Adolescent development and risk of injury: using developmental science to improve interventions

The Etiology and Epidemiology of Pediatric Facial Fractures in North-Western Romania: A 10-Year Retrospective Study

Pediatric facial fractures are not as common as facial fractures occurring in the adult population. Their therapeutic approach is different because they affect patients with active growth, and have an etiology and epidemiology that vary depending on different cultural, religious and demographic factors. This research aimed to identify the main factors involved in the etiology of pediatric facial fractures, as well as the epidemiology of pediatric facial fractures in a sample of children and adolescents from North-Western Romania. This 10-year retrospective study was performed in a tertiary center for oral and maxillofacial surgery in North-Western Romania. Medical files of patients that were admitted between 1 January 2002 and 31 December 2022 were analyzed. Pediatric patients aged 0 to 18 years were included in this study. The final sample consisted of 142 children and adolescents diagnosed with facial fractures, with this number representing 14.1% of all patients affected by facial fractures. Most frequently, fractures were identified in the 13–18 age group (78.9%, n = 112), which were more often associated with fractures caused by interpersonal violence than caused by road traffic accidents, falls or animal attacks. Boys were more affected (88%, n = 125), and were more frequently associated with fractures caused by interpersonal violence. The most frequently identified etiological factors included interpersonal violence (50%, n = 71), falls (18.3%, n = 26) and road traffic accidents (11.3%, n = 16). In terms of location, the mandible was the most affected facial bone structure (66.2%, n = 94), and patients with mandibular fractures were more frequently associated with fractures caused by interpersonal violence. The incidence of pediatric facial fractures should be lowered because they may interfere with the proper development of the facial skeleton. Establishing measures aimed at preventing interpersonal violence, as well as other causes involved in the etiology of facial fractures is imperative.

Socioeconomic factors associated with helmet use in pediatric ATV and dirt bike trauma

Objectives

Recreational off-road vehicle crashes can produce severe injury and death among children, often from head trauma sustained while riding unhelmeted. Although required for competition, recreational riders commonly forego helmets. This study aimed to identify socioeconomic factors associated with unhelmeted injuries among children riding all-terrain vehicles (ATVs) and dirt bikes recreationally, thus informing injury prevention efforts.

Methods

A retrospective review was completed of patients younger than 18 years who presented after recreational ATV or dirt bike crash to a single American College of Surgeons-verified level 1 pediatric trauma center (2010-2019). Demographic, injury, and outcome data were collected. US Census data regarding median and per capita income, poverty prevalence, and scholastic graduation rates were recorded for each patient's home county. Relationships between helmet use at the time of injury, demographics, and socioeconomic variables were examined.

Results

The cohort comprised 680 injured recreational ATV (n=510; 75%) and dirt bike (170; 25%) riders. Unhelmeted riders (n=450) were significantly older (median age 13 vs 11 years; p=0.008) and more often rode ATVs (n=399). Significantly greater percentages of females (77.9%; p<0.001) and passengers (89.5%; p<0.001) were unhelmeted at the time of injury. Residents of counties with lower median and per capita income, higher poverty prevalence, and lower high school and college graduation rates were significantly more likely to be unhelmeted at the time of their crash (p=0.003). In multivariable analysis, unhelmeted injuries were independently associated with ATV use (OR=6.757; p<0.0001), passenger status (OR=6.457; p<0.0001), and older age (OR=1.219; p<0.0001).

Conclusion

In children, ATV use, passenger status, and older age associated independently with unhelmeted riding in recreational vehicle crash. Residence in a county with both lower median income and scholastic graduation rates associated with unhelmeted crashes, and lower median income significantly predicted unhelmeted crashes. This study revealed socioeconomic factors that identify communities with greatest need for injury prevention initiatives.

Level of evidence

III-retrospective comparative epidemiological study.

