bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a community based childhood injury prevention program.
Authors: Bablouzian L. , Freedman E. S. , Wolski K. E. , Fried L. E.
Published: October 2008

OBJECTIVES: This pilot study evaluates the effectiveness of a community based childhood injury prevention program on the reduction of home hazards. METHODS: High risk pregnant women, who were enrolled in a home visiting program that augments existing health and human services, received initial home safety assessments. Clients received education about injury prevention practices, in addition to receiving selected home safety supplies. Fourteen questions from the initial assessment tool were repeated upon discharge from the program. Matched analyses were conducted to evaluate differences from initial assessment to discharge. RESULTS: A significantly larger proportion of homes were assessed as safe at discharge, compared with the initial assessment, for the following hazards: children riding unbuckled in all auto travel, Massachusetts Poison Center sticker on the telephone, outlet plugs in all unused electrical outlets, safety latches on cabinets and drawers, and syrup of ipecac in the home. CONCLUSIONS: A community based childhood injury prevention program providing education and safety supplies to clients significantly reduced four home hazards for which safety supplies were provided. Education and promotion of the proper use of child restraint systems in automobiles significantly reduced a fifth hazard, children riding unbuckled in auto travel. This program appears to reduce the prevalence of home hazards and, therefore, to increase home safety.
High levels of incorrect use of car seat belts and child restraints in Fife--an important and under-recognised road safety issue.
Authors: Campbell H. , Macdonald S. , Richardson P.
Published: October 2008

OBJECTIVE: To pilot data collection instruments and to make a preliminary estimate of the level of incorrect use of car seat belts and child restraints in Fife, Scotland. DESIGN: Cross sectional survey of cars containing adults and children at a number of public sites across Fife in 1995 to assess use of car occupant restraints. Trained road safety officers assessed whether seat restraints were appropriate for the age of the passengers and whether restraints were used correctly. These assessments were based on standards published by the Child Accident Prevention Trust. PARTICIPANTS: The survey gathered data from 596 occupants in 180 cars: 327 adults and 269 children. Ten per cent of drivers who were approached refused to participate. Car occupant restraint was assessed in 180 drivers, 151 front seat passengers, and 265 rear seat passengers. MAIN RESULTS: Three hundred and sixty one occupants wore seat belts, 68 were restrained by a seat belt and booster cushion, 63 in toddler seats, 25 in two way seats, and 18 in rear facing infant carriers. Ninety seven per cent of drivers, 95% of front seat passengers, and 77% of rear seat passengers were restrained. However, in 98 (52%) vehicles at least one passenger was restrained by a device that was used incorrectly. Seven per cent of adults and 28% of children were secured incorrectly. The commonest errors were loose seat belts and restraint devices not adequately secured to the seat. Rates of incorrect use were highest in child seat restraints, reaching 60% with two way seats and 44% with rear facing infant seats. CONCLUSIONS: The incorrect use of car occupant restraints is an under-recognised problem, both by health professionals, and the general public. Incorrect use has been shown to reduce the effectiveness of restraints, can itself result in injury, and is likely to be an important factor in child passenger injuries. The correct use of car seat restraints merits greater attention in strategies aiming to reduce road traffic casualties. Areas of intervention that could be considered include raising public awareness of this problem, improving information and instruction given to those who purchase child restraints, and encouraging increased collaboration between manufacturers of cars and child restraints, in considering safety issues.
Sibling power: influence of older siblings' persuasive appeals on younger siblings' judgements about risk taking behaviours.
Authors: Morrongiello B. A. , Bradley M. D.
Published: October 2008

OBJECTIVES: Although many injuries happen when school age children are away from home and in the company of other children, we know surprisingly little about interpersonal influences on children's risk taking decisions. The aim of the present study was to examine the influence of older siblings' persuasive appeals on young children's decisions about engaging in behaviours that could threaten their physical safety. METHODS: Forty same sex sibling pairs participated. Children were shown drawings of play scenes (bicycling, river crossing, and sledding), with each depicting lower and higher risk paths of travel. Children of 8 years made initial decisions as to which paths they would take. Subsequently, their older sibling acted as a confederate and tried to persuade them to change their decisions. RESULTS: After the appeals of older siblings, younger children significantly shifted their decisions: choices of less risky paths replaced the initial selection of more risky paths, and vice versa. A positive sibling relationship was predictive of younger siblings' decision changes. Boys and girls were equally effective in persuasion but they did so using different types of arguments, with boys communicating primarily appeals to fun and girls emphasizing appeals to safety. CONCLUSIONS: These findings highlight the effect that older siblings can have on risk taking decisions of younger siblings. Accordingly, they document the importance of considering the interpersonal context of risk taking when designing interventions to reduce injuries among elementary schoolchildren.
Socioeconomic status and the prevention of child home injuries: a survey of parents of preschool children.
Authors: Evans S. A. , Kohli H. S.
Published: October 2008

