Trends and subgroup differences in transportation-related injury risk and safety behaviors among high school students, 1991-1997

Alcohol-related deaths among young passengers: An analysis of national alcohol-related fatal crashes

INTRODUCTION

There is consensus that riding with an impaired driver (RWI) constitutes a major threat to public health. The aim of this study was to characterize the factors contributing to the motor-vehicle deaths of 15-20 year-old (y/o) passengers that RWI with a peer.

METHOD

Secondary analyses of the 2010-2018 Fatality Analysis Reporting System. 5,673 passengers aged 15-20 y/o killed while riding in passenger cars with a driver aged 21 or older, 3,542 of these drivers also aged 15-20 y/o. Analyses were conducted between October 2019 and December 2020.

RESULTS

Sixty-three percent of the young passengers were killed while riding with a driver 15-20 y/o. Of these drivers, 26.8% had a blood alcohol concentration (BAC) >0.00 g/dL and 77.1% had a BAC ≥0.08 g/dL. Compared with those occurring during the day on weekdays, fatalities of young passengers who RWI with a peer driver with a BAC ≥ 0.08 g/dL often occurred on weekend nights (OR = 8.2) and weekday nights (OR = 5.2), and when the passenger and driver were both male (OR = 1.8). Race/ethnicity was not a significant contributor to RWI fatalities.

CONCLUSIONS

Most 15-20 y/o RWI fatalities occurred on weekends, at night, when the driver was a young peer with a high BAC, and the passenger and driver were male. The high prevalence of fatalities in these high-risk situations suggests that young driver-passenger dynamics may contribute to alcohol-related fatalities. Practical Applications: To curb RWI fatalities among underage passengers, countermeasures should focus not only on underage drinking drivers and riders, but also on drinking drivers of all ages. Prevention should increase focus on situations in which both the young passenger and young driver are males.

Young females at risk while driving with a small child

INTRODUCTION

Previous research suggests that young mothers with little driving experience are at risk when driving with a small child passenger. In this study we examined the prevalence, characteristics and risk of fatal motor vehicle crashes involving an infant passenger under the age of one among female drivers of different ages.

METHODS

We used crash data from the US Fatality Analysis Reporting System for 1994-2013. The prevalence of fatal crashes involving infants was examined by age of female drivers and compared to the number of births among mothers of a similar age. The essential characteristics of the crashes were described, and the odds of being at fault were determined for young (16-24-year-olds) and older female drivers (25-39-year-olds) with an infant passenger or with no passengers.

RESULTS

The prevalence of fatal crashes involving infant passengers was higher among young female drivers in relation to the number of births among mothers of a similar age than among older females. Young female drivers with an infant passenger were more often at fault than older drivers (aOR=1.83, 95%, CI=1.52, 2.20). Their vehicles were older and smaller and they used proper safety seats for infants less often than the older drivers. In addition, young female drivers with an infant passenger but with no adult passenger in the vehicle were more often at fault than young female drivers with no passengers (aOR=1.27, 95% CI=1.06, 1.51). Both young and older female drivers' crashes involving an infant passenger typically occurred in ordinary driving conditions, but these drivers with infant passengers were more often reported as having fallen asleep or inattentive than those with no passengers. The presence of an adult passenger in addition to an infant passenger lowered female drivers' odds of being at fault, regardless of the driver's age.

CONCLUSIONS

Young females driving with an infant passenger, probably most often mothers, are at an elevated risk of a fatal crash, especially when they drive alone with an infant. The protective effect of an adult passenger suggests that another adult in the vehicle can assist the driver by taking care of the infant and enabling the driver to focus on driving.

“Developing Holistic Nursing Interventions to Improve Adolescent Health”

Adolescents learn health behaviors in a sociocultural context of community, family, and peers. Although many adolescents engage in behaviors that protect and promote health, others engage in behaviors that threaten or compromise their health. The purpose of this review article is to provide an overview of health-risk behaviors and the morbidities and mortalities of adolescence that are related to these behaviors. Interventions that address these health behaviors and outcomes are presented along with suggestions for a holistic nursing response to this important public health concern.

