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OBJECTIVES: To evaluate the impact of the partial repeal of Michigan's universal motorcycle helmet law on helmet use, fatalities, and head injuries. METHODS: We compared helmet use rates and motorcycle crash fatality risk for the 12 months before and after the April 13, 2012, repeal with a statewide police-reported crash data set. We linked police-reported crashes to injured riders in a statewide trauma registry. We compared head injury before and after the repeal. Regression examined the effect of helmet use on fatality and head injury risk. RESULTS: Helmet use decreased in crash (93.2% vs 70.8%; P < .001) and trauma data (91.1% vs 66.2%; P < .001) after the repeal. Although fatalities did not change overall (3.3% vs 3.2%; P = .87), head injuries (43.4% vs 49.6%; P < .05) and neurosurgical intervention increased (3.7% vs 6.5%; P < .05). Male gender (adjusted odds ratio [AOR] = 1.65), helmet nonuse (AOR = 1.84), alcohol intoxication (AOR = 11.31), intersection crashes (AOR = 1.62), and crashes at higher speed limits (AOR = 1.04) increased fatality risk. Helmet nonuse (AOR = 2.31) and alcohol intoxication (AOR = 2.81) increased odds of head injury. CONCLUSIONS: Michigan's helmet law repeal resulted in a 24% to 27% helmet use decline among riders in crashes and a 14% increase in head injury.
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Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/epidemiologia , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Motocicletas/legislação & jurisprudência , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Traumatismos Craniocerebrais/mortalidade , Feminino , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: Serious crashes are more likely when teenage drivers have teenage passengers. One likely source of this increased risk is social influences on driving performance. This driving simulator study experimentally tested the effects of peer influence (i.e., risk-accepting compared to risk-averse peer norms reinforced by pressure) on the driving risk behavior (i.e., risky driving behavior and inattention to hazards) of male teenagers. It was hypothesized that peer presence would result in greater driving risk behavior (i.e., increased driving risk and reduced latent hazard anticipation), and that the effect would be greater when the peer was risk-accepting. METHODS: Fifty-three 16- and 17-year-old male participants holding a provisional U.S., State of Michigan driver license were randomized to either a risk-accepting or risk-averse condition. Each participant operated a driving simulator while alone and separately with a confederate peer passenger. The simulator world included scenarios designed to elicit variation in driving risk behavior with a teen passenger present in the vehicle. RESULTS: Significant interactions of passenger presence (passenger present vs. alone) by risk condition (risk-accepting vs. risk-averse) were observed for variables measuring: failure to stop at yellow light intersections (Incident Rate Ratio (IRR)=2.16; 95% Confidence Interval [95CI]=1.06, 4.43); higher probability of overtaking (IRR=10.17; 95CI=1.43, 73.35); shorter left turn latency (IRR=0.43; 95CI=0.31,0.60); and, failure to stop at an intersection with an occluded stop sign (IRR=7.90; 95CI=2.06,30.35). In all cases, greater risky driving by participants was more likely with a risk-accepting passenger versus a risk-averse passenger present and a risk-accepting passenger present versus driving alone. CONCLUSIONS: Exposure of male teenagers to a risk-accepting confederate peer passenger who applied peer influence increased simulated risky driving behavior compared with exposure to a risk-averse confederate peer passenger or driving alone. These results are consistent with the contention that variability in teenage risky driving is in part explained by social influences.
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PURPOSE: Screening for depression, sleep-related disturbances, and anxiety in patients with diagnosed adenocarcinoma of the pancreas. MATERIALS AND METHODS: Patients were evaluated at initial consultation and subsequent visits at the multidisciplinary pancreatic cancer clinic at our University Cancer Center. Cross-sectional and longitudinal psychosocial distress was assessed utilizing Personal Health Questionnaire 9 (PHQ9) to screen for depression and monitor symptoms, the Penn State Worry Questionnaire (PSWQ) for generalized anxiety, and the University of Michigan Sleep Questionnaire to monitor sleep symptoms. RESULTS: Twenty-two patients diagnosed with pancreatic cancer participated during the 6-month pilot study with longitudinal followup for thirteen patients. In this study, mild-to-moderate depressive symptoms, anxiety, and potential sleep problems were common. The main finding of the study was 23% of the patients who were part of this pilot project screened positive for moderately severe major depressive symptoms, likely anxiety disorder or a potential sleep disorder during the study. One patient screened positive for moderately severe depressive symptoms in longitudinal followup. CONCLUSIONS: Depression, anxiety, and sleep problems are evident in patients with pancreatic cancer. Prospective, longitudinal studies, with larger groups of patients, are needed to determine if these comorbid symptoms impact outcome and clinical course.
