The effect of a trauma center-based intervention program on recidivism among adolescent driving offenders

Factors Influencing Participation and Engagement in a Teen Safe Driving Intervention: A Qualitative Study

(1) Background: Few teen driving safety programs focus on increasing parental engagement with high-risk teen drivers, specifically those with a traffic violation. This study explored parents'/guardians' ('parents') experiences with a teen driving safety program, ProjectDRIVE, including facilitators and barriers to program engagement. (2) Methods: We conducted virtual, semi-structured interviews with parents who completed ProjectDRIVE, which included in-vehicle driving feedback technology and individualized virtual training with parents on effective parent-teen communication. (3) Results: Twenty interviews (with 17 females and three males) were transcribed verbatim and independently coded by three coders using systematic, open, and focused coding. Three major themes were identified: factors influencing a parent's initial decision to participate, factors influencing continued engagement, and perceived benefits of participation. The decision to participate was influenced by these subthemes: parental motivation to help their teen, perceived program usefulness, program endorsement, program incentives, parents' busy schedules, and lack of access to a car/internet. Subthemes impacting continued engagement included enhanced communication skills, teen willingness to engage, strong parental engagement, and teens' other priorities. Perceived benefits included greater self-efficacy in communication, improved communication patterns and frequency, and enhanced parent-teen relationships. (4) Conclusions: These findings may set the foundation for developing and implementing future court-ordered parent-based teen safe driving programs for teens with traffic citations.

Assessing the effectiveness of psychoeducational interventions on driving behavior: A systematic review and meta-analysis

This review aimed to quantitatively summarize the evidence concerning the effectiveness of psychoeducational interventions on driving behavior. A final pool of 138 studies, totaling approximately 97,000 participants, was included in the analyses and covered all types of driving behavior targeted by the interventions. Using a random effects model, significant results were found for almost all driving outcomes, both post-intervention and long-term. The strongest effect was for reducing distracted driving at post-intervention (d = 1.87 [1.12, 2.60], Z = 4.94, p < 0.001). The only non-significant effects were for reducing errors in the long term (d = 0.50 [-0.87, 1.86], Z = 0.71, p = 0.48) and driving under the influence at post-intervention (d = 0.35 [0.00, 0.71], Z = 1.96, p = 0.05). Concerning which type of intervention was more effective, feedback, training and motivational ones appear to work best. Educational interventions show only weak effects, while awareness interventions seem mostly ineffective. Overall, our results show that most interventions can reduce different types of driving behaviors, but there are specific aspects to be considered based on the targeted behavior.

Operating under the influence: Three year recidivism rates for motivation-enhancing versus standard care programs

Operating a motor vehicle under the influence of alcohol (OUI) is an international problem. In the United States, one intervention strategy is to require offenders to attend group-delivered interventions. We compared three year rearrest rates among 12,267 individuals in Maine receiving either a motivation-enhancing (ME) program, Prime For Life(®), or historical standard care (SC) programs. We created two cohorts, one when Maine used SC (9/1/1999-8/31/2000) and one after the ME program was implemented (9/1/2002-8/31/2003). Adjusted for control variables, rearrest rates among people not completing an assigned program did not differ for the ME versus SC cohorts (12.1% and 11.6%, respectively; OR=1.05, ns). In contrast, ME compared to SC program completers had lower rearrest rates (7.4% versus 9.9%, OR=0.73, p<.05). The same pattern occurred for people required to take these programs plus substance use treatment (12.1% versus 14.7%, OR=0.82, p<.01). For those rearrested, time to rearrest did not differ between ME and SC cohorts. Among those required to have substance abuse treatment, ME and SC arrest rates did not differ for younger individuals; otherwise, the ME cohort's lower rearrest rates occurred across gender, age, having a previous OUI, and having completed a previous intervention program.

Changes in eye protection behavior following an occupational eye injury

This study investigated whether workers modify eye protection behavior following an occupational eye injury. Workers treated for work-related eye injuries were questioned regarding the use of protective eyewear for the work-month prior to their eye injuries and again 6 to 12 months later. Workers reported an increase in the proportion of work-time they used eye protection (from a median of 20% to 100%; p < .0001). The effect appeared to be driven by whether eye protection was used at the time of the injury. Most respondents (66%) indicated they were more likely to use eye protection since their injuries. Workers not using eye protection at the time of injury were more likely to use eye protection in the future. A variety of employer and employee factors may influence this change. Although many workers' behaviors changed, health care providers should embrace the teachable moment when treating occupational eye injuries to encourage continued use or more appropriate forms of eye protection.

