Criminal deterrence as a public health strategy

Punitive legal responses to prenatal drug use in the United States: A survey of state policies and systematic review of their public health impacts

BACKGROUND

Punitive legal responses to prenatal drug use may be associated with unintended adverse health consequences. However, in a rapidly shifting policy climate, current information has not been summarized. We conducted a survey of U.S. state policies that utilize criminal or civil legal system penalties to address prenatal drug use. We then systematically identified empirical studies evaluating these policies and summarized their potential public health impacts.

METHODS

Using existing databases and original statutory research, we surveyed current U.S. state-level prenatal drug use policies authorizing explicit criminalization, involuntary commitment, civil child abuse substantiation, and parental rights termination. Next, we systematically identified quantitative associations between these policies and health outcomes, restricting to U.S.-based peer-reviewed research, published January 2000-December 2022. Results described study characteristics and synthesized the evidence on health-related harms and benefits associated with punitive policies. Validity threats were described narratively.

RESULTS

By 2022, two states had adopted policies explicitly authorizing criminal prosecution, and five states allowed pregnancy-specific and drug use-related involuntary civil commitment. Prenatal drug use was grounds for substantiating civil child abuse and terminating parental rights in 22 and five states, respectively. Of the 16 review-identified articles, most evaluated associations between punitive policies generally (k = 12), or civil child abuse policies specifically (k = 2), and multiple outcomes, including drug treatment utilization (k = 6), maltreatment reporting and foster care entry (k = 5), neonatal drug withdrawal syndrome (NDWS, k = 4) and other pregnancy and birth-related outcomes (k = 3). Most included studies reported null associations or suggested increases in adverse outcome following punitive policy adoption.

CONCLUSIONS

Nearly half of U.S. states have adopted policies that respond to prenatal drug use with legal system penalties. While additional research is needed to clarify whether such approaches engender overt health harms, current evidence indicates that punitive policies are not associated with public health benefits, and therefore constitute ineffective policy.

Could Telling Parents About Substance Use Decrease Involvement in Crime of Substance Users?

INTRODUCTION

Substance use disorder and criminal behaviors are increasing all over the world day by day. Factors that affect the involvement in crime among people with substance use disorders need to be examined more. This research aims to investigate the protective factors of substance users' involvement in crime and clarify the importance of telling parents about their substance use.

METHOD

A total of 190 patients with substance use disorders were included. Patients were divided into two groups: those who told their families about their substance use (TP+) and those who did not tell (TP-). A sociodemographic data form, the short form of My Memories of Upbringing Scale for perceived parental attitudes, Experiences in Close Relationships Scale-Revised, and Emotional Autonomy Scale were used.

RESULTS

Our study found that people in the TP+group were less involved in crime than TP-. Telling rates increased proportionally when individuals' anxious attachment and individuation levels rose. In the TP+group, criminal history was correlated positively with substance use duration.

CONCLUSION

Telling their families that they are using substances can be a protective factor in itself against crime among drug users, especially in the early stages of addiction. Professionals in addiction psychiatry should encourage their patients to tell their substance use. Teaching and encouraging them to communicate with their relatives might play a key role for policymakers while dealing with substance use disorders and related outcomes.

Building capacity for injury prevention: a process evaluation of a replication of the Cardiff Violence Prevention Programme in the Southeastern USA

OBJECTIVES

Violence is a major public health problem in the USA. In 2016, more than 1.6 million assault-related injuries were treated in US emergency departments (EDs). Unfortunately, information about the magnitude and patterns of violent incidents is often incomplete and underreported to law enforcement (LE). In an effort to identify more complete information on violence for the development of prevention programme, a cross-sectoral Cardiff Violence Prevention Programme (Cardiff Model) partnership was established at a large, urban ED with a level I trauma designation and local metropolitan LE agency in the Atlanta, Georgia metropolitan area. The Cardiff Model is a promising violence prevention approach that promotes combining injury data from hospitals and LE. The objective was to describe the Cardiff Model implementation and collaboration between hospital and LE partners.

