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Total cost estimates for crime in the USA are both out-of-date and incomplete. We estimated incidence and costs of personal crimes (both violent and non-violent) and property crimes in 2017. Incidence came from national arrest data, multi-state estimates of police-reported crimes per arrest, national victimization and road crash surveys, and police underreporting studies. We updated and expanded upon published unit costs. Estimated crime costs totaled $2.6 trillion ($620 billion in monetary costs plus quality of life losses valued at $1.95 trillion; 95 % uncertainty interval $2.2–$3.0 trillion). Violent crime accounted for 85 % of costs. Principal contributors to the 10.9 million quality-adjusted life years lost were sexual violence, physical assault/robbery, and child maltreatment. Monetary expenditures caused by criminal victimization represent 3 % of Gross Domestic Product – equivalent to the amount spent on national defense. These estimates exclude the additional costs of preventing and avoiding crime such as enhanced lighting and burglar alarms. They also exclude crimes against businesses and most white-collar and corporate offenses.

This cross-sectional study investigates the epidemiology of drug poisoning suicides in US state census and national sample data., Key Points Question What is the association between classes of drugs consumed and the lethality of suicidal drug overdoses? Findings In this cross-sectional study of state censuses and national samples that included 421 466 medically identified suicidal drug overdoses, the risk that an overdose would be fatal was highest if an opioid or barbiturate was involved. Lethality increased with age, whereas youth overdoses often involved toxins with low lethality. Meaning These findings suggest that drugs that are lethal in overdose when combined should be stored securely in homes, and lethal drugs should be blister packed., Importance Prior lethality analyses of suicide means have historically treated drug poisoning other than alcohol poisoning as a lumped category. Assessing risk by drug class permits better assessment of prevention opportunities. Objective To investigate the epidemiology of drug poisoning suicides. Design, Setting, and Participants This cross-sectional study analyzed censuses of live emergency department and inpatient discharges for 11 US states from January 1, 2011, to December 31, 2012, as well as Healthcare Cost and Utilization Project national live discharge samples for January 1 to December 31, 2012, and January 1 to December 31, 2016, and corresponding Multiple Cause of Death census data. Censuses or national samples of all medically identified drug poisonings that were deliberately self-inflicted or of undetermined intent were identified using diagnosis and external cause codes. Data were analyzed from June 2019 to January 2020. Main Outcomes and Measures Distribution of drug classes involved in suicidal overdoses. Logistic regressions on the state data were used to calculate the odds and relative risk (RR) of death for a suicide act that involved a drug class vs similar acts excluding that class. Results Among 421 466 drug poisoning suicidal acts resulting in 21 594 deaths, 19.6% to 22.5% of the suicidal drug overdoses involved benzodiazepines, and 15.4% to 17.3% involved opioids (46.2% men, 53.8% women, and

Background The Mine Safety and Health Administration (MSHA) requires reporting of injuries and illnesses to their Part 50 program. A 2011 study indicated that the Part 50 program did not capture many cases of injury in Kentucky, causing concern about underreporting in other states. Methods MSHA Part 50 reports from Illinois for 2001-2013 were linked to Illinois Workers' Compensation Commission (IWCC) data. IWCC cases not found in the Part 50 data were considered unreported. Results Overall, the Part 50 Program did not capture 66% of IWCC cases from 2001 to 2013. Chronic injuries or illnesses were more likely to be unreported to MSHA. Conclusions The majority of occupational injuries and illnesses found in the IWCC from this time period, were not captured by Part 50. Inaccurate reporting of injuries and illnesses to the Part 50 program hinders MSHA's ability to enforce safety and health standards in the mining industry.