Cross-domain influences on youth risky driving behaviors: A developmental cascade analysis

We apply a developmental cascade approach to study the longitudinal, cross-domain effects of negative family influence, deviant peer associations, and individual substance use on risky driving among a sample of low-income African American youth. Participants (N = 681) were followed from age 16 to age 21. Using structural equation modeling, we examined conceptual models of pathways to risky driving. Results indicated strong associations between domains within time points among negative family environment, deviant peer associations, individual substance use, and risky driving. Deviant peer associations were related to future risky driving. Alcohol and marijuana use also predicted later deviant peer relationships. The pathways were observed both between age 16 and 18 and between age 18 and 21. Consistent with the cascade hypotheses, we found that risks in one domain manifested as risks in the same domain across time in addition to spreading to other domains.

Disparities in safety belt use by sexual orientation identity among US high school students

OBJECTIVES

We examined associations between adolescents' safety belt use and sexual orientation identity.

METHODS

We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys (n = 26,468 weighted; mean age = 15.9 years; 35.4% White, 24.7% Black, 23.5% Latino, 16.4% other). We compared lesbian and gay (1.2%), bisexual (3.5%), and unsure (2.6%) youths with heterosexuals (92.7%) on a binary indicator of passenger safety belt use. We stratified weighted multivariable logistic regression models by sex and adjusted for survey wave and sampling design.

RESULTS

Overall, 12.6% of high school students reported "rarely" or "never" wearing safety belts. Sexual minority youths had increased odds of reporting nonuse relative to heterosexuals (48% higher for male bisexuals, 85% for lesbians, 46% for female bisexuals, and 51% for female unsure youths; P < .05), after adjustment for demographic (age, race/ethnicity), individual (body mass index, depression, bullying, binge drinking, riding with a drunk driver, academic achievement), and contextual (living in jurisdictions with secondary or primary safety belt laws, percentage below poverty, percentage same-sex households) risk factors.

CONCLUSIONS

Public health interventions should address sexual orientation identity disparities in safety belt use.

The response patterns of young bicyclists to a right-turning motorcycle: a simulator study

This study was designed to assess how bicyclists (30 men, 30 women) responded to right-turning motorised vehicles, which is a risky situation for bicyclists, and employed a scenario in which a motorcycle made a right turn in front of a bicyclist. The factors of speed difference and cut-in time gap were generated to objectively investigate steering control, speed, and the associated collisions in a bicycle simulator. There was no effect for sex, but as expected, for shorter cut-in time gaps, the steering angles were smaller (deflected to the right to avoid the passing motorcycle), the speeds were lower, and the variations in the steering angle and speed were larger. Variations in the steering angle and speed were unexpectedly lower for larger speed differences than for smaller speed differences. Response patterns comprised 5 patterns: early response and quickly depress the brake, last-moment response and slowly depress the brake, late response and quickly depress the brake, very late response and quickly depress the brake, and no response. Larger speed differences and the no-response pattern resulted in two collisions. Individuals with less experience may not have associated speed differences with potential dangers.

The role of sensation seeking, perceived peer pressure, and harmful alcohol use in riding with an alcohol-impaired driver

Alcohol-related motor vehicle collisions have been the top of policy agenda for more than three decades in Korea. Despite implementation of various traffic safety measures, some drivers' alcohol use and abuse has resulted in a high number of alcohol-impaired traffic fatalities every year. This paper presents the association of theoretical factors with behavior of riding with an alcohol-impaired driver (RAID) among all age groups in the Korean adult sample. The theoretical factors of the drivers are personality factor, socio-psychological factor, and alcohol-related behavioral risk factor. We utilized national survey data from 1007 respondents consisting of 703 males and 304 females aged 20-66 collected by Korean Institute of Criminology (KIC) to test our theorized model. Our results indicated that there were three major predictors of RAID involvement: sensation seeking propensity, perceived peer pressure, and frequent harmful drinking. Overall, prediction of RAID behavior by gender was mediated entirely through these predictors. The issue of males' higher risk of RAID involvements was addressed for effective communication strategies such as campaigns.

