Post-traumatic stress disorder in a child following an automobile accident

A 3-year-old girl was diagnosed with post-traumatic stress disorder (PTSD) following a minor automobile accident. The child presented with nightmares, violent play, and trauma-specific fears. The common symptoms of PTSD in childhood are reviewed, and the importance of careful history-taking and prompt referral to a mental health professional are discussed.

Emergency room: individuals, families and groups in trauma

Each year in Israel hundreds of people lose their lives in road accidents; many more are injured (Field Staff, 1986). The effect on families, on hospital staff, and even on whole communities can be debilitating. Recognizing the grave impact of trauma and its aftermath, the Haemak Medical Center, Afula, established an emergency/trauma program in 1986. The program was developed by the Department of Social Work Services, with the cooperation of the emergency room (ER) team. Based on meetings with and preparation of the ER team (physicians, nurses, and social work staff), the department developed a protocol for integrating social workers and psychosocial concepts into the emergency/trauma situation.

The role of designated driver programs in the prevention of alcohol-impaired driving: a critical reassessment

We review the "designated driver" concept and the current debate over its role in preventing alcohol-impaired driving. In our view, the focus on this strategy by broadcasters, the alcohol industry, and various public service groups has deflected attention from other alcohol-related problems that account for the vast majority of deaths and injuries associated with alcohol use. This focus has also distracted many public health advocates and policymakers from the bigger and more important jobs of increasing public awareness of the social, environmental, and economic factors that influence alcohol consumption and promoting debate on legislation and other public policy solutions to alcohol-impaired driving. As part of a comprehensive strategy, we strongly encourage a renewed focus on "sobriety checkpoints," strict enforcement of laws against alcohol sales to minors, alcohol advertising reform, increased excise taxes, and other public policy initiatives supported by the Surgeon General. These measures will curb underage and heavy alcohol consumption and will create a legal and social environment in which individuals are motivated to avoid impaired driving through several alternative strategies, including but not limited to the use of designated drivers.

Personality traits and behaviors of alcohol-impaired drivers: a comparison of first and multiple offenders

Using an interview and questionnaire format, 358 driving under the influence of alcohol (DUI) first offenders and 141 DUI multiple offenders were compared on measures of personality traits, drinking behavior and problems, and driving behavior and history. In addition, official driving records for the two groups were compared. Results indicated that multiple offenders were significantly higher in hostility, sensation seeking, psychopathic deviance, mania, and depression than first offenders. Multiple offenders were significantly lower in emotional adjustment and assertiveness. Multiple offenders had significantly more nontraffic arrests, accidents, and traffic tickets than first offenders. They also consumed significantly more alcohol, evidenced more alcohol problems, and had higher BACs at the time of arrest than first offenders. Results are discussed in terms of general problem behavior and implications for intervention and treatment.

Primary prevention of catastrophic injury

Motor vehicle crashes are a leading cause of injury and death until age 45. Efforts to prevent these injuries have largely followed the dictates of the public health movement focusing on interventions for entire communities or regulatory statutes. Individual interventions, more congruent with traditional psychological approaches, have been rare. This article argues that a blending of these two approaches is warranted. Evaluation of prevention programs should focus on multiple levels including the individual, the community, and regulatory processes. Identification of subgroups of adolescents and young adults with unique psychological and behavioral dispositions regarding injury must be paired with realistic interventions of adequate duration.

Convicted impaired drivers and high-risk drivers: how similar are they?

The present study was a partial replication of one by D.M. Donovan (1980). Donovan's results indicated that convicted impaired drivers (DWIs) and high-risk drivers were overlapping populations with shared deviant characteristics. The present study, like Donovan's, compared three types of drivers: DWI, high-risk (either high-accident or high-violation) and general population control. Unlike Donovan, the present study attempted to match the age and sex distributions of the groups. Data were obtained from personal interviews and driver records. The DWI group was the most deviant on behavioral and personality measures and had more accidents and traffic convictions than did controls. High-risk drivers were more deviant than controls on several measures but the two groups were quite similar in other respects. The results suggest that some of the deviance attributed to high-risk drivers by Donovan may have been exaggerated by confounding with age. Secondly, the heterogeneity within the DWI and high-risk driving populations appears to outweigh their differences.