METHODS

The Cardiff Model was replicated in the USA. A process evaluation was conducted by reviewing project materials, nurse surveys and interviews and ED-LE records.

RESULTS

Cardiff Model replication centred around four activities: (1) collaboration between the hospital and LE to form a community safety partnership locally called the US Injury Prevention Partnership; (2) building hospital capacity for data collection; (3) data aggregation and analysis and (4) developing and implementing violence prevention interventions based on the data.

CONCLUSIONS

The Cardiff Model can be implemented in the USA for sustainable violent injury data surveillance and sharing. Key components include building a strong ED-LE partnership, communicating with each other and hospital staff, engaging in capacity building and sustainability planning.

Differences in Characteristics and Outcome of Patients with Penetrating Injuries in the USA and the Netherlands: A Multi-institutional Comparison

INTRODUCTION

The incidence and nature of penetrating injuries differ between countries. The aim of this study was to analyze characteristics and clinical outcomes of patients with penetrating injuries treated at urban Level-1 trauma centers in the USA (USTC) and the Netherlands (NLTC).

METHODS

In this retrospective cohort study, 1331 adult patients (470 from five NLTC and 861 from three USTC) with truncal penetrating injuries admitted between July 2011 and December 2014 were included. In-hospital mortality was the primary outcome. Outcome comparisons were adjusted for differences in population characteristics in multivariable analyses.

RESULTS

In USTC, gunshot wound injuries (36.1 vs. 17.4%, p < 0.001) and assaults were more frequent (91.2 vs. 77.7%, p < 0.001). ISS was higher in USTC, but the Revised Trauma Score (RTS) was comparable. In-hospital mortality was similar (5.0 vs. 3.6% in NLTC, p = 0.25). The adjusted odds ratio for mortality in USTC compared to NLTC was 0.95 (95% confidence interval 0.35-2.54). Hospital stay length of stay was shorter in USTC (difference 0.17 days, 95% CI -0.29 to -0.05, p = 0.005), ICU admission rate was comparable (OR 0.96, 95% CI 0.71-1.31, p = 0.80), and ICU length of stay was longer in USTC (difference of 0.39 days, 95% CI 0.18-0.60, p < 0.0001). More USTC patients were discharged to home (86.9 vs. 80.6%, p < 0.001). Readmission rates were similar (5.6 vs. 3.8%, p = 0.17).

CONCLUSION

Despite the higher incidence of penetrating trauma, particularly firearm-related injuries, and higher hospital volumes in the USTC compared to the NLTC, the in-hospital mortality was similar. In this study, outcome of care was not significantly influenced by differences in incidence of firearm-related injuries.

Reprint of "Media reporting of traffic legislation changes in British Columbia (2010)"

INTRODUCTION

In 2010, British Columbia (BC) introduced new traffic laws designed to deter impaired driving, speeding, and distracted driving. These laws generated significant media attention and were associated with reductions in fatal crashes and in ambulance calls and hospital admissions for road trauma.

OBJECTIVE

To understand the extent and type of media coverage of the new traffic laws and to identify how the laws were framed by the media.

METHODS

We reviewed a database of injury related news coverage (May 2010-December 2012) and extracted reports that mentioned distracted driving, impaired driving, or speeding. Articles were classified according to: (i) Type, (ii) Issue discussed, (iii) 'Reference to new laws', and (iv) 'Pro/anti traffic law'. Articles mentioning the new laws were reread and common themes in how the laws were framed were identified and discussed.

RESULTS

Over the course of the study, 1848 articles mentioned distraction, impairment, or speeding and 597 reports mentioned the new laws: 65 against, 227 neutral, and 305 supportive. Reports against the new laws framed them as unfair or as causing economic damage to the entertainment industry. Reports in favor of the new laws framed them in terms of preventing impaired driving and related trauma or of bringing justice to drinking drivers. Growing evidence of the effectiveness of the new laws generated media support.

CONCLUSIONS

BC's new traffic laws generated considerable media attention both pro and con. We believe that this media attention helped inform the public of the new laws and enhanced their deterrent effect.

