Family, social, and cultural factors in pedestrian injuries among Hispanic children

Unintentional Injuries and Sociodemographic Factors among Households in Ethiopia

Background

Unintentional injuries are a public health problem throughout the world including Africa. Most of the injury studies in Ethiopia are from the healthcare facility or workplace that does not reflect the problem at the community level. Therefore, this study aimed to assess the unintentional injuries and sociodemographic factors among households in Ethiopia.

Methods

This study was done from the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about unintentional injuries and injury mechanisms in the past 12 months among 16,650 households. The selection of households was from nine regions and two city administrations of Ethiopia using a stratified cluster sampling procedure. Descriptive statistics were used to characterize the data and the chi-square test was applied as a test of significance and a p value of <0.05 was considered statistically significant.

Result

Of the 16,650 households that participated in the study, 394 (2.4%) reported that at least one household member suffered from an unintentional injury in the past 12 months. The leading mechanisms of injury were unintentional falls (152 falls, 33.2%) and road traffic incidents (96 incidents, 21.0%). Among household members who were injured, 84.3% survived and 15.7% died because of the injury. Divorce marital status of the household head [AOR: 2.12, 95% CI (1.12–4.41)] and family size of the household ≥ 6 [AOR:1.65, 95% CI (1.21–2.26)] were associated with high likelihood of occurrence of an injury, while lowest household wealth index [AOR: 0.69, 95% CI (0.50–0.95)] was protective against injuries.

Conclusion

A low prevalence of unintentional injury was found from the community in this survey, which might be due to the tendency of the community to report severe injuries. Fall and road traffic accidents were the leading mechanisms of selected sociodemographic factors of the households that were associated with unintentional injuries. Injury prevention efforts should focus on falls and transportation injuries with special attention to the sociodemographic context of the communities.

Agricultural Safety Comic Book for Latinx Migrant Families: Development and Evaluation

INTRODUCTION

Comic books and graphic novels have been used in health education. The youth of migrant and seasonal agricultural workers are highly vulnerable to the health hazards associated with agricultural work and the migrant workers' itinerant home environment.

METHOD

The purpose of the study was to create a bilingual, culturally specific educational comic book to inform families of safety issues in youth hand-harvesting agricultural work and provide anticipatory guidance safety tips for agricultural work camp residence. In a mixed-methods design, a multistate and multidisciplinary team used focus groups to obtain the voice of potential users regarding the strengths and weaknesses of the comic book prototype and scales on satisfaction, helpfulness, and usability.

RESULTS

Focus group participants contributed constructive criticism to modify the prototype. Quantitative surveys found the comic book to be satisfactory, helpful, and highly usable.

DISCUSSION

This report describes the steps in the creation of the comic book that can be used for health promotion education.

Factors related to road system organisation and its association with mortality due to motor vehicle-pedestrian collisions in Guadalajara Metropolitan Area

Introduction

Traffic events are one of the five leading causes of mortality in Mexico. Pedestrians are one of the main road users involved in such incidents and have the highest mortality rate, which is regularly analysed in relation to vehicles and pedestrians, but not the built environment. The purpose of this study was to analyse the elements of the road system organisation that influences the mortality rate of pedestrians hit by motor vehicles in the Guadalajara Metropolitan Area.

Method

We designed a case and control study in which the cases were sites where a pedestrian died during 2012. The controls were sites close to where the death occurred, as well as those with road infrastructure characteristics similar to those where the events took place. We obtained the pedestrian data from the death certificates and assessed some of the environmental elements of the road sites. A logistic regression analysis was used to estimate OR; 95% CI.

Results

Road system factors related with pedestrian mortality in close locations were: the presence of bus stops on intersections in one street or both, and road system features, such as the presence of traffic islands, vehicle flow and pedestrian flow.

Conclusions

According to the urban network theory and multiple theory, the final elements resulted as risk factors due to a fault in connectivity between the nodes. A temporal analysis of urban features will help urban planners make decisions regarding the safety of pedestrians and other road users.

Neighborhood Influences on Vehicle-Pedestrian Crash Severity

Socioeconomic factors are known to be contributing factors for vehicle-pedestrian crashes. Although several studies have examined the socioeconomic factors related to the location of the crashes, limited studies have considered the socioeconomic factors of the neighborhood where the road users live in vehicle-pedestrian crash modelling. This research aims to identify the socioeconomic factors related to both the neighborhoods where the road users live and where crashes occur that have an influence on vehicle-pedestrian crash severity. Data on vehicle-pedestrian crashes that occurred at mid-blocks in Melbourne, Australia, was analyzed. Neighborhood factors associated with road users' residents and location of crash were investigated using boosted regression tree (BRT). Furthermore, partial dependence plots were applied to illustrate the interactions between these factors. We found that socioeconomic factors accounted for 60% of the 20 top contributing factors to vehicle-pedestrian crashes. This research reveals that socioeconomic factors of the neighborhoods where the road users live and where the crashes occur are important in determining the severity of the crashes, with the former having a greater influence. Hence, road safety countermeasures, especially those focussing on the road users, should be targeted at these high-risk neighborhoods.

