Dog bites: still a problem?

OBJECTIVE: To estimate the incidence of dog bites in the USA and compare it with similar estimates from 1994. DESIGN: Nationally representative cross-sectional, list-assisted, random-digit-dialed telephone survey conducted during 2001-2003. METHODS: Weighted estimates were generated from data collected by surveying 9684 households during 2001-2003 and compared with results from a similar survey conducted in 1994. Estimates for persons aged 15-17 years were extrapolated on the basis of rates for 10-14-year-olds. RESULTS: Whereas the incidence of dog bites among adults remained relatively unchanged, there was a significant (47%) decline in the incidence of dog bites among children compared with that observed in the 1994 survey, particularly among boys and among those aged 0-4 years. Between 2001 and 2003, an estimated 4 521 300 persons were bitten each year. Of these, 885 000 required medical attention (19%). Children were more likely than adults to receive medical attention for a dog bite. Among adults, bite rates decreased with increasing age. Among children and adults, having a dog in the household was associated with a significantly increased incidence of dog bites, with increasing incidence also related to increasing numbers of dogs. CONCLUSIONS: Dog bites continue to be a public health problem affecting 1.5% of the US population annually. Although comparison with similar data from 1994 suggests that bite rates for children are decreasing, there still appears to be a need for effective prevention programs.

Studying "exposure" to firearms: household ownership v access.

BACKGROUND: Firearm ownership has often been used to measure access to weapons. However, persons who own a firearm may not have access to it and conversely, persons who do not own a firearm may be able to access one quickly. OBJECTIVES: To examine whether using firearm ownership is a reasonable proxy for access by describing the demographic characteristics associated with ownership and access. METHODS: Data are from the 1994 Injury Control and Risk Survey, a national, random digit dial survey. Information about household firearm ownership and ready access to a loaded firearm were collected and weighted to provide national estimates. Adjusted odds ratios for three separate models were calculated using logistic regression. RESULTS: A total of 1353 (27.9%) respondents reported both having a firearm in the household and ready access to one. An additional 313 respondents (8.1%) reported having a firearm, but were not able to access these weapons. Another 421 respondents (7.2%) did not have a firearm in or around their home, yet reported being able to retrieve and fire one within 10 minutes. Based on the logistic regression findings, the demographic characteristics of this latter group are quite different from those who report ownership. Those who do not have a firearm, but report ready access to one, are more likely to be ethnic minorities, single, and living in attached homes. CONCLUSIONS: Asking only about the presence of a firearm in a household may miss some respondents with ready access to a loaded firearm. More importantly, those who do not own a firearm, but report ready access to one, appear to be qualitatively different from those who report ownership. Caution should be exercised when using measures of ownership as a proxy for access.

Attitudinal acceptance of intimate partner violence among U.S. adults.

Attitudinal acceptance of intimate partner violence (IPV) is an important correlate of violent behavior. This study examined acceptance of IPV using data collected from a nationally representative telephone survey of 5,238 adults. Multivariable logistic regression analyses were used to test for associations between sociodemographic characteristics, exposure to violence, question order, and acceptance of hitting a spouse or boyfriend/girlfriend under specific circumstances. Depending on the circumstance examined, acceptance of IPV was significantly higher among participants who were male and younger than 35; were non-White; were divorced, separated, or had never married; had not completed high school; had a low household income; or were victims of violence within the past 12 months. Participants were more accepting of women hitting men; they also were consistently more likely to report tolerance of IPV if they were asked first about women hitting men rather than men hitting women. Reports of IPV tolerance need to be interpreted within the context of the survey. Efforts to change IPV attitudes can be tailored to specific IPV circumstances and subgroups, and these efforts should emphasize that the use of physical violence is unacceptable to both genders.

Trends and subgroup differences in transportation-related injury risk and safety behaviors among high school students, 1991-1997.