Confirmation of Tabachnick and Klugman's hypothesis that the death instinct is constant

In reporting the accident death rate and the chronic liver disease death rate for 1980, the Bureau of the Census divided the United States into nine areas. To test Tabachnick and Klugman's hypothesis that the amount of death instinct per capita remains constant across regions, the 1980 death rates for accidents and chronic liver disease were correlated. Contrary to earlier studies, the present study gave support for Tabachnick and Klugman's hypothesis.

Motorcycling attitudes and behaviours. I. 12 and 13 year old adolescents

The death and serious injury of adolescent motorcyclists is a major public health problem. Effective preventive strategies depend on knowledge about target populations. The attitudes and patterns of exposure to motorcycling of 730 13 year old New Zealand adolescents are described. Fifty-two per cent could ride a motorcycle, a further 13% intended to learn, 22% had driven on-road, and 60% had ridden as pillion passengers on-road. Significantly more males than females were riders (P less than 0.001) and had ridden as pillion passengers (P less than 0.05). More male than female non-riders intended to learn (P less than 0.001). Eighty per cent of the sample recognized road 'accidents' as the main cause of death for their peers, and 31% had known a motorcyclist killed or injured. Seventeen per cent of on-road riders had not worn a helmet when last riding. Few statistically significant differences in risk perception were obtained between males and females or riders and non-riders. Preventive options are discussed.

An examination of gender differences in traffic accident risk perception

Excessively optimistic judgements of driving competency and accident risk have often been implicated in the disproportionate involvement of young males in traffic crashes. In this study, young male and female drivers (ages 18-24) were asked to judge their relative driving safety, skill, and accident likelihood. Comparisons were made using both peers and the average motorist as referent groups. Subjects then rated 15 risky driving behaviors on four dimensions: frequency in everyday driving, seriousness, accident potential, and apprehension likelihood. Self-report driving experience/history data were also collected. Substantial optimism was evident in both sexes, but males tended to be more optimistic, particularly when judging their driving skill. Males were equally optimistic with respect to the two referent groups; females tended to be less optimistic when making comparisons to the average motorist. Males and females held similar perceptions concerning the frequency and accident likelihood of the risky behaviors, but males perceived the behaviors as generally less serious and less likely to results in accidents. Regression analyses showed that considerably more variance in optimism could be explained for males than females. Driving record was the single best predictor of perceived safety; its role, however, was diminished for perceived skill and subjectively estimated accident likelihood.

Errors in young children's decisions about traffic gaps: experiments with roadside simulations

Young children's vulnerability as pedestrians has often been attributed to deficiencies in their decision making about vehicle approach times. Some studies have found a preponderance of risky decisions below the age of eight years. In contrast, studies using a closer simulation of road crossing, known as the pretend road, have found a preponderance of overcautious decisions in young children: traffic gaps of adequate size were frequently rejected (missed opportunities). However, the pretend road has potentially distorting characteristics which may account for this divergent pattern of findings. The experiments reported below show that new simulations that eradicate distortions nevertheless validate the pattern of results produced with the pretend road. Differences between adults and young children were pronounced for missed opportunities, but not for risky decisions. Subsidiary analyses suggest that the risky decisions of the youngest children may have arisen through lapses in attention, rather than deficits in timing. These findings run contrary to the view that attributes young children's pedestrian vulnerability to perceptuo-motor deficiency.

A modeling analysis of young drivers' judgments of accident risk due to alcohol use and other driving conditions

Male (60) and female (60) college students who were under the legal drinking age completed a personal driving experience questionnaire and judged the probability of an accident occurring in 100 driving scenarios, half involving an intoxicated male driver and half a sober male driver. The scenarios also varied in terms of the safety levels of five other driving factors. Mathematical models derived from the probability judgments permitted measurement of the influence of the various driving factors on perceived risk. The driving factors in order of their influence on the accident probability judgments were driver intoxication-nonintoxication, vehicle speed, road conditions, driver mood and driving experience, which did not significantly differ, and the driver's experience with alcohol use. Accident probability estimates of the alcohol scenarios increased as an additive function of the other driving factors, whereas increased risk of an accident in the no-alcohol scenarios was more dependent upon multiple unsafe factors. Female students judged the probability of an accident higher overall than did male students. Subject drinking classification (abstain-light, moderate or heavy) was not related to accident probability estimates.