Seat belt use among overweight and obese adolescents

Motor vehicle crashes are the leading cause of death for adolescents. Previous studies with adults found an association between weight status and decreased use of seat belts. Research has also found significantly higher morbidity and mortality rates in obese individuals who are involved in motor vehicle crashes. If these relationships hold true in obese adolescents they represent additional risk factors for complications from motor vehicle trauma. Given the prevalence of obesity in adolescents (17.4%) and the increased risk of harm associated with obese individuals involved in motor vehicle crashes, this study explored whether there was an association between obesity in adolescents and their use of seat belts. Initial investigation found that rarely/never wearing seat belts was significantly greater for African Americans (22.6%), 18 years of age or older (19.4%), lived with adults other than both parents (15.7%), and males (15.4%). Bivariate logistic regression analysis controlling for demographic variables found that there was no statistically significant difference between overweight and normal weight adolescents. However, obese students were 1.72 times as likely as normal weight students to never or rarely wear their seat belts when riding in a car as a passenger. In particular, obese females and obese students in the middle school age ranges were statistically significantly more likely than normal weight students to never or rarely wear their seat belts.

Analysis of teenage seat belt use: from the 2007 Missouri high school seat belt survey

INTRODUCTION

This study analyzed high school teenagers' seat belt use based on the observational surveys of more than 15,000 teenagers at 150 schools and was conducted in the state of Missouri, U.S., in 2007. Since fatal car accidents involving high school teenagers are disproportionately high, and increased seat belt use saves lives in what would otherwise be fatal accidents, it is imperative that teenagers' safety be protected through an increase in use.

METHOD

This study investigated various personal, vehicle, school, and locational factors associated with high school teenagers' seat belt use. Descriptive and binary logit analyses were conducted.

RESULTS

We find that low seat belt use is associated with males, African-Americans, pick-up trucks, accompanying occupants, weekends, inclement driving conditions, small size of school, lower socio-economic status, and rural county school locations. Several factors influencing teenage seat belt use are quite similar to those affecting adult seat belt use, in addition to certain risky behaviors to which teenagers are prone, supporting the importance of early intervention.

CONCLUSIONS

Programs in schools, the adoption of primary seat belt laws, GDL provisions requiring seat belt use, targeted education and campaign efforts for African-American teenagers, seat belt reminder systems, and more resources for rural counties on safety education and enforcement may help increase seat belt use in this vulnerable age group, though other research questions are implied.

ATV and bicycle deaths and associated costs in the United States, 2000-2005

OBJECTIVE

We determined the rate and costs of recent U.S. all-terrain vehicle (ATV) and bicycle deaths.

METHODS

Fatalities were identified from the National Center for Health Statistics Multiple Cause-of-Death public-access file. ATV and bicycle deaths were defined by International Classification of Diseases, 10th Revision codes V86.0-V86.9 and V10-V19, respectively. Lifetime costs were estimated using standard methods such as those used by the National Highway Traffic Safety Administration.

RESULTS

From 2000 through 2005, 5,204 people died from ATV crashes and 4,924 from bicycle mishaps. A mean of 694 adults and 174 children died annually from ATV injuries, while 666 adults and 155 children died from bicycle injuries. Death rates increased among adult ATV and bike riders and child ATV riders. Males had higher fatality rates for both ATVs and bicycles. Among children, total costs increased 15% for ATV deaths and decreased 23% for bicycle deaths. In adults, ATV costs increased 45% and bike costs increased 39%.

CONCLUSIONS

Bicycle- and ATV-related deaths and associated costs are high and, for the most part, increasing. Promotion of proven prevention strategies, including helmet use, is indicated. However, enforcement of helmet laws is problematic, which may contribute to observed trends.

Trends and subgroup differences in transportation-related injury risk and safety behaviors among US high school students, 1991-2007

BACKGROUND

Seventy percent of unintentional injury-related fatalities--the leading cause of death among youth in the United States--are motor vehicle traffic related. Examining traffic-related safety, therefore, is crucial to public health. This study examines trends in traffic safety issues among US high school students: helmet use while riding a bicycle, seat belt use as a passenger, driving when drinking alcohol, and riding in a car with a driver who had been drinking alcohol.