PURPOSE: To examine national trends in transportation-related injury risk and safety behaviors among U.S. high school students. METHODS: To examine secular trends in riding with a driver who had been drinking, driving after drinking, and using seat belts, bicycle helmets, and motorcycle helmets, we used logistic regression to analyze data from national Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered, anonymous survey that uses a national probability sample of U.S. students in public and private schools from grades 9-12 (N = 55,734 for all years combined). RESULTS: The percentages of students who rode with a driver who had been drinking (36.6% in 1997), drove after drinking alcohol (16.9% in 1997), always wore seat belts (33.2% in 1997), and always wore a motorcycle helmet when riding a motorcycle (45.0% in 1997) remained stable between 1991 and 1997. From 1991 to 1997, the percentage of bicycle riders who always wore a helmet when bicycling showed a small but statistically significant increase (1.1% in 1991 to 3.8% in 1997), but helmet use remained low. CONCLUSION: Many young people place themselves at unnecessary risk for motor vehicle- and bicycle-related crash injuries and fatalities. Improved motor vehicle- and bicycle-related injury prevention strategies are needed that specifically target adolescents.

Measuring community bicycle helmet use among children.

Bicycling is a popular recreational activity and a principal mode of transportation for children in the United States, yet about 300 children die and 430,000 are injured annually. Wearing a bicycle helmet is an important countermeasure, since it reduces the risk of serious brain injury by up to 85%. The Centers for Disease Control and Prevention (CDC) have funded state health departments to conduct bicycle helmet programs, and their effectiveness has been evaluated by monitoring community bicycle helmet use. Although it would appear that measuring bicycle helmet use is easy, it is actually neither simple nor straightforward. The authors describe what they have learned about assessing helmet use and what methods have been most useful. They also detail several key practical decisions that define the current CDC position regarding helmet use assessment. Although important enough in their own right, the lessons learned in the CDC's bicycle helmet evaluation may serve as a model for evaluating other injury prevention and public health programs.

Breeds of dogs involved in fatal human attacks in the United States between 1979 and 1998.

OBJECTIVE: To summarize breeds of dogs involved in fatal human attacks during a 20-year period and to assess policy implications. ANIMALS: Dogs for which breed was reported involved in attacks on humans between 1979 and 1998 that resulted in human dog bite-related fatalities (DBRF). PROCEDURE: Data for human DBRF identified previously for the period of 1979 through 1996 were combined with human DBRF newly identified for 1997 and 1998. Human DBRF were identified by searching news accounts and by use of The Humane Society of the United States' registry databank. RESULTS: During 1997 and 1998, at least 27 people died of dog bite attacks (18 in 1997 and 9 in 1998). At least 25 breeds of dogs have been involved in 238 human DBRF during the past 20 years. Pit bull-type dogs and Rottweilers were involved in more than half of these deaths. Of 227 reports with relevant data, 55 (24%) human deaths involved unrestrained dogs off their owners' property, 133 (58%) involved unrestrained dogs on their owners' property, 38 (17%) involved restrained dogs on their owners' property, and 1 (< 1%) involved a restrained dog off its owner's property. CONCLUSIONS: Although fatal attacks on humans appear to be a breed-specific problem (pit bull-type dogs and Rottweilers), other breeds may bite and cause fatalities at higher rates. Because of difficulties inherent in determining a dog's breed with certainty, enforcement of breed-specific ordinances raises constitutional and practical issues. Fatal attacks represent a small proportion of dog bite injuries to humans and, therefore, should not be the primary factor driving public policy concerning dangerous dogs. Many practical alternatives to breed-specific ordinances exist and hold promise for prevention of dog bites.

Testing the impact attenuation of loose-fill playground surfaces.

OBJECTIVES: Our objective was to measure the impact attenuation performance of five types of loose-fill playground surfaces at a variety of drop heights, material depths, and conditions. METHODS: In a laboratory setting, an instrumented head form was dropped on varying depths of loose-fill materials at one foot height increments until critical deceleration values were exceeded. The effects of test box size, material temperature, and compression were also studied. RESULTS: Data suggest that a larger test box size influences test results. Uncompressed materials performed quite unexpectedly, that is, resilience did not necessarily increase with increasing depth of material and temperature did not have uniform effects. Compression before testing improved consistency of results. CONCLUSION: The current standard test procedure (ASTM F1292) appears problematic for loose-fill materials. Our results indicate that (1) shredded rubber was the best performer; (2) there was little difference between sand, wood fibers, and wood chips; and (3) pea gravel had the worst performance, making it a poor choice for playground surfacing.

