William Haddon

A logical framework for categorizing highway safety phenomena and activity.

A LOGICAL FRAMEWORK FOR CATEGORIZING HIGHWAY SAFETY PHENOMENA AND ACTIVITY WILLIAM HADDON; The Journal of Trauma: Injury, Infection, and Critical Care

A CONTROLLED STUDY OF THE EFFECT OF TELEVISION MESSAGES ON SAFETY BELT USE

A set of television messages based on the findings of a preliminary study of factors associated with actually observed use of safety belts was produced and shown on one cable of a dual cable television system for nine months. Observations of actual use of safety belts were obtained before and throughout the study period. The automobiles in which safety belt use was observed were matched to the households of experimental and control cables through license numbers, motor vehicle registry files and the cable company files. The television messages had no effect whatsoever on safety belt use. This study adds to the growing body of evidence that a behavior modification approach is an inefficient and often ineffective means of reducing highway losses. Passive approaches, i.e., those which reduce the frequency and severity of damage to people and property irrespective of voluntary action show greater promise of reducing highway losses. (A)

A Controlled study of fatal automobile accidents in New York City

Drivers of non-commercial automobiles fatally injured in accidents in New York City were compared with non-involved drivers passing the accident sites at the same times of day and on the same days of week. The greatest difference between the two groups was in the prior use of alcohol. Among drivers rated as probably responsible for their accidents 73 per cent had been drinking to some extent whereas only 26 per cent of the similarly exposed, but non-involved drivers had been drinking. Forty-six per cent of the accident-responsible group had blood alcohol concentrations in the very high, 250 mg % and over, range. In contrast, not a single one of the drivers in the large control group had a concentration in this range. Also represented in the fatally-injured group, but not in the control group, were drivers of fleeing stolen cars, one driver killed in a drag race and a small group of drivers, all in the fifth decade of life, whose accidents resulted from the prior, medical incapacitation. It is pointed out that all of the drivers in these latter categories were sober, and that the occurrence of accidents in the medical group should not per se be used in justification of programs of medical license restrictions on the basis of present evidence. Those fatally-injured were significantly closer to home than were the similarly exposed, but non-involved drivers, and almost none of those fatally-injured lived outside the city. The case group was composed entirely of males. Although few women were driving at the times and places of the predominantly nighttime and early morning accidents, males were nonetheless significantly overrepresented in the case group. The fatally-injured were also significantly less often married, and in the entire case-control group those not married had significantly higher alcohol concentrations than those married. The fatally-injured drivers were not significantly different in age or socioeconomic status from the similarly exposed but non-involved controls, and no association between accident involvement and vehicle age were found. Finally, it is suggested that alcoholism rather than merely social drinking was involved in the case of the drivers with very high alcohol concentrations.

Automobile head restraints--frequency of neck injury claims in relation to the presence of head restraints.

THE STUDY SAMPLE CONSISTED OF 67,143 INSURANCE CLAIMS; THE MANUAL SEARCH OF THE FILES ASSOCIATED WITH THESE CLAIMS LED TO THE IDENTIFICATION OF 6,833 STRUCK CARS MEETING THE STUDY CRITERIA. FOR THESE CLAIMS THE FOLLOWING ITEMS OF DATA WERE RECORDED FOR EACH FORWARD CAR: MODEL YEAR, MANUFACTURER, SEX OF THE DRIVER, AND WHETHER ANY TYPE OF NECK OR BACK INJURY WAS CLAIMED. IT WAS DETERMINED THAT THERE WAS AN 18 PERCENT REDUCTION IN THE FREQUENCY OF CLAIMED NECK INJURIES TO DRIVERS (BOTH SEXES COMBINED) IN CARS WITH HEAD RESTRAINTS AS STANDARD EQUIPMENT WHEN COMPARED WITH THE FREQUENCY FOR DRIVERS IN CARS WITHOUT HEAD RESTRAINTS AS STANDARD EQUIPMENT. SIMILAR RESULTS BY SEX OF DRIVER ARE ALSO PRESENTED. AN ANALYSIS BY MANUFACTURER REVEALED DIFFERENCES SIMILAR TO THE OVERALL PATTERN, BUT THE NUMBERS OF OBSERVATIONS WHEN DIVIDED INTO THESE VARIOUS SUBGROUPS WERE GENERALLY TOO SMALL TO SUPPORT FIRM CONCLUSIONS. THE RESULTS OF A VISUAL SURVEY OF DRIVERS IN 4,983 MOVING DOMESTIC PASSENGER CARS WITH ADJUSTABLE HEAD RESTRAINTS IN THE LOS ANGELES AND WASHINGTON, D. C. METROPOLITAN AREAS INDICATED THAT IN THE LOS ANGELES AREA, 74 PERCENT OF THE MALE DRIVERS AND 57 PERCENT OF THE FEMALE DRIVERS HAD THE HEAD RESTRAINTS IMPROPERLY POSITIONED WHILE IN THE WASHINGTON, D. C. AREA 93 PERCENT OF THE MALES AND 80 PERCENT OF THE FEMALES HAD THE RESTRAINTS IMPROPERLY POSITIONED. THE STUDY IS CONCLUDED WITH A DISCUSSION OF PREVIOUS RESEARCH ON WHIPLASH INJURIES AND HEAD RESTRAINTS.

