RESUMO
One of the most substantial challenges facing the field of injury and violence prevention is bridging the gap between scientific knowledge and its real-world application to achieve population-level impact. Much synergy is gained when academic and practice communities collaborate; however, a number of barriers prevent better integration of science and practice. This article presents 3 examples of academic-practitioner collaborations, their approaches to working together to address injury and violence issues, and emerging indications of the impact on integrating research and practice. The examples fall along the spectrum of engagement with nonacademic partners as coinvestigators and knowledge producers. They also highlight the benefits of academic-community partnerships and the engaged scholarship model under which Centers for Disease Control and Prevention-funded Injury Control Research Centers operate to address the research-to-practice and practice-to-research gap.
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Relações Interinstitucionais , Universidades , Violência/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Centers for Disease Control and Prevention, U.S./organização & administração , Relações Comunidade-Instituição , Humanos , Veículos Automotores/normas , New York , North Carolina , Estudos de Casos Organizacionais , Pennsylvania , Administração em Saúde Pública , Segurança , Pesquisa Translacional Biomédica , Estados Unidos , Universidades/organização & administraçãoRESUMO
Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001-2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (Ptrend < 0.0001). FFIs remained constant (change = 0.02; Ptrend = 0.22) while NFIs increased (change = 0.35; Ptrend < 0.0001). Homicide FFIs declined (change = -0.05; Ptrend < 0.0001) while homicide NFIs increased (change = 0.43; Ptrend < 0.0001). Suicide FFIs increased (change = 0.07; Ptrend < 0.0001) while unintentional FFIs and NFIs declined (changes = -0.01 and -0.09, respectively; Ptrend < 0.0001 and 0.005). Among whites, FFIs (change = 0.15; Ptrend < 0.0001) and NFIs (change = 0.13; Ptrend < 0.0001) increased; among blacks, FFIs declined (change = -0.20; Ptrend < 0.0001). Among Hispanics, FFIs declined (change = -0.28; Ptrend < 0.0001) while NFIs increased (change = 0.55; Ptrend = 0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.
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Ferimentos por Arma de Fogo/epidemiologia , Acidentes/mortalidade , Acidentes/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Armas de Fogo/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Grupos Raciais/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/mortalidade , Adulto JovemRESUMO
Although seatbelt use is known to reduce motor vehicle occupant crash injury and death, rear-seated adult occupants are less likely to use restraints. This study examines risk and protective factors associated with injury severity in front- and rear-seated adults involved in a motor vehicle crash in New York State. The Crash Outcome Data Evaluation System (CODES) (2016-2017) was used to examine injury severity in front- and rear-seated occupants aged 18 years or older (N = 958,704) involved in a motor vehicle crash. CODES uses probabilistic linkage of New York State hospitalization, emergency department, and police and motorist crash reports. Multivariable logistic regression models with MI analyze employed SAS 9.4. Odds ratios are reported as OR with 95% CI. The mortality rate was approximately 1.5 times higher for rear-seated than front-seated occupants (136.60 vs. 92.45 per 100,000), with rear-seated occupants more frequently unrestrained than front-seated occupants (15.28% vs. 1.70%, p < 0.0001). In adjusted analyses that did not include restraint status, serious injury/death was higher in rear-seated compared to front-seated occupants (OR:1.272, 1.146-1.412), but lower once restraint use was added (OR: 0.851, 0.771-0.939). Unrestrained rear-seated occupants exhibited higher serious injury/death than restrained front-seated occupants. Unrestrained teens aged 18-19 years old exhibit mortality per 100,000 occupants that is more similar to that of the oldest two age groups than to other young and middle-aged adults. Speeding, a drinking driver, and older vehicles were among the independent predictors of serious injury/death. Unrestrained rear-seated adult occupants exhibit higher severe injury/death than restrained front-seated occupants. When restrained, rear-seated occupants are less likely to be seriously injured than restrained front-seated occupants.
