Effect of potential oocyte transport protocols on blastocyst rates after intracytoplasmic sperm injection in the horse.

REASONS FOR PERFORMING STUDY: Intracytoplasmic sperm injection (ICSI) is used to produce foals from otherwise infertile mares and from stallions with limited sperm stores, but requires expensive equipment and is technically demanding. Methods to transport oocytes to ICSI laboratories would allow collection of oocytes by the referring veterinarian and enable greater application of this technique. OBJECTIVES: This study was conducted to evaluate protocols that could be used to transport immature and maturing oocytes for ICSI. STUDY DESIGN: In vitro experiment. METHODS: Oocytes were recovered by transvaginal ultrasound-guided follicular aspiration either from dominant follicles 24 h after deslorelin administration (dominant stimulated follicle [DSF]), or from subordinate (immature) follicles at the same time. To mimic transport, DSF oocytes were incubated overnight under differing conditions before ICSI; immature oocytes were placed in varying conditions overnight before in vitro maturation, followed by ICSI. The rate of blastocyst production was compared among treatments. RESULTS: Blastocysts were produced in all groups. Dominant stimulated follicle oocytes held in sealed tubes in pre-equilibrated control maturation medium maintained at 37°C yielded blastocyst development equal to that obtained for control incubated oocytes (70%). Dominant stimulated follicle oocytes held similarly in a warm passive device yielded poor blastocyst development (10%). Immature oocytes held for one or 2 nights in modified M199 medium, or for one night in commercial embryo holding solution, in air at room temperature, yielded 35-37% blastocyst development per injected oocyte. CONCLUSIONS: A commercially available medium can be used for shipping immature oocytes at room temperature with good resulting blastocyst rates. Better blastocyst rates per oocyte are obtained from DSF oocytes; however, these require maintenance at 37°C and as they are already maturing at the time of collection, are more sensitive to delays. This new, practical information supporting transport of both immature and DSF oocytes for ICSI may allow wider use of this procedure.

Drinking and recreational boating fatalities: a population-based case-control study.

CONTEXT: Alcohol is increasingly recognized as a factor in many boating fatalities, but the association between alcohol consumption and mortality among boaters has not been well quantified. OBJECTIVES: To determine the association of alcohol use with passengers' and operators' estimated relative risk (RR) of dying while boating. DESIGN, SETTING, AND PARTICIPANTS: Case-control study of recreational boating deaths among persons aged 18 years or older from 1990-1998 in Maryland and North Carolina (n = 221), compared with control interviews obtained from a multistage probability sample of boaters in each state from 1997-1999 (n = 3943). MAIN OUTCOME MEASURE: Estimated RR of fatality associated with different levels of blood alcohol concentration (BAC) among boaters. RESULTS: Compared with the referent of a BAC of 0, the estimated RR of death increased even with a BAC of 10 mg/dL (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4). The OR was 52.4 (95% CI, 25.9-106.1) at a BAC of 250 mg/dL. The estimated RR associated with alcohol use was similar for passengers and operators and did not vary by boat type or whether the boat was moving or stationary. CONCLUSIONS: Drinking increases the RR of dying while boating, which becomes apparent at low levels of BAC and increases as BAC increases. Prevention efforts targeted only at those operating a boat are ignoring many boaters at high risk. Countermeasures that reduce drinking by all boat occupants are therefore more likely to effectively reduce boating fatalities.

Initial effects of graduated driver licensing on 16-year-old driver crashes in North Carolina.

