Impact evaluation of a farm safety awareness workshop in New Zealand.

OBJECTIVE: Farming is a hazardous occupation, with high rates of injury and death. FarmSafe, a whole-country approach, sought to address work-related injury on New Zealand sheep, beef, and dairy farms. More than 10 000 farmers participated in 630 workshops held over two years. This short communication presents the results of an impact evaluation of the FarmSafe Awareness Workshop (FSAW) in its first two years of operation. METHODS: All FSAW participants completed, and received credit for, formal educational assessments. Pass rates were used to assess safety knowledge, and a quasi-experimental design with intervention and comparison groups was applied to assess attitudes, safety behaviors, and environmental determinants of injury. RESULTS: An intervention (N=111) and two comparison groups (C1, N=409, and C2, N=78) completed before and after questionnaires. At follow-up, the intervention group (IG) showed a small improvement in attitudes toward safety (IG=79.3, C1=77.4; C2=77.4, P=0.035), but there were no differences between groups for personal safety practice or the safety environment of the farm. However, if a respondent registered their interest in the workshop, but a different person from the same farm attended, there was some improvement in the safety of the farm environment score. CONCLUSION: Well-conducted safety training tailored to farmers was still not enough to change safety practice. Future interventions may be more likely to achieve progress if they are comprehensive, include environmental and enforcement features, and target more than one participant per farm.

The epidemiology of life-threatening work-related injury--a demonstration paper.

BACKGROUND: Workers' compensation (WC) data traditionally provides information to stakeholders on work-related disabling injuries. It is important to complement this with information on serious threat to life (TTL) injury, which is the focus of this paper. METHODS: In this cross-sectional descriptive epidemiological study, based on New Zealand's WC data linked to hospital discharge data, TTL was measured using the ICD10-based Injury Severity Score (ICISS); ICISS ≤ 0.941 was used to define serious TTL injury. RESULTS: During 2002-2004, there was an average of 368 serious TTL work-related injury cases annually. The distribution of these injuries was very different from those traditionally found using WC data to describe disabling injury. For example, for serious TTL injury the main injury types included traumatic brain injury, whereas for disabling injury it was sprains and dislocations. CONCLUSIONS: The method presented provides the opportunity for government agencies to produce a national description of the epidemiology of serious TTL work-related injuries.

Pre-licensed driving experience and car crash involvement during the learner and restricted, licence stages of graduated driver licensing: Findings from the New Zealand drivers study.

OBJECTIVE: The aim of this study was to determine whether pre-licence driving experiences, that is driving before beginning the licensing process, increased or decreased crash risk as a car driver, during the learner or the restricted licence stages of the graduated driver licensing system (GDLS). METHOD: Study participants were 15-24 year old members of the New Zealand Drivers Study (NZDS) - a prospective cohort study of newly licensed car drivers. The interview stages of the NZDS are linked to, the three licensing stages of the GDLS: learner, restricted and full. Baseline demographic (age, ethnicity, residential location, deprivation), personality (impulsivity, sensation seeking, aggression) and, behavioural data, (including pre-licensed driving behaviour), were obtained at the learner licence interview. Data on distance driven and crashes that occurred at the learner licence and restricted licence stages, were reported at the restricted and full licence interviews, respectively. Crash data were also obtained from police traffic crash report files and this was combined with the self-reported crash data. The analysis of the learner licence stage crashes, when only supervised driving is allowed, was based on the participants who had passed the restricted licence test and undertaken the NZDS, restricted licence interview (n=2358). The analysis of the restricted licence stage crashes, when unsupervised driving is first allowed, was based on those who had passed the full licence test and completed the full licence interview (n=1428). RESULTS: After controlling for a range of demographic, personality, behavioural variables and distance driven, Poisson regression showed that the only pre-licence driving behaviour that showed a consistent relationship with subsequent crashes was on-road car driving which was associated with an increased risk of being the driver in a car crash during the learner licence period. CONCLUSION: This research showed that pre-licensed driving did not reduce crash risk among learner or restricted licensed drivers, and in some cases (such as on-road car driving) may have increased risk. Young people should be discouraged from the illegal behaviour of driving a car on-road before licensing.

An outcome evaluation of a New Zealand farm safety intervention: a historical cohort study.