OBJECTIVES: To examine the effect of socioeconomic status on the attitudes parents of preschool children towards child home safety issues and practice of home safety measures. SETTING: A community based study in the Lanarkshire Health Board area, a mixed urban-rural setting in central Scotland. METHODS: A postal survey of two random samples of parents of preschool children (aged 3 years). One sample (A) involved parents living in more affluent areas and the other (B) parents living in less affluent areas. RESULTS: In general, parents in both groups showed similar attitudes towards home safety. The only significant differences to emerge were over parental perceptions of the safety of the neighbourhood in which they lived and over the availability of money to keep their child safe (group B > group A, p < 0.0042). Parents from group B also tended to report similar or safer levels of home safety behaviour to parents from group A. CONCLUSIONS: The findings do not suggest that differences in the injury experience of children from more and less affluent backgrounds are due to differences in parental attitude, knowledge, or practice of home safety measures. Thus, the study does not support the selective targeting of families from less affluent areas with educational interventions. Instead, the findings do support the use of a multi-method approach to home safety, where educational approaches are complemented by environmental modification.
Does sharing the cost of a bicycle helmet help promote helmet use?
Authors: Kim A. N. , Rivara F. P. , Koepsell T. D.
Published: October 2008

OBJECTIVE: To determine whether asking for a $5.00 donation for bicycle helmets, compared with distribution free of charge, would affect helmet use among children receiving helmets and an educational intervention from public health clinics. SETTING: Six public health clinic sites in King County, Washington. METHODS: Six participating clinic sites were randomly assigned to either free helmet distribution or to a $5.00 suggested donation for the helmets, stratified by whether a helmet law was in place. Three sites were assigned to each arm. Children who were between 6 and 12 years of age and who reported riding bicycles, but having no bicycle helmets, were eligible. Clinicians distributed helmets and delivered an educational intervention to 506 eligible children, or siblings of children seen at the clinic between March and July 1993. Parents were contacted after helmet distribution to ascertain helmet use. RESULTS: 82% of children whose parents were asked for a copayment and 77% of children who received free helmets were reported to wear their helmets every time they rode their bicycles (p=0.20). The adjusted odds ratio for the association between copayment compared with free helmets and helmet use was 1.66 (95% confidence interval 0.94 to 2.92). CONCLUSIONS: Helmet use was not significantly different among children whose parents were asked for a small copayment, compared with those who received helmets free. Use of copayments can increase helmet use by increasing the number of helmets given to low income children.
School injuries in an occupational health perspective: what do we learn from community based epidemiological studies?
Authors: Laflamme L. , Menckel E.
Published: October 2008

OBJECTIVE: The paper reviews community based epidemiological studies of injuries at school. It discusses their main findings in the light of a frame of analysis that emphasizes multidimensionality of causes, and in a Swedish context, where school injuries are legally regarded as occupational injuries. METHODS: A frame of analysis, inspired by research in the arena of occupational accident, was developed. It employs four key concepts to distinguish between injury and accident sequence, and between situational and structural factors as potential injury determinants. It also stresses the interaction between pupil, school, and community, in injury genesis. In parallel, a review of community based epidemiological studies of school injuries was undertaken after searching the relevant literature. The knowledge gathered from these studies is appraised in the light of the frame of analysis. RESULTS: In general, the studies point to potential risk groups, and to hazardous locations and activities. They address injury characteristics, but largely fail to define typical mechanisms. The literature sheds little light on whether there are particular characteristics of the community, school, or pupil(s)--other than gender and age--that influence injury event occurrence. CONCLUSIONS: Further research should devote attention to the sequences of events culminating in school injuries, and to the structural determinants of accident sequences. In this, surveillance systems might prove to be of great utility.
Infant walker use, injuries, and motor development.
Authors: Thein M. M. , Lee J. , Tay V. , Ling S. L.
Published: October 2008

OBJECTIVES: To study the impact of infant walker use on motor development and injuries. POPULATION: One hundred and eighty five parents or primary care givers who attended a Singapore government polyclinic from September 1993 to February 1994, with their infants between 7 to 10 months, for a developmental assessment session. SETTING: A government polyclinic in Singapore. METHODS: The parent or primary care giver answered questions pertaining to infant walker use and injuries attributed to its use. Each infant was then given the Singapore modified version of the Denver Developmental Screening Test (DDST-S), along with a full clinical examination; both testers were blinded to walker use. RESULTS: One hundred and sixty seven (90%) of 185 infants used walkers regularly, and 21 (12.5%) of the users had one or more injuries. Most injuries were minor, such as bruises and swellings on the head, forehead, face, and cheeks. None of the children who did not use walkers showed any abnormal DDST-S results whereas 18 (10.8%) of the 167 walker users had either abnormal or questionable DDST-S results. CONCLUSIONS: 12.5% of walker users had one or more injuries and walker use may also delay the child's motor development. These findings will help the physician or nurse in primary care settings to advise parents about the potential hazards of walker use.
A descriptive analysis of children's playground injuries in the United States 1990-4.
Authors: Mack M. G. , Hudson S. , Thompson D.
Published: October 2008

