Beachgoers’ beliefs and behaviours in relation to beach flags and rip currents

Background

Coastal drownings claim on average 82 people per year in Australia. Beach flags are a primary safety strategy used on beaches. They are located away from rip currents, which are the main beach hazard affecting swimmers. Little is known about the behavioural and motivational factors associated with people choosing where to swim in relation to flags and rips.

Aims

To assess the beliefs and behaviours of beachgoers in relation to beach flags and rip currents.

Methods

Beachgoers at beaches in NSW were interviewed about their swimming beliefs and behaviours. They were asked to indicate on pictures depicting beach scenarios involving beach flags and fixed rip currents, where they would and would not swim. Logistic regression analysis was undertaken to determine predictors of correct and incorrect swimming behaviour.

Results

Beachgoers who are aged from 30 to 49 years (OR 0.34, 95% CI 0.16, 0.74, p = 0.006) are less likely to choose to swim between the flags than other swimmers. In addition, beachgoers who are at the beach with children are significantly more likely to choose to swim between the flags (OR 2.74, 95% CI 1.39, 5.40, p = 0.004). Beachgoers with basic knowledge about rip currents are significantly more likely to swim away from the rip (OR 11.59, 95% CI 5.89, 22.81, p < 0.001).

Discussion and conclusions

Ocean swimmers aged from 30 to 49 years may choose to swim outside the flags, though they may not necessarily be swimming in the rip. Swimming outside of the flags may be linked with experience. The flags appear to be attractive to parents and carers of children. Whilst the flags indicate a relatively safe area of the beach, it is still vitally important for parents and carers to supervise children in this area. Basic rip current knowledge is an essential component in developing national interventions aimed at reducing coastal drowning. Beachgoers clearly need to know what a rip looks like in order to actively avoid swimming in it.     

煤矿工人工作相关肌肉骨骼疾患的干预效果评估

目的评估煤矿工人工作相关肌肉骨骼疾患(WMSDs)健康教育的效果,为制定预防WMSDs的策略、措施提供理论依据。方法干预的538名煤矿工人群体,在时间段2 a内无任何其他同类干预的情况下,分别于2009年10月和2011年7月对该群体横断面整群抽样,并分析干预前后煤矿工人对WMSDs的认知和态度的变化,以及WMSDs患病率的改变。结果干预后与干预前相比,工人在WMSDs的认知和态度方面皆有改善(P<0.05)。任意部位WMSDs的年患病率在干预前、干预3个月后以及干预后21个月分别为78.3%,64.1%和73.7%(P<0.05)。其中,掘进区工人腰部WMSDs的年患病率下降明显,分别为70.8%、35.0%和54.5%(P<0.05)。煤矿工人根据干预措施采纳程度不同分为"全部采纳"组和"几乎无采纳"组,两组在主观回答WMSDs的防治效果上是不同的(P<0.05)。结论干预措施对掘进区工人腰部WMSDs患病率降低效果明显。在煤矿行业实施针对性的职业健康教育,使工人对WMSDs的"知和信"两方面都有改善,并能长期降低工人任意部位WMSDs的年患病率。因此,在我国针对煤矿行业WMSDs采取健康教育是一种经济有效的干预措施,应长期推广。     

Preventing adolescent drowning: Understanding water safety knowledge,attitudes and swimming ability. The effect of a short water safety intervention

Worldwide, epidemiological data indicate that children are a high-risk group for drowning and while progress has been made in understanding toddler drownings, there is a lack of empirical evidence regarding the drowning risk and protective factors inherent for adolescents and young adults. This study used a self-report questionnaire to establish swimming and water safety knowledge and attitudes of young adults and objectively measured their actual swimming ability using formal practical testing procedures. Participants then completed a short, 12-week intervention that encompassed swimming, survival and rescue skills, along with water safety knowledge applicable to a range of aquatic environments. Knowledge, attitudes and swimming ability were then re-measured following the intervention to evaluate its effectiveness. The Wilcoxon matched pairs signed ranks test was performed to detect whether there were significant differences between knowledge, attitude and swim ability scores pre-intervention and post-intervention. A total of 135 participants completed the baseline and follow up questionnaire and all practical testing. Results indicated that these young adults had a very low level of water safety knowledge pre-intervention, although the majority had sound swimming and water safety skills and attitudes. Overall, significant improvements were evident in knowledge (p < 0.001) and swim ability (p < 0.001) post-intervention, although no changes were observed in attitudes (p = 0.079). Previous participation in formal swimming lessons and/or swimming within the school curriculum had no significant impact on water safety knowledge, skills or attitudes of these young adults, and there were few significant gender differences. While it is important to conduct further studies to confirm that these findings are consistent with a more representative sample of young adults, our findings are the first to provide empirical evidence of the value of a comprehensive aquatic education program as a drowning prevention strategy for young adults.     

