Long-term effectiveness of eculizumab: Data from the International PNH Registry.

OBJECTIVES: Data from the International PNH Registry (NCT01374360) were used to estimate the overall survival and first occurrence of thromboembolic events/major adverse vascular events (TEs/MAVEs) for eculizumab-treated patients with paroxysmal nocturnal hemoglobinuria (PNH) compared with a contemporaneous untreated cohort. METHODS: Patients enrolled in the Registry from March 16, 2007, to February 14, 2022, were included. Treated patients received eculizumab for >35 days; untreated patients did not receive eculizumab at any time. Univariable and multivariable analyses were performed using a Cox proportional hazards regression model comparing eculizumab treatment periods to untreated periods and were adjusted for baseline covariates (e.g., high disease activity [HDA], transfusion dependency, and eculizumab treatment status). RESULTS: The analysis included 4118 patients. The univariable hazard ratio (HR) (95% CI) for mortality in eculizumab-treated time versus untreated time was 0.51 (0.41-0.64; p < 0.0001). Significant baseline covariates included age, sex, history of bone marrow failure, ≥4 erythrocyte transfusions within 12 months before baseline, and an estimated glomerular filtration rate ≤ 60 mL/min/1.73 m2 (all p < 0.0001). In the adjusted analysis, patients with baseline HDA had the greatest reduction in mortality risk (HR [95% CI], 0.51 [0.36-0.72]). Treated patients had approximately 60% reduction in TE/MAVE risk during treated versus untreated time (HR [95% CI]: TE: 0.40 [0.26-0.62], MAVE: 0.37 [0.26-0.54]; p < 0.0001). CONCLUSION: Using data from the largest Registry of patients with PNH, with ≥14 years of overall follow-up, we demonstrate that treatment with eculizumab conferred a 49% relative benefit in survival and an approximately 60% reduction in TE/MAVE risk.

Defensive Functioning Among Women With Breast Cancer and Matched Community Controls.

OBJECTIVE: The general theory of defense mechanisms posits that stress is associated with using defenses lower on the hierarchy of defensive adaptation. Some have observed that individuals with cancer use certain defenses, such as repression, denial, and immature defenses. This cross-sectional study examined four hypotheses about defensive functioning in a sample of women who are mothers with a recent history of breast cancer (BC), compared to a matched sample of healthy mothers in the community. METHOD: We rated defenses from interview transcripts about interpersonal vignettes, using the Defense Mechanism Rating Scales quantitative method. Measures of symptoms and functioning were also gathered. RESULTS: The BC group displayed lower (z = 5.39, df = 1,231, p < .0001) overall defensive functioning than controls: 5.32 [95% CI: 5.13 to 5.51] versus 5.63 [95% CI: 5.50 to 5.76], which is equivalent to a medium effect size (0.62). Compared to controls, the BC group displayed more denial, idealization, displacement, isolation of affect, and splitting of others' images; conversely, they used less altruism, anticipation, intellectualization, and undoing. Controls used a mixture of high adaptive (35.5%), neurotic (43.0%), and immature defenses (21.4%). In contrast, the BC group used fewer high adaptive (30.7%) and neurotic (38.8%) and more immature defenses (30.5%). Both groups scored in relatively healthy ranges on other measures. Correlations with other measures supported the hierarchy of defense adaptiveness. CONCLUSIONS: The relationships among stress, defensive functioning, and adaptation were largely as predicted. Future studies should examine defenses in the process of seeking care, diagnosis, and treatment response for breast cancer.

Physical activity and sedentary behavior patterns using accelerometry from a national sample of United States adults.

