Evaluation of the effectiveness of low blood alcohol concentration laws for younger drivers.

OBJECTIVE: This study aimed to determine whether low blood alcohol concentration (BAC) laws among younger drivers reduce motor vehicle injuries. SEARCH STRATEGIES: We used Cochrane Collaboration search strategies of electronic databases, reference lists of past studies and reviews, governmental agency publications, and direct contacts with experts in the field. SELECTION CRITERIA: Studies were included if they provided objectively measured data on an injury outcome and if they used an appropriate comparison group to assess the impact of the law. DATA COLLECTION AND ANALYSIS: Six studies met selection criteria. We abstracted information using standard data collection sheets. Since the studies all were of ecologic designs, we did not carry out any pooled analyses. MAIN RESULTS: All six studies showed a reduction in injuries or crashes after the implementation of the law, although, for three studies, these reductions were not statistically significant. This study with the smallest reduction in injuries was also the study with the least power. This study only had a power of 70% to detect a hypothetical 10% decline in serious injuries. Reductions in outcome in the other studies ranged from 11% to 33% with a cluster of parameter estimates just under 20%. One study evaluated laws with differing levels of BAC and found a dose-response effect. The greatest reduction (22%) was reported for nighttime, single vehicle fatalities in those states with zero BAC laws. In states with 0.02% BAC laws, the reduction averaged 17% and in states with 0.04 to 0.06% BAC laws, the reduction was only 7%. CONCLUSIONS: Despite the methodologic difficulties of ecologic studies, the six studies reviewed represent accumulating evidence in support of the effectiveness of these laws. The sum of the evidence is strengthened because similar results were found in different countries (Australia and the United States), using different laws (some aimed at younger drivers and others aimed at inexperienced drivers), using different outcome variables (fatalities, injuries, and crashes), and using different research methodologies (interrupted time series and pre- and post-studies). In addition, the largest U.S. study found that laws with lower BAC limits resulted in greater casualty reductions, analogous to a dose response effect.

The role of surveillance and evaluation research in the reduction of violence against workers.

BACKGROUND: Violence against workers is garnering increased attention as awareness grows of the toll violent events have on workers and work environments. METHODS: In this review, we summarize information about surveillance of violent events in the workplace and summarize evaluations of intervention programs to reduce such violence. We describe surveillance programs that nationally collect data, and we compare some data. We summarize two systematic studies of workplace violence-prevention programs: The first study examined evaluations of the Crime Prevention Through Environmental Design approach to prevention, and the second examined evaluations of behavioral and administrative interventions. RESULTS: Reliable national data sets of worker homicides exist, but case identification and coding problems have yet to be solved. Although the number of workplace homicides has decreased since the mid-1990s, much less is known about the incidence of nonfatal events. The role that prevention programs have played in reducing workplace homicide remains largely unknown because so few evaluations have been conducted. CONCLUSIONS: Information about effective methods to reduce violence against workers is needed. Research that evaluates existing prevention programs, especially efforts conducted in a collaborative manner, will be invaluable to shaping effective programs in the future.

Administrative and behavioral interventions for workplace violence prevention.

BACKGROUND: Violence in the workplace accounts for 1000 fatalities and over 20,000 nonfatal events annually in the United States. The occupations with the most fatalities are taxicab drivers, employees in retail establishments, and law enforcement officers. Environmental strategies as well as behavioral and administrative measures could be employed to address violence. METHODS: This paper reports a critical review of the published literature on administrative and behavioral interventions directed at addressing workplace violence. Searching 17 different databases, we identified 137 papers that described workplace violence intervention strategies. Papers were further categorized according to whether they provided empirical data about an intervention or merely suggested intervention ideas. Suggested interventions were categorized according to applicability to types of workplace violence and organized according to the Haddon Matrix. RESULTS: Forty-one reports suggested intervention strategies but provided no empirical data; nine reported results of intervention evaluations. All intervention studies were based in the health care industry and addressed violent encounters between workers and patients. Overall, the research designs employed were weak and the results inconclusive. None used experimental designs. CONCLUSIONS: The lack of rigorous research to assess administrative and behavioral measures to address workplace violence represents a significant gap. Intervention research needs to draw on appropriate theoretical and conceptual frameworks, address the multiple contexts in which violence occurs, and employ strong evaluation research designs, including attention to process, impact, and outcome measures.

Health risk factors and occupation among Iowa workers.

