Tracy Young

Teenage driver crash incidence and factors influencing crash injury by rurality.

BACKGROUND Previous research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads. METHODS All crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes. RESULTS For younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider. CONCLUSIONS Intervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways. IMPACT ON INDUSTRY Teen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways.

Occupational Injuries Among Emergency Medical Service Providers in the United States

Objective: Occupational injury is a significant problem among emergency medical services (EMS) providers. A national survey was conducted to describe the problem of occupational injury among EMS providers. Methods: This study examined the most common types of nonfatal injuries and the activities and environments where injury most frequently occurred, including additional variables and paid versus volunteer status. Results: Occupational injury in the past 12 months was reported by more than 29% of 659 survey respondents, with multiple injuries reported by 64% of those reporting an injury. Paid providers had approximately twice the prevalence of overall injury than volunteer providers, controlling for age and gender. Paid providers were more likely than volunteer providers to experience back injury and physical assault. Conclusions: This study clearly identifies important occupational injury problems in EMS, including the need to examine paid and volunteer providers as separate occupational groups.

A population based study of reporting patterns and characteristics of men who abuse their female partners

Objective: This study estimates the prevalence of male abusive behavior reported by men and their female partners and identifies characteristics of abusive men. Design: Baseline survey from a population based cohort study of general health. Setting: A rural county in Iowa, USA. Subjects: 572 men and their cohabitating female partners. Main outcome measures: Male-to-female physical, emotional, and sexual abuse reported by either partner. Results: In this cohort, 13.6% of men had performed at least one act of physical abuse and 34.9% emotional abuse. More than 45% of abusive men reported their own behaviors. Alcohol problems, antisocial personality characteristics, depressive symptoms, and financial stress were all positively associated with both physical and emotional abuse, but suicidal thoughts were less likely among abusers. Conclusion: Identification of common characteristics of abusive men may predict proclivity towards partner violence and barriers to behavior modification.

Implementation Evaluation of Steering Teens Safe Engaging Parents to Deliver a New Parent-Based Teen Driving Intervention to Their Teens

Parents play a fundamental role in teaching their children safe driving skills to reduce risk of motor vehicle crashes, the leading cause of death for teens. Steering Teens Safe is a new parent-based intervention that equips parents with communication skills to talk about, demonstrate, and practice safe driving behaviors and skills with their teens. This implementation evaluation focuses on a sample of 83 parents who delivered Steering Teens Safe to their teens. One-, 2- and 3-month follow-up assessments were conducted with intervention parents to evaluate the self-reported quantity and quality of talking about, demonstrating, and practicing safe driving goals with teens; perceived success and benefit of the program; and barriers to implementation. Over 3 months of follow-up, parents discussed driving goals with their teens for a median of 101.5 minutes. The most frequently addressed topics were general safety principles, including distracted driving, driving in bad weather, wearing a seat belt, and being a safe passenger. Parents spent a median of 30 minutes practicing safe driving skills such as changing lanes. Sixty-seven percent of parents talked to their children about rural road safety, but just 36% demonstrated and half practiced these skills with their teens. Barriers to implementation include time and opportunity barriers and resistant attitudes of their teens. However, barriers neither affected frequency of engagement nor parents’ perceived benefit and comfort in delivering the program. Parents with time/opportunity barriers also had higher practice and demonstration times than parents without these barriers. Findings indicate high acceptability among parent implementers and promise for real-world delivery. Future studies are needed to assess intervention impact.

Smoke alarms by type and battery life in rural households: a randomized controlled trial.

BACKGROUND Although the use of smoke alarms is widely recommended, little guidance is available on the types of alarms and batteries that function best. This study examined smoke alarm and battery function 12 months after installation in rural residential households. METHODS An RCT, involving the installation of either a photoelectric or ionizing smoke alarm with either a lithium or carbon-zinc battery, was conducted in 643 rural Iowa households in July 2003. The functionality of each installed smoke alarm was tested 12 months later. Generalized estimating equations were used to model the effects of alarm type and battery type on alarm function and false alarms 12 months after installation. RESULTS Of 643 study homes, 98.8% had at least one functioning alarm, and 81.5% had all alarms functioning 12 months after installation. No difference was observed in alarm function between photoelectric alarms and ionizing alarms 12 months after installation (OR=1.30, 95% CI=0.88, 1.92). However, photoelectric alarms had significantly lower odds of false alarms than ionizing alarms. Alarms with lithium batteries had 91% higher odds of functioning than those with carbon-zinc batteries. The main reasons for nonfunctioning included a missing battery (30.7%); a missing alarm (28%); and a disconnected battery (11.3%). CONCLUSIONS Although lithium batteries and photoelectric alarms are more expensive than their counterparts, the financial investment might be worthwhile in terms of overall performance.

Steering teens safe: a randomized trial of a parent-based intervention to improve safe teen driving

BackgroundCrashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving.MethodsSteering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for analysis.ResultsIntervention teens ranked their parent’s success in talking about driving safety higher than control teens (p = 0.035) and reported that their parents talked about more topics (non-significant difference). The Risky Driving Score was 21% lower in intervention compared to control teens (85% CI = 0.60, 1.00). Interaction between communication quantity and the intervention was examined. Intervention teens who reported more successful communication had a 42% lower Risky Driving Score (95% CI = 0.37, 0.94) than control parents with less successful communication.ConclusionsThis program had a positive although not strong effect, and it may hold the most promise in partnership with other programs, such as Driver’s Education or Graduated Driver’s License policies.Trial registrationClinicalTrials.gov NCT01014923. Registered Nov. 16, 2009.