BACKGROUND: This study described the patterns of accelerometer-determined physical activity and sedentary behavior among adults using a nationally representative sample from the United States. METHODS: Using 2003-2006 National Health and Nutrition Examination Survey (NHANES) data, 7931 adults at least 18 years old wore an ActiGraph accelerometer for one week, providing at least 3 days of wear for >=8 hours/day. Cutpoints defined moderate to vigorous physical activity (MVPA; >= 2020 and >=760 counts/minute), vigorous physical activity (> = 5999 counts/minute), and sedentary behavior (<100 counts/minute). Latent class analysis (LCA) was used to estimate patterns of physical activity and sedentary behavior. All estimates were weighted to reflect the United States population. RESULTS: For weighted percent of MVPA out of total wearing time, 5 classes were identified from least to most active: 65.3% of population (weighted mean 9.3 minutes/day), 24.9% (32.1 minutes/day), 3.2% that was low on the weekdays but much higher on the weekends (52.0 minutes/day), 5.9% (59.9 minutes/day), and 0.7% in the highest class (113.6 minutes/day). Using the lower MVPA threshold, 6 classes emerged with each class ranging in population from 1.2% to 43.6%. A vigorous activity class could not be derived due to low prevalence. For weighted percent of sedentary behavior out of total wearing time, 5 classes were identified from most to least sedentary: 6.3% of population (weighted mean 660.2 minutes/day), 25.1% (546.8 minutes/day), 37.7% (453.9 minutes/day), 24.0% (354.8 minutes/day), and 7.0% (256.3 minutes/day). Four of the classes showed generally similar results across every day of the week, with the absolute percents differing across classes. In contrast, the least sedentary class showing a marked rise in percent of time spent in sedentary behavior on the weekend (weighted mean 336.7-346.5 minutes/day) compared to weekdays (weighted mean 255.2-292.4 minutes/day). CONCLUSION: The LCA models provided a data reduction process to identify patterns using minute-by-minute accelerometry data in order to explore meaningful contrasts. The models supported 5 or 6 distinct patterns for MVPA and sedentary behavior. These physical activity and sedentary behavior patterns can be used as intervention targets and as independent or dependent variables in future studies of correlates, determinants, or outcomes.

Cardiometabolic correlates of low type 2 diabetes incidence in western Alaska Native people - The WATCH study.

AIMS: Previously rare among Alaska Native (AN) people, type 2 diabetes (DM2) prevalence as indicated by registry data has increased by as much as 300% in some western Alaska regions. We sought to determine prevalence and incidence of DM2 and analyze associated cardiometabolic risk factors in western AN people. METHODS: DM2 and prediabetes prevalence and incidence were determined by the Western Alaska Tribal Collaborative for Health using consolidated data from cohort studies conducted during 2000-2010. Crude and age-adjusted incidence for DM2 and prediabetes were calculated using 2010 American Diabetes Association criteria. Effects of covariates on DM2 and prediabetes were determined using univariate and multivariate Cox proportional hazards analyses, adjusted for age and sex. RESULTS: Excluding baseline diabetes (n=124, 4.5%), 53 cases of new DM2 were identified among 2630 participants. Age- and sex-adjusted DM2 incidence was 4.3/1000 (95% CI 2.9, 5.0) person-years over an average 5.9-year follow up. After excluding baseline prediabetes, 387 new cases of prediabetes were identified among 1841 participants; adjusted prediabetes incidence was 44.5/1000 (95% CI 39.5, 49.5) person years. Independent predictors for DM2 included age, impaired fasting glucose, and metabolic syndrome; family history of diabetes and obesity were additional independent predictors for prediabetes. CONCLUSIONS: DM2 incidence in western AN people is substantially lower than that for U.S. whites; however, incidence of prediabetes is more than 10-fold higher than western AN DM2 incidence and more closely aligned with U.S. rates. Interventions aimed at achieving healthy lifestyles are needed to minimize risk factors and maximize protective factors for DM2 in this population.

Prevalence of Hypertension and Associated Risk Factors in Western Alaska Native People: The Western Alaska Tribal Collaborative for Health (WATCH) Study.

Hypertension is a common chronic disease and a key risk factor in the development of cardiovascular disease. The Western Alaska Tribal Collaborative for Health study consolidates baseline data from four major cohorts residing in the Norton Sound and Yukon-Kuskokwim regions of western Alaska. This consolidated cohort affords an opportunity for a systematic analysis of high blood pressure and its correlates in a unique population with high stroke rates over a wide age range. While the prevalence of hypertension among western Alaska Native people (30%, age-standardized) is slightly less than that of the US general population (33%), cardiovascular disease is a leading cause of mortality in this rural population. The authors found that improvement is needed in hypertension awareness as about two thirds (64%) of patients reported awareness and only 39% with hypertension were controlled on medication. Future analyses assessing risk and protective factors for incident hypertension in this population are indicated.

College students' knowledge about fetal alcohol spectrum disorder.