Context: Ice hockey is a high-speed, full-contact sport with a high risk of head/face/neck (HFN) injuries. However, men's and women's ice hockey differ; checking is allowed only among men.Objectives: To describe the epidemiology of HFN injuries in collegiate men's and women's ice hockey during the 2009−2010 through 2013−2014 academic years.Design: Descriptive epidemiology study.Setting: Ice hockey data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program during the 2009−2010 through 2013−2014 academic years.Patients or Other Participants: Fifty-seven men's and 26 women's collegiate ice hockey programs from all NCAA divisions provided 106 and 51 team-seasons of data, respectively.Main Outcome Measure(s): Injury rates per 1000 athlete-exposures and rate ratios with 95% confidence intervals (CIs).Results: The NCAA Injury Surveillance Program reported 496 and 131 HFN injuries in men's and women's ice hockey, respectively. The HFN injury rate was higher in men than in women (1.75 versus 1.16/1000 athlete-exposures; incidence rate ratio = 1.51; 95% CI = 1.25, 1.84). The proportion of HFN injuries from checking was higher in men than in women for competitions (38.5% versus 13.6%; injury proportion ratio = 2.82; 95% CI = 1.64, 4.85) and practices (21.9% versus 2.3%; injury proportion ratio = 9.41; 95% CI = 1.31, 67.69). The most common HFN injury diagnosis was concussion; most concussions occurred in men's competitions from player contact while checking (25.9%). Player contact during general play comprised the largest proportion of concussions in men's practices (25.9%), women's competitions (25.0%), and women's practices (24.0%). While 166 lacerations were reported in men, none were reported in women. In men, most lacerations occurred from player contact during checking in competitions (41.8%) and player contact during general play in practices (15.0%).Conclusions: A larger proportion of HFN injuries in ice hockey occurred during checking in men versus women. Concussion was the most common HFN injury and was most often due to player contact. Lacerations were reported only among men and were mostly due to checking. Injury-prevention programs should aim to reduce checking-related injuries.

Context Injuries in professional ultimate Frisbee (ultimate) athletes have never been described. Objective To determine injury rates, profiles, and associated factors using the first injury-surveillance program for professional ultimate. Design Descriptive epidemiology study. Setting American Ultimate Disc League professional ultimate teams during the 2017 season. Patients or Other Participants Sixteen all-male teams. Main Outcome Measure(s) Injury incidence rates (IRs) were calculated as injuries per 1000 athlete-exposures (AEs). Incidence rate ratios were determined to compare IRs with 95% confidence intervals, which were used to calculate differences. Results We observed 299 injuries over 8963 AEs for a total IR of 33.36 per 1000 AEs. Most injuries affected the lower extremity (72%). The most common injuries were thigh-muscle strains (12.7%) and ankle-ligament sprains (11.4%). Running was the most frequent injury mechanism (32%). Twenty-nine percent of injuries involved collisions; however, the concussion rate was low (IR = 0.22 per 1000 AEs). Injuries were more likely to occur during competition and in the second half of games. An artificial turf playing surface did not affect overall injury rates (Mantel-Haenszel incidence rate ratio = 1.28; 95% confidence interval = 0.99, 1.67). Conclusions To our knowledge, this is the first epidemiologic study of professional ultimate injuries. Injury rates were comparable with those of similar collegiate- and professional-level sports.

Total cost estimates for crime in the United States are both out-of-date and incomplete. We estimated incidence and costs of personal crimes (both violent and non-violent) and property crimes in 2017. Incidence came from national arrest data, multi-state estimates of police-reported crimes per arrest, national victimization and road crash surveys, and police underreporting studies. We updated and expanded upon published unit costs. Estimated crime costs totaled $2.6 trillion ($620 billion in monetary costs plus quality of life losses valued at $1.95 trillion; 95% uncertainty interval $2.2 - $3.0 trillion). Violent crime accounted for 85% of costs. Principal contributors to the 10.9 million quality-adjusted life years lost were sexual violence, physical assault/robbery, and child maltreatment. Monetary expenditures caused by criminal victimization represent 3% of GDP – equivalent to the amount spent on national defense. These estimates exclude the additional costs of preventing and avoiding crime such as enhanced lighting and burglar alarms. They also exclude crimes against businesses and most white-collar and corporate offenses.

