Carol S. Wolf Runyan

Risk factors for fatal residential fires

BACKGROUND Residential fires are the most important cause of fire-related mortality in the United States. Previous research has concentrated on fatal fires in urban areas; considerably less is known about fatal fires in rural areas. METHODS We studied fatal and nonfatal residential fires in predominantly rural areas. Using a case-control design, we compared all 151 fatal fires (cases) in single-family dwellings in North Carolina during a 13-month period with a sample of nonfatal fires (controls). Case fires were identified through the medical-examiner system, and control fires that occurred within a few weeks of the case fires were chosen from the records of randomly selected fire departments statewide. For each fire, fire officials were interviewed about the dwelling, the fire, the people involved, and the fire-response system. RESULTS Although heating incidents were the leading cause of fires, fatal fires were more likely to have been caused by smoking (31 percent of fatal fires vs. 6 percent of nonfatal fires). Mobile homes posed a higher risk of death if a fire occurred (odds ratio, 1.7; 95 percent confidence interval, 1.1 to 2.6), as did the absence of a smoke detector (odds ratio, 3.4; 95 percent confidence interval, 2.1 to 5.6). Smoke detectors were more protective against death in fires involving young children and when no one present was impaired by alcohol or drugs or had a physical or mental disability. The presence of an alcohol-impaired person was the strongest independent risk factor for death in the case of a fire (odds ratio, 7.5; 95 percent confidence interval, 4.4 to 12.7). CONCLUSIONS Residential fires are most likely to be caused by heating equipment or smoking materials. The risk of death is greatest in fires in mobile homes, in those involving alcohol-impaired persons, and in those in houses without smoke detectors.

Unintentional injuries in the home in the United States: Part II: Morbidity

BACKGROUND Homes are an important setting for nonfatal unintentional injuries. The purpose of this study was to quantify and describe nonfatal, unintentional injuries in the United States, in which the injury took place at home. METHODS Data derived from the National Health Interview Survey, National Ambulatory Medical Care Survey, and National Hospital Ambulatory Medical Care Surveys for Outpatient and Emergency Departments. The nonfatal unintentional home injury rate and 95% confidence interval were computed for the United States overall (1998-1999), as well as by type of injury, gender, and age group. Weights were applied for each data set as designated by the National Center for Health Statistics. RESULTS In 1998, there were more than 12 million unintentional home injuries requiring some form of medical attention. Falls were the most common injury among all age groups, followed by cutting/piercing injuries, and injuries associated with being struck by or against an object or person. Injury rates were highest among the oldest and youngest age groups. There was inconsistency across data sets with regard to the presence of location information and definitions of the home environment, inclusion criteria, and the presence of external cause of injury and poisoning codes (E-codes). Depending on the data set, information was missing for 8% and 41% of cases on the location of injury, making it impossible to determine whether the injuries occurred in the home environment. CONCLUSIONS Falls are a significant problem, particularly among older adults. Additionally, data collection systems need to be improved so that location of injury data are routinely collected using consistent definitions so as to allow comparisons across data sets and over time.

Femicide in North Carolina, 1991-1993: A Statewide Study of Patterns and Precursors

This population-based study describes all 586 North Carolina femicide victims age 15 and older between 1991 and 1993. We combined reviews of medical examiner records with interviews of law enforcement officers to obtain information about the events and the contexts in which the Femicides occurred. Victimization rates were highest for African American and young women. Fifty-four percent of the femicides were committed with firearms and 67% occurred at a residence. More than half the women were killed by current or former intimate partners; at least 67% of these cases were preceded by domestic violence. Nonpartner femicides often involved multiple overlapping circumstances such as criminal activity, drug-related activity, and arguments. The findings demonstrate the complexity of femicide and the need to disentangle the many contributing factors. Medical examiner data and law enforcement interviews proved complementary, but information gaps still exist, signaling possibilities for changes in data collection, as well as needs for further research.

Adequacy of health and safety training among young Latino construction workers.

Objectives: This study aimed to assess the adequacy of safety training provided to young Latino immigrant construction workers. The study posited that, because of their youth and immigrant status, these workers would be less likely to receive adequate training. Methods: We interviewed 50 youths aged ≤21 who had worked at least 10 days in construction in the previous year. The in-person interview included 140 questions covering a range of construction work and health and safety experiences. Results: Participants reported performing a range of hazardous tasks, some while under the age of 18. Of these, 68% to 72% reported receiving some training, but median training time was only 1 hour. Only 24% reported receiving written training material. Those with less English ability received less training. Conclusions: Young Latino immigrants in this study received inadequate training given the hazardous work they performed. Clinical Significance: Results of this research, especially the relatively low level of English communication skills among young Latino workers, point to the need for increased bilingual services not just in worker safety training programs, but also in medical clinics and emergency rooms that treat Latino workers.