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Acidentes de Trânsito , Ferimentos e Lesões , Humanos , Acidentes de Trânsito/estatística & dados numéricos , Acidentes de Trânsito/mortalidade , Adulto , Pessoa de Meia-Idade , New York/epidemiologia , Feminino , Masculino , Adulto Jovem , Idoso , Adolescente , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/etiologia , Fatores de Risco , Fatores de Proteção , Idoso de 80 Anos ou mais , Cintos de Segurança/estatística & dados numéricosRESUMO
Despite an observed daytime front-seat seat belt use that exceeds 90%, nearly half of motor vehicle occupants who die in New York State (NYS) each year are not wearing a seat belt. Crash outcomes were examined by occupant, vehicle, environmental and traffic enforcement patterns related to the annual Click It or Ticket high visibility seat belt enforcement campaign. Three periods of enforcement were examined: pre-enforcement, peri-enforcement (during/immediately after), and post-enforcement. Of the 14.4 million traffic citations, 713,990 (5.0%) were seat belt violations. Relative risk with 95% CI was assessed using deaths from the Fatality Analysis Reporting System (FARS) and SAS Glimmix 9.4 software. Mortality was lower peri-enforcement (32.9%) compared to pre- (40.9%) or post-enforcement (37.1%) (p < 0.001) and tended to be elevated in low enforcement response areas (43.6%). Fatalities were 30% lower (0.7, 95% CI 0.6−0.9) during peri-enforcement in models adjusted for demographics, law coverage, enforcement response, rural, weekend, impairment, speeding, and vehicle type. Adjusted mortality was higher in rural (1.9, 1.6−2.6), alcohol-involved (1.8, 1.4−2.9), and speeding-involved (2.0, 1.7−2.5) crashes. Peri-enforcement alcohol- and speed-involved fatalities tended to be lower in restrained, unrestrained and occupants missing belt status. The finding of lower mortality in both belted and unbelted occupant's peri-enforcementin the context of fewer fatal speed and alcohol-involved crashessuggests that the mechanism(s) through which high visibility seat belt enforcement lowers mortality is through impacting multiple risky driving behaviors.
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Condução de Veículo , Cintos de Segurança , Humanos , Acidentes de Trânsito , New York/epidemiologia , Veículos AutomotoresRESUMO
OBJECTIVES: To determine whether there are prehospital differences between blacks and whites experiencing out-of-hospital cardiac arrest and to ascertain which factors are responsible for any such differences. METHODS: Cohort study of 3869 adult patients (353 blacks and 3516 whites) in the Illinois Prehospital Database with out-of-hospital cardiac arrest as a primary or secondary indication for emergency medical service (EMS) dispatch between 1 January 1996 and 31 December 2004. RESULTS: Return of spontaneous circulation was lower for black patients (19.8%) than for white patients (26.3%) (unadjusted OR 0.69, 95% CI 0.53 to 0.91). After adjusting for age, sex, prior medical history, prehospital event factors, patient zip code characteristics and EMS agency characteristics, the no difference line was suggestive of a trend, with a CI just transposing 1.00 (adjusted OR 0.71, 95% CI 0.50 to 1.01, p=0.053). CONCLUSIONS: Blacks were less likely to experience a return of spontaneous circulation than whites, less likely to receive defibrillation or cardiopulmonary resuscitation from EMS and more likely to receive medications from EMS. Differences in underlying health, care prior to the arrival of EMS, and delays in the notification of EMS personnel may contribute to racial disparities in prehospital survival after out-of-hospital cardiac arrest.