Smoke Alarm and Battery Function 42 Months After Installation A Randomized Trial

BACKGROUND This randomized trial presents findings from the longest follow-up study of smoke alarm and battery function to date. PURPOSE The purpose of this study is to examine differences in long-term function of smoke alarm and battery combinations. METHODS A total of 691 households in an ongoing cohort study were randomly allocated into smoke alarm groups of ionizing and photoelectric and battery groups of zinc and lithium. Smoke alarm function was measured in 633 (91.6%) households from January 2007 through February 2008, 42 months following original smoke alarm/battery installation. Data analyses were conducted in 2009. RESULTS After 3.5 years, 81.9% of the 1898 smoke alarms were functional. Ionizing alarms with zinc batteries were the least likely to function (72.7%). In comparison, photoelectric alarms with lithium batteries were 2.9 times (95% CI=1.8, 4.5) more likely to function; ionizing alarms with lithium batteries were 2.0 times (95% CI=1.3, 3.1) more likely to function; and photoelectric alarms with zinc batteries were 1.7 times (95% CI=1.1, 2.5) more likely to function. Functionality was strongly tied to number of reports of nuisance alarms, which was higher for ionizing than photoelectric alarms. CONCLUSIONS Photoelectric smoke alarms and lithium batteries are the most likely to function long after smoke alarm installation, and may be worthwhile investments despite their increased cost.

Emergency department visits for nonfatal childhood injuries in Romania.

Background Childhood injury rates are higher in low and middle-income countries than in high-income countries. Childhood injuries have not been widely studied in Romania, a middle-income country, because data sources are lacking. Objective This study presents the first surveillance data of nonfatal childhood injuries from a large childrens hospital in Cluj, a major city of Romania. Methods This retrospective study included review of medical records of injured children of 0–18 years of age treated in a major city pediatric emergency department from 1999 to 2003. Results In the 5-year study period, 1179 childhood injuries were treated in the emergency department, for an average of 236 patients per year. For the county of Cluj, this represents an annual average injury incidence of 197 per 100 000 children younger than 5 years, 140 per 100 000 children aged 5–14 years, and 135 per 100 000 for children aged 15–18 years. Unintentional injuries represented 77.8% of cases, 18% were self-harm and suicide attempts, and 4.3% were assaults. Conclusion These trends, among the first reported from Romania, can help identify priority prevention areas.

Effect of war on weapon-related deaths in Croatian children and youth.

OBJECTIVE To identify trends in weapon-related deaths associated with the Homeland War (1991-1995) among children in Croatia. DESIGN Retrospective review. PARTICIPANTS Croatian children aged from birth through 19 years who died as the result of a weapon-related injury from 1986 through 2005. Main Exposure Injury deaths of children by intent (homicide, suicide, operations of war, and unintentional), cause, and age. OUTCOME MEASURES Number and rate of injury deaths among Croatian children before, during, and after the war. RESULTS Compared with the period before the war, weapon-related homicide and suicide rates increased by more than 3-fold, and unintentional weapon-related deaths increased by more than 6-fold during the war. These increases persisted for 5 years following the end of the war and decreased more than 5 years after the war. Death rates from non-weapon causes did not increase during this period. Overall, 81.9% of the weapon-related deaths were caused by firearms and 18.1% were caused by explosive devices. CONCLUSIONS The Homeland War led to an increase in weapon-related deaths of all intents. Programs that focus on the prevention of weapon-related injuries should be integrated into programs that assist countries in rebuilding after political unrest.

Rural Roadway Safety Perceptions Among Rural Teen Drivers Living in and Outside of Towns

PURPOSE To compare perceptions about rural road and general driving behaviors between teens who live in- and out-of-town from rural communities in Iowa. METHODS A cross-sectional survey was conducted with 160 teens anticipating their Intermediate License within 3 months upon enrollment into this study. Self-administered surveys were used to collect demographics and driving exposures (eg, frequency of driving, age when first drove unsupervised). Two Likert scales were included to measure agreement with safe driving behaviors on rural roads and general safe driving behaviors (eg, speeding, seat belt use). T-tests were calculated comparing mean composite scores between in- and out-of-town teens, and between mean rural road and general driving safety attitude scores. A linear regression multivariable model was constructed to identify predictors of the rural road score. RESULTS While the majority of teens endorsed rural road and general safe driving behaviors, up to 40% did not. Thirty-two percent did not believe the dangers of animals on rural roads, and 40% disagreed that exceeding the speed limit is dangerous. In-town teens were less safety conscious about rural road hazards with a significantly lower mean composite score (4.4) than out-of-town teens (4.6); mean scores for general driving behaviors were similar. Living out-of-town and owning ones own car were significant predictors of increased rural road safety scores. CONCLUSION Rural, in-town teens have poorer safety attitudes about rural roadway hazards compared with out-of-town teens. Interventions that involve education, parental supervision, and practice on rural roads are critical for preventing teen crashes on rural roads.