Hassan Saleheen

All-terrain vehicle riding among youth: how do they fair?

PURPOSE Pediatric all-terrain vehicle (ATV) injuries have been increasing annually for more than a decade. The objective of this study was to describe the riding behaviors, helmet use, and crash history of young ATV riders. METHODS A 38 question self-administered survey was distributed to a convenience sample of children at 4 agricultural fairs during 2007. A total of 228 surveys were reviewed. Collected data included demographic information, ATV characteristics, helmet use, driving habits, and crash history. RESULTS Survey respondents were predominantly male (71%) with an average age of 13.6 +/- 2.0 years. Riding began at a young age (9.2 +/- 3.2 years). Few children reported using age-appropriate sized engines (3% < 90 cm(3)), and 22% of children rode ATVs with engines more than 300 cm(3). Respondents rode primarily for recreation (94%), and more than a third reported riding without a helmet (40%). More than 70% of children reported riding with passengers, 60% without adult supervision, and nearly half (46%) rode after dark. Less than 5% of riders received any formal ATV riding/safety instruction. Of the respondents, 45% reported being involved in an ATV crash. Those children who reported a crash also rode more powerful ATVs, were more often self-taught, and overall reported higher rates of riding with passengers and without supervision, and riding after dark (P < .05). CONCLUSION Dangerous driving behavior among children who ride ATVs is widespread, and current safety recommendations are largely ignored. Renewed efforts are needed to improve safety programs and create policy measures that prevent pediatric ATV crash-related injuries.

Using Trauma Registry Data to Guide Injury Prevention Program Activities

BACKGROUND Injury prevention programs should be based on objective injury data. This study demonstrates how local injury data can be used to help guide injury prevention programs. METHODS We reviewed trauma registry data (2004-2006) from a Level I pediatric trauma center. Data included demographic information, anatomic location of injury, mechanism of injury, safety device utilization, Injury Severity Score (ISS), and temporal and geographic variables. The Injury Prevention Priority Score for each mechanism of injury was calculated. RESULTS There were 1,874 trauma patients. Most admissions were among white males, aged 11 years to 15 years (mean, 7.9 years ± 5.2 years). Most admissions occurred during summertime and on weekend evenings. Blunt injuries (92%) and fractures (56%) predominated (mean ISS, 5.9). A severe ISS >15 was highest among 11 year to 15 year and lowest among patients older than 15 years (p < 0.01). Falls, cut, or pierce, ATV, and off-road motorcycle ranked highest in the Injury Prevention Priority Score. Of the 134 motor vehicle occupants, 52% (n = 70) were restrained in car seats/seat belts. Only 15% of bicyclists, 24% of motorcyclists, and 58% of ATV riders wore helmets. CONCLUSION A significant percentage of injured children and adolescents were not using proven effective injury prevention devices at the time of their injury. These data identified areas for further study and will help guide community injury prevention programs at our institution.

Under the counter: the diffusion of narcotic analgesics to the inner city street.

Abstract During the past decade, there has been a well-documented rise in the non-medical use of prescription painkillers, often referred to as narcotics analgesics (NA). Relatively little is known, however, about who these users are, the range of health and social consequences associated with their use, and the presence of illicit NA use on the inner city street. Results of a survey conducted with a sample of 242 street drug users indicated that NA use is now widespread in the inner city, and that it is associated with a number of serious health and psychiatric conditions. Other characteristics of this emerging drug user group are explored and the need for future research is highlighted.

