Individual and area socioeconomic inequalities in cause-specific unintentional injury mortality: 11-Year follow-up study of 2.7 million Canadians

This study investigated the association between individual and area socioeconomic status (SES) and leading causes of unintentional injury mortality in Canadian adults. Using the 1991–2001 Canadian Census Mortality Follow-up Study cohort (N = 2,735,152), Cox proportional hazard regression was used to calculate hazard ratios and 95% confidence intervals for all-cause unintentional injury, motor vehicle collision (MVC), fall, poisoning, suffocation, fire/burn, and drowning deaths. Results indicated that associations with SES differed by cause of injury, and were generally more pronounced for males. Low education was associated with an elevated risk of mortality from all-cause unintentional injury and MVC (males only) and poisoning and drowning (both sexes). Low income was strongly associated with most causes of injury mortality, particularly fire/burn and poisoning. Having no occupation or low occupational status was associated with higher risks of all-cause injury, fall, poisoning and suffocation (both sexes) and MVC deaths among men. Associations with area deprivation were weak, and only areas with high deprivation had elevated risk of all-cause injury, MVC (males only), poisoning and drowning (both sexes). This study reveals the importance of examining SES differentials by cause of death from a multilevel perspective. Future research is needed to clarify the mechanisms underlying these differences to implement equity-oriented approaches for reducing differential exposures, vulnerability or consequences of injury mortality.     

The association of activity level, parent mental distress, and parental involvement and monitoring with unintentional injury risk in fifth graders

Objective

Extend findings with young children by examining the strength of association of activity level, parent mental distress, and parental involvement and monitoring with fifth graders’ unintentional injuries.

Methods

Ordinal logistic regression models were used to predict unintentional injury frequency among 4745 fifth-graders. Examined predictors included demographics, parent reports of mental distress, temperamental activity level (tendency to be fidgety, restless, and constantly in motion), and parental involvement and monitoring in adolescents’ lives.

Results

Higher levels of both activity level and parent mental distress predicted more frequent injuries.

Conclusions

As has been found with younger children, unintentional injuries in fifth graders are associated with both parent and child characteristics. The result is discussed in the context of adolescent development. Implications include those for injury prevention (multi-dimensional prevention strategies that incorporate environmental modifications as well as training of youth and parents) and future research (study of potential mechanisms behind injury risk behavior via longitudinal and experimental research; study of injury risk during this phase of child development).     

Child pedestrian safety: Parental supervision, modeling behaviors, and beliefs about child pedestrian competence

Pedestrian injuries are a significant health risk to children, particularly those 5–9 years of age. Surprisingly, few studies have explored parent-related factors that may moderate this risk. The present study used naturalistic observations of parent–child pairs crossing at uncontrolled intersections and a short interview to examine parental supervision of children during crossings, modeling of safe-crossing behaviors, beliefs about how children come to cross streets safely, and whether child attributes (age, sex) relate to parental practices and beliefs. Results revealed that parents more closely supervised younger than older children, they modeled safer crossing practices for sons more than daughters, particularly younger sons, and although over half the sample believed children need to be explicitly taught how to cross safely, few actually provided any instruction when crossing with their children. Providing parents both with guidelines for how to accurately appraise their child's readiness for crossing independently and with information about best practices for teaching children how to cross safely may facilitate parents’ implementing these practices, particularly if this is coupled with public advocacy highlighting the important role they could play to reduce the risk of child pedestrian injury.     

Child bystanding: A risk factor for injury and identifying its’ determinants on midwestern agricultural operations

Background

Agriculture is considered among the most dangerous occupations and has consistently ranked among the top three. Production processes, associated with this occupation, place at risk not only workers but also others who live on the operations. We evaluated the incidence and determinants of associated bystander injuries in the Regional Rural Injury Study-II (RRIS-II).

Methods

The RRIS-II followed 32,601 people (∼85% of eligible) from rural communities in the Midwest for 1999 and 2001, using six-month recall periods, and identified their injury events. Demographic, injury, and exposure data were collected through comprehensive and case-control computer-assisted telephone interviews. Multivariate logistic regression analyses were used to estimate the risk of child bystanding and agricultural injury, while controlling for potentially confounding variables.