CONTEXT: Since 1997, 32 states have enacted graduated driver licensing (GDL) systems to reduce crash rates among young novice drivers. OBJECTIVE: To determine the initial effect of the North Carolina GDL system on crashes among 16-year-old drivers. DESIGN, SETTING, AND SUBJECTS: Comparison of population-based North Carolina motor vehicle crash rates before (1996-1997) and after (1999) 16-year-old drivers were licensed under the GDL system. To control for other factors that might have influenced crashes, changes for 16-year-old drivers were compared with those of drivers 25 to 54 years of age. Crashes per licensed driver were also examined. INTERVENTION: The North Carolina GDL system, enacted December 1, 1997, requires beginning drivers 15 to 17 years of age to hold level 1 licenses, allowing driving only while supervised by a designated adult for a full year; followed by level 2 licensure, allowing unsupervised driving from 5 AM to 9 PM and supervised driving at any time for at least 6 months; and, finally, level 3-a full, unrestricted license. MAIN OUTCOME MEASURES: Rates of motor vehicle crashes among 16-year-old drivers in 1996-1997 vs 1999, overall and by crash severity (fatal, injury, and noninjury), time (night vs day), type (single vs multiple vehicle), driver alcohol use, and driving environment (more vs less rural counties). RESULTS: Crash rates declined sharply for all levels of severity among 16-year-old drivers after the GDL program was implemented. Following GDL, 16-year-old driver crashes were substantially less likely. Comparing 1996 with 1999, fatal crashes declined 57%, from 5 to 2 per 10 000 population (rate ratio [RR], 0.43; 95% confidence interval [CI], 0.27-0.70); crashes with no or minor injuries decreased 23%, from 1068 to 826 per 10 000 (RR, 0.77; 95% CI, 0.75-0.80). Nighttime crashes were 43% less likely (156 vs 88 per 10 000; RR, 0.57; 95% CI, 0.52-0.61) and daytime crashes decreased by 20% (951 vs 764 per 10 000; RR, 0.80; 95% CI, 0.78-0.83). Single-vehicle crashes (245 vs 175; RR, 0.71; 95% CI, 0.67-0.76) declined somewhat more than multiple-vehicle crashes (866 vs 681; RR, 0.79; 95% CI, 0.76-0.81). CONCLUSION: In its initial years, the North Carolina GDL system produced substantial declines in 16-year-old driver crashes.

Evaluation of the effects of North Carolina's 0.08% BAC law.

This study was conducted to determine whether the lowered BAC limit for drivers in North Carolina resulted in fewer alcohol-related motor vehicle crashes. We used time-series analysis to examine several indicators of alcohol involvement in both injury and fatal crashes between 1991 and 1996. Data from NC crash files as well as the Fatality Analysis Reporting System (FARS) are used. We also examined several indicators used in previous research on lower BAC limits using a before-after design to compare North Carolina with 37 states that did not change their BAC limit for 24 months before and after the BAC limit was lowered. When controlling for the pre-existing downward trend in drinking driver crashes, along with other pertinent factors such as amount of travel and number of weekends per month, there was no evidence of either a significant shift or a change in the downward trend of alcohol-related crashes associated with the lowered BAC limit. In conclusion, although the lower BAC limit was actively enforced and a substantial proportion of drinkers were aware of the new BAC limit, the drinking-driving population in North Carolina, at the time the lower limit took effect in October 1993, was simply unresponsive to this change.

Use of protective equipment by in-line skaters: an observational study.

OBJECTIVE: To determine the extent of protective equipment use (that is, helmets, wrist guards, elbow pads, knee pads) in a representative sample of in-line skaters. SETTING: Fifteen municipalities throughout the province of British Columbia. METHOD: A province-wide observational survey was conducted in the summer of 1999. Skaters were observed at four types of sites (commuter, recreational, neighbourhood, general community) in 15 municipalities to provide a representative sample of in-line skaters. RESULTS: The observed use of protective equipment by the 877 in-line skaters was relatively low: wrist guards 25%, helmets 13%, elbow pads 14%, and knee pads 10%. CONCLUSION: Despite the availability of relatively inexpensive protective equipment, few in-line skaters take advantage of the opportunity to protect themselves from injury. Policies and programs that serve to increase the use of protective equipment by in-line skaters are needed to help reduce the frequency of skating related injuries.

Merkel cell carcinoma arising in the head and neck: optimizing therapy.