A prospective, multi-institutional study of pediatric all-terrain vehicle crashes

BACKGROUND Pediatric all-terrain vehicle (ATV) injuries have been increasing annually for more than a decade. The purpose of this study was to prospectively evaluate crash circumstances and clinical outcomes resulting from pediatric ATV crashes. METHODS Three pediatric trauma centers prospectively collected data from patients during their hospitalization for injuries sustained in ATV crashes from July 2007 through June 2012. Patients completed a 35-item questionnaire describing the crash circumstances (ATV engine size, safety equipment use, and training/experience). Clinical data (injuries, surgical procedures, etc.) were collected for each patient. RESULTS Eighty-four patients were enrolled, with a mean (SD) age of 13.0 (3.1) years, and were predominantly male (n = 55, 65%). Injuries were musculoskeletal (42%), central nervous system (39%), abdominal (20%), thoracic (16%), and genitourinary (4%). Multisystem injuries were prevalent (27%), and two patients died. Thirty-three patients (43%) required operative intervention. Most children were riding for recreation (96%) and ignored ATV manufacturers’ recommendation that children younger than 16 years ride ATVs with smaller (⩽90 cc) engines (71%). Dangerous riding practices were widespread: no helmet (70%), no adult supervision (56%), double riding (50%), riding on paved roads (23%), and nighttime riding (16%). Lack of helmet use was significantly associated with head injury (53% vs. 25%, p = 0.03). Rollover crashes were most common (44%), followed by collision with a stationary object (25%) or another vehicle (12%). Half (51%) of children said that they would ride an ATV again. CONCLUSION These data demonstrate a relationship between dangerous ATV riding behaviors and severe injuries in children who crash. Children younger than 16 years should not operate ATVs, and legislation that effectively restricts ATV use in children is urgently needed. LEVEL OF EVIDENCE Epidemiologic study, level III.

Impact of Connecticut's graduated driver licensing system on teenage motor vehicle crash rates

BACKGROUND In response to high rates of teen motor vehicle crashes (MVCs) many states have enacted graduated driver licensing (GDL) systems. GDL delays full licensure and allows beginners to obtain experience under lower risk conditions. The purpose of this study is to evaluate the impact over the past 10 years to determine its effect on teen MVCs. METHODS Connecticut MVC data from 1999 to 2008 were analyzed. Percent change (1999 vs. 2008) in MVC rates per 10,000 registered drivers was calculated by age, gender, during the night restriction (11:00 pm and 5:00 am), and MVCs with passengers. Linear regression analysis estimated the decrease of MVC rates each year. RESULTS The MVC rate decreased by 40% for 16-year-old and 30% for 17-year-old drivers. In comparison, rates among 18-year-old, 19-year-old, 25- to 29-year-old, and 30- to 59-year-old drivers were reduced by 16%, 7%, 8%, and 11%, respectively. The MVC rate for 20- to 24-year-old drivers increased by 1%. During nighttime restricted driving times, MVC rates decreased by 54% among 16-year-old and 49% among 17-year-old drivers. The MVC rate with passengers decreased by 65% for 16-year-old and 53% for 17-year-old drivers. In comparison, rates of nighttime and with passenger MVCs among older drivers were significantly less. CONCLUSIONS Implementation of Connecticuts GDL system has resulted in significant reductions in MVC rates among novice drivers. This analysis provides a method for other states to examine the impact of their GDL system.

Wishful thinking: Safe transportation of newborns at hospital discharge

BACKGROUND Motor vehicle occupant injury is a significant source of morbidity and mortality among children. Correctly used child safety seats (CSSs) substantially reduce injury morbidity and mortality. The objective of this study was to describe how parents learn to use and install CSS at newborn discharge. METHODS We prospectively enrolled maternal/newborn infant dyads at discharge from a large urban teaching hospital. Survey data included maternal demographics and parental knowledge on CSS installation. After survey completion, a certified child passenger safety technician observed and recorded CSS information, infant placement in CSS, and CSS placement in vehicle. Nine specific misuse categories were recorded. RESULTS A total of 101 mothers were enrolled, with mean age 29.4 years (15–45 years); 52% were white, 18% were black, and 27% were Hispanic; 50% had college degree or higher; and 41% were privately insured. We observed 254 CSS errors (range, 0–7; mean, 2.5). There were 52% infant placement in CSS misuse errors (range 0–4; mean, 1.3), and 48% CSS placement in vehicle misuse errors (range, 0–4; mean, 1.2). The CSS placement misuse included 29% CSS not attached to vehicle. More frequent misuse occurred among non-white, non–college-educated mothers (p < 0.01).There was no difference in misuse related to how, when, and where mothers learned about CSS installation. CONCLUSION Despite national, state, and hospital policies that require newborns to be transported in a CSS, we found a significant number of concerning CSS misuse in our study population. These results highlight the need for improved CSS education starting with the first ride home. LEVEL OF EVIDENCE Therapeutic study, level III.

