Disability and risk of non-fatal residential injuries among adults.

OBJECTIVE: Many unintentional injuries occur in the home, but little research has considered the specific vulnerability of people with disabilities. DESIGN: Cross-sectional study examining nationally representative data from the 2004-2006 National Health Interview Surveys. SUBJECTS: Adults aged 18 and older who reported having an unintentional, non-motor vehicle-related injury in the home (n = 2189) or outside the home (n = 2072) and those who reported no injuries (n = 81,919) 3 months before their interview. MAIN OUTCOME MEASURE: Non-fatal, unintentional, non-motor vehicle-related injuries. RESULTS: Among respondents experiencing a residential injury, 21.2% reported one type of disability, 11.2% reported two disabilities, and 9.1% reported three or more disabilities. As the number of disabilities increased, the odds of reporting a residential injury increased. Adults with three or more disabilities had three times the odds of reporting a residential injury (adjusted odds ratio = 3.2, 95% CI 2.7 to 3.9), compared with adults reporting no injury. CONCLUSION: The risk of injury in the residential environment among adults with disabilities increases with increasing numbers of disabilities. Attention to home safety issues for residents with disabilities is needed.

Storage of household firearms: an examination of the attitudes and beliefs of married women with children.

Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n=185). We examined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon-Mann-Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices.

Suicide among North Carolina women, 1989-93: information from two data sources.

OBJECTIVES: To characterize the events and examine suicide precursors among women and to examine gaps in surveillance. SETTING: A statewide study in North Carolina. METHODS: Suicides of women age 15 and older for the time period 1989-93, as identified from the Office of the Chief Medical Examiner, were included. All case files were reviewed by hand and telephone interviews were attempted with investigating law enforcement officials for every case in 1993. RESULTS: Altogether 882 suicides met the case definition, for an age adjusted rate that fluctuated between 5.53 and 7.26 per 100 000 women across the period. Interviews with law enforcement officials were completed for 135 of the 177 cases from 1993. White women had rates nearly three times those of racial minorities. Women under age 45 were proportionally more likely than older women to have recently experienced the breakup of an intimate relationship. Information about precursors was not as consistently reported as had been hoped. Medical examiner records were variable in completeness. Law enforcement interviews frequently did not yield information about the factors we had hoped to examine, probably because the investigations were conducted primarily to rule out homicide. CONCLUSIONS: This study suggests somewhat different precursor patterns by age group. It also points to the need for reconsidering how suicide surveillance is accomplished as a strategy to guide intervention.

Homicide on the job: workplace and community determinants.

Homicide is the second leading cause of death on the job for workers in the United States. To identify workplace-level predictors of homicide risk, a case-control study of worker killings in North Carolina in 1994-1998 was conducted. Workplaces were the units of analysis: case workplaces (n = 105) were those where a worker was killed during the study period, while controls (n = 210) were a density sample of North Carolina workplaces, matched on time and industry sector. Potential risk and protective factors were assessed in telephone interviews with workplace managers. Associations were measured by the exposure odds ratio and 95% confidence interval, estimated via conditional logistic regression. Characteristics associated with notably higher risk included being at the current location for 2 years or less (odds ratio (OR) = 5.3, 95% confidence interval (CI): 2.2, 12.6), having only one worker (OR = 2.9, 95% CI: 1.2, 7.2), and having night (OR = 4.9, 95% CI: 2.7, 8.8) or Saturday (OR = 4.2, 95% CI: 1.9, 9.2) hours. Workplaces with only male employees (OR = 3.1, 95% CI: 1.5, 6.5) or with African-American or Asian employees were also more likely to experience a killing. While few of the preceding risk factors are directly modifiable through workplace interventions, it is important to identify them before developing or evaluating preventive measures.

Pediatric injury prevention counseling: an observational study of process and content.

OBJECTIVES: To describe routine injury prevention counseling; to observe how three visit components - printed prompts, parent remarks, and parent behaviors - affect such counseling; to describe the process and content of discussions about car seats as an example of routine injury prevention. METHODS: A total of 128 well-child visits of children under 7 months of age to a university pediatric clinic were videotaped (76% of eligible visits). RESULTS: Three injury topics were mentioned, on an average, per visit. Parents or caregivers rarely introduced injury topics (5%). Physicians frequently introduced those topics listed on age-specific prompting sheets (73%). Car seat counseling typically began with a physician's question (82%). Most asked simply about ownership or use (93%). Few addressed difficult issues, such as consistency of use (11%). CONCLUSIONS: Physicians bring up the injury topics that are prompted. However, most discussion is superficial. Printed prompts that address counseling process as well as content might be beneficial.

State gun control advocacy tactics and resources.

