bluuebunny/crossref_metadata_2025 huggingface dataset:
Surveillance of pediatric injury hospitalizations in Southern California.
Authors: Agran P. F. , Winn D. G. , Anderson C. L.
Published: October 2008

OBJECTIVES: This study was designed to determine the incidence and causes of injury hospitalizations/fatalities to children less than 15 years of age. SETTING: Central Orange County, California. DESIGN: Cases were identified through a population based hospital and coroner's office surveillance system. SUBJECTS: The sample consisted of children 0-14 years of age who were residents of the study area and sustained an injury between 1 January 1991 and 31 December 1992 resulting in hospitalization or death. RESULTS: Over the two year study period, 1361 children 0-14 years of age were hospitalized or died as a result of injury. This represents a crude annual injury rate of 318/100,000 children. Rates were highest for children less than 5 years--this age group sustained the highest rate for eight of nine specific causes of injury. Falls were the leading cause of hospitalizations for all ages. Pedestrian injuries were more common among children 1-4 years and 5-9 years, while bicycle injuries were more common among older children. CONCLUSIONS: This study, one of the first population based studies in a Southern California urban/suburban community, found lower rates of injury hospitalization than studies conducted over a decade ago. These lower rates may reflect changes in hospitalization trends and/or injury prevention programs. Comparisons with more recent studies in inner city communities in the north east also show regional differences in rates and causes. Injury prevention efforts should particularly address the higher injury rates among children less than 5 years of age. This study also illustrates the need for regional and local data to guide injury control.
Cycling to school--a significant health risk?
Authors: Kopjar B. , Wickizer T. M.
Published: October 2008

OBJECTIVES: The risk of injury to children riding bicycles has been previously documented. However, the specific risk arising from the use of bicycles as a mode of transportation to and from school is unknown. This study examines the incidence of bicycle related injuries among school age children. METHODS: A comprehensive prospective injury registration system was established in Stavanger, Norway. Data were obtained from this system to identify bicycle related injuries occurring from 1990-3 to children aged 10-15. The incidence of injuries was computed for two groups of children: (1) children cycling to school and (2) children cycling for other purposes. RESULTS: 352 children received medical treatment for bicycle related injuries, 12.6/1000 bicycle riders; 108 (30%) of the 352 children were injured while cycling to or from school. The incidence of bicycle related injuries was significantly higher for boys than girls. Seventy seven per cent of the injuries occurred in a non-collision accident, 9% in a collision with another bicycle, and 14% in a collision with a motor vehicle. Twenty per cent of the injured children sustained upper head injuries and 13% required inpatient treatment. Average maximum abbreviated injury severity (MAIS) score was similar for the injuries sustained during travel to/from school and other injuries. CONCLUSIONS: Bicycle related injuries occurring during travel to or from school are a significant contributor to the total incidence of bicycle related injuries. Increased attention among parents, school officials, public health officials, and medical professionals should be paid to this health risk.
Motor vehicle occupant injuries in children 2 years and younger: a comparison between Western Australia and New South Wales 1982-92.
Authors: Stevenson M. , Palamara P.
Published: October 2008

OBJECTIVES: To compare the age specific rate of passenger injury and associated restraint use for children 2 years and younger in the state of Western Australia (WA), with the state of New South Wales (NSW), Australia for the period 1982-92. SETTING: The states of WA and NSW, Australia. METHODS: A descriptive retrospective study of child passenger injuries in WA and NSW was conducted for the period 1 January 1982 to the 31 December 1992. The data provided information about the injured child, such as sex and restraint use, the driver, vehicle, and collision factors, such as time and posted speed limit. RESULTS: A total of 2280 children aged 0 to 2 years were injured in motor vehicle collisions during the study period. Of these children, 653 were from WA and 1627 from NSW. Both the injury and mortality rates were higher in WA compared with NSW over the study period. However 80% and 79% of child passengers injured in WA and NSW, respectively, were restrained at the time of injury. Thus both the sex of the driver and the year the motor vehicle was manufactured best predicted the likelihood of a child being restrained. CONCLUSIONS: As at 1992, WA's population age specific passenger injury rate for children 0-2 years was more than twice the rate in NSW. The comparable rate of reported restraint use by injured children 0-2 years in WA and NSW suggests that non-use of restraints cannot be singled out as the most likely cause of WA's comparatively high rate of injury. It is difficult to determine whether the disparity in rates could be explained by the child passenger's exposure to crash risk factors, as little is known about child passenger levels of exposure to these factors. Further research is needed to address this issue.
Can we prevent accidental injury to adolescents? A systematic review of the evidence.
Authors: Munro J. , Coleman P. , Nicholl J. , Harper R. , Kent G. , Wild D.
Published: October 2008