The Association between Regional Environmental Factors and Road Trauma Rates: A Geospatial Analysis of 10 Years of Road Traffic Crashes in British Columbia, Canada

Background

British Columbia, Canada is a geographically large jurisdiction with varied environmental and socio-cultural contexts. This cross-sectional study examined variation in motor vehicle crash rates across 100 police patrols to investigate the association of crashes with key explanatory factors.

Methods

Eleven crash outcomes (total crashes, injury crashes, fatal crashes, speed related fatal crashes, total fatalities, single-vehicle night-time crashes, rear-end collisions, and collisions involving heavy vehicles, pedestrians, cyclists, or motorcyclists) were identified from police collision reports and insurance claims and mapped to police patrols. Six potential explanatory factors (intensity of traffic law enforcement, speed limits, climate, remoteness, socio-economic factors, and alcohol consumption) were also mapped to police patrols. We then studied the association between crashes and explanatory factors using negative binomial models with crash count per patrol as the response variable and explanatory factors as covariates.

Results

Between 2003 and 2012 there were 1,434,239 insurance claim collisions, 386,326 police reported crashes, and 3,404 fatal crashes. Across police patrols, there was marked variation in per capita crash rate and in potential explanatory factors. Several factors were associated with crash rates. Percent roads with speed limits ≤ 60 km/hr was positively associated with total crashes, injury crashes, rear end collisions, and collisions involving pedestrians, cyclists, and heavy vehicles; and negatively associated with single vehicle night-time crashes, fatal crashes, fatal speeding crashes, and total fatalities. Higher winter temperature was associated with lower rates of overall collisions, single vehicle night-time collisions, collisions involving heavy vehicles, and total fatalities. Lower socio-economic status was associated with higher rates of injury collisions, pedestrian collisions, fatal speeding collisions, and fatal collisions. Regions with dedicated traffic officers had fewer fatal crashes and fewer fatal speed related crashes but more rear end crashes and more crashes involving cyclists or pedestrians. The number of traffic citations per 1000 drivers was positively associated with total crashes, fatal crashes, total fatalities, fatal speeding crashes, injury crashes, single vehicle night-time crashes, and heavy vehicle crashes. Possible explanations for these associations are discussed.

Conclusions

There is wide variation in per capita rates of motor vehicle crashes across BC police patrols. Some variation is explained by factors such as climate, road type, remoteness, socioeconomic variables, and enforcement intensity. The ability of explanatory factors to predict crash rates would be improved if considered with local traffic volume by all travel modes.

Media reporting of traffic legislation changes in British Columbia (2010)

INTRODUCTION

In 2010, British Columbia (BC) introduced new traffic laws designed to deter impaired driving, speeding, and distracted driving. These laws generated significant media attention and were associated with reductions in fatal crashes and in ambulance calls and hospital admissions for road trauma.

OBJECTIVE

To understand the extent and type of media coverage of the new traffic laws and to identify how the laws were framed by the media.

METHODS

We reviewed a database of injury related news coverage (May 2010-December 2012) and extracted reports that mentioned distracted driving, impaired driving, or speeding. Articles were classified according to: (i) Type, (ii) Issue discussed, (iii) 'Reference to new laws', and (iv) 'Pro/anti traffic law'. Articles mentioning the new laws were reread and common themes in how the laws were framed were identified and discussed.

RESULTS

Over the course of the study, 1848 articles mentioned distraction, impairment, or speeding and 597 reports mentioned the new laws: 65 against, 227 neutral, and 305 supportive. Reports against the new laws framed them as unfair or as causing economic damage to the entertainment industry. Reports in favor of the new laws framed them in terms of preventing impaired driving and related trauma or of bringing justice to drinking drivers. Growing evidence of the effectiveness of the new laws generated media support.

CONCLUSIONS

BC's new traffic laws generated considerable media attention both pro and con. We believe that this media attention helped inform the public of the new laws and enhanced their deterrent effect.

Factors which predict violence victimization in Uganda

Introduction

Violence is a major public health issue, globally and on the African continent. This paper looks at Uganda and begins the process of identifying the factors that predict violence in that country. The purpose is to interpret the implications of the study results for violence prevention programs.