Results

Nearly 60% of all 425-child injury cases (<20 years) responded to sometimes/frequently bystanding in six out of seven different agricultural environments (e.g., workshops, animal areas, etc.) Multivariate regression analyses, with odds ratios and 95% confidence intervals, showed increased odds of injury for bystanding near used (1.5; 1.1, 1.9) or stored (1.4; 1.1, 1.8) machinery, and near fields and barnyards (1.4; 1.0, 1.9). Further, multivariate analyses revealed increased odds of bystanding for parental beliefs, such as: child age (1.4; 1.0, 2.0) near stored equipment. Parental levels of strictness were also evaluated and showed decreased odds of bystanding when the parents were not strict about the child's wearing a seatbelt near used equipment (0.5; 0.3, 1.0). Households with only one child had decreased odds of bystanding for five of the exposures while there was an increased odds of bystanding near animals for households with five or more children.

Conclusions

Although parents cannot child-proof their operations, it is important for them to understand the apparent odds of and risks associated with bystanding. Children can have injury odds similar to adults in this environment; therefore, it is necessary to examine parental factors that may be associated with children's likelihood of bystanding in high-risk work environments.     

Gender differences in injury severity risks in crashes at signalized intersections

This paper analyzes gender differences in crash risk severities using data for signalized intersections. It estimates gender models for injury severity risks and finds that driver condition, type of crash, type of vehicle driven and vehicle safety features have different effects on females’ and males’ injury severity risks. Also, it finds some variables which are significantly related to females’ injury severity risks but not males’ and others which affect males’ injury severity risks but not females’. It concludes that better and more in-depth information about gender differences in injury severity risks is gained by estimating separate models for females and males.     

The role of risk-taking and errors in children's liability to unintentional injury

There is likely to be heterogeneity in the processes putting children at risk of injury. This paper examines whether errors may form a dissociable process from risk-taking. We further examine whether these constructs mediate the links between emotional and behavioural problems and unintentional injury. We designed the parent-report Children's Injury Related Behaviour (CIRB) questionnaire to measure errors and risk-taking in everyday activities. The sample consisted of 499 children aged 4-11 years recruited from the community. Principal components analysis showed that a two factor solution was appropriate and provided scales to measure risk and error with good psychometric properties. Both risk and error scales were independently related to injury history. Errors were associated with conduct problems, emotional problems and hyperactivity. Risk-taking was associated with conduct problems and hyperactivity only. Risk-taking and errors accounted for the links of conduct problems and hyperactivity with injury involvement. The distinction between risk and error has implications for research and interventions to reduce childhood injuries.     

Race,Hispanic origin,and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults

Black and Hispanic adults travel less in motor vehicles than whites but may be at greater risk when they do travel. Passenger vehicle occupant deaths per 10 million trips among persons ages 25-64 were computed by race, Hispanic origin, gender, and socioeconomic status (SES) using 1995 data from the Fatality Analysis Reporting System (FARS) and Nationwide Personal Transportation Survey. Educational level was used as the indicator of SES. Blacks, particularly black men, were at increased risk of dying relative to whites when traveling in motor vehicles (rate ratio (RR) for black men=1.48; 95% confidence interval (CI)=1.42-1.54). Hispanic men, but not Hispanic women, also had elevated occupant death rates, but their risk was less than that of black men (RR=1.26; 95% CI=1.20-1.31). SES was the strongest determinant of occupant deaths per unit of travel; RRs among those who had not completed high school were 3.52 (95% CI=3.39-3.65) for men and 2.79 (95% CI=2.69-2.91) for women, respectively. Whites without high school degrees had the highest death rates per 10 million trips. After adjustment for SES, the elevated risk of occupant fatalities persisted among black men and women, but not among Hispanic men. Seat belt use and alcohol-impaired driving were examined among fatally injured passenger vehicle drivers. Among those with no education beyond high school, higher percentages were reported as having high blood alcohol concentrations (BACs) or having not used belts. Reported belt use rates were lower among black men and women, even after controlling for SES, whereas Hispanic men and women had belt use rates similar to those of whites. High BACs were more common among Hispanic men, which appeared largely to be an effect of SES because most Hispanic men killed in crashes had not completed high school, the education level with the highest percentage that drove while impaired by alcohol. More effective public health efforts are needed to reduce occupant deaths among persons of lower SES, blacks, and Hispanics, including measures to increase use of seat belts and reduce alcohol-impaired driving.     