OBJECTIVES: As part of the Department of Health strategy The Health of the Nation, a systematic review of published and unpublished literature relating to the effectiveness of interventions in reducing accidental injury in the population aged 15-24 years was carried out. METHODS: The literature was reviewed under the standard setting headings of road, work, home, and sports and leisure, and graded for quality of evidence and strength of recommendation using a scale published in the UK national epidemiologically based needs assessment programme. RESULTS: The most effective measures appear to be legislative and regulatory controls in road, sport, and workplace settings. Environmental engineering measures on the road and in sports have relatively low implementation costs and result in fewer injuries at all ages. There is little evidence that purely educational measures reduced injuries in the short term. Community based approaches may be effective in all age groups, and incentives to encourage safer behaviour hold promise but require further evaluation. The potential of multifactorial approaches seems greater than narrowly based linear approaches. CONCLUSIONS: Few interventions to reduce injury in adolescents have been rigorously evaluated using good quality randomised controlled trials, and where such evidence is available, fewer have been shown to be definitely worthwhile. Many studies relied on surrogate measures rather than actual injury rates, and substantial issues relating to the efficacy or implementation of preventive measures in adolescent and young adult populations remain unresolved.
Bicycle ownership, use, and injury patterns among elementary schoolchildren
Authors: Waller Julian A
Published: October 2008

Patterns of bicycle ownership and injury were studied over a four month period among over 6000 schoolchildren. Two thirds of the bikes owned were standard style and one third high rise. Boys more often had high rise bikes. Slightly over 2% of bike owners are injured annually, but no differences were found according to bike style either in injury rate or severity. Bike borrowing and riding double were common factors in the injury events. Injury from spokes and loss of control because of loose handlebars were identified as problems resulting from product design.
Annual incidence of unintentional injury among 54,000 children.
Authors: Walsh S. S. , Jarvis S. N. , Towner E. M. , Aynsley-Green A.
Published: October 2008

OBJECTIVE: To enhance the case definition of unintentional injuries in childhood by applying an objective severity measure to fatal and non-fatal cases. DESIGN: A descriptive prospective epidemiological study of a defined resident childhood population (< 16 years of age) for a one year period, 1990. SETTING: Newcastle upon Tyne, England. Child population estimate for 1990 was 54,400. SUBJECTS: Resident children who died, were admitted to local hospitals, or attended local accident and emergency departments. OUTCOME MEASURES: Using recognised severity scoring systems (for example the injury severity score, trauma score) injuries were classified as severe, moderate, or mild. RESULTS: There were six deaths, 904 admissions, and 11,682 accident and emergency department attendances. All deaths, 25% of admissions, and 1% of accident and emergency attenders were classified as severe. The underlying determinants of severe injuries are different than those for all other injuries (for example age, social class). A comparison with a local survey in 1986 showed a 26% rise in hospital admissions, but no significant rise in the frequency of severe or moderately injured children. Comparisons with other international data showed higher rates of injury admissions and attendances for England, but no significant differences in the frequency of severe injuries. CONCLUSIONS: Objective severity scoring enhances the case definition of unintentional injuries in childhood by allowing for the identification, and, therefore, the more reliable ascertainment of severely injured children. This more completely ascertained set of population cases increases the accuracy of comparisons of injury frequency over time and by place, and, in addition, enhances our basic understanding about the epidemiological characteristics of childhood unintentional injury.
Teaching safety: evaluation of a children's village in Maryland.
Authors: Gielen A. C. , Dannenberg A. L. , Ashburn N. , Kou J.
Published: October 2008

OBJECTIVES: The purpose of this study was to evaluate Children's Village, a life safety education facility for children. SETTING: The study took place in Washington County, Maryland, a rural county. METHODS: Eight elementary schools with 20 second grade classrooms (410 students aged 7 and 8) were selected to participate. Using a quasiexperimental design, tests were administered to two cohorts of children before (pretest) and after (post-test) they attended the Children's Village during 1993-4. Parent and teacher surveys were also completed after the program. RESULTS: Among children who attended in December 1993-January 1994, there was a significant improvement in average test scores between the pretest (58% correct) and post-test (78%). Among children who attended in April 1994, there also was a significant improvement in test scores between pretest (74%) and post-test (85%). Among parents, 70% reported that their child learned a great deal at Children's Village and 33% reported having made changes in their home as a result. The parent survey also revealed that 25% of children and 35% of adults did not always wear their seat belts, and 74% of children did not always wear bicycle helmets. Teachers' responses to the program were generally positive. CONCLUSIONS: Children's Village brought together an extensive network of community leaders, parents, and teachers dedicated to safety education of children. The curriculum had a positive impact on children's knowledge and, to a lesser extent, on parents' safety practices. Program impact could be enhanced by more emphasis on automobile restraints and helmets (behaviors that parents reported were not consistently practiced) and by expanding the village services to parents as well as children. Others considering creating similar programs need to identify community leaders willing to commit the time, effort, and resources required to develop and sustain such programs.
Purchasing a cycle helmet: are retailers providing adequate advice?
Authors: Plumridge E. , McCool J. , Chetwynd J. , Langley J. D.
Published: October 2008