Influence of a Survival Swimming Training Programme on Water Safety Knowledge, Attitudes and Skills: A Randomized Controlled Trial among Young Adults in Sri Lanka

Drowning among young adults is high in Sri Lanka. Water safety education is a recommended strategy for drowning prevention but is often overlooked for young adults. This study aimed to evaluate the effectiveness of an adapted educational intervention, "Swim for Safety" on improving water safety knowledge, attitudes and survival swimming skills among undergraduates (19-28 years) in Sri Lanka. This study employed a parallel-group, two-arm randomized controlled trial design. The intervention group (n = 78) received a face-to-face, 12-lesson education programme, and the control group (n = 78) received a brochure and weekly mobile phone messages for six consecutive weeks. Baseline, post-intervention and three-month follow-up knowledge, attitudes and skills were evaluated. Knowledge and attitudes were assessed using a self-administered questionnaire and skills were evaluated following a skills assessment protocol. In total 116 participants, 60 intervention group and 56 control group, completed the study. At baseline there were no differences between groups in median scores of water safety knowledge, attitudes and survival swimming skills. The intervention group demonstrated statistically significant increases in median water safety knowledge, attitudes and survival swimming skill scores compared with the control group, following the intervention and maintained at three-month follow-up (p < 0.05). The adapted Swim for Safety programme significantly improved water safety knowledge, attitudes, and survival swimming skills among young adults in Sri Lanka. Therefore, it is recommended that the SfS programme be implemented widely to prevent drowning in young adults.

Orofacial trauma injuries and disability assessment in adolescents: A Portuguese study

BACKGROUND/AIMS

Orofacial injuries are a significant public health issue. The evidence-based knowledge associated with adolescent violence and trauma is highlighted by the World Health Organization with regard to its specific needs related to disability, violence, and unintentional injuries. The main aim of this study was to present evidence-based information about orofacial traumatic injuries of an adolescent population using Portuguese epidemiological data. The second aim was to report follow-up data of injuries for disability assessment in a trauma prevention approach.

METHODS

An observational cohort study was performed using the clinical database of the national-specialist-healthcare-centre-of-trauma (2014-2018). Information was collected regarding gender, school age range, etiology, injury type, injury time, and severity. Mann-Whitney (p < .05), Kruskal-Wallis (p < .001), and Cox regression (p < .001) analyses were performed.

RESULTS

Orofacial trauma injuries were present in 23.3% of Portuguese adolescents (age range 10-18 years). The majority were male (72.6%), and no age range stood out in frequency. School accidents (90.6%) were the major etiology for all groups of injuries. The diagnosis of superficial intraoral injuries was the most frequent (50.8%), followed by similar injuries to the face (22.5%). A Cox regression model with an adequate fit was yielded (χ2 [6] = 54.893, p < .001), suggesting that variable injury type was a predictor of disability, considering injury time. Tooth and alveolar loss, complicated tooth fracture, complicated face injury, and temporomandibular injuries were more predictive (1<hazard ratio < 5.329 [95% CI:1.340-12.685]).

CONCLUSION

The type of injury could be used to predict the time of temporary disability. Regarding definitive damage, some injuries were more predictive of severity than others. Preventive procedures should be highlighted in schools.

Impact of In-hospital and Outreach models for regional P.A.R.T.Y. Program participants

OBJECTIVE

This retrospective observational study aimed to compare the impact of the Prevent Alcohol and Risk-Related Trauma Youth (P.A.R.T.Y.) Program when delivered as In-hospital or Outreach models to rural and regional students.

METHODS

The study population were consented participants from regional areas between 2013 and 2017 who completed pre-programme, immediately post-programme and 3-5 months post-programme surveys. Responses from the metropolitan In-hospital programme participants and regional Outreach programme participants were analysed within groups across the three time points. The primary outcome variable was a change in self-reported perception of driving after drinking alcohol. Secondary outcome variables were designating a safe driver after drinking, perception of risk of injury if not wearing a seatbelt, risks of injury if undertaking physical risk-taking activities and likelihood of the programme changing perceptions.

RESULTS

There were 1314 participants invited to participate and 547 (42%) sets of complete surveys were received, of whom 296 (54%) were Outreach participants. Pre-programme, a significantly lower proportion of Outreach participants reported 'definitely not' to driving after drinking (84% vs 91%), and perceived a 'definite' likelihood of sustaining injury if not wearing a seatbelt (57% vs 66%). Outreach participants displayed improvements in likelihood to drive after drinking alcohol immediately post-programme and on follow up (P = 0.028). Responses to all other secondary outcome measures demonstrated some improvement.