Geophysical variables and behavior: LXVIII. Distal and lunar variables and traffic accidents in Saskatchewan 1984-1989

The daily total number of traffic accidents and traffic accident severity for the years 1984 to 1989 in Saskatchewan were analyzed to estimate relationships with day of the week, season of the year, and various lunar variables (lunar phase, distance of the moon from the earth, and moon-sun tidal index). A regression model with both a linear term and a trigonometric term was fitted to the data. No relationship between lunar cycles and total accidents or severity of accident was found. A larger number of total accidents was found during the winter months and weekends; however, more severe accidents tended to occur during the summer months. A slight linear trend was uncovered for total accidents over the time period under consideration.

[Symptoms in patients with neck injury after a car crash. A retrospective study]

139 persons who contacted The Regional Hospital, Trondheim, between 1 January and 1 September for whiplash injury caused by a car crash from behind were asked whether they still had problems six months or more after the accident. 51% reported having symptoms and 12% reported serious problems. Five persons were still out of work because of the neck injury. 63% of the questioned persons were female and the percentage of women increased with increasing symptoms. There was no correlation between age and problems. There were more persons without symptoms among office employees (70%), managers/university educated persons (53%) and students/pupils (50%) than among unskilled workers/professional drivers (35%) and housewives/retired persons/pensioners/unemployed (35%).

[Revoking the driver's license--ingenious discovery or anachronism]

There are good reasons to argue, that the withdrawal of the driving license is a necessary, but not a sufficient condition to change behavior. It is proposed to enrich the withdrawal through the offer of an traffic-psychological counselling, so that the time without license can be used more problem-solving.

Behavior and parental expectations of child pedestrians

Pedestrian injuries remain the most common cause of death from trauma for young school-age children. This study was based on the hypothesis that parents' abilities to accurately assess their children's street-crossing skills vary with the crossing test and age of the children, being less accurate for younger children. Children at three developmental levels (aged 5 through 6, 7 through 8, and 9 through 10 years) and their parents were evaluated on four street-crossing tests and a control vocabulary test. For each test, children's answers were compared to parents' estimates of their children's performance. Parents overestimated the abilities of their 5-through 6-year-olds on all four tests (P less than .01). Parents overestimated the abilities of 7- through 8-year-olds on two of the tests (P less than .05) and parents accurately assessed the abilities of the 9- through 10-year-olds. On the vocabulary test, parents overestimated their children's performance at all age levels (P less than .01). The results support the hypothesis and indicate that parents' expectations for their children's pedestrian skills are least accurate for 5- and 6-year-olds, with the mismatch decreasing as children get older. Inaccurate expectations of children's pedestrian skills may be fruitful target for injury prevention programs.

Motor vehicle accidents, headaches and post-traumatic stress disorder: assessment findings in a consecutive series

Results of 20 consecutive cases referred for post-traumatic headache (PT-HA) to a psychological practice were assessed for both psychiatric and neurological diagnoses. Nineteen of the 20 cases (95%) had a diagnosable psychiatric disorder, with 15 presenting with a post-traumatic stress disorder. Prior headache history was reported for only 25% of the referred patients, while a prior psychiatric disorder was found for 7 (35%) of the cases. Findings suggest that consideration of a psychiatric disorder should be made for PT-HA patients.

Return to work of road accident victims claiming compensation for personal injury

Road accidents resulting in personal injury are an increasing cost to society. This study is based on 609 accident victims (of whom 521 survived injury) who were in employment when injured and whose claims for personal injury were settled for 5000 pounds or more by one insurance company over 2 years. It examines survivors' residual disablement, return to work and involvement with rehabilitation services. Data on a representative sample of 101 cases are analysed in more detail to identify possible 'predictors' of return to work. Both univariate and stepwise logistic regression analysis suggest that return to work is less associated with clinical variables, on which much medical advice on return to work is based, than with such other variables as time off work, absence of psychological problems and younger age. Very low rates of referral to rehabilitation may indicate that a rehabilitative approach to cost containment is underutilized in comparison with the traditional emphasis on preventive measures and enhanced medical treatment. More effective rehabilitation, however, may require new approaches to clinical case management, especially in orthopaedic departments where most personal injury claimants are treated.

Injury control: What psychologists can contribute

Psychologists are inadequately represented in the injury control field, despite the size of the problem and the importance of behavioral factors in injury. Using motor vehicle injuries as an example, this article discusses modern injury control principles and the role psychologists can play in injury reduction.