BACKGROUND: There is limited evidence that farm safety-related interventions based solely on an educational element have an effect on injury rates. Our aim was to evaluate a New Zealand national educational program, FarmSafe™ Awareness, for its effect on injury rates. METHODS: We used a before-after design followed by a historical cohort study of sheep, beef, and dairy farmers/workers. The outcomes were work-related injuries, identified from workers compensation data. Cox regressions were used to compare intervention with matched control group rates. RESULTS: FarmSafe™ Awareness was associated with significantly higher rates of work-related injury, than matched controls. CONCLUSIONS: It is difficult to see how FarmSafe™ Awareness could be causing an increased rate of work-related injury. We detected no reporting bias, and selection bias is likely to act in the opposite direction to the observed results. We conclude that there is no evidence that FarmSafe™ Awareness prevents farm injury.

Non-response bias in a web-based health behaviour survey of New Zealand tertiary students.

OBJECTIVE: There has been little investigation of non-response bias in web-based health surveys. We hypothesised that non-respondents have a higher prevalence of risk behaviours than respondents. METHOD: In 2005, random samples of students aged 17-25 years from 12 New Zealand tertiary institutions (n=7130) were invited to complete a web-based health behaviour survey, with three e-mail reminders. Early respondents (before 2nd reminder) were compared with late respondents (after 2nd reminder). Late respondents served as a proxy for non-respondents. RESULTS: 2607 students (37%) responded early, 676 (9%) responded late, and 3847 (54%) did not respond. There were differences between early and late respondents in high school binge drinking (38% vs 47%, p=0.002) and non-compliance with physical activity guidelines (12% vs 18%, p=0.004). Differences in overweight/obesity (26% vs 31%, p=0.058), smoking (18% vs 22%, p=0.091) and non-compliance with dietary guidelines (76% vs 77%, p=0.651) were non-significant but point estimates were in the expected direction. Estimated bias in prevalence of risk behaviours was an absolute difference of 1-4% and a relative difference of 0-21%. CONCLUSION: Respondents whose participation was hardest to elicit reported more risk behaviour. Assuming non-respondents' behaviour is similar or more extreme than that of late respondents, prevalence will have been substantially underestimated.

Identifying Maori ethnicity for estimating trends in fatal and serious non-fatal injury.

OBJECTIVES: Counts of mortality and morbidity based on routinely collected national datasets have undercounted Maori, the indigenous people of New Zealand. To correct for the undercount, when estimating fatal and serious non-fatal injury incidence, the 'ever-Maori' method has been used. This study sought to determine how well the ever-Maori method corrects for the undercount. METHODS: Trends in frequencies and age-standardised rates for fatal injury indicators were compared using: (a) ever-Maori classification; (b) New Zealand Census Mortality Study adjustment ratios applied to Total Maori counts from the Mortality Collection; and (c) Total Maori counts from the Mortality Collection. For serious non-fatal injury, trends using ever-Maori were compared with Total Maori from hospital discharge data. RESULTS: The absolute number of injuries attributable to Maori varied depending on the method used to adjust for ethnicity status, but trends over time were comparable. CONCLUSIONS AND IMPLICATIONS: At present, there is no optimal method for adjusting for the undercount of Maori in routinely collected health databases. Reassuringly, trends in fatal and serious non-fatal injury are similar across the methods of adjusting for the undercount.

Estimating person-based injury incidence: accuracy of an algorithm to identify readmissions from hospital discharge data.

BACKGROUND: Effective use of routinely collected hospital discharge data (HDD) to estimate injury incidence requires a separate identification of new injuries from readmissions for a previous injury. The aim was to determine the accuracy of a computerised algorithm to identify injury readmissions in HDD. METHODS: A random sample of 2000 events ('key events') were selected from the 2006 injury subset of New Zealand's HDD. Discharge histories from 1989 to 2007 were extracted for individuals and manually reviewed by at least two people to determine the 'gold standard' readmission status of each key event. The algorithm relies on four variables: unique national person identifier, dates of injury, admission and discharge. Reviewers were provided with these variables as well as additional discharge information (eg, discharge type and external cause code narrative) recorded in the HDD. Results of the manual review were compared to those obtained from the algorithm. RESULTS: The algorithm assigned 1811 (90.6%) as incident admissions compared to 1800 (90.0%) classified by the gold standard. Agreement was 97.9%, and accuracy measures (sensitivity, specificity, negative predictive value and positive predictive value) ranged from 87% to 99%. No statistically significant differences between readmission assignation by the algorithm and the gold standard were observed by age, nature of injury, external cause of injury or body region. CONCLUSIONS: Any country with electronic HDD could readily identify readmissions and, thus, accurately estimate injury incidence from HDD, providing that a unique person identifier and the date of injury were included in addition to the obligatory dates of admission and discharge.

Recruitment and retention of farm owners and workers for a six-month prospective injury study in New Zealand: a feasibility study.