BACKGROUND: Fetal Alcohol Spectrum Disorders (FASDs) are the leading known preventable birth defects in North America. Knowledge surveys about FASD have been conducted with various health and allied healthcare providers and have proven useful in identifying gaps in knowledge and differences among provider groups to support prevention efforts. To date, no research has been conducted exploring FASD knowledge among college students. OBJECTIVE: This study explored FASD knowledge in a sample of college students, a group at particularly high risk for alcohol-exposed pregnancies. Findings are compared to professionals in several healthcare and affiliated professional groups who were previously surveyed with the same FASD-related items. METHODS: Surveys from 1,035 college students at a northwestern university were analyzed. Included with the ACHA-National College Health Assessment II were questions regarding FASD. College students' knowledge was compared with that of professionals in key healthcare and affiliated positions to define their relative awareness of FASD risk. RESULTS: Overall, findings revealed adequate FASD knowledge among college students. Although minor differences emerged when comparing students and professionals' responses, most respondent groups answered with an 85% accuracy rate or higher. CONCLUSION: College students demonstrated adequate knowledgeable about FASD. Future research must explore whether such knowledge translates into lower risk behavior and consequent reduction in alcohol-exposed pregnancies.

All-cause, cardiovascular, and cancer mortality in western Alaska Native people: western Alaska Tribal Collaborative for Health (WATCH).

OBJECTIVES: We determined all-cause, cardiovascular disease (CVD), and cancer mortality in western Alaska Native people and examined agreement between death certificate information and adjudicated cause of deaths. METHODS: Data from 4 cohort studies were consolidated. Death certificates and medical records were reviewed and adjudicated according to standard criteria. We compared adjudicated CVD and cancer deaths with death certificates by calculating sensitivity, specificity, predictive values, and κ statistics. RESULTS: Men (n = 2116) and women (n = 2453), aged 18 to 95 years, were followed an average of 6.7 years. The major cause of death in men was trauma (25%), followed by CVD (19%) and cancer (13%). The major cause of death in women was CVD (24%), followed by cancer (19%) and trauma (8%). Stroke rates in both genders were higher than those of US Whites. Only 56% of deaths classified as CVD by death certificate were classified as CVD by standard criteria; discordance was higher among men (55%) than women (32%; κs = 0.4 and 0.7). CONCLUSIONS: We found lower rates for coronary heart disease death but high rates of stroke mortality. Death certificates overestimated CVD mortality; concordance between the 2 methods is better for cancer mortality. The results point to the importance of cohort studies in this population in providing data to assist in health care planning.

Adaptive defense mechanisms: function and transcendence.

This article reviews the high-adaptive (mature) defense mechanisms, along with case material illustrating each. These defenses are described in terms of not only the specific means by which they serve to ward off anxiety and manage conflict, but also how they often transcend their role as defenses by contributing to the creation of new "products" of value, such as new meanings, perspectives, modes of relating, and works of art or science. This report also discusses the implications of the use of adaptive defenses, especially humor, in the context of psychotherapy.

Agreement Between Self-Report and Medical Record Prevalence of 16 Chronic Conditions in the Alaska EARTH Study.

The gold standard for health information is the health record. Hospitalization and outpatient diagnoses provide health systems with data on which to project health costs and plan programmatic changes. Although health record information may be reliable and perceived as accurate, it may not include population-specific information and may exclude care provided outside a specific health care facility. Sole reliance on medical record information may lead to underutilization of health care services and inadequate assessment of population health status. In this study, we analyzed agreement, without assuming a gold standard, between self-reported and recorded chronic conditions in an American Indian/Alaska Native cohort. Self-reported health history was collected from 3821 adult participants of the Alaska EARTH study during 2004-2006. Participant medical records were electronically accessed and reviewed. Self-reported chronic conditions were underreported in relation to the medical record and both information sources reported the absence more reliably than the presence of conditions (across conditions, median positive predictive value = 64%, median negative predictive value = 94%). Agreement was affected by age, gender, and education. Differences between participant- and provider-based prevalence of chronic conditions demonstrate why health care administrators and policy makers should not rely exclusively on medical record-based administrative data for a comprehensive evaluation of population health.

Utilizing harmonization and common surveillance methods to consolidate 4 cohorts: the Western Alaska Tribal Collaborative for Health (WATCH) study.

