Risk Of Unintentional Injury Research Articles

Interactions Between Child Behavior Patterns and Parenting: Implications for Children's Unintentional Injury Risk

Two factors were considered as predictors of children's risk for unintentional injury: (a) children's temperamentally difficult behavior patterns and (b) parenting. Along with hypotheses to replicate previous univariate effects, it was hypothesized that active, involved parents with sufficient time resources might reduce injury risk among temperamentally at-risk children. Study 1 used a retrospective design with a diverse sample of over 10,000 5-year-olds. Study 2 replicated Study 1 using a prospective design and behavioral data from a sample of over 1,000 children followed from 6 to 36 months of age. In Study 1, male gender, child hyperactivity, and family poverty predicted injury in a univariate manner. In Study 2, male gender and lack of positive parenting predicted injury in a univariate manner. Interaction effects also emerged: in Study 1 the interaction between child hyperactivity and parental time resources protected children from injury, and in Study 2 the interaction between child's difficult temperament and positive parenting protected children from injury. Children at increased risk for injury, i.e., those with hyperactive and difficult behavior patterns, might be protected in the environment of positive parenting. Theoretically, results suggest that researchers should consider Temperament x Environment interactions along with univariate predictors of outcome behavior. From an applied perspective, results have implications for the design of injury prevention campaigns: Parents who spend positive time with temperamentally difficult children might protect them from injury.

The role of fathers in toddlers' unintentional injury risk.

Previous work suggests that maternal parenting and supervision reduces risk for children's unintentional injuries, but very little research has examined the role of fathers in children's unintentional injury risk. The role of fathers in protecting children from unintentional injury was considered. A prospective longitudinal design predicted injury risk in 181 toddlers from the ages of 6 to 36 months. Predictor variables included child gender and temperament, individual difference factors of the mother and father, and parenting factors of the mother and father. Hierarchical regression models suggested that fathers' report of gains to the family from their employment was the strongest predictor of risk of children's unintentional injury. Several other paternal and maternal factors were also modestly related to injury risk. Data indicate the need to consider the role of fathers in protecting children from unintentional injuries.

The role of impulsivity in children's estimation of physical ability: Implications for children's unintentional injury risk.

Unintentional injuries are the leading cause of pediatric mortality. One factor that appears to predict injury risk is children's overestimation of physical ability. Fifty-seven 6-year-olds judged their ability to complete basic physical tasks. Half the sample was required to wait 7 s before judging their ability; the other half was permitted to judge immediately. There were no differences in ability estimation accuracy between the 2 groups, suggesting that the institution of a forced decision latency does not increase children's ability estimation accuracy. Replicating previous work, children tended to overestimate their ability, and overestimation of ability was related to history of unintentional injury. Possible explanations for the null finding are offered, and implications to injury prevention and future research are discussed.

Transitioning the second-generation antihistamines to over-the-counter status: a cost-effectiveness analysis.

A U.S. Food and Drug Administration advisory committee deemed the second-generation antihistamines (SGA) safe for over-the-counter use against the preliminary opposition of the manufacturers. As a result, loratadine is now available over-the-counter. First-generation antihistamines (FGA) are associated with an increased risk of unintentional injuries, fatalities, and reduced productivity. Access to SGA over-the-counter could result in decreased use of FGA, thereby reducing deleterious outcomes. The societal impact of transitioning this class of medications from prescription to over-the-counter status has important policy implications. To examine the cost-effectiveness of transitioning SGA to over-the-counter status from a societal perspective. A simulation model of the decision to transition SGA to over-the-counter status was compared with retaining prescription-only status for a hypothetical cohort of individuals with allergic rhinitis in the United States. Estimates of costs and effectiveness were obtained from the medical literature and national surveys. Sensitivity analysis was performed using a second-order Monte Carlo simulation. Discounted, quality-adjusted life-years saved as a result of amelioration of allergic rhinitis symptoms and avoidance of motor vehicle, occupational, public and home injuries and fatalities; discounted direct and indirect costs. Availability of SGA over-the-counter was associated with annual savings of 4 billion dollars (2.4-5.3 billion dollars) or 100 dollars (64-137 dollars) per allergic rhinitis sufferer and 135,061 time-discounted quality-adjusted life years (84,913-191,802). The sensitivity analysis provides evidence in support of these results. Making SGA available over-the-counter is both cost-saving and more effective for society, largely as a result of reduced adverse outcomes associated with FGA-induced sedation. Further study is needed to determine the differential impact on specific vulnerable populations.