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine dermal neoplasm. Because of the limited number of cases described in the literature (approximately 600 to date), statistically significant data regarding treatment are difficult to obtain. The majority of MCC cases affect the head and neck and are thought to be caused by the actinic damage associated with sun exposure. This study evaluates cases of head and neck MCC at Naval Medical Center San Diego (NMCSD) and compares the treatment regimens and outcomes from multiple institutions. This study is a retrospective outcomes analysis of all cases of head and neck MCC seen at NMCSD, between January 1, 1988 and June 30, 1998. The records of the NMCSD Tumor Registry were searched for patients with that diagnosis, and supplemental information was retrieved from the Radiation Oncology and Head & Neck Surgery Clinic charts. Eight of nine patients in this study were treated with either wide-local excision or Mohs microsurgery. The surgical margins were free of disease in all eight patients. One patient presented with distant metastatic disease, and two others were subsequently found to have nodal involvement. Subsequent therapy varied among the patients. Survey of the available literature revealed inconsistency in terms of which treatment regimens are optimal. Tumor resections are recommended by most groups to include a 2-cm to 3-cm tumor-free margin around the primary lesion when possible, but this is often difficult to achieve in the head and neck. Data, which do not reach statistical significance, suggest improved outcomes with tumor-free margins. Treatment of the regional draining lymph nodes is also recommended in most series. Prophylactic lymph node dissection or radiation therapy to the nodal chain may decrease local recurrence but does not consistently affect overall survival. Adjuvant chemotherapy is advocated by most groups in the treatment of metastatic disease because MCC is pathologically similar to small-cell lung carcinoma. However, no chemotherapy protocol has been shown to improve survival. Head and neck MCC is a rare and aggressive dermal tumor of neuroendocrine origin that requires multimodality therapy, including surgery, radiation therapy, and possibly adjuvant chemotherapy. Multiinstitutional studies are crucial to obtain sufficiently large populations to investigate and optimize therapy in this disease.

Alcohol and motor vehicle-related deaths of children as passengers, pedestrians, and bicyclists.

CONTEXT: The overall percentage of motor vehicle deaths associated with alcohol consumption declined between 1991 and 1996, but the risk of death due to alcohol-related crashes for children warrants analysis. OBJECTIVE: To examine the association between alcohol use by drivers and mortality of children who were passengers, pedestrians, and bicyclists. DESIGN AND SETTING: Analysis of data from the Fatality Analysis Reporting System, a nationwide US registry of motor vehicle deaths, for 1991-1996. SUBJECTS: A total of 16,676 children younger than 16 years who were passengers, pedestrians, or bicyclists and whose death was due to a motor vehicle crash. MAIN OUTCOME MEASURE: Alcohol use by drivers involved in crashes in which children died, assessed by age and sex of the child and driver and type of crash. RESULTS: A total of 3310 deaths (19.9%) involved alcohol-related crashes. The percentage declined from 21.6% in 1991 to 17.8% in 1996. Considering only crashes in which the alcohol-use status of the child's driver was relevant, the decline was less marked, from 18.8% in 1991 to 15.1% in 1995, with an increase to 16.4% in 1996. Among crashes involving alcohol, the child's own driver had been drinking in 66.3% of cases, varying from 58.0% to 70.7% over time. Drivers younger than the legal drinking age of 21 years who had been drinking alcohol accounted for 30.3% of alcohol-related passenger deaths among children. CONCLUSION: While the overall percentage of alcohol-related motor vehicle deaths for children declined between 1991 and 1996, experiences for passengers, pedestrians, and bicyclists differ. Selected characteristics of children and drivers that elevate the risk of an alcohol-related motor vehicle death point to the need for further policy and clinical interventions.

Tonsillectomy in diagnosis of the unknown primary tumor of the head and neck.

OBJECTIVES: The purpose of this study was to discuss the experience of one tumor registry with performing tonsillectomy in the diagnostic approach to unknown head and neck primary tumors. It also describes the importance of including tonsillectomy in this evaluation algorithm. STUDY DESIGN: A retrospective chart review was done of 68 patients with either tonsillar or unknown primary squamous cell carcinoma culled from 829 patients seen from 1956 to 1996 at the head and neck tumor registry at the Naval Medical Center San Diego. METHODS: Records from the head and neck tumor registry, radiation oncology service, and pathology department were reviewed with attention to presenting symptom, initial examination, diagnostic studies performed, and type and result of biopsies performed. RESULTS: Thirty-four patients sought treatment for a neck lymph node metastasis of squamous cell carcinoma without an identifiable primary tumor site. Six of these (18%) had the primary site diagnosed by performing tonsillectomy ipsilateral to the presenting neck mass. Six of 14 T1 tonsillar carcinomas in this series had the primary site identified by tonsillectomy. CONCLUSIONS: Despite a diligent search, a primary tumor site may not be found in the head and neck cancer patient. The tonsil may harbor an occult squamous cell carcinoma. The patient benefits from identification of the initial tumor site because postoperative irradiation ports may be reduced and because surveillance for recurrence may be improved. For these reasons, tonsillectomy should be performed ipsilateral to the presenting cervical metastasis if no other primary tumor site is identified.