The purpose of this research was to reanalyze data collected from the National Highway Traffic Safety Administration's Drug and Alcohol Crash Risk Study to investigate whether driving under the influence of cannabis (THC-positive) was associated with elevated crash risk for younger and older drivers. The data came from a case-control relative risk study collected from Virginia Beach, VA, over a 20-month period. Data collectors gathered driver information from the scene of vehicle crashes and, in some cases, from hospitals. Non-crash controls were sampled from the same locations, days, and times as crashes. Key data items included driver demographics and oral fluid and blood samples, which were assayed for licit and illicit drugs. We found no overall association between cannabis use and risk of crash involvement. However, when age and age2 were allowed to interact with THC, significant interaction effects emerged. THC was associated with increased risk of crash involvement for older drivers. Difference between THC-positive and sober drivers emerged as significant at age 64. The research underscores the value of examining drugged driving in the context of driver age. Age-related declines in neurocognitive and psychomotor functioning were not measured but might be important in explaining the results.

Objectives. In the United States, state firearm ownership has been correlated with homicide rates. More than 90% of homicides of law enforcement officers (LEOs) are committed with firearms. We examined the relationship between state firearm ownership rates and LEO occupational homicide rates. Methods. We obtained the number LEOs killed from 1996 to 2010 from a Federal Bureau of Investigation (FBI) database. We calculated homicide rates per state as the number of officers killed per number of LEOs per state, obtained from another FBI database. We obtained the mean household firearm ownership for each state from the Behavioral Risk Factor Surveillance System. Results. Using Poisson regression and controlling for factors known to affect homicide rates, we associated firearm ownership with the homicide rates for LEOs (incidence rate ratio = 1.044; P = .005); our results were supported by cross-sectional and longitudinal sensitivity analyses. LEO homicide rates were 3 times higher in states with high firearm ownership compared with states with low firearm ownership. Conclusions. High public gun ownership is a risk for occupational mortality for LEOs in the United States. States could consider methods for reducing firearm ownership as a way to reduce occupational deaths of LEOs.

BACKGROUND: For truck drivers, distracted driving is a workplace behavior that increases occupational injury risk. We propose safety climate as an appropriate lens through which researchers can examine occupational distracted driving. METHODS: Using a mixed methods study design, we surveyed truck drivers using the Safety Climate Questionnaire (SCQ) complemented by semi-structured interviews of experts on distracted driving and truck safety. Safety climate was assessed by using the entire SCQ as an overall climate score, followed by factor analysis that identified the following safety climate factors: Communications and Procedures; Management Commitment; and Work Pressure. RESULTS: In multivariate regression, the overall safety climate scale was associated with having ever experienced a crash and/or distraction-involved swerving. Interview participants described how these SCQ constructs could affect occupational distracted driving. CONCLUSION: To reduce distraction-related crashes in their organizations, management can adhere to safe policies and procedures, invest in engineering controls, and develop safer communication procedures. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc. Keywords: Driver distraction; Language: en

A concurrent mixed methods design was used to explore personal and workplace factors, informed by the Theory of Planned Behavior, that affect truck drivers' decision-making about distracted driving on the job. Qualitative data were collected via semi-structured interviews with experts in truck safety and distracted driving, and quantitative data were collected via online survey of truck drivers in the United States. Findings from the interviews illustrated how drivers perceived distractions and the importance of supervisors enforcing organizational distracted driving policies. Survey results found that behavioral intentions were most important in regards to texting and crash and near-crash outcomes, while perceived norms from management best described the correlation between dispatch device use and negative crash-related outcomes. By using a mixed methods design, rather than two separate studies, these findings revealed nuanced differences into the influence of supervisors on distracted driving.

Context The burden of injuries to college ultimate players has never been fully described. Objective To quantify the injury rate in ultimate players and describe the diagnoses, anatomic locations, and mechanisms of injuries. Design Descriptive epidemiology study. Setting College ultimate teams in the United States during the 2012 season. Main Outcome Measure(s) Initial injury rate per 1000 athlete-exposures. Results The initial injury rate in college ultimate players was 12.64 per 1000 athlete-exposures; the rate did not differ between men and women (P = .5). Bivariate analysis indicated that injuries occurred twice as often during games as during practices, men were more likely than women to be injured when laying out for the disc, and men were more likely to incur strains and sprains than women. Conclusions Injury patterns to college ultimate players were similar to those for athletes in other National Collegiate Athletic Association sports. This is the first study to systematically describe injuries to ultimate players.

