Effects of graduated driver licensing on licensure and traffic injury rates in Upstate New York

Objective

In 2003, New York State implemented an enhanced graduated driving licensing (GDL) program that requires extended supervised driving and a passenger restriction. This study examines its safety benefit in 55 Upstate New York counties.

Methods

We analyzed fatal/incapacitating traffic injury data among 16-, 17- and 21-24-year olds for the years 2001 and 2005 using the negative binomial model. To adjust for trends in the traffic injury rate, the relative rate ratio (rRR) of 16- and 17-year olds relative to 21-24-year olds was estimated.

Results

GDL implementation was associated with a 31% reduction in the driver injury rate (rRR 0.69, 95% confidence interval (CI) 0.49-0.96), but not with any statistically significant change in the passenger injury rate (rRR 1.19, 95% CI 0.77-1.84), or pedestrian and bicyclist injury rate (rRR 1.53, 95% CI 0.89-2.62) among 16-year olds. Sixteen-year olds experienced a 21% decline in licensure rates between 2001 and 2005. GDL implementation had no appreciable impact on driver injury and licensure rates for 17- and 21-24-year olds.

Conclusions

GDL implementation is associated with a significant reduction in licensure and driver injury rate among 16-year olds. GDL implementation does not have a statistically significant impact on passenger, pedestrian, and bicyclist injury rates for 16-year olds.     

Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study

A population-based study was carried out in 1996-2001 to provide the incidence and to identify the risk factors of severe traumatic brain injury (TBI) resulting from a road accident. The severe TBI was defined as an injury to the brain or the skull, excluding scalp injuries, with an abbreviated injury scale (AIS) severity score greater than 2. The severe TBI of 1238 patients were described. The annual incidence and mortality of severe TBI were, respectively, 13.7 per 100,000 and 5.3 per 100,000. The fatality rate increased from 20% in childhood to 71% over 75-year-old. Compared to restrained car occupants, the odds ratio for having a severe TBI was 18.1 (95% confidence interval, CI=12.8-25.5) for un-helmeted motorcyclists, 9.2 (95% CI=7.5-11.3) for pedestrians, 6.4 (95% CI=4.7-8.8) for un-helmeted cyclists, 3.9 (95% CI=3.1-4.8) for unrestrained car occupants and 2.8 (95% CI=2.2-3.5) for helmeted motorcyclists. Even after adjustment for several severity factors, male gender and age above 55 were both risk factors. Prevention programs aiming at improving the head protection should be promoted. The circumstances of the accident should be taken into account to predict a severe TBI.     

Prevalence and correlates of handgun access among adolescents seeking care in an urban emergency department

Objective

To determine prevalence and correlates of handgun access among adolescents seeking care in an urban Emergency Department (ED) in order to inform future injury prevention strategies.

Methods

In this observational cross-sectional study performed in the ED of a large urban hospital, 14- to 18-year-old adolescents completed a computerized survey of risk behaviors. Adolescents seeking ED care (for injury or medical complaint) were approached seven days a week over a 22-month period. Validated measures included measures of demographics, sexual activity, substance use, injury, violent behavior, and handgun access. A logistic regression model predicting handgun access was performed.

Results

A total of 3050 adolescents completed the survey (44% male, 58.9% African-American), with 417 (12%) refusing to participate. One-third of the sample (n = 1003) reported access to a handgun, and of those 54% were males (n = 542). Logistic regression results indicated that older age (AOR: 1.58; 95% CI: 1.30-1.94), African-American race (AOR: 1.34; 95% CI: 1.11-1.61), male gender (AOR: 1.99; 95% CI: 1.66-2.37), and being employed (AOR: 1.35; 95% CI: 1.11-1.65), as well as seeking ED care for a medical complaint as compared to intentional injury (AOR: 1.69; 95% CI 1.62-2.50) predicted handgun access. Binge drinking (AOR: 1.75; 95% CI: 1.37-2.27), marijuana use (AOR: 1.93; 95% CI: 1.58-2.36), sexual activity (AOR: 1.64; 95% CI: 1.32-2.02), prior injury by a gun (AOR: 1.80; 95% CI: 1.32-2.46), serious physical violence (AOR: 1.37; 95% CI: 1.13-1.66) and group fighting (AOR: 2.07; 95% CI: 1.68-2.56) also predicted access.

Conclusions

High rates of handgun access were evident among adolescents presenting in an inner city ED, including those seeking care for non-injury related reasons. Adolescents with access to handguns were more likely to report risk behaviors and past injury, providing clinicians with an opportunity for injury prevention initiatives.     

The effect of seating location on the injury of properly restrained children in child safety seats

Properly restrained child passengers in the National Automotive Sampling System (NASS), General Estimates System (GES), were studied for the effect of seating position on the risk of injury. The analysis focused on children seated in a child safety seat in a rear seat location. A multiple logistic regression model was used to assess whether the center rear seat is a safer seating position than either of the outboard rear seats. Standard errors for the odds ratios (ORs) of injury for several correlates of injury including seating position were obtained using a jackknife procedure. This analysis of the data showed that the center rear seat is not a safer seating position than either of the outboard rear seats in terms of odds of injury (left seat OR = 0.88, 95% CI = 0.73-1.03; right seat OR = 1.03, 95% CI = 0.85-1.20). These results do not agree with those of previous studies that suggested the center rear seat is the safest position for parents to place a child safety seat.     

Roles of safety climate and shift work on perceived injury risk: a multi-level analysis

This study evaluated the relationship between employees’ work shift (i.e., day shift versus night shift) and perceptions of injury risk, and how the relationship is affected by company level safety climate and injury frequency. The results showed that night shift workers perceived a higher level of injury risk compared to day shift workers. Both company level safety climate and injury frequency played critical roles in predicting individual perceived work injury risk. Perception of injury risk of night shift workers was significantly lower when they perceived high-level rather than low-level safety climate. However, this pattern was not noticeable for day shift workers. These findings highlighted the importance of considering company level factors when attempting to understand the differences between day shift and night shift work on an individual's perception of injury risk.     

Ecotoxicological evaluation of three tertiary wastewater treatment techniques via meta-analysis and feeding bioassays using Gammarus fossarum

Advanced treatment techniques, like ozone, activated carbon and TiO₂ in combination with UV, are proposed to improve removal efficiency of micropollutants during wastewater treatment. In a meta-analysis of peer-reviewed literature, we found significantly reduced overall ecotoxicity of municipal wastewaters treated with either ozone (n = 667) or activated carbon (=113), while TiO₂ and UV was not yet assessed. As comparative investigations regarding the detoxification potential of these advanced treatment techniques in municipal wastewater are scarce, we assessed them in four separate Gammarus-feeding trials with 20 replicates per treatment. These bioassays indicate that ozone concentrations of approximately 0.8 mg ozone/mg DOC may produce toxic transformation products. However, referred effects are removed if higher ozone concentrations are used (1.3 mg ozone/mg DOC). Moreover, the application of 1 g TiO₂/l and ambient UV consistently reduced ecotoxicity. Although activated carbon may remove besides micropollutants also nutrients, which seemed to mask its detoxification potential, this treatment technique reduced the ecotoxicity of the wastewater following its amendment with nutrients. Hence, all three advanced treatment techniques are suitable to reduce the ecotoxicity of municipal wastewater mediated by micropollutants and may hence help to meet the requirements of the European Water Framework Directive.