Myofibromas and myofibromatosis of the oral region: A clinicopathologic analysis of 79 cases.

The clinicopathologic features of 79 myofibromas or myofibromatoses of the oral and maxillofacial region were studied. The case studies were taken from the files of the Armed Forces Institute of Pathology. The tumors affected 44 males and 33 females (gender was unknown in 2 cases). The patients' ages at diagnosis ranged from birth to 84 years, with mean and median ages of 26.6 and 22 years, respectively. Four patients had infantile myofibromatosis; 2 had extraoral bone lesions and 2 had multiple subcutaneous tumors. In descending order, tumors involved the mandible, tongue, lips, cheek or buccal area, maxilla or palate, pterygomandibular raphae, floor of mouth, and submandibular gland. One third of the tumors affected the bones of the jaws; 12 were central and 15 were cortical or periosteal. All medullary tumors occurred in patients under age 18. On gross examination, the lesions were firm, homogeneous or whorled, white-grey fibrous masses that ranged in size from 0.5 to 5.0 cm. Microscopically, all tumors demonstrated a pattern of nodules or bundles of spindle cells separated by areas of greater cellularity and crescent-shaped vascular spaces. Distinct hemangiopericytoma-like areas were present in 22 cases. Despite apparent circumscription, the tumors commonly infiltrated and entrapped adjacent muscle, nerve, or salivary tissue. Immunohistochemically, 37 of 37 and 39 of 39 tumors stained positively for alpha-smooth muscle actin and muscle-specific actin, respectively, with the former eliciting a more intense reaction. Eight of 8 tumors were weakly positive for CD68, and one case stained focally with S-100 protein. No desmin staining was present in 36 tumors examined. Diagnostic interpretations by the pathologists seeking consultation were malignant or aggressive tumors in 31 cases and other benign conditions in 26. Nine were interpreted as myofibromatosis and 13 offered no interpretation. Thirty-two patients were alive and free of tumor an average of 42 months after initial diagnosis. Four patients had one recurrence each, and 2 had lesions recur twice. Myofibromas are relatively common soft tissue tumors of the maxillofacial region, which have been misinterpreted as malignant or aggressive lesions.

Effectiveness of graduated driver licensing in reducing motor vehicle crashes.

OBJECTIVE: To determine whether graduated driver licensing (GDL) systems and nighttime curfews reduce motor vehicle crashes, fatalities, or injuries among young drivers. METHODS: We used Cochrane Collaboration search strategies to locate studies of graduated licensing or night driving restrictions. Studies were selected if they examined the effects of either (1) a comprehensive graduated driver licensing system including well-integrated components, or (2) nighttime driving restrictions/curfews that could affect young persons' nighttime driving, on a clearly defined crash or injury outcome. Seven studies met inclusion criteria. RESULTS: Two independent studies of the New Zealand graduated licensing program found a sustained 7%-8% reduction in teen driver crash injuries attributable to the program. No other full graduated licensing system has been evaluated to date. Four studies of either a general curfew or a nighttime driving restriction for teens, a key element of graduated licensing, found substantial crash reductions during restricted hours, with 23%-25% lower crash injury and fatality rates for curfews beginning prior to midnight. One study found no change in late night crashes before and after a 1 a.m.-6 a.m. night driving restriction took effect. CONCLUSIONS: The logic and empirical bases for graduated licensing are sound. Moreover, there is evidence that one central element, a restriction on nighttime driving by novices, reduces young driver crashes. However, a definitive conclusion about the effectiveness of GDL systems for reducing motor vehicle crashes or crash-related injuries must await examination of other GDL systems. This should be possible within the next few years, as several states and Canadian provinces have recently enacted GDL programs.

Sutureless cartilage graft laryngotracheal reconstruction using fibrin sealant.