Child passenger safety and the immunity fallacy: Why what we are doing is not working

Motivating parents to take certain safety precautions when traveling with their children remains an elusive challenge for advocates, as caregiver naiveté contributes to poor parental participation in safety-seat checks, low booster-seat use, poor adherence to rear-seat positioning, and intermittent safety-belt use. Because of inherent human biases and unfortunate characteristics of vehicle travel, it is argued that most caregivers possess an immunity fallacy, or a reduced perception of risk for motor vehicle injury to their children. Consequently, traditionally designed child passenger safety campaigns, which are primarily informational, fail to have an impact on most parents. Rather, for maximum behavioral success, injury prevention messages must shock and surprise parents into paying attention to something they would normally dismiss as unimportant.     

Predictors of injury among younger and older adults in fatal motor vehicle crashes

With 2003 Fatality Analysis Reporting System data, we examined relationships among predictors of motor vehicle injury/fatality outcomes for younger (35–54 years) and older (65 years and older) drivers. Using the Precede-Proceed Model of Health Promotion as an organizing framework, we classified variables into person, vehicle and environment domains and conducted a multinomial logistic regression.Significant risk factors for older driver injuries were impact crashes at 1–3 o’clock (OR = 1.65; CI: 1.05–2.59), 7–9 o’clock angles (OR = 2.59; CI = 1.45–4.63), and driving with one passenger (OR = 2.25; CI: 1.58–3.20). Previous other motor vehicle convictions were significantly associated with reduced risk of injury (OR = 0.55; CI = 0.34–0.90). The 7–9 o’clock angle (OR = 3.06; CI: 1.83–5.12), and driving in daylight hours were risk factors for fatality among older drivers.Many risk factors (e.g., female gender, non-seatbelt use, rollover crashes, and vehicle body type), and protective factors (e.g., number of lanes and non-airbag deployment) were relevant for younger and older drivers. Findings showed relevant factors for drivers from both age groups, with some pointing to older adults, and set the stage for further research to develop injury and fatality prevention programs.     

Factors associated with parental safe road behaviour as a pedestrian with young children in metropolitan New South Wales, Australia

A cross-sectional population-based randomised telephone survey of parents with children aged between 5 and 12 years was conducted to investigate factors associated with safe road behaviour of parents as pedestrians with their young children in Sydney metropolitan and near by cities in New South Wales, Australia. Parental perception of the road environment as hazardous associated significantly with their safe road behaviour as pedestrian while with their children. This held true even after adjusting for the non-English speaking background and the age of the child. Knowledge of road rules, on the other hand, was not associated with parental safe road behaviour. The results of this study suggested that parental safe road behaviour require much attention in future research and in programme development. The perception of the road environment is a very important factor in motivating safe road behaviour. This should be taken into consideration in designing road safety campaigns.     

Risky driving habits and motor vehicle driver injury

Risky driving is an important cause of motor vehicle injury, but there is a lack of good epidemiological data in this field, particularly data comparing risky driving in younger drivers to those of other age groups. We examined the relationship between risky driving habits, prior traffic convictions and motor vehicle injury using cross-sectional data amongst 21,893 individuals in New Zealand, including 8029 who were aged 16-24 years. Those who reported frequently racing a motor vehicle for excitement or driving at 20 km/h or more over the speed limit, and those who had received traffic convictions over the past 12 months, were between two and four times more likely to have been injured while driving over the same time period. Driving unlicensed was a risk factor for older but not younger drivers, and driving at 20 km/h or more above the speed limits was a stronger risk factor for younger (<25 years) than older drivers. These results confirm the need for interventions targeting risky driving and suggest that different strategies may be required for different high-risk groups.     

Pedestrian injury risk and the effect of age

Older adults and pedestrians both represent especially vulnerable groups in traffic. In the literature, hazards are usually described by the corresponding injury risks of a collision. This paper investigates the MAIS3 + F risk (the risk of sustaining at least one injury of AIS 3 severity or higher, or fatal injury) for pedestrians in full-frontal pedestrian-to-passenger car collisions.Using some assumptions, a model-based approach to injury risk, allowing for the specification of individual injury risk parameters for individuals, is presented. To balance model accuracy and sample size, the GIDAS (German In-depth Accident Study) data set is divided into three age groups; children (0–14); adults (15–60); and older adults (older than 60). For each group, individual risk curves are computed. Afterwards, the curves are re-aggregated to the overall risk function.The derived model addresses the influence of age on the outcome of pedestrian-to-car accidents. The results show that older people compared with younger people have a higher MAIS3 + F injury risk at all collision speeds. The injury risk for children behaves surprisingly. Compared to other age groups, their MAIS3 + F injury risk is lower at lower collision speeds, but substantially higher once a threshold has been exceeded. The resulting injury risk curve obtained by re-aggregation looks surprisingly similar to the frequently used logistic regression function computed for the overall injury risk. However, for homogenous subgroups – such as the three age groups – logistic regression describes the typical risk behavior less accurately than the introduced model-based approach.Since the effect of demographic change on traffic safety is greater nowadays, there is a need to incorporate age into established models. Thus far, this is one of the first studies incorporating traffic participant age to an explicit risk function. The presented approach can be especially useful for the modeling and prediction of risks, and for the evaluation of advanced driver assistance systems.     

The influence of alcohol, age and number of passengers on the night-time risk of driver fatal injury in New Zealand

Breath alcohol measurements and other data collected at randomly selected roadside sites were combined with data on fatally injured drivers in crashes occurring on the same weekdays and times (Friday and Saturday nights) at locations matched by the size of the nearest town. A logistic model was fitted to these data for the years 1995-2000 to estimate the effects of alcohol, driver's age and the influence of passengers carried on the risk of driver fatal injury in New Zealand. The estimated risks increased steeply with increasing blood alcohol concentration (BAC), closely following an exponential curve at levels below about 200mg/dl (i.e. 0.2%) and increasing less than exponentially thereon. The model fitted to data for drivers under 200mg/dl showed that risks at all BAC levels were statistically significantly higher for drivers aged under 20 (over five times) and for drivers aged 20-29 (three times) than for drivers aged 30 and over. Further, controlling for age and BAC level, driving with a single passenger was associated with approximately half the night-time risk of driver fatal injury relative to driving either solo or with two or more passengers. According to a recent travel survey, the types of passengers carried at the times of night and days of week studied appear to differ significantly from the types of passengers carried generally, which may lead to different passenger effects on driver behaviour. The high relative risk of teenage drivers means that they reach high risk levels commonly regarded as unacceptable in the field of road safety even at their current legal limit of 30mg/dl, particularly when more than one passenger is carried in the car.     

Passenger carriage and car crash injury: a comparison between younger and older drivers

This study was conducted to investigate the effects of passenger carriage, including the number of passengers and the ages of passengers, on the risk of car crash injury. The study utilised data obtained from a case–control study conducted in the Auckland region of New Zealand between 1998 and 1999. Cases were car drivers who involved in crashes in which at least one occupant was hospitalised or killed. Controls were selected from a cluster random sample of car drivers on the roads in the same region. Self-report information on the numbers of passengers carried and their ages at the time of crash or at the time of the roadside survey, as well as potential confounding factors, was obtained from the drivers, or a proxy, using an interviewer-administered questionnaire. A total of 571 cases (93% response rate), including 195 younger drivers (aged <25 years), and 588 controls (79% response rate), including 94 younger drivers participated in the study. After adjusting for other risk factors, the odds of car crash injury among younger drivers was 15.55 times (95% CI 5.76–42.02) for those who carried two or more same age passengers, and 10.19 times (95% CI 2.84–36.65) for those who carried two or more other age passengers, compared with unaccompanied drivers. In comparison, no increase in risk was observed for older drivers who carried two or more passengers regardless of age. The carriage of two or more passengers, irrespective of the ages of passengers, significantly increases the risk of car crash injury among younger drivers. Passenger restriction as part of the graduate licensing system was discussed in the light of these results.     

Modeling improvements in booster seat use: a discrete choice conjoint experiment

Automobile crashes are the leading cause of death in children aged 1–14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4–9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.     

The role of parental alcohol consumption on driving under the influence of alcohol: results from a longitudinal, nationally representative sample

Purpose

Many studies have examined the role of peer and parental alcohol use on drinking behaviors among adolescents. Few studies, however, have examined parental influences on driving under the influence (DUI) of alcohol. The current study uses data from a longitudinal study to examine the role of parental alcohol use during adolescence on the risk for DUI among young adult men and women.

Methods

Data were derived from 9559 adolescents and young adults who participated in the National Longitudinal Study of Adolescent Health (Add Health) Waves I and III. Survey logistic regression was used to examine the relationship between multilevel risk and protective factors and self-reported DUI. Analyses were stratified by gender and frequency of parental alcohol consumption to understand the role of parental alcohol use on risk for DUI among their youth.

Results

Risk and protective factors for DUI were very similar among men and women. Parental alcohol use significantly predicted DUI among women (OR = 1.39, p < 0.01) and men (OR = 1.33, p < 0.05). When parents did not report alcohol use, peer alcohol use significantly increased risk for DUI for both women (OR = 1.26, p < 0.05) and men (OR = 1.31, p < 0.001). When parents reported alcohol use, however, peer alcohol use was not a significant independent predictor.

Conclusions

Findings suggest remarkable similarities in risk and protective factors for DUI across gender groups. For men and women, parental alcohol consumption was a risk factor for DUI. Peers’ alcohol use predicted DUI only when parents did not use alcohol.     

Family planning and the health of women and children

Use of family planning has the potential to produce reductions of 10–20% in infant and child mortality. Similar reductions in the mortality rate associated with pregnancy can be expected for mothers. A larger impact on maternal mortality is possible through fertility reduction with decreased exposure to the risks of pregnancy. First births carry excess risks for mothers and children, but these are, by definition, unavoidable. Births to young mothers also pose increased risks for mothers and children. High birth order and older age of mothers probably have been overemphasized as risk factors for children. Very high parity does pose risks to mothers. Poor spacing of births is associated with increased health risks to children. Estimation of mortality reduction through family planning requires knowledge of risk distribution as well as relative risk. High-risk births are relatively rare, and most deaths occur to mothers and babies at average or low risk. Family planning does not avert all high-risk pregnancies because of a lack of acceptance and imperfect use.     

The independent contribution of driver,crash, and vehicle characteristics to driver fatalities

Several driver, crash, and vehicle characteristics may affect the fatality risk of drivers involved in crashes. To determine the independent contribution of these variables to drivers’ fatality risk, we used data from single-vehicle crashes with fixed objects contained in the US Fatal Accident Reporting System. A multivariate logistic regression revealed that the odds ratio (OR) of a fatal injury increased with age, reaching 4.98 (99% confidence interval (CI)=2.01–12.37) for drivers aged 80+ compared with drivers aged 40–49 years. Female gender (OR=1.54, 99% CI=1.35–1.76) and blood alcohol concentration greater than 0.30 (OR=3.16, 99% CI=1.96–5.09) were also associated with higher fatality odds. In comparison with front impacts, driver-side impacts doubled the odds of a fatality (OR=2.26, 99% CI=1.92–2.65), and speeds in excess of 111 kilometers per hour (kph; 69 mph) prior to or at impact were related to higher fatality odds (OR=2.64, 99% CI=1.82–3.83) compared with speeds of less than 56 kph (35 mph). Three-point seatbelts were protective against fatal injuries (OR=0.46, 99% CI=0.39–0.53 compared with no belt). These data suggest that increasing seatbelt use, reducing speed, and reducing the number and severity of driver-side impacts may prevent fatalities. The importance of age and gender suggests that the specific safety needs of older drivers and female drivers may need to be addressed separately from those of men and younger drivers.