OBJECTIVES: To review playground injury statistics over a five year period in order to develop an awareness of how and where children in the United States are being injured. METHODS: All data are based on the United States Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) for playground related injuries during 1990-4. The surveillance data includes injuries recorded in more than 90 hospital emergency departments located throughout the United States. RESULTS: Each year there are roughly 211,000 preschool or elementary school-children in the United States who receive emergency department care for injuries associated with playground equipment. On average, 17 of these cases result in death. 70% of all injuries occur on public playgrounds, with nearly one third classified as severe. Swings, climbers, and slides are the pieces of playground equipment associated with 88% of all NEISS reported injuries. Falls to the surface are responsible for 70%. CONCLUSIONS: NEISS playground injury statistics contribute to our understanding of playground injuries. By identifying where and how children are injured, suggestions can be made in an attempt to make playgrounds safer.
Reduction in paediatric burn admissions over 25 years, 1970-94
Authors: Streeton C , Nolan T
Published: October 2008

Objective–To describe trends in burn admissions to a large paediatric burn centre, between 1970 and 1994.

Methods–Hospital records of the Royal Children's Hospital burns unit were audited for the years 1970-94 (n=4992), statewide hospital admissions identified from the Victorian Inpatient Minimum Database for the period, 1987-94 (n=3353), and Victorian burn deaths ascertained from the Australian Bureau of Statistics (n=163), 1970-94.

Results–Between 1970 and 1994 there was a 66% reduction in the annual number of burn admissions to the Royal Children's Hospital, a similar reduction across the state, from 52.4 (95% confidence interval (CI): 48 to 57)/100 000 in 1987 to 34.5 (95% CI:31 to 38)/100 000 in 1994 (p<0.05), and over a 40% fall in the mortality rate. Reductions occurred for all types of burns: scalds 60%; flame burns 55%; and contact burns 70%, but at differing time periods corresponding to the introduction of product legislation, education programs, or changes in heating practices. There was no decline in beverage related scalds. The proportion of children admitted with severe burns increased over the 25 year period, probably reflecting changes in referral practice, while the average length of hospital stay steadily declined, independent of burn type or burn severity.

Conclusions–We believe these reductions reflect the effects of mandatory changes in sleepwear standards and regulations, modifications in heating practices, legislated improvements in the safety of household products, and to a lesser extent the effect of burn education prevention campaigns in the media, especially those directed towards hot water burn injuries among younger children.
Epidemiology of bicycle injuries and risk factors for serious injury.
Authors: Rivara F. P. , Thompson D. C. , Thompson R. S.
Published: October 2008

OBJECTIVE: To determine the risk factors for serious injury to bicyclists, aside from helmet use. DESIGN: Prospective case-control study. SETTING: Seven Seattle area hospital emergency departments and two county medical examiner's offices. PATIENTS: Individuals treated in the emergency department or dying from bicycle related injuries. MEASUREMENTS: Information collected from injured bicyclists or their parents by questionnaire on circumstances of the crash; abstract of medical records for injury data. Serious injury defined as an injury severity score > 8. ANALYSIS: Odd ratios computed using the maximum likelihood method, and adjusted using unconditional logistic regression. RESULTS: There were 3854 injured cyclists in the three year period; 3390 (88%) completed questionnaires were returned 51% wore helmets at the time of crash. Only 22.3% of patients had head injuries and 34% had facial injuries. Risk of serious injury was increased by collision with a motor vehicle (odds ratio (OR) = 4.6), self reported speed > 15 mph (OR = 1.2), young age (< 6 years), and age > 39 years (OR = 2.1 and 2.2 respectively, compared with adults 20-39 years). Risk for serious injury was not affected by helmet use (OR = 0.9). Risk of neck injury was increased in those struck by motor vehicles (OR = 4.0), hospitalized for any injury (OR = 2.0), and those who died (OR = 15.1), but neck injury was not affected by helmet use. CONCLUSIONS: Prevention of serious bicycle injuries cannot be accomplished through helmet use alone, and may require separation of cyclists from motor vehicles, and delaying cycling until children are developmentally ready.
Characteristics and outcomes of self inflicted pediatric injuries: the role of method of suicide attempt.
Authors: Li G. , Ling J. , DiScala C. , Nordenholz K. , Sterling S. , Baker S. P.
Published: October 2008