CONCLUSIONS

Although demographically similar, baseline perceptions toward alcohol, risk-taking and injury differed between groups. Improvements in perception were demonstrated across both models. These findings support P.A.R.T.Y. as an injury prevention initiative for regional youth.

Childhood vulnerability to drowning in the Western Cape, South Africa: Risk differences across age and sex

INTRODUCTION

Drowning is amongst the leading causes of death of children and young people worldwide, with high concentrations in Southeast Asia and Sub-Saharan Africa. In the Western Cape province in South Africa, drowning mortality rates for children were reported at 3.8 per 100,000 population. Internationally, evidence suggests that unimpeded access to water bodies and containers and lapses in supervision together with the child's limited developmental capacities, place children at greater risk of drowning. This study examined the risk for fatal drowning by age cohort and sex in child and adolescent (0-19 years old) in the Western Cape.

METHOD

Demographic and descriptive data for child drowning fatalities from 2010 to 2016 were obtained from the Western Cape Forensic Pathology Service. Descriptive variables included location of drowning incident by body of water, time of day, day of week and season. Data were analysed by age cohorts aligned to child psychosocial developmental stages. Descriptive statistics reported fatality frequencies by age cohort and sex, and logistic regression was conducted to detect differences in drowning risk across these categories.

RESULTS

A total of 538 childhood drowning fatalities were analysed, with the highest proportion occurring in children aged 13-19 years (29.6%) and the majority occurring in males (75.8%). Sex, location of drowning incident and season were significant predictors of drowning across the age cohorts. Relative to females, males between ages 0-1 and 2-3 years were less likely to drown when compared with older children.

CONCLUSION

This study confirms existing evidence that children younger than five are most at risk of drowning. In contrast to international and local research findings that have indicated a similar or higher risk for drowning amongst boys compared with girls aged 3 years and younger, this study identified that males were less likely to drown between the ages of 0 and 3 years compared with girls.

Inter-relatedness of underlying factors for injury and violence among adolescents in rural coastal Kenya: A qualitative study

We utilized a socio-ecological model to explore views from 85 young people and 10 local stakeholders on forms and underlying factors for unintentional injury, violence, self-harm, and suicidal behavior of adolescents in Kilifi County, Kenya. Young people took part in 11 focus group discussions, whereas 10 in-depth interviews were conducted with the local stakeholders. Road traffic accidents, falls, fights, sexual and gender-based violence, theft, and vandalism were viewed as common. There was an overlap of risk factors, especially at intra- and interpersonal levels (gender, poverty, substance use, parenting behavior, school drop-out). Some broader-level risk factors were insecure neighborhoods and risky sources of livelihood. Research is needed to quantify burden and to pilot feasible injury prevention interventions in this setting.

Naturalistic assessment of the learner license period

The purpose of this study was to describe the characteristics and progression of practice driving during the learner license period in a sample of teenagers. During the first and last 10h of practice driving, we examined (1) the amount, variety and complexity of conditions of practice; (2) the nature of parental instruction; and (3) errors that teens made while driving. Data were collected from 90 teens and 131 parents living in Virginia, USA, using in-vehicle cameras, audio recorders, GPS and trip recorders. Based on data collected from the instrumented vehicles, teens practiced for 46.6h on average, slightly higher than the GDL requirement for their jurisdiction, though half did not complete the required 45h of practice and only 17% completed the required 15h of night time driving. Exposure to diverse roadways increased over the practice driving period, which averaged 10.6 months. Most driving instruction occurred in reaction to specific driving situations, such as navigating and identifying hazards, and could be characterized as co-driving. Higher order instruction, which relates to the tactics or strategies for safe driving, was less frequent, but remained stable through the practice driving period. Instruction of all forms was more likely following an elevated gravitational force (g-force) event. Errors decreased over time, suggesting improvements in manual and judgment skills, but engagement in potentially distracting secondary tasks increased (when an adult was in the vehicle). A small percentage of trips occurred with no passenger in the front seat, and the g-force rate during these trips was almost 5 times higher than trips with an adult front-seat passenger. Taken collectively, these findings indicate (1) most teens got at least the required amount of supervised practice, but some did not; (2) instruction was mainly reactive and included some higher order instruction; (3) teens driving skills improved despite increased exposure to complex driving conditions, but secondary tasks also increased. Opportunities remained for improving the quality and variability in supervision and enhancing the development of skills during the lengthy period of practice.