Improving seat belt use among teen drivers: Findings from a service-learning approach

Background

Low seat belt use and higher crash rates contribute to persistence of motor vehicle crashes as the leading cause of teenage death. Service-learning has been identified as an important component of public health interventions to improve health behavior.

Methodology

A service-learning intervention was conducted in eleven selected high schools across the United States in the 2011–2012 school year. Direct morning and afternoon observations of seat belt use were used to obtain baseline observations during the fall semester and post-intervention observations in the spring. The Mann–Whitney U test for 2 independent samples was used to evaluate if the intervention was associated with a statistically significant change in seat belt use. We identified factors associated with seat belt use post-intervention using multivariable logistic regression.

Results

Overall seat belt use rate increased by 12.8%, from 70.4% at baseline to 83.2% post-intervention (p < 0.0001). A statistically significant increase in seat belt use was noted among white, black, and Hispanic teen drivers. However, black and Hispanic drivers were still less likely to use seat belts while driving compared to white drivers. Female drivers and drivers who had passengers in their vehicle had increased odds of seat belt use.

Conclusion

A high school service-learning intervention was associated with improved seat belt use regardless of race, ethnicity, or gender, but did not eliminate disparities adversely affecting minority youth. Continuous incorporation of service-learning in high school curricula could benefit quality improvement evaluations aimed at disparities elimination and might improve the safety behavior of emerging youth cohorts.     

Rasch measurement in the assessment of amytrophic lateral sclerosis patients

This paper examines the sensitivity to change over time of the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40). Individuals' health status change was assessed by means of the Rasch-based Reliable Change Index (RCI) for ALSAQ-40 questionnaires completed on two occasions, three months apart. In addition, at follow-up respondents indicated how much change they had experienced since baseline via dimension-specific self reported transition questions. 764 individuals returned questionnaires at baseline and follow-up. For all dimensions, of respondents defined by the RCI as worse, a majority rated themselves as worse. However, on two dimensions over 60% of the respondents who rated themselves as being worse were defined as unchanged by the RCI. As with effect size smaller RCI cut-off points might be needed for subjects with ALS. This study confirms that the ALSAQ-40 is a valid and responsive disease specific health related quality of life instrument for use in studies of patients with ALS or other motor neuron diseases.     

Swimming between the flags: A preliminary exploration of the influences on Australians’ intentions to swim between the flags at patrolled beaches

Swimming at patrolled beaches reduces the likelihood of drownings and near-drownings. The present study tested the Theory of Planned Behaviour (TPB), with the addition of risk perceptions, in predicting people's intentions to swim between the flags at patrolled beaches. We examined also the predictors of people's willingness to swim [1] up to 10 m and [2] more than 10 m outside of the patrol flags. Participants (N = 526) completed measures of attitudes, subjective norm, perceived behavioural control (PBC), intentions/willingness, and both objective and subjective risk perceptions. Two weeks later, a sub-sample of participants reported on their beach swimming behaviour for the previous fortnight. Attitude and subjective norm predicted intentions to swim between and willingness to swim outside of the flags. Age and PBC influenced willingness to swim beyond the flags. Objective risk predicted willingness to swim beyond the flags (both distances) while subjective risk predicted willingness to swim up to 10 m outside the flags. People's intentions to swim between the flags were correlated with their behaviour at follow-up. This study provides a preliminary investigation into an important safety behaviour and identifies factors to target when promoting safe swimming behaviours to prevent drowning deaths on Australian beaches.     

Evaluation of the Click It or Ticket intervention in Utah

Objective

To evaluate the Click It or Ticket (CIOT) intervention conducted in Utah by comparing changes in safety belt use using observational safety belt surveys pre- and post-intervention.

Methods

Observational surveys of safety belt use for drivers and front seat passengers (collectively referred to as front seat occupants) were conducted before and after the media and enforcement blitz of the CIOT intervention. Data were collected from 16 urban sites during the daytime and nighttime. Logistic regression and generalized estimating equations were used to compute odds ratios for safety belt use adjusted for front seat occupant characteristics.

