Lynne Warda

House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury

Objective—To summarize house fire injury risk factor data, using relative risk estimation as a uniform method of comparison. Methods—Residential fire risk factor studies were identified as follows: MEDLINE (1983 to March 1997) was searched using the keywords fire*/burn*, with etiology/cause*, prevention, epidemiology, and smoke detector* or alarm*. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by the above keywords, as well as safety, skills, education, and training. Other sources included: references of retrieved publications, review articles, and injury prevention books; Injury Prevention journal hand search; government documents; and internet sources. When not provided by the authors, relative risk (RR), odds ratio, and standardized mortality ratios were calculated, to enhance comparison between studies. Results—Fifteen relevant articles were retrieved, including two case-control studies. Non-modifiable risk factors included young age (RR 1.8–7.5), old age (RR 2.6–3.6), male gender (RR 1.4–2.9), non-white race (RR 1.3–15.0), low income (RR 3.4), disability (RR 2.5–6.5), and late night/early morning occurrence (RR 4.1). Modifiable risk factors included place of residence (RR 2.1–4.2), type of residence (RR 1.7–10.5), smoking (RR 1.5 to 7.7), and alcohol use (RR 0.7–7.5). Mobile homes and homes with fewer safety features, such as a smoke detector or a telephone, presented a higher risk of fatal injury. Conclusions—Risk factor data should be used to assist in the development, targeting, and evaluation of preventive strategies. Development of a series of quantitative systematic reviews could synthesize existing data in areas such as house fire injury prevention.

URBAN AND RURAL PATTERNS OF BICYCLE HELMET USE: FACTORS PREDICTING USAGE

Objectives—To document current bicycle helmet use in Winnipeg, Manitoba and nearby rural communities, and to identify target groups for a helmet promotion campaign. Methods—Cyclist helmet use was observed between 28 May and 20 August 1996 at a sample of urban and rural locations. Age, gender, helmet use, riding companion(s), location type, correct helmet use, and use of headphones were recorded. Univariate and multivariate analyses were performed. Adjusted odds ratios with 95% confidence intervals were calculated from the final models. Results—Altogether 2629 cyclists (70% male, 30% female) were observed: 2316 at 183 urban locations and 313 at 25 rural locations, with nearly equal numbers of children and adults observed. Overall helmet use was 21.3%, with lower use in males (18.9%) than females (26.3%), despite gender only being a significant variable on multivariate analysis for children under 8 years and adults. Urban helmet use was considerably higher (22.9%) than rural use (8.9%). Helmet use increased linearly as mean neighbourhood income increased, with a nearly fourfold difference in use between the highest and lowest income neighbourhoods. Children less than 8 years old and adults had the highest, and teenagers the lowest, use. Significant predictive variables were identified separately by age category to inform targeted programming. Conclusions—We documented low helmet use in our region, emphasizing the need for a regional helmet promotion campaign as well as future helmet legislation. A marked urban-rural difference in helmet use that has not been previously reported was also identified. Target groups for a future campaign include adolescents, males, rural cyclists, and those in lower income neighbourhoods.

House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions

Objective—To evaluate and summarize the house fire injury prevention literature. Methods—MEDLINE (1983 to March 1997) was searched by keyword: fire, burn, etiology, cause, prevention, epidemiology, and smoke detector/alarm. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by keyword: as above, and safety, skills, education, and training. Other sources included references of retrieved publications, review articles, and books; Injury Prevention hand search; government documents; and internet sources. Sources relevant to residential fire injury prevention were selected, evaluated, and summarized. Results—Forty three publications were selected for review, including seven randomized controlled trials, nine quasiexperiments, two natural experiments, 21 prospective cohort studies, two cross sectional surveys, one case report, and one program evaluation. These studies examined the following types of interventions: school (9), preschool (1), and community based educational programs (5); fire response training programs for children (7), blind adolescents (2), and mentally retarded adults (5) and children (1); office based counseling (4); home inspection programs (3); smoke detector giveaway campaigns (5); and smoke detector legislation (1). Conclusions—This review of house fire prevention interventions underscores the importance of program evaluation. There is a need for more rigorous evaluation of educational programs, particularly those targeted at schools. An evidence based, coordinated approach to house fire injury prevention is critical, given current financial constraints and the potential for program overload for communities and schools.