Methods

The study includes the responses of 2 399 Ugandans collected in 2011 by the Fifth Round of the Afrobarometer surveys. The study concentrates on 259 respondents who reported either they or someone else in their family had been the victim of violence, defined as being physically attacked, in the last year.

Results

Logistical regression analysis identified six factors that predict physical violence in Uganda. In order, these included being the victim of a property crime, age, gender, fear of crime in the home, poverty, and residential crowding. The surprising findings relate to what may be called target hardening, especially for those likely to be re-victimized. Respondents did tend to be re-victimized, with about 61 percent of violence victims also property crime victims. Fear of crime in home was another predictor of violence victimization, and many of these respondents had been crime victims.

Conclusion

These findings imply that target hardening should be the basis to begin to implement violence prevention programs in Uganda. The suggestion is crime prevention personnel/ law enforcement need to respond to reported incidents of property and/or violence victimization and attempt to prepare victims to protect both their premises and their persons in the future.

Reduction in fatalities, ambulance calls, and hospital admissions for road trauma after implementation of new traffic laws

OBJECTIVES

We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010).

METHODS

We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls.

RESULTS

In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI]=15.3, 26.4) and in hospital admissions (8.0%; 95% CI=0.6, 14.9) and ambulance calls (7.2%; 95% CI=1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI=34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving.

CONCLUSIONS

These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported.

Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: experimental study and time series analysis

OBJECTIVE

To evaluate the effectiveness of anonymised information sharing to prevent injury related to violence.

DESIGN

Experimental study and time series analysis of a prototype community partnership between the health service, police, and local government partners designed to prevent violence.

SETTING

Cardiff, Wales, and 14 comparison cities designated "most similar" by the Home Office in England and Wales.

INTERVENTION

After a 33 month development period, anonymised data relevant to violence prevention (precise violence location, time, days, and weapons) from patients attending emergency departments in Cardiff and reporting injury from violence were shared over 51 months with police and local authority partners and used to target resources for violence prevention.

MAIN OUTCOME MEASURES

Health service records of hospital admissions related to violence and police records of woundings and less serious assaults in Cardiff and other cities after adjustment for potential confounders.

RESULTS

Information sharing and use were associated with a substantial and significant reduction in hospital admissions related to violence. In the intervention city (Cardiff) rates fell from seven to five a month per 100,000 population compared with an increase from five to eight in comparison cities (adjusted incidence rate ratio 0.58, 95% confidence interval 0.49 to 0.69). Average rate of woundings recorded by the police changed from 54 to 82 a month per 100,000 population in Cardiff compared with an increase from 54 to 114 in comparison cities (adjusted incidence rate ratio 0.68, 0.61 to 0.75). There was a significant increase in less serious assaults recorded by the police, from 15 to 20 a month per 100,000 population in Cardiff compared with a decrease from 42 to 33 in comparison cities (adjusted incidence rate ratio 1.38, 1.13 to 1.70).

CONCLUSION

An information sharing partnership between health services, police, and local government in Cardiff, Wales, altered policing and other strategies to prevent violence based on information collected from patients treated in emergency departments after injury sustained in violence. This intervention led to a significant reduction in violent injury and was associated with an increase in police recording of minor assaults in Cardiff compared with similar cities in England and Wales where this intervention was not implemented.

O aumento no encarceramento e a redução nos homicídios em São Paulo, Brasil, entre 1996 e 2005

O desenvolvimento social dos estados do Brasil não tem sido acompanhado pela redução nas taxas de homicídio. O Estado de São Paulo é uma exceção positiva, porque nele houve uma clara redução na taxa de homicídio entre 1999 e 2005. Naquele estado houve um aumento marcante na taxa de encarceramento, que antecedeu, e logo em seguida coincidiu, com um declínio igualmente expressivo na taxa de homicídio. Um teste bivariado de causalidade de Granger revelou que valores passados de encarceramento ajudaram a prever homicídio no Estado de São Paulo entre 1999 e 2005. Apesar de não ser possível concluir que essa relação seja causal, constatou-se uma associação temporal clara, compatível com a interpretação de que o aumento no encarceramento de criminosos exerceu seu efeito incapacitador e/ou dissuador do crime em São Paulo. Outros fatores não avaliados neste estudo podem ter causado a redução do homicídio no Estado de São Paulo entre 1999 e 2005.