Temperamental risk factors for children’s unintentional injury: the role of impulsivity and inhibitory control

Previous research suggests both high temperamental impulsivity and low temperamental inhibitory control contribute to children’s risk for unintentional injury, but attempts to distinguish the relative contributions of the two constructs are lacking. A multi-method approach was used to assess temperamental impulsivity and inhibitory control and identify links between temperament and unintentional injury history. Parent-report, self-report, and behavioral measures of temperament were collected from a sample of 57 six-year-olds. Parents reported children’s injury history. The strongest predictor of injury was parent-reported effortful control. Implications for both temperament theory and injury prevention are discussed.

Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students.

This study explored whether college students who were first intoxicated by alcohol at ages younger than 19 are more likely to become alcohol dependent and frequent heavy drinkers, drive after drinking, ride with intoxicated drivers and be injured after drinking. It also investigated whether these results occur because these students believe they can drink more and still drive legally and safely. In 1999, 14,138 of 23,751 full-time 4-year students from a random sample of 119 college and universities nationwide completed self-administered questionnaires (response rate: 60%). This analysis focused on 12,550 who were aged 19 or older. Respondents were asked the age at which they first got drunk, as well as questions about recent alcohol-related behaviors and consequences. Compared with respondents first drunk at age 19 or older, those first drunk prior to age 19 were significantly more likely to be alcohol dependent and frequent heavy drinkers, to report driving after any drinking, driving after five or more drinks, riding with a driver who was high or drunk and, after drinking, sustaining injuries that required medical attention. Respondents first intoxicated at younger ages believed they could consume more drinks and still drive safely and legally; this contributed to their greater likelihood of driving after drinking and riding with high or drunk drivers. Educational, clinical, environmental and legal interventions are needed to delay age of first intoxication and to correct misperceptions among adolescents first drunk at an early age about how much they can drink and still drive safely and legally.

Early Age of First Drunkenness as a Factor in College Students’ Unplanned and Unprotected Sex Attributable to Drinking

Early age of drinking onset has been associated with a greater likelihood among adults of experiencing alcohol dependence, frequent heavy drinking even among nondependent drinkers, and an increased risk of motor vehicle crashes, unintentional injuries, and physical fights after drinking. This study explores whether first getting drunk at a younger age is associated with a greater likelihood of college students reporting that they had unplanned or unprotected sexual intercourse because of their drinking. In 1999 11 739 full-time 4-year college students from 128 randomly selected US colleges and universities completed a self-administered survey that asked them about their drinking practices and whether their drinking had caused them, since the beginning of the school year, to: 1) engage in unplanned sexual intercourse or 2) not use protection when having sex. Among college students who drink, those first drunk before age 13 compared with those never drank until age 19 or older had a 2.0 times greater odds of having unplanned sex and a 2.2 times greater odds of having unprotected sex reportedly because of drinking, even after controlling for age, race/ethnicity, marital status, parental drinking history, age of first smoking, and marijuana use. After further controlling for history of alcohol dependence and frequency of heavy drinking those first drunk before age 13 had a 1.5 times greater odds of unplanned sex and a 1.7 times greater odds of unprotected sex reportedly because of drinking. Clinical, educational, legal, and community interventions to delay age of first getting drunk need to be coupled with efforts to prevent unplanned and unprotected sexual intercourse among US college students.

Unintentional injury in preschool boys with and without early onset of disruptive behavior.

To determine subsequent risk of unintentional injury among preschool boys diagnosed with ODD, boys with comorbid ODD and ADHD, and boys matched demographically to the clinical sample; to test predictive validity of a measure of injury proneness; and to examine factors that might predict injury beyond clinic status. Seventy-nine consecutive clinic-referred preschool-age boys and 76 demographically matched boys without disruptive behavior participated in a 2-year prospective longitudinal design. Time 1 assessment included clinical diagnosis, parent-reported injury proneness, attachment, and verbal abilities. Injury history was measured 1 and 2 years later. Clinic-referred children had more injuries than the comparison group. Children with comorbid ODD and ADHD had approximately the same injury rate as those with ODD but not ADHD. Parent-reported injury proneness was unrelated to subsequent injuries. Neither attachment nor verbal ability predicted injury significantly beyond clinic status. Children with early disruptive behavior are at increased risk of unintentional injury and therefore should be considered prime candidates for injury prevention campaigns.