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População Negra/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , População Branca/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/estatística & dados numéricos , Estudos de Coortes , Circulação Coronária/fisiologia , Cardioversão Elétrica/estatística & dados numéricos , Feminino , Humanos , Illinois/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/etnologia , Parada Cardíaca Extra-Hospitalar/terapia , Fatores SocioeconômicosRESUMO
There are reports that historically higher mortality observed for front- compared to rear-seated adult motor vehicle (MV) occupants has narrowed. Vast improvements have been made in strengthening laws and restraint use in front-, but not rear-seated occupants suggesting there may be value in expanding the science on rear-seat safety. METHODS: A linked 2016-2017 hospital and MV crash data set, the Crash Outcomes Data Evaluation System (CODES), was used to compare characteristics of front-seated (n = 115,939) and rear-seated (n = 5729) adults aged 18 years and older involved in a MV crash in New York State (NYS). A primary enforced seat belt law existed for front-seated, but not rear-seated occupants. Statistical analysis employed SAS 9.4. RESULTS: Compared to front-seated occupants, those rear-seated were more likely to be unrestrained (21.2% vs. 4.3%, p < 0.0001) and to have more moderate-to-severe injury/death (11.9% vs. 11.3%, p < 0.0001). Compared to restrained rear-seated occupants, unrestrained rear-seated occupants had higher moderate-to-severe injury/death (21.5% vs. 7.5%, p < 0.0001) and 4-fold higher hospitalization. More than 95% of ejections were unrestrained and had 7-fold higher medical charges. Unrestrained occupants' hospital stays were longer, charges and societal financial costs higher. CONCLUSIONS: These findings extend the science of rear-seat safety in seriously injured rear-seated occupants, document increased medical charges and support the need to educate consumers and policy makers on the health and financial risks of adults riding unrestrained in the rear seat. The lack of restraint use in adult rear-seated motor vehicle occupants consumes scarce health care dollars for treatment of this serious, but largely preventable injury.
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Preços Hospitalares , Ferimentos e Lesões , Adulto , Humanos , Acidentes de Trânsito , Veículos Automotores , Cintos de Segurança , HospitaisRESUMO
BACKGROUND: Gender and racial disparities in injury mortality have been well established, but less is known regarding differences in fracture-related hospitalizations across the age span. METHODS: Cross-sectional analysis of annual incident fracture hospital admissions used statewide acute care hospital discharge data (Statewide Program and Research Cooperative System) for non-Hispanic White (n = 138,763) and non-Hispanic Black (n = 19,588) residents of New York State between 2000 and 2002. US census data with intercensal estimates were used to ascertain the population at risk. Gender- and race-specific incident fracture was calculated in 5-year age intervals. The χ test was used to analyze categorical variables. RESULTS: Mechanisms of injury vary by race and gender in their relative contribution to injury-related fractures across the age span. Black males exhibited higher fracture incidence until approximately age 62, while incidence in women diverged around age 45. Total motor vehicle traffic-related fracture hospitalization is bimodal in Whites but not in Blacks. Over the life span, all groups exhibited bimodal pedestrian fractures with pedestrian fractures accounting for 8.8% and 2.5% of all fractures in Blacks and Whites, respectively. Racial disparities were present from preschool through age 70. Violence-related fractures were 10 times higher in Blacks, accounting for 18.2% of hospitalizations. Black males exhibit higher fracture incidence due to violence by age 5 and higher gun violence by age 10; both remain elevated through age 75. CONCLUSIONS: Despite historical studies demonstrating higher bone density in Blacks, this study found racial disparities with increased fracture risk in both Black children and adults across most nonfall-related injury mechanisms examined.