Unintentional injuries among refugee and immigrant children and youth in Ontario, Canada: a population-based cross-sectional study

BACKGROUND

Unintentional injuries are a leading reason for seeking emergency care. Refugees face vulnerabilities that may contribute to injury risk. We aimed to compare the rates of unintentional injuries in immigrant children and youth by visa class and region of origin.

METHODS

Population-based, cross-sectional study of children and youth (0-24 years) from immigrant families residing in Ontario, Canada, from 2011 to 2012. Multiple linked health and administrative databases were used to describe unintentional injuries by immigration visa class and region of origin. Poisson regression models estimated rate ratios for injuries.

RESULTS

There were 6596.0 and 8122.3 emergency department visits per 100 000 non-refugee and refugee immigrants, respectively. Hospitalisation rates were 144.9 and 185.2 per 100 000 in each of these groups. The unintentional injury rate among refugees was 20% higher than among non-refugees (adjusted rate ratio (ARR) 1.20, 95% CI 1.16, 1.24). In both groups, rates were lowest among East and South Asians. Young age, male sex, and high income were associated with injury risk. Compared with non-refugees, refugees had higher rates of injury across most causes, including for motor vehicle injuries (ARR 1.51, 95% CI 1.40, 1.62), poisoning (ARR 1.40, 95% CI 1.26, 1.56) and suffocation (ARR 1.39, 95% CI 1.04, 1.84).

INTERPRETATION

The observed 20% higher rate of unintentional injuries among refugees compared with non-refugees highlights an important opportunity for targeting population-based public health and safety interventions. Engaging refugee families shortly after arrival in active efforts for injury prevention may reduce social vulnerabilities and cultural risk factors for injury in this population.

Childhood Injury Prevention: Predictors of Home Hazards in Latino Families Enrolled in SafeCare®

Objective

This archival project (a) examined potential risk and protective factors for hazards in the homes of Spanish-speaking immigrant Latino families and (b) provided an independent examination of the SafeCare®+ Home Safety module adapted for Latino families at high risk for child neglect.

Methods

The sample comprised 92 Latina caregivers of young children enrolled in SafeCare®+.

Results

Results of the negative binomial regression model of predictors of home hazards before the Home Safety module found none of the factors were significant. The longitudinal analysis with a negative binomial model found significant effects both during (b = -0.905, p < .001) and after (b = -2.118, p < .001) the intervention. Depression was negatively associated with the number of hazards (b = -0.026, p < .05, β = -.1858).

Conclusions

Support for application of SafeCare®+ Home Safety module to prevent access to hazards for Latino children was found.

Unintentional injuries in children and youth from immigrant families in Ontario, Canada: a population-based cross-sectional study

BACKGROUND

Unintentional injury is the leading cause of childhood death. Injury is associated with a number of sociodemographic characteristics, but little is known about risk in immigrants. Our objective was to examine the association between family immigrant status and unintentional injury in children and youth.

METHODS

We performed a population-based, cross-sectional study involving children and youth (age 0-24 yr) residing in Ontario from 2008 to 2012. Multiple linked health and administrative databases were used to describe unintentional injuries by family immigrant status. Unintentional injury events (e.g., emergency department visits, admissions to hospital, deaths) were analyzed using Poisson regression models to estimate rate ratios (RRs) for injury by immigrant status.

RESULTS

Annualized injury rates were 11 749 emergency department visits per 100 000 population, 267 hospital admissions per 100 000 population and 12 deaths per 100 000 population. Injury rates were lower among immigrants across all causes of unintentional injury (adjusted RR 0.56, 95% confidence interval [CI] 0.54-0.59). Among nonimmigrants, lowest neighbourhood income quintile was associated with the highest rates (RR 1.13, 95% CI 1.08-1.18, quintile 5 v. 1); among immigrants, lowest income quintile was associated with the lowest rates of injury (RR 0.88, 95% CI 0.82-0.94, quintile 5 v. 1). Highest rates of injury for nonimmigrants were among adolescents (age 10-14 yr, RR 1.23, 95% CI 1.18-1.28; v. 20-24 yr), but for immigrants, was highest among young children (0-4 yr RR 1.23, 95% CI 1.16-1.31; v. 20-24 yr).

INTERPRETATION

Rates of unintentional injury are lower among immigrant than among Canadian-born children, supporting a healthy immigrant effect. Socioeconomic status and age have different associations with injury risk, suggesting alternative causal pathways for injuries in immigrant children and youth.

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Objective

This prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation.

Materials and methods

Patients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure.

Results

Totally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001).

Conclusion

It seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.

Latino migrant farmworker student development of safety instructional videos for peer education

The purpose of this community-based study was to test effectiveness of a peer-education safety education program that included student-produced videos and photovoice, nested in a 7-week summer Migrant Education Program. The second aim was to evaluate psychometrics of an adapted safety survey from Westaby and Lee used to evaluate changes in safety knowledge and attitudes. This was a one-group pre/post design intervention study. The convenience sample was Latino migrant students (N=117, middle school [grades 6-8, n=37], lower school [grades 3-5, n=80]), with data collected at baseline and post-intervention. Participants were male n=59, female n=58. Nine student safety videos were created by the middle schoolers who presented safety to the lower school. There were no statistically significant results comparing pre/post median subscale scores but results showed increased safety knowledge and there was a slight increase in injury experience. Wilcoxon Signed Rank Tests split for middle versus lower school showed statistical difference in middle school students over lower school students (P=.054) in safety knowledge. Kruskal Wallis analysis by gender showed statistical differences in medians in safety consciousness (χ2=5.949, df 1, P=.015); dangerous risk-taking (χ2=5.409, df 1, P=.020). There were positive significant associations between age and dangerous risk taking participation; safety consciousness and dangerous risk taking; safety knowledge with safety activity participation; and safety activities with safety consciousness. Survey showed 0.69% random missing data. Cronbach's alphas ranged .689-.863. Future research needs to review lessons learned and replication with larger samples.

