Injury deaths of US citizens abroad: new data source, old travel problem.

BACKGROUND: Global travel continues to increase, including among US citizens. The global burden of injuries and violence, accounting for approximately 5 million deaths worldwide in 2000, is also growing. Travelers often experience heightened risk for this biosocial disease burden. This study seeks to further describe and improve our understanding of the variable risk of travel-related injury and death. METHODS: Information on US civilian citizen deaths from injury while abroad was obtained from the US Department of State Web site. This information was categorized into regional and causal groupings. The groupings were compared to each other and to injury deaths among citizens in their native countries. RESULTS: From 2004 to 2006, there were 2,361 deaths of US citizens overseas due to injury. Of these US citizen injury deaths, 50.4% occurred in the Americas region. Almost 40% (37.8%) of US citizen injury deaths in the low- to middle-income Americas were due to vehicle crashes compared to about half that (18.9%) (proportional mortality ratio [PMR] = 1.72, 95% confidence interval [CI] 1.59-1.62) for low- to middle-income Americas citizen injury deaths. Similar differences between US citizen injury death abroad and the in-country distributions were also found for vehicle crashes in Europe (35.9% vs 16.5%, PMR = 2.17, 95% CI 1.78-2.64; p < 0.0005), for drowning deaths in the Americas (13.1% vs 4.6%, PMR = 2.67, 95% CI 2.29-3.11) and many island nations (63.5% vs 3.5%, PMR = 11.38, 95% CI 8.17-15.84), and for homicides in the low- to middle-income European countries (16.9% vs 10.5%, PMR = 1.52, 95% CI .90-2.57). CONCLUSIONS: US citizens should be aware of regional variation of injury deaths in foreign countries, especially for motor vehicle crashes, drowning, and violence. Improved knowledge of regional variations of injury death and risk for travelers can further inform travelers and the development of evidence-based prevention programs and policies. The State Department Web site is a new data source that furthers our understanding of this challenging travel-related health issue.

Graduated driver licensing policy in the Great Lakes states: current benefits and future potential.

BACKGROUND: Motor vehicle crashes are the leading cause of teenage deaths in the United States. Graduated Driver Licensing (GDL) policies effectively decrease teenage crash deaths. Emerging research is identifying the most effective components of GDL. This study examines GDL policies across 6 Great Lakes states, describing the beneficial impact, and investigating how evidence-based policy modifications could further reduce teenage driving deaths and injuries. METHODS: GDL policies were reviewed in 6 Great Lakes states (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin). Incidence rate ratios for fatal and injury crashes for 16-year-old drivers were obtained from the Nationwide Review of GDL Study. Ratios were applied to the fatal and injury crashes reported from each state between 2002 and 2006 for 16-year-old drivers. The potential impact (crashes avoided) for each state was determined based on the state using a 3-phase GDL policy (a learner and intermediate stage prior to full licensure). In addition, the impact on crash reductions for each state if they had employed 5 of the recommended GDL components was determined. RESULTS: All 6 states had a 3-phase GDL policy, resulting in potential avoidance of 124 fatal and more than 21,000 injury crashes. The 6 states had 1 to 3 of the qualifying GDL components. If these states had adopted 5 of the qualifying components, an additional 309 fatal and more than 27,000 injury crashes could have been avoided. CONCLUSION: Three-phase GDL policy is effective at saving the lives of teenage drivers and vehicle occupants; evidence-based modification of GDL has the potential to further reduce teenage motor vehicle crash deaths and injuries.