Casualty crash types for which teens are at excess risk.

This study identified casualty crash types for which teen drivers experience excess risk relative to adults. Michigan State Police crash records were used to examine casualty crashes in two statewide populations of drivers who experienced at least one crash from 1989-1996 (pre-graduated driver licensing in Michigan): teens (ages 16-19) and adults (ages 45-65). Rates and rate ratios (RR) based on crash occurrence per 100,000 person miles driven (PMD) compared teens and adults from the two statewide populations. Excess risk was defined as a RR for a specific type of crash that was significantly greater than the RR for all crashes combined. The RRs for all crashes combined for teenage males was 2.41 and 1.75 for teenage females. RRs for teenage males ranged from a low of 2.16 for casualty crashes attributed to alcohol to 8.98 for casualty road departure crashes at night. Among teenage females, RRs ranged from 2.06 for casualty crashes on the weekend to 7.86 for casualty crashes at night with passengers. Casualty crash rates for teenage males ranged from 0.21 per 100,000 PMD for rollover crashes to 1.95 per 100,000 PMD for crashes with passengers. Among teen females, casualty crash rates ranged from 0.21 per 100,000 PMD for drink/driving with passengers to 3.31 per 100,000 PMD for crashes with passengers. Implications for graduated driver licensing, teen driver supervision, and policy are discussed. This study was funded by the National Institute on Alcohol Abuse and Alcoholism and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control.

Pathologists' participation in postmortem examinations for patients with dementia.

Pathologists (n = 571) in Michigan were surveyed to examine the problem of limited access to autopsy experienced by families of patients with dementia and to assist with the implementation of the Michigan Dementia Program. The survey determined the extent to which pathologists performed autopsies for patients with dementia and/or were willing to do so as part of a statewide Postmortem Examination Program. Responses from 394 pathologists (69%) indicated that 49% were willing to perform brain removal and 44% were interested in learning more about the statewide program. The survey results were used to recruit pathologists, to identify potential problems, and to provide baseline data against which to measure the effects of a fully implemented program.

Services for persons with dementia and their families: a survey of information and referral agencies in Michigan.

In planning a statewide Dementia Program, Michigan agencies (N = 244) providing geriatric information and referral (I&R) were surveyed to determine service availability, families' needs, and problems providing I&R for persons with dementia and their families. Home-delivered meals, nursing and social work assessments were considered more available. Medical assessment, however, was considered "very available" by only 60%. Respite and adult day care were least available and most needed. Least was known about autopsy and financial services. For several services, non-urban areas reported less availability than urban areas. With additional information and training, existing agencies could provide more available and extensive I&R for persons with dementia and their families, forming a statewide network.

Alcohol-related predictors of adolescent driving: gender differences in crashes and offenses.

Demographic and alcohol-related data collected from eight-grade students (age 13 years) were used in logistic regression to predict subsequent first-year driving crashes and offenses (age 17 years). For young men's crashes and offenses, good-fitting models used living situation (both parents or not), parents' attitude about teen drinking (negative or neutral), and the interaction term. Young men who lived with both parents and reported negative parental attitudes regarding teen drinking were less likely to have crashes and offenses. For young women's crashes, a good-fitting model included friends' involvement with alcohol. Young women who reported that their friends were not involved with alcohol were least likely to have crashes. No model predicting young women's offenses emerged.

An elementary school-based alcohol misuse prevention program: a follow-up evaluation.

An alcohol misuse prevention study (AMPS) curriculum for fifth- and sixth-grade students was developed, implemented and evaluated with over 5,000 students. The AMPS program emphasized social pressures resistance training, focusing on the immediate effects of alcohol, risks of alcohol misuse and social pressures to misuse alcohol. Schools were randomly assigned to curriculum, curriculum plus booster or control groups with half of each group pretested and all posttested. Measures focused on susceptibility to peer pressure, internal health locus of control, understanding of the curriculum material, alcohol use and alcohol misuse. After 26 months, there was a significant treatment by occasion interaction on internal health locus of control (sixth grade). A significant treatment by occasion interaction effect was also found with respect to curriculum measures in both grades. There was no significant treatment by occasion interactions with respect to alcohol use or misuse when the groups as a whole were considered. When subgroup analyses based on type of prior drinking experience were conducted, however, significant program effects on alcohol misuse were found among sixth-grade students who had experienced unsupervised as well as supervised drinking prior to the prevention program.