Perceived descriptive safety-related driving norms within and outside Arab towns and villages in Israel

OBJECTIVE

Involvement in car crashes is higher among Israeli Arabs compared to Jews. This study characterized perceived descriptive driving norms (PDDNs) within and outside Arab towns/villages and estimated their association with involvement in car crashes.

METHODS

Arab drivers (594) living in 19 towns and villages were interviewed in face-to-face interviews. The questionnaire included questions about involvement in car crashes, PDDNs within and outside the towns/villages, attitudes toward traffic safety laws, traffic law violations, and socioeconomic and demographic variables. PDDNs represent individuals' perceptions on how safe other people typically drive. The low scores indicate a low percentage of drivers performing unsafe behaviors (safer driving-related norms). A structural equation modeling analysis was applied to identify factors associated with PDDNs and involvement in car crashes.

RESULTS

A large difference was found in PDDNs within and outside the towns/villages. Mostly, the respondents reported higher rates of unsafe PDDNs within the towns/villages (mean = 3.76, SD = 0.63) and lower rates of PDDNs outside the towns/villages (mean = 2.12, SD = 0.60). PDDNs outside the towns/villages were associated with involvement in a car crash (r = -0.12, P <.01), but those within the towns/villages were not. Within the towns/villages, attitudes toward traffic laws and PDDNs were positively associated with traffic law violations (r = 0.56, P <.001; r = 0.11, P <.001 respectively), where traffic law violations were directly associated with involvement in a car crash (r = -0.14, P <.001).

CONCLUSIONS

Unsafe PDDNs may add directly and indirectly to unsafe driving and involvement in car crashes in Arab Israelis. Because PDDNs outside towns/villages were better, increased law enforcement within towns/villages may improve these norms and decrease involvement in car crashes.

Increased inequality in mortality from road crashes among Arabs and Jews in Israel

OBJECTIVE

Previous studies in several countries have shown that the economically disadvantaged seem to have a greater risk of being involved in a car crash. The aim of the present study was to compare rates and trends in mortality and injury from road crashes by age among the Arab and Jewish populations in Israel.

METHODS

Data on road crashes with casualties (2003-2011) from the Israeli Central Bureau of Statistics were analyzed. Age-adjusted road crash injury rates and mortality rates for 2003 to 2011 were calculated and time trends for each age group and population group are presented. Time trend significance was evaluated by linear regression models.

RESULTS

Arabs in Israel are at increased risk of injury and mortality from road crashes compared to Jews. Road crash injury rates have significantly decreased in both populations over the last decade, although the rates have been persistently higher among Arabs. Road crash mortality rates have also decreased significantly in the Jewish population but not in the Arab population. This implies an increase in the disparity in mortality between Jews and Arabs. The most prominent differences in road crash injury and mortality rates between Arabs and Jews can be observed in young adults and young children.

CONCLUSIONS

The reduction in road crashes in the last decade is a positive achievement. However, the reductions are not equal among Arabs and Jews in Israel. Therefore, an increase in the disparities in mortality from road crashes is apparent. Public health efforts need to focus specifically on decreasing road crashes in the Arab community.

Determinants of Behavior of Students as Pedestrian and Car Occupants in Relation to Traffic Laws in 2013, Gorgan, Iran; An Application of Health Belief Model

OBJECTIVES

To determine the behavioral pattern of Golestan University of Medical Science (GUMS) students as pedestrian and car occupants in relation to traffic law based on Health Belief Model.

METHODS

This cross-sectional study was performed during 2012 in GUMS. A total of 370 students of GUMS were selected using multi-stage sampling method  including stratified and  random  sampling. Data were collected by using a reliable and valid questionnaire. All the participants filled the questionnaire and the data was extracted according to previously described method. Data were analyzed by using SPSS 18 Software. Descriptive statistic and Spearman correlation was used for analyzing the data.

RESULTS

Mean age of the participants was 20.92±1.98 (range 17-32) years. Mean score of perceived susceptibility was 81.87±17.18, being in desirable level. Mean score of perceived severity was 73.39±18.4, being also in desirable level. Mean score of perceived benefits was 77.22 ±16.13, which was also assumed to be in desirable level. Mean score of perceived barriers was 53.46±16.27, assumed as moderate level. In the same way the mean score of practice was 66.17±17.51, so practice in students was in moderate level. Television was the most important cues to action.

CONCLUSION

Perceived susceptibility, perceived severity, perceived benefits regarding safety behaviors was in good level but perceived barriers and behavior was in moderate level and according to the importance of Television, we recommended appropriate intervention such as health education and advocacy, especially through national Television.