BACKGROUND: Agricultural workers experience high rates of occupational injury. There is a lack of analytic studies which provide detailed occupational exposure information to inform intervention development. METHODS: A feasibility study simulating a six month prospective cohort study was designed and undertaken. The levels of farm and worker participation and retention were analysed to determine the feasibility of the methods for wider deployment. RESULTS: Recruitment levels were comparable with other studies, with 24% of farms and 36% of non-owner workers participating. Once recruited, retention was high at 85% and 86% respectively. CONCLUSIONS: The main challenges identified were in the recruitment process. Once recruited, farms and workers tended to complete the study, indicating that prospective studies in this the agricultural workforce may be feasible. Issues encountered and potential solutions for future studies are discussed.

The role of drinking locations in university student drinking: findings from a national web-based survey.

BACKGROUND: The study examined associations between type of drinking location and alcohol use in a national sample of New Zealand university students. METHODS: We conducted a cross-sectional web-based survey with random sampling of 17- to 24-year-old undergraduates from six university campuses in 2005. There were 2548 respondents (response fraction: 63%). Measures included the number of standard drinks (10 g ethanol) consumed on each day of the preceding week in pubs/bars/nightclubs, student flats/houses, residential halls, and 'other' locations (e.g., restaurants). We used multilevel regression to test for associations between type of drinking location and consumption per episode, adjusting for student- and episode-level covariates. RESULTS: Respondents consumed an average of 7.1 drinks (SD 5.2) per drinking day, including 5.4 drinks (SD 4.5) in pubs/bars/nightclubs, flats/houses, and residential halls, and 3.7 drinks (SD 3.4) in other locations. Overall, men drank more per location (mean 8.4, SD 6.3) than did women (mean 6.2, SD 4.0). Multilevel analyses revealed positive associations between the first three location types and drinks per episode relative to other locations when adjusting for student- and episode-level covariates including duration of episode. CONCLUSIONS: Certain drinking locations (i.e., pubs, residential halls, off-campus houses) appear to promote or facilitate heavy alcohol consumption among students. Better enforcement of laws prohibiting service to intoxication should be prioritized to reduce alcohol-related harm among university students. Consideration should be given to strengthening alcohol policies in residential halls and methods for managing heavy drinking in private residences.

Neighbourhood deprivation and access to alcohol outlets: a national study.

People living in poor areas suffer higher mortality than those in wealthy areas. Environmental factors partly explain this association, including exposure to pollutants and accessibility of healthcare. We sought to determine whether proximity to alcohol outlets varied by area deprivation in New Zealand. Roadway travel distance from each census unit to the nearest alcohol outlet was summarised according to socioeconomic deprivation for each area. Analyses were conducted by license type (pubs/bars, clubs, restaurants, off-licenses) and community urban-rural status. Strong associations were found between proximity to the nearest alcohol outlet and deprivation, there being greater access to outlets in more-deprived urban areas.

Randomized controlled trial of web-based alcohol screening and brief intervention in primary care.

BACKGROUND: There is compelling evidence supporting screening and brief intervention (SBI) for hazardous drinking, yet it remains underused in primary health care. Electronic (computer or Web-based) SBI (e-SBI) offers the prospects of ease and economy of access. We sought to determine whether e-SBI reduces hazardous drinking. METHODS: We conducted a randomized controlled trial in a university primary health care service. Participants were 975 students (age range, 17-29 years) screened using the Alcohol Use Disorders Identification Test (AUDIT). Of 599 students who scored in the hazardous or harmful range, 576 (300 of whom were women) consented to the trial and were randomized to receive an information pamphlet (control group), a Web-based motivational intervention (single-dose e-SBI group), or a Web-based motivational intervention with further interventions 1 and 6 months later (multidose e-SBI group). RESULTS: Relative to the control group, the single-dose e-SBI group at 6 months reported a lower frequency of drinking (rate ratio [RR], 0.79; 95% confidence interval [CI], 0.68-0.94), less total consumption (RR, 0.77; 95% CI, 0.63-0.95), and fewer academic problems (RR, 0.76; 95% CI, 0.64-0.91). At 12 months, statistically significant differences in total consumption (RR, 0.77; 95% CI, 0.63-0.95 [equivalent to 3.5 standard drinks per week]) and in academic problems (RR, 0.80; 95% CI, 0.66-0.97) remained, and the AUDIT scores were 2.17 (95% CI, -1.10 to -3.24) points lower. Relative to the control group, the multidose e-SBI group at 6 months reported a lower frequency of drinking (RR, 0.85; 95% CI, 0.73-0.98), less total consumption (RR, 0.79; 95% CI, 0.64-0.97 [equivalent to 3.0 standard drinks per week]), reduced episodic heavy drinking (RR, 0.65; 95% CI, 0.45-0.93), and fewer academic problems (RR, 0.78; 95% CI, 0.65-0.93). At 12 months, statistically significant differences in academic problems remained (RR, 0.75; 95% CI, 0.62-0.90), while the AUDIT scores were 2.02 (95% CI, -0.97 to -3.10) points lower. CONCLUSIONS: Single-dose e-SBI reduces hazardous drinking, and the effect lasts 12 months. Additional sessions seem not to enhance the effect. Trial Registration www.anzctr.org.au Identifier:ACTRN012607000103460.