OBJECTIVES: The aim of this study was to examine the selling of cycle helmets in retail stores with particular reference to the adequacy of advice offered about the fit and securing of helmets. METHODS: All 55 retail outlets selling cycle helmets in Christchurch, New Zealand were studied by participant observation. A research entered each store as a prospective customer and requested assistance to purchase a helmet. She took detailed field notes of the ensuing encounter and these were subsequently transcribed, coded, and analysed. RESULTS: Adequate advice for helmet purchase was given in less than half of the stores. In general the sales assistants in specialist cycle shops were better informed and gave more adequate advice than those in department stores. Those who have good advice also tended to be more good advice also tended to be more active in helping with fitting the helmet. Knowledge about safety standards was apparent in one third of sales assistants. Few stores displayed information for customers about the correct fit of cycle helmets. CONCLUSIONS: These findings suggest that the advice and assistance being given to ensure that cycle helmets fit properly is often inadequate and thus the helmets may fail to fulfil their purpose in preventing injury. Consultation between retailers and policy makers is a necessary first step to improving this situation.
Cross cultural child injury prevention awareness.
Authors: Ritzel D. O. , Klein K. , Gast J. , Sarvela P. D.
Published: October 2008

PURPOSE: The purpose of this study was to determine how injury prevention awareness of children ages 3, 4, and 5, based on recognition of hazards in pictures differs in the United States, Belgium, East Germany and West Germany. METHODS: Children from these four countries were presented with 10 different pictures. Each picture represented a common injury producing situation to which children are exposed in traffic, home, and recreation. RESULTS: Results indicate that for pictures relating to home hazards, less than 22% of children from Belgium (21.5%), West Germany (4.7%), and the United States (20.3%) clearly recognized the essential hazards in the pictures, whereas over 40% of the East German children clearly recognized these dangers. A higher proportion of the children from all countries recognized the traffic hazards. Only 23.9% of all children had a clear recognition of the playground situations. The child's age had a bearing on ability to recognize hazards overall. CONCLUSIONS: Children need to be provided with better injury prevention education at an early age, especially those from West Germany.
The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in the UK: a pilot study.
Authors: Stone D. H. , Doraiswamy N. V.
Published: October 2008

OBJECTIVES: To assess the feasibility, strengths and weaknesses, and preventive utility of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in a paediatric setting in the UK. DESIGN: Implementation and operational evaluation of CHIRPP. SETTING: A paediatric accident and emergency department in Glasgow, Scotland, UK. METHODS: CHIRPP forms were used to collect and analyse data on the circumstances, mechanisms, and types of injuries in 2516 children (age range 0-13 years) presenting to the accident and emergency department over the period of 1 April 1993 to 31 January 1995. The strengths and weaknesses of CHIRPP were assessed by direct observation, discussion with staff, operation of the CHIRPP software, and scrutiny of the output. RESULTS: After initial technical problems, CHIRPP ran smoothly. Although parental compliance was high, staff compliance was low, and this resulted in a low capture rate. Tabulations indicated the potential of the system for identifying both hazardous environments and vulnerable population subgroups at whom specific preventive measures can be targeted. Specific proposals for enhancing the efficiency and preventive utility of CHIRPP in this setting were formulated. CONCLUSIONS: CHIRPP offers hospitals, public health departments, and government agencies in the UK a promising tool for planning national, regional, and local injury prevention.
Dog bites: how big a problem?
Authors: Sacks J. J. , Kresnow M. , Houston B.
Published: October 2008

OBJECTIVE: To estimate the magnitude of the dog bite problem in the US. METHODS: Data on dog bites were gathered as part of a 1994 national telephone survey of 5,238 randomly dialed households. Data were weighted to provide national estimates. RESULTS: The weighted total number of dog bites was 4,494,083 (estimated incidence = 18/1,000 population); of these, 756,701 persons sustained bites necessitating medical attention (incidence rate = 3/1,000). Children had 3.2 times higher medically attended bite rates than adults (6.4/1,000 children v 2/1,000 adults). CONCLUSIONS: More attention and research needs to be devoted to the prevention of dog bites. Potential prevention strategies include: educational programs on canine behavior, especially directed at children; laws for regulating dangerous or vicious dogs; enhanced animal control programs; and educational programs regarding responsible dog ownership and training. Unfortunately, the relative or absolute effectiveness of any of these strategies has not been assessed. Continuing surveillance for dog bites will be needed if we are to better understand how to reduce the incidence of dog bites and evaluate prevention efforts.
Limitations of child injury data from the CPSC's National Electronic Injury Surveillance System: the case of baby walker related data.
Authors: Weiss H. B.
Published: October 2008

