Bicycle helmet use among persons 5 years and older in the United States, 2012

IntroductionIn 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States.MethodCDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18 + years) were asked about bicycle riding and helmet use in the last 30 days for themselves and their children (5 to 17 years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use.ResultsAmong adults, 21% rode bicycles within the past 30 days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30 days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%).ConclusionsDespite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding.Practical applicationStates and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14.     

路径-脆弱点最短距离最大化的危险品运输网络设计

为了实现危险品运输网络的有效设计,进而降低危险品运输风险。将分布于公路两侧的医院、学校、居民区、购物中心等人口集聚场所定义为“脆弱点”,并通过计算运输路径和脆弱点间的加权距离来评估路段风险;结合双层理论构建模型,上层规划为政府的网络设计问题,通过关闭部分路段来最大化危险品车辆行驶路径与各脆弱点间的最小加权距离,下层规划则为承运商的车辆路径选择问题;为求解模型,设计1类启发式算法,并对算法的计算时间复杂性进行证明,最后根据算例分析发现,该算法经过有限数量的迭代即可得到风险最小的、次小的、…、第k小的运输路径及对应的路段关闭方案,为寻求兼顾运输风险和运输成本的最优方案提供决策支持。     

Sixteen-year-old drivers in fatal crashes, United States, 2003

OBJECTIVE: Key features of graduated licensing were introduced in 46 states and the District of Columbia between 1993 and 2003. State evaluations consistently have reported positive overall effects and positive effects of nighttime and passenger restrictions. Sixteen year-olds are the main target of graduated licensing, and the present study investigated changes in their fatal crash involvement and crash characteristics that have taken place nationally during 1993-2003. By looking at 16 year-olds nationally, the study does not constitute a direct test of the effect of graduated licensing laws per se. METHODS: Data on fatal crashes were obtained from the Fatality Analysis Reporting System. Sixteen year-olds were compared with older drivers. RESULTS: During these years, the extent to which 16-year-old drivers were in fatal crashes decreased substantially compared with older age groups. The drop in the per capita crash rate for 16 year-olds was 26%. The major change was a reduction in crashes involving transporting young passengers, especially in jurisdictions with restrictions that target these crashes. There was no change in the proportion of fatal late-night crashes even in states restricting this activity. CONCLUSIONS: There has been some progress nationally in reducing the crash problem for 16 year-olds, but this still is a big problem. To achieve further progress, the gaps and weaknesses in present graduated licensing laws will need to be addressed.     

Seat Belt Use in States and Territories with Primary and Secondary Laws -- United States, 2006

Problem

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.

Methods

Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).

Results

In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.

Discussion

Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.     

Pedestrian fatalities, Atlanta Metropolitan Statistical Area and United States, 2000-2004

Motor vehicle crashes killed almost 5,000 pedestrians in 2005 in the United States. Pedestrian risk may be higher in areas characterized by urban sprawl. From 2000 to 2004, pedestrian fatality rates declined in the United States, but the Atlanta metropolitan statistical area did not experience the same decline. Pedestrian fatality rates for males, Hispanics, and the 15–34 and 35–54 year age groups were higher in Atlanta than in the United States overall. Pedestrian safety interventions should be targeted to high-risk populations and localized pedestrian settings.     

学校安全教育的主要模式、驱动机制与路径选择

学校安全教育模式是保障学校安全教育效果的关键。准确界定学校安全教育模式的概念内涵,精炼概括学校安全教育两种模式—传统模式和现代模式,在学校安全教育系统中应同时采用传统模式和现代模式,使其相互补充则是学校安全教育的发展趋势,并从法律保障—法律、法规和政策的健全、内驱动力—对比较利益的追求、外驱动力—教育现代化三个方面深刻剖析学校安全教育的驱动机制,从而提出学校安全教育的路径选择。     

中美煤矿安全监察执法对比研究

我国煤矿安全生产事故呈现逐年大幅度下降的趋势,对比中美煤炭百万吨死亡率,显示,我国与美国相比还存在比较大的差距。继而,通过分析中美煤矿安全监察执法的特点,发现,中美在安全监察执法、职业培训、执法人员权责、煤矿监管监察技术方面存在不同,并针对这几方面提出了进一步完善我国煤矿安全监察工作的建议,可为完善我国安全监察执法体系提供参考和借鉴。     

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.     