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Negro ou Afro-Americano/estatística & dados numéricos , Fraturas Ósseas/etnologia , População Branca/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Fraturas Ósseas/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: In New York State (NYS), motor vehicle (MV) injury to child passengers is a leading cause of hospitalization and emergency department (ED) visits in children aged 0-12 years. NYS laws require appropriate child restraints for ages 0-7 years and safety belts for ages 8 and up while traveling in a private passenger vehicle, but do not specify a seating position. METHODS: Factors associated with injury in front-seated (n = 11,212) compared to rear-seated (n = 93,092) passengers aged 0-12 years were examined by age groups 0-3, 4-7 and 8-12 years using the 2012-2014 NYS Crash Outcome Data Evaluation System (CODES). CODES consists of Department of Motor Vehicle (DMV) crash reports linked to ED visits and hospitalizations. The front seat was row 1 and the rear rows 2-3. Vehicle towed from scene and air bag deployed were proxies for crash severity. Injury was dichotomized based on Maximum Abbreviated Injury Severity (MAIS) scores greater than zero. Multivariable logistic regression (odds ratios (OR) with 95% CI) was used to examine factors predictive of injury for the total population and for each age group. RESULTS: Front-seated children had more frequent injury than those rear-seated (8.46% vs. 4.92%, p < 0.0001). Children in child restraints experienced fewer medically-treated injuries compared to seat belted or unrestrained children (3.80, 6.50 and 13.62%, p < 0.0001 respectively). A higher proportion of children traveling with an unrestrained vs. restrained driver experienced injury (14.50% vs 5.26%, p < 0.0001). After controlling for crash severity, multivariable adjusted predictors of injury for children aged 0-12 years included riding in the front seat (1.20, 1.10-1.31), being unrestrained vs. child restraint (2.13, 1.73-2.62), being restrained in a seat belt vs. child restraint (1.20, 1.11-1.31), and traveling in a car vs. other vehicle type (1.21, 1.14-1.28). Similarly, protective factors included traveling with a restrained driver (0.61, 0.50-0.75), a driver aged < 25 years (0.91, 0.82-0.99), being an occupant of a later vehicle model year 2005-2008 (0.68, 0.53-0.89) or 2009-2015 (0.55, 0.42-0.71) compared to older model years (1970-1993). CONCLUSIONS: Compared to front-seated children, rear-seated children and children in age-appropriate restraints had lower adjusted odds of medically-treated injury.
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BACKGROUND: Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations is complex and could be greatly aided by an improved understanding of contributing factors. METHODS: Injury and health conditions were examined for hospitalized New York City homeless persons (n = 326,073) and low socioeconomic status (SES) housed residents (n = 1,202,622) using 2000 to 2002 New York statewide hospital discharge data (Statewide Program and Research Cooperative System). Age- and gender-adjusted odds ratios with 95% confidence intervals were calculated within age groups of 0.1 years to 9 years, 10 years to 19 years, 20 years to 64 years, and ≥65 years, with low SES housed as the comparison group. RESULTS: Comorbid conditions, injury, and injury mechanisms varied by age, gender, race or ethnicity, and housing status. Odds of unintentional injury in homeless versus low SES housed were higher in younger children aged 0 years to 9 years (1.34, 1.27-1.42), adults (1.13, 1.09-1.18), and elderly (1.25, 1.20-1.30). Falls were increased by 30% in children, 14% in adolescents or teenagers, and 47% in the elderly. More than one-quarter (26.9%) of fall hospitalizations in homeless children younger than 5 years were due to falls from furniture with more than threefold differences observed in both 3 year and 4 year olds (p = 0.0001). Several comorbid conditions with potential to complicate injury and postinjury care were increased in homeless including nutritional deficiencies, infections, alcohol and drug use, and mental disorders. CONCLUSIONS: Although homelessness presents unique, highly complex social and health issues that tend to overshadow the need for and the value of injury prevention, this study highlights potentially fruitful areas for primary, secondary, and tertiary prevention.
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Nível de Saúde , Pessoas Mal Alojadas/estatística & dados numéricos , Classe Social , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Características de Residência , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined injury and expenditures for motor vehicle traffic (MV) occupant injury among 3 year to 8 year olds covered versus uncovered by booster seat legislation. METHODS: Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in children covered versus uncovered by booster seat legislation. Data sources included Kids Inpatient Database 2003 and Web-based Injury Statistics Query and Reporting System. Statistical analyses used chi, Fisher's exact, and analysis of variance. Odds ratios were calculated with 95% confidence intervals (CI). RESULTS: Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than uncovered children (odds ratio, 0.78; 95% CI, 0.69-0.88). MV occupant injury constituted a smaller proportion of total injury expenditures in children covered (4.9%) versus uncovered (6.9%) by booster seat legislation. Covered children residing in areas with zip code incomes above the median had 26% lower MV occupant/total injury (p = 0.001) compared with 13% lower MV occupant/total injury for those below the median income (p = 0.0712). The proportion of injury dollars spent for MV occupant injury was higher in self-pay children for covered (7.8%) and uncovered (8.9%) children. CONCLUSIONS: This study suggests that booster seat laws are associated with a lower proportion of injury expenditures for MV occupant injuries in booster seat-aged children. Observed income disparities raise questions regarding whether access to booster seats, quality of affordable seats, and proper use and/or enforcement strategies impede legislative effectiveness.