Intoxication by drinking location: a web-based diary study in a New Zealand university community.

Drinking to intoxication is a modifiable risk factor for various health, social, and legal problems. The objective was to estimate the relative risk of intoxication by type of drinking location. Participants were 1614 university students (mean age 19.0 years) in residential halls who completed a web survey (67% response). Respondents reported their drinking for each day of the preceding week, in residential halls, pubs/bars/nightclubs, student flats/houses, and 'other' locations. An estimated blood alcohol concentration (EBAC) was computed and intoxication was defined as EBAC>0.08%. Pubs/bars/nightclubs accounted for 51% of all alcohol consumed, followed by residential halls (34%), student flats/houses (9%), and other locations (6%). Episodes resulting in intoxication comprised 61% of all drinking episodes in pubs/bars/nightclubs, 55% in student flats/houses, 53% in residential halls, and 37% in other locations. Multi-level analyses revealed positive associations between the first three location types (relative to 'other') and intoxication among women. Drinking in pubs/bars/nightclubs was associated with intoxication among men. Other significant predictors included hazardous drinking in the respondent's residential hall, pre-university drinking, and first-year status. Student intoxication is commonplace in licensed premises and residential halls. These environments are amenable to interventions to reduce the incidence of intoxication.

Quality of hospital discharge data for injury prevention.

OBJECTIVE: To examine the use of unspecified codes for the circumstances of injury for New Zealand public hospital discharges at a district health board (DHB) level. METHODS: Hospital injury discharges for the period 2000-3 were examined. The use of the International Classification of Diseases unspecified categories was examined for mechanism of injury, activity and place of occurrence. RESULTS: For all DHBs, the combined age-adjusted and mechanism-adjusted usage of unspecified mechanism codes was 7% and ranged from 3% to 11%. Most (57%) of these cases were unspecified falls. The comparable usage for activity was 39% and ranged from 17% to 52%, and for place of occurrence the respective figures were 23% and 7-36%. Only 50% of hospital discharges were completely specified in terms of mechanism of injury, activity and place of occurrence; this varied from 36% to 74% between DHBs. For several DHBs a significant degree of inconsistency was found in performance across mechanism, activity and place of occurrence coding. CONCLUSIONS: Those DHBs with a high proportion of cases coded as unspecified would serve the prevention efforts of their communities better by making efforts to determine the cause of this situation and implement measures to reduce the problem.

Assessment may conceal therapeutic benefit: findings from a randomized controlled trial for hazardous drinking.

CONTEXT: The concept that assessment of a person's health status without subsequent intervention has beneficial effects in itself has stimulated much interest in underlying psychological mechanisms, methodological implications and its public health potential. There have, however, been few experimental studies of assessment effects. AIM: To test the hypothesis that assessment in itself produces a reduction in hazardous drinking. DESIGN AND SETTING: Two conditions (group A, leaflet only and group B, leaflet and assessment but no intervention) of a four-arm randomized controlled trial with enrollment in March-April 2003. PARTICIPANTS: A total of 975 students (17-29 years) attending a primary health-care clinic completed a web-based Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Of 599 who scored >or= 8576 consented to follow-up and were included in the full four-arm trial, of whom 293 (153 women) were assigned to groups A and B. INTERVENTION: Group A received an information leaflet at baseline. Group B received the information leaflet and 10 minutes of web-based assessment 4 weeks later. MEASUREMENTS: Drinking frequency, typical quantity, heavy episode frequency, personal problems and academic problems. FINDINGS: Baseline mean AUDIT scores were 15.0 (SD = 5.4) and 14.9 (SD = 5.0) in groups A and B, respectively. Twelve months after baseline, relative to group A, group B reported lower overall consumption (geometric means ratio 0.82, 95% CI: 0.68-0.98), fewer heavy drinking episodes (0.66, 0.47-0.91), fewer problems (0.81, 0.67-0.99) and lower AUDIT scores (beta = -1.63, -0.62 to -2.65). CONCLUSIONS: Brief assessment appeared to reduce hazardous drinking. Controlled trials that rely on assessment may therefore underestimate treatment effects. Limitations include the possibility of measurement artefact due to social desirability bias.