Correspondence between secular changes in alcohol dependence and age of drinking onset among women in the United States

BACKGROUND

Several lines of evidence suggest that the lifetime prevalence of alcohol dependence among women has increased in recent decades, but has not risen significantly for men. Early age at onset of drinking (AOD) is strongly correlated with risk for alcohol dependence and there is evidence that mean AOD has also decreased, particularly for women. The present report sought to confirm the trends in AOD and to determine the extent to which they might account for secular trends in alcohol dependence.

METHODS

Repeated cross-sectional analyses of data from 2 large, national epidemiological surveys were conducted to enable estimates of cross-cohort differences while controlling for age-related factors. Regression analyses were used to compute risk for alcohol dependence associated with birth cohort membership, before and after inclusion of AOD as a covariate.

RESULTS

Both men and women born between 1944 and 1963 had earlier ages of onset for drinking than did the earliest birth cohort analyzed (1934-43). However, the net decrease in AOD was twice as large for women (3.2 years) than that for men (1.6 years). After adjusting for AOD, differences in lifetime prevalence between different birth cohorts of women were rendered nonsignificant, indicating that AOD accounts for a substantial portion of change in the lifetime prevalence of alcohol dependence.

CONCLUSIONS

These results suggest that a decrease in AOD accounts for much of the increase in lifetime alcohol dependence among women. AOD is likely to be an indicator of dynamic, and therefore modifiable risk behaviors impacting risk for alcohol dependence.

Sustainability of the effects of the demerit points system on seat belt use: a region-wide before-and-after observational study in Italy

To assess the short and long term effects of the demerit points system on seat belt use, we set a region-wide cross-sectional observational study 3 months before, and 3 and 15 months after the introduction of the scheme (July 2003) in the Veneto Region, Italy. We analysed differences in seat belt use by year of observation, gender and position in the vehicle, and obtained adjusted prevalence ratio (APR) through Poisson regression. A total of 29,303 drivers, 28,778 front and 12,186 rear passengers were observed. Prevalence levels of 54% for drivers and 53% for front passengers in 2003 switched to 83 and 76%, respectively, 3 months after the new legislation, with further slight increases 15 months thereafter. Seventy-four percent rear passengers were still not compliant with the legislation in 2005. The probability of being belted was 25% lower in males than females (APR=0.75, 95% CI 0.73-0.77) at the beginning of the study period. However, the effect of the new legislation was 19% greater among males (APR=1.19, 95% CI 1.16-1.23). A substantial increase in seat belt use was reached and sustained with the demerit points system. Specific efforts should target rear passengers whose seat belt use still remains worryingly low.

Non-firearm weapon use and injury severity: priorities for prevention

OBJECTIVES

To test the hypothesis that weapon-related violence (excluding firearms) results in more severe injury relative to the use of body parts (fists, feet and other body parts), and to rank order of injury severity by assault mechanism.

DESIGN

Retrospective cohort study.

PARTICIPANTS

24,660 patients who were treated in a UK emergency department for violence-related injury.

MAIN OUTCOME MEASURE

Score on the Manchester Triage Scale.

RESULTS

The use of a weapon resulted in significantly more serious injury (adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI) 1.00 to 1.28). However, of all mechanisms of violent injury, the use of feet resulted in most severe injury (AOR 1.41, 95% CI 1.17 to 1.70), followed by blunt objects (AOR 1.35, 95% CI 1.14 to 1.58), other body parts (AOR 1.22, 95% CI 1.06 to 1.40) and sharp objects (AOR 1.09, 95% CI 0.91 to 1.5), compared with use of fists.