Misclassification of current benzodiazepine exposure by use of a single baseline measurement and its effects upon studies of injuries.

Measurement of drug exposure is a major methodologic challenge for pharmacoepidemiologic studies of acute effects of medications taken intermittently. If the effect is plausible only during periods of active drug use, daily (or even more frequent) exposure measurement is optimal. Benzodiazepines, episodically used hypnotics and anxiolytics, impair psychomotor function and some epidemiologic studies have reported users have increased risk of unintentional injuries. However, several prospective cohort studies of this question defined benzodiazepine exposure status from a single baseline measurement, and these have not consistently reported increased risk. We used data from an historical cohort study to demonstrate the extent of misclassification potentially induced by this practice. The cohort consisted of 2510 Tennessee nursing home residents 65 years of age or older identified in a prior study of antidepressants and falls. Both baseline users (any in 7 days preceding start of follow-up) and current use (use on a given day of follow-up) of benzodiazepines were determined from facility medication administration records, which record information on drugs given to the resident each day. Falls were ascertained from nursing home incident reports and medical records. The effect of benzodiazepine exposure for each ascertainment method was estimated from incidence rate ratios adjusted for multiple fall risk factors by Poisson regression. The 666 baseline benzodiazepine users had current use on 44.6% (95% CI, 40.2-49.2%) of follow-up person-days; baseline non-users had current use for 3.7% of days (2.8-4.7%). Misclassification increased with length of follow-up and with quintile of fall risk. The adjusted fall incidence rate ratios for the baseline user and current use definitions were 1.02 (95% CI, 0.95-1.10) and 1.44 (1.33-1.56), respectively. These findings strongly suggest that to avoid potentially serious misclassification, studies of the acute effects of benzodiazepines and other drugs taken intermittently need to track exposure on a day-by-day basis.

Life dissatisfaction as a predictor of fatal injury in a 20-year follow-up.

To investigate the role of life satisfaction (LS) in fatal injuries with special references to unintentional injuries and whether health status modifies this relationship. A sample of adult Finns unselected for health status (n=29 173) responded in 1975 to a LS scale. Nationwide registry for deaths was used. The dissatisfied were compared with the satisfied by Cox regression. During 1976-1995, 469 fatal injuries occurred, of which 235 were unintentional. Dissatisfaction predicted fatal unintentional [hazard ratio (HR)=2.83; 95% confidence interval (CI) 1.77-4.51] and intentional injury (HR=3.26; 2.01-5.30). The risk of fatal unintentional injury was 7.8-fold (women) and 4.0-fold (men) increased in the sick and dissatisfied compared with the healthy and satisfied. A repeatedly reported dissatisfaction (1975, 1981) provided a HR of 5.17 (1.48-18.0) for unintentional injury death during 1981-1995. The found effect was partly mediated through health behavior and social situation. Life dissatisfaction predicts both unintentional and intentional injury death.

National underascertainment of sudden unexpected infant deaths associated with deaths of unknown cause.

To investigate underascertainment of unexpected infant deaths at the national level as a result of probable classification as attributable to unknown cause. Using linked birth and death certificates for all US birth cohorts from 1983-1991 and 1995-1996, we identified 53 470 sudden infant death syndrome (SIDS) fatalities, 9071 unintentional injury deaths, 3473 injury deaths classified with intentional or suspicious intent, and 8097 deaths with unknown underlying cause. For these deaths, we compared relative risks (RRs) for maternal and infant variables available on birth certificates known to be predictive of SIDS, unintentional injury, and homicides. Variables available on death certificates were compared for unlinked and linked records. Factors related to state and national management of cases pending final cause determination are reviewed. For deaths from unknown cause, rates were consistently high among the same risk groups that have been shown to be at increased risk for SIDS, unintentional injury, and homicides. For most risk factors, RRs for deaths attributable to unknown causes were somewhat lower than for RRs for intentional/suspicious injury deaths but higher than for SIDS or unintentional injury, indicating combined contributions from all causes. For example, age at death from unknown cause includes RRs that more strongly resemble patterns of intentional/suspicious injuries than SIDS or unintentional injury. Deaths from unknown cause were more likely to occur during the first week of life for unattended births occurring outside clinical settings or when birth certificates were not found, similar to intentional/suspicious injury deaths. Risk profiles indicate that deaths of unknown cause are likely to represent a mixture of unexpected deaths. The process for determination of cause of unexpected death affects national underascertainment of SIDS and injury deaths. Better coordination among child fatality review teams and local, state, and national officials should reduce underascertainment and improve documentation of circumstances surrounding deaths for prevention efforts.