Minimum purchasing age for alcohol and traffic crash injuries among 15- to 19-year-olds in New Zealand.

OBJECTIVES: In 1999, New Zealand lowered the minimum purchasing age for alcohol from 20 to 18 years. We tested the hypothesis that this increased traffic crash injuries among 15- to 19-year-olds. METHODS: Poisson regression was used to compute incidence rate ratios for the after to before incidence of alcohol-involved crashes and hospitalized injuries among 18- to 19-year-olds and 15- to 17-year-olds (20- to 24-year-olds were the reference). RESULTS: Among young men, the ratio of the alcohol-involved crash rate after the law change to the period before was 12% larger (95% confidence interval [CI]=1.00, 1.25) for 18- to 19-year-olds and 14% larger (95% CI=1.01, 1.30) for 15- to 17-year-olds, relative to 20- to 24-year-olds. Among young women, the equivalent ratios were 51% larger (95% CI=1.17, 1.94) for 18- to 19-year-olds and 24% larger (95% CI=0.96, 1.59) for 15- to 17-year-olds. A similar pattern was observed for hospitalized injuries. CONCLUSIONS: Significantly more alcohol-involved crashes occurred among 15-to 19-year-olds than would have occurred had the purchase age not been reduced to 18 years. The effect size for 18- to 19-year-olds is remarkable given the legal exceptions to the pre-1999 law and its poor enforcement.

Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial.

BACKGROUND: Strong evidence exists for the efficacy of screening and brief intervention for reducing hazardous drinking. However, problems have been highlighted with respect to its implementation in health-care systems, not least of which is a reluctance of some doctors to discuss alcohol proactively with their patients. AIMS: To determine the efficacy of a novel web-based screening and brief intervention (e-SBI) to reduce hazardous drinking. DESIGN: A double-blind randomized controlled trial. SETTING: A university student health service. PARTICIPANTS: A total of 167 students (17-26 years) were recruited in the reception area and completed a 3-minute web-based screen including the Alcohol Use Disorder Identification Test (AUDIT) questionnaire. Of these, 112 tested positive, and 104 (52 females) who consented to follow-up were included in the trial. MEASUREMENTS: Drinking frequency, typical occasion quantity, total volume, heavy episode frequency (females > 80 g ethanol, males > 120 g ethanol), number of personal problems, an academic problems score. INTERVENTION: Participants were randomized to 10-15 minutes of web-based assessment and personalized feedback on their drinking (intervention, n = 51) or to a leaflet-only control group (n = 53). FINDINGS: Mean baseline AUDIT scores for control and intervention groups were 16.6 (SD = 6.0) and 16.6 (SD = 5.7). At 6 weeks, participants receiving e-SBI reported significantly lower total consumption (geometric mean ratio = 0.74; 95% confidence interval: 0.56-0.96), lower heavy episode frequency (0.63; 0.42-0.92) and fewer personal problems (0.70; 0.54-0.91). At 6 months personal problems remained lower (0.76; 0.60-0.97), although consumption did not differ significantly. At 6 months, academic problems were lower in the intervention group relative to controls (0.72; 0.51-1.02). CONCLUSIONS: e-SBI reduced hazardous drinking among university students, to an extent similar to that found for practitioner-delivered brief interventions in the general population. e-SBI offers promise as a strategy to reduce alcohol-related harm in a way that is non-intrusive, appealing to the target group, and capable of being incorporated into primary care. Research is required to replicate the findings, to determine the duration of intervention effects, and to investigate the mechanisms by which the intervention operates.

Identifying predictors of persistent non-alcohol or drug-related risky driving behaviours among a cohort of young adults.

This study sought to identify adolescent risk factors that predicted persistent risky driving behaviours among young adults. It was part of a longitudinal study of a birth cohort (474 males and 459 females). The potential predictors were self-reported data obtained at ages 15, 18, 21 years (academic qualifications, personality, mental health, anti-social behaviour and driving behaviour). The risky driving behaviour outcomes were obtained at ages 21 and 26 years and included driving fast for thrills, taking deliberate risks for fun, excessive speed, dangerous overtaking, and close following (tailgating). Persistent risky drivers were defined as those who often, or fairly often engaged in a behaviour at both ages. A minority of males and very few females were classified as persistent risky drivers. Among the males, the factors that predicted at least one, or more of the outcomes were the personality trait of low constraint (i.e. low scores for control, harm avoidance, and traditionalism), aggressive behaviour, and cannabis dependence. These are characteristics to be borne in mind when developing programmes for young drivers that aim to deter the development of persistent risky driving behaviour.