Injury prevention practices as depicted in G-rated and PG-rated movies.

BACKGROUND: Previous studies on alcohol, tobacco, and violence suggest that children's behavior can be influenced by mass media; however, little is known about the effect of media on unintentional injuries, the leading cause of death among young persons in the United States. OBJECTIVE: To determine how injury prevention practices are depicted in G-rated (general audience) and PG-rated (parental guidance recommended) movies. DESIGN: Observational study. SETTING: The 25 movies with the highest domestic box-office grosses and a rating of G or PG for each year from 1995 through 1997. Movies that were predominantly animated or not set in the present day were excluded from analysis. SUBJECTS: Movie characters with speaking roles. MAIN OUTCOME MEASURES: Safety belt use by motor vehicle occupants, use of a crosswalk and looking both ways by pedestrians crossing a street, helmet use by bicyclists, personal flotation device use by boaters, and selected other injury prevention practices. RESULTS: Fifty nonanimated movies set in the present day were included in the study. A total of 753 person-scenes involving riding in a motor vehicle, crossing the street, bicycling, and boating were shown (median, 13.5 person-scenes per movie). Forty-two person-scenes (6%) involved falls or crashes, which resulted in 4 injuries and 2 deaths. Overall, 119 (27%) of 447 motor vehicle occupants wore safety belts, 20 (18%) of 109 pedestrians looked both ways before crossing the street and 25 (16%) of 160 used a crosswalk, 4 (6%) of 64 bicyclists wore helmets, and 14 (17%) of 82 boaters wore personal flotation devices. CONCLUSIONS: In scenes depicting everyday life in popular movies likely to be seen by children, characters were infrequently portrayed practicing recommended safe behaviors. The consequences of unsafe behaviors were rarely shown. The entertainment industry should improve its depiction of injury prevention practices in G-rated and PG-rated movies.

Nonfatal physical violence, United States, 1994.

OBJECTIVES: Most surveillance and research efforts focus on severe violence, especially on homicides. Because less extreme forms of violence may be precursors to more extreme forms, the authors analyzed data from a national survey to describe the extent of nonfatal physical violence in the US. METHODS: The authors generated weighted national estimates from responses to a random-digit-dialed telephone survey. Respondents were asked if they had been "hit, slapped, pushed, or kicked by another person or hit with an object or weapon" in the preceding 12 months. Respondents were also asked how many times such incidents had occurred and, for the last such episode, their relationship with the perpetrator, whether they had been injured, and, if so, whether they had sought medical treatment. RESULTS: The authors estimate that approximately 15 million people, or 8% of the US adult population, experienced nonfatal physical violence, as defined for this study, during a 12-month period. Male gender, the 18-24-year-old age group, never having been married, being out of work or a student, and heavy drinking were associated with a higher likelihood of being assaulted. An estimated 75% of assaults were by a known person and 26% by a stranger. Women were more likely than men to be assaulted by current or former intimate partners; men were more likely than women to be assaulted by strangers. An estimated 18% of incidents resulted in injuries, and an estimated 7% required medical attention. CONCLUSIONS: Nonfatal physical violence is fairly common in the US and may lead to more than one million medical encounters each year.

Alcohol-influenced recreational boat operation in the United States, 1994.

BACKGROUND: There were 783 recreational boating fatalities in the United States in 1994. One contributor to this toll is alcohol-influenced operation of boats. Our study objective was to determine the prevalence of alcohol-influenced motor boat operation, and describe its relationship to demographic factors and other risk behaviors. METHODS: In 1994, a randomly dialed national telephone survey contacted 5238 adult respondents who reported on their operation of motor boats, alcohol use, and other potential injury risk behaviors. Data were weighted to obtain national estimates and percentages. RESULTS: Of 597 respondents who operated a motor boat in 1994, 31% (206 respondents) reported doing so at least once while alcohol-influenced. Alcohol-influenced operation of a motor boat was significantly more likely among males, individuals between 25 and 34 years of age, and those with greater than a college education. Alcohol-influenced motor boat operation was also more common among those who drove motor vehicles while alcohol-influenced, and those who drove a motor vehicle without using a seat belt. CONCLUSIONS: To decrease alcohol-influenced boating, new strategies should be developed. Strategies used to decrease drinking and driving motor vehicles may prove adaptable to preventing alcohol-influenced boating. More effective means of monitoring alcohol-influenced boating is needed. Alcohol use by passengers on boats should not be overlooked as a problem.