CONTEXT: Enacting state laws to regulate firearm use, availability, or manufacture is one plausible strategy for preventing firearm-related injuries. Organizations that use a wide range of advocacy tactics may be successful in promoting gun control policies. OBJECTIVES: To describe tactics commonly used by groups that advocate for state gun control laws and to assess whether financial resources were associated with groups' use of these advocacy tactics. DESIGN/PARTICIPANTS: We identified 679 local and state organizations potentially active on state-level gun control issues in 1998 and mailed a 153-item questionnaire to the groups' leaders. MAIN OUTCOMES: Organizations' use of 35 gun control advocacy tactics. RESULTS: Seventy-nine percent (n=538) of groups responded to our survey, and, of those eligible, eighty-one percent (n=207) completed questionnaires. Organizations commonly used public education, media, and legislative lobbying tactics, and fewer engaged in electioneering and litigation. Except for lobbying, no associations were found between groups' use of advocacy tactics and their level of financial resources. CONCLUSIONS: Organizations advocating for state gun control laws have a varied tactical repertoire, with fewer using electioneering and litigation than other approaches. Financial resources do not appear to be the determining factor in the advocacy methods employed.

The role of surveillance and evaluation research in the reduction of violence against workers.

BACKGROUND: Violence against workers is garnering increased attention as awareness grows of the toll violent events have on workers and work environments. METHODS: In this review, we summarize information about surveillance of violent events in the workplace and summarize evaluations of intervention programs to reduce such violence. We describe surveillance programs that nationally collect data, and we compare some data. We summarize two systematic studies of workplace violence-prevention programs: The first study examined evaluations of the Crime Prevention Through Environmental Design approach to prevention, and the second examined evaluations of behavioral and administrative interventions. RESULTS: Reliable national data sets of worker homicides exist, but case identification and coding problems have yet to be solved. Although the number of workplace homicides has decreased since the mid-1990s, much less is known about the incidence of nonfatal events. The role that prevention programs have played in reducing workplace homicide remains largely unknown because so few evaluations have been conducted. CONCLUSIONS: Information about effective methods to reduce violence against workers is needed. Research that evaluates existing prevention programs, especially efforts conducted in a collaborative manner, will be invaluable to shaping effective programs in the future.

Moving forward with research on the prevention of violence against workers.

OVERVIEW: This article highlights the major issues discussed at the Workplace Violence Intervention Research Workshop convened in April 2000. It includes discussion of impediments to developing research on interventions that address violence against workers, and it suggests directions for establishing a research agenda. To identify potential interventions strategies, the article provides examples to demonstrate the utility of developing interventions described in two distinct conceptual frameworks developed by William Haddon.

The downside of adolescent employment: hazards and injuries among working teens in North Carolina.

Occupational injuries are major adverse outcomes of teen employment in the United States. Using data from a survey of teens employed in three different retail trade settings (food service, grocery, and other retail) in the state of North Carolina, we examine how experience, gender, work setting, and the pace of work are associated with hazard exposures and injury experiences. Multivariate analyses show that, after controlling for individual and job-level variables, perceived work-pace pressure and hazard exposure are positively associated with variation in the types of injury experiences. We emphasize the need to include characteristics of the workplace and the labor process when assessing the adverse consequences of work on adolescent well-being.

Epidemiology and prevention of injuries among adolescent workers in the United States.

In the United States, most adolescents are employed at some time during their teen years. Provisions of the Fair Labor Standards Act, the nation's child labor law, address some of the risks of adolescent employment; however, > 70 teenage workers are estimated to die from work-related injuries each year, with greater risk among males, whites, and older adolescents. Furthermore, the nonfatal work-related injuries of the > or = 64,000 teens who receive emergency department care each year are believed to significantly undercount actual injuries. Many of these nonfatal injuries are severe, with 15%-45% leading to work restriction or permanent disabilities. Significant methodological issues limit the ability of existing surveillance systems to monitor youth worker injury. Risk factor and intervention research is very limited, but does suggest the role of some worker characteristics, management practices, and training issues. However, these factors need more careful study. This review considers existing information about occupational injuries among adolescents and identifies needs for research and policy attention.

Killed on the clock: a population-based study of workplace homicide, 1977-1991.

BACKGROUND: This paper describes the epidemiology of workplace homicides in North Carolina, with emphasis on the circumstances. METHODS: Workplace homicide victims were identified by and data were abstracted from the North Carolina medical examiner system. RESULTS: Workplace homicide rates are highest for men, older and self-employed workers, minorities and specific occupations, especially taxi drivers. Robberies, mostly in retail settings, accounted for half of the cases, while 20% were known to involve disputes, the contexts of which differed by sex. Women were most likely to be killed by estranged partners. CONCLUSIONS: Preventive strategies need to address the specific contexts in which workplace homicide occurs, such as retail and taxi robberies, and law enforcement officers interacting with suspects. A workplace response to domestic violence is also needed. Other areas for future research and intervention include environmental modifications, employee screening and training, and identifying more inclusive occupational data sources.