Occupational electrical injuries in the United States, 1992-1998, and recommendations for safety research

PROBLEM: CFOI and SOII data show that 2,287 U.S. workers died and 32,807 workers sustained days away from work due to electrical shock or electrical burn injuries between 1992 and 1998. METHOD: The narrative, work activity, job title, source of injury, location, and industry for each fatal electrical accident were examined. A primary causal factor was identified for each fatality. RESULTS: Electrical fatalities were categorized into five major groups. Overall, 44% of electrical fatalities occurred in the construction industry. Contact with overhead power lines caused 41% of all electrical fatalities. DISCUSSION: Electrical shock caused 99% of fatal and 62% of nonfatal electrical accidents. Comprising about 7% of the U.S. workforce, construction workers sustain 44% of electrical fatalities. Power line contact by mobile equipment occurs in many industries and should be the subject of focused research. Other problem areas are identified and opportunities for research are proposed. IMPACT ON INDUSTRY: Improvements in electrical safety in one industry often have application in other industries.     

Gender,extra‐firm mobility,and compensation attainment in the United States and Hong Kong

Using data from 739 U.S. managers and professionals and 593 Hong Kong Chinese managers and professionals we examined the moderating effects of gender on the relationship between changing employers and compensation attainment. While there were no gender‐based compensation differences early in the careers of these individuals (in 1991), large pay differences favoring men were observed in 1999 only among those who had followed an external labor market strategy. These results demonstrate that this phenomenon is not isolated to labor markets of the United States and strengthen the view that much of the observed pay differential favoring men has its origins in extra‐firm mobility, not intra‐firm gender discrimination. Copyright © 2004 John Wiley & Sons, Ltd.     

Driver's obesity and road crash risks in the United States

Objective: We assessed obesity trends in U.S. drivers involved in fatal crashes since 1999 and distinguished whether crash risk factors were different between obese and nonobese drivers.

Methods: We included only drivers of passenger cars involved in fatal traffic crashes between January 1, 1999, and December 31, 2012. Obesity was classified according to the World Health Organization guidelines and profiled between 1999 and 2012 using the adjusted prevalence ratio (aPR) from log-binomial regression models. Differences in crash risks (e.g., driver's fatality, drunk driving, seat belt nonuse) between obese and nonobese drivers were estimated as adjusted odds ratios (aORs) using logistic regression models.

Results: A total of 753,024 U.S. drivers were involved in fatal crashes, for which obesity information was available for 534,887. About 56% (n = 299,078) were driving passenger cars. The prevalence of class I obesity increased from 10% in 1999 to 14% in 2012 (aPR = 1.50, 95% confidence interval [CI], 1.42–1.58), class II obesity from 3 to 5% (aPR = 2.22, 95% CI, 2.05–3.01), and class III obesity from 1 to 2% (aPR = 2.65; 95% CI, 2.27–3.10). Compared to nonobese controls, obese drivers had significantly higher risks for fatality (1.10 ≤ aOR ≤ 1.47), seat belt nonuse (1.00 ≤ aOR ≤ 1.21), need for extrication (1.01 ≤ aOR ≤ 1.23), and ambulance transport time ≥30 min (1.01 ≤ aOR ≤ 1.28). Compared to nonobese controls, obese drivers were less likely to drink drive (0.41 ≤ aOR ≤ 0.72) or speed >65 mph (0.78 ≤ aOR ≤ 0.93).

Conclusion: The rising national prevalence of obesity extends to U.S. drivers involved in fatal crashes and indicates the need to improve seat belt use, vehicle design, and postcrash care for this vulnerable population.     