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety

PROBLEM Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety. METHODS A 31-item self-administered survey was mailed to pediatricians. RESULTS 160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash. CONCLUSIONS A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. IMPACT ON INDUSTRY Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.

Correlates of drug use and driving among undergraduate college students.

Objective: Drug use by drivers is a significant and growing highway safety problem. College students are an important population to understand drugged driving. The objective of this study was to examine correlates of drugged driving among undergraduate college students. Methods: We conducted an anonymous, confidential, 24-question survey at a large New England public university during the 2010–2011 academic year among undergraduates in courses that met a graduation requirement. Data include demographics; academics; housing status; lifestyle; personal values; high school/college drug use; and driving following alcohol use, drug use, or both; and as a passenger with a driver who used alcohol, drugs, or both. Descriptive statistics were calculated. Chi-square tests compared driver alcohol use, drug use, or both with demographic, academic, and lifestyle variables. Logistic regression analyses were performed with drugged driving as the dependent variable. Odds ratios and corresponding 95 percent confidence intervals were calculated for each of the potential explanatory variables in relation to the outcome. Results: Four hundred forty-four of 675 students completed surveys (66% participation rate). Participants were representative of the student body with a mean age of 19.4 (±1.3 years), 51 percent male, 75 percent white, and 10 percent Hispanic. Seventy-eight percent lived on campus, 93 percent had a drivers license, and 37 percent had access to a car. Students disagreed that cannabinoids impair driving (18%) compared to other drugs (17%), stimulants (13%), depressants (11%), hallucinogens (8%), and alcohol (7%). Twenty-three percent drove after alcohol use and 22 percent drove after drug use. Forty-one percent reported having been a passenger with a driver who had been drinking and 37 percent with a driver using drugs. Drugged driving was more likely among males vs. females (30% vs. 14%, P < .01), those living off campus (34% vs. 19%, P < .01), those reporting that parties are important (33% vs. 14%, P < .01), those reporting that community service is not important (28% vs. 18%, P < .05), those reporting that religion is not important (28% vs. 14%, P < .01), and those reporting personal drug use in high school (75% vs. 14%, P < .01) and well as that their best friends used drugs in high school (42% vs. 12%, P < .01) and college (50% vs. 8%, P < .01). Those factors most associated with drugged driving included using drugs in high school (odds ratio [OR] = 9.5, 95% confidence interval [CI]: 4.6–19.6) and best friends in college used drugs regularly (OR = 6.2, 95% CI: 3.4–11.6). Conclusion: Self-reported drugged driving and riding as a passenger with a drugged driver is common among subgroups of college students. The identification of undergraduate subgroups at risk for drugged driving will guide the design and implementation of traffic safety activities.

Can nurse education in the postpartum period reduce car seat misuse among newborns