The Bloomberg Road Safety Program (BRSP) supports the development of traffic safety laws, regulations, and activities. Six low- and middle-income countries (LMICs) enacted over a dozen such regulations between 2007 and 2013. Purpose This evaluation estimates the lives saved by these laws in 2007–2013 then projects future reductions in motor vehicle crash (MVC) mortality through 2023. Methods Local BRSP staff identified traffic laws in Brazil, China, Kenya, Mexico, Turkey, and Vietnam that we categorised as driving while intoxicated, seat belt use, motorcycle-related, and other. To calculate reductions in deaths, we used domestic and international systematic reviews to identify effectiveness of such laws. Discounts in reductions were made for those laws that had poor enforcement, as determined by BRSP staff. Historic MVC deaths saved were estimated using data from the Global Burden of Disease (GBD). Historic growth rates from the GBD were then used to project mortality reductions through 2023. Results BRSP helped pass laws and regulations that saved an estimated 19 000 lives from 2007–2013. Those laws and regulations will save another 90 000 lives in 2014–2023. Of the 1 09 000 estimated lives likely to be saved, over half will be in China and one-third will be in Vietnam. Limitations for our estimates include use of historic fatality rates; paucity of country-specific intervention publicity, enforcement and effectiveness data; and inherent weaknesses of GBD data. Conclusion In LMICs, traffic safety interventions associated with the BRSP have the potential to save over 1 00 000 lives from 2007–2023. Significance Economic analyses can estimate lives saved due to traffic safety regulations in LMICs. Better estimates of local implementation, enforcement, and effectiveness could improve such estimates in the future.

Statement of Purpose We updated ten-year-old estimates of interpersonal violence costs per case and per year for murder, rape, robbery, arson, impaired driving, and other assault, and separately state the costs of child maltreatment, intimate partner violence, and firearm violence. Methods/Approach Incidence came from Vital Statistics mortality, National Criminal Victimisation Survey, FBI crime statistics (adjusted for under-reporting), National Incidence Survey on Child Abuse and Neglect, National Intimate Partner and Sexual Violence Survey, surveys of prisoners, and national crash data sets. Cost updates primarily used methods paralleling earlier studies. We estimated costs with data from the incidence sources, Healthcare Cost and Utilisation Program data, and Truven’s Medstat medical claims data. Cost categories included were medical, mental health, work loss, value of lost quality of life, property damage/loss, public services, adjudication, sanctioning, and perpetrator work loss. Results Quality of life accounted for 73% of the trillion-dollars-plus in annual violence costs. Costs of rape and sexual assault comprised 42% of the total, far exceeding the contribution of murder and non-domestic assault; impaired driving accounted for 12% and child maltreatment for 17.5%. Firearm violence accounted for one third of murder, physical assault, and robbery costs. Annually, violence against juveniles cost more than twice violence by juveniles. Governments paid 13% of the violence bill. Violent crime caused 7% of all government consumption spending and gross investment, exclusive of defense spending. Conclusions Violent crime imposes a heavy burden on US citizens and government budgets. Children bear a disproportionately large share of violence costs, as do sexual assault victims and their families. Significance and Contributions to Injury and Violence Prevention Science This major update on the costs of violence will support improved economic analyses of prevention, inform resource allocation, and better communicate the dimensions of America’s violence problem.