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Acidentes de Trânsito/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Disparidades nos Níveis de Saúde , Equipamentos para Lactente/normas , Ferimentos e Lesões/economia , Criança , Pré-Escolar , Humanos , Equipamentos para Lactente/economia , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Most injuries to infants occur at home and are known to have a modifiable component. Additional information on safety behaviors, practices, and device ownership could inform prevention programs aimed at reducing injury-related race and ethnic disparities. METHODS: This study is a secondary data analysis of race and ethnic differences in home safety using data collected by the Connecticut, Ohio, Pennsylvania, Minnesota, and New York sites of the Injury Free Coalition for Kids. Study participants were English- and Spanish-speaking parents/guardians of infants aged 4 months to 6 months. All participants received a voucher redeemable for free safety devices and educational materials. RESULTS: Five hundred forty-two study participants were 37.8% black, 41.7% Hispanic, 10.5% white, and 10.0% other race. Whites more frequently owned/had safety devices including cabinet latches (chi2 =28.9, p < 0.0001), drawer latches (chi2 =21.4, p < 0.0001), bath thermometers (chi2 =22.5, p < 0.0001), electric outlet covers (chi2 =15.9, p = 0.0004), and poison control number (chi 2=93.8, p < 0.0001). Practice of unsafe behaviors, such as stomach sleep position, was higher in blacks (29.3%) than whites (15.8%) or Hispanics (17.7%) (chi2 =11.8, p < 0.0083). Overall, 62.1% redeemed vouchers, but this varied significantly by ethnicity: blacks (42.2%), non-Hispanic whites (64.6%), and Hispanics (76.3%) (chi2 = 48.5, p < 0.0001). CONCLUSIONS: Compared with whites, both blacks and Hispanics were less likely to own a variety of safety devices at baseline, but Hispanics were more likely than blacks to redeem vouchers. This one shot voucher program was effective at increasing device ownership, but was not sufficient alone to achieve population saturation of safety devices.
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Prevenção de Acidentes/instrumentação , Comportamentos Relacionados com a Saúde/etnologia , Educação em Saúde/métodos , Disparidades nos Níveis de Saúde , Adulto , Feminino , Humanos , Lactente , Masculino , Pais , Pobreza , Grupos Raciais , Estados UnidosRESUMO
BACKGROUND: To assess the relation between strength of graduated driver licensing (GDL) laws and motor vehicle (MV) injury burden, this study examined injury mortality, hospitalizations and related charges for 15 year to 17 year olds in 36 states by strength of GDL legislation. METHODS: Data sources include the CDC's Web-Based Injury Statistics Query and Reporting System (WISQARS) and the 2003 Healthcare Cost and Utilization Kids' Inpatient database (KID). Hospital admissions for injuries in 15 year to 17 year olds (n = 49,520) are unweighted. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores. The Insurance Institute for Highway Safety rating system was used to categorize legislative strength: good, fair, marginal/poor, and none. Logistic regression was used to assess independent predictors of MV injury. RESULTS: MV injury accounted for 14.6% of all-cause injury-related hospital admissions with 47.7% classified as drivers. Total MV occupant mortality was 14.6% lower after enactment of GDL with greater improvement observed in the good law category (26.0%). In multivariate models for hospitalized injury, all GDL law categories were protective for MV driver injury in 16 year olds. Compared with whites, black and Hispanic teens were more frequently injured as passengers than drivers. The contribution of MV occupant to all-cause injury-related hospital charges was 16.0% lower in good versus no-GDL categories and 39.5% lower for MV drivers. CONCLUSIONS: These findings suggest that the presence of any GDL legislation is associated with a lower burden of MV-related injury and expenditures with the largest differences observed for 16-year-old drivers.