The psychophysiology of motor vehicle accident related posttraumatic stress disorder

Heart rate, BP, and electrodermal responses of four individuals with PTSD secondary to motor vehicle accidents (MVAs) were measured while they imagined two separate scenes related to their MVA. Results showed reliable HR responses to these images. In addition, SBP and DBP also showed some responsivity to the images while skin resistance level changed reliably in only 2 of 4 subjects. Psychophysiological measurement could play a role in the assessment and treatment of MVA-related PTSD.

Information-seeking triggered by age

Age labels may lead to the seeking of age-stereotypic information from target individuals. Using Carver and de la Garza's information-seeking procedure (which asked respondents to judge the relative importance of various kinds of information they would glean from drivers involved in an automobile accident for assigning accident responsibility), but extending it to a wider life span (16 to 91 years of age) and to both genders, we generalized earlier findings to a similar undergraduate sample (n = 437) in another country. Also demonstrated for the first time is the fact that ageist information-seeking across the life span was independent of the driver's gender, the participant's age, and the participant's gender. Specifically, participants wanted to know from younger drivers about their driving conduct (whether they had been drunk and speeding), and from older drivers about their capacity for driving (mental competence, vision, and health). The seeking of environmental information (car safety and road conditions) did not vary with the age of driver in any systematic way.

Preventative mental health in disaster situations: "terror on the autobahn"

As part of Return of Forces to Germany 1990, a number of Second Armored Division soldiers participated in the heroic rescue of German and American civilians injured in a 32-vehicle crash on an autobahn in West Germany. Six people were killed and 18 others were seriously injured at the accident site. This paper (1) briefly reviews acute and chronic stress reactions; (2) describes the accident and rescue; (3) emphasizes specific risk factors for the rescuers; and (4) reviews specific preventative actions that were taken to minimize the risk of future psychologic morbidity in these individuals.

Homicide as a risk factor for PTSD among surviving family members

In this National Institute of Justice-funded study, random digit dialing telephone survey methodology was used to screen a large, nationally representative sample (N = 12,500) of the noninstitutionalized U.S. adult population to identify surviving family members and friends of victims of criminal homicide and alcohol-related vehicular homicide. A total of 9.3% of the national sample had lost a family member or friend to homicide. Immediate family survivors (n = 206) completed an interview assessing demographic characteristics and DSM-III-R criteria for homicide-related post-traumatic stress disorder (PTSD). The interview participation rate was 84%. Among immediate family survivors, 23.3% developed PTSD at some point in their lifetimes, and 4.8% met full diagnostic criteria for PTSD during the preceding 6 months. Survivors of criminal and vehicular homicide victims were equally likely to develop PTSD. Survivors who experienced the homicide during their childhood, adolescence, or adulthood also showed equal likelihood of PTSD. Clinical implications of findings are discussed.

[Life style of schoolchildren in Frederiksberg]

In 1989, a total of 674 pupils in the sixth and eighth grades in nine municipal schools in the Municipality of Frederiksberg replied to a questionnaire containing questions about health knowledge and behaviour. The behaviour of the pupils as regards tobacco, alcohol, diet, exercise, sleep, traffic, employment of medicine and general health were compared. In the sixth grade, 16% of the pupils and 48% of the pupils in the eighth grade had somewhat unsuitable behaviour as regards more than three of the above mentioned factors. In particular, girls in the eighth grade showed less suitable behaviour in several fields: many of these drank alcohol and smoked tobacco. In the eighth grade, several of the pupils had less suitable behaviour in the traffic than pupils in the sixth class. In addition, it was noted that over half of the pupils in both the grades involved had taken medicine within the past month. The majority of this medicine was for headaches. On the basis of these findings, the Medical Officers of Health for the Municipalities of Copenhagen and Frederiksberg have compiled a report in which they recommend that the schools under the local authority provide prophylactic measures against consumption of alcohol and tobacco and that these measures should be directed towards the girls, that the high consumption of medicine should be investigated further, that traffic drill for the older pupils should be considered and that prophylaxis of accidents during athletics both in schools and sports clubs should be included.