Changes in eye protection behavior following an occupational eye injury

This study investigated whether workers modify eye protection behavior following an occupational eye injury. Workers treated for work-related eye injuries were questioned regarding the use of protective eyewear for the work-month prior to their eye injuries and again 6 to 12 months later. Workers reported an increase in the proportion of work-time they used eye protection (from a median of 20% to 100%; p < .0001). The effect appeared to be driven by whether eye protection was used at the time of the injury. Most respondents (66%) indicated they were more likely to use eye protection since their injuries. Workers not using eye protection at the time of injury were more likely to use eye protection in the future. A variety of employer and employee factors may influence this change. Although many workers' behaviors changed, health care providers should embrace the teachable moment when treating occupational eye injuries to encourage continued use or more appropriate forms of eye protection.

The development and application of a proxy measure of alcohol-related traffic crashes for rural communities

CONTEXT

To date, no studies have adequately examined whether community-level, rather than individual-level, characteristics, are associated with high rates of alcohol-related traffic crashes (ARTC).

OBJECTIVE

This study aims to identify a proxy measure of ARTC most appropriate to rural communities in New South Wales (NSW), Australia, and to identify community characteristics that predict higher rates of ARTC.

METHODS

ARTC (2001-2007) incident data from 20 rural communities in NSW were obtained. Cost data were applied to take account of ARTCs of different severity.

RESULTS

The method used to define a proxy measure of ARTCs for NSW generally was found to be inadequate when applied to local communities within NSW: specifically, two time periods were found to be alcohol-related for local communities only and seven time periods were found to be non-alcohol-related for local communities only. Applying a community-specific proxy measure of ARTCs to 20 communities identified substantial variation in ARTC cost-ratios, ranging from 1.20 to 0.15. Higher cost-ratios were statistically significantly predicted by the proportion of residents who were male and less than 25 years.

CONCLUSIONS

Proxy measures of ARTCs represent an ideal method of utilising routinely collected data to identify specific types of ARTCs that are most relevant to a defined community, identify community-specific factors associated with higher rates of ARTCs and measure the impact of interventions tailored to those risk factors. Such measures ought to be community-specific because these results suggest national or provincial-level definitions are not necessarily directly applicable to local communities. These results show substantial variability between communities in their rates of ARTC and identify communities with higher proportions of young males as being at increased risk.

Changing epidemiology of trauma deaths leads to a bimodal distribution

Injury mortality was classically described with a trimodal distribution, with immediate deaths at the scene, early deaths due to hemorrhage, and late deaths from organ failure. We hypothesized that the development of trauma systems has improved prehospital care, early resuscitation, and critical care and altered this pattern. This population-based study of all trauma deaths in an urban county with a mature trauma system reviewed data for 678 patients (median age, 33 years; 81% male; 43% gunshot, 20% motor vehicle crashes). Deaths were classified as immediate (scene), early (in hospital, ≤4 hours from injury), or late (>4 hours after injury). Multinomial regression was used to identify independent predictors of immediate and early versus late deaths, adjusted for age, gender, race, intention, mechanism, toxicology, and cause of death. Results showed 416 (61%) immediate, 199 (29%) early, and 63 (10%) late deaths. Compared with the classical description, the percentage of immediate deaths remained unchanged, and early deaths occurred much earlier (median 52 vs 120 minutes). However, unlike the classic trimodal distribution, the late peak was greatly diminished. Intentional injuries, alcohol intoxication, asphyxia, and injuries to the head and chest were independent predictors of immediate death. Alcohol intoxication and injuries to the chest were predictors of early death, while pelvic fractures and blunt assaults were associated with late deaths. In conclusion, trauma deaths now have a predominantly bimodal distribution. Near elimination of the late peak likely represents advancements in resuscitation and critical care that have reduced organ failure. Further reductions in mortality will likely come from prevention of intentional injuries and injuries associated with alcohol intoxication.