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Acidentes de Trânsito/economia , Acidentes de Trânsito/mortalidade , Exame para Habilitação de Motoristas/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Acidentes de Trânsito/prevenção & controle , Adolescente , Comportamento do Adolescente , Distribuição por Idade , Feminino , Humanos , Masculino , Estações do Ano , Distribuição por Sexo , Estados Unidos/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/mortalidadeRESUMO
BACKGROUND: Information about risk factors of aviation crashes is crucial for developing effective intervention programs. Previous studies assessing factors associated with crash risk were conducted primarily in general aviation, air taxis, and commuter air carriers. METHODS: A matched case-control design was used to examine the associations of geographic region, basic weather condition, and pilot age with the risk of air carrier (14 CFR Part 121) crash involvement. Cases (N = 373) were air carrier crashes involving aircraft made by Boeing, McDonnell Douglas, and Airbus recorded in the National Transportation Safety Board's aviation crash database during 1983 through 2002, and controls (N = 746) were air carrier incidents involving aircraft of the same three makes selected at random from the Federal Aviation Administration's aviation incident database. Each case was matched with two controls on the calendar year when the index crash occurred. Conditional logistic regression was used for statistical analysis. RESULTS: With adjustment for basic weather condition, pilot age, and total flight time, the risk of air carrier crashes in Alaska was more than three times the risk for other regions ladjusted odds ratio (OR) 3.18, 95% confidence interval (CI) 1.35-7.49]. Instrument meteorological conditions were associated with an increased risk for air carrier crashes involving pilot error (adjusted OR 2.26, 95% CI 1.15-4.44) and a decreased risk for air carrier crashes without pilot error (adjusted OR 0.60, 95% CI 0.37-0.96). Neither pilot age nor total flight time were significantly associated with the risk of air carrier crashes. CONCLUSIONS: The excess risk of air carrier crashes in Alaska and the effect of adverse weather on pilot-error crashes underscore the importance of environmental hazards in flight safety.
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Acidentes Aeronáuticos , Tempo (Meteorologia) , Adulto , Fatores Etários , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Estados Unidos , Tolerância ao Trabalho ProgramadoRESUMO
BACKGROUND: Although the growth of state-level legalization of marijuana is aimed at increasing availability for adults and the chronically ill, one fear is that this trend may also increase accessibility in younger populations. The objectives of this study are to evaluate marijuana use in teen driver study participants and to compare their survey self-reported use with oral fluid and blood tests for psychoactive metabolites of tetrahydrocannabinol (THC). METHODS: The National Roadside Survey (NRS) of 2013-2014 was used to examine marijuana use in drivers aged 16-19 years. Of 11,100 drivers surveyed at 300 U.S. locations in 24 states, 718 were 16-19 years, and 666 (92.8%) provided oral fluid and/or blood. We examined weighted and unweighted data, but present unweighted findings. Kappa statistics, Chi square, and multivariable logistic regressions were used to assess agreement, associations and independent predictors of outcomes. RESULTS: More than one-quarter (203/718) of teen drivers reported either using marijuana in the last year or were THC positive. Overall incidence of a THC positive fluid test was 13.7%. In addition to 175 (27.3%) teen drivers who reported use in the last year, 28 (4.4%) who denied using in the past year, tested positive for THC. Of 45 teen drivers reporting use in the last 24 h, more than two-thirds (71.1%) were THC positive. Disagreement between the oral and blood test for 305 teen drivers who had both tests was 17 (5.6%), with a Kappa of 0.78 (95% CI 0.69-0.88). Of THC-positive drivers, nearly 20% started drinking alcohol by age 14 and more than 70% by age 16. Age, gender- and income-adjusted independent predictors of a positive THC test included survey completion during the school year (OR 3.2, 95% CI 1.6-6.2), survey-reported marijuana use in last year (OR 5.3, 95% CI 3.0-9.2), current smoker (OR 2.1, 95% CI 1.1-3.7), and alcohol consumption before age 16 (OR 2.3, 95% CI 1.1-3.7). CONCLUSIONS: Although specific THC thresholds for safe driving have not been established, taken in the context of teen crash statistics, THC documented impairments and rapidly relaxing marijuana laws, these findings suggest the need for increased vigilance and stepped-up surveillance in teen drivers.