CONCLUSIONS

Use of weapons resulted in more severe injury than use only of body parts. The use of feet caused the most serious injuries, whereas the use of fists caused the least severe injuries. Injury severity varied by number of assailants and age of the patient--peaking at 47 years--but not by number of injuries. Preventing the use of feet in violence, and preventing group violence should be major priorities.

Preventing violence — caring for victims

Part of the great tradition of surgery, exemplified by the Royal College precept, 'From Here Health', is that surgeons are committed to prevention as well as cure. King James IV and his able contemporary in China, where this lecture was delivered, Emperor Hongzhi, would have approved of it. This tradition has, perhaps, been neglected since the emergence of public health as a medical specialty. However, opportunities and reasons for surgeons to contribute to prevention have never been greater. Community violence prevention--increasing public safety in the towns and cities in which surgeons work--is an example. Primary prevention of injury achieved by collecting and sharing unique information about weapons and the locations of assault, secondary prevention achieved by combining wound care with motivational interviewing to reduce alcohol misuse, and tertiary prevention achieved by early referral to mental health professionals for treatment of post-traumatic stress, have been integrated into a new care pathway which combines prevention with surgical care. Individuals and communities would benefit substantially if every surgical specialty incorporated prevention--a professionally highly-rewarding activity--into its training curriculum.

Preventing alcohol-related violence: a public health approach

BACKGROUND

Studies of the relationship between alcohol and violent injury confirm that while there is some evidence of a direct pharmacological association, many other factors are relevant to the frequency and severity of both violent perpetration and being a victim of violence. It is now widely recognized that official police statistics are a poor indicator of the nature and extent of public violence.

AIMS

Accident and emergency departments and trauma surgeons are not only in a position to provide more accurate information on the nature and extent of clinically significant injury, but they can contribute substantially to violence prevention. This can be achieved through individually targeted interventions in conjunction with other clinicians on the one hand, and on the other through public health and community initiatives, in conjunction with other community agencies, including the police and local authorities. This article describes some of those initiatives and the evidence underpinning them.

Policing the drunk driver: measuring law enforcement involvement in reducing alcohol-impaired driving

INTRODUCTION

With many thousands of deaths still annually attributable to driving under the influence (DUI), it remains imperative that we continually address the problem of producing and sustaining effective countermeasures, and that we subject these efforts to empirical scrutiny. This article presents relevant findings from state-wide datasets.

RESULTS

A formula generating a potentially useful metric for assessing aspects of the DUI prosecutorial chain is presented, focusing on the rate of proactive DUI arrests. While in need of cautious interpretation due to issues of inherent inaccuracies in large databases, small numbers of crashes and/or arrests in multiple jurisdictions, and the lack of replication in other states, the analyses show no relationship between the level of DUI arrest activity and DUI-related crashes. This finding brings into question the efficacy of the many millions of dollars devoted each year to targeted DUI enforcement, as it is currently being implemented.

CONCLUSIONS

Results are discussed in terms of developing adequate disincentives to DUI so as to raise general deterrence via dramatic increases in proactive DUI enforcement and then engaging in pervasive and persistent social marketing of such efforts to maximize the perception that arrest and punishment for DUI is always imminent, that penalties will be swift, certain, and severe. It is echoed that accurate data need to be collected at all levels of the DUI arrest and prosecution process in every jurisdiction within a state, so as to facilitate the empirical assessment of countermeasure efficacy in reducing alcohol-related crashes.

IMPACT ON INDUSTRY

Given that this work needs to be replicated, the impact on the traffic safety industry is potentially huge. The present data indicate that law enforcement efforts to further abate DUI-related crashes are apparently ineffective, though likely necessary to maintain reductions achieved in the 80s and early 90s. Thus, to attain additional systematic reductions, a dramatic increase in enforcement will be necessary as will a diversification of abatement efforts, including an increase in aggressive social marketing tactics to positively impact our traffic safety culture by making DUI universally unacceptable (for a discussion of this latter issue and on the use of positive reinforcement to change driver behavior, see Dula & Geller, 2007).