Adolescent and adult drivers' mobile phone use while driving with different interlocutors

PURPOSE

We examined the frequency of adolescents' and their parents' mobile phone use while driving (MPUWD) in the context of their peer and parent-child interlocutors (i.e., communication partners), considering individual differences in perceived risk and symptoms of technology addiction.

METHODS

Ninety-four participants (47 parent-adolescent dyads) completed a survey battery measuring their symptoms of technology addiction, perceived risk of MPUWD, and MPUWD with family members and with their peers as assessed via the proportion of trips when drivers used a mobile phone to communicate.

RESULTS

For both adolescents and their parents across both types of interlocutors (parent-child, peer), stronger risk perceptions were associated with less MPUWD, and stronger symptoms of technology addiction were associated with more MPUWD. A three-way interaction among technology addiction, interlocutor (parent-child, peer), and driver (parent, adolescent) was observed. For adolescents, the association between technology addiction and MPUWD was significantly stronger for MPUWD with their peers than it was for their MPUWD with their parents; this association was not observed for parents. Parents engaged in MPUWD with their children as frequently as adolescents engaged in MPUWD with their peers.

CONCLUSIONS

Symptoms of technology addiction play a stronger role for adolescents' MPUWD with their peers than it does for adolescents' MPUWD with their parents. These and other driver-by-interlocutor interactions should be considered in future research on distracted driving and in prevention efforts.

Learning to swim: role of gender, age and practice in Latino children, ages 3-14

OBJECTIVE

We evaluate the effectiveness of a swim skill acquisition intervention among Latino youths, ages 3-14, a minority population at increased risk of drowning.

METHODS

Parents were recruited through community institutions to have their children participate in group swim lessons. Each child's swim ability was assessed at baseline, and they were then exposed to swim lessons over an 8-week period, taught by trained professionals. The swim skill curriculum focused on water safety, flotation and endurance, at five levels of increasing skill acquisition. Final swim ability was assessed on the last day of the child's participation. Programme effectiveness was measured using direct pre-post comparisons with and without adjustment for key moderators (age and gender) and a mediator (number of practices). We also present a bias-adjusted estimate comparing low with high practice volume relying on a propensity score analysis.

RESULTS

Among the 149 participating children, average acquisition was 12.3 swim skills (95% CI 10.7 to 14.1). Skill acquisition varied by age category (3-5, 6-9 and 10-14 years) and by gender. We found a strong practice intensity effect, with skill acquisition accelerated for those participating in 10 or more swimming lessons. The propensity-adjusted estimate of the impact of 10 or more compared with 9 or fewer lessons was 8.2 skills (95% CI 4.8 to 11.8).

CONCLUSIONS

An 8-week swim intervention is effective at building skills in a community-based sample of Latino children, ages 3-14 years. The number of swimming lessons was a far stronger correlate of skill acquisition than were age or gender.

Investigating risky, distracting, and protective peer passenger effects in a dual process framework

Prior studies indicated higher collision rates among young novice drivers with peer passengers. This driving simulator study provided a test for a dual process theory of risky driving by examining social rewards (peer passengers) and cognitive control (inhibitory control). The analyses included age (17-18 yrs, n=30; 21-24 yrs, n=20). Risky, distracting, and protective effects were classified by underlying driver error mechanisms. In the first drive, participants drove alone. In the second, participants drove with a peer passenger. Red-light running (violation) was more prevalent in the presence of peer passengers, which provided initial support for a dual process theory of risk driving. In a subgroup with low inhibitory control, speeding (violation) was more prevalent in the presence of peer passengers. Reduced lane-keeping variability reflected distracting effects. Nevertheless, possible protective effects for amber-light running and hazard handling (cognition and decision-making) were found in the drive with peer passengers. Avenues for further research and possible implications for targets of future driver training programs are discussed.