OBJECTIVE: To examine the epidemiologic characteristics and clinical outcomes of self inflicted pediatric injuries in relation to the method of suicide attempt. METHODS: Using data from the National Pediatric Trauma Registry Phase II, a comparative analysis was conducted for children under 15 years of age who were admitted from 1 October 1988 through 30 April 1996 because of self inflicted injury by firearm (n = 28), hanging (n = 38), or jumping from heights (n = 21). RESULTS: Of the 87 cases under study, 90% occurred at home, and 86% occurred between noon and midnight, with a peak in early evening (between 6 pm and 7 pm)-More than one quarter (29%) had preexisting mental disorders, such as disturbance of conduct and depression. Toxicological tests were conducted on admission on 40 (46%) of the patients; 20% tested positive for alcohol or other illicit drugs. The method of suicide attempt was associated with gender and age of the patients: 75% of the firearm cases and 82% of the hanging cases were boys compared with 29% of the jumping cases (p < 0.01); 79% of the hanging cases were aged 13 years or younger compared with 39% of the firearm cases and 48% of the jumping cases (p < 0.01). The mean injury severity score was 18.6 for the firearm cases and 16.3 for the hanging cases, significantly greater than 8.5 for the jumping cases (p < 0.02). Reflecting the differences in injury severity, firearm cases and hanging cases were more likely than jumping cases to be sent to intensive care units or operating rooms from emergency departments, and to develop complications during hospitalization. The case fatality rate was 50% for the firearm cases, 32% for the hanging cases, and 5% for the jumping cases (p < 0.01). On average, these patients stayed in hospitals for 11 days and 52% of those who were alive at discharge had at least one impairment in communication, cognition, or self care functions. CONCLUSION: Boys and older children tend to use more lethal methods in suicide attempts. Even in this age group, suicide attempts often involve psychiatric disorders and acute abuse of alcohol or other illicit drugs. Firearms are associated with significantly increased risk of inhospital fatality. The clinical outcomes of self inflicted injuries appear to be worse than other injuries treated in the same trauma centers.
A seven item scale for the assessment of disabilities after child and adolescent injuries.
Authors: Gofin R. , Adler B.
Published: October 2008

OBJECTIVES: To develop a scale to assess physical disabilities after child or adolescent injuries. SETTING: The three main hospitals of Jerusalem. METHODS: Telephone interviews pertaining to the injury's effect on the functioning of children 4-17 years old (n = 281) were carried out six months after an injury. Disabilities were recalled by the parents for the period immediately after the injury (short term) and at the time of interview (long term). Of 25 questions derived from the International Classification of Impairments, Disabilities and Handicaps, seven were selected: limitations in walking, running, getting up/lying down, moving in bed, going to the toilet, bathing/keeping personal hygiene, and dressing. Construct validity was tested using the usual, sport, school, and leisure time activities as the gold standard. RESULTS: The prevalence of short term disabilities ranged from 23.8% to 37.7% and of long term disabilities from 0.4% to 11.8%. Cronbach's alpha was 0.91 for the short term scale and over 0.90 for the different categories of the sociodemographic variables. It decreased to 0.66 for the long term scale. Sensitivity of the short term scale ranged from 77% to 89%, but was lower for the long term scale. Specificity varied from 72% to 84% and increased to 88% to 90%, six months after the injury. CONCLUSIONS: This scale could be used to study disability after injury among children and adolescents in different cultures. It is a simple method that does not require expert personnel and has relatively high validity and internal reliability.
Personality characteristics of the child accident repeater
Authors: Manheimer Dean I , Mellinger Glen D
Published: October 2008

From 8874 boys and girls aged 4 to 18 in Berkeley-Oakland, California, 684 were selected to represent high-, intermediateor low-accident-liability children, based on records of medically attended injuries. Using data from intensive interviews with mothers supplemented with school records, we found a statistically significant relation between accident liability and indexes of extraversion, daring, roughhousing, and other traits tending to expose children to hazards. Similar relations held for traits such as poor discipline, aggressiveness toward peers, and, for girls, attention-seeking, which compete with the child's ability to cope with hazards. Other traits that may impair ability to cope with hazards were also found to be related to accident liability (impulsivity, carelessness, and unreliability) as were several indexes denoting maladjustment.
An international study of the exposure of children to traffic.
Authors: Roberts I. , Carlin J. , Bennett C. , Bergstrom E. , Guyer B. , Nolan T. , Norton R. , Pless I. B. , Rao R. , Stevenson M.
Published: October 2008

OBJECTIVES: To examine the extent of international differences in children's exposure to traffic as pedestrians or bicyclists. DESIGN: Children's travel patterns were surveyed using a parent-child administered questionnaire. Children were sampled via primary schools, using a probability cluster sampling design. SETTING: Six cities in five countries: Melbourne and Perth (Australia), Montreal (Canada), Auckland (New Zealand), Umeå (Sweden), and Baltimore (USA). SUBJECTS: Children aged 6 and 9 years. MAIN OUTCOME MEASURES: Modes of travel on the school-home journey, total daily time spent walking, and the average daily number of roads crossed. MAIN FINDINGS: Responses were obtained from the parents of 13423 children. There are distinct patterns of children's travel in the six cities studied. Children's travel in the three Australasian cities, Melbourne, Perth and Auckland, is characterised by high car use, low levels of bicycling, and a steep decline in walking with increasing car ownership. In these cities, over a third of the children sampled spent less than five minutes walking per day. In Montreal, walking and public transport were the most common modes of travel. In Umeå, walking and bicycling predominated, with very low use of motorised transport. In comparison with children in the Australasian and North American cities, children in Umeå spend more time walking, with 87% of children walking for more than five minutes per day. CONCLUSIONS: There are large international differences in the extent to which children walk and cycle. These findings would suggest that differences in 'exposure to risk' may be an important contributor to international differences in pedestrian injury rates. There are also substantial differences in pedestrian exposure to risk by levels of car ownership-differences that may explain socioeconomic differentials in pedestrian injury rates.
Measuring the implementation of injury prevention programs in state health agencies.
Authors: Cassady C. E. , Orth D. A. , Guyer B. , Goggin M. L.
Published: October 2008