BACKGROUND: According to health status reports, chronic disease prevalence appears to be rising in western Alaska Native (AN) people, and accurate population-based data are needed. Four cohort studies of western AN people were conducted in the Norton Sound and Yukon-Kuskokwim regions, but none have been large enough to allow reliable estimates of rates of chronic diseases and evaluate their risk factors. OBJECTIVE: In this article, the methods used to combine 4 major cohort studies of rural western AN people are described and the benefits and challenges encountered in combining data and standardizing surveillance methods for these studies are discussed. DESIGN: Tribal permission was obtained for each cohort study and the consolidated study. Data from baseline exams were directly combined or harmonized into new variables. Common surveillance methods were developed and implemented to identify incidence and risk factors for cardiovascular disease (CVD) events and type 2 diabetes. RESULTS: A cohort of 4,569 western AN participants (2,116 men and 2,453 women), aged 18-95 years, was established to study CVD and diabetes prevalence. Prospective surveillance data over an average 6.7-year follow-up can now be used to study CVD and diabetes incidence and associated risk factors in a subset of 2,754 western AN participants (1,218 men and 1,536 women) who consented to initial surveillance. CONCLUSIONS: The combined cohort provides statistical power to examine incidence rates and risk factors for CVD and diabetes and allows for analyses by geographic region. The data can be used to develop intervention programmes in these populations and others.

Alternative and complementary treatment needs and experiences of women with breast cancer.

OBJECTIVES: The study objectives were to explore the potential need for and use of complementary and alternative (CAM) services among women diagnosed with breast cancer and to investigate reasons for nonreceipt of CAM. DESIGN: The Alaska Breast Cancer Needs Assessment Survey was completed by female breast cancer survivors in Alaska. The survey assessed physical and psychologic symptoms, services received, satisfaction with treatment, communication with providers, and informational needs. Survey responses were obtained from 309 women with breast cancer, with a mean age of 56 years and high level of education. RESULTS: Results revealed that most breast cancer survivors have significant needs for CAM services, and yet only a small proportion actually receives them. For example, virtually all women reported symptoms potentially amenable to treatment via individual counseling or nutritional interventions; however, only 29% and 45%, respectively, received such services. Women who did and those who did not receive CAM services (e.g., counseling, massage, meditation, and supplementation) generally did not differ in terms of their need for such services as measured via symptoms that could be supported by these interventions. However, the majority failed to be referred for such treatments or were unable to access them if referred. CONCLUSIONS: Results suggest that while access to services played a small role in nonreceipt of CAM services, the largest reason for CAM nonreceipt was failure to recognize their potential benefit on the part of providers and at least some patients. Raising awareness about the potential value of CAM among care providers for women with breast cancer is crucial, as it will likely lead to more CAM acceptance and utilization. Once providers accept and refer for CAM, patients' quality of life may be considerably enhanced, as the extant literature has demonstrated the potential value of CAM for breast cancer survivors.

Associations between patterns of objectively measured physical activity and risk factors for the metabolic syndrome.

PURPOSE: To determine whether certain patterns of objectively measured physical activity (PA) are associated with the risk factors for or the diagnosis of the metabolic syndrome (MS). DESIGN: Latent class analysis, including assessment of the associations between latent PA classes and risk factors for the MS. SETTING: Random sample from throughout the United States using data from the 2003-2004 National Health and Nutrition Examination Survey. SUBJECTS: A total of 3458 civilian adult noninstitutionalized U.S. citizens. MEASURES: Daily minutes of moderate-to-vigorous PA across a 7-day week based on accelerometer measurements, as well as high blood pressure, blood glucose levels, triglyceride levels, and body mass index, along with low levels of high density lipoproteins, using clinical cut points. RESULTS: Membership in the more active PA classes was consistently associated with lower odds of all risk factors for the MS. However, when participants were categorized into quartiles of the coefficients of variation of PA across 7 days, few differences were seen in any of the risk factors. CONCLUSIONS: Accumulating the total weekly recommended amount of PA is consistently associated with positive health profiles, and more PA than the recommended amounts may be even better. However, the manner in which this activity is accumulated, either spread over most days of the week or compressed into just a couple of days, may have similar associations with the risk factors for the MS.

Patterns of objectively measured physical activity in the United States.