OBJECTIVES: The US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) is a primary source for children's consumer product injury surveillance data in the US. Differing interpretations of the emergency department based NEISS baby walker data by various parties prompted this detailed examination, reclassification, and analysis of the NEISS data to explain these discrepancies. METHODS: Case selection was performed by searching the NEISS 1982-91 database for the baby walker product code and various text strings for children less than 24 months old. False negative and false positive cases were identified and reclassified. Adjusted population rates were computed and the types and locations of hospitals contributing to the sample were examined. RESULTS: One per cent false positive and 4% false negative misclassification rates were observed. In 1991, two children's hospitals reported 14% of the baby walker related injuries, though these hospitals made up just 2% of the sample frame. Through random allocation, one state currently contains four acute care hospitals and the only two children's hospitals reporting to the NEISS system. These six hospitals contributed 18% of the walker cases whereas the state represents only 3% of the US infant population. CONCLUSIONS: Misclassification in NEISS baby walker reports is minimal, with false negatives outweighing false positives. For trend analysis of product related injuries at the frequency of occurrence observed for baby walkers, NEISS suffers from low sensitivity due to sampling error. For children's injuries, NEISS' estimates have been affected by children's hospitals coming in and out of the sample and currently reflects a random geographic imbalance because one state contributes both of the reporting children's hospitals. To overcome these problems improved multiple product coding, a unique baby walker code, and stratification of children's hospitals in an enlarged NEISS sample is recommended.
Injuries and their relation to potential hazards in child day care.
Authors: Cummings P. , Rivara F. P. , Boase J. , MacDonald J. K.
Published: October 2008

OBJECTIVES: To prospectively determine the incidence rate of injuries that required medical attention among children in day care and to identify possible hazards related to these injuries. SETTING: King County, Washington. METHODS: Prospective cohort study of children in a sample of licensed day care facilities. RESULTS: From 1 July 1992 to 30 June 1993, 53 medically attended injuries were reported by 133 day care sites; incidence rate 1.9 per 100,000 hours of day care attendance. The rate of injury in 91 small family day care homes was essentially the same as that in 42 larger day care centers; relative rate 1.0 (95% confidence interval 0.6 to 1.9). Injuries that required sutures accounted for 39% of the cases, while 17% required a cast, splint, or sling. No child was hospitalized. Sixty nine sites were inspected and all had potentially correctable physical hazards, with a median of 15 hazards per site (range 7 to 26). These potential hazards had little relationship to the risk of injury and a case-by-case review identified only two injuries that might have been prevented by a more energy absorbent playground surface. CONCLUSIONS: The incidence of medically attended injuries found in this study is consistent with other studies from the United States. Most injuries were minor and had little relation to physical hazards at day care locations.
Can child fatalities in house fires be prevented?
Authors: Squires T. , Busuttil A.
Published: October 2008

OBJECTIVES: To analyse all child deaths in house fires in Scotland between 1980 and 1990. METHODS: Retrospective study of all child house fire fatalities based on the 'sudden death' investigation instigated by the procurator fiscal in whose jurisdiction the death occurred. The necropsy, toxicology, police, and fire brigade reports were examined in each case. RESULTS: There were 168 child deaths occurring in 118 house fires. In the 0-5 years age group 40% of deaths occurred in fires started as a direct result of the actions of children. The careless disposal of smoking materials was the most frequent cause of fatal fires killing older children. Upholstery and bedding were common materials of first ignition, accounting for over half the incidents. The majority of children were dead before the arrival of the emergency services and most died as a result of the inhalation of smoke. CONCLUSIONS: This survey emphasises the importance of 'self escape' which, particularly in the case of young children, requires the assistance of adult carers. The number of fires started as a result of children playing with sources of ignition raises important questions of supervision and the provision of a safe environment. There is, we contend, a need to highlight the importance of individual behaviour and responsibility while recognising the need to develop measures that are relevant to, and effective in, a particular socioeconomic context.
Airgun injuries in New Zealand, 1979-92.
Authors: Langley J. D. , Norton R. N. , Alsop J. C. , Marshall S. W.
Published: October 2008

OBJECTIVES: To describe the epidemiology of serious airgun injury in New Zealand. METHODS: Cases were selected from the New Zealand Health Information Service's hospital inpatient morbidity data files for the period 1979 to 1992 inclusive. RESULTS: There were 718 airgun related injuries resulting in 1.56 injuries/100,000 population/year. Males and 10-14 year olds had higher than average rates of injury. The majority of the incidents were unintentional. There has been a marked decline in injury rates since 1989. CONCLUSIONS: Airgun injuries, while not as serious as powder firearm injuries, account for a significant personal and societal burden. The results suggest that strategies aimed at controlling these injuries, especially those pertaining to children, are in need of review.
Golf cart related injuries in a North Carolina island community, 1992-4.
Authors: Passaro K. T. , Cole T. B. , Morris P. D. , Matthews D. L. , MacKenzie W. R.
Published: October 2008