METHODS

Data from the 1991-2007 national Youth Risk Behavior Surveys (YRBS) were analyzed. The YRBS is a self-administered, anonymous survey that uses a national probability sample of US students in public and private schools in grades 9-12. Demographic subgroup differences were determined for 2007 data using t tests. Temporal changes were analyzed using logistic regression analyses.

RESULTS

From 1991 to 2007, the percentage of high school students who rarely or never wore bicycle helmets decreased from 96.2% to 85.1%; decreases were also seen in the percentage who never wore a seat belt (from 25.9% to 11.1%), rode with a driver who had been drinking alcohol (39.9-29.1%), and who drove when drinking alcohol (16.7-10.5%).

CONCLUSIONS

Although the trends are encouraging, many students still put themselves at risk. Policy approaches (eg, state or local laws or ordinances) complemented by community and school programs may be the best approach to reducing transportation-related injuries and fatalities.

Driver and passenger seatbelt use among U.S. high school students

BACKGROUND

In 2005, 40% of motor-vehicle occupant deaths in the group aged 16-19 years involved passengers. Although seatbelts can reduce crash mortality by 50% or more, little is known about the differences in driver-versus-passenger seatbelt use among teens.

METHODS

In 2007, data from the 2001 and 2003 Youth Risk Behavior Surveys were analyzed for 12,731 black, white, and Hispanic high school students aged >or=16 years reporting seatbelt use as both drivers and passengers. Seatbelt use was compared for driver- and passenger-seat positions, and stratified by age, gender, race/ethnicity, school grades, and histories of either drinking and driving or riding with a drinking driver.

RESULTS

Overall, 59% of students always used seatbelts when driving, but only 42% always buckled up as passengers. Across all covariate strata, passenger seatbelt use was significantly less prevalent than driver seatbelt use (p<0.001). A concordance analysis showed that only 38% of students always wore seatbelts both when driving and while riding as a passenger. Multivariate analyses indicated that, regardless of seat position, seatbelt use was lower for young men, blacks, students with poor grades, and students who reported either drinking and driving or riding with a drinking driver.

CONCLUSIONS

U.S. high school students aged >or=16 years are significantly less likely to wear seatbelts as passengers than as drivers. Interventions designed to promote seatbelt use among teens need to address this disparity.

Congenital and acquired brain injury. 1. Epidemiology, pathophysiology, prognostication, innovative treatments, and prevention

This self-directed learning module reviews the current epidemiology of traumatic brain injury (TBI), its pathophysiology, prognostication after injury, currently available innovative early approaches to diagnosis and treatment, and effective methods of prevention. It is intended to provide the rehabilitation clinician with current knowledge to accurately inform patients, families, significant others, referring physicians, and payers and to aid in clinical decision making while caring for patients after TBI.

OVERALL ARTICLE OBJECTIVE

To describe current knowledge in traumatic brain injury epidemiology, pathophysiology, prognostication, acute treatment, and prevention.

How much can you drink before driving? The influence of riding with impaired adults and peers on the driving behaviors of urban and rural youth

AIMS

Following an ecological model to specify risks for impaired driving, we assessed the effects of youth attitudes about substance use and their experiences of riding in cars with adults and peers who drove after drinking alcohol or smoking cannabis on the youths' own driving after drinking or using cannabis.

DESIGN AND METHODS

Participants were 2594 students in grades 10 and 12 (mean age = 16 years and 2 months; 50% girls) from public high schools in urban (994) and rural communities (1600) on Vancouver Island in British Columbia, Canada; 1192 of these were new drivers with restricted licenses. Self-report data were collected in anonymous questionnaires. Regression analyses were used to assess the independent and interacting effects of youth attitudes about substance use and their experiences of riding in cars with adults or peers who drove after drinking alcohol or smoking cannabis on youth driving.

