Pauline J. Gulliver

Child maltreatment: variation in trends and policies in six developed countries

We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada). One or more child protection agency indicators increased in five of six countries, particularly in infants, possibly as a result of early intervention policies. Comparisons of mean rates between countries showed five-fold to ten-fold differences in rates of agency indicators, but less than two-fold variation in violent deaths or maltreatment-related injury, apart from high rates of violent child death in the USA. These analyses draw attention to the need for robust research to establish whether the high and rising rates of agency contacts and out-of-home care in some settings are effectively reducing child maltreatment.

Personality factors as predictors of persistent risky driving behavior and crash involvement among young adults

Objectives: The aim of this study was to examine the relationship between personality factors assessed during adolescence and persistent risky driving behavior and traffic crash involvement among young adults. Design: Data for this investigation were drawn from the Dunedin Multidisciplinary Health and Development Study, a longitudinal study of a cohort born in Dunedin, New Zealand. Subjects: The study population was 1037 young people born between 1 April 1972 and 31 March 1973. Main outcome measures: The main outcome measures were persistent risky driving behaviors and crash involvement, collected in a face-to-face road-safety interview at ages 21 and 26. Results: The only outcomes for which there were sufficient numbers of females were a driver involved in any crash and a driver involved in an injury crash. Univariate logistic regression revealed that there were no significant predictors for either of these outcomes. For the males, at the univariate level, aggression, traditionalism, and alienation were the personality scales most frequently associated with risky driving behavior and crash risk. After adjusting for driving exposure, only high levels of aggression predicted being a driver involved in a crash, and alienation predicted being a driver involved in an injury crash. Conclusion: These results suggest that road-safety interventions seeking to deter young adult males from persistent risky driving behavior need to be directed at those who do not endorse traditional views, are aggressive, and feel alienated from the rest of society.

Usual water-related behaviour and 'near-drowning' incidents in young adults.

Objective: To describe usual water‐related behaviour and ‘near‐drowning’ incidents in a cohort of young New Zealand adults.

Risk factors for injury in rugby union football in New Zealand: a cohort study

Objective To identify risk factors for injury in amateur club rugby. Design Prospective cohort design; with follow-up over the 2004 season. Setting Amateur club rugby in New Zealand. Participants Seven hundred and four male rugby players, aged 13 years and over. Assessment of risk factors The study investigated the independent effect on injury incidence of age, ethnicity, rugby experience, height, weight, body mass index, physical activity, cigarette smoking, previous injury, playing while injured, grade, position, training, time of season, warm-up, foul play, weather conditions, ground conditions and protective equipment. Generalised Poisson regression was used to estimate the effect of each factor after adjusting for all other factors. Main outcome measures Game injury, defined as ‘any event that resulted in an injury requiring medical attention or causing a player to miss at least one scheduled game or team practice’. Results A total of 704 players, representing 6263 player-games, contributed information on injury and exposure. Evidence was obtained of the effect on injury incidence of increasing age, Pacific Island versus Maori ethnicity (injury rate ratio (IRR)=1.48, 1.03–2.13), ≥40 h strenuous physical activity per week (IRR=1.54, 1.11–2.15), playing while injured (IRR=1.46, 1.20–1.79), very hard ground condition (IRR=1.50, 1.13–2.00), foul-play (IRR=1.87, 1.54–2.27) and use of headgear (IRR=1.23, 1.00–1.50). Conclusions Opportunities for injury prevention might include promoting injury-prevention measures more vigorously among players of Pacific Island ethnicity, ensuring injured players are fully rehabilitated before returning to play, reducing the effects of ground hardness through ground preparation and stricter enforcement of the laws relating to foul play.

A Longitudinal Examination of the Relationship between Adolescent Problem Behaviors and Traffic Crash Involvement during Young Adulthood

Previous research examining the relationship between adolescent problem behaviors and young adult traffic outcomes (crashes, convictions, risky driving) has produced differing results. Possible reasons for this may be the heterogeneity of the crash outcomes (from minor fender-benders to fatal crashes), the gender of the driver, and/or the age of the driver. The aim of this research was to investigate the relationship between adolescent problem behaviors and young adult crashes to determine the extent to which the above factors influenced this relationship. This study was part of the Dunedin Multidisciplinary Health and Development Study (DMHDS), which is a longitudinal study of a cohort (n = 1,037) born in Dunedin, New Zealand, from April 1972 to March 1973. This cohort has been followed up regularly since birth, and the data for the present research were obtained at the 18-, 21-, and 26-year-old follow-up interviews. The problem behaviors examined were those identified by Jessor in the theory of problem behavior, namely, tobacco smoking, marijuana use, alcohol use, delinquent behavior, and unsafe sexual behavior. Data for these measures were obtained in personal interviews when the cohort was aged 18 years. The self-reported crash data were obtained at the age 21 and age 26 follow-up interviews. Driving exposure, academic qualifications, employment, being a parent, and marital status were included as potential confounders. The results show that involvement in adolescent problem behaviors predicted crash involvement at age 21 for the females but not the males and at age 26 for the males but not the females. Possible explanations for these differences by age and gender are discussed.