OBJECTIVE: Injury prevention programs have been implemented with varying degrees of success in the United States. The objective of this study was to identify the variables that influence the successful implementation of injury prevention programs. METHODS: The key indicators of implementation success and its correlates were identified through consultation with a panel of experts. This consultation informed the content of a mail questionnaire sent to all United States state health departments, followed by telephone interviews. Data were analyzed using factor analysis and regression to identify significant relationships between variables. RESULTS: Data were obtained from 64 programs, representing 44 states; these included 24 programs in injury control units, 12 in maternal and child health units, 10 in health promotion/education units; and eight in emergency medical services units. Analysis identified four factors that are associated with an index of successful injury prevention program implementation; (1) participation and advocacy by constituent groups; (2) organizational capacity; (3) administrative control; and (4) attributes of relevant policies. CONCLUSIONS: Findings indicated that constituent participation (the extent and efficacy of constituency support and advocacy) and organizational capacity (a function of program staff and their skill levels) had the greatest influence on successful program implementation. Support from advocacy groups and knowledgeable staff members, whose time is dedicated to the program, are critical for conducting the activities necessary for successful implementation of these programs.
Injury prevention programmes in primary care: a high risk group or a whole population approach?
Authors: Kendrick D. , Marsh P.
Published: October 2008

OBJECTIVE: To examine the relationship between risk factors for childhood unintentional injury and injury outcome and to assess the feasibility of using risk factors to identify children at high risk of injury. SETTING: One general practice in Nottingham, UK. METHOD: A postal questionnaire survey to all parents of children registered with the practice (n = 771) to obtain data on risk and sociodemographic factors. All children still registered with the practice one year later were followed up for occurrence of a medically attended injury. RESULTS: The response rate was 78%. The injury rate over the follow up year was 246 injuries per 1000 children. Previous medically attended injury was associated with each of the injury outcomes (odds ratio (confidence interval) for all attendances, 2.33 (1.37 to 4.05); for accident and emergency attendances, 2.27 (1.15 to 4.4); and for primary health care team attendances, 2.58 (1.33 to 5.0)). Male sex was associated only with accident and emergency department attendance (odds ratio 2.13 (1.06 to 4.2)). Maternal age and previous injury were associated with a higher number of injuries in the subsequent year on univariate and multivariate analyses. The sensitivity and positive predictive value of the risk factors were low, except for previous injury and male sex. The number of children needing an injury prevention intervention to prevent one injury as identified by the risk factors was not significantly different from that required if a whole population approach were to be used. CONCLUSION: Primary care based injury prevention programmes, at present, should not be targeted at children identified as being at 'high risk' of injury. Nevertheless, a larger study using a wider cross section of the population is needed to address this issue further.
Factors affecting the severity of motor vehicle traffic crashes involving young drivers in Ontario.
Authors: Mao Y. , Zhang J. , Robbins G. , Clarke K. , Lam M. , Pickett W.
Published: October 2008

OBJECTIVES: To assess the factors affecting the severity of motor vehicles traffic crashes involving young drivers in Ontario. POPULATION: Ontario young drivers, aged 16 to 20, involved in traffic crashes resulting in injury, between 1 January 1988 and 31 December 1993, on public roads in Ontario. METHODS: Population based case-control study. Cases were fatal injury, major injury, and minor injury crashes involving young drivers. Controls were minimal injury crashes involving young drivers. Cases and controls were obtained retrospectively from the Canadian Traffic Accident Information Databank. Unconditional logistic regression was used for data analysis. RESULTS: Factors significantly increasing the risk of fatal injury crashes include: drinking and driving (odds ratio (OR) 2.3), impairment by alcohol (OR 4.8), exceeding speed limits (OR 2.8), not using seat belts (OR 4.7), full ejection from vehicle (OR 21.3), intersection without traffic control (OR 2.2), bridge or tunnel (OR 4.1), road with speed limit 70-90 km/hour (OR 5.6) or 100 km/hour (OR 5.4), bad weather (OR 1.6), head-on collision (OR 80.0), and overtaking (OR 1.9). Results of the same model applied to major and minor injury crashes demonstrated consistent but weaker associations with decreasing levels of crash severity. CONCLUSIONS: A casual relationship between crash severity and the risk factors listed above was proposed. Risk factors recommended for preventive intervention include: alcohol consumption, speeding, and use of seat belts. Head-on collisions are of primary concern.
Fatal and non-fatal farm injuries to children and adolescents in the United States, 1990-3.
Authors: Rivara F. P.
Published: October 2008