OBJECTIVES AND METHODS: The use of electric golf carts for roadway transportation is increasing in many regions of the United States, but injuries associated with the operation of these vehicles have not been previously described. In response to reports of golf cart related injuries in a North Carolina island community, we reviewed ambulance call report (ACR) information to identify and describe all injuries related to golf cart operation in this community in 1992-4. We also conducted telephone interviews with the subset of injured people who consented to be contacted. SETTING: Bald Head Island, North Carolina. RESULTS: Twenty two people were included in the case series, and 55% of these provided interview information to supplement ACR data. Fifty nine per cent of the 22 injured people were injured when they fell from a moving golf cart; of those injured in this manner, all with available information on seating position were passengers (rather than drivers). Eighty six per cent received immediate medical treatment at a mainland hospital. Thirty two per cent of injury incidents occurred among children aged 10 or younger. Forty per cent of injured adults were known to have been drinking alcohol before their injuries occurred, while alcohol was not known to have been involved in any of the children's injuries (in terms of drinking either by children or by accompanying adults). CONCLUSIONS: In settings where golf carts are used for road transportation, their users and traffic safety officials should be aware of potential safety hazards associated with the use of these vehicles, and installation of appropriate occupant restraints should be considered seriously.
Teenagers' attitudes towards bicycle helmets three years after the introduction of mandatory wearing.
Authors: Finch C. F.
Published: October 2008

OBJECTIVES AND SETTING: To address helmet wearing by 13-17 year olds this study posed the following research questions: 'Do education programs continue to be necessary even after the community wearing rate has increased?' and 'Are helmet laws more effective in encouraging wearing among certain age groups?' Victoria was the first place in the world to introduce bicycle helmet legislation. Experiences in Victoria therefore provide a good model for the introduction of similar legislation in other areas. This study is the first to examine teenagers' attitudes towards helmet wearing after the introduction of compulsory helmet wearing legislation. METHODS: A survey of 1240 year 9 and year 10 students, aged 13-17 years, from 14 secondary schools in the outer south eastern suburbs of Melbourne, was conducted in September 1993. Information about bicycle use, helmet wearing, and attitudes towards helmets was obtained by a self report questionnaire. RESULTS: Bicycles are a popular form of wheeled recreation/self transport among teenagers. 65% of teenagers reported that they owned a helmet but only one third wore a helmet the last time they rode a bicycle. Fewer than 25% of students always wore a helmet when they rode a bicycle, despite compulsory helmet wearing legislation. Major factors leading to teenagers not wanting to wear a helmet were appearance and comfort. Both safety considerations and parental pressures were factors that influenced a teenager to wear a helmet. CONCLUSIONS: The major areas that need to be addressed are low helmet wearing rates; the low priority given to safety issues compared with comfort and peer acceptance; an ignorance of the need for helmets in all riding situations; and a perception that the legislation would not be enforced.
The SF-36 health survey: a valid measure of changes in health status after injury.
Authors: Kopjar B.
Published: October 2008

OBJECTIVES: The aim of this study is to evaluate the criterion validity and responsiveness to changes over time of the Medical Outcome Study Short Form 36 (MOS SF-36) measure. METHODS: A consecutive sample of 775 patients 16 to 78 years treated for an unintentional injury at the hospital or emergency clinic in Drammen, Norway was selected for the study. Data about activity restrictions and health status measured by SF-36 were obtained by a postal questionnaire 6-10 weeks after the injury. A follow up survey was sent 24-28 weeks later to all who reported activity restriction at the time of the first survey. Fifty two of these replied (63%). RESULTS: 469 patients responded to the survey questionnaire and of these, 82 experienced some restriction of activity. These scored lower (p < 0.01) on all eight SF-36 health dimensions (physical functioning, social functioning, role limitation (physical), role limitation (emotional), bodily pain, mental health, vitality, and general health) than the 387 patients without activity restriction. Scores on physical functioning, social functioning, role limitation (physical), bodily pain, and vitality significant improved (p < 0.01) among the 52 patients who were followed up. Scores on the other dimensions, however, showed no significant changes over time. CONCLUSION: The MOS SF-36 appears to be a valid instrument, responsive to changes in health status over time among unintentionally injured adult people. Thus it may be possible to use the SF-36 to describe changes in health due to injury. The applicability of this or similar measures for injured children remains to be established.
Preventing childhood unintentional injuries--what works? A literature review.
Authors: Dowswell T. , Towner E. M. , Simpson G. , Jarvis S. N.
Published: October 2008