Epidemiology of alcohol and drug screening among pedestrian fatalities in the United States, 2014–2016

Objective: U.S. pedestrian fatalities increased by 25% between 2010 and 2015. Risk factors include distractions, the built environment, urbanization, economic variables, and weather conditions. Of interest is the role of alcohol and drugs in premature death among pedestrians. This study sought to explore the prevalence of substance use screenings among pedestrian fatalities in the United States between 2014 and 2016.

Methods: Data were collected from the Fatality Analysis Reporting System provided by the NHTSA. Pedestrian crash variables included demographics as well as information regarding alcohol or drug testing status. Frequency and cross-tabulation tables were constructed to assess the prevalence of screening by person, place, and time. Log-linear analyses were completed to explore age, race, and sex differences. A 3-year examination period was used to control for yearly fluctuations and to incorporate an increasing trend in cases.

Results: Pedestrian fatalities accounted for 84% of all deaths among vulnerable road users during the examination period. Those most at risk were white males between the ages of 45 and 64. Over all states, 74.7% of fatalities were tested for alcohol and 67.1% were tested for drugs; further, 66.5% of cases were tested for both alcohol and drugs and 24.8% were tested for neither substance. Cases screened for both alcohol and drugs ranged from 2.9% in North Carolina to 95.7% in Nevada and those testing for neither substance ranged from a high of 68.9% in Indiana to a low of 1.1% in Maryland. Log-linear regression revealed significant differences in alcohol screening by age and race but not by sex. Differences in drug screening were not identified for any demographic variable. Fatalities tested for alcohol were significantly more likely to be tested for drugs; only 8.2% were screened solely for alcohol and 0.05% were screened for drugs alone.

Conclusions: Preventive strategies become more important as pedestrian crashes and fatalities increase. Risk reduction in the form of policy change, alterations to the built environment, or interdisciplinary approaches to injury prevention is dependent upon best evidence supported in part by more deliberate and consistent screening.     

Probability of death,disability, and restricted work activity in United States underground bituminous coal mines, 1975–1981

This study examined relationships between mine and miner characteristics and severity of 82,945 underground bituminous coal mine injuries using logistic regression techniques. Injuries were classified as severe if they resulted in death, disability, or restricted work activity. Supervisory and maintenance personnel were found to have fewer chances of severe injuries than “all other” job classifications. A shaft or slope had a lower association with severe injuries than the face. The probability of a severe injury increased each succeeding year from 1975 through 1981. Mining method was not related to degree of injury. Older miners had the same probability of severe injuries as younger miners. Weeks of experience in mining, on a particular job, and in a specific mine were not related to severity of injuries. Mobile equipment operators had the same chance of severe injuries as miners in “all other” job classifications. Accidents at intersections and “other” locations were as likely to produce severe injuries as those at the face. Elapsed shift time prior to an injury was not related to injury severity. The implications of these findings are discussed and recommendations made for future research.     

Fatal pedestrian crashes on interstates and other freeways in the United States

Introduction: More than 800 pedestrians die annually in crashes on interstates and other freeways in the United States, but few studies have examined their characteristics. Method: Data from the Fatality Analysis Reporting System on pedestrians fatally injured during 2015–2017 were analyzed. Chi-square tests compared characteristics of pedestrians killed on interstates and other freeways with those that died on other roads, and across crash types among freeway deaths. Land use characteristics of locations where pedestrians were killed while crossing freeways in a large state (California) were identified using Google Earth. Results: A larger proportion of pedestrians killed on freeways died on dark and unlit roads (48% vs. 32%), were male (78% vs. 68%), or were ages 20–44 (55% vs. 32%) compared with pedestrians killed on other roads. Crossing (42%) was the most common crash type among pedestrian deaths on freeways, followed by disabled-vehicle-related crashes (18%). Pedestrians who died while crossing more often had blood alcohol concentrations ≥ 0.08 g/dL (40%) than those in disabled-vehicle-related (22%) or other crashes (34%). Deaths in crossing crashes were more likely than other freeway deaths to occur on urban roads (81%), at speed limits ≤50 mph (13%), or between 18:00 and 23:59 (49%), and 58% of crossing crashes analyzed for land use were located between residential and other (e.g., commercial, recreational) uses. Over a third (37%) of deaths in disabled-vehicle-related crashes occurred at speed limits ≥70 mph. Conclusions: A surprising proportion of pedestrian deaths occur on controlled-access roads not designed for walking. Countermeasures for these crashes need to be implemented to see meaningful reductions in pedestrian fatalities overall. Practical applications: Improving roadway and vehicle lighting, requiring reflective warning devices for marking disabled vehicles, constructing pedestrian overpasses and underpasses in areas frequently crossed, and promoting alternative means of traveling between residential and commercial areas could help.     