OBJECTIVE: Examine the current magnitude of the injury problem to children and adolescents on farms, and to compare these data to that from 1978-83. DATA SOURCES: US National Center for Health Statistics Mortality Multiple Cause of Death Tapes for the years 1991-3, and the US Consumer Product Safety Commission National Electronic Injury Surveillance System for data on emergency department visits for 1990-3. SUBJECTS: Children and adolescents 19 years and younger injured on farms. RESULTS: There were an average of 104 deaths per year due to injuries occurring on farms. The rate of 8.0 deaths per 100,000 child farm residents is 39% lower than in 1979-81. More of the deaths occurred in hospital than previously. There were an average of 22,288 emergency department treated injuries per year. The rate of 1717 injuries per 100,000 child farm residents is 10.7% higher than 1979-83. Males were injured more frequently than females. Tractors accounted for 20.9% of all injuries, followed by horses (8.4%), all terrain vehicles and minibikes (8.0%), and farm wagons (7.7%). CONCLUSIONS: Farm injuries continue to be a major problem to children living on farms. While improved medical care may have contributed to the reduction in mortality, the continued high rate of injuries warrants study of a variety of intervention strategies to reduce the injury toll. There is also a need for ongoing injury surveillance to provide accurate data on the farm injury problem.
Economic costs of motor vehicle crashes involving teenaged drivers in Kentucky, 1994.
Authors: Goldstein L. A. , Spurlock C. W. , Kidd P. S.
Published: October 2008

OBJECTIVES: To analyze data from motor vehicle crashes (MVCs) involving teenaged drivers in Kentucky for 1994, and derive cost estimates of these crashes. METHODS: Crash data were obtained from the Kentucky Traffic Accident Facts 1994 Report and the Kentucky Accident Reporting System. The National Highway Traffic Safety Administration's Crash-Cost program was used to generate cost estimates for Kentucky data. RESULTS: Teenaged drivers had significantly higher MVC fatal and non-fatal injury rates than did adult drivers. The deaths rates were 43.6 and 19.0 per 100,000 for teens and adult drivers, respectively. Odds ratios (ORs) were calculated to estimate the relative risk for (1) involvement in an MVC, (2) fatal or incapacitating injury, and (3) fatal injury for teenaged compared with adult drivers. The crude ORs were statistically significant at each age. Cost estimates were calculated on a per person/vehicle basis. A single fatal injury was $642,700. A critical injury was $563,000. In general, unit costs rose with increasing levels of injury severity. For the total number of fatal injuries, costs exceeded $91 million. For non-fatal injuries and property damage only crashes, total costs were $318 million. Overall, the total cost estimate for MVCs involving teenaged drivers was nearly $410 million. CONCLUSIONS: Strategies aimed to reduce the number of MVCs attributed to teenaged drivers should reduce both the number and costs of crash related deaths and injuries. Graduated driver licensing (GDL) systems are one plausible approach toward achieving this goal. By recently enacting a GDL system in Kentucky, it is anticipated that many lives and dollars will be saved.
Estimation of age specific incidence rates of childhood burns from a prevalence survey of burn scars.
Authors: Forjuoh S. N. , Keyl P. M. , Diener-West M.
Published: October 2008

OBJECTIVES: This paper describes two methods of estimating the age specific incidence rates of childhood burns from a prevalence survey of burn scars. METHODS: A prevalence survey of burn scars was carried out in 1992 on 15,742 Ghanaian children aged 5 years or less. Nine hundred and fifty five (6.1%) of these children had scars from burn, and for 630 (66%) of these children, additional information about the burn incident, including the child's age at the time of the burn, was obtained from the mother two to three months later. Thirty four per cent of mothers of children with burn scars were not interviewed due to absence, relocation, or inaccessibility. Age specific incidence rates of burns were estimated for eight age groups using two methods. In method I, the number of incident cases of burns for each age group were estimated from the burn scars by subtracting the estimated contribution of scars from burns that had occurred at earlier ages. In method II, the estimate was based on the mother's recall of the age of the child at the time of the burn. RESULTS: Slightly different results were obtained with the two methods, and problems were noted with both methods. CONCLUSION: We recommend the use of these methods for estimating age specific incidence rates from retrospective population surveys for health conditions which result in long term residual markers.
A controlled study of health education in accident prevention: the Rockland County Child Injury Project. 1966.
Authors: Schlesinger E. R. , Dickson D. G. , Westaby J. , Lowen L. , Logrillo V. M. , Maiwald A. A.
Published: October 2008