AIM: The aim of this paper is to report on a systematic review of the world literature to provide information about the most effective forms of health promotion interventions to reduce childhood (0-14 years) unintentional injuries. The findings are of relevance to policy makers at a local or national level, to practitioners and researchers. METHODS: The relevant literature has been identified through the use of electronic databases, hand searching of journals, scanning reference lists, and consultation with key informants. RESULTS: Examples of interventions that have been effective in reducing injury include: bicycle helmet legislation, area wide traffic calming measures, child safety restraint legislation, child resistant containers to prevent poisoning, and window bars to prevent falls. Interventions effective in changing behaviour include bicycle helmet education and legislation, child restraint legislation, child restraint loan schemes, child restraint educational campaigns, pedestrian education aimed at the child/parent, provision of smoke detectors, and parent education on home hazard reduction. For the community based campaigns, the key to success has been the sustained use of surveillance systems, the commitment of interagency cooperation and the time needed to develop networks and implement a range of interventions. Education, environmental modification and legislation all have a part to play and their effect in combination is important. CONCLUSION: The design of evaluations in injury prevention needs to be improved so that more reliable evidence can be obtained. Better information is needed on process, so that successful strategies can be replicated elsewhere. There is also a need for literature reviews on effectiveness to be updated regularly and for their findings to be widely disseminated to policy makers, researchers, and practitioners.
The exposure of young children to accident risk as pedestrians.
Authors: Routledge D. A. , Repetto-Wright R. , Howarth C. I.
Published: October 2008

Pedestrian road accidents show a marked peak for children aged 5, 6 and 7 years with boys twice as involved as girls at these ages. Howarth et al (1974) described a framework in which measures of exposure were defined and related to the accident statistics to obtain estimates of absolute levels of risk for different categories of pedestrian in different traffic situations. The present paper describes a survey of children's exposure carried out to provide suitable data for this quantitative analysis. We interviewed a representative sample of Nottingham schoolchildren about their journeys in the previous 24 hours and recorded the number of roads crossed and the traffic densities of these roads. The measures of exposure obtained are presented in relation to the accompaniment of children on their journeys, the type of area in which they live, and time of day. Risk was assessed by relating exposure measures both to the national and local accident statistics. The analysis provides estimates of the risk to children of different ages and sex in their normal pattern of road crossing and in crossing roads of different traffic density and indicates that the accident statistics alone considerably underestimate the degree of risk to children under the age of eight. Interviews with a sample of the parents of the children suggest that children may provide a more accurate measure of their exposure than do their parents.
Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study.
Authors: Chalmers D. J. , Marshall S. W. , Langley J. D. , Evans M. J. , Brunton C. R. , Kelly A. M. , Pickering A. F.
Published: October 2008

OBJECTIVES: Despite the widespread promotion of safety standards no epidemiological studies have adequately evaluated their effectiveness in preventing injury in falls from playground equipment. This study evaluated the effectiveness of the height and surfacing requirements of the New Zealand standard for playgrounds and playground equipment. SETTING: Early childhood education centres and schools in two major cities in the South Island of New Zealand. METHODS: Data were collected on 300 children aged 14 years or less who had fallen from playground equipment. Of these, 110 (cases) had sustained injury and received medical attention, while 190 (controls) had not sustained injury requiring medical attention. RESULTS: Logistic regression models fitted to the data indicated that the risk of injury being sustained in a fall was increased if the equipment failed to comply with the maximum fall height (odds ratio (OR) = 3.0; 95% confidence interval (CI) 0.7 to 13.1), surfacing (OR = 2.3; 95% CI 1.0 to 5.0), or safe fall height (OR = 2.1; 95% CI 1.1 to 4.0) requirements. Falls from heights in excess of 1.5 metres increased the risk of injury 4.1 times that of falls from 1.5 metres or less and it was estimated that a 45% reduction in children attending emergency departments could be achieved if the maximum fall height was lowered to 1.5 metres. CONCLUSIONS: Although the height and surfacing requirements of the New Zealand standard are effective in preventing injury in falls from playground equipment, consideration should be given to lowering the maximum permissible fall height to 1.5 metres.
Children falling from a height in London.
Authors: Keogh S. , Gray J. S. , Kirk C. J. , Coats T. J. , Wilson A. W.
Published: October 2008

OBJECTIVES: To determine the frequency and geographical distribution of children falling from a height in London and to suggest possible causes and preventative measures. METHODS: All relevant cases attended by the Helicopter Emergency Medical Service (HEMS) in a three and a half year period were reviewed and the locations related to the boroughs. The rates, per 1,000 resident children, were compared with socioeconomic indices for the boroughs concerned. In addition, a survey was undertaken of window fittings and maintenance in high rise flats close to one particular incident. RESULTS: A total of 90 incidents were attended involving 91 patients (64 male, 27 female) of whom five died. HEMS attends approximately one third of incidents involving serious trauma. In the study period the maximum frequency was 0.2 fallers per 1,000 resident children, occurring in three boroughs. In three boroughs there were no fallers. There was no overlap in socioeconomic indices between the five boroughs with the highest fall rates and the five with the lowest. The building survey found a high incidence of faulty window catches, a slow response rate for repair, and a lack of safety advice for residents. CONCLUSIONS: The frequency of falling is related to urban deprivation, poor maintenance, and lack of safety information. A combination of regulation and targeted education could substantially decrease deaths and injuries in children from this cause.
A population based case-control study of agricultural injuries in children.
Authors: Stueland D. T. , Lee B. C. , Nordstrom D. L. , Layde P. M. , Wittman L. M.
Published: October 2008