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Adenocarcinoma/psicologia , Ansiedade/diagnóstico , Depressão/diagnóstico , Neoplasias Pancreáticas/psicologia , Transtornos do Sono-Vigília/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Motor vehicle crashes are a leading cause of injury, and teen drivers contribute disproportionately to that burden. Graduated Driver Licensing (GDL) programs are effective at reducing teen crash risk, but teen crash rates remain high. Between-state variation in the teen crash rate reduction following GDL implementation has been documented, but this is the first study to examine small-area variation in such a reduction. Fusing together crash data from the Michigan State Police, census data, and organizational data (alcohol outlet, movie theatre, and school locations), we analyzed spatial correlates of teen injury crash, and place-based features that modified the injury crash rate difference following GDL implementation. Specifically, using census-based units, we estimated changes in injury crash rates among teens using negative binomial regression controlling for spatial autocorrelation, and tested whether any measured spatial characteristics modified the crash rate change in the pre versus post GDL periods. There was a substantial reduction in teen crashes after GDL implementation (RR = 0.66, 95%CI: [0.65, 0.67]), and this effect was robust across gender and time-of-day (light/dark). We found evidence that this reduction varied across space; areas with more alcohol outlets corresponded to a larger daytime crash rate reduction post-GDL, while areas near schools corresponded to a smaller daytime crash rate reduction. Concentrations of movie theatres corresponded to larger post-GDL crash rate reductions after dark. Maximizing the substantial successes of GDL programs requires understanding why crash rate reductions were larger in some areas following GDL implementation, and harnessing that understanding to improve its effectiveness across a state, focusing on identifying priorities for improving driver training (e.g., by parents and driver educators), law enforcement, and future policy changes to current GDL laws.
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Acidentes de Trânsito , Condução de Veículo , Comércio , Educação não Profissionalizante , Licenciamento , Instituições Acadêmicas , Análise Espacial , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Condução de Veículo/educação , Censos , Feminino , Redução do Dano , Humanos , Aplicação da Lei , Masculino , Michigan , Polícia , Políticas , RiscoRESUMO
Motorcycle crashes result in a significant health burden, including many fatal injuries and serious non-fatal head injuries. Helmets are highly effective in preventing such trauma, and jurisdictions that require helmet use of all motorcyclists have higher rates of helmet use and lower rates of head injuries among motorcyclists. The current study examines helmet use and characteristics of helmeted operators and their riding conditions in Michigan, following a weakening of the state's universal motorcycle helmet use law in April 2012. Data on police-reported crashes occurring during 2012-14 and from a stratified roadside observational survey undertaken in Southeast Michigan during May-September 2014 were used to estimate statewide helmet use rates. Observed helmet use was more common among operators of sports motorcycles, on freeways, and in the morning, and least common among operators of cruisers, on minor arterials, and in the afternoon. The rate of helmet use across the state was estimated at 75%, adjusted for roadway type, motorcycle class, and time of day. Similarly, the helmet use rate found from examination of crash records was 73%. In the observation survey, 47% of operators wore jackets, 94% wore long pants, 54% wore boots, and 80% wore gloves. Protective clothing of jackets and gloves was most often worn by sport motorcycle operators and long pants and boots most often by riders of touring motorcycles. Findings highlight the much lower rate of helmet use in Michigan compared with states that have a universal helmet use law, although the rate is higher than observed in many states with partial helmet laws. Targeted interventions aimed at specific groups of motorcyclists and situations where helmet use rates are particularly low should be considered to increase helmet use.
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Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/prevenção & controle , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Dispositivos de Proteção da Cabeça/normas , Motocicletas/legislação & jurisprudência , Motocicletas/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: Driver distraction is an important contributor to crash risk. Teenage driver distraction can be influenced by the attitudes and behaviors of parents. This study examined teens' and their parents' engagement in distracting behavior while driving. METHOD: Survey data were collected from a national sample of 403 parent-teen dyads using random-digit dialing telephone interviews. RESULTS: Results demonstrated few parent or teen sex differences in distracting behavior engagement while driving, or in their perceptions of each others' behavior. Parents and teens' frequencies of distracting behavior engagement were positively correlated. Parents' and teens' perceptions of each others' distracting behavior engagement while driving exceeded their own selfreports. Finally, the likelihood that teens reported engaging in distracting behavior while driving was more strongly associated with their perceptions of their parents' distracting behavior than by parents' self reports of their own behavior. CONCLUSIONS: These results suggest that parents' examples of driving behavior are an important influence on teen driving behavior, but potentially more important are teens' perceptions of their parents' behaviors.
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Comportamento do Adolescente , Atenção , Atitude , Condução de Veículo , Relações Pais-Filho , Pais , Assunção de Riscos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poder Familiar , Percepção , Risco , Autorrelato , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Teenage passengers affect teenage driving performance, possibly by social influence. To examine the effect of social norms on driving behavior, male teenagers were randomly assigned to drive in a simulator with a peer-aged confederate to whom participants were primed to attribute either risk-accepting or risk-averse social norms. It was hypothesized that teenage drivers would engage in more risky driving behavior in the presence of peer passengers than no passengers, and with a risk-accepting compared with a risk-averse passenger. METHOD: 66 male participants aged 16 to 18 years holding a provisional driver license were randomized to drive with a risk-accepting or risk-averse passenger in a simulator. Failure to Stop at a red light and percent Time in Red (light) were measured as primary risk-relevant outcomes of interest at 18 intersections, while driving once alone and once with their assigned passenger. RESULTS: The effect of passenger presence on risky driving was moderated by passenger type for Failed to Stop in a generalized linear mixed model (OR = 1.84, 95% CI [1.19, 2.86], p < .001), and percent Time in Red in a mixed model (B = 7.71, 95% CI [1.54, 13.87], p < .05). CONCLUSIONS: Exposure of teenage males to a risk-accepting confederate peer increased teenage males' risky simulated driving behavior compared with exposure to a risk-averse confederate peer. These results indicate that variability in teenage risky driving could be partially explained by social norms.