Injury risk in young people with intellectual disability.

Epidemiological studies have established injury as a major public health problem for young people in the general population, but minimal population-based injury information exists on those with intellectual disability (ID). The present study investigated risk factors for injury to subjects in the Australian Child and Adolescent Development (ACAD) programme, which is examining emotional and behavioural problems in young people with ID. Extensive biopsychosocial data for the ACAD programme were collected at two time intervals (i.e. 1990-1991 and 1995-1996). Carer report of medically attended injury over one year was collected for the first time period (1995-1996) on a sample of 465 ACAD subjects (aged 5-29 years) representative of young people with ID (IQ < 70) to determine risk factors for injury using the ACAD biopsychosocial data. Psychopathology [odds ratio (OR)=3.4] epilepsy (OR = 2.4) and an overly sociable temperament (OR=2.2) are associated with injury in young people with ID. Social and family factors had minimal influence on injury risk in this population. Those who are highly disruptive, self-absorbed, anxious, have problems relating socially, have communication disturbance or have attention deficit hyperactivity symptoms are particularly at increased risk for injury. The present study demonstrates a largely under-recognized public health problem of a high unintentional injury risk for young people with ID, and identifies substantial and important risk factors for injury. Injury prevention programmes, with a particular focus on those with highly disturbed behaviours or epilepsy, are warranted in this population.

Socioeconomic inequalities in injury: critical issues in design and analysis.

Injuries continue to place a tremendous burden on the public's health and rates vary widely among different groups in the population. Increasing attention has recently been given to the effects of socioeconomic status (SES) as a determinant of health among both individuals and communities. However, relatively few studies have focused on the influence of SES and injuries. Furthermore, those that have, and the other injury studies that have included measures of SES in their analysis, have varying degrees of conceptual and methodological rigor in their use of this measure. Recent advances in data linkage and analytic techniques have, however, provided new and improved methods to assess the relationship between SES and injuries. This review summarizes the relevant literature on SES and injuries, with particular attention to study design, and the measurement and interpretation of SES. We found that increasing SES has a strong inverse association with the risk of both homicide and fatal unintentional injuries, although the results for suicide were mixed. However, the relationship between SES and nonfatal injuries was less consistent than for fatal injuries. We offer potential explanatory mechanisms for the relationship between SES and injuries and make recommendations for future research in this area.

Pupil injury risks as a function of physical and psychosocial environmental problems experienced at school

Objectives—To investigate relations between physical and psychosocial environmental problems in schools, as perceived by school principals, and injuries among pupils. Method—Proportionate injury ratios (PIRs) were computed for 77 public sector...

Injury related infant death: the impact of race and birth weight

Objective—To examine the effect of race and birth weight independent of other sociodemographic factors on injury related infant death using national data. Setting—Infants born in the United States to mothers...

Age of drinking onset and unintentional injury involvement after drinking.

In 1997, unintentional injury was the leading cause of death for persons aged 1 to 34 years. Approximately one third of deaths due to unintentional injury in the United States are estimated to be alcohol related. Onset of drinking at an early age has been found to be associated with alcohol dependence, but whether early-onset drinking increases risk for unintentional injury while drinking is unknown. To explore whether persons who started drinking at an early age are more likely to have experienced unintentional injuries while under the influence of alcohol. The National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey conducted in 1992 of a representative sample of the US population. A total of 42,862 randomly selected adults (response rate, 90%; mean age, 44 years). Unintentional injury involvement while under the influence of alcohol by age of drinking onset (categorized as <14 years, each age from 14-20 years, or >/=21 years). Relative to respondents who began drinking at age 21 years or older, those who started before age 14 years as well as those who started at each intervening age up to 21 years were significantly more likely to have been injured while under the influence of alcohol, even after controlling for history of alcohol dependence, heavy drinking frequency during the period that they drank most, family history of alcoholism, and other characteristics associated with earlier onset of drinking. After adjusting for these variables, odds ratios for having been injured while under the influence of alcohol were as follows: for younger than 14 years, 2.98 (95% confidence interval [CI], 2.29-3.89); age 14 years, 2.96 (95% CI, 2.26-3.88); age 15 years, 3.14 (95% CI, 2.48-3.97); age 16 years, 2.38 (95% CI, 1.90-2.98); age 17 years, 2.12 (95% CI, 1.66-2.71); age 18 years, 1. 33 (95% CI, 1.08-1.64); age 19 years, 1.42 (95% CI, 1.07-1.89); and age 20 years, 1.39 (95% CI, 1.01-1.91). Drinking onset at ages younger than 21 years is associated with having experienced alcohol-related injuries. JAMA. 2000;284:1527-1533

High-risk periods for childhood injury among siblings.