FINDINGS

Youth driving risk behaviors were associated independently with their own high-risk attitudes and experiences riding with peers who drink alcohol or use cannabis and drive. However, risks were highest for the youth who also report more frequent experiences of riding with adults who drink alcohol or use cannabis and drive.

CONCLUSIONS

Prevention efforts should be expanded to include the adults and peers who are role models for new drivers and to increase youths' awareness of their own responsibilities for their personal safety as passengers.

Epidemiology of bicycle injuries in 13 health divisions, Islamic Republic of Iran 2003

Bicyclists are vulnerable road users for severe injury all over the world. The nature and extent of such injuries are less well known in Iran. Using data from a comprehensive survey conducted by the Ministry of Health and Medical Education in 13 health divisions of Iran, in 2003, we examined circumstances around bicyclist injury and death. Trained health workers completed the survey instruments by interviewing patients who stayed more than 24h in hospitals and/or relatives, hospital personnel and by reviewing patient charts. Data were cross-matched with medico-legal documents to prevent missing deaths. The information that was collected from 64 cities/towns' emergency departments (EDs), over the study period, showed that 440 injured cyclists were hospitalized and/or died due to traffic collisions. Most injuries occurred in males (94.8%) and in the young (median age: 14 years with 75% </=18 years). Head injury occurred in 14% of all hospitalized and in 90% of fatally injured bicyclists. Striking a moving vehicle increased the odds of death (OR: 32.3; 95% CI 3.5-291.0) as well as the odds of severe injury (OR: 1.9; 95% CI 1.2-3.2) compared with other mechanisms of injury. As a conclusion, bicyclists in Iran, particularly males and young children, are vulnerable to severe injury and death when struck by moving vehicles on highways.

Seat belt use among Hispanic ethnic subgroups of national origin

OBJECTIVE

Findings from over a dozen studies of Hispanic/white disparities in seat belt use have been inconsistent, variably revealing that seat belt use prevalence among Hispanics is higher, lower, or comparable to use among non-Hispanics. In contrast to previous studies, this study investigates disparities in seat belt use by Hispanic subgroups of national origin.

METHODS

Data from the US Fatality Analysis Reporting System were used to compare seat belt use among 60 758 non-Hispanic whites and 6879 Hispanics (Mexican American (MA), n = 5175; Central American/South American (CASA), n = 876; Puerto Rican (PR), n = 412; Cuban (CU), n = 416) killed in crashes from 1999-2003. Logistic regression was used to adjust for age, gender, seat belt law, seat position, urban/rural region, and income.

RESULTS

Overall adjusted odds ratios for seat belt use among Hispanic subgroups, relative to non-Hispanic whites, were 1.04 (95% confidence interval (CI) 0.85 to 1.28) for CUs, 1.17 (95% CI 0.95 to 1.44) for PRs, 1.33 (95% CI 1.25 to 1.42) for MAs, and 1.66 (95% CI 1.44 to 1.91) for CASAs. Relative to their non-Hispanic white counterparts, odds ratios among MA and CASA Hispanics were highest for men, younger age groups, drivers, primary law states, rural areas, and lower income quartiles.

CONCLUSION

Among all Hispanic subgroups, seat belt use was at least as prevalent as among non-Hispanic whites. In the CASA and MA subgroups, which have the most rapidly growing subpopulations of immigrants, seat belt use was significantly more common than among whites.

Adolescent passengers of drunk drivers: a multi-level exploration into the inequities of risk and safety

AIMS

This study determined the individual-, neighbourhood- and provincial-level effects of rural residence, socio-economic status (SES), substance use and driving behaviours on adolescents' riding with a drunk driver (RDD).

DESIGN

Multi-level study based on cross-sectional self-reported anonymous data from the Student Drug Use Survey in the Atlantic Provinces (SDUSAP) and Census Canada data, merged on the postal code of participating schools. The sample design of the SDUSAP was a single-stage cluster sample of randomly selected classes stratified by grade and region.

SETTING

The Atlantic provinces of Canada.

PARTICIPANTS

A total of 12 990 students in junior and senior high schools, with an average age of 15 years, participated in the 2002 SDUSAP.