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BACKGROUND: Use of appropriate child passenger safety restraints reduces injury in infants, with rear facing restraints favored over forward facing. In 2011, the American Academy of Pediatrics (AAP) began recommending that infants and children under the age of 2 years be restrained in a rear-facing seat installed in the vehicle's rear seat. This study examines the practice of rear-facing restraints pre- and post-AAP recommendations for children under 2 years. METHODS: Data from the Fatality Analysis Reporting System (FARS) from 2008 to 2015 were used to examine restraint status and injuries in rear-seated infants and toddlers aged 0 to less than 2 years involved in fatal collisions (n = 4966). Subpopulation analyses were conducted on 1557 children with seat facing direction recorded. Multivariable logistic regression was used to generate odds ratios (OR) with 95% confidence intervals (CI). Covariates considered for inclusion in the multivariable model included passenger characteristics (age, gender, seating position), driver characteristics (age, gender, seat belt status, alcohol status, drug status, previous traffic violations), vehicle characteristics (vehicle type), and crash-level characteristics (day/night, weekday/weekend, rush hour, expressway/surface street, urban/rural). RESULTS: Approximately 6.7% (330 of 4996) of infants and toddlers were unrestrained with mortality that was approximately triple that of restrained infants (40.0% vs 13.7%, P < 0.0001). In multivariable adjusted models, predictors of an infant being unrestrained included unrestrained driver (OR: 3.17, 95% CI: 2.38-4.21), driver aged less than 20 years (OR: 2.18, 95% CI: 1.42-3.34), driver alcohol use (OR: 2.21, 95% CI: 1.42-3.44), center-seated infant (OR: 1.55, 95% CI: 1.19-2.03) and weekday crash (OR: 1.52, 95% CI: 1.12-2.01). Of all rear-seated children whose restraint status were reported (4966), rear-facing restraint use increased from 5.0% to 23.2% between 2008 and 2015 (P < 0.0001). The odds of rear-facing restraint use increased after introduction of the AAP guideline among infants aged 0 to < 1 year old (OR: 2.12, 95% CI: 1.46-3.10) and among toddlers aged 1 to < 2 years old (OR: 1.97, 95% CI: 1.03-3.79). CONCLUSION: Trends in the use of rear-facing child restraints improved over the timeframe of this study, but remain low despite the introduction of AAP guidelines and the strengthening of child restraint laws.
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Rural areas of New York State (NYS) have higher rates of alcohol-related motor vehicle (MV) crash injury than metropolitan areas. While alcohol-related injury has declined across the three geographic regions of NYS, disparities persist with rural areas having smaller declines. Our study aim was to examine factors associated with alcohol-related MV crashes in Upstate and Long Island using multi-sourced county-level data that included the Crash Outcome Data Evaluation System (CODES) with emergency department visits and hospitalizations, traffic citations, demographic, economic, transportation, alcohol outlets, and Rural-Urban Continuum Codes (RUCCS). A cross-sectional study design employed zero-truncated negative binominal regression models to assess relative risks (RR) with 95% confidence interval (CI). Counties (n = 57, 56,000 alcohol-related crashes over the 3 year study timeframe) were categorized by mean annual alcohol-related MV injuries per 100,000 population: low (24.7 ± 3.9), medium (33.9 ± 1.7) and high (46.1 ± 8.0) (p < 0.0001). In multivariable analyses, alcohol-related MV injury was elevated for non-adjacent, non-metropolitan counties (RR 2.5, 95% CI: 1.6-3.9) with higher citations for impaired driving showing a small, but significant protective effect. Less metropolitan areas had higher alcohol-related MV injury with inconsistent alcohol-related enforcement measures. In summary, higher alcohol-related MV injury rates in non-metropolitan counties demonstrated a dose-response relationship with proximity to a metropolitan area. These findings suggest areas where intervention efforts might be targeted to lower alcohol-related MV injury.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Intoxicação Alcoólica/epidemiologia , Aplicação da Lei , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Codificação Clínica , Estudos Transversais , Humanos , New York/epidemiologiaRESUMO
