Child and family safety device affordability by country income level: an 18 country comparison.

OBJECTIVE: To compare availability, urban price, and affordability of child/family safety devices between 18 economically diverse countries. DESIGN: Descriptive: urban price surveys by local safety organisations or shoppers. SETTING: Retail stores and internet vendors. MAIN OUTCOME MEASURES: Prices expressed in US dollars, and affordability measured by hours of factory work needed to buy a child safety seat, a belt-positioning booster seat, a child bicycle helmet, and a smoke alarm. RESULTS: Prices of child and family safety devices varied widely between countries but the variation for child safety seats and bicycle helmets did not relate strongly to country income. Safety devices were expensive, often prohibitively so, in lower income countries. Far more hours of factory work were required to earn a child safety device in lower income than middle income, and middle income than higher income, countries. A bicycle helmet, for example, cost 10 hours of factory work in lower income countries but less than an hour in higher income countries. Smoke alarms and booster seats were not available in many lower income countries. CONCLUSIONS: Bicycles and two-axle motor vehicles were numerous in lower and middle income countries, but corresponding child safety devices were often unaffordable and sometimes not readily available. The apparent market distortions and their causes merit investigation. Advocacy, social marketing, local device production, lowering of tariffs, and mandatory use legislation might stimulate market growth. Arguably, a moral obligation exists to offer subsidies that give all children a fair chance of surviving to adulthood.

Suicide acts in 8 states: incidence and case fatality rates by demographics and method.

OBJECTIVES: This study examined incidence rates of medically identified suicide acts (self-inflicted injuries, either fatal or nonfatal) and case fatality rates by age, sex, race, and method used. METHODS: The authors analyzed data on 10,892 suicides and 57,439 attempted suicides among hospital-admitted individuals in 8 states, along with 6219 attempted suicides among individuals released from emergency departments in 2 states. RESULTS: The 8 states experienced a mean of 11 suicides and 119 attempted suicides per 100,000 residents each year. Groups with high suicide rates were men, the elderly, and Whites; groups with high attempted suicide rates were teenagers, young adults, women, and Blacks and Whites aged 25 to 44 years. Blacks aged 15 to 44 years evidenced high attempted suicide rates undocumented in previous studies. Poisoning and firearm were the most common methods used among those attempting suicide and those completing suicide acts, respectively. The most lethal method was firearm. CONCLUSIONS: The characteristics of suicides and attempted suicides differ dramatically. Method used is important in the lethality of the act.

The cost of childhood unintentional injuries and the value of prevention.

Cost data are useful in comparing various health problems, assessing risks, setting research priorities, and selecting interventions that most efficiently reduce health burdens. Using analyses of national and state data sets, this article presents data on the frequency, costs, and quality-of-life losses associated with unintentional childhood injuries in 1996. The frequency, severity, potential for death and disability, and costs of unintentional injury make it a leading childhood health problem. Unintentional childhood injuries in 1996 resulted in an estimated $14 billion in lifetime medical spending, $1 billion in other resource costs, and $66 billion in present and future work losses. These injuries imposed quality-of-life losses equivalent to 92,400 child deaths. Since Medicaid and other government sources paid for 39% of the days children spent in hospitals due to unintentional injuries, the government has a financial interest in, and arguably a responsibility for, assuring the safety of disadvantaged children. Federal agencies, however, devote relatively few public dollars to injury prevention research and programming. Several proven child safety interventions cost less than the medical and other resource costs they save. Thus, governments, managed care companies, and third-party payers could save money by encouraging the routine use of selected child safety measures such as child safety seats, bicycle helmets, and smoke detectors. Yet, these and other proven injury prevention interventions are not universally implemented.

Incidence and costs of 1987-1994 childhood injuries: demographic breakdowns.