[The behavior of schoolchildren in traffic in the municipality of Frederiksberg]

A questionnaire investigation was undertaken among pupils in the sixth and eighth grades in the Municipality of Frederiksberg. In this they were questioned about their behaviour in traffic and whether they had been involved in traffic accidents. One fourth of the pupils in the sixth grade stated that they had been involved in a traffic accident and 38% of these had resulted in contact with the health services in the form of admission to hospital, contact with the casualty department or the general practitioner. In the eighth grade, one third of the pupils stated that they had been involved in a traffic accident and 28% of these had resulted in contact with the health services. Equal numbers of pupils frequently disobeyed the highway code concerning a number of instances, pupils who frequently disobeyed one or two traffic rules and pupils who rarely or never disobeyed traffic rules. A connection was observed between frequent disobedience to traffic rules and involvement in traffic accidents. The number of pupils who frequently disobey traffic rules was shown to increase between the sixth and eighth grades. It is therefore considered suitable to continue traffic drill in the older classes. The pupils' attitudes to use of bicycle helmets appeared to be dominated by the fact that bicycle helmets constitute a cosmetic problem.

The effects of road traffic accidents on driving behaviour

Questionnaires about the effects of accidents on subsequent driving behaviour were sent to 869 people admitted consecutively to a general hospital as a result of involvement in road traffic accidents 4-6 years previously. There were 418 (48 per cent) replies, 67 per cent of delivered questionnaires. One-fifth of the motorcyclists had stopped using a motorcycle. Nearly one-half the motorcyclists and vehicle drivers reported that they now drove more slowly and that they were more cautious. A considerable proportion of replies described emotional distress, avoidance and limitation of activities. Lack of confidence in driving was common immediately after the accident. After 4-6 years, one-third of respondents reported that they still suffered specific anxiety about the place of the accident and about situations similar to the accident. Many people were anxious about being passengers. The findings have implications for road safety, for the recognition and management of a common, and often disabling, clinical problem, and for the assessment of disabilities in medical reports for compensation proceedings.

[Study on risk factors involving train traffic accidents--effects of human factors on accidents]

This article analysed human factors involving train traffic accidents by using log-linear model. The results showed that lower degree of culture (OR = 2.571) and weak nervous type (OR = 2.099) were risk factors involving train traffic accidents. Interactions were shown to exist between nervous type and degree of culture, average sleeping time everyday, and visuomotor reaction time.

Note on risk-homeostasis and night-time pedestrian casualties

Data from published studies suggest risk-homeostasis as an explanation for accidents at night is not as effective an hypothesis as in other circumstances.

Native Americans and the constant death instinct hypothesis

To test Tabachnick and Klugman's hypothesis that the amount of death instinct per capita in different regions is constant, 1975-1977 death rates for motor vehicle accidents, cirrhosis, and suicide were obtained from the US Indian Health Service for all 11 health service areas. In contrast to predictions derived from the hypothesis that the death instinct is constant, no negative correlations were found among these three variables. Although an analysis of other behaviors might yield different findings, these results do not support an hypothesis of a constant death instinct among Indian Health Service regions.

Beer versus mixed-drink consumption at fraternity parties: a time and place for low-alcohol alternatives

Blood alcohol concentration (BAC) measurements were taken of university students entering and exiting three fraternity parties: during each party, the rates of drinking beer and mixed drinks were monitored. The parties choose beer or mixed drinks to consume exclusively throughout the evening at no cost. Unbeknownst to the subjects, the following conditions were manipulated across successive parties: (1) at the first party (64 males and 43 females) the beer alternative had standard alcohol content (i.e., 7% alcohol by volume), (2) at the second party (70 males and 48 females) the beer was a low-alcohol beer (3% alcohol) and (3) at the third party (53 males and 41 females) the partiers were randomly assigned to a regular alcohol content conditions of beer or mixed drinks or to a low-alcohol content condition (i.e., 3% beer or mixed drinks made with 7/8-oz of distilled spirits). Since those assigned to the low-alcohol conditions did not consume more beverages than those in the regular alcohol conditions, a titration hypothesis was not supported and the exit BACs were significantly lower for partiers in the low-alcohol conditions. When females drank at the same rate as males, their exit BACs were significantly higher than those of males. Implications for DWI prevention are discussed.