Results

Overall safety belt use was observed at 76.5% pre-intervention and 84.8% post-intervention, an improvement of 8.3% (95% confidence interval [CI]: 5.2%, 11.3%). Daytime and nighttime safety belt use improved by 7.8% (95% CI: 3.5%, 12.1%) and 9.7% (95% CI: 6.4%, 13.0%), respectively. While males showed a greater improvement (9.9%) in safety belt use when compared to females (5.7%); males were still less likely to use safety belts than females.

Conclusions

The CIOT intervention is associated with increased safety belt use at the sites observed in Utah, including among the two high risk groups targeted by the intervention: nighttime occupants and males.     

Age of drinking onset, driving after drinking, and involvement in alcohol related motor-vehicle crashes.

This study assessed whether persons who begin drinking at younger ages are more likely to report drunk driving and alcohol-related crash involvement over the life course, even after controlling analytically for diagnosis of alcohol dependence, years of drinking alcohol, and other personal characteristics associated with the age respondents started drinking. A national survey asked 42,862 respondents the age that they started drinking, whether they drove after drinking too much, and whether they were in motor-vehicle crashes because of their drinking. This analysis focused on 27,081 (65%), who reported ever drinking in their lifetime. The earlier the age respondents started drinking, the more likely they were to report driving after drinking too much and being in a motor-vehicle crash because of their drinking even after adjusting for current/ever diagnosis of alcohol dependence, number of years respondents had been drinking, and other characteristics and behaviors associated with the age respondents started drinking. Particularly, among persons who were never alcohol-dependent, those who began drinking in each age group under 21, relative to those starting at age 21 or older, were more likely to report "ever" and "in the past year" being in a crash after drinking too much. The traffic safety benefits of delaying drinking may extend well beyond the legal drinking age of 21.     

Evaluation of inter-organizational traffic injury prevention in a WHO safe community

The objective of the study was to examine the effect of a community-based injury prevention program on traffic injuries. A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on inter-organizational participation in detecting and taking action against traffic injuries. The total relative risk for traffic injury in the study area showed only a tendency to decrease following program exposure (odds ratio 0.91; 95% confidence interval 0.81-1.02). No change in relative risk was observed in the control area. The analyses of program impact on injury severity showed that the relative risk for moderate injuries in the study area was reduced by almost half (odds ratio 0.59; 95% confidence interval 0.49-0.69), the risk for severe or fatal injuries remained constant (odds ratio 1.27; 95% confidence interval 0.80-2.02), and the risk for minor injuries increased (odds ratio 1.34; 95% confidence interval 1.13-1.59). The relative risk for moderate injuries was reduced by at least half for mopedists, cyclists, pedestrians, and those leaving or entering a motor vehicle. Community-based injury prevention can be a complement to national traffic safety programs.     

Effectiveness of hands-on education for correct child restraint use by parents

This study evaluates whether a hands-on educational intervention makes a significant difference in the proper use of a child passenger restraint by a parent. The clinical trial design included a sample of 111 parents who were at least seven months pregnant and who were randomly assigned to one of two groups (56 intervention and 55 control). All participants received a free car seat and a standardized education session on the safety and use of child passenger restraints. The experimental group received an additional component consisting of a hands-on demonstration and return demonstration of correct installation and use in their own vehicle. Follow-up observation for correctness of use was done after birth using a standardized tool.A total of 24 (22%) parents correctly used the car seat; of these, 18 (32%) were in the intervention group and 6 (11%) were in the control group. The intervention group was four times more likely to have correct use than the control group (odds ratio 4.3, p-value = 0.0074). The range for the number of errors per person was 0-7, with the majority (70%) having 0-2. The rate of errors was 33% less in the intervention group (ratio of 0.67). There were few serious errors in either group. No secondary variable (age, education, income, or help from others) had a significant effect on the outcome.The hands-on educational intervention made a significant difference in the proper use of a child passenger restraint by a parent. This study demonstrates the value of hands-on teaching for learning how to install and use a child car seat.     