A geographic analysis of collisions involving child pedestrians in a large Southern California county

OBJECTIVES

The goal of this study is to explore the relationship between child pedestrian injuries and socioeconomic characteristics of neighborhoods in the context of local traffic volume.

METHODS

Child pedestrian collisions were identified in the data of the California Statewide Integrated Traffic Records System (SWITRS). Nine hundred sixty crashes over a 5-year period were identified, geocoded, and mapped to Orange County census tracts. Census data from 2000 were used to identify tracts, population, and population characteristics in the county of approximately 3,000,000 individuals. Pedestrian collision maps were merged with census characteristics and analyzed using STATA (Version 10.1, Stata Corp, College Station, IX) to determine correlations between socioeconomic factors and collision rates within census tracts.

RESULTS

The percentage of the population living in households with low income (less than 185% of the federal poverty level) was the strongest predictor of pedestrian injuries. One fourth of census tracts had less than 9 percent of residents with low income and averaged 6 per 100,000 child pedestrian crashes annually. One fourth of the census tracts had more than 32 percent of residents with low income and an average of 56 child pedestrian crashes per 100,000 annually. These data indicate an 8.8-fold increase in collision frequency in the lowest income quartile over the highest income quartile. Other socioeconomic correlates strongly associated with increased child collisions include population density, proportion of population speaking English less than very well, lack of high school education, number of multifamily residences, and Latino ethnicity.

CONCLUSIONS

Our study showed that child pedestrian collisions are nearly 9 times more frequent in the poorest quartile of neighborhoods than in the richest quartile. Other factors associated with increased pediatric collision risk include increased neighborhood crowding, low levels of education and English speaking ability, and Latino ethnicity.

Incidence and risk factors of non-fatal injuries in Chinese children aged 0-6 years: a case-control study

AIM

To identify the incidence and related risk factors of injuries in pre-school children aged 0-6 years in China.

METHODS

Children with non-fatal injuries (n=122) were matched to healthy controls by sex, age, community of residency and history of injury. Conditional multiple logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The overall incidence of injuries was 3.3%. After adjustment for all selected variables, the risk factors for childhood injuries included father's occupation as a self-employed person (OR: 5.7, 95% CI: 1.8-18.5), child's active temperament type (OR: 2.8, 95% CI: 1.5-5.3), inappropriate storage of medicines (OR: 3.1, 95% CI: 1.3-6.9) and inappropriate placement of heating equipment (OR: 2.1, 95% CI: 1.0-4.4). The protective factors included children's acquirement of safety education from their teachers at school (OR: 0.03, 95% CI: 0.01-0.2), and from their parents (OR: 0.08, 95% CI: 0.02-0.3).

CONCLUSIONS

Interventions targeting the risk factors specifically may help prevent and reduce the occurrence of injuries in young children.

Evaluation of criteria for developing traffic safety materials for Latinos

This quantitative study assessed the validity of guidelines that identified four key characteristics of culturally appropriate Spanish-language traffic safety materials: language, translation, formative evaluation, and credible source material. From a sample of 190, the authors randomly selected 12 Spanish-language educational materials for analysis by 15 experts. Hypotheses included that the experts would rate materials with more of the key characteristics as more effective (likely to affect behavioral change) and rate materials originally developed in Spanish and those that utilized formative evaluation (e.g., pilot tests, focus groups) as more culturally appropriate. Although results revealed a weak association between the number of key characteristics in a material and the rating of its effectiveness, reviewers rated materials originally created in Spanish and those utilizing formative evaluation as significantly more culturally appropriate. The findings and methodology demonstrated important implications for developers and evaluators of any health-related materials for Spanish speakers and other population groups.

The relationship of pedestrian injuries to socioeconomic characteristics in a large Southern California County

OBJECTIVES

The goal of this study is to explore the relationship between pedestrian injuries and socioeconomic characteristics.

METHODS

Pedestrian collisions were identified in the data of the California Statewide Integrated Traffic Records System (SWITRS), which is assembled from police crash reports by the California Highway Patrol Information Services Unit. Four thousand crashes were identified and geocoded within the census tracts in a county population of 2,846,289 over a 5-year period. Population and population characteristics for census tracts were obtained from the 2000 U.S. Census.

RESULTS

The percentage of the population living in households with low income (less than 185% of the federal poverty level) was the strongest predictor of pedestrian injuries. One fourth of census tracts had less than 8.7 percent of residents with low income and averaged 11 per 100,000 pedestrian crashes annually. One fourth of the census tracts had more than 32.2 percent of residents with low income and an average of 44 pedestrian crashes per 100,000 annually. Negative binomial regression showed that with each 1 percent increase in the percentage of residents with low income was associated with a 2.8 percent increase in pedestrian crashes. The percentage of residents age 14 years or less, adult residents who had not completed high school, residents who spoke English less than "very well" and spoke another language at home, and the population density were each associated with a higher frequency of pedestrian crashes. However, when low income was added to these 4 regression models, the relationship between low income and pedestrian crashes increased.

CONCLUSIONS

Our study showed that pedestrian crashes are 4 times more frequent in poor neighborhoods and that neither age of the population, education, English language fluency, nor population density explained the effect of poverty.