OBJECTIVE: To determine whether fibrin sealant can replace suture as a means of holding a cartilage graft securely in the trachea. DESIGN: Randomized blinded control study comparing the use of fibrin sealant vs sutures in laryngotracheal reconstruction in ferrets. We compared results at 7 and 30 days. SUBJECTS: Forty ferrets randomized into 2 groups of 20: fibrin sealant and sutures. Within each group, half were studied at 7 days and the rest at 30 days. No ferrets were withdrawn from study because of adverse effects of the intervention. INTERVENTION: A carved costal cartilage graft was placed in the anterior cricoid split incision, and was secured with either fibrin sealant or sutures. All animals were extubated after recovery from anesthesia. Specimens were examined grossly and histologically. RESULTS: All animals survived until humanely killed. The pathologist, unaware of the groupings, measured lumen expansion in millimeters, cartilage graft migration, mucosal in-growth, degree of inflammation, graft integration, and graft viability. The fibrin sealant group had statistically significant (P<.05) better results in mucosal in-growth. In no categories was the suture group better than the fibrin sealant group. In comparing 7-day with 30-day results, the 30-day group had significantly better results in inflammation and graft viability. CONCLUSIONS: Fibrin sealant can be used in place of sutures with improvement in mucosal growth in costal cartilage laryngotracheal reconstruction in the experimental animal model. Use of fibrin sealant (instead of sutures) may result in less surgical trauma and edema, less surgical time, and faster recovery.

Hepatic undifferentiated (embryonal) sarcoma arising in a mesenchymal hamartoma.

We report the case of a hepatic undifferentiated (embryonal) sarcoma (UES) arising within a mesenchymal hamartoma (MH) in a 15-year-old girl. Mapping of the tumor demonstrated a typical MH transforming gradually into a UES composed of anaplastic stromal cells. When evaluated by flow cytometry, the MH was diploid and the UES showed a prominent aneuploid peak. Karyotypic analysis of the UES showed structural alterations of chromosome 19, which have been implicated as a potential genetic marker of MH. The histogenesis of MH and UES is still debated, and reports of a relationship between them, although suggested on the basis of histomorphologic similarities, have never been convincing. The histologic, flow cytometric, and cytogenetic evidence reported herein suggests a link between these two hepatic tumors of the pediatric population.

Drinking drivers missed at sobriety checkpoints.

OBJECTIVE: Sobriety checkpoints are an effective deterrent to alcohol-impaired driving although a substantial proportion of drinking drivers who pass through checkpoints are missed. The present study was designed to determine the extent to which police officers correctly identify individuals with blood alcohol concentrations (BACs) at or above 0.05% at checkpoints, and if there are characteristics of drivers, vehicles or checkpoints that are associated with decreased chances of detection. METHOD: To determine which drivers are likely to be missed, drivers not detained by police for additional sobriety evaluation were interviewed and voluntary breath samples were provided at 156 sobriety checkpoints in North Carolina. RESULTS: More than 50% of the drivers with BACs in excess of 0.08% and almost 90% of drivers with BACs in excess of 0.05% were not detained by officers. For drivers with BACs of 0.05% or higher, women and those 35 or younger were more likely to be missed than were men and older drivers. Drivers without passengers were more likely to be missed than those with passengers. Drivers were also more likely to be missed during weekend checkpoints. Similar results were found for drivers with BACs at or above 0.08%. CONCLUSIONS: Alerting police officers to characteristics of drinking drivers more likely to be missed may improve detection rates. In addition, passive alcohol sensors could improve the effectiveness and efficiency of sobriety checkpoints in detecting drinking drivers.

Salivary gland cystadenocarcinomas. A clinicopathologic study of 57 cases.

Current classification schemes for salivary gland neoplasms categorize cystadenocarcinomas on the basis of a recurring histomorphologic pattern of cystic, and often, papillary growth without features of other specific types of salivary gland tumors. To ascertain the clinicomorphologic spectrum and biologic behavior of this tumor, the clinicopathologic features of 57 cystadenocarcinomas from the files of the Armed Forces Institute of Pathology were studied. Excluding five Veterans Administration military cases, men and women were equally affected. Patients ranged in age from 20 to 86 years (mean, 58.8; median, 64), and patients aged over 50 years accounted for 71% of cases. Thirty-seven tumors (65%) occurred in major salivary glands, 35 in the parotid, and two in the sublingual glands. The 20 minor salivary gland tumors (35%) involved, in descending order, the lips, buccal mucosa, palate, tongue, retromolar area, and floor of mouth. Grossly, the lesions were cystic or multicystic masses that ranged in size from 0.4 to 6.0 cm. Microscopically, all tumors demonstrated an invasive, cystic growth pattern, and 75% had a conspicuous papillary component. The predominant cell type varied among tumors and included small cuboidal cells (35 cases), large cuboidal cells (nine cases), and tall columnar cells (seven cases). Six cases exhibited an admixture of cell types. Ruptured cysts with hemorrhage and granulation tissue were common. All 40 patients with follow-up data were either alive or had died of other causes and were free of tumor a mean interval of 59 months after their initial surgery. Three tumors recurred locally (mean interval, 76 months). Three tumors were metastatic to regional lymph nodes at the time of diagnosis, and one patient developed a regional lymph node metastasis after 55 months. Salivary gland cystadenocarcinomas represent a distinct group of malignancies that have an indolent biologic behavior.