MEASUREMENTS

The outcome variable was past-year RDD. The main individual-level independent variables were SES, rural residence, substance use and driving behaviours. The school-neighbourhood independent variables were the prevalence of heavy episodic drinking, driving under the influence of alcohol, driver's licence, highest level of educational attainment and low income.

FINDINGS

The prevalence of RDD was 23.3% in 2002. Among students in grades 9-12, lower family SES, rural residence, substance use and driving under the influence were found to be independent individual-level risk factors for RDD; having a driver's licence was found to be protective. At the provincial and school-neighbourhood levels, a high prevalence of driving under the influence of alcohol and low educational attainment were found to be independent risk factors for RDD after taking into account individual characteristics.

CONCLUSIONS

This study provides evidence that inequities exist in the options for adolescents to be ensured of passenger safety, and that interventions aimed at decreasing the extent to which adolescents engage in riding with a drunk driver should be based on conceptual approaches that recognize ecological factors as well as individual-level susceptibility.

Seat belt law enforcement and racial disparities in seat belt use

BACKGROUND

Numerous reports have documented a lower prevalence of seat belt use among blacks in the United States, compared with whites. Limited data suggest that black-white disparities in states with primary seat belt laws (motorists can be stopped and cited solely for violating a seat belt law) are less marked than in states with secondary laws (motorists can be cited for violating a seat belt law only if stopped for another offense).

METHODS

Data from the Fatality Analysis Reporting System were analyzed in 2005 to compare seat belt use among 11,574 blacks and 73,639 whites aged 16 or more years killed in crashes from 1999 to 2003 in 33 states with a primary or secondary adult seat belt law and annual reporting of race for 80% or more of decedents. After stratification of states by type of seat belt law, logistic regression was used to calculate odds ratios and 95% confidence intervals (CIs) for seat belt use among blacks, relative to whites, with adjustment for age, gender, seat position, urban/rural region, and income.

RESULTS

Odds ratios and 95% CIs for seat belt use among blacks were 1.05 (0.97-1.13) and 0.89 (0.83-0.95), in primary- and secondary-law states, respectively.

CONCLUSIONS

Black-white disparities in seat belt use were mitigated in states with primary seat belt laws. Only 24 states have primary laws. Enacting primary laws in other states might reduce or eliminate racial disparities in seat belt use.

Voluntary risk taking and skill deficits in young driver accidents in the UK

In absolute terms, young drivers have three to four times as many accidents per year as older drivers; and even allowing for their relative numbers in the population, their accident involvement is about 2.5 times higher than older drivers. A sample of 3437 accident reports was considered, including 1296 in detail, from midland police forces in the UK, involving drivers aged 17-25, and covering the years 1994-1996 inclusive. Four types of accident were identified as being of particular concern due to their high frequency: 'cross-flow'-turns; rear-end shunts; loss of control on bends; and accidents in darkness. (The term 'cross-flow' is used in relation to turns to denote an intersection accident where a driver is turning across the path of oncoming traffic, i.e., left turns in the US and continental Europe, but right turns in the UK and other countries where driving on the left side of the road is the norm.) An examination of driver risk taking behaviours as revealed in police interviews gave an insight into some of the motivational factors underlying young driver behaviour. Young driver accidents of all types are found to be frequently the result of 'risk taking' factors as opposed to 'skill deficit' factors. It had previously been thought that one of the main problems that young drivers have is in the area of specific skills needed in the driving task. However, it appears that a large percentage of their accidents are purely the result of two or three failures resulting from voluntary risk taking behaviour, rather than skill deficits per se. It is shown that specific groups of young drivers can even be considered as above average in driving skills, but simultaneously have a higher accident involvement due to their voluntary decisions to take risks.

Teen drivers and the risk of injury to child passengers in motor vehicle crashes

OBJECTIVES

The first aim was to examine the relationship between driver's age (novice teens, older teens, and adults) and child passenger's restraint status, front row seating, and injury risk. The second aim was to explore whether there was an excess injury risk to child passengers in teen crashes compared to those in adult crashes by examining the contributing factors.