Preventing pediatric pedestrian injuries

Pedestrian-related crashes cause an estimated 1.2 million deaths and 50 million injuries worldwide. There were 32,590 nonfatal injuries reported among children 0 to 14 years of age in the United States in 2006. The incidence of pedestrian injuries seems to be decreasing due to improvements in trauma care and a nationwide decline in walking. This article is a special communication and overview of selected literature regarding efforts to decrease the frequency of pediatric pedestrian trauma. WalkSafe an elementary school-based pedestrian injury prevention program will be discussed as an example of a program that has been able to demonstrate a decrease in injuries in children.

Road traffic injuries among middle school students in a rural area of China

OBJECTIVE

Injuries resulting from road traffic crashes are a major and growing public health problem worldwide, disproportionately affecting vulnerable road users in developing countries. However, research on road traffic injuries in developing countries has been limited. We studied road traffic injuries among middle school students in a rural area of China.

METHODS

We surveyed 1551 students in Hunan province using a hard-copy survey questionnaire. The survey was conducted at two middle schools with the cooperation of teachers and school officials. The questionnaire gathered data including sociodemographics, school activities, and sleep patterns along with road traffic injuries among middle students during a 3-month recall period in 2006. Road traffic injuries were defined as injuries incurred as a result of a road traffic collision involving at least one vehicle in motion on a public or private road that resulted in at least one person being injured.

RESULTS

There were 56 road traffic injuries reported by the surveyed students yielding a rate of 3.6 percent over the 3-month period. The greatest percentage of those injuries involved a motorcycle (80%). Nearly two fifths of injuries resulted in a period of activity restriction lasting one day or more (39%). The multivariable logistic regression analysis indicated that there were statistically significant associations between the assignment of extra homework by parents (odds ratio [OR] = 3.78, 95% confidence intervals [CI] = 1.49-9.60, p-value < 0.01) and parents' treatment for poor academic performance (OR = 2.18, 95% CI = 1.18-4.02, p-value < 0.05) with road traffic injuries and difficulty falling asleep was a marginally a significant risk factor (OR = 2.03, 95% CI = 0.78-5.28, p-value = 0.06).

CONCLUSION

School-related stress and sleep disturbance were identified as possible risk factors for road traffic injuries among students in a rural area of China. Further research is warranted in order to develop prevention strategies to address these preventable injuries.

Pedestrian road traffic injuries in urban Peruvian children and adolescents: case control analyses of personal and environmental risk factors

Background

Child pedestrian road traffic injuries (RTIs) are an important cause of death and disability in poorer nations, however RTI prevention strategies in those countries largely draw upon studies conducted in wealthier countries. This research investigated personal and environmental risk factors for child pedestrian RTIs relevant to an urban, developing world setting.

Methods

This is a case control study of personal and environmental risk factors for child pedestrian RTIs in San Juan de Miraflores, Lima, Perú. The analysis of personal risk factors included 100 cases of serious pedestrian RTIs and 200 age and gender matched controls. Demographic, socioeconomic, and injury data were collected. The environmental risk factor study evaluated vehicle and pedestrian movement and infrastructure at the sites in which 40 of the above case RTIs occurred and 80 control sites.

Findings

After adjustment, factors associated with increased risk of child pedestrian RTIs included high vehicle volume (OR 7·88, 95%CI 1·97–31·52), absent lane demarcations (OR 6·59, 95% CI 1·65–26·26), high vehicle speed (OR 5·35, 95%CI 1·55–18·54), high street vendor density (OR 1·25, 95%CI 1·01–1·55), and more children living in the home (OR 1·25, 95%CI 1·00–1·56). Protective factors included more hours/day spent in school (OR 0·52, 95%CI 0·33–0·82) and years of family residence in the same home (OR 0·97, 95%CI 0·95–0·99).

Conclusion

Reducing traffic volumes and speeds, limiting the number of street vendors on a given stretch of road, and improving lane demarcation should be evaluated as components of child pedestrian RTI interventions in poorer countries.

Individual factors explain neighbourhood variations in accidents to children under 5 years of age

Previous studies have identified possible neighbourhood-level influences on the risk of injuries to preschool children, but none have had sufficient data at both household and area level to explain these neighbourhood effects. We used data from the Avon Longitudinal Study of Parents and Children, which recruited over 14,062 children at birth in the former county of Avon, UK, and collected information about accidents, as well as extensive social, health and developmental data throughout the first 5 years of life. This information was combined with census and geographical data in order to identify neighbourhood influences on accident risks and then attempt to explain these using multilevel regression modelling. A small but statistically significant amount of between-neighbourhood variance in accident risk was found, with neighbourhood intraclass correlation coefficients of 0.82% for any accident, and 0.84% for accidents resulting in injury requiring medical attention. This was entirely accounted for by a variety of child, parental and household level variables. Independent risk factors for both outcomes were children who were developmentally more advanced or displayed greater conduct and behavioural problems, mothers who were of younger age, who were without work, who were smokers, whose partners were unemployed or drank alcohol excessively, and households in which there had recently been adverse life events, or which were under financial stress. The mother's perceptions of neighbourhood quality also explained some of the risks for any accident, but not for medically attended accidents, and this was a variable that operated at the level of individual households rather than at the level of neighbourhoods. The implications of this study are that differences in accident risk between neighbourhoods are explained by geographical clustering of similar types of children, families and households. Interventions should focus more on parental factors and household social circumstances than on the physical environment or community based risks. However, many of these factors are those most resistant to modification without broader societal change.

