100,000 registered vessels. Chi square analysis and non-parametric tests for significance were applied. Statistical significance was deemed p < .05. Results: A total of 415 people drowned while boating during the study period, 91.8% male and 35.7% aged between 25 and 44 years. Men were 10 times more likely to drown when boating than females (RR = 10.64 CI:7.55–14.97). Over one-quarter (28.7%) of incidents involved alcohol, in 30.6% drugs were identified (31.3% were illegal) and 90.4% were not wearing a lifejacket. Children were more at risk of drowning on a houseboat than adults (RR = 7.13; CI:1.61–31.61). Females were more likely to drown than males when using a personal watercraft (RR = 10.53; CI:2.75–40.33). Conclusion: Boaters may be taking unnecessary risks by disregarding safety regulations, such as not wearing lifejackets and substance use (such as alcohol and illegal drugs). Boating in remote locations presents a high risk of drowning. While safety regulations are in place, enforcement and behavior change remain challenges. Practical application: Findings support recommendations for increased enforcement of alcohol-related regulations and introducing drug-testing for boaters. Consistency of boating safety regulations, especially around lifejacket wear, is recommended to influence behavior change. The effectiveness of current lifejacket regulations need to be critically evaluated in the context of increasing wear rates for adults and children.