Objective To estimate lives saved during 2008–2023 by traffic safety laws passed in six developing countries while participating in the Bloomberg Road Safety Program (BRSP). Methods BRSP-funded local staff identified relevant laws and described enforcement to the study team. We analyzed road crash death estimates for 2004–2013 from the Global Burden of Disease and projected estimates absent intervention forward to 2023. We amalgamated developing country and US literature to estimate crash death reductions by country resulting from laws governing drink driving, motorcycle helmets, safety belt use, and traffic fines. Results BRSP helped win approval of traffic safety laws in Brazil, China, Kenya, Mexico, Turkey, and Vietnam. In 2008–2013, those laws saved an estimated 19,000 lives. Many laws only took effect in 2014. The laws will save an estimated 90,000 lives in 2014–2023. Of the 109,000 lives saved, drink driving laws will account for 84%, increased motorcyclist protection for 13%, increased fines and penalty points for 2%, and safety belt usage mandates for 1%. Drink driving reductions in China will account for 56% of the savings and reduced drink driving and motorcycling deaths in Vietnam for 35%. The savings in China will result from a narrow intervention with just 4% estimated effectiveness against drink driving deaths. As a percentage of deaths anticipated without BRSP effort, the largest reductions will be 11% in Vietnam and 5% in Kenya. Conclusions Viewed as a public health measure, improving traffic safety provided large health gains in developing nations.

ObjectivesTo assess the medical expenditures of American adults by their smoking status—Current, Former or Never smokers. We update these expenditures through 2015 controlling for personal characteristics and medical history and assess the impact of years-since-quitting and decade of life.Setting and participantsWeighted sample of American adults, 2011–2015. The linked National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS) are annual weighted representations of approximately 250 million adults. Sampling of NHIS is multistage with data collected throughout the year.Primary outcome measuresUsing data from NHIS and MEPS, we collected demographic data, self-reported medical history and current smoking status. Smoking status was designated as Never, Current and Former, along with years-since-quitting. Total medical expenditures were collected from MEPS for 2011–2015. We used Manning’s two-part model to estimate average expenditures per individual and marginal costs for individuals at all levels of smoking status.ResultsAmerican adults averaged US$4830 in average medical expenditures. Never smokers (US$4360, 95% CI 4154.3 to 4566.3), had lower expenditures than Current (US$5244, 95% CI 4707.9 to 5580.3) and Former (US$5590, 95% CI 5267.4 to 5913.5) smokers. CI for Current and Former smokers overlapped. Results were similarly significant when controlling for disease history. Years-since-quitting did not affect expenditures. In each decade of adult life, Former smokers had the highest annual medical expenditures, followed by Current and then Never smokers.ConclusionsWe updated annual medical expenditures during the Affordable Care Act era by smoking status using the current best practice model. While we identify Former smokers as having higher medical expenditures than Current smokers, we do not examine how care-seeking behaviour varies between levels of each risk factor.

Objective To understand the circumstances surrounding the occupational homicides of law enforcement officers (LEOs) in the USA. Methods Narrative text analysis of Federal Bureau of Investigation Law Enforcement Officers Killed and Assaulted reports. Results A total of 796 officers were killed in the line of duty between 1996 and 2010. The occupational homicide rate during the time peaked in 2001 at 3.76/100 000 (excluding those killed during the September 11 2001 terrorist attacks), and was lowest in 2008 at 1.92/100 000. Most LEOs (67%) were killed by short-barrel firearms; 10% were killed with their own service weapon. The most frequent encounter with a suspect prior to a homicide was responding to a disturbance call. Conclusions These results should inform officer training and the policies, as well as procedures used when interacting with suspects, especially when firearms are involved.

BACKGROUND: This study describes and compares the three surveillance systems used to record occupational injury fatalities among U.S. law enforcement officers (LEOs). METHODS: The Census of Fatal Occupational Injuries (CFOI), National Law Enforcement Officer Memorial Fund database (NLEOMF), and Law Enforcement Officers Killed and Assaulted reports (LEOKA) were examined for LEO deaths between 2003 and 2009. Fatality rates per 100,000 workers were calculated and compared. RESULTS: Between 2003 and 2009, the NLEOMF reported 1,050 fatalities (rate of 16.4 per 100,000 workers), the CFOI reported 968 fatalities (15.1 per 100,000), and the LEOKA recorded 853 fatalities (13.3 per 100,000). The LEOKA under-counted the number of fatalities compared to the NLEOMF and CFOI. Discrepancies were found between the LEOKA, NLEOMF, and CFOI regarding age, race, and Hispanic origin. Similar patterns for cause of fatality were found; however, the NLEOMF recorded a higher number of "other" fatalities compared to the other two systems. CONCLUSIONS: This study fills a critical knowledge gap by providing an overview of the three surveillance systems used to enumerate LEO occupational deaths. Understanding the differences across the systems is critical when utilizing them for surveillance research. Am. J. Ind. Med. Published 2013. This article is a U.S. Government work and is in the public domain in the USA. Language: en