Injury mortality among ethnic minority groups in the Netherlands

OBJECTIVES

To prepare a comprehensive overview of ethnic differences in injury related mortality in the Netherlands and to determine the role of area income and urbanisation degree.

METHODS

Data for the period 1995-2000 were obtained from the population and cause of death registries. Injury related death rates were compared for persons from Turkish, Moroccans, Surinamese, and Antillean/Aruban origin with rates for the native Dutch population.

RESULTS

Compared with the native Dutch population, all ethnic minorities combined had an increased mortality for all injuries together (RR = 1.29). Ethnic minorities experienced a significantly higher risk of death from pedestrian accidents (RR = 1.87), drowning (RR = 2.58), poisoning (RR = 1.76), fire and scalds (RR = 1.95), and homicide (RR = 3.24). Mortality for cyclists (RR = 0.53) and motorcycle drivers (RR = 0.47) was significantly lower among ethnic minorities compared with the native Dutch. Adjustment for area income and urbanisation decreased the mortality risk difference for most of the non-traffic injuries, but showed a difference in risk for car driver and passenger accidents (RR = 1.37). Compared with the native Dutch inhabitants, Surinamese and Antillean/Aruban population had a higher risk of total injury mortality (RR = 1.33 and 1.53 respectively), while Turkish and Moroccans had increased risk only for selected conditions. Inequalities in injury mortality were the highest among children and young adults, but persisted in the age group above 50 years old.

CONCLUSION

Ethnic differences in injury mortality in the Netherlands strongly depended on type of injury, ethnic group, sex, and age. Policies should be aimed at the prevention of high risk injuries among the most vulnerable ages and ethnic groups.

Lower rates of emergency department injury visits among Latino children in the USA: no association with health insurance

BACKGROUND AND OBJECTIVE

Latino children have lower rates of injury visits to emergency departments (EDs) than non-Latino white and African American children. This study tests the hypothesis that this difference reflects health insurance status.

DESIGN

Secondary analysis. Patients/

SETTING

Children under 19 years of age visiting EDs in the USA, sampled in the National Hospital Ambulatory Medical Care Survey of EDs (NHAMCS-ED) from 1997 to 2001.

MAIN OUTCOME MEASURES

Rates of ED injury visits; ED injury visit rates by race/ethnicity stratified by health insurance and adjusted for other covariates; subtypes of injury visits; and procedures and hospital admissions by race/ethnicity.

RESULTS

Injuries accounted for >56 million, or 40.5%, of total ED visits among pediatric patients. Injury visits occurred at lower rates for Latino children (9.9 per 100 person years) than non-Latino white and African American children (16.2 and 18.3, respectively), although total ED visit rates were similar. Regardless of health insurance status, Latino children had lower rates of injury visits than non-Latino white and African American children. Latino children had lower rates of the three major subtypes of injury visits (sports, accidental falls, struck by/between objects). Latino children had similar rates of procedures and hospital admissions to non-Latino white children.

CONCLUSIONS

Irrespective of their insurance status, Latino children have lower rates of ED injury visits in the USA than non-Latino white children. Possible reasons for this difference include different healthcare seeking behavior or different injury patterns by race/ethnicity, but not differences in health insurance status or barriers to accessing ED care.

A Comparison of Nonfatal Unintentional Injuries in the United States Among U.S.-Born and Foreign-Born Persons

The objective of this research was to compare the risk of nonfatal unintentional injuries between foreign-born and U.S.-born persons. Cross-sectional, nationally representative data were used from the 2000-2003 National Health Interview Survey to compare the risk of injury between 62,267 foreign-born and 322,200 U.S.-born persons. Nonfatal unintentional injuries occurring during the three months prior to the interview were compared by age, gender, education, poverty status, region of residence, family size, and health insurance coverage status. There were a total of 7,654 injured persons with U.S.-born persons having a weighted injury prevalence of 2.3% (95% confidence interval [CI]: 2.2, 2.4) and foreign-born persons having a weighted injury prevalence of 1.2% (95% CI: 1.0, 1.3). With the U.S.-born population as the reference and while controlling for sociodemographic characteristics, the odds ratio of injury risk was 0.54 (95% CI: 0.48, 0.62) for the foreign-born population. Transportation-related injuries occurred more frequently among foreign-born persons than among U.S.-born persons (23.7%, 95% CI: 19.7, 28.3 vs. 15.0%, 95% CI: 14.0, 16.2, respectively). This research is the first step in determining the morbidity from unintentional injuries among the foreign-born population in the U.S.

Emergency department visits among pediatric patients for sports-related injury: basic epidemiology and impact of race/ethnicity and insurance status

OBJECTIVES

(1) To characterize the demographics and external causes of pediatric sports injury-related visits (SIRVs) to emergency departments (EDs). (2) To analyze the effect of race/ethnicity and insurance on SIRVs to EDs.