Partner homicide-suicide involving female homicide victims: a population-based study in North Carolina, 1988-1992.

Homicide-suicide is a form of fatal violence in which an individual commits homicide and subsequently kills him- or herself. One hundred and sixteen homicide-suicide events involving 119 female homicide victims in North Carolina from 1988-1992 were identified through state medical examiner files. Case files were reviewed retrospectively to identify event characteristics, precursors, and typologies. In 86% of cases the perpetrator was the current or former partner of the victim. During the study period, 24% of men who killed their female partners in North Carolina subsequently committed suicide and another 3% attempted suicide but survived. Victim separation from the perpetrator was the most prevalent precursor (41%), followed by a history of domestic violence (29%). In nearly half of the cases with a history of domestic violence, the victim had previously sought protection from the perpetrator in the form of an arrest warrant, restraining order, or intervention by a law enforcement officer. Children of the victim (and/or perpetrator) witnessed the homicide-suicide, were in the immediate vicinity, found their parents’ bodies, or were killed, in 43% of cases. The prevalence of separation and domestic violence suggests several potential points of intervention, including stronger domestic violence legislation. Future research should place priority on assessing the impact of partner homicidesuicides on the families in which they occur. Such studies are essential for the informed development of preventive and therapeutic interventions for the families of both the victims and perpetrators of these fatal events. In addition, research focused on assisting men in coping with issues of control and separation is needed.

Teens at work: A statewide study of jobs, hazards, and injuries

PURPOSE Occupational injury is an ongoing and serious threat to American youth. However, little is known about the environments in which youth work or the hazards to which they are exposed. The purpose of this study was to document the patterns of work, exposures to hazardous equipment and situations, and work-related injury experiences of adolescents. METHODS We identified a statewide targeted sample of North Carolina households with teens age 14-17 years and interviewed those who had ever worked for pay or worked on a farm. RESULTS Five hundred sixty-two teens from 700 eligible households reported that they had worked non-farm jobs for pay. One-third were paid for work before age 14 years; two-thirds had held more than one paid job. Place of employment was most often someones home, a retail store, or a restaurant. Common jobs were lawn care worker, cashier, and dishwasher. Common hazards to which teens were exposed included ladders or scaffolding; forklifts, tractors or riding mowers; and working around loud noises. Over half were injured at least once while working a paid job, most often from being cut or burned. CONCLUSIONS Work among youth is common. Teens hold a variety of jobs, mostly in the retail trade and the service sector, exposing them to hazardous equipment and situations. Injuries at work are frequent and some are serious. This study supports the need to include an occupational history and work-related safety counseling in clinical encounters with adolescents.

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.

Work-related hazards and workplace safety of US adolescents employed in the retail and service sectors

OBJECTIVE. Our goal was to examine the hazard exposures, work experiences, and workplace safety training of adolescents employed in retail and service jobs in the United States. METHODS. This was a cross-sectional telephone survey among working adolescents, 14 to 18 years old, in the continental United States. Data were collected in 2003. Survey items measured self-reported hazard exposures, training, and supervision experiences of working adolescents. RESULTS. Teens reported working an average of 16.2 hours per week during the school year, including working an average of 2.9 times per week after 7 pm on school nights and 2.6 nights per week after 9 pm. Thirty-seven percent of those under age 16 reported working after 7 pm on a school night, indicating employer violation of federal law. Teens typically perform multiple kinds of tasks in a given job. Higher proportions of females than males are involved in cash handling (84% vs 61%), whereas males are more likely than females to be involved in physically challenging tasks, such as lifting heavy objects (57% vs 22%) or working at heights (35% vs 17%). Despite federal regulations prohibiting teens under 18 from using certain types of dangerous equipment (eg, slicers, dough mixers, box crushers, paper balers) or serving or selling alcohol in places where it is consumed, 52% of males and 43% of females reported having performed ≥1 prohibited task. Although more males reported receiving safety training, they were also more likely to report working without supervision than their female counterparts. CONCLUSIONS. Teens are exposed to multiple hazards, use dangerous equipment despite federal prohibitions, and work long hours during the school week. They also lack consistent training and adult supervision on the job. It is important for adolescent medicine practitioners to become involved in prevention efforts through both anticipatory guidance and policy advocacy.

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.

Newspapers: a source for injury surveillance?

Newspapers have not been extensively evaluated as an injury surveillance source. We compared clippings with medical examiner records for 45 residential fire deaths and 58 drownings of children to assess extent, completeness, and accuracy of newspaper coverage. Newspapers covered 96% of the fire fatalities and 78% of the drownings and contained more information than medical examiner records on several factors, including fire cause and smoke detector presence, pool fences, warning signs, and supervision of children.