Administrative and behavioral interventions for workplace violence prevention.

BACKGROUND: Violence in the workplace accounts for 1000 fatalities and over 20,000 nonfatal events annually in the United States. The occupations with the most fatalities are taxicab drivers, employees in retail establishments, and law enforcement officers. Environmental strategies as well as behavioral and administrative measures could be employed to address violence. METHODS: This paper reports a critical review of the published literature on administrative and behavioral interventions directed at addressing workplace violence. Searching 17 different databases, we identified 137 papers that described workplace violence intervention strategies. Papers were further categorized according to whether they provided empirical data about an intervention or merely suggested intervention ideas. Suggested interventions were categorized according to applicability to types of workplace violence and organized according to the Haddon Matrix. RESULTS: Forty-one reports suggested intervention strategies but provided no empirical data; nine reported results of intervention evaluations. All intervention studies were based in the health care industry and addressed violent encounters between workers and patients. Overall, the research designs employed were weak and the results inconclusive. None used experimental designs. CONCLUSIONS: The lack of rigorous research to assess administrative and behavioral measures to address workplace violence represents a significant gap. Intervention research needs to draw on appropriate theoretical and conceptual frameworks, address the multiple contexts in which violence occurs, and employ strong evaluation research designs, including attention to process, impact, and outcome measures.

Training by satellite: planning and evaluating a video conference for injury prevention practitioners.

A non-experimental design was employed to conduct both a process and impact evaluation of a video conference for injury control specialists and other community members. The video conference was designed to teach participants how to conceptualize, develop, and implement community-based injury and violence prevention programs. The six-hour event was broadcast to 120 sites all across the United States and had a total of 1270 participants. The video conference format included a panel of injury control specialists and a moderator, video and audio clips that were shown throughout the program, on and off screen activities for participants, and an opportunity for participants to ask questions of the panel. Three groups were included in the evaluation sample: participants; site facilitators; and stakeholders; which included the planning committee members, conference speakers, moderator, and audiovisual personnel. Evaluation data were collected by telephone and in-person interviews, focus groups, and surveys completed at all the viewing sites. Results showed that there was high satisfaction among the participants and that the program should be continued as a series of video conferences with a changing content. There was lower satisfaction with the on-line activities, applicability of material to their work, and the opportunity to network with others and to participate in discussion. Recommendations made for improving future programs include shortening the video conference program, focusing on specific issues within injury and violence prevention, training the program presenters on the workings of the satellite video conference technology, use of video streaming, and using web-based forms for registration and evaluation.

Barriers to pediatric injury prevention counseling.

OBJECTIVES: Physicians cite numerous barriers to incorporating injury prevention counseling into routine care. Health behavior models suggest that beliefs about barriers are associated with physician characteristics. This study explores associations between physician characteristics and physician perceptions of barriers. METHODS: Self administered structured questionnaires were sent to all five North Carolina (United States) pediatric residency programs. A total of 160 (72%) physicians training in pediatrics or medicine-pediatrics in these programs replied. Associations between perceived barriers and knowledge, gender, training, experience, and correlation between perceived barriers and other physician beliefs about injury prevention counseling, were measured. RESULTS: Although most residents believed that talking to parents about injury prevention during routine visits was important, they felt they lacked time, did not think to ask parents about injury prevention, or had more important things to do. The more importance residents placed on asking parents about hazards, the less the extent to which barriers were perceived (r = 0.32). Barriers were perceived to a greater extent by residents who thought their preceptors did not expect them to counsel about injury prevention (r = 0.28), lacked confidence that their counseling helped parents (r = 0.32), or felt uncomfortable counseling parents about injury prevention (r = 0.18). Knowledge, residency year, training, and previous experience with injury were not related to perceived barriers. CONCLUSIONS: Residency programs should teach the importance of injury prevention; provide opportunities for residents to become comfortable talking with parents about this; and train residents in the appropriate use of counseling as one strategy for addressing injury prevention.

Partner homicide-suicide involving female homicide victims: a population-based study in North Carolina, 1988-1992.

Homicide-suicide is a form of fatal violence in which an individual commits homicide and subsequently kills him- or herself. One hundred and sixteen homicide-suicide events involving 119 female homicide victims in North Carolina from 1988-1992 were identified through state medical examiner files. Case files were reviewed retrospectively to identify event characteristics, precursors, and typologies. In 86% of cases the perpetrator was the current or former partner of the victim. During the study period, 24% of men who killed their female partners in North Carolina subsequently committed suicide and another 3% attempted suicide but survived. Victim separation from the perpetrator was the most prevalent precursor (41%), followed by a history of domestic violence (29%). In nearly half of the cases with a history of domestic violence, the victim had previously sought protection from the perpetrator in the form of an arrest warrant, restraining order, or intervention by a law enforcement officer. Children of the victim (and/or perpetrator) witnessed the homicide-suicide, were in the immediate vicinity, found their parents' bodies, or were killed, in 43% of cases. The prevalence of separation and domestic violence suggests several potential points of intervention, including stronger domestic violence legislation. Future research should place priority on assessing the impact of partner homicide-suicides on the families in which they occur. Such studies are essential for the informed development of preventive and therapeutic interventions for the families of both the victims and perpetrators of these fatal events. In addition, research focused on assisting men in coping with issues of control and separation is needed.

Improving safety for teens working in the retail trade sector: opportunities and obstacles.

BACKGROUND: Using both quantitative and qualitative data, this study examined teen workers' perceptions about their work environments and the ways in which teens believe workplaces can be made safer. METHODS: We conducted telephone interviews (n = 117) and six focus groups (n = 49) with two separate samples of North Carolina teens who worked in the retail trade sector. RESULTS: Survey findings indicate one-fifth of teens used equipment they thought dangerous; nearly 40% always or often felt rushed at work; and about half received training on how to avoid injury. Teens in the focus groups expressed concerns about workplace physical hazards, the threat of assault, being rushed, and having little power in the work environment. They also indicated that their workplace safety training was ineffective and that child labor laws were unnecessary. CONCLUSIONS: In order to be effective, interventions targeted at working teens need to address the organization of work and adolescent-manager interaction patterns.

Injury-control education in six U.S. medical schools.

PURPOSE: To assess knowledge, attitudes, and formal instruction related to injury control among fourth-year medical students. Injury is the leading cause of death among Americans aged 1 to 44 years. METHOD: The authors conducted a cross-sectional survey of fourth-year students at six U.S. medical schools, four of which maintain federally funded injury prevention research centers. Main outcome measures included injury-related knowledge scores, three attitude measures, and self-reported exposures to injury prevention education. RESULTS: Six hundred and thirty-five fourth-year medical students (73% of those eligible) participated. The responding students were, on average, unable to correctly answer half of the questions testing injury-related knowledge. They rated medical problems more important and more preventable than injury problems, and they felt more comfortable asking their patients about risk factors for medical problems. These findings may be explained, in part, by the students' reported minimal exposure to injury control education in medical school. The students encountered the topic more frequently on rotations in pediatrics (84%), family medicine (73%), and preventive medicine (66%) than on rotations in emergency medicine (47%), internal medicine (41%), or obstetrics and gynecology (34%). Injury control was encountered least often on rotations in psychiatry (23%) and surgery (14%). CONCLUSIONS: These findings suggest that injury control is given limited coverage in the curricula of U.S. medical schools. As a result, students have little understanding of the principles and benefits of injury control.

Fatal residential fires: who dies and who survives?

CONTEXT: The United States has one of the highest fire fatality rates in the developed world, and three quarters of these deaths are in residential fires. OBJECTIVE: To compare characteristics of those who die and those who survive in the same residential fire. DESIGN: Data on fatal residential fires were collected from the medical examiner and interviews with local fire officials. SETTING: North Carolina. SUBJECTS: Persons in residential fires with at least 1 fatality in a 1-year period. MAIN OUTCOME MEASURE: Dying vs surviving a fatal residential fire that occurred with more than 1 person at home. RESULTS: Of the 190 decedents, 124 (65%) were male, 78 (41%) were home alone, and 69 (53%) of 130 adults who had blood alcohol measured were intoxicated (blood alcohol content >22 mmol/L [100 mg/dL]). Of the 254 persons present during fires in which more than 1 person was at home, 112 died. Individuals more likely to die (high-vulnerability group) were younger than 5 years or 64 years or older, had a physical or cognitive disability, or were impaired by alcohol or other drugs (risk of death for group, odds ratio [OR], 4.01; 95% confidence interval [CI], 2.29-7.03). The presence of an adult with no physical or cognitive disabilities who was unimpaired by alcohol or other drugs (a potential rescuer) reduced the risk of death in the high-vulnerability group (OR, 0.49; 95% CI, 0.24-0.99) but not the low-vulnerability group. Overall, a functioning smoke detector lowered the risk of death (OR, 0.39; 95% CI, 0.18-0.83). CONCLUSIONS: Smoke detectors were equally effective in both low- and high-vulnerability populations. The high-vulnerability group was more likely to survive if, in addition to a smoke detector, a potential rescuer was present. Further research should seek to identify prompts that facilitate speedy egress from a burning structure and that can be incorporated into residential fire alarm systems.