Changes in young adult offense and crash patterns over time.

A study of 13,809 young adult drivers in Michigan examined offenses and crashes ('incidents') for an average of 7 years after their original license date. During this period, 73% of subjects committed an offense that resulted in a conviction and 58% had a crash that was reported to the police. Forty-two percent had committed an offense classified as 'serious,' and 21% had an 'at-fault' crash. The odds of an offense being serious decreased approximately 8% per year of licensure, independent of gender or age at licensure. Similarly, the odds of a crash being at-fault decreased overall about 6% per year of licensure, but the decline was more than twice as fast for women as for men. Examining the empirical rates directly, it was found that the rate for minor offenses increased somewhat with time and then stabilized, while the rate for serious offenses declined. Also, offenses were less likely to be serious the later they occurred in the sequence of offenses for an individual. For crashes, the risk of having an at-fault crash declined more rapidly than the risk of a not-at-fault crash, although the rate of decrease began to equalize after approximately 5 years of licensure. The proportion of crashes that were at-fault did not decline over the sequence of crashes for an individual. Although crashes and offenses are positively correlated, they follow different trajectories over the early years of licensure.

Adolescent antecedents of high-risk driving behavior into young adulthood: substance use and parental influences.

Driver history data, in combination with previously collected tenth-grade questionnaire data, for 4403 subjects were analyzed by Poisson regression models to identify the significant substance use and parental characteristics predicting subsequent high-risk driving of new drivers (starting at age 16) through age 23-24 years. Substance use (cigarettes, marijuana, and alcohol) reported at age 15 was shown to be an important predictor of subsequent excess risk of serious offenses and serious crashes for both men and women. In addition, negative parental influences (lenient attitudes toward young people's drinking; low monitoring, nurturance, family connectedness), were also demonstrated to increase the risk of serious offenses and serious crashes for both men and women.

Children with juvenile rheumatoid arthritis at school. Functional problems, participation in physical education. The implementation of Public Law 94-142.

Parents of 135 children with juvenile rheumatoid arthritis (JRA) completed a mailed questionnaire about problems at school. Writing was the most frequently reported difficulty, with hand involvement causing more problems than decreased mobility. Compared to children with pauciarticular JRA, those with polyarticular or systemic JRA were significantly more likely to miss school, experience problems, participate less in physical education, have an Individualized Educational Plan (IEP) developed, and receive related services. Only 39 parents had heard of PL 94-142, and only 21 of those could define the federal law. Twenty children had an IEP within the previous two years. Possible deficiencies in the implementation of PL 94-142 were discovered. This study demonstrates that the treatment of children with JRA should include efforts to: 1) identify and remediate potential performance limitations before they become problematic at school; 2) communicate this information to parents and school personnel; 3) and improve parents' awareness and understanding of PL 94-142.

Longitudinal evaluation of an enhanced alcohol misuse prevention study (AMPS) curriculum for grades six-eight.

For students progressing from sixth to eighth grade, an enhanced Alcohol Misuse Prevention Study (AMPS) curriculum that emphasized social pressure resistance training, peer support, and norm-setting was developed, implemented, and evaluated. Schools were randomly assigned within communities to curriculum or control groups. Students were pretested early in sixth grade before the intervention and posttested at the end of sixth, seventh, and eighth grades. Results indicated the curriculum was effective in increasing students' knowledge of curriculum material, and among the subgroup of students who had used alcohol unsupervised by adults before the pretest, in reducing the rate of increase of alcohol misuse. The findings result from a replication of the analytic approach used with the initial AMPS cohort data.

Factors in adolescent drinking/driving: binge drinking, cigarette smoking, and gender.

During three consecutive years, 3,137 high school seniors from three graduating classes in one Michigan county were surveyed. The primarily White sample reported their use of alcohol and cigarettes, driving experience, and drinking/driving experience. Survey data were linked with state driver history records. Fully one-third of the high school seniors reported driving after drinking in the past six months. To identify factors associated with self-reported drinking/driving, correlation and regression analyses were conducted. Frequent binge drinking and riding with a drinking driver were consistent factors in driving after drinking frequency. Being male, smoking cigarettes, having frequent use of a motor vehicle, having a driving offense on record, and number of years licensed were important correlates, varying by year of graduation. Comprehensive interventions to moderate drinking, smoking, and driving after drinking are needed.