Motor vehicle crashes (MVCs) are a leading cause of death among children. Multivariable analyses of age-appropriate child restraint system (CRS) use in the "booster-aged" population are needed. The current study identified factors associated with age-appropriate CRS use in fatal MVCs for children 4 to 7 years old, using 2011 to 2015 data from the Fatality Analysis Reporting System. Of 929 MVC fatalities, 32% of fatally injured children were in an age-appropriate restraint. While age-appropriate CRS use was higher for 4-, 5-, and 6-year-olds relative to 7-year-olds (adjusted relative risk [aRR] = 2.57, 2.51, and 2.18, respectively; p < .01 for each comparison), black children (aRR = 0.62; p < .01) relative to white children, and drivers who had not used a lap-shoulder belt (aRR = 0.40; p < .01) relative to belted drivers were associated with lower levels of age-appropriate CRS use. Our findings underscore the continued importance of communicating best practice guidelines on CRSs to caregivers of young children.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Sistemas de Proteção para Crianças/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , Etnicidade/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Grupos Raciais/estatística & dados numéricos , Fatores de RiscoRESUMO
Preventing injuries in older populations (aged 50-86 years) is more complex than in younger populations because of frailty, comorbidities, polypharmacy, and physical and cognitive functional limitations. To improve accessibility and delivery of comprehensive, focused injury prevention, we developed a model incorporating applicable features of our national children's program with additional elements to address challenges of older populations. The older adult injury prevention model addresses gaps in prevention by improving access to risk factor screening, safety devices, education, counseling, medical care, and referrals.
Assuntos
Acessibilidade aos Serviços de Saúde , Serviços de Saúde para Idosos , Comportamento de Redução do Risco , Ferimentos e Lesões/prevenção & controle , Idoso , Aconselhamento , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Modelos Teóricos , Cidade de Nova Iorque , Educação de Pacientes como Assunto , Encaminhamento e Consulta , Medição de Risco , Segurança , População UrbanaRESUMO
BACKGROUND: Examination of expenditures in areas where more universal application of effective injury prevention approaches is indicated could identify specific mechanisms and age groups where effective intervention may impact public injury-related expenditures. METHODS: The Healthcare Cost and Utilization Project 2003 (KID-HCUP) contains acute care hospitalization data for U.S. children and adolescents residing in 36 states. The study population includes 240,248 unweighted (397,943 weighted) injury-related hospital discharges for ages 0 to 19 years. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores (ICISS). SUDAAN was employed to adjust variances for stratified sampling. Expenditures were weighted to represent the U.S. population. RESULTS: Injury-related hospitalizations (mean $28,137 +/- 64,420, median $10,808) were more costly than non-injury discharges, accounting for approximately 10% of all persons hospitalized (unweighted), but more than one-fifth of expenditures. Public sources were the primary payor for 37.7% of injured persons. Incidence and cost per case variations across specific injury mechanisms heavily influenced total mechanism specific expenditures. Motor vehicle crashes were the largest expenditures for private and public payors with two thirds of expenditures in teenagers - more than 40% for drivers. Medicaid covered 45.6% ($192 million) of burn expenditures and 59.2% in 0-4 year olds. Expenditures per case (mean +/- SD, median) were: firearm ($36,196 +/- 58,052, $19,020), motor vehicle driver ($33,731 +/- 50,583, $18,431), pedestrian ($31,414 +/- 57,103, $16,552); burns ($29,242 +/- 64,271, $10,739); falls ($13,069 +/- 20,225, $8,610); and poisoning ($8,290 +/- $15,462, $5,208). CONCLUSIONS: More universal application of proven injury prevention has the potential to decrease both the public and private health expenditure burden among several modifiable injury mechanisms.