OBJECTIVES: To identify preventable risk factors related to agricultural injuries occurring to children on family farms. SETTING: A geographically defined central region of Wisconsin, USA with nearly 1800 family dairy farms. METHODS: A two year, population based incidence study of occupational injuries among farm residents was conducted. For cases, trained staff abstracted information on the nature, severity, and treatment of the injury from the patient's medical record. Staff also administered a telephone questionnaire to cases and controls, usually answered by parents. RESULTS: There were 60 cases of farm residents younger than 18 years who sought care for acute agriculture related injuries. Farms on which uninjured children lived served as controls (n = 102). Multivariate analyses of 16 different variables revealed three significantly related to injuries to children: hours worked per week (odds ratio (OR) = 1.05; 95% confidence interval (CI) = 1.01 to 1.08); presence of disabled safety device (OR = 2.64; 95% CI = 1.10 to 6.35); and feeding cows by grazing (OR = 0.22; 95% CI = 0.06 to 8.83). CONCLUSIONS: Interventions designed to reduce the risk of agricultural injuries to farm children should acknowledge the participation of children as productive workers on the farm. Although education has been the standard method for encouraging safe practices in farm work, additional approaches, such as limiting the number of hours a child works, avoiding the disabling of safety devices, and using specific methods of managing cows, should also be adopted to minimize injury risks to farm children.
Safety measures taken by Norwegian mothers.
Authors: Ueland O. , Kraft P.
Published: October 2008

OBJECTIVES: To identify predictors of the adoption of safety measures by mothers of 2 year old children. SETTING: 26 municipalities in the county of Sogn and Fjordane, and four municipalities in the county of Møre and Romsdal in Norway. METHODS: Data was collected by questionnaires mailed to all mothers of 2 year olds in the 30 municipalities (response rate 70.7%, n = 1233). Information was obtained on socioeconomic variables, the child's injury history, adoption of safety measures, and variables describing mother's health related beliefs (parent health locus of control) and the value of health (health value). RESULTS: Income, municipality of residence, age of the mother, and marital status were significantly associated with the reported adoption of safety measures. High income and older, married mothers were positively associated with the adoption of safety measures. CONCLUSIONS: The significant effect of income on the adoption of safety measures, underlined by the fact that safety measures were less often adopted by young single mothers, may indicate that the implementation of structural measures such as loan schemes and subsidies, are necessary to increase the adoption of child safety measures. The lack of association between education and social cognitive beliefs, respectively, and the adoption of safety measures, offer less optimism for traditional health education initiatives.
A statewide survey of hazards in child care centers.
Authors: Browning K. S. , Runyan C. W. , Kotch J. B.
Published: October 2008

OBJECTIVES: The purpose of this study was to determine adherence to selected recommended safety standards in North Carolina child care centers. METHODS: A self administered questionnaire eliciting information about safety practices in child care was mailed to a randomly selected sample of 409 North Carolina child care centers. RESULTS: One hundred and ninety five usable questionnaires were returned from child care centers in 75 counties. Results indicated that all of the standards included in the state's child regulations were being adhered to by at least 80% of the centers. However, adherence to recommended standards not included in the state's regulations was quite variable, with one standard implemented by less than 5% of the centers. The lowest rates of adherence were found for standards specifying that resilient surface material be used under playground equipment (4%) and that certain foods that may present a choking hazard to small children not be served (27%). CONCLUSIONS: Many hazards not addressed in North Carolina child care regulations are present in child care centers. Some safety standards are not adhered to due to lack of knowledge or limited resources. Inclusion of national standards in state child care regulations appears to reduce, but not eliminate, the likelihood of hazards being reported. Further research should include on-site inspections and attention to safety in family child care.
Bicycle helmet use among American children, 1994.
Authors: Sacks J. J. , Kresnow M. , Houston B. , Russell J.
Published: October 2008