The Predictive Influence of Youth Assets on Drinking and Driving Behaviors in Adolescence and Young Adulthood

Drinking and driving among adolescents and young adults remains a significant public health burden. Etiological research is needed to inform the development and selection of preventive interventions that might reduce alcohol-involved crashes and their tragic consequences. Youth assets-that is, skills, competencies, relationships, and opportunities-can help youth overcome challenges, successfully transition into adulthood, and reduce problem behavior. We examined the predictive influence of individual, relationship, and community assets on drinking and driving (DD) and riding with a drinking driver (RDD). We assessed prospective relationships through analysis of data from the Youth Assets Study, a community-based longitudinal study of socio-demographically diverse youth. Results from calculation of marginal models using a Generalized Estimating Equation approach revealed that parent and peer relationship and school connectedness assets reduced the likelihood of both drinking and driving and riding with a drinking driver approximately 1 year later. The most important and consistent asset that influenced DD and RDD over time was parental monitoring, highlighting the role of parental influence extending beyond the immediate teen driving context into young adulthood. Parenting-focused interventions could influence factors that place youth at risk for injury from DD to RDD, complementing other evidence-based strategies such as school-based instructional programs and zero tolerance Blood Alcohol Concentration laws for young and inexperienced drivers.

Road safety impact of Ontario street racing and stunt driving law

OBJECTIVE

The purpose of this study was to conduct a process and outcome evaluation of the deterrent impact of Ontario's street racing and stunt driving legislation which came into effect on September 30, 2007, on collision casualties defined as injuries and fatalities. It was hypothesized that because males, especially young ones, are much more likely to engage in speeding, street racing and stunt driving, the new law would have more impact in reducing speeding-related collision casualties in males when compared to females.

METHODS

Interrupted time series analysis with ARIMA modelling was applied to the monthly speeding-related collision casualties in Ontario for the period of January 1, 2002 to December 31, 2010, separately for young male drivers 16-25 years of age (primary intervention group), mature male drivers 26-65 years of age (secondary intervention group), young female drivers 16-25 years of age (primary comparison group) and mature female drivers 26-65 years of age (secondary comparison group). A covariate adjustment using non-speeding casualties was included.

RESULTS

A significant intervention effect was found for young male drivers with, on average, 58 fewer collision casualties per month, but not for mature male drivers, when non-speeding casualties were controlled for. No corresponding effect was observed in either comparison (females) group.

CONCLUSION

These findings indicate a reduction in speeding-related casualties among young males of 58 fewer casualties per month subsequent to the introduction of Ontario's street racing and stunt driving legislation and suggest the presence of a general deterrent effect.

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

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

Adolescence, attention allocation, and driving safety

Motor vehicle crashes are the leading source of morbidity and mortality in adolescents in the United States and the developed world. Inadequate allocation of attention to the driving task and to driving hazards are important sources of adolescent crashes. We review major explanations for these attention failures with particular focus on the roles that brain immaturity and lack of driving experience play in causing attention problems. The review suggests that the potential for overcoming inexperience and immaturity with training to improve attention to both the driving task and hazards is substantial. Nevertheless, there are large individual differences in both attentional abilities and risky driving tendencies that pose challenges to novice driver policies. Research that can provide evidence-based direction for such policies is urgently needed.

Evaluation of deterrent impact of Ontario's Street Racing and Stunt Driving Law on extreme speeding convictions

OBJECTIVE

The purpose of this study was to conduct a process and outcome evaluation of the deterrent impact of Ontario's street racing and stunt driving legislation, introduced in September 2007, on extreme speeding convictions. It was hypothesized that because males are much more likely to engage in speeding, street racing, and stunt driving, the new law would have more impact in reducing extreme speeding in males compared to females.

METHODS

Descriptive statistics and time series plots were used for the suspensions data. Interrupted time series analysis with autoregressive integrated moving average (ARIMA) modeling was applied to the monthly extreme speeding convictions in Ontario for the period of January 1, 2003, to December 31, 2011, to assess the impact of the new legislation, separately for male drivers (intervention group) and female drivers (comparison group).

RESULTS

The results indicated that per licensed driver, 1.21 percent of 16- to 24-year-old male drivers and 0.37 percent of 25- to 64-year-old male drivers had their licenses suspended between September 2007 and December 2011. This is in contrast to female drivers: 0.21 percent of 16- to 24-year-old female drivers and 0.07 percent of 25- to 64-year-old female drivers had their licenses suspended during the same time period. A significant intervention effect of reduced extreme speeding convictions was found in the male driver group, though no corresponding effect was observed in the female driver group. The findings of this study are consistent with previous research on demographics of street racers and stunt drivers.