PURPOSE: We used latent class analysis (LCA) to assess patterns of physical activity among adults, using the 7 d of accelerometer data from the 2003-2004 NHANES. METHODS: For each participant, we determined the daily minutes of moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA), and minutes of MVPA that occurred in bouts of 10 min. Participants were then categorized into patterns of activity, using LCA and adjusting for sociodemographic characteristics. RESULTS: For overall MVPA, five classes of physical activity were defined, including two least active classes, which averaged less than 25 min of MVPA per day and represented 78.7% of the total study population. The most active class averaged 134 min of MVPA per day and comprised 0.9% of the population. The results for bout minutes of MVPA were similar to the patterns produced for overall MVPA, with the exception of a "weekend warrior" class with moderate levels of physical activity Monday through Friday but with a much higher level of activity on the weekend, particularly on Sunday. This class represented 1.8% of the population. Only 1.4% of all days achieved 10 min or more of VPA, and in 91.1% of all days, participants accumulated less than 1 min of VPA. The LCA analysis of VPA did not produce stable results, because of the small number of participants registering any minutes of VPA. CONCLUSION: Our results indicate that a very large portion of the U.S. population may be classified into patterns of physical activity that represent low levels of MVPA throughout the week. The LCA analysis provided a novel approach for assessing patterns of objectively measured physical activity in epidemiologic studies.

The association between sex and mortality among burn patients as modified by age.

Although an increased risk of death among female patients suffering thermal injury has been noted, the differential influence of age has received little attention. Because experimental evidence suggests that sex hormones influence the immune response to thermal injury, an age-related sex influence on patient mortality is biologically plausible as the hormone milieu changes with the onset of menopause. The goal of this study was to estimate the association between sex and mortality after thermal injury in a large, population-based sample. The National Trauma Data Bank yielded data for more than 6200 burn patients 20 years of age or older. Logistic regression was used to calculate mortality odds ratios (OR) with 95% confidence intervals (CIs) for men relative to women, both overall and by age. Adjustments for age, race, burn etiology, percent body surface area burned, comorbid conditions, and inhalation injury were performed. For the overall study population, the adjusted risk of death was approximately 30% lower for males (OR 0.67, 95% CI 0.52-0.87). Within age strata, the adjusted association was statistically significant only in those aged 20 to 34 years (OR 0.45; 95% CI 0.24-0.87); 35 to 49 years (OR 0.71; 95% CI 0.39-1.30); 50 to 64 years (OR 0.55; 95% CI 0.31-1.00); and 65 years or older (OR 0.85; 95% CI 0.57-1.27). The results of the present study not only indicate that women have an increased odds of mortality after thermal injury but also demonstrate a differential effect of age on the association between sex and mortality. On the basis of the findings of the present study as well as the results of experimental studies, further clinical research is needed to investigate the impact of sex hormones on mortality among burn patients.

Choosing psychotherapy as a career: why did we cross that road?

This article addresses the question "Why do people become psychotherapists?" via two approaches. The first involves an examination of the empirical and clinical literature on motivations and influences common to most psychotherapists. The second approach explores multiple pathways to becoming a psychotherapist by considering distinct gender-linked career trajectories. We identify 12 oft-noted themes in the literature on therapists' career paths (e.g., cultural marginalization, a psychologically minded way of understanding self and others) and link these to the narratives of the eight authors in this issue. Finally, we discuss ways in which understanding career motivations may be useful for therapists in their practice.

Motor vehicle mismatch-related spinal injury.

BACKGROUND/OBJECTIVE: Motor vehicle collision (MVC)-related spinal cord injury (SCI) is the most prevalent etiology of SCI. Few studies have defined SCI risk factors. Vehicle mismatch occurs in 2-vehicle MVCs in which there are significant differences in vehicle weight, stiffness, and height. This study examined SCI risk and vehicle mismatch. METHODS: A matched case-control study using the 1995 to 2003 National Automotive Sampling System (NASS). Study subjects were identified from 2-vehicle MVCs. Cases were occupants who had suffered a cervical, thoracic, or lumbar SCI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: There were 101,682 cases of SCI matched to 805,091 controls. Occupants of passenger vehicles involved in MVCs with a light truck or van (LTV) were at increased risk for SCI (OR = 1.87, 95% CI = 1.07-3.24) and this risk was greatest for thoracic SCI (OR = 5.09, 95% CI = 2.33-11.13). In addition, occupants of LTVs involved in MVCs with passenger vehicles were at significant increased risk for cervical (OR = 1.39) and lumbar (OR = 2.65) SCI; and occupants of LTVs involved in MVCs with other LTVs were at increased risk of any SCI (OR = 2.02, 95% CI = 1.52-2.69). For these subjects, significant increased risks were seen for all spine regions: cervical (OR = 1.41), thoracic (OR = 2.86), and lumbar (OR = 2.38). CONCLUSIONS: The results of this study suggest that occupants of passenger vehicles are at increased SCI risk when involved in 2-vehicle MVCs with LTVs; and that occupants of LTVs are at increased SCI risk, regardless.