METHODS

A stratified random-sample cross-sectional survey of EDs in the National Hospital Ambulatory Medical Care Survey was conducted from 1997-2001; for patients younger than 19 years, we used all visits [n = 33,654; injury-related visits (IRVs) = 13,496, SIRVs = 2990]. We examined both the external cause codes and the actual verbatim text of all IRVs. National estimates of pediatric IRVs were obtained using the assigned patient visit weights in the National Hospital Ambulatory Medical Care Survey databases and SUDAAN 9.1 software (SAS Institute, Inc., Cary, NC).

RESULTS

Sports injuries resulted in 2.5 million visits annually, or 23% of ED IRVs. Male sex, older age (6-18 years), and white race/ethnicity are associated with higher rates of SIRVs. Cycling, basketball, playground injuries, and football resulted in the largest numbers of ED SIRVs. Leading diagnoses for SIRVs included fractures and dislocations, sprains and strains, open wounds, and contusions. Hispanic race/ethnicity was associated with lower rates of SIRVs across all insurance types. After controlling for demographic factors and insurance, Hispanic children were less likely to have an SIRV than white children (odds ratio, 0.7; 95% confidence interval, 0.6-0.9).

CONCLUSIONS

Sports and recreation are the leading causes of pediatric ED IRVs. Hispanic children, regardless of insurance status, had lower rates of SIRVs than white children, which helps explain the lower rate of nonfatal IRVs to EDs among Hispanic youth.

Relationships between child, family and neighbourhood characteristics and childhood injury: a cohort study

There has been little research into the role of neighbourhood effects in childhood injury. We report results from a cohort study, comprising 1717 families (2357 children aged 0-7 years) registered at 47 general practices in Nottingham, UK. Multi-level Poisson regression examined relationships between electoral ward (neighbourhood), family and child characteristics and medically attended injury rates. Primary care attendance rates were higher for children in rented accommodation and those aged 2-3 years. An n-shaped relationship was found between geographical access to services and the primary care attendance rate. Accident and Emergency (A&E) department attendance rates were higher amongst boys, children in rented accommodation, with a teenage mother, aged 2-5 years and living in wards with a higher number of parks and play areas. They were lower for children whose families had a smoke alarm. Hospital admission rates were higher amongst children living in more deprived wards and wards with higher violent crime rates. They were lower in children whose families had smoke alarms, stair gates and stored sharp objects safely. Primary care and A&E attendance rates varied significantly between families. Variation between wards in the A&E attendance rate was explained by family characteristics. We conclude that characteristics of wards, families and children are associated with medically attended childhood injury rates. This study did not find a neighbourhood effect for A&E attendances that could not be explained by family level characteristics. Studies with greater power and a measure of injury severity independent of health service utilisation are needed to explore the relationship between neighbourhood effects and more severe injuries. The greater variation in injury rates vary between families than between neighbourhoods suggests reducing inequalities in injury rates may be achieved more effectively by focussing prevention at families rather than neighbourhoods, but in practice interventions at both levels are likely to be necessary.

Minority status and the risk of serious childhood injury and death

OBJECTIVE

Minority populations have an increased risk for trauma, but little is known about injury rates for minority children. This study compares the causes, rates and outcomes of traumatic injuries between minority and white children in a statewide population sample.

METHODS

A cohort study of 5,973 children (age <16) receiving inpatient care for treatment of acute injuries at the pediatric trauma centers in Ohio from 1999--2001. Case records were analyzed for race, injury type, injury severity, length of stay and demographic information. Supplemental data sources included the 2000 U.S. census and Ohio Vital Statistics death certificates 1996--2001.

MAIN OUTCOME MEASURES

Hospital admission rate, mortality rate, length of stay, rate of admission to rehabilitation service.

RESULTS

African-American children, who composed the vast majority of the minority population sample, were 7.7 more times likely to sustain a burn or gunshot wound, seven times more likely to be struck by a car, six times more likely to be intentionally injured and over twice as likely to killed by an injury than white children. However, after adjusting for injury severity, they have the same mortality, hospital length of stay and referral rate to rehabilitation as white children.

CONCLUSION

Trauma has a far greater impact on minority children than on white children. Research and development of injury prevention initiatives that specifically target minority children are urgently needed.

Does poverty lead to non-fatal unintentional injuries in rural Vietnam?

The aim of this study was to identify associations between poverty at the household level and unintentional injury morbidity. A cohort consisting of 24,874 person-time episodes, representing 24,776 people living in 5,801 households (classified into rich, middle income and poor by local authorities in 1999) was followed during 2000, in order to identify and assess non-fatal unintentional injuries. Incidence rate ratios were calculated using a Poisson regression model. The results showed that poverty was a risk factor for unintentional injuries generally. When looking at different types of injury, poverty was a risk for home, work and "other" injuries, protective for school injuries, while the risk of traffic injuries was not affected. The results also showed that communes in mountainous areas were at higher risk for home, work and other injuries. Overall, poverty was associated with unintentional injury morbidity. However, the relationship varied by sex, age and type of injury. Specifically, poverty increased the risk for children and elderly people being injured at home, and for adults (15-59 years) being affected by work injuries.

Evaluation of a community-based intervention to promote rear seating for children

OBJECTIVES

We evaluated the short-term effect of a community-based effort to promote child rear seating in a low-income Hispanic community.