美国联邦应急预案演变历程与启示

应急预案是指面对突发事件,如自然灾害、事故灾难、公共卫生事件和社会安全事件,政府及社会各机构、组织团体、社区及家庭个人等事先制定好的应急管理、指挥、响应、救援和恢复等各方面的应对计划。美国联邦应急预案建设起步较早,在曲折发展中积累了大量经验,了解、分析和研究其演变历程,对创新完善我国应急预案工作具有较大的启示借鉴意义。     

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older,United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern.MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups.ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion.ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare.Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.     

Impact of improving vehicle front design on the burden of pedestrian injuries in Germany,the United States,and India

Objective: European car design regulations and New Car Assessment Program (NCAP) ratings have led to reductions in pedestrian injuries. The aim of this study was to evaluate the impact of improving vehicle front design on mortality and morbidity due to pedestrian injuries in a European country (Germany) and 2 countries (the United States and India) that do not have pedestrian-focused NCAP testing or design regulations.

Methods: We used data from the International Road Traffic and Accident Database and the Global Burden of Disease project to estimate baseline pedestrian deaths and nonfatal injuries in each country in 2013. The effect of improved passenger car star ratings on probability of pedestrian injury was based on recent evaluations of pedestrian crash data from Germany. The effect of improved heavy motor vehicle (HMV) front end design on pedestrian injuries was based on estimates reported by simulation studies. We used burden of disease methods to estimate population health loss by combining the burden of morbidity and mortality in disability-adjusted life years (DALYs) lost.

Results: Extrapolating from evaluations in Germany suggests that improving front end design of cars can potentially reduce the burden of pedestrian injuries due to cars by up to 24% in the United States and 41% in India. In Germany, where cars comply with the United Nations regulation on pedestrian safety, additional improvements would have led to a 1% reduction. Similarly, improved HMV design would reduce DALYs lost by pedestrian victims hit by HMVs by 20% in each country. Overall, improved vehicle design would reduce DALYs lost to road traffic injuries (RTIs) by 0.8% in Germany, 4.1% in the United States, and 6.7% in India.

Conclusions: Recent evaluations show a strong correlation between Euro NCAP pedestrian scores and real-life pedestrian injuries, suggesting that improved car front end design in Europe has led to substantial reductions in pedestrian injuries. Although the United States has fewer pedestrian crashes, it would nevertheless benefit substantially by adopting similar regulations and instituting pedestrian NCAP testing. The maximum benefit would be realized in low- and middle-income countries like India that have a high proportion of pedestrian crashes. Though crash avoidance technologies are being developed to protect pedestrians, supplemental protection through design regulations may significantly improve injury countermeasures for vulnerable road users.     

美国应急管理的顶层设计及对我国的启示

为研究如何做好一个国家的应急管理顶层设计,以美国的应急管理为例,详细梳理其发展变更,其主要经过了无设计、联邦政府层面的顶层设计和全国层面的顶层设计3个阶段,最终通过建立一套突发事件管理系统,克服了联邦制对应急管理权力运行的阻碍,建立了能够把各级政府和社会力量组织起来、有效应对各种突发事件的应急管理系统,实现了顶层设计的目标.美国的实践,可为我国的应急管理体系建设在充分发挥制度优势、提供法律保障、实现标准化等方面提供借鉴.     

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.