BACKGROUND Despite national, state, and hospital policies that require newborns to be transported in correctly used child safety seats (CSSs), significant CSS misuse frequently occurs among newborn infants. The objective of this study was to evaluate a comprehensive educational CSS training program for nurses and parents in a maternal/newborn unit. METHODS In the preintervention phase, we conducted a survey among maternal/newborn unit nurses in a large urban teaching hospital to measure CSS knowledge, attitude, and practice. We then enrolled 60 maternal-newborn dyads at discharge to survey maternal CSS knowledge and observe the CSS misuse rate. Our intervention phase included a 1-hour “mandatory” nurse CSS education classroom session, a nurse hands-on CSS demonstration and practice in a mother’s room. During the postintervention phase, we enrolled 70 maternal-newborn dyads at discharge to survey maternal CSS knowledge and observe change in CSS misuse rate. RESULTS In the preintervention phase, 43 (73%) of 59 eligible nurses completed the survey, and 47 (80%) of 59 completed the CSS education and training program. In the preintervention CSS survey, 23% of the nurses reported that education is part of their routine, 44% have CSS educational materials, 32% feel comfortable providing CSS education to parents, 12% feel CSS trained, 25% have time, 84% identify that CSS misuse is a problem, and 16% received CSS training. Enrolled mothers reflect maternal/newborn unit demographics as follows: maternal mean age of 29 years (range, 16–48 years), white (54%), black (11%), Hispanic origin (28%), English as primary language (83%), high school degree (31%), college degree (30%), Medicaid (23%), and private insurance (65%). Of 70 postintervention mothers, 44% reported receiving no nurse education, 21% reported receiving a brochure only, and 31% reported receiving nurse education. CSS misuse among mothers who received registered nurse education was not reduced compared with mother’s who received a brochure only and those who did not receive CSS education. Comparison of CSS misuse before (n = 60) and after (n = 70) observations revealed an increase in average misuse (1.8 vs. 3.0, p < 0.05) and a decreases or no significant change in appropriate use as follows: harness in lowest slot (95% vs. 87%), retainer clip at axilla level (63% vs. 33%, p < 0.01), harness snug (50% vs. 27%, p < 0.01), attached to the vehicle (80% vs. 80%), 45-degree angle (60% vs. 19%, p < 0.01), and CSS moves (32% vs. 27%). CONCLUSION Car safety seat misuse did not improve following implementation of a comprehensive nursing education and training program. CSS misuse in our study population was frequent and may increase injury risk in the event of a motor vehicle crash. Future work is needed to develop novel approaches and identify appropriate settings to reduce newborn CSS misuse. LEVEL OF EVIDENCE Therapeutic study, level V.

Does Knowledge of Teen Driving Risks and Awareness of Current Law Translate into Support for Stronger GDL Provisions? Lessons Learned from One State

Objective: Many states are considering strengthening their graduated driving licensing (GDL) systems for teenage drivers but most do not know the level of public support for proposed upgrades. This study provides a method for states to identify specific demographic groups that may differ with regard to their awareness of teen driving risks, knowledge of current GDL law, and support for GDL upgrades. Methods: A 28-item questionnaire was administered to Connecticut adults by phone survey during January 2008. We collected demographic information and whether respondents understood driving risks, were aware of the current GDL system, and whether they would support GDL upgrades. The states motor vehicle crash file (1999–2006) was used to calculate motor vehicle crash rate among 16- and 17-year-old drivers by town and correlate that with support for GDL upgrades. Results: Eight hundred seven people were interviewed. More women than men (92% vs. 86%, p < .05) and more parents than other adults (96% vs. 84%, p < .01) were aware of the current learners permit law. Female respondents (55% vs. 43%, p < .01) and adults who were not parents (54% vs. 45%, p < .05) were more likely to support increasing the minimum driving age. Parents were more aware than other adults (91% vs. 73%, p < .01) of the supervised driving provision. Women were more supportive of a supervised driving upgrade (83% vs. 69, p < .01). There was more support for a night restriction upgrade among other adults than parents (59% vs. 51%, p < .05), and the lowest support was in affluent towns (38%). Two thirds supported a passenger restriction upgrade with no differences based upon sex or geographic location. There was less support for an increased penalties in Fairfield County when compared to all other counties (55% vs. 63%, p < .05) and more support in Hartford County versus all other counties (70% vs. 58%, p < .05). Conclusions: Parents of Connecticut teens were more knowledgeable of current law but less supportive of GDL upgrades compared to other adults. Women were more apt to favor GDL upgrades than men. This study identifies subgroups that can be targeted for prevention activities and illustrates a useful method to assess public support for GDL upgrades.