All terrain vehicle ownership, use, and self reported safety behaviours in rural children

Objectives—To describe all terrain vehicle (ATV) ownership, access, use, and safety behaviours in rural Manitoba children. Methods—Questionnaire administered to a convenience sample of grade 6 students attending an agricultural fair. Results—162 grade 6 children participated. The mean age was 11.4 years, and 46% were male. 125 students (77%) reported having access to ATVs, including 69 four wheeled, 24 three wheeled, and four both three and four wheeled ATVs. ATV experience was reported in 95 students, significantly more often in males and among those with a family owned ATV, with no difference between children living on a farm and in a town. Use of helmets and protective clothing was inadequate (10–40%), and dangerous riding habits common, with males and children living on a farm reporting significantly fewer desirable behaviours. Conclusions—ATVs are commonly used by children in rural Manitoba, with inadequate protective gear and dangerous riding habits. Mandatory rider training, consumer and dealer education, and legislation enforcement could improve ATV safety in this population.

An observational study of protective equipment use among in-line skaters

Objectives—To describe the patterns of protective equipment use by in-line skaters in Winnipeg, Manitoba and nearby rural communities. Methods—In-line skaters were observed for three months in 1996 at 190 urban and 30 rural sites selected using a formal sampling scheme. Age, gender, protective equipment use, skating companions, correct helmet use, and use of headphones were recorded. Results—Altogether 123 in-line skaters were observed at 61 sites, including one rural site. No skaters were observed at the remaining sites. There were 37 adults and 86 children; 56% were male. Helmet use was 12.2% (95% confidence interval (CI ) = 6.4% to 18.0%), wrist guard use was 16.3% (95% CI = 9.7% to 22.8%), knee pad use was 9.8% (95% CI = 5.2% to 16.4%), and elbow pad use was 7.3% (95% CI = 3.4% to 13.4%). Children were more likely to wear a helmet than teens 12–19 years of age (relative risk (RR) = 30, 95% CI = 4.01 to 225). Adults were more likely to wear wrist guards than children (RR = 4.32, 95% CI = 1.87 to 9.94). No gender differences were found. Incorrect helmet use was documented in four skaters; three skaters were wearing headphones. Conclusions—Low rates of protective equipment use were documented in our region, significantly lower than those reported in the literature. Barriers to equipment use are not known, and should be examined by further study. In-line skating safety programs should be developed, promoted, and evaluated. Teens should be targeted for future preventive efforts.

Modeling improvements in booster seat use: a discrete choice conjoint experiment.

Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.

Developing injury indicators for Canadian children and youth: a modified-Delphi approach

Objective To develop a set of national injury indicators for Canadian children and youth which will eventually be used to reflect and monitor identified prevention priorities. Methods The Canadian Injury Indicators Development Team brought together injury researchers, policy makers, and practitioners to develop injury indicators in the following areas: overall health services implications; motor vehicle occupant; sports, recreation, and leisure; violence; and trauma care, quality, and outcomes. A modified-Delphi process was used to establish a set of indicators that met evidence-based criteria, were useful, and that would prompt action. Each indicator was rated by 132 respondent injury experts and stakeholders on its usefulness and ability to prompt action to reduce injury among Canadian children and youth. Results From an initial list of 51 indicators, a refined set of 34 indicators was established. Indicators were grouped into three categories related to: policies; risk and protective factors; and outcomes. Indicators related to motor vehicle injury were rated as most useful and most able to prompt action. Injury mortality rate and injury hospitalisation rate were also rated highly for both usefulness and ability to prompt action. Policy, violence, sport and recreation, and trauma indicators were all rated higher for usefulness, but somewhat lower for ability to prompt action. Conclusion Results suggest that a broad-based modified-Delphi process is an important first step in developing useful and relevant indicators for injury prevention activity focused on Canadian children and youth.

Challenges in the Accurate Surveillance of Booster Seat and Bicycle Helmet Usage by Children: Lessons from the Field

Motor vehicle collisions and bicycle collisions and falls are a leading cause of death by preventable injury for children. In order to design, implement and evaluate campaigns and programs aimed at improving child safety, accurate surveillance is needed. This paper examined the challenges that confront efforts to collect surveillance data relevant to child traffic safety, including observation, interview, and focus group methods. Strategies to address key challenges in order to improve the efficiency and accuracy of surveillance methods were recommended. The potential for new technology to enhance existing surveillance methods was also explored.