Psychological performance of accident-prone automobile drivers in China: a case-control study

To evaluate the role of neurobehavioural factors in the aetiology of recurrent automobile accidents, we administered the Revised Wechsler Adult Intelligence Scale (WAIS-R), the Eysenck Personality Questionnaire (EPQ), and choice and simple reaction time tests to 31 accident-prone automobile drivers. These drivers who had caused three or more traffic accidents during the years 1980-1984, were selected from records of 2723 traffic accidents registered by Hefei Traffic Police Department during the years 1980-1984. The same tests were administered to an equal number of sex- and age-matched control drivers who had no reported involvement in automobile accidents. None of the subjects had suffered from any neuropsychiatric illness or head injury. Comparisons between the two groups indicated that for accident-prone drivers scores on picture completion and block design subtests of the WAIS-R were significantly lowered (p less than 0.05); scores for neurosis extrovert behaviour and psychosis (EPQ) were significantly higher (p less than 0.05); and the number of errors in the choice reaction time test was significantly higher (p less than 0.01). It is suggested that accident-prone drivers have lower psychological performance, poorer judgement and a higher tendency than safe drivers to be neurotic, extrovert and psychotic.

Predictors of post-traumatic stress disorder following physical trauma: an examination of the stressor criterion

A prospective study documenting psychopathology was undertaken in 48 subjects exposed to a range of physical trauma, but whose injuries were of similar severity. No support was found for the DSM-III-R view correlating the severity of the stressor with the development of post-traumatic stress disorder (PTSD). Distress post injury (high scores on the impact of event scale), indicative of difficulty with cognitive assimilation of the traumatic event, was found to be highly predictive of psychiatric morbidity and PTSD at 6 months.

A Fake Bad Scale on the MMPI-2 for personal injury claimants

This paper presents a scale for using the Minnesota Multiphasic Personality Inventory-2 for the detection of malingerers in personal injury claims. Data are reported for personal injury claimants and for medical outpatients simulating emotional distress caused by motor vehicle accidents, industrial stress, and toxic exposure. Criterion problems are discussed. The answers and scored directions are presented in an appendix to the paper.

Psychological interventions after child and adolescent disasters in the community

This paper describes how a community mental health center responded to requests in dealing with disasters which impacted on communities it serves. Two events are described which illustrate the theoretical understanding and practical interventions utilized. These aspects are examined in the context of selected publications on the mental health aspects of disasters.

Age differences in estimating vehicle velocity

Automobile accidents among older adults may be related to difficulties in judging the speed of other vehicles. To examine this possibility, 3 groups of observers in the young adult, middle-aged, and older adult age ranges were asked to estimate the velocity of an isolated automobile traveling at 15-50 mph (24-80 kph). Across all age groups, perceived and actual velocity were related by a power function with an exponent of 1.36. Age was significantly and positively correlated with intercepts, but negatively correlated with exponents; that is, older observers showed less sensitivity to changes in actual velocity. Results bear on the issues of ontogenetic changes in accident involvement and sensitivity to motion.

[Epidemiological features and causes of railway traffic accidents]

This article reports on epidemiological features of railway traffic accidents and factors influencing traffic safety. An analysis of various kinds of railway traffic accidents over 30 years in Nanjing Railway Branch, Showed that railway traffic accidents have become a sort of modern social disease, and had particular epidemiological features. The peak of the epidemic curve appeared cyclically and had a close relation to social disturbances, Frequency of accident occurrence was the highest in the first season (period of spring transport) and the third season (period of high temperature) of the year thus most accidents happen in February and August. Most accidents occurred on Fridays and least on Mondays. Distribution of accidents had obvious "antenna" phenomenon in round graph which had a 24-hour cycle. Analysing the multiple factors influencing traffic safety, the results showed that the upper-limit-age of a train driver should not be more than 50 years old; The phenomenon "bathtub" between personage accident rate and age must be taken seriously. More attention should be paid to the psychological aspects when recruiting train drivers. In our country, it is urgent to set up standard of psychomovement function for choosing train locomotive drivers. Fatigue was one of the direct causes resulting in accident occurrences. No statistical correlation was found between biorhythm and accident occurrence.

Adolescent risk-takers: a trauma center study of suicide attempters and drivers

Adolescence is a developmental stage characterized by excessive risk-taking behavior that produces adverse health effects, typically in the form of injury. At issue is whether adolescent suicide attempters and injured adolescent motor vehicle drivers constitute a common risk group and are differentiated by the response of the emergency medical care system and by case disposition. Data originated in the medical records of a Rhode Island (USA) trauma center. The two study groups were not distinguished by religious preference, socioeconomic status or timing of the injury incident, but differed significantly by gender, race, emergency vehicle use, hospital admission rates, and seasonal injury patterns. Alcohol and drug involvement was examined, but serious data deficiencies were noted.