BACKGROUND: Health behaviors represent major risks for premature morbidity and mortality. This study aimed to establish whether health risks varied substantially across occupational groups. METHODS: We focused on the 2223 Iowa Behavioral Risk Factor Surveillance System (BRFSS) subjects who reported, in 1999, that they were currently working. RESULTS: Even after controlling for age and gender, we found significant associations between occupation and health risk factors. We found these associations among the different categories of health risk factors, including insurance/access, health conditions, preventive behaviors, and screening behaviors. CONCLUSIONS: The considerable differences in the prevalence of risk factors for chronic disease and injury across occupational groups in Iowa underscore the need for nationwide ongoing collection of occupational status in the BRFSS. These national data on the distribution of risk factors across occupations will support development of more targeted prevention interventions.

Risk factors for injury in rural Iowa: round one of the Keokuk County Rural Health Study.

BACKGROUND: Unintentional injuries represent a major cause of morbidity and mortality in rural communities. This study aimed to determine the distribution of injury risk factors in a rural Iowa community and to identify the rural subgroups at highest risk for injury. METHODS: We reported on 1583 participants, aged > or =25 years, from Round One of the Keokuk County Rural Health Study, a longitudinal panel study of a rural community. The self-reported data were collected during face-to-face interviews. RESULTS: Our data suggested that several risk factors for injury are not uniformly distributed among rural populations. Male farmers were significantly less likely to wear their seatbelts than townspeople or rural nonfarmers. However, farm women were as likely to wear seatbelts as other women. Both male and female farmers were more likely to use all-terrain vehicles than townspeople or rural nonfarmers. In contrast, townspeople were more likely to ride bicycles than either farmers or rural nonfarmers. Townspeople were less likely to have firearms in their homes than either farmers or rural nonfarmers. Farmers were most likely to have fired a gun in the last year. Male farmers aged <65 years were less than half as likely as other men the same age to report a history of alcohol abuse. Binge drinking was equally frequent among farmers, rural nonfarmers, and townspeople. CONCLUSIONS: These differences in risk behavior in a rural county suggest the possibility of targeting specific rural injury prevention interventions at those with the highest risk for dangerous behavior.

Injury-control education in six U.S. medical schools.

PURPOSE: To assess knowledge, attitudes, and formal instruction related to injury control among fourth-year medical students. Injury is the leading cause of death among Americans aged 1 to 44 years. METHOD: The authors conducted a cross-sectional survey of fourth-year students at six U.S. medical schools, four of which maintain federally funded injury prevention research centers. Main outcome measures included injury-related knowledge scores, three attitude measures, and self-reported exposures to injury prevention education. RESULTS: Six hundred and thirty-five fourth-year medical students (73% of those eligible) participated. The responding students were, on average, unable to correctly answer half of the questions testing injury-related knowledge. They rated medical problems more important and more preventable than injury problems, and they felt more comfortable asking their patients about risk factors for medical problems. These findings may be explained, in part, by the students' reported minimal exposure to injury control education in medical school. The students encountered the topic more frequently on rotations in pediatrics (84%), family medicine (73%), and preventive medicine (66%) than on rotations in emergency medicine (47%), internal medicine (41%), or obstetrics and gynecology (34%). Injury control was encountered least often on rotations in psychiatry (23%) and surgery (14%). CONCLUSIONS: These findings suggest that injury control is given limited coverage in the curricula of U.S. medical schools. As a result, students have little understanding of the principles and benefits of injury control.

Cigarette smoking at hire as a predictor of employment outcome.

We have reported that cigarette smoking at the time of hire is associated with elevated rates of accidents, injuries, absence, discipline, and firing among US postal workers. We followed this cohort of 2537 for a second year to assess whether these associations would change with time in a workplace with active smoking cessation programs. Smokers' elevated risks for accidents, injuries, and discipline decreased after the first year. Risk for involuntary turnover was slightly higher in the 2-year analysis. The elevation in the rate of absence for smokers remained comparable in both periods. Although it is possible that the decline in the relative risk of accidents, injuries, and discipline may reflect changes in smoking status, we were unable to obtain follow-up data on smoking status to test this hypothesis.

Injuries among construction workers in rural Iowa: emergency department surveillance.

Surveillance of all emergency department admissions for nine rural hospitals identified visits for injuries by 189 employed patients with construction occupations out of a total of 1843 injury visits of all employed patients with known occupations. The injury rate for construction workers was 20.28 injuries per 100 workers per year-more than 2.5 times that of all other employed people. The work-related injury rate was 7.63 per 100 construction workers, more than four times that of all other employed people. The injuries of construction workers seen in the emergency department were primarily open wounds, fractures and dislocations, and contusions, injuries similar to those of other workers. The percentage of work-related burns was higher in construction workers than for other workers, particularly because of burns to roofers and laborers from tar or hot fluids and flash burns from welding.

Occupational injuries among older workers with visual, auditory, and other impairments. A validation study.

This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.

Farm-related dermatoses in Iowa male farmers and wives of farmers: a cross-sectional analysis of the Iowa Farm Family Health and Hazard Surveillance Project.