Past studies indicated that overall Basic Combat Training (BCT) attrition (discharge) was associated with various risk factors. BCT has changed considerably since many of these studies were conducted. This study examined Soldiers medically attrited from BCT. Potential attrition risk factor data on recruits (n = 4,005) were collected from medical records, BCT unit records, and questionnaires. Attrition data from Fort Jackson, South Carolina, showed 203 medical discharges. Cox regression (univariate and multivariate) obtained hazard ratios and 95% confidence intervals for attrition risk factors. Higher attrition risk was associated with female gender. Higher attrition risk for men was associated with cigarette smoking, injury during BCT, and less exercise before BCT. Higher attrition risk for both genders was associated with failure on the initial 2-mile run test and separated or divorced marital status. Attrition risk factors found in this study were similar to those previously identified despite changes in BCT.

Consumer products are often associated with fall injuries, but there is limited research on nonfatal unintentional falls in children that examines both the child’s age group and the involvement of consumer products and activities. We combined 2 data sources to investigate products and activities that contribute to fall injuries in children at different developmental ages (ie

Background: Shoe manufacturers market motion control, stability, and cushioned shoes for plantar shapes defined as low, normal, and high, respectively. This assignment procedure is presumed to reduce injuries by compensating for differences in running mechanics. Hypothesis: Assigning running shoes based on plantar shape will not reduce injury risk in Marine Corps basic training. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: After foot examinations, Marine Corps recruits in an experimental group (E: 408 men, 314 women) were provided motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. A control group (C: 432 men, 257 women) received a stability shoe regardless of plantar shape. Injuries during the 12 weeks of training were determined from outpatient visits obtained from the Defense Medical Surveillance System. Other known injury risk factors (eg, fitness, smoking, prior physical activity) were obtained from a questionnaire, existing databases, or the training units. Results: Cox regression indicated little difference in injury risk between the E and C groups among men (hazard ratio [E/C] = 1.01; 95% confidence interval, 0.82-1.24) or women (hazard ratio [E/C] = 0.88; 95% confidence interval, 0.70-1.10). Conclusion: This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries even after considering other injury risk factors.

Purpose: Popular running magazines and running shoe companies advise using the shape of the weight-bearing plantar surface of the foot as a basis for selecting a proper type of running shoe to reduce injury risk. The imprint is assumed to reflect the height of the medial longitudinal arch (MLA). This study examined the assumption that plantar surface morphology was a surrogate for height of the MLA. Methods: Recruits (n = 3968) entering US Army Basic Combat Training had their plantar foot surfaces assessed visually as low, normal, or high by two raters who viewed imprints of the plantar foot surface. Actual arch height was measured with calipers as distance from the standing surface to the inferior medial border of the navicular tuberosity. Measured MLA heights were compared with plantar surface imprints to evaluate the effectiveness of visual inspection as a means of arch height classification. Results: For the right foot, individuals with low, normal, or high plantar shapes had a mean +/- SD arch height of 33.5 +/- 6.8, 40.4 +/- 7.2, and 43.1 +/- 7.3 mm, respectively (ANOVA, P < 0.01); however, the individuals' measured MLA heights fell into the corresponding plantar shape percentiles (low, normal, high) only 65% of the time. Increased body mass index (BMI) decreased correct assessment of the MLA. Conclusions: Visual assessment of indicating progressively higher plantar shapes corresponded to progressively higher average differences in measured arch heights; nonetheless, there was considerable overlap among the three plantar shapes