METHODS

A cross sectional study involving telephone interviews with insured drivers in a probability sample of 12 163 crashes involving 19 111 children was conducted. Sequential logistic regressions were employed.

RESULTS

Among child passengers aged 4-8, appropriate restraint was <1% for novice teens, 4.5% for older teens, and 23.6% for adults. Front row seating for children <13 years was more common in the novice teen group (26.8%) than in the other two groups. Compared with children riding with adults, those with both teen groups experienced excess injury risk. After adjusting for crash severity, there was a 43% reduction in the odds ratio (OR) for novice teens (OR 1.58, 95% confidence interval (CI) 1.14 to 2.19) and a 24% reduction for older teens (OR 2.15, 95% CI 1.42 to 3.26). After adjusting for vehicle type, child's restraint status and front row seating, there was a further 19% reduction in the OR for novice teens (OR 1.37, 95% CI 1.00 to 1.88) and a further 13% reduction for older teens (OR 1.74, 95% CI 1.14 to 2.66).

CONCLUSION

These findings suggest ways in which graduated driver licensing laws may be further enhanced to better protect child passengers from the excess injury risk associated with teen crashes.

A survey of teenager unnatural deaths in northern Sweden 1981-2000

OBJECTIVE

To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.

SETTING

The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.

MATERIAL AND METHODS

All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.

RESULTS

Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.

CONCLUSIONS

Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

Bicycle injuries and safety helmets in children. Review of research

Bicycle injuries are the most common cause of serious head injury in children, and most of these injuries are preventable. The protective effect of bicycle helmets is well documented, but many child bicyclists do not wear them. This article summarizes the current state of research on bicycle injuries and helmet use and examines the effectiveness of legislation and injury-prevention strategies. Current studies indicate that children who wear helmets experience fewer head injuries and decreased severity of injury. Community-wide helmet-promotion campaigns combined with legislation are most successful in increasing helmet use and decreasing injury. Nurses can participate both at the institutional level and in community advocacy groups to promote bicycle safety for children.

Association between state level drinking and driving countermeasures and self reported alcohol impaired driving

OBJECTIVES

In 1999, alcohol related motor vehicle crashes in the United States claimed 15786 lives and injured more than 300000 persons. Drinking and driving behavior is shaped by individual and environmental level influences. In this study, the association between each state's driving under the influence of alcohol (DUI) countermeasures and self reported alcohol impaired driving was explored.

METHODS

Mothers Against Drunk Driving's (MADD's) Rating the States 2000 survey, which graded states on their DUI countermeasures from 1996-99, was used as an index of each state's comprehensive DUI prevention activities. Information on alcohol impaired driving from residents of each state was obtained from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey. The association between the MADD state grades and alcohol impaired driving was assessed using multiple logistic regression.

RESULTS

Of the 64162 BRFSS respondents who reported drinking any alcohol during the past month, 2.1% of women and 5.8% of men reported at least one episode of alcohol impaired driving in the past month. Those living in states with a MADD grade of "D" were 60% more likely to report alcohol impaired driving than those from states with a MADD grade of "A" (odds ratio 1.6, 95% confidence interval 1.3 to 2.1). The association existed for men and women.

CONCLUSION

These findings suggest that stronger state level DUI countermeasures are associated with lower rates of self reported alcohol impaired driving.

The Youth Risk Behavior Surveillance System: updating policy and program applications

To monitor behaviors that place adolescents at increased risk for premature morbidity and mortality, the Centers for Disease Control and Prevention developed the Youth Risk Behavior Surveillance System (YRBSS). This system measures six categories of behaviors, including behaviors that contribute to violence and unintentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and inadequate physical activity. This article summarizes how some education and health agencies and nongovernmental organizations, in collaboration with community agencies, school boards, parents, and youth, use YRBSS data to describe risk behaviors, create awareness, supplement staff development, set and monitor program goals, develop health education programs, support health-related legislation, and seek funding. Ways in which YRBSS data are distributed electronically also are summarized.