A comparison of driver- and passenger-based estimates of alcohol-impaired driving.

INTRODUCTION: Persons who drive after drinking or ride with drinking drivers are at increased risk of motor vehicle crash. Although alcohol is involved in 40% of fatal motor vehicle crashes yearly, there exist few systems to monitor alcohol-impaired driving. In this study we compare driver- and passenger-based estimates of the prevalence of alcohol-impaired driving. DESIGN: A random-digit-dialing telephone survey of the United States. Participants were adults aged 18 or older who were English- or Spanish-speaking from 5238 households (response rate = 56.1%). RESULTS: From the 4603 respondents who reported driving in the preceding 30 days, we estimate that there were 126 million drinking-driving episodes in the United States in 1994. From the 4380 passengers in the preceding 30 days, we estimate 191 million episodes. Three percent of respondents self-reported as drinking drivers (4.8% of males and 1.3% of females) and 4.9% as passengers of drinking drivers. Drinking drivers were more likely to be passengers of drinking drivers (44% versus 4% of nondrinking drivers). Drinking drivers were also more than twice as likely to report drinking daily, and only one half as likely to report always wearing their safety belts. CONCLUSION: Passengers who report riding with a drinking driver may provide an important estimate of the prevalence of drinking driving. Passengers of drinking drivers represent a high-risk group that is not considered in most prevention efforts. Because being a passenger of a drinking driver is not illegal, it may be an easier topic for clinicians to broach than drinking and driving.

Incidence of suicidal ideation and behavior in the United States, 1994.

Completed suicides reflect only a portion of the impact of suicidal behavior; sublethal behaviors cause morbidity and can signal treatable problems such as depression. There is no national quantification of nonlethal suicidal behaviors. The present study used a random-digit-dialed telephone survey to estimate the 12-month incidence of suicidal ideation, planning, and attempts among U.S. adults. Of 5,238 respondents, 5.6% (representing about 10.5 million persons) reported suicidal ideation, 2.7% (about 2.7 million) made a specific suicide plan, and 0.7% (about 700,000) made a suicide attempt (estimate = 1.1 million attempts). Hence, suicidal behaviors are not uncommon and occur along a continuum ranging from ideation to completed suicides. Preventing nonlethal precursor behaviors may prevent deaths.

Injury among cavers: results of a preliminary national survey.

BACKGROUND: To estimate the frequency of and risk factors for caving-associated injuries. METHODS: A standardized questionnaire covering demographics, caving exposure, and injury history was distributed to all members of the National Speleological Society by inclusion in the monthly newsletter. RESULTS: Of 9,532 members sent a questionnaire, 301 responded (3.2%). Respondents had an average of 18 years of caving experience, and 37% had sustained one or more injuries while caving. Hypothermia was the most frequent injury, followed by fractures, animal bites, and concussions. The rate of injury was about 1 per 1,990 hours in a cave. Injury rates for females were about twice those of males; older persons and those with more than 5 years of caving experience seemed to have lower injury rates. CONCLUSIONS: Many caving injuries appear potentially preventable. Proper technique for safe climbing should be a part of exploration training. There is a need for proper belaying or rappelling for even short ascents or descents. Helmet use should be stressed, as should adequate protection from hypothermia.

Emerging infectious diseases: public health issues for the 21st century.

Infectious diseases are the third leading cause of death in the United States and the leading cause worldwide. As the new millennium approaches, the public health community must replenish capacity depleted during years of inadequate funding while simultaneously incorporating new technologies and planning for the longer term. Among the challenges facing the public health community is the need for coordinated, global, multisectoral approaches to preventing and controlling complex infectious disease problems.

Residential smoke alarms and fire escape plans.