OBJECTIVES: Injuries pose a threat to health and well-being and are a major source of medical spending in the United States for children and youth 0 to 21 years of age. This study provides national estimates of the incidence of fatal and nonfatal childhood injuries and comprehensive cost estimates by age, gender, race, family income, metropolitan residence, and place of incident. METHODS: Eight years of National Health Interview Survey data (1987 to 1994) were used to estimate nonfatal injury incidence rates among children and youth 21 years of age and younger. The survey documents all medically attended or temporarily disabling injuries within the 2 weeks before the interview. Injuries were defined as diagnoses 800-995 in the International Classification of Diseases, Ninth Revision, excluding late effects cases. Fatality counts came from 1994 Vital Statistics. Estimates of the costs of injuries (1994 US dollars) included medical spending, lost future work, and lost quality of life. Medical payments included spending on hospital and professional services, rehabilitation, prescriptions, home health care, and medical equipment. Lost future work and lost quality of life consisted of the present value of work that children will be unable to do as adults if they are killed or permanently disabled combined with the pain and suffering that children and their families experience because of the injury. Cost estimates excluded parental income losses from work missed, property damage, legal costs, and insurance claims-adjustment costs related to permanent disability and death. RESULTS: INCIDENCE. A total of 3,073 injury episodes for 3,058 children were obtained from 8 years of National Health Interview Survey data. This represents 20.6 million children in the United States who were injured each year, or approximately 25 per 100 children. This translates to 56,000 nonfatal injury episodes each day that require medical attention or limit children's activity. For fatal injuries, the rate was 38 children per 100,000. The nonfatal injury rate for males (mean: 30; 95% confidence interval [CI]: 29,31) was higher than the rate for females (mean: 20; 95% CI: 19,21); the fatal injury rate for males was more than twice that of females. Injury rates increased with age. Children 0 to 9 years of age had the lowest rate of nonfatal injury. Rates for nonfatal injury among children 0 to 4 years of age were lower (mean: 20; 95% CI: 18,21) than those for the 5 to 9 age group (mean: 22; 95% CI: 20, 23). However, the rate for fatal injuries (21 per 100,000) among the 0 to 4 age group was higher than the 5 to 9 age group (9 per 100,000). Nonfatal injury rates for children 10 years of age and older were higher, with the highest estimated injury rates in late adolescence (15-19 years; mean: 31; 95% CI: 29,33). Nonfatal injuries occurred at higher rates among white children (mean: 27; 95% CI: 26,28) than black children (mean: 19; 95% CI: 17,21) or children from other racial backgrounds (mean: 13; 95% CI: 10,16). The reverse was true for fatal injuries, with higher fatality rates among black children (59 per 100,000). Children in families with incomes under $5,000 had the highest rate of nonfatal injury (mean: 31; 95% CI: 27,35), followed by those in the $35,000 to $49,999 income range (mean: 25; 95% CI: 23,27). The rate of nonfatal injuries in the other income brackets were fairly similar, with those in the highest income bracket having the lowest rate (mean: 14; 95% CI: 13,15). Fatality rates by family income were not available. The nonfatal injury rate in nonmetropolitan areas (mean: 10; 95% CI: 9,11) was higher than in metropolitan areas (mean: 8; 95% CI: 7,8); the same was true for fatal injury rates (33 per 100,000 in nonmetropolitan areas vs 25 in metropolitan areas). Males consistently had higher injury rates than females across all places of injury. Youth 15 years of age and older had higher rates for injuries that occur on the public roads, in recreatio

How intoxicated are drivers in the United States? Estimating the extent, risks and costs per kilometer of driving by blood alcohol level.

This study develops and applies an algorithm with international applicability for estimating vehicle kilometers (kms) driven by blood alcohol level (BAL) from police crash report data. In the United States, an estimated one in 120 kms was driven with BAL > or = 0.10% in 1992-1993. The ratio increased to 1 in 7 kms driven on weekend evenings. The estimated cost per vehicle km driven with BAL > or = 0.08% was $3.40 compared to $0.07 per sober km. Males, those age 21-29 and those driving between 22:00 and 04:00 had the greatest percentage of driving with BAL > or = 0.08%. These estimates are computed, in part, from early 1960s data on crash odds by driver BAL and assume crash odds by BAL relative to sober do not vary with driver age and sex. Preliminary investigation indicates that the method provides reliable estimates of alcohol-positive kms from roadside surveys at night, but seems to over-estimate high-BAL kms. Direct field validation is highly desirable.

Who is driving when unrestrained children and teenagers are hurt?

This paper examines driver characteristics in crashes where child and teenage motor vehicle crash victims were injured, in particular factors that determine whether or not the victim was restrained. Analyzing the data on children and teenagers who are injured revealed that the presence of a second adult in a vehicle increased the likelihood that these passengers were unrestrained. Other findings are more predictable: victim restraint use generally mirrored driver restraint use; a male driver, a young driver, a drinking driver, a speeding or reckless driver, an unlicenced or suspended driver, and a night-time trip each independently raised the odds that child and teenage passengers were not restrained when they were injured.

How safe are our schools?

OBJECTIVES: The goal of this study was to provide national estimates of the frequency and cost of school injuries. METHODS: Six years of National Health Interview Survey data were used to estimate nonfatal injury incidence rates, multiple sources were used to estimate fatalities, and national highway crash data were used to estimate school bus injury incidence. RESULTS: Each year, 3.7 million children suffer a substantial injury at school, resulting in an estimated $3.2 billion in medical spending and $115 billion in good health lost. Nonschool fatalities greatly exceed school fatalities; from an incidence per hour perspective, however, school hours are no safer than nonschool hours despite greater formal supervision. School bus injuries account for half of school injury deaths but less than 1% of total school injury costs. CONCLUSIONS: Nonfatal injury is a problem in schools. The concentration of injury at secondary schools suggests that interventions there may be most cost-effective. Data on school injury causes are greatly needed.

Highway crash costs in the United States by driver age, blood alcohol level, victim age, and restraint use.

This paper estimates 1993 U.S. highway crash incidence and costs by driver age, alcohol use, victim age, occupant status, and restraint use. Notable findings are: (1) crash costs of novice drivers are high enough to yield preliminary benefit-cost ratios around 4-8 for a provisional licensing system that restricts driving after midnight and 11 for zero alcohol tolerance for young drivers with violators receiving a 6-month suspension; (2) the costs to people other than the intoxicated driver per mile driven at BACs of 0.08-0.099% exceed the value of driver mobility; (3) the safety costs of drunk driving appear to exceed $5.80 per mile, compared with $2.50 per mile driven at BACs of 0.08-0.099%, and $0.11 per mile driven sober; (4) highway crashes cause an estimated 3.2% of U.S. medical spending, including more than 14% of medical spending for ages 15-24; (5) ignoring crash-involved occupants whose restraint use is unknown, the 13% of occupants who police reported were traveling unrestrained accounted for an estimated 42% of the crash costs; and (6) if these unrestrained occupants buckled up, the medical costs of crashes would decline by an estimated 18% (almost $4 billion annually) and the comprehensive costs by 24%.