Visual/cognitive correlates of vehicle accidents in older drivers

Older drivers have more accidents per miles driven than any other age group and tend to have significant impairments in their visual function, which could interfere with driving. Previous research has largely failed to document a link between vision and driving in the elderly. We have taken a comprehensive approach by examining how accident frequency in older drivers relates to the visual/cognitive system at a number of levels: ophthalmological disease, visual function, visual attention, and cognitive function. The best predictor of accident frequency as recorded by the state was a model incorporating measures of early visual attention and mental status, which together accounted for 20% of the variance, a much stronger model than in earlier studies. Those older drivers with a visual attentional disorder or with poor scores on a mental status test had 3-4 times more accidents (of any type) and 15 times more intersection accidents than those without these problems.

Errors and violations on the roads: a real distinction?

In considering the human contribution to accidents, it seems necessary to make a distinction between errors and violations; two forms of aberration which may have different psychological origins and demand different modes of remediation. The present study investigated whether this distinction was justified for self-reported driver behaviour. Five hundred and twenty drivers completed a driver behaviour questionnaire (DBQ) which asked them to judge the frequency with which they committed various types of errors and violations when driving. Three fairly robust factors were identified: violations, dangerous errors, and relatively harmless lapses, respectively. Violations declined with age, errors did not. Men of all ages reported more violations than women. Women, however, were significantly more prone to harmless lapses (or more honest) than men. These findings were consistent with the view that errors and violations are indeed mediated by different psychological mechanisms. Violations require explanation in terms of social and motivational factors, whereas errors (slips, lapses, and mistakes) may be accounted for by reference to the information-processing characteristics of the individual.

The basic driver error: late detection

Over the past two or three decades we have been quite successful in reducing injuries of car occupants by the use of energy-absorbing techniques; but we have not been as successful in reducing the risks of having collisions. When drivers are asked why an accident occurred very often they claim that they saw the other road user too late to avoid collision. This paper discusses the basic road user error of failing to see another road user in time, why such errors happen, and how they can be reduced. A detection error is basic, because without detection no processing of information, no decision process including that road user, takes place. Among the many causes of detection error two of the more important are: a lapse of cognitive expectation, illustrated by the failure to scan for a particular class of road user, or to look in the appropriate direction; a difficulty with perceptual thresholds, illustrated by the failure to discern the relevant stimuli in lower levels of ambient illumination or in situations where vehicles approach in the peripheral visual field of road users.

The situational riskiness of alcoholic beverages

Using face-to-face interview data on a sample of young adults, this study investigates the perceived risk of alcohol consumption in drinking and driving, interactions with police and the probability of intoxication. Results show that beer is perceived as less risky than liquor in two risk situations, with men and drinkers in particular ranking beer as a lower risk beverage. When intoxication is considered, drinkers rank their preferred beverage as less risky than their alternative. Finally, an analysis of the relative riskiness of beer in comparison to liquor reveals that beer is perceived as less risky than liquor. This consensus does not vary significantly by sex or most other respondent characteristics.

Perceived consequences associated with the use of beer, wine, distilled spirits, and wine coolers

Based on a national probability sample of 2,401 Americans aged 21 and over (1,069 of whom were deemed "drinkers" on the basis of having drunk at least one alcoholic beverage in the past 7 days), this study examines which of six specific problems people associate with the use of beer, distilled spirits, wine, and wine coolers. It was found that people are most likely to associate alcoholism, birth defects, drunk driving, and fighting and rowdy behavior equally with these four types of alcohol. But when beverage associations are made, distilled spirits and beer are blamed most frequently for these problems, whereas wine and wine coolers are virtually never thought of as being closely related to any of the problems under study. It was also determined that nearly 1 out of every 7 drinkers surveyed stated that birth defects are unrelated to alcohol use of any kind.

Driving while intoxicated: increased deterrence or alternative transportation for the drunk driver

The current investigation was designed to examine the community impact from introducing free alternative transportation for the drunk/drugged driver in Sacramento, California. Baseline data were obtained from 1,522 bar and nightclub patrons in Sacramento and San Jose, California. The major findings show that drinking and driving is commonplace, as is riding with intoxicated motorists, in spite of the perceived unacceptability of this behavior. The majority of customers also noted they felt confident in their ability to drive safely when "feeling intoxicated." Increased law enforcement patrols are not seen as a deterrence to drunk driving behavior by the majority of respondents. If free alternative transportation was available for the drunk/drugged driver in the area surveyed, however, 85% of respondents said they "might use" to "definitely would use" the service.