The Rockland County Child Injury Prevention Project was designed to test the effects of public health education for parents on the incidence of accidental injuries to children under 7 years of age in a controlled situation. The incidence of accidental injuries, defined as any actual or presumed trauma following an accident for which medical or dental attention was obtained, was determined in a study population before, during, and after exposure to the educational program and in a comparable control group during a corresponding period of time. The study group was exposed to an intensive education program involving neighborhood discussion groups conducted by lay and professional leaders, meetings with organized groups, and a monthly newsletter. The study population was organized into small neighborhood units of about 24 homes within the suburban housing developments. To measure the effect of the education program, accident rates were computed for each three month reporting period, projected on an annual basis. No consistent differences were discernible in the trends in the accident rates between the study and control groups during the three years of the project. On the contrary, the curve for the study group crossed that of the control group on no less than five occasions. There was a sharp decline in accidents during the second half of the education phase. Any conclusions regarding a positive effect of the education program proved untenable in the light of the sharp and disproportionate increase in the accident rate in the study group during the six month phase after education had stopped. After what appeared to be a contrary trend earlier, developments during this period demonstrated vividly the need to continue reporting for a sufficient time in a controlled situation to be sure that fortuitous changes over short periods do not lead to unwarrented conclusion. The flow of reports from hospitals was more consistent than from physicians. This suggested that, in selected control studies, adequate rates for comparative purposes might have been obtained entirely from hospital records.
Pediatric injuries in an Arabian Gulf country.
Authors: Bener A. , el-Rufaie O. E. , al-Suweidi N. E.
Published: October 2008

OBJECTIVE: To determine the common types of injuries among children (0-14 years) in Al-Ain, United Arab Emirates (UAE). DESIGN: A retrospective descriptive hospital based study. SETTING: Al-Ain Medical District, Al-Ain Teaching Hospital, UAE. SUBJECTS: All patients aged 0-14 years seen at Al-Ain Teaching Hospital for injuries during 1994. RESULTS: The number of children with an injury who attended the emergency room was 16,518 (69.9% boys; 30.1% girls). Injury rates were higher among non-UAE nationals. The most frequent reason for hospital admission was poisoning (41%). In the age group < 5 years, the most common causes were falls, blunt trauma, and burns or scalds, while in the 5-9 year and in 10-14 year groups the most frequent cause was road traffic accidents (RTAs). Fights and sporting injuries were also seen frequently in children aged 10-14 years. CONCLUSION: Injury rates were higher in boys and RTAs mostly occurred in children over 10 years. The majority of cases (56%) occurred among non-UAE nationals, who are usually of lower socio-economic status. RECOMMENDATION: Injuries can be prevented by developing strategies to substantially increase the profile of health education to parents and children, by educating policy makers and health professionals, and by environmental modification, legislation, and enforcement. The UAE government can play an important part by establishing and supporting injury prevention programs with these goals.
Caregiver factors and pool fencing: an exploratory analysis.
Authors: Fisher K. J. , Balanda K. P.
Published: October 2008

OBJECTIVES: To explore the relationship between caregiver characteristics and the adequacy of domestic swimming pool fencing. SETTING: A typical metropolitan area of a large Australian capital city, Brisbane. METHODS: From a reanalysis of the dataset of the 1989 Brisbane Home Safety Survey of 1050 householders, associations between 10 caregiver factors, pool ownership, and quality of pool fencing, were analysed. Household characteristics relating to toddlers (children < or = 4 years), and socioeconomic measures were also included in the analyses. Pool fencing quality was measured on an ordinal scale derived from Australian Standards Association guidelines, confirmed through home visits by trained inspectors. RESULTS: Caregiver factors did not distinguish households with a swimming pool from those without, nor were they associated with adequacy of pool fencing among pool owners. Pool owners, with or without children, were less likely to perceive having a childproof fence as being important. Strongest correlates of adequacy of pool fencing were socioeconomic indicators of surrounding districts. CONCLUSIONS: These results do not support the arguments of opponents of compulsory pool fencing that caregiver factors are adequate to prevent toddler drownings and obviate the need for a pool fence. Pool owners do not appear to perceive their pool as a hazard for young children, and complacency about the adequacy of pool fencing needs to be replaced by increased caregiver health beliefs, skills, and perceptions.
Relationship between driver's record and automobile versus child pedestrian collisions.
Authors: Lightstone A. S. , Peek-Asa C. , Kraus J. F.
Published: October 2008