CONCLUSIONS

These findings are congruent with deterrence theory that certain, swift, and severe sanctions can deter risky driving behavior and support the hypothesis that legal sanctions can have an impact on the extreme speeding convictions of the intervention group.

Texting while driving and other risky motor vehicle behaviors among US high school students

OBJECTIVE

To assess the prevalence of texting/e-mailing while driving (TWD) and association of TWD with other risky motor vehicle (MV) behaviors among US high school students.

METHODS

Data were used from the Centers for Disease Control and Prevention's 2011 national Youth Risk Behavior Survey, which assessed TWD during the 30 days before the survey among 8505 students aged ≥16 years from a nationally representative sample of US high school students. TWD frequency was coded into dichotomous and polychotomous variables. Logistic regression assessed the relationship between TWD and other risky driving behaviors, controlling for age, race/ethnicity, and sex.

RESULTS

The prevalence of TWD on ≥1 days during the 30 days before the survey was 44.5% (95% confidence interval: 40.8%-48.2%). Students who engaged in TWD were more likely than their non-TWD counterparts to not always wear their seatbelt (prevalence ratio; 95% confidence interval: 1.16; 1.07-1.26), ride with a driver who had been drinking alcohol (1.74; 1.57-1.93), and drink alcohol and drive (5.33; 4.32-6.59). These other risky MV behaviors were most likely to occur among students who frequently engaged in TWD.

CONCLUSIONS

Nearly half of US high school students aged ≥16 years report TWD during the past 30 days; these students are more likely to engage in additional risky MV behaviors. This suggests there is a subgroup of students who may place themselves, their passengers, and others on the road at elevated risk for a crash-related injury or fatality by engaging in multiple risky MV behaviors.

Adolescence extended: implications of new brain research on medicine and policy

Last December, the Excellence in Paediatrics conference presented a panel discussion of how new biologic findings from brain imaging cast new light on adolescent development. This study will review this presentation, focusing on the interplay between adolescent development and new brain research findings.

CONCLUSION

Paediatricians can consider these new insights in both interacting individually with patients and advocating for policies within their communities.

The relative odds of involvement in seven crash configurations by driver age and sex

INTRODUCTION

Much is known about sex and age differences in collision types, but most studies have examined the effect of declining physical and mental capabilities on older drivers' performance. Fewer studies have focused on the relationship between younger driver's sex and crash type, and these studies have largely ignored the multidimensionality of crashes, have not consistently examined sex differences, and are based on outdated data. This study addressed these issues by examining differences in the likelihood of involvement in seven crash configurations between adolescent and adult male and female drivers.

METHOD

Fatal crash data from the Fatality Analysis Reporting System and nonfatal crash data from the General Estimation System for years 2005-2009 were used. Crash configurations were identified using point of initial impact, manner of collision, and vehicle action (i.e., striking or struck). Logistic regression estimated relative odds ratios among four driver groups: male and female drivers aged 15-19 years, and male and female drivers aged 45-64 years.

RESULTS

Crash likelihood varied dramatically by driver age and sex across crash configuration. Adolescent male drivers were most likely to be in single-vehicle and fatal head-on crashes; adolescent drivers had a higher likelihood of front-to-rear crashes; adults had the highest likelihood of rear-end crashes; and female drivers had higher likelihoods of left- and right-side crashes.

CONCLUSIONS

These findings may result from differences in driving experience, driving styles, or cognitive spatial abilities. Future research is needed to identify contributors to different crash configurations so that they can be directly addressed through tailored interventions and programs.

The role of child and adolescent development in the occurrence of agricultural injuries: an illustration using tractor-related injuries

Agricultural settings are dangerous, especially for children. This article focuses on child and adolescent development, and how development might influence children's safety in the occurrence of pediatric farm injuries. The authors focus especially on one of the most traumatic causes of pediatric farm injury, those associated with tractor operation. The roles of physical, perceptual, cognitive, and social development are reviewed and discussed, as are relevant sociocultural factors. Following review of developmental risks for child injury in agricultural settings, the authors present a case study of a fatal youth tractor injury and provide illustrations of the child development factors that may have contributed to the death. The authors conclude with a discussion of the implications of developmental aspects of pediatric agricultural injury for behaviorally oriented intervention strategies, including public policy.