Agricultural workers are exposed to a variety of hazards that increase their risk for dermatitis. Nevertheless, the prevalence, patterns, and risk factors for dermatitis have not been well characterized among farmers in the United States. We assessed the prevalence and risk factors for dermatitis among 382 male farmers and 256 wives of farmers in Iowa using a cross-sectional study design. From 1992 to 1994, we collected data on potential risk factors and dermatitis. The results showed that 9.6% of male farmers and 14.4% of wives of farmers reported dermatitis during the previous 12-month period. In multivariable models, a history of allergy (odds ratio [OR], 8.2; 95% confidence interval [CI], 2.0 to 33.3) was strongly associated with dermatitis among male farmers. Among wives of farmers, some college education (OR, 3.4; 95% CI, 1.1 to 9.9) and exposure to petroleum products (OR, 3.1; 95% CI, 1.3 to 7.0) were associated with dermatitis. These results can be used to form preventive efforts in controlling farmwork-related exposures.

Risk factors for work-related injury among male farmers in Iowa: a prospective cohort study.

Agriculture is one of the most hazardous occupations in the United States. We examined the work-related injury rate and risk factors among 290 Iowa male principal farm operators using a population-based, prospective study. Baseline data were collected between 1991 and 1994, and injury events were surveyed in the fall of 1995. Cumulative incidence of farmwork-related injury during the previous year was 10.5%. We found that depressive symptoms (odds ratio, 3.22; 95% confidence interval, 1.04 to 9.99) and the number of hours working with animals (odds ratio, 2.14; 95% confidence interval, 1.04 to 4.44) were associated with the incidence of farmwork-related injuries.

Risk for occupational low-back injury after lumbar laminectomy for degenerative disc disease.

Thirty-two Postal Service applicants who had undergone laminectomies were classified as low risk for back injury after preplacement examinations and were subsequently hired for employment. Each was compared with six control subjects, who were matched by age, gender, date of hire, and job classification. The odds ratios for occupational back injury with 95% confidence intervals were 5.9 (1.9-18.8) overall and 9.1 (1.5-73.8) for letter carriers. Of subjects, 25% were injured, compared with 6% of controls. The median elapsed time between surgery and hire was 5.9 years for injured subjects and 6.8 years for uninjured subjects. A rank sum test comparing the elapsed times of the two groups was not significant (P = 0.30). Postal workers are at increased risk for back injury after laminectomy. The risk does not appear to decrease with increased time since surgery.

A case-control study of risk factors for industrial low back injury. The utility of preplacement screening in defining high-risk groups.

Using a cohort of 8183 postal workers, this study assesses the efficacy of preplacement medical examinations in defining the risk of occupational low back injuries. From this cohort, 154 subjects with occupational low back injuries between 1983 and 1988 and 942 control subjects who did not have low back injuries were identified. A multivariate logistic regression shows that a history of prior disability, odds ratio 2.90 (95% confidence interval 1.88-4.48), and a heavy lifting job, odds ratio 1.91 (1.32-276) are associated with occupational low back injuries. However, a history of previous back injury on screening examination is not associated with subsequent occupational injury. The association between a history of disability and occupational low back injury has not been previously noted and warrants further research.

Self-reported postwar injuries among Gulf War veterans.

OBJECTIVE: From September 1995 to May 1996, the authors conducted a telephone survey of Iowa military personnel who had served in the regular military or activated National Guard or Reserve during the Gulf War period. To assess the association between military service in a combat zone and subsequent traumatic injury requiring medical consultation, the authors analyzed veterans' interview responses. METHODS: Using data from the larger survey, the authors compared rates of self-reported postwar injuries requiring medical consultation in a sample of Iowa Gulf War veterans to the rates in a sample of Iowa military personnel who served at the same time, but not in the Persian Gulf. RESULTS: Of 3695 veterans, 605 (16%) reported a traumatic injury in the previous three months requiring medical consultation. Self-reported injuries were associated with service in the Persian Gulf (odds ratio 1.26; 95% confidence interval 1.02, 1.55). CONCLUSION: This finding is consistent with the results of earlier studies of traumatic injury mortality rates among war veterans.

Depressive symptoms as a risk factor for unintentional injury: a cohort study in a rural county.