OBJECTIVES: The purpose of this study was to explain the relationship of a history of driver's violations as a factor in motor vehicle versus child pedestrian injury incidents. METHODS: A case-control study was conducted utilizing police reports from 1 January 1993, to 30 June 1995, to identify drivers (cases) whose car struck a child pedestrian less than 15 years of age. Controls were randomly selected drivers identified from the license files of the California Department of Motor Vehicles (DMV) who had no record of striking a child pedestrian in the 30 month study period. Two controls per case were selected based on postal code of residence and incident date of case. Prior driver citations, safety violations, license suspension/revocation, and negligent operator points were analyzed from 1 April 1991, to the incident date for cases and controls. RESULTS: Of 327 drivers who met the case definition, 237 (73%) had information on file in the California DMV driver records. Analysis was based on 237 cases and 474 controls. Drivers who hit a child pedestrian were more likely to have had a prior citation, more citations, more safety violations, a suspended or revoked license, or more negligent operator points than drivers who did not hit a child pedestrian in the study period. A positive association exists between the number of citations, safety violations, or negligent operator points and the likelihood that a driver hit a child pedestrian. CONCLUSIONS: Drivers with a history of driving infractions represent a high risk source of danger to child pedestrians. Possible routes of intervention include more rigorous sanctions against these drivers, more intensive education of the involved driver regarding pedestrians, higher insurance and monetary penalties, and a need to pursue more rigorously hit-and-run and unlicensed drivers, including modification of driver code violations for such cases.
Injuries among children in home and out-of-home care.
Authors: Kotch J. B. , Dufort V. M. , Stewart P. , Fieberg J. , McMurray M. , O'Brien S. , Ngui E. M. , Brennan M.
Published: October 2008

As the number of children receiving care in out-of-home settings increases in the United States, the risk of injury in such settings has become the subject of intense research. OBJECTIVES: This study examined the relative safety of out-of-home care compared with care in a child's own home. METHODS: This community based prospective cohort study of 656 families in three adjacent counties in the Piedmont region of North Carolina characterizes the patterns and rates of injuries among children less than 5 years of age in three child care settings, home care (HC), center based care (CBC), and other out-of-home care (OOHC). Information about minor and severe injuries was obtained from parents using monthly telephone interviews over a one year period. Statistical modeling designed to handle unbalanced data with correlated observations was used as the primary tool for analysis. RESULTS: Rate of minor injuries was highest in CBC, followed by HC, and then OOHC. However, these differences for OOHC may have been due to reporting biases and errors in rate estimates. There were no significant differences in severe injury rates among the three settings. CONCLUSIONS: The risk of serious injury among children under 5 in CBC is not different from that of children in HC or OOHC despite the fact that the risk of minor injury is higher.
Socioeconomic and racial/ethnic factors affecting non-fatal medically attended injury rates in US children.
Authors: Overpeck M. D. , Jones D. H. , Trumble A. C. , Scheidt P. C. , Bijur P. E.
Published: October 2008

OBJECTIVE: Using a representative survey of US children, the purpose was to evaluate separate effects of socioeconomic and racial/ethnic factors, including access to care, on medically attended non-fatal injury rates. METHODS: Multivariate linear regression models were used to determine associations between injuries and health care coverage (insurance or Medicaid), having a place to go for care, race/ethnicity, maternal education, number of adults and children in the household, poverty, and urbanicity. The 1988 Child Health Supplement to the National Health Interview Survey included questions on medically attended injuries, and their cause, location, and effects on the child. Injury categories included total, consequential, occurrence at home or school, falls, and being struck or cut. RESULTS: Lack of health care coverage was consistently associated with lower medically attended injury rates in non-Hispanic blacks or whites and Mexican-Americans, but affected total rates for each group differently due to unequal distribution of health care coverage. Injuries occurred about 40% more frequently to children and adolescents living in single adult households compared with two adult homes for all injury categories except for injuries occurring at school. CONCLUSIONS: Preventive interventions targeted to specific populations based on assumptions that poverty, lack of education, or minority status result in greater risks for injuries require a closer look. Efficient targeting should address underlying factors such as differences in exposures and environments associated with single adult homes or recreational activities. Data sources used to target high risk populations for interventions need to address bias due to access to care.
Occupational injury deaths of 16 and 17 year olds in the US: trends and comparisons with older workers.
Authors: Castillo D. N. , Malit B. D.
Published: October 2008

OBJECTIVE: To examine patterns of occupational injury deaths of 16 and 17 year olds in the United States for the three year period 1990-2, examine trends since the 1980s, and compare fatality rates with those of older workers. METHODS: Occupational injury deaths were analyzed using the death certificate based National Traumatic Occupational Fatalities (NTOF) surveillance system. Fatality rates were calculated using estimates of full time equivalent (FTE) workers based on data from the Current Population Survey, a monthly household survey. RESULTS: There were 111 deaths of 16 and 17 year olds for the years 1990-2. The average yearly rate was 3.5 deaths/100,000 FTE. The leading causes of death were motor vehicle related, homicide, and machinery related. All causes occupational injury fatality rates for 16 and 17 year olds were lower than for adults for 1990-2. Rates for the leading causes of death (motor vehicle related, homicide, and machinery related) were comparable or slightly higher than the rates for young and middle aged adult workers. Although rates decreased dramatically from 1980 to 1983, the decreasing trend attenuated in later years. CONCLUSIONS: Comparisons of youth fatality rates to those of adult workers should address differences in patterns of employment, most importantly hours of work. Comparisons to narrow age groupings of adults is preferable to a single category of all workers 18 years and older. Increasing compliance with federal child labor regulations could help reduce work related deaths of youth. Other measures are needed, however, as there are many work hazards, including those associated with homicides, that are not addressed by United States federal child labor law regulations.