The epidemiology of home injuries to children under five years in New Zealand

Objective:

Is length of stay in hospital a stable proxy for injury severity

Research question Is length of stay (LoS) in hospital a stable proxy for severity of injury when monitoring time trends in serious injury incidence? Objective To investigate whether LoS metrics (mean, median and proportion exceeding several LoS thresholds) have changed over time for injury diagnoses with known severity. Design Time series investigation. Subjects and setting New Zealand population admitted to hospital for injury and discharged during the period 1989 to 1998. Main outcome measures Interpolated median and geometric mean lengths of stay, as well as the proportion of cases that have an LoS greater than or equal to 3, 4, 7 and 14 days in hospital. Methods ICD-9-CM diagnoses that are approximately homogeneous in regard to severity of injury (ICD-HS diagnoses) were identified. Trends were investigated in the LoS statistics for: injury and non-injury diagnoses combined; all injury diagnoses; major body sites of injury; severity strata; and ICD-HS diagnoses. Results Almost without exception, there was a decline in the LoS statistics over time for all diagnoses, all injury diagnoses, each body site of injury investigated, severity strata, and the ICD-HS diagnoses. Conclusions Reductions in median and geometric mean LoS over time, as well as reductions in the proportion exceeding selected LoS thresholds, were due to factors other than reductions in the incidence of serious injury; for example, changes in service delivery over time. An LoS threshold should not be used as a proxy for severity of injury if the goal is to monitor time trends in injury incidence.

Internationally comparable diagnosis-specific survival probabilities for calculation of the ICD-10-based Injury Severity Score.

BACKGROUND The International Statistical Classification of Diseases, 10th Revision (ICD-10)–based Injury Severity Score (ICISS) performs well but requires diagnosis-specific survival probabilities (DSPs), which are empirically derived, for its calculation. The objective was to examine if DSPs based on data pooled from several countries could increase accuracy, precision, utility, and international comparability of DSPs and ICISS. METHODS Australia, Argentina, Austria, Canada, Denmark, New Zealand, and Sweden provided ICD-10–coded injury hospital discharge data, including in-hospital mortality status. Data from the seven countries were pooled using four different methods to create an international collaborative effort ICISS (ICE-ICISS). The ability of the ICISS to predict mortality using the country-specific DSPs and the pooled DSPs was estimated and compared. RESULTS The pooled DSPs were based on a total of 3,966,550 observations of injury diagnoses from the seven countries. The proportion of injury diagnoses having at least 100 discharges to calculate the DSP varied from 12% to 48% in the country-specific data set and was 66% in the pooled data set. When compared with using a country’s own DSPs for ICISS calculation, the pooled DSPs resulted in somewhat reduced discrimination in predicting mortality (difference in c statistic varied from 0.006 to 0.04). Calibration was generally good when the predicted mortality risk was less than 20%. When Danish and Swedish data were used, ICISS was combined with age and sex in a logistic regression model to predict in-hospital mortality. Including age and sex improved both discrimination and calibration substantially, and the differences from using country-specific or pooled DSPs were minor. CONCLUSION Pooling data from seven countries generated empirically derived DSPs. These pooled DSPs facilitate international comparisons and enables the use of ICISS in all settings where ICD-10 hospital discharge diagnoses are available. The modest reduction in performance of the ICE-ICISS compared with the country-specific scores is unlikely to outweigh the benefit of internationally comparable Injury Severity Scores possible with pooled data. LEVEL OF EVIDENCE Prognostic and epidemiological study, level III.

Hitting Back Women’s Use of Physical Violence Against Violent Male Partners, in the Context of a Violent Episode

This article explores women’s use of physical violence in the context of experiencing intimate partner violence (IPV). Data were drawn from the New Zealand Violence Against Women Study, a cross-sectional household survey conducted using a population-based cluster-sampling scheme. Multinomial logistic regression was used to identify factors associated with women’s use of physical violence against their partners when they were being physically hurt. Of the 843 women who had experienced physical violence perpetrated by an intimate partner, 64% reported fighting back at least once or twice whereas 36% never fought back. Analyses showed that women’s use of violence more than once or twice was associated with experience of severe IPV, IPV that had “a lot of effect” on their mental health, and with children being present when the woman was being physically abused. Women’s use of physical violence only once or twice was associated with both partners having alcohol problems and both having been exposed to violence as a child. Of the women who fought back, 66% reported that this did not result in the violence stopping.

Pre-licensed driving experience and car crash involvement during the learner and restricted, licence stages of graduated driver licensing: Findings from the New Zealand drivers study.

OBJECTIVE The aim of this study was to determine whether pre-licence driving experiences, that is driving before beginning the licensing process, increased or decreased crash risk as a car driver, during the learner or the restricted licence stages of the graduated driver licensing system (GDLS). METHOD Study participants were 15-24 year old members of the New Zealand Drivers Study (NZDS) - a prospective cohort study of newly licensed car drivers. The interview stages of the NZDS are linked to, the three licensing stages of the GDLS: learner, restricted and full. Baseline demographic (age, ethnicity, residential location, deprivation), personality (impulsivity, sensation seeking, aggression) and, behavioural data, (including pre-licensed driving behaviour), were obtained at the learner licence interview. Data on distance driven and crashes that occurred at the learner licence and restricted licence stages, were reported at the restricted and full licence interviews, respectively. Crash data were also obtained from police traffic crash report files and this was combined with the self-reported crash data. The analysis of the learner licence stage crashes, when only supervised driving is allowed, was based on the participants who had passed the restricted licence test and undertaken the NZDS, restricted licence interview (n=2358). The analysis of the restricted licence stage crashes, when unsupervised driving is first allowed, was based on those who had passed the full licence test and completed the full licence interview (n=1428). RESULTS After controlling for a range of demographic, personality, behavioural variables and distance driven, Poisson regression showed that the only pre-licence driving behaviour that showed a consistent relationship with subsequent crashes was on-road car driving which was associated with an increased risk of being the driver in a car crash during the learner licence period. CONCLUSION This research showed that pre-licensed driving did not reduce crash risk among learner or restricted licensed drivers, and in some cases (such as on-road car driving) may have increased risk. Young people should be discouraged from the illegal behaviour of driving a car on-road before licensing.