Environmental impact assessment of coal mining at Enugu,Nigeria

This study determined the views of respondents in Akwuke and Iva mine communities concerning the impact of coal mining activities on animal and plant species, pattern of settlement, pollution effect and health of people living in these two mined areas in Enugu, Nigeria. Data were generated through sample survey using a well-structured questionnaire and personal observation in the field. Khaya ivorensis (mahogany) was the major tree species that had gone extinct (72% of respondents), and Geochelone sulcata (tortoise) was the major animal species that has gone extinct (80% of respondents) in the two mined areas. Sixty-five percent of the respondents said that water pollution was most severe environmental impact of mining in Akwuke. The major health hazard caused by mining in Akwuke (55% of respondents) and Iva (65% of respondents) was blindness. Indeed, 82.5% of respondents indicated that mining affected the pattern of settlement in the two mined areas. Emphatically, coal mining affected negatively some of the socio-economic activities of the inhabitants of the mined area through removal of vegetation to access coal deposit vis-à-vis blasting, quarrying and crushing of coal.     

Performance of mammography equipment in the Macedonian breast screening campaign 2008/2009

Breast screening campaign in Macedonia started in the end of 2007 and 19 national mammography departments were included. Contrary to the European Guidelines for Quality Assurance in Mammography Screening, the quality assurance activities were not implemented before the start of the campaign, except at the University Clinic of Radiology, Skopje. The quality control tests were performed for the very first time at 13 mammography units under a licence-obtaining procedure. One of the machines was suspended from clinical and screening practice due to heavy malfunction of the generator, X-ray tube and automatic exposure control (AEC) system. Only 3 of the 13 mammography machines met the criteria for tube voltage (kV) accuracy. Two of the seven AEC systems were calibrated in the optimal optical density (OD) range (OD >1.4). AEC settings corresponded to the recommendations at eight units, while nine units met basic overall image quality criteria. Mean glandular dose (MGD) was higher than the recommended level of 2.5 mGy in four departments. Mean gradient of the film G(0.25-2.0) was below 2.8 at four units. Only two light boxes had a luminance of >1700 cd m(-2) and six rooms had an ambient light level of <50 lx. The findings of this work clearly suggest that the performance of the mammography equipment involved in the campaign in almost 50 % do not supply basic quality criteria for a breast screening programme.     

Pedestrians in wintertime—Effects of using anti-slip devices

Pedestrians slipping and falling is a major safety problem around the world, not least in countries with long winters such as Sweden. About 25 000-30 000 people need medical care every year for treatment of fall injuries in Sweden. Use of appropriate shoes and anti-slip devices are examples of individual measures that have been suggested to prevent slipping and falling.An intervention study was performed during the period February to April 2008. The study, which focused on healthy adults in northern Sweden, examined the effect of using anti-slip devices on daily walking journeys and prevention of slip and falls.The respondents were divided into three groups: an Intervention Group, a Control Group, with similar distribution of gender and age, and a Comparison Group. Four questionnaires were distributed: (1) background, (2) daily diary of distance walked and occurrence of incidents or accidents reported weekly, (3) detailed incident or fall report and (4) experiences of using anti-slip devices for those who used these devices during the trial period.Half of the respondents stated that they had previous experience of using anti-slip devices. In this study, 52% of the respondents used anti-slip devices. Anti-slip devices improve the walking capability during wintertime. Among those using appropriate anti-slip devices, the average daily walking distance was found to be statistically significantly longer compared to people not using anti-slip devices. This study indicates that an increase in daily walking distance can be made without increasing the risk of slips/falls when using anti-slip devices. The study also indicates that by using appropriate anti-slip devices and having information about when and where to use them, based on their design, people avoid having slips and falls. The respondents experienced in using anti-slip devices in this study will continue to use them and will also recommend others to use anti-slip devises.     

Physician participation in TQM in geriatric medicine

BACKGROUND: Quality improvement (QI) approaches such as total quality management (TQM) and continuous quality improvement (CQI) have great potential for improving the care provided to older people. Geriatricians have the necessary experience and skills to initiate and lead these QI efforts. A national sample of practicing geriatricians was surveyed in 1998 regarding involvement in, satisfaction with, and insights regarding TQM processes in four care settings. RESULTS: Of 537 questionnaires returned in time for analysis, 497 were included for analysis after omitting questionnaires that were undeliverable or unusable (n = 25) and those from respondents who worked fewer than 20 hours per week (n = 15). More than one-third of the respondents (37.1%) reported no TQM activity at all. For the remainder, the primary site for TQM activity was the nursing home (33.0%), the hospital (22.5%), the office (11.4%), and the patient's home (3.7%). A majority of the respondents spent two hours per week or less on TQM projects. Planning an intervention and acting to maintain it in practice after its evaluation were the two stages of the improvement cycle these respondents engaged in most frequently. DISCUSSION: More geriatricians should be encouraged to participate in TQM training and in specific projects to improve systems of care for older people. Incentives to increase participation should be made available. Rapid-cycle improvement may fit better with physicians' culture of working for outcomes that have relatively short turnaround times.     