Susceptibility to peer pressure as an explanatory variable for the differential effectiveness of an alcohol misuse prevention program in elementary schools.

A school-based alcohol misuse prevention program had differential effects on students' susceptibility to peer pressure, depending on prior experience with alcohol. These effects paralleled those on alcohol use and misuse, indicating program effects on use and misuse were mediated by reductions in the rate of increase on susceptibility to peer pressure. Experimental group students with prior unsupervised use of alcohol showed a significantly greater reduction than their controls in the rate of increase in susceptibility to peer pressure, alcohol use, and alcohol misuse. This difference was not found among students without prior unsupervised use of alcohol.

Differential effectiveness of an elementary school-based alcohol misuse prevention program.

An elementary school social skills/peer pressure resistance curriculum for the prevention of alcohol misuse was developed, implemented, and evaluated. Schools were randomly assigned to curriculum and control groups, with half of each group pretested prior to intervention and all students posttested two months, 14 months, and 26 months following intervention. Students in grade five at the beginning of the study were randomly assigned to treatment, treatment plus booster, and control conditions. Students in grade six were randomly assigned to treatment and control conditions. Three way repeated measures analyses of covariance (treatment condition by type of prior drinking experience by occasion) were conducted for each grade level on indices of "frequency/quantity of alcohol use" and "total alcohol misuse." Results indicated the intervention was effective in reducing the rate of increase of alcohol use and misuse among grade six students who entered the study with prior unsupervised as well as supervised alcohol use. After corrections for intraclass correlations on the dependent variables, the significant finding regarding the alcohol misuse variable was maintained.

Validity of adolescents' self-reports of alcohol use and misuse using a bogus pipeline procedure.

Past research, particularly in the area of adolescent smoking behavior, has suggested that more valid self-reports of socially undesirable behavior can be obtained when a bogus pipeline procedure is implemented. "Bogus pipeline" refers to a methodology in which subjects are informed that their self-reports can and will be objectively verified by the researcher through a procedure such as a biochemical test. In actuality, no verification takes place. Recent studies using this methodology have produced mixed results. In the current study, a bogus pipeline procedure designed to increase the validity of adolescents' self-reports of alcohol use and misuse was devised and evaluated as part of the pilot work for an alcohol misuse prevention study in southeastern Michigan schools. A total of 291 students in grades seven through nine were tested in the pilot study. Of these, 173 experienced the bogus pipeline approach in which saliva samples were collected, while 118 served as controls. The differences between the two conditions were examined with respect to nine variables concerning alcohol use and misuse. An overall frequency of use index and an overall misuse index were also examined. Two-way analyses of variance (treatment by grade level and treatment by gender) were conducted. The F values for a main effect of treatment ranged from .00 to 1.27 for the 11 variables. None of these was significant at the prespecified alpha level of .20. In addition, there was no interaction of the treatment procedure with either grade level or gender. In the context of a school-based study in which confidentiality was assured, adolescents' self-reports of alcohol use and misuse were not significantly affected by a bogus pipeline procedure.

Driving exposure by driver age in Michigan.

BACKGROUND: This study compared driving exposure between two high-crash-risk groups (16-17 and 18-24-year-olds), with a low-crash-risk group (35-64-year-olds). In addition, patterns of association between driving exposure measures and demographic and driving behavior variables were examined. METHODS: Respondent's total miles, minutes, and trips driven were calculated within a 48-hour period, using state-wide survey data collected in 2004 and 2005. RESULTS: The youngest drivers drove fewer miles and minutes, but a comparable number of trips as the two older groups. Employment and high vehicle access were associated with greater driving exposure for 16-17-year-olds and 18-24-year-olds. Employment, high household income, large household size, and low vehicle access were associated with greater driving exposure for 35-64-year-olds. More driving was done alone than with passengers present and during the day than at night across all ages. There was a positive association between two driving exposure measures (miles and minutes driven) and demographic and driving behavior variables, which did not extend to trips driven. DISCUSSION: Driving exposure is directly related to stage of life. The entire sample of 16-17-year-old respondents were in high school, which directly influenced their driving times, destinations, and purpose. Those aged 18-24years displayed driving behavior patterns that were closer to the older drivers, while retaining some differences. The oldest drivers were likely to be shouldering the greatest household responsibilities, and their greater driving exposure may reflect this reality. IMPACT ON INDUSTRY: These findings provide new information about driving exposure for two high-risk and one low-risk group of drivers. They also raise concern over potential workplace safety issues related to teens' higher driving exposure, and concomitant crash risk, related to being employed. Future research should examine this issue more carefully so that evidence based recommendations can be made to enhance the safety of teens who are employed, especially those who are employed as drivers.