METHODS

Child seating patterns were observed pre- and postintervention at intersections in 1 intervention and 2 control cities. Brief interviews assessed exposure to program messages.

RESULTS

Child rear seating increased from 33% to 49% in the intervention city (P <.0001), which represented a greater increase than that in the control cities (P <.0001). The greatest improvement was observed in relatively higher-income areas. Rear seating was significantly correlated with reported program exposure. Incentives and exposure to the program across multiple channels seemed to have the greatest effect.

CONCLUSIONS

Independent of legislation, community-based programs incorporating incentives can increase child rear seating.

Assuring the health of immigrants: what the leading health indicators tell us

Over the past 20 years, the United States has experienced one of the largest waves of immigration in its history. Understanding the health status and needs of immigrants is important because of their growing numbers and their contribution to the health of the nation, but it is challenging because of gaps in national databases, the heterogeneity of immigrant populations, and uncertainty about how migration affects health. Healthy People 2010 outlines the nation's public health objectives for the current decade. It includes ten leading health indicators (LHIs) chosen because of their importance as public health issues, their ability to motivate action, and the availability of data to measure their progress. In this paper, we discuss the health of immigrants from the perspective of these LHIs, as they provide a framework for anticipating some of the future health needs of immigrants and help define priority areas for research and action.

Measuring contextual characteristics for community health

OBJECTIVE

To conceptualize and measure community contextual influences on population health and health disparities.

DATA SOURCES

We use traditional and nontraditional secondary sources of data comprising a comprehensive array of community characteristics.

STUDY DESIGN

Using a consultative process, we identify 12 overarching dimensions of contextual characteristics that may affect community health, as well as specific subcomponents relating to each dimension.

DATA COLLECTION

An extensive geocoded library of data indicators relating to each dimension and subcomponent for metropolitan areas in the United States is assembled.

PRINCIPAL FINDINGS

We describe the development of community contextual health profiles, present the rationale supporting each of the profile dimensions, and provide examples of relevant data sources.

CONCLUSIONS

Our conceptual framework for community contextual characteristics, including a specified set of dimensions and components, can provide practical ways to monitor health-related aspects of the economic, social, and physical environments in which people live. We suggest several guiding principles useful for understanding how aspects of contextual characteristics can affect health and health disparities.

Injuries among Hispanics in the United States: implications for research

The purpose of this article is to provide a brief overview of U.S. injury mortality among Hispanics, of past research, and of recommended research needs in the field of injury prevention and control. U.S. mortality data from the National Center for Health Statistics from 1990 to 1998 were accessed and summarized. It was found that injuries were the third leading cause of death among Hispanics and the leading cause for those 1 to 44 years of age. There were 119,314 injury deaths resulting in more than 5,000,000 years of potential life lost. Death rates from drugs and/or poisonings and falls increased 23% and 3%, respectively, whereas rates declined for all other causes. There are many gaps in published research focusing on injuries in Hispanic populations. Further research initiatives must be a priority because injuries clearly result in a disproportionate share of Hispanic mortality.

Family characteristics and pedestrian injury risk in Mexican children

BACKGROUND

Family characteristics have been described as risk factors for child pedestrian and motor vehicle collision. Research results come mainly from developed countries, where family relationships could be different than in developing ones.

OBJECTIVE

To examine family characteristics as risk factors for pedestrian injury in children living in Guadalajara City, Mexico.

METHODS

Case-control study of injuries among children 1-14 years of age involved in pedestrian-motor vehicle collisions. Cases resulting in death or injuries that required hospitalization or medical attention were included and identified through police reports and/or emergency room registries. Two neighborhood matched controls were selected randomly and compared with cases to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Significant risk factors were: male (OR 2.3, 95% CI 1.2 to 4.4), number of siblings in household (two siblings, OR 3.2, 95% CI 1.4 to 6.6; three siblings, OR 4.5, 95% CI 1.9 to 11.0; four or more siblings, OR 3.7, 95% CI 1.1 to 12.9), and number of non-siblings/non-parents in household (four or more, OR 6.2, 95% CI 1.5 to 26.6). Children of a sole mother, working mother, or grandmother living in house did not show increased risk after adjusting for socioeconomic conditions.

CONCLUSION

Household size has implications for child pedestrian and motor vehicle collision prevention efforts and is relatively easy to identify. Also, the lack of risk association with working mothers may indicate that grandmothers are not part of the social support network that cares for children of working mothers.

Increasing the use of child restraints in motor vehicles in a Hispanic neighborhood

The use of restraints in motor vehicles is less common in minority and low-income populations than in the general population. A preliminary survey of Hispanic preschool-aged children in west Dallas, Tex, conducted in 1997 showed much lower child restraint use (19% of those surveyed) than among preschool children of all races in the rest of the city (62%). Because there are few reports of successful programs to increase child restraint use among Hispanics, we undertook to implement and evaluate such a program. The program was conducted by bilingual staff and was tailored for this community. It was successful in increasing both child restraint use and driver seat belt use.

Social differences in traffic injury risks in childhood and youth--a literature review and a research agenda

OBJECTIVES

The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda.

METHOD

A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries.

RESULTS

For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender.

CONCLUSIONS

The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.