Preventing vehicle crashes with trains at grade crossings: the risk seeker challenge

A formative evaluation for a communication campaign to decrease rail-automobile accidents was conducted with a survey of 891 randomly selected residents in Michigan, USA. The formative evaluation was theoretically grounded in the extended parallel process model. The results of the study suggest that the majority of respondents engage in safe driving behaviors around railways. However, 10-20% reported extremely risky behaviors such as trying to 'beat the train' (labeled 'risk seekers'). Further analyses revealed that the risk seekers were disproportionately male with strong sensation seeking tendencies to engage in new and novel experiences and to avoid boredom. The results suggest that high sensation seeking tendencies cause one to experience greater frustration and exhibit greater judgment distortions around rail crossings, which in turn, cause one to try and beat the train. Specific recommendations are given for campaign developers and limitations to the study are addressed.     

Evaluating a novice driver and pre-driver road safety intervention

Intervention or evaluation studies represent a small proportion of traffic psychology research. The current study evaluated the effectiveness of a road safety intervention by measuring attitudes toward unsafe driving behaviors and risk perception. A sample of high school students (n = 133) participated in a road safety intervention program focusing on attitudes and risk perceptions of young people as novice drivers, pre-drivers, and passengers. This sample was compared with a matched sample of students who did not take the program (n = 172) on their attitudes and perceived risk toward unsafe driving, both prior to the program (T1), immediately after the program (T2), and at 6-week follow-up (T3). While no changes in attitudes toward unsafe driving were found for the control group, the intervention group reported riskier attitudes toward unsafe driving behaviors from T1 to T2 and T3. No differences were found from T1 to T3 in perceived risk toward unsafe driving for either the intervention or control groups. Implications of the study include encouraging a higher rate of road safety program evaluations, leading to better understanding of the effectiveness of road safety intervention programs and how they may be designed and delivered to ensure lower engagement in unsafe driving behaviors by young drivers.     

A survey of suspension and revocation effects on the drinking-driving offender

While previous studies have shown that driving during the term of a license suspension or revocation occurs frequently, the driver's assessment of the impact of the action has not been documented to any great degree. Analysis of the survey results reported here indicated that those who drove while under licensing action did so 20 times or more; however, 65% of the admitted drivers reported reduced exposure and more careful driving. Most respondents acknowledged that the licensing action they received was fair (55% of the admitted drivers and 61.5% of the non-admitted drivers did so). All drivers had an accurate perception of the applicable fines, had they received further convictions. However, they tended to believe that potential jail sentences were more severe than they actually were, especially those who did not admit driving. Sixty-five percent of all respondents admitted that they drove during the period of licensing action. Admission rates were approximately 55% for drivers with no additions to the record. For drivers with additions to the record, the admission rate was 75% for those with suspensions and 84% for those with revocations. In addition to the results, recommendations concerning use of restricted licenses for all DUI offenders were presented.     

An outcome evaluation of the ‘Skipper’ designated driver program

The general aim of designated driver programs is to reduce the level of drink driving by encouraging potential drink drivers to travel with a driver who has abstained from (or at least limited) consuming alcohol. Designated driver programs appear to be quite widespread around the world, however a limited number have been subject to rigorous evaluation. This paper reports results from an outcome evaluation of a designated driver program called ‘Skipper’, which was trialled in a provincial city in Queensland, Australia. The outcome evaluation included surveys three weeks prior to (baseline), four months following (1st follow-up), and 16 months following (2nd follow-up) the commencement of the trial in both the ‘intervention area’ (baseline, n = 202; 1st follow-up, n = 211; 2nd follow-up, n = 200) and a ‘comparison area’(baseline, n = 203; 1st follow-up, n = 199; 2nd follow-up, n = 201); and a comparison of random breath testing and crash data before and after the trial. The survey results indicate that awareness of the program in the intervention area was quite high four months following its introduction and that this was maintained at 16 months. The results also suggest that the ‘Skipper’ program and the related publicity had positive impacts on behaviour with an increase in the proportion of people participating in designated driver as a passenger. It is less clear, however, whether the ‘Skipper’ program impacted on other behaviours of interest, such as drink driving or involvement in alcohol-related crashes. Suggestions for further research and program improvement are discussed as well as limitations of the research.