Sclerosing polycystic adenosis of major salivary glands. A clinicopathologic analysis of nine cases.

We describe nine cases of a histologically distinct and previously unreported lesion of the major salivary glands. The patients ranged in age from 12 to 63 years and included four males, five females. The lesions were slow-growing masses in the parotid gland (eight cases) and submandibular gland (one case). The clinical impression in each case was a benign salivary gland tumor. Grossly, the lesions were discrete, pale, rubbery nodules embedded within the salivary gland parenchyma. Microscopically, the lesions were unencapsulated, circumscribed masses of sclerotic and hyalinized collagenous tissue. Irregularly distributed throughout the collagenous tissue in a vaguely lobular pattern were hyperplastic ductal and acinar elements that were usually accompanied by cystically ectatic ducts. The dilated ducts frequently showed apocrine-like metaplasia and epithelial hyperplasia, which often formed transluminal bridges in a cribriform pattern. This epithelial hyperplasia sometimes surrounded eosinophilic globules as seen in so-called collagenous spherulosis. The combination of fibrosis, epithelial hyperplasia, and cystic changes were reminiscent of fibrocystic changes of the breast. Focally, acinar elements contained large, intensely eosinophilic, periodic acid-Schiff's-positive, intracytoplasmic granules believed to represent altered zymogen granules. A sparse to focally intense lymphocytic infiltrate accompanied the epithelial proliferations. Previous interpretations of these masses have included mucoepidermoid carcinoma, low-grade adenocarcinoma, benign adenoma, and mixed tumor. The limited available follow-up suggests that this process has a favorable prognosis despite recurrences in two cases. It is postulated that these lesions represent a pseudoneoplastic condition that results in both fibrosis and epithelial proliferation. We suggest the term sclerosing polycystic adenosis for these rare lesions.

Estrogen and progesterone receptors in salivary gland adenoid cystic carcinoma.

Adenoid cystic carcinomas of salivary glands occur more frequently in women and bear remarkable similarity to adenoid cystic carcinomas of the breast. In addition, breast carcinomas express estrogen and progesterone receptors that impact prognostic significance. This suggests a possible role for sex steroid hormones in the development and progression of salivary gland adenoid cystic carcinoma. On this basis, 12 samples of formalin-fixed, paraffin-embedded salivary gland adenoid cystic carcinomas and 12 samples of normal salivary gland tissue were immunohistochemically evaluated for estrogen and progesterone receptor protein expression. Estrogen receptors were not detected in either group; however, a significantly higher progesterone receptor level was evident in the neoplastic group compared with normal tissue (p < 0.01). These data confirm the presence of progesterone receptors within normal and neoplastic salivary gland tissue. Progesterone receptor expression may be of possible prognostic and therapeutic value in some cases of adenoid cystic carcinoma.

Seat belt use among drinking drivers in Minnesota.

OBJECTIVES: Among the reasons cited for recent declines in alcohol-related traffic fatalities is the enactment of seat belt use laws by most states. It is suspected that drinking drivers are less likely to comply with such laws, although evidence on the relationship between belt use and drinking by drivers is sparse and conflicting. The purpose of this study was to examine the relationship of drinking to driver seat belt use. METHODS: Observational, self-report, and chemical breath test data were collected on nighttime drivers in 16 Minnesota communities during September, 1990. RESULTS: Drivers with an illegal blood alcohol concentration (> or = 100 mg/dL) were substantially less likely to be wearing a seat belt (odds ratio [OR] = 2.17). Belt use was also more common among females (OR = 2.02) and before midnight (OR = 1.47). Males who had been drinking were less likely to be belted. Belt use was related to drinking before, but not after, midnight. Belt use was not related to drinking status among college graduates, but it was strongly related to drinking status among those with less education. CONCLUSIONS: The present findings provide further argument for rapid implementation of passive countermeasures (airbags) and for development of creative, carefully focused interventions to target high-risk populations.