Teen driving exposure in Michigan: demographic and behavioral characteristics.

Motor vehicle crashes are the leading cause of death and a leading cause of non-fatal injury for teenagers in the United States. Understanding teen crashes requires a good measure of crash risk. The measure of exposure that is used in the calculation of risk estimates determines what information the resulting rates and rate ratios provide and the conclusions that can be drawn about teen driver crash risk. The purpose of this study is to provide an initial description of three measures of individual-level exposure to driving for 16-17-year-olds in the state of Michigan, using data from the state-wide Michigan Travel Counts survey conducted in 2004 and 2005. The total miles, minutes, and trips driven within the 48-h survey period were calculated for each respondent using self-reported measures and geo-spatial mapping. Young drivers who worked and those with greater access to a vehicle drove significantly more than their peers who did not work and those who had less access to a vehicle. Those from urban residences spent more time driving than those from rural residences. All 16-17-year-olds drove substantially more during the day than at night, and on their own than with passengers. There was little difference in overall driving exposure and driving behavior between young men and young women. This study provides an initial description of driving exposure and behavior for a population for which there is very little specific information about amounts and patterns of individual driving exposure. The relationship between individual driving exposure and risk of motor vehicle crash, injury or fatality requires further investigation.

Influences on youthful driving behavior and their potential for guiding interventions to reduce crashes.

This paper presents an organized, comprehensive view of the factors known to influence young drivers' behavior and how those factors might inform interventions to reduce crashes. This effort was done from the perspective of a public health professional, with a background in health behavior and health education, interested in preventing injury and death among young people from motor vehicle crashes. The author's own studies, selected relevant literature, observation, and experience were considered and organized. A framework of six categories of influences on youthful driving behavior was developed, including the following elements: driving ability, developmental factors, personality factors, demographics, the perceived environment, and the driving environment. It is apparent that a complex set of many different factors influences young drivers' behavior. To reduce crashes, comprehensive, multilevel interventions are needed that target those factors in the framework that are amenable to change.

Compliance in children and adults: review of studies.

Adherence to prescribed medication, or patient compliance, was studied over a period of several years in 3 populations with seizure disorders: 2 pediatric (n = 90, n = 211), and 1 adult population (n = 177). Compliance was assessed in several different ways: self-reports and serum levels analyzed for the level/dose ratio as well as the coefficient of variation for each patient. Correlates studied included Health Belief Model variables as well as internal locus of control, social support, knowledge about seizures and other variables. The assessed extent of compliance ranged from 54% to 82% in the various groups. Overall, compliance was related to motivation, value of illness threat reduction, and probability that compliant behavior will reduce the threat. Also related to compliance were some measures of the following types of variables: demographic, structural, attitudinal, provider/patient interaction, social support, experience with the regimen, internal control, and knowledge. A group discussion intervention designed to enhance compliance was implemented and evaluated effectively in the pediatric seizure population. In the adult population, compliance and seizure control both increased over a 2 year follow-up period, but were not significantly related.

Intervention to improve compliance with pediatric anticonvulsant therapy.

Daily anticonvulsant drug therapy is the major treatment of seizure disorders. Compliance with the prescribed therapy is essential but not always achieved. Among 201 pediatric seizure clinic patients taking phenobarbital and phenytoin, 70 (35%) were judged noncompliant on at least one medication. The mothers of these patients were randomly assigned to experimental or control groups. An educational intervention in the form of a mothers' group discussion led by the clinic social worker was tested. On follow-up, medication compliance in the intervention group was judged significantly greater than that of the control group.