OBJECTIVE: To estimate the proportion of U.S. homes with installed smoke alarms, smoke alarms on the same floor as occupants' bedrooms, and fire escape plans. METHODS: The authors analyzed data on smoke alarm use and fire escape planning from a 1994 stratified random telephone survey of 5238 U.S. households. RESULTS: Respondents from 91% of surveyed households reported the presence of at least one installed smoke alarm, and 94% of respondents reported having an alarm on the same level of the home as their sleeping area. The prevalence of installed smoke alarms varied by highest education level in the household and income level. Sixty percent of all households had designed or discussed a fire escape plan at least once; only 17% of these households had actually practiced one. CONCLUSIONS: Although overall use of smoke alarms was high, certain population subgroups were less likely to have smoke alarms or to have them installed on the same floor as bedrooms. Fire escape planning, another important safety measure, was somewhat less common, and very few respondents reported having practiced a fire escape plan with the members of their household.

Evaluation of three smoke detector promotion programs.

CONTEXT: Seventy percent of U.S. residential fire deaths occur in homes without a working smoke detector. To help prevent residential fire deaths, many programs have distributed or installed detectors in unprotected homes. Because persons receiving a detector may not install it and because detector batteries require annual replacement, the enduring effectiveness of these programs may be questioned. OBJECTIVE: We evaluated the long-term functional status of smoke detectors distributed to high-risk households in eight areas of Minnesota, Cherokee County (North Carolina), and Oklahoma City (Oklahoma). DESIGN: Cross-sectional. SETTING: Home visits were made to check the detectors that were distributed 3 to 4 years earlier. PARTICIPANTS: Randomly selected households from the three detector promotion programs. MAIN OUT-COME MEASURE: At least one working smoke detector. RESULTS: Participation rates ranged from 72% to 82%. The percentage of evaluation households with at least one working detector ranged from 58% in Oklahoma to 73% in North Carolina. In 76% of households with nonworking detectors, the batteries were either missing or disconnected. When batteries in nonworking detectors were replaced, 83% of the detectors regained function. CONCLUSIONS: Future programs should consider distributing detectors that do not require annual battery changes or find effective ways to ensure that batteries are routinely replaced. Programs should also provide each household with the number of detectors needed to meet the most current recommended standard of the National Fire Protection Agency. The evaluation's participation rates support the practicality of unannounced home visits to evaluate home injury prevention programs in high-risk groups.

Exposure to and compliance with pediatric injury prevention counseling--United States, 1994.

BACKGROUND: Because injuries are the leading cause of death in children, injury prevention counseling is recommended as part of routine pediatric care. Increasing such counseling is a national health objective. Estimating the proportion of US children who receive such counseling and assessing their compliance with safety recommendations may help improve counseling efforts. METHODS: Respondents to a 1994 random digit-dial telephone survey of the US population were asked about receipt of age-appropriate injury prevention counseling at a medical visit and related safety practices for a randomly selected child 0 to 14 years of age in the household (N = 1596). RESULTS: Receiving any injury prevention counseling was reported for 39.3% of children 0 to 14 years old who had a medical visit in the past year and was more common among children who were younger, lived in urban areas, and lived in poverty. In general, receiving counseling was associated with safer behaviors. Counseling about ipecac was reported for 17.2% of children 0 to 6 years old; having ipecac in the home was more likely for those counseled (73.4% vs 32.0%). Counseling about posting the poison control number was reported for 24.9% of children 0 to 6 years old; posting this number was more common among those counseled (79.3% vs 52.6%). Counseling about bicycle helmets was reported for 18.6% of children 5 to 14 years old; a report of always wearing a helmet was more common among those counseled (43.9% vs 19.1%). Counseling about car seats and safety belts was reported for 25.4% of children 0 to 14 years old; a report of always using occupant restraints was more common among those counseled (89.0% vs 78.2%). CONCLUSIONS: Injury prevention counseling is associated with reported preventive safety practices among US children, but a relatively small proportion of households with young children report receiving such counseling. Health care providers should increase efforts to provide injury prevention counseling. counseling, wounds and injuries, child, accident prevention.