OBJECTIVE: The authors used data from a population based prospective cohort study to determine if depressive symptoms predicted incidence of unintentional injury. METHODS: The Keokuk County Rural Health Study, based in Iowa, is a prospective cohort study of health status that includes injury outcomes. Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale at the beginning of the study on 1493 participants. Quarterly follow up phone calls were made to measure injury incidence. RESULTS: 471 injuries were reported for an overall injury rate of 9.8 per 100 person-years. Crude injury rates were significantly higher for those with depressive symptoms (p = 0.0003). Those with depressive symptoms had a 41% increased risk for injury after controlling for antidepressant medication use, gender, prior injury, income, and sleepiness (RR = 1.41, 95% CI 1.10 to 1.80). Depressive symptoms remained a risk factor for injury regardless of current antidepressant medication use (no medication use, RR = 1.43, 95% CI 1.09 to 1.88; medication use, RR = 1.31, 95% CI 0.76 to 2.26). CONCLUSIONS: Depressive symptoms were found to be risk factors for unintentional injury. Medical practitioners should consider talking about safety with their patients, especially those reporting symptoms of depression, and recognize that an increased risk for injury remains until the depressive symptoms subside.

Tractor overturn concerns in Iowa: perspectives from the Keokuk county rural health study.

Agriculture remains one of the most hazardous industries in the U.S., with tractor overturns producing the greatest number of agricultural machinery-related fatalities. Rollover protective structures (ROPS) and seatbelts effectively reduce tractor overturn deaths. However, a large proportion of tractors in use in American agriculture are older tractors without ROPS and seatbelts. This article describes the tractor-related responses from participants in a population-based study conducted in Keokuk County, Iowa. This study was designed to measure rural and agricultural adverse health and injury outcomes and their respective risk factors. Questionnaires were partially developed from well-documented national surveys. Questions about agricultural machinery use, presence of safety equipment on the machinery, work practices, and attitudes about farm safety were included. Study participants on farms who owned tractors had an average of 3.1 tractors with an average age of 27 years. Only 39% of the 665 tractors had ROPS. Tractor age was associated with the presence of ROPS; 84% of tractors manufactured after 1984 were ROPS-equipped, whereas only 3% of tractors manufactured before 1960 were ROPS-equipped. ROPS-equipped tractors were significantly more common on larger farms and households with higher income. Only 4% of the farmers reported that their tractors had seatbelts and they wore them when operating their tractors. The results of this study support the findings of other studies, which indicate that many older tractors without ROPS and seatbelts remain in use in American agriculture. Until a dramatic reduction in the number of tractors in the U.S. operated without ROPS and seatbelts is achieved, the annual incidence of 120 to 130 deaths associated with tractor overturns will persist.

When one is not enough: prevalence and characteristics of homes not adequately protected by smoke alarms.

OBJECTIVE: The National Fire Protection Association (NFPA) has specific recommendations about the number, location, and type of smoke alarms that are needed to provide maximum protection for a household. No previous studies have examined whether or not homes are completely protected according to these guidelines. The authors describe the prevalence and home characteristics associated with compliance to recommendations for smoke alarm installation by the NFPA. DESIGN, SETTING, AND SUBJECTS: Data are from the baseline on-site survey of a randomized trial to measure smoke alarm effectiveness. The trial was housed in a longitudinal cohort study in a rural Iowa county. Of 1005 homes invited, 691 (68.8%) participated. MAIN OUTCOME MEASURES: Information about smoke alarm type, placement, and function, as well as home and occupant characteristics, was collected through an on-site household survey. RESULTS: Although 86.0% of homes had at least one smoke alarm, only 22.3% of homes (approximately one in five) were adequately protected according to NFPA guidelines. Fourteen percent of homes had no functioning smoke alarms. More than half of the homes with smoke alarms did not have enough of them or had installed them incorrectly, and 42.4% of homes with alarms had at least one alarm that did not operate. Homes with at least one high school graduate were nearly four times more likely to be fully protected. Homes that had multiple levels, a basement, or were cluttered or poorly cleaned were significantly less likely to be fully protected. CONCLUSION: These findings indicate that consumers may not be knowledgeable about the number of alarms they need or how to properly install them. Occupants are also not adequately maintaining the alarms that are installed.

A population based study of reporting patterns and characteristics of men who abuse their female partners.

OBJECTIVE: This study estimates the prevalence of male abusive behavior reported by men and their female partners and identifies characteristics of abusive men. DESIGN: Baseline survey from a population based cohort study of general health. SETTING: A rural county in Iowa, USA. SUBJECTS: 572 men and their cohabitating female partners. MAIN OUTCOME MEASURES: Male-to-female physical, emotional, and sexual abuse reported by either partner. RESULTS: In this cohort, 13.6% of men had performed at least one act of physical abuse and 34.9% emotional abuse. More than 45% of abusive men reported their own behaviors. Alcohol problems, antisocial personality characteristics, depressive symptoms, and financial stress were all positively associated with both physical and emotional abuse, but suicidal thoughts were less likely among abusers. CONCLUSION: Identification of common characteristics of abusive men may predict proclivity towards partner violence and barriers to behavior modification.