Did changes in minimum age drinking laws affect adolescent drowning (1970-90)?

OBJECTIVE

To test the hypothesis that changes in the minimum legal drinking age (MLDA) laws would affect drowning among adolescents, the effects of changes in state MLDA laws on drowning were examined for the targeted (18-20 years) and two adjacent (15-17 years and 21-23 years) age groups, over a period of 21 years (1970-90).

METHODS

Poisson maximum likelihood regression was used to estimate the effects of both lowering and increasing the MLDA. The dependent variable in these analyses was the number of drownings per state per year for the age groups observed. At first only state and year effects were controlled for and then any other variable potentially associated with the incidence of drowning was included. The other control variables included proportion of population living near border states with lower MLDA laws, urbanicity, unemployment, divorce, education, poverty, beer tax, and proxy measures for MLDA law enforcement.

RESULTS

No significant association between drowning and MLDA was found for any of the age groups studied.

CONCLUSION

It is concluded that MLDA laws are not an important public policy strategy for affecting drowning rates among adolescents and young adults.

A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults

A randomized, single-blind controlled trial was conducted to test the efficacy of a community-based group intervention to reduce fear of falling and associated restrictions in activity levels among older adults. A sample of 434 persons age 60+ years, who reported fear of falling and associated activity restriction, was recruited from 40 senior housing sites in the Boston metropolitan area. Data were collected at baseline, and at 6-week, 6-month, and 12-month follow-ups. Compared with contact control subjects, intervention subjects reported increased levels of intended activity (p < .05) and greater mobility control (p < .05) immediately after the intervention. Effects at 12 months included improved social function (p < .05) and mobility range (p < .05). The intervention had immediate but modest beneficial effects that diminished over time in the setting with no booster intervention.

Covariates of fear of falling and associated activity curtailment

With a sample survey (N = 266) of elderly adults residing in six housing developments in Massachusetts, we used logistic regression to: (a) identify covariates of fear of falling among all subjects and (b) identify covariates of activity curtailment among the subset of subjects who were afraid of falling. Fifty-five percent of respondents were afraid of falling; of those who were afraid, 56% had curtailed activity due to this fear. Factors associated with fear of falling were: being female, having had previous falls, and having fewer social contacts. Factors associated with activity curtailment among those who were afraid were: not communicating about falls; having less social support; and knowing someone who had fallen. Falls history appears an important contributor to fear of falling, whereas the impact of this fear on activities appears more a function of social support. These findings suggest different strategies for the primary and secondary prevention of fear of falling.

Intensity and correlates of fear of falling and hurting oneself in the next year: baseline findings from a Roybal Center fear of falling intervention

Fear of falling is highly prevalent and associated with restricted activity. To help inform design of interventions, the authors examined the correlates of this fear. Data came from baseline information on subjects in a community-based falls intervention study (N = 392). In a multivariate model, lower levels of fear of falling and hurting oneself in the next year were related to being younger, having higher levels of dysfunction, and having lower levels of perceived ability to manage falls, with the last two remaining significant even after controlling for generalized fearfulness. When analyzing specific domains of dysfunction, higher levels of fear of falling and hurting oneself in the next year were associated with higher levels of physical dysfunction. The findings lend support to the expanding awareness that fear of falling may imperil quality of life and suggest the importance of interventions aimed at enhancing ability to manage falls.

Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE)

A new instrument was developed to assess the role of fear of falling in activity restriction. The instrument assesses fear of falling during performance of 11 activities, and gathers information about participation in these activities as well as the extent to which fear is a source of activity restriction. The instrument demonstrated good internal consistency reliability and showed convergent validity with other fear of falling measures. Concurrent (empirical) validity was demonstrated in that the scale was effective in differentiating among those who were expected to be afraid vs. not afraid of falling. Criterion validity was examined in relation to quality of life variables. Fear of falling was shown to be related to lower quality of life, even when controlling for related background factors. One advantage of this measure over existing measures is the possibility for differentiating fear of falling that leads to activity restriction from fear of falling that accompanies activity. This may provide useful information for those interested in treating fear of falling of promoting activity among the elderly.

Sunbathing habits and sunscreen use among white adults: results of a national survey

OBJECTIVES

This study assessed current levels of sunbathing and sunscreen use in the United States.