Energy Damage and the Ten Countermeasure Strategies

A major class of ecologic phenomena involves the transfer of energy in such ways and amounts, and at such rapid rates, that inanimate or animate structures are damaged. The harmful interactions with people and property of hurricanes, earthquakes, projectiles, moving vehicles, ionizing radiation, lightning, conflagrations, and the cuts and bruises of daily life illustrate this class. There are ten strategies for reducing the human and other losses that make this class of social concern. These are identified in logical sequence and copiously illustrated by tactics widely employed. The reduction of animate and inanimate damage due to interaction with most environmental hazards, including pollutants, drugs, and microorganisms can be approached in the same manner, as can strategies for population control. Appendices provide additional examples and four illustrative case studies concerned, respectively, with reducing: losses associated with femoral fractures among the elderly; thermal energy damage to children and others; drownings; mob damage to the White House or other private or public building.

Caries in deciduous teeth in relation to maternal ingestion of fluoride.

THE prophylactic effect of fluoride in the pre,vention of dental ca,ries is well established, and this effect is known to be greate.st when teeth are exposed during the period of calcification. Since much of the enamel of deciduo-us teeth calcifies prior to birth, the po,ssible benefit from maternal ingestion of fluoride during pre,gnancy is a subject of both practical and theoretical interest. A recent report (1) states that 25 ppm of fluoride (a,s Na,F) in water given rats during gestation had no effect on caries incidence in the offspring. Evidence regarding transplacental passage of fluoride is conflicting. The existence of a placental barrier which mediates and perhaps impedes the transfer of the ion has been suggested (2, 3). However, in man, a considerably higher cord-blood fluoride concentration has been demonstrated with mothers exposed to fluoridated water throughout pregnancy (4). Although these investigations are of interest, they do not answer the fundamental question as to the effects of maternal ingestion of fluoride during pregnancy on the occurrence of caries in the deciduous teeth of offspring. This report provides such information for 178 children who were in utero before and after the beginning of water fluoridation in Newburglh, N.Y.

FREQUENCY OF MEDICAL X-RAY EXAMINATIONS IN MONROE COUNTY, NEW YORK.

LN RECENT YEARS, a substantial interest has developed in the doses of ionizing radiation received by the population from manmade and natural sources. This interest has stemmed from an increasing awareness of the genetic and somatic effects of ionizing radiation and from the realization that the radiation exposures received by the population may not always be so small as to be without harmful effects. Of the various forms of manmade radiation, that administered during diagnostic X-ray practice is the largest contributor to population exposure. Laughlin and associates (1) have estimated that medical exposures in the United States deliver an average gonadal dose of 5 roentgens during the prereproductive years of life. A comprehensive epidemiologic and dosimetric study (2) in the United Kingdom in 1960 indicated that the medical sources of that country deliver an exposure of about 0.5 roentgen to the reproductive organs of the population during the first 30 years of life. Benefits from the use of X-rays in the diagnosis and treatment oif disease are substantial. If unnecessary irradiation is avoided, biomedical risks to the individual patient are not likely to be large, although their cumulative effect in the entire population may be substantial. In view of such cumulative effects, the increasing application of X-rays in medicine, and the not infrequent carelessness with which these X-rays a.re used, pulblic health authorities need detailed and continuing information lon the radiological practices of the health professions. The numbers and types of examinations being performed largely determine the doses of ionizing radiation received by the population from X-ray sources. Thus, surveys to develop such information are an important part of public health programs concerned with the use, effects, and control of ionizing radiation. Surveys of appropriate population groups not only permit an evaluation of the general magnitude of the radiation dosage levels to which the public is exposed, but also, through the use of suitable dosimetric data, may provide relatively precise estimates of the doses certain critical tissues receive. This paper reports a survey to determine the frequencies of the various medical radiological examinations performed in a large, predominantly urban popula.tion. It describes the second of two similar surveys; the first dealt with radiological examinations performed by dentists (3).