OBJECTIVE: To estimate ownership and use of bicycle helmets among children in the US in 1994. METHODS: As part of a 1994 national telephone survey of 5,238 randomly dialed households, adult respondents reported data on bicycle helmet ownership and helmet use among 1,645 child bicyclists. Data were weighted to provide national estimates. RESULTS: It is estimated that 72.7% of children 5-14 year olds ride bicycles, that is, 27.7 million child bicyclists. Of the bicyclists, 50.2% have a helmet and 25.0% reportedly always wore their helmet when cycling. Reported helmet ownership and use increased with income and educational level and decreased with age. Among regions of the US, those with the highest proportion of states with helmet use laws in 1994 also had the highest proportion of helmet use among children. Among child bicyclists who had been seen by a health care provider in the preceding 12 months, 43.9% of those counseled to wear a bicycle helmet were reported to comply compared with 19.1% of those seen by a provider but not so counseled (p < 0.001). CONCLUSIONS: To meet the year 2000 objective of 50% of bicyclists wearing helmets, use among American children will have to double. Concerted and increased efforts to promote the wearing of bicycle helmets are necessary.
Smoke alarm use: prevalence and household predictors.
Authors: Roberts I.
Published: October 2008

OBJECTIVE: To determine the prevalence of smoke alarm use among families with children and to identify household factors that predict the absence of a smoke alarm. DESIGN: Cross sectional analysis of data collected in the September and November 1995 Omnibus Survey, conducted by the Office of Population Censuses and Surveys in the UK. SUBJECTS: A random sample of British households. Interviews were completed with 4,043 householders. The response rate was 78%. RESULTS: 29% of British households do not have a smoke alarm and smoke alarms were absent in 20% of households with children under 15 years. A smoke alarm was absent in 41% of privately rented homes compared with 17% of owner occupied homes. Living in private rental accommodation was the strongest household predictor of the absence of a smoke alarm (odds ratio = 3.25, 95% confidence interval 1.94 to 5.42). Householders who had heard of National Fire Safety Week or the TV smoke alarm advertising campaign were significantly more likely to have a smoke alarm. The apparent effect of these campaigns was greatest in families with children. CONCLUSIONS: Smoke alarm use has continued to increase but a substantial proportion of British homes still do not have smoke alarms. Homes at greatest risk of residential fire are the least likely to have an alarm. Health professionals may be able to increase smoke alarm use among families with children, by counselling families about the benefits of smoke alarms. They may also be effective in this regard by lobbying local councils, houseing associations, or private landlords to install alarms in all properties and by advocating for national legislation.
Behavior and injury in urban and rural adolescents.
Authors: Riley A. W. , Harris S. K. , Ensminger M. E. , Ryan S. , Alexander C. , Green B. , Starfield B.
Published: October 2008

OBJECTIVES: This study investigates the consistency of factors associated with adolescent injury in separate urban and rural samples. SAMPLES: Adolescents, 11-17 years old, in public schools in urban and rural Maryland (n = 2,712). METHODS: Separate bivariate and logistic regression analyses were conducted for each sample to determine individual and environmental factors associated with major and minor injuries experienced in the previous year. RESULTS: Multivariate analyses revealed that, for both samples, the probability of a major injury was highest for boys and, among both boys and girls, for those who played several team sports. Among rural youth, other significant covariates of both major and minor injuries were a tendency to engage in risky behavior and to use alcohol. For urban youth, being white, carrying a weapon for protection, attending an unsafe school, and working for pay were also significant covariates. Interactions were important and complex. CONCLUSIONS: The consistency of predictive factors, such as multiple sports team participation and risky and aggressive behaviors in completely different physical environments, underscores the need to address the contexts of heightened injury risk that some adolescents create wherever they live by playing sports and/or behaving in an antisocial, aggressive manner. Moreover, the perception of lack of safety in schools and neighborhoods is associated with increased injury rates, suggesting the need for policy interventions to target social environments as well as behavior.
Firearm ownership and storage practices in Pennsylvania homes.
Authors: Forjuoh S. N. , Coben J. H. , Dearwater S. R.
Published: October 2008

OBJECTIVE: To determine the household prevalence of firearms in Pennsylvania, and describe the storage practices for these weapons. DESIGN: A statewide telephone survey of 3,620 Pennsylvania adults selected from households by random digit dialing in 1994. MAIN OUTCOME MEASURES: Firearm ownership and storage practices were computed by household characteristics using logistic regression. RESULTS: The prevalence of firearm ownership was 37% (95% confidence interval = 35.4 to 38.6). Ownership of firearms was significantly higher for white residents, households with annual income of $20,000 or more, those in rural counties, and those with children and adolescents. Of the households with firearms, 23% contained a single firearm, the majority of which were handguns (40%) or rifles (40%); 76% had two or more firearms, with 57% reporting one handgun or more and 83% reporting one rifle or more. Storage of firearms in 72% of households involved two or more of these barriers: (1) taken apart; (2) trigger lock applied; (3) kept in a locked place; (4) unloaded; (5) no other ammunition; (6) locked ammunition; 6% stored at least one of their firearms with none of these barriers. The strongest predictor of storing a firearm with fewer than two protective barriers was households with no children or adolescents. CONCLUSIONS: Firearms are present in a large number of Pennsylvania homes. Many of these homes also contain children. To reduce the potential risks of firearms, optimal methods of storage of firearms in the home need to be determined.