Restraint use and lower extremity fractures in frontal motor vehicle collisions.

BACKGROUND: Seat belts and air bags have been shown to significantly reduce morbidity and mortality following MVCs. Research suggests that restraint use does not protect against lower extremity fracture; however, no population-based studies of this association exist. The purpose of this study is to compare the effectiveness of combined seat belt and airbag restraint systems with airbag alone, seat belt alone, and no restraints with respect to incidence and location of lower extremity fractures. METHODS: A retrospective analysis of front seat occupants involved in police-reported, tow-away frontal MVCs was conducted using data from the 1995 through 2000 National Automotive Sampling System (NASS). Incidence and relative risk (RR) of fracture to specific bony regions were measured according to seat belt use and airbag deployment. RESULTS: Compared with unrestrained occupants, occupants restrained with airbag only had significantly higher risk for all types of lower extremity fractures whereas those occupants restrained with either seat belt only or seat belt and airbag had lower risk of fracture. The greatest difference was seen with tibia/fibula fractures in airbag only (RR, 2.14) but this trend continued to be significant with femur and pelvic fractures (RR, 1.13 and 1.23, respectively). CONCLUSION: While airbags may reduce the risk of death when used alone or in combination with seat belts, the results of this study demonstrate that air bags increase the risk of lower extremity fractures when used as the sole method of passenger protection. Also, they may do so differentially according to skeletal region. This data strongly support the consideration of developing accessory knee bolster airbags to prevent the "submarining" or sliding under the airbag that may be responsible for this finding.

Is seat belt use associated with fewer days of lost work after motor vehicle collisions?

BACKGROUND: Seat belt use has consistently been shown to reduce motor vehicle collision (MVC)-related morbidity and mortality. The goal of this study is to determine whether seat belt use is associated with fewer lost workdays among occupants involved in MVCs. METHODS: The 1995 to 2000 National Automotive Sampling System (NASS) data files were used. The NASS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Occupants' lost workdays, which are routinely collected as part of an NASS investigation, were compared according to seat belt use. RESULTS: During 1995 to 2000 in the United States, surviving occupants involved in MVCs lost a total of 42.1 million workdays (approximately 7.0 million lost workdays per year; 2.4 lost workdays per person). The overall difference in lost workdays between the belted and unbelted occupants was 1.59 days (1.99 days vs. 3.58 days, respectively; p < 0.001). After adjusting for potentially confounding factors, belted occupants had 1.52 fewer lost workdays compared with unbelted occupants (p < 0.001). This translates to an estimated 7.3 million lost workdays and an associated $566 million in lost wages and $1.25 billion in work-place costs attributable to lack of seat belt use in the United States during 1995 to 2000. CONCLUSION: Lost workdays attributable to MVCs in the United States have sizable financial implications. Furthermore, seat belt use significantly reduces lost time at work and is associated with a significant cost savings. The national impact of unbelted driving on work productivity is dramatic, and further efforts to promote appropriate seat belt use should continue as part of the national safety agenda.

The influence of side airbags on the risk of head and thoracic injury after motor vehicle collisions.

BACKGROUND: Side airbags (SABs) were developed as an energy-absorbing barrier to protect specific occupant body regions in near side impact motor vehicle collisions. METHODS: The National Automotive Sampling System Crashworthiness Data System was used to evaluate drivers and front-seated passengers in 1998 or newer vehicles involved in near side impact collisions. Risk ratios were calculated comparing the risk of head and thoracic injury among occupants in vehicles with and without SABs adjusting for occupant, vehicle, and collision characteristics. RESULTS: Occupants in vehicles equipped with head protection SABs had a 75% lower risk of head injury (p = 0.008) after near side collisions. With respect to thoracic injury, SABs that provide thoracic protection are associated with a 68% reduction (p = 0.01) in thoracic injury risk. CONCLUSION: As SAB-equipped vehicles become an increasingly larger segment of the on-road vehicle fleet, the impact of head and thoracic injury after near side impact collision is likely to be reduced.