Traffic law enforcement in Hyderabad, India

The aim of the study was to understand traffic law enforcement (TLE) carried out by the police to reduce non-compliance with traffic laws on the roads of Hyderabad city in India for 2001-2003. The Traffic Police database of citations issued to drivers who violated traffic laws in Hyderabad was analysed for the years 2001-2003 to describe the TLE activities of the police, to describe and compare the TLE activities for the different types of vehicles and to compare the TLE activities for the 3 years. The violations were classified in five categories - those related to driving, parking, vehicle, document and others; and TLE into safety and other TLE. A total of 646 161 traffic-law violations were registered in 2001, 904 447 in 2002 and 964 275 in 2003 for Hyderabad. Driving and parking violations were the most common violations registered in all 3 years, with parking violations slightly higher in 2001 (43.5%) and driving violations slightly higher in 2002 (35%) and 2003 (36.4%). Auto-rickshaws (three-wheel commercial passenger vehicles) accounted for the highest violations registered in 2001 (41.4%) whereas motorized two-wheelers had the highest registered violations in 2002 (35.5%) and 2003 (33.2%). Safety TLE activity (detecting and registering driving violations) was only one-third of all the TLE activity performed by the police in the 3 years, and disobeying traffic signals was the most common violation registered under safety TLE. Indian rupees 50 (US$1.1) were collected by way of a fine in 87% of the cases registered. Age and gender of the violators were not recorded in the database. These data can be used for planning, monitoring and evaluating TLE in Hyderabad. These can help identify traffic control and human factors that could lead to traffic noncompliance, and help identify priorities for improving road safety. These data indicate a need to enhance the safety TLE activity of the police, to make TLE more visible in Hyderabad, and to assess the effectiveness of the current legal action as deterrence to improve road safety. Recommendations to enhance TLE within the given resources of the police are made. More effort is needed towards systematic collection and analysis of data on TLE in India to facilitate long-term improvements in TLE for safer roads.

Prevention of alcohol-related assault and injury

There is a causal link between alcohol intoxication and injury in assault, mediated by individual, contextual and cultural factors. Harm reduction can be achieved through practical measures like plastic glasses and bottles in licensed premises, controlling drinks prices and targeted policing organized on the basis of police and accident and emergency data.

Nursing Care Partnerships with Women Leaving Jail

Crime is a significant and complex social issue with profound health consequences for individuals, families, and communities. Conceptualizing criminal behaviors as health behaviors reflects the potential for innovative interdisciplinary approaches and alliances to interrupt cycles of crime as a way to improve health. Incarcerated populations have extremely high rates of undiagnosed and undertreated infectious diseases and mental illnesses. Nursing is uniquely positioned to develop prevention, intervention, and treatment strategies for individuals involved in criminal activities before, during, and after incarceration.

Signs of intoxication and server intervention among 18-39-year-olds drinking at licensed premises in New South Wales, Australia

AIMS

To estimate the extent of responsible service of alcohol (RSA) practice to young adults showing signs of alcohol intoxication on licensed premises in New South Wales.

DESIGN

Telephone-based cross-sectional survey.

SETTING

New South Wales, Australia.

PARTICIPANTS

A total of 1090 people aged 18-39 years old.

FINDINGS

Seventy-five per cent of males and 64% of females reported that they had consumed at levels for acute alcohol-related harm during the previous 12 months, with 34% of males and 24% of females reporting doing so weekly; 54% (95% CI: 51-58%) of both males and females who had consumed at acute-risk levels, reported that this last drinking occasion occurred at a licensed premises. Of these, 56% (95% CI: 51-61%) reported that they had exhibited at least one sign of overt alcohol intoxication, while 19% (95% CI: 15-23%) reported showing three or more signs of intoxication. Among those reporting at least one sign of intoxication, only 10% (95% CI: 7-15%) reported that the licensed premises staff had provided at least one of seven different responsible service initiatives, while 55% (95% CI: 48-61%) reported that they were continued to be served alcohol. While these results suggest that intoxicated patrons are not being refused service as often as they should, there was evidence for some degree of responsible service provision with around half of the 'non-intoxicated' patrons reporting that they had seen licensed premises staff intervene in some way with other 'intoxicated' patrons.