METHODS

From a general-population telephone survey of aquatic activities among adults in 3042 US households, we examined responses by the 2459 Whites.

RESULTS

Most adults (59%) reported sunbathing during the past year, and 25% reported frequent sunbathing. Of the subsample who reported sunbathing during the month before the interview, 47% routinely used sunscreen. Of these individuals, almost half did not use sunscreens with a solar protection factor of 15 or higher.

CONCLUSIONS

About a quarter of US White adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreens at recommended levels. These results should help focus future sun protection educational efforts.

State-level clustering of safety measures and its relationship to injury mortality

This article proposes a social model of investigating injury mortality. The authors hypothesize that (1) state-level laws and regulations on safety cluster together in one or more groupings; (2) groupings of safety measures play a significant role in injury mortality; and (3) injury mortality is very highly associated with social structural variables. There is a clustering of safety policies, with five factors explaining 67 percent of variance, although no "master factor" was discovered. The strongest factor, explaining 21 percent of variance, includes three gun laws and low speed limits before the 1973 federal law. One factor is the most global in that it taps three distinct areas, including helmet laws, minor blood alcohol levels, and smoke detectors, though it only explains 7.5 percent of variance. The only factor that remains in a regression for injury mortality is one that includes strong seat belt laws and strong enforcement of those laws, though in the direction opposite to that hypothesized. This factor, along with percentage rural and environmental spending per capita, is significant for both motor vehicle and non-motor vehicle mortality. For motor vehicle mortality alone, deaths are higher in states with higher percentages of Hispanics and fewer people receiving food stamps and AFDC. Many factors that usually predict individual injury mortality do not hold at the state level, suggesting the usefulness of looking at social factors for new insights into injury mortality and prevention.

Worksite barriers to the effective management of alcohol problems

The purpose of this analysis is to describe barriers to workplace interventions in cases of alcohol abuse. A survey of 7255 supervisors in 114 worksites across seven major corporations was completed (79% responded). Information about barriers to intervention was elicited by 12 questions. Cluster analysis revealed three analytically independent classes of barriers--Organizational, Interpersonal, and Individual. Most managers reported encountering some barriers to intervention: the extent of barriers perceived was related to characteristics of the worksite, job, and/or the environment. Barriers were greatest for female managers, managers in larger worksites, and the first-line supervisors. Barriers were also related to the form (formal vs informal) of intervention a manager was willing to make. Intervention strategies must take into account differences between company worksites and job levels, and not assume that policies are equally effective throughout the corporation.

Employee attitudes toward work-site alcohol testing

Few studies have been published on how employees feel about work-site alcohol testing. By mail, we surveyed employees (n = 6370) at 16 corporate work sites stratified by type of work force, industrial setting, and managerial tolerance toward drinking. We queried respondents about their drinking on the job and support for work-site alcohol testing under three conditions: pre-employment testing, testing after an accident, and random testing. Sixty-five percent of respondents supported pre-employment testing, 81% supported testing after an accident, and 49% supported random testing. Support was relatively consistent across hierarchy (managers, supervisors, and workers) but different by age, education, occupation, type of work force, and perceived exposure to occupational hazards. Support for work-site alcohol testing was highest among blue-collar workers whose jobs involved manufacturing or exposure to work-site hazards.

Insulin and secretagogues differentially regulate fluid-phase pinocytosis in insulin-secreting beta-cells

The physiological role of the beta-cell insulin receptor is unknown. To evaluate a candidate function, the insulin regulation of fluid-phase pinocytosis was investigated in a clonal insulinoma cell line (beta TC6-F7) and, for comparison, also in Chinese hamster ovary cells transfected with the human insulin receptor (CHO-T cells). In CHO-T cells, the net rate of fluid-phase pinocytosis was rapidly increased 3-4-fold over the basal rate by 100 nM insulin, with half-maximal stimulation at 2 nM insulin, as assayed by cellular uptake of horseradish peroxidase from the medium. Wortmannin, an inhibitor of phosphatidylinositol (PI)-3-kinase, blocked insulin-stimulated pinocytosis with an IC50 of 7.5 nM without affecting the basal rate of pinocytosis. In insulin-secreting beta TC6-F7 cells, the secretagogues glucose and carbachol (at maximally effective concentrations of 15 mM and 0.5 mM respectively) augmented fluid-phase pinocytosis 1.65-fold over the basal rate. Wortmannin also inhibited secretagogue-stimulated pinocytosis in these beta-cells with an IC50 of 7 nM but did not affect the basal rate of pinocytosis measured in the absence of secretagogues. Wortmannin did not influence either basal or secretagogue-induced insulin secretion. Although these beta TC6-F7 cells have cell-surface insulin receptors, adding exogenous insulin or insulin-like growth factor 1 did not affect their rate of fluid-phase pinocytosis, either in the absence or presence of secretagogues. From these observations, we conclude that: (1) in both insulin-secreting beta-cells and in conventional, insulin-responsive CHO-T cells, a common, wortmannin-sensitive reaction, which probably involves PI-3-kinase, regulates fluid-phase pinocytosis; (2) the insulin-receptor signal transduction pathway is dissociated from the regulation of fluid-phase pinocytosis in the insulin-secreting beta-cell line we studied; and (3) the enhancement of fluid-phase pinocytosis associated with secretagogue-induced insulin release in beta TC6-F7 cells is not attributable to autocrine activation of beta-cell surface insulin receptors.

Work-site variation in managerial drinking

To assess cross-work-site variation in the general drinking behaviors (on and off the job) of employees, we conducted a cross-sectional survey of managers (n = 7255) at 114 places of work located throughout the continental United States. The work-site mean for the total number of drinks consumed on a typical drinking day ranged from 1.4 to 3.17, a two-fold differential. Regression analysis showed an independent work-site effect, controlling for respondents demographics and type of work. This finding suggests that modifiable work-site characteristics could influence what employees drink on and off the job.

Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program

OBJECTIVES

The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce alcohol-impaired driving, related driving risks, and traffic deaths and injuries.

METHODS

Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993. In annual roadside surveys conducted at randomly selected locations, safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed. Four statewide telephone surveys (n = 15188) monitored self-reported driving after drinking.

RESULTS

In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years, fatal crashes declined 25%, from 178 to 120, and fatal crashes involving alcohol decreased 42%, from 69 to 36. Visible injuries per 100 crashes declined 5%, from 21.1 to 16.6. The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half.

CONCLUSIONS

Interventions organized by multiple city departments and private citizens can reduce driving after drinking, related driving risks, and traffic deaths and injuries.

Expression of insulin receptor mRNA and insulin receptor substrate 1 in pancreatic islet beta-cells

The expression of insulin receptor mRNA was examined in rat pancreatic islet cells by single-cell reverse transcriptase (RT)-polymerase chain reaction (PCR). Single cells from disaggregated islets were individually isolated in a microcapillary pipet, and the beta-cells were identified by amplification of the mRNA for insulin. We found that in single beta-cells, the mRNA for the insulin receptor was also expressed. The fraction of single islet cells expressing both insulin receptor and insulin mRNAs corresponds closely to the fraction of beta-cells in the disaggregated islet cell preparation. These results indicate that normal beta-cells have the potential to express authentic insulin receptors. Immunohistochemical analysis was insufficiently sensitive for assaying insulin receptor protein; however, insulin receptor substrate 1 (IRS-1) was readily immunolocalized in islet beta-cells. Since IRS-1 links several cell surface receptors, including those for insulin and IGF-I, to distal signal transduction pathways, our observations indicate that hormonal regulation of islet beta-cells potentially involves the same signal transduction pathway that mediates insulin and growth factor signaling in peripheral insulin target tissue cell types.

Perceptions of risks of drinking and boating among Massachusetts boaters

OBJECTIVES

Public policy has treated drinking and boating as though it were analogous to drinking and driving. Accordingly, recent Federal and state laws to prevent drinking and boating have focused solely on alcohol use by the boat operator. This study was designed to determine boaters' knowledge about the epidemiology of boating fatalities and how boaters perceive the risks of drinking and boating.

METHODS

In the summer of 1995, the authors conducted a survey by mail of a random sample of 600 owners of boats registered in Massachusetts.

RESULTS

Survey results indicated that boaters believe passengers can safely drink more than operators. Respondents also thought that people on boats at rest can safely drink more than people on boats underway.

CONCLUSIONS

The results of this study could be helpful in designing future boating safety campaigns by identifying gaps in knowledge about about the risks of drinking and boating for both operators and passengers.

Why are most drowning victims men? Sex differences in aquatic skills and behaviors

Men have higher drowning rates than women for most age groups. Data from a 1991 national household survey (n = 3042) on aquatic activities were used to examine hypotheses about differential drowning rates by sex. Men and women were compared by (1) exposure to aquatic environments; (2) frequency of aquatic activities involving or potentially involving, submersion; (3) swimming training and ability; (4) aquatic risk-taking behaviors; and (5) alcohol use on or near the water. Men had elevated risks for exposure, risk taking, and alcohol use. It was concluded that several factors contribute to their relatively high drowning rates, including a possible interaction between overestimation of abilities and heavy alcohol use.

Predicting radon testing among university employees

To determine covariates of radon testing behavior, we surveyed by mail a random sample of all Boston University employees (N = 915) six to nine months after they had been informed of the availability of radon testing services through the University's medical center. The response rate was 58%. Analysis suggests blue collar workers were underrepresented within the response rate. Slightly more than half of the respondents (51%) were men. The majority (69%) were under the age of 45. Twenty-seven percent of the respondents (N = 143) had tested their homes for radon. Bivariate analysis revealed important differences between radon testers and nontesters. Testers were 12 times more likely to be home owners than renters (p = 0.00), and were more knowledgeable about radon's characteristics and testing procedures (p = 0.00). Testers were more likely to view radon as a serious problem (p = 0.00), to consider radon testing efficacious (p = 0.00), and to consider themselves susceptible to exposure (p = 0.00). Testers were also less likely to perceive barriers to radon testing. We used logistic regression to compare the usefulness of the Health Belief Model and the Diffusion of Innovations Model in predicting radon testing. We concluded that the knowledge deficits and barriers to radon testing identified in this study should be targeted in radon educational interventions.

Laparoscopic assisted vaginal hysterectomy: an audit plus a word of caution

Laparoscopic assisted vaginal hysterectomy (LAVH) performed in 109 cases has been reviewed. In this series the mean operative time was 89 minutes and mean inpatient hospitalization was 3.7 days. Throughout the review, 6 patients were considered to have major complications and each is discussed. The association of previous caesarean section and bladder damage is noted. LAVH widens the indications available for vaginal hysterectomy in younger women in whom the abdominal approach would previously be indicated, but extra caution is advised when this technique is first introduced to a gynaecological service.

Evaluation of an office- and hospital-based intervention to increase the use of cloth diapers

To evaluate an office-based educational intervention to promote the use of cloth diapers, we randomly assigned parents of 193 infants either to the intervention group or to a control group. The intervention consisted of physician advice and written material on cloth and disposable diapers at the 2-week office visit. Midway through the study, one of the birth hospitals switched to the exclusive use of cloth diapers. The results indicate that the diapering decisions of parents can be influenced by practices in hospitals and by office-based physician and nurse counseling.

Alcohol and non-traffic unintended injuries

In a review of the English language literature on alcohol and unintentional injury we identified 21 studies on falls, 36 on drownings and 32 on burns from 1947-1986. The proportion of fatal and non-fatal fall victims who had been drinking ranged from 21-77%, and 18-53% respectively. In three more recent studies, 35-63% of persons fatally injured in falls had been drinking. In five other studies 13-37% of persons injured in non fatal falls had been drinking. In our earlier review of drowning studies with complete ascertainment and duration of submergence specified, 27-47% of those who drowned had positive BAC's. In eight subsequent studies, alcohol was identified in 21-47% of drowning deaths. In our earlier review alcohol was involved in 9-86% of burn deaths. In five more recent US studies, alcohol was found in 12-61% of fatally injured burn victims. Case control studies are needed to establish whether alcohol increases the risk of trauma. Studies are also needed of interventions to reduce the proportion of these injuries where alcohol is involved.

Fear of falling among the community-dwelling elderly

To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (> or = 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling.

Using chronic disease risk factors to adjust Medicare capitation payments

This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.