To determine whether the risk of unintentional injury requiring emergency department (ED) or inpatient care in children is transiently increased over a 90-day period after injury to a sibling. Retrospective cohort. King County, Washington. Participants. A total of 41 242 children 0 to 15 years of age continuously enrolled in Medicaid and living in King County during the period October 1, 1992 through September 30, 1993 (27 450 child-years). The outcome was an unintentional injury treated in the ED or inpatient setting. Incidence rates and hazard ratios were calculated for children whose sibling had been injured in the previous 90 days, compared with children without such exposure. Multivariate analysis was used to adjust for age, gender, race, sibling group size, and noninjury ED use. . There were 4921 injuries treated only in the ED and 82 hospital admissions. The incidence of ED treated injury was 305 per 1000 child-years among children whose sibling had been injured in the previous 90 days and 174 per 1000 child-years among children without this exposure (relative risk: 1.75; 95% confidence interval: 1.56-1.95). The incidence of injury-related hospitalization was 1.7 per 1000 child-years among children whose sibling had been injured in the previous 90 days, compared with 3.0 per 1000 child-years among children without this exposure (relative risk:.57; 95% confidence interval:.07-2.12). Injury risk peaked in the period 4 to 10 days after a sibling's injury and returned toward, but did not attain, baseline risk over the subsequent 21/2 months. The magnitude of this effect depended on the child's age; the relative risk of injury was higher among older children. Injuries treated in the ED or inpatient setting appear to cluster within sibling groups over brief periods of time. Shared social or environmental exposures may contribute to this clustering and may be amenable to targeted, time-limited prevention interventions.

From Risk for Trauma to Unintentional Injury Risk: Falls—A Concept Analysis

Concept analysis of the nursing diagnosis risk for trauma. To examine the nursing diagnosis risk for trauma and to specify the risk factors for falling. Research and informational articles on falling, and NANDA Nursing Diagnoses: Definitions and Classification, 1999-2000. Replace the current nursing diagnosis risk for trauma with the more specific nursing diagnosis unintentional injury risk: falls. The other risks included in risk for trauma (e.g., burns) also will need to be developed.

Predictors of unintentional injuries to school-age children seen in pediatric primary care.

To identify predictors of unintentional injury to school-age children seen in pediatric primary care. Members of a managed health care system (295 children ages 5-11 years and their mothers) participated. We used Time 1 measures of child, maternal, and family functioning and health care utilization to predict rates of unintentional child injury for the following year. Multiple regression analyses were performed to identify variables contributing to prospective injury rates. The final regression model included eight Time 1 variables and accounted for 21% of the variance in Time 2 injury rates. Significant predictors of increased injury liability were younger child age, more children at home, child behavior problems, child social competence, three indices of reduced child health, and maternal anxiety. We discuss the utility of these predictors for pediatric psychologists in targeting primary care preventive interventions to families at risk for unintentional child injury.

"I Didn't Know the Gun Was Loaded": An Examination of Two Safety Devices That Can Reduce the Risk of Unintentional Firearm Injuries

Some handguns contain built-in safety devices intended to prevent injuries caused by erroneously believing that a handgun is loaded. A loaded chamber indicator indicates the presence of ammunition in the gun; a magazine safety prevents the gun from being fired when the ammunition magazine is removed, even if one round remains in the firing chamber. In our patent search these devices date back to the turn of the century. But on 1998 pistol models, only 11% contained a loaded chamber indicator and 14% had a magazine safety. In our random-digit-dial telephone survey of U.S. adults, 34.8% of poll respondents (incorrectly) thought that a firearm with its ammunition magazine removed could not be shot, or said that they did not know. Some of the 1100 unintentional gun deaths in the U.S. each year might be prevented if the prevalence of these and other safety devices is increased through legislation, litigation, or voluntary manufacturer action.