CONCLUSIONS

While the majority of 18-39-year-olds report showing signs of intoxication while drinking at licensed premises in NSW, only a small minority report experiencing RSA initiatives from bar staff in response to these signs.

Explaining feast or famine in randomized field trials. Medical science and criminology compared

A feast of randomized controlled trials (RCTs) in medical science and comparative famine in criminology can be explained in terms of cultural and structural factors. Of central importance is the context in which the evaluation of interventions is done and the difference in status of situational research in the two disciplines. Evaluation of medical interventions has traditionally been led by practitioner (clinical) academics. This is not the case in criminal justice, where theory has had higher status than intervention research. Medical science has advanced in, or closely associated with, university teaching hospitals, but links between criminology and criminal justice services are far more tenuous. The late development of situational crime prevention seems extraordinary from a medical perspective, as does the absence of university police schools in the United Kingdom and elsewhere. These structural and cultural factors explain concentration of expectation, resource, and RCT productivity in medical science. The Campbell Collaboration and the Academy of Experimental Criminology are forces which are reducing this polarization of feast and famine in RCTs. But unless scientific criminology is embedded in university schools which are responsible for the education and training of law, probation, and police practitioners, convergence in terms of RCTs and implementation of findings in practice seems unlikely.

Use of, and outputs from, an assault patient questionnaire within accident and emergency departments on Merseyside

OBJECTIVES

To describe the implementation, use of, and outputs from an assault patient questionnaire (APQ) introduced in accident and emergency (A&E) departments to determine Crime & Disorder and Community Safety priorities on Merseyside, a metropolitan county in north west England, UK.

METHODS

Why and how the APQ was implemented, data collected, and information obtained. The subsequent incorporation of the APQ into the Torex Patient Administration System (PAS) at the Royal Liverpool University Hospital A&E department and its routine completion by trained reception staff.

RESULTS

Analysis is based upon anonymised data-for example, patient ID and date of birth information is suppressed. A summary of "baseline" information obtained from the data collected is provided.

CONCLUSIONS

It is possible for the APQ to be implemented at no extra cost in a large A&E department in an acute general teaching hospital. Valuable intelligence can be obtained for Crime & Disorder Act and Community Safety processes. The APQ forms part of a medium to long term strategy to prevent and reduce violent assaults in the community that subsequently require treatment in an A&E department. Such incidents include assaults both inside and outside licensed premises, attacks by strangers on the street, and domestic violence. Emphasis is also placed upon the feedback of results to staff in A&E departments.

Increased mortality among previously apprehended drunken and drugged drivers

Most studies in the field of impaired driving have focused on the hazards imposed on society by the impaired drivers, whereas little attention has been paid to the future outcome of the drivers. The aim of the study was to identify mortality rates and causes of death among drunken and drugged drivers during the years after apprehension. Prospective cohort study on apprehended drunken and drugged drivers, follow-up period: 7.5 years, outcome variable: death. Apprehended drivers 20-39 years old who provided samples positive for alcohol (n=2531) or drugs other than alcohol (n=918) constituting the total national samples of these two driver categories in 1992. The mortality rate among male drunken drivers was higher than in an age-matched Norwegian population (standardised mortality ratio, SMR=3.7 (95% Cl 2.9-4.7). The SMR for drugged drivers was 18.1 (14.9-21.8) for men and 27.9 (14.4-48.8) for women. In a subgroup of male drugged drivers using heroin, SMR was 39.8 (28.8-53.6). The dominant causes of death among drunken and drugged drivers were drug poisoning/overdose, accidents and suicide. Apprehension for drunken or drugged driving and subsequent analytical verification, is an indicator of increased risk of future premature death in the age group 20-39 years, particularly for drugged drivers. To our knowledge this is a new finding, and studies to confirm it should be carried out in other countries. If verified, the results should lead to the consideration of new public health approaches towards apprehended impaired drivers.

Recording of community violence by medical and police services

OBJECTIVES

To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police.

METHODS

Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located.

RESULTS

Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0).

CONCLUSIONS

Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0-10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection.