Educating women about congenital cytomegalovirus: assessment of health education materials through a web-based survey.

BACKGROUND: Congenital cytomegalovirus (CMV) is the most common congenital infection in the U.S. and can result in permanent disabilities, such as hearing and vision loss, intellectual disability, and psychomotor and language impairments. Women can adopt prevention behaviors in an attempt to reduce their exposure to CMV. Currently, few women are familiar with CMV. To increase awareness of CMV, the Centers for Disease Control and Prevention (CDC) developed draft health education materials. The purpose of this study was to pilot test two health education materials to gauge their appeal and to determine if they increase knowledge about CMV and motivate audiences to seek additional information on CMV and adopt CMV prevention behaviors. METHODS: African-American (n = 404) and Caucasian women (n = 405), who had a young child and were either pregnant or planning a pregnancy, were recruited to participate in a 15-minute web survey. Participants were randomly assigned to view one of two CMV health education materials, either a factsheet or video. Pre and post survey measures were used to assess changes in knowledge of CMV and motivation to adopt prevention behaviors. We also examined audience preferences regarding materials and motivation. RESULTS: CMV knowledge score increased significantly after presentation of either the video or factsheet (from 3.7 out of 10 to 9.1 out of 10, p <0.001). The average materials appeal score was high, with a mean of 3.6 on a four-point scale, indicating women responded very positively to both materials. Regression analyses indicated that appeal, message involvement (e.g., information seeking, discussing with others), post materials knowledge score, and viewing the video (vs. factsheet) were significantly positively associated with increased support for CMV prevention behaviors. CONCLUSIONS: Overall, we found that the health education materials improved women's knowledge of CMV and encouraged them to adopt prevention behaviors. Given the low awareness levels among women currently, these findings suggest that appropriate education materials have the potential to greatly increase knowledge of CMV. As women become more knowledgeable about CMV and transmission routes, we expect they will be more likely to adopt prevention behaviors, thereby reducing their risk of CMV infection.

The effects of closer monitoring on driver compliance with interlock restrictions.

This randomized controlled trial of 2168 DWI multiple offenders assigned to a state-wide ignition interlock program in Maryland compared non-compliance with interlock requirements among drivers who were closely monitored (by Westat staff) and drivers who received standard monitoring (by the Motor Vehicle Administration). Compliance comparisons relied on datalogger data from MVA's interlock providers plus driver records that contained demographic information, prior alcohol-related traffic violations, their dispositions, and interlock duration. Measures for quantifying non-compliance included rates per 1000 engine starts for initial breath test failures at varying BAC levels and time periods, retest failures, retest refusals, interlock disconnects, startup violations, and summation measures. Regression analysis estimated the effects of closer monitoring on non-compliance, using linear mixed models that included random driver effects and fixed effects for study-group assignment, prior alcohol-related traffic violations, and months of continuous datalogger data with a quadratic function that assessed changes and rates of change in interlock non-compliance over time. All the separate non-compliance rates and summary measures derived from them were lower for closer monitored than control drivers for continuous data series of at least 6, 12, or 24 months. The differences for initial test failures and the two summary measures were statistically significant. Most measures of non-compliance decreased significantly as continuous time on the interlock increased. Parallel trends in each study group indicated that drivers learned to improve their compliance over time. Thus, this study convincingly demonstrates that closer monitoring substantially enhanced compliance with requirements of the ignition interlock and that regardless of group assignment, compliance increased over time.

Latency periods between alcohol-related traffic violations: implications for recidivism.

OBJECTIVE: Before October 1, 2002, Maryland's regulations for relicensing drivers with 2 recorded alcohol-related traffic violations distinguished between offenders with 5 or more years between their first and second violations and those with less than 5 years. Our research examined whether this policy was supported by differential probabilities of recidivism and violation-free survival. METHODS: We compared recidivism rates and survival probabilities among the 2 latency subgroups and 2 control groups (first offenders and drivers with no previous alcohol-related traffic violation). Data were extracted from Maryland's driver record database and segregated files and analyzed by age quintiles using Cox proportional hazards models containing identifiers for risk factors, including prior violations. All drivers (N = 64,536) were matched on age quintile, gender, and month of offenders' index violations. Effects of violation histories on survival and recidivism probabilities were measured by contrasts of regression coefficients. RESULTS: Among second offenders, the shorter latency subgroup consistently had higher recidivism and lower violation-free survival than the longer latency subgroup, whose rates fell between those of first offenders and the shorter latency subgroup. Although highly significant, the subgroup differences were small and paled by comparison to differences between first and zero offenders in probability of a subsequent violation. CONCLUSIONS: An earlier study that showed similar overall recidivism for these latency subgroups helped encourage Maryland to change its regulations governing license reinstatement. New regulations issued October 1, 2002, focused on 2 alcohol violations "during any period of time" where investigation indicated alcoholism or unaddressed alcohol problems. To obtain relicensure, these offenders could be required to enter or complete a lengthy certified alcohol treatment program. Our current results are consistent with these requirements. License reinstatement should be primarily guided by the extent of alcohol impairment, especially because both latency subgroups showed higher risks of recidivism than first offenders, who themselves had comparatively high risk.

First-time DWI offenders are at risk of recidivating regardless of sanctions imposed.

OBJECTIVE: Research demonstrates that punitive approaches to DWI employed by the judiciary have failed to significantly reduce recidivism. However, little is known about the deterrent effects of administrative and diversion sanctions. We examine whether such sanctions deter first-time DWI offenders. METHODS: We grouped combinations of administrative, judicial, and diversion sanctions routinely employed in the state of Maryland for processing drivers arrested for DWI into one of eight mutually exclusive disposition sequences. We applied this classification to Maryland drivers who had been licensed in the state and had precisely one DWI on their record prior to January 1, 1999. We then used a proportional hazards model to estimate the probability of remaining free of a new DWI during a 6-year period (January 1, 1999 - December 31, 2004) as a function of the disposition of the index violation, and of selected factors that could affect that probability. RESULTS: Drivers with a prior DWI were at relatively high risk of recidivating regardless of how they were sanctioned. Those who received administrative and alternative sanctions had a risk of recidivating similar to that of drivers who were convicted. CONCLUSION: All dispositions sequences, not just convictions, indicate that first-time DWI offenders are at high risk of recidivating.

Using the U.S. National Household Travel Survey to estimate the impact of passenger characteristics on young drivers' relative risk of fatal crash involvement.

Motor vehicle crashes are the main cause of morbidity and mortality in teenagers and young adults in the United States. Driving exposure and passenger presence, which can both vary by driver and passenger characteristics, are known to influence crash risk. Some studies have accounted for driving exposure in calculating young driver fatal crash risk in the presence of passengers, but none have estimated crash risk by driver sex and passenger age and sex. One possible reason for this gap is that data collection on driving exposure often precludes appropriate analyses. The purpose of this study was to examine, per 10 million vehicle trips (VT) and vehicle-miles traveled (VMT), the relative risk of fatal crash involvement in 15-20-year-old male and female drivers as a function of their passenger's age and sex, using solo driving as the referent. The Fatality Analysis Reporting System provided fatal motor vehicle crash data from 1999 to 2003 and the 2001 National Household Travel Survey (NHTS) provided VT and VMT. The NHTS collects driving exposure for both household and non-household members (e.g., friends, colleagues), but demographic characteristics only on household members. Missing age and sex of non-household passengers were imputed with hot deck using information from household passengers' trips with non-household drivers, thereby enabling the calculation of crash rate and relative risk estimates based upon driver and passenger characteristics. Using this approach, the highest risk was found for young male drivers with 16-20-year-old passengers (relative risk [RR] per 10 million VT=7.99; 95% confidence interval [CI], 7.34-8.69; RR per 10 million VMT=9.94; 95% CI, 9.13-10.81). Relative risk was also high for 21-34-year-old passengers, again particularly when both drivers and passengers were male. These effects warrant further investigation and underscore the importance of considering driving exposure by passenger characteristics in understanding crash risk. Additionally, as all imputation techniques are imperfect, a more accurate estimation of U.S. fatal crash risk per distance driven would require national surveys to collect data on non-household passenger characteristics.

Risk of alcohol-impaired driving recidivism among first offenders and multiple offenders.

OBJECTIVES: We sought to determine the statewide impact of having prior alcohol-impaired driving violations of any type on the rate of first occurrence or recidivism among drivers with 0, 1, 2, or 3 or more prior violations in Maryland. METHODS: We analyzed more than 100 million driver records from 1973 to 2004 and classified all Maryland drivers into 4 groups: those with 0, 1, 2, or 3 or more prior violations. The violation rates for approximately 21 million drivers in these 4 groups were compared for the study period 1999 to 2004. RESULTS: On average, there were 3.4, 24.3, 35.9, and 50.8 violations per 1000 drivers a year among those with 0, 1, 2, or 3 or more priors, respectively. The relative risks for men compared with women among these groups of drivers were 3.8, 1.2, 1.0, and 1.0, respectively. CONCLUSIONS: The recidivism rate among first offenders more closely resembles that of second offenders than of nonoffenders. Men and women are at equal risk of recidivating once they have had a first violation documented. Any alcohol-impaired driving violation, not just convictions, is a marker for future recidivism.

Variable selection and raking in propensity scoring.

This paper discusses some practical issues in applying propensity scoring in the context of endpoint analysis in a pre-/posttest longitudinal design with an ordinal measure of treatment intensity and a high-dimensional potential covariate space: how many covariates to include in propensity models; how to evaluate the adequacy of tentative propensity models; and how to tailor models to provide hypercontrol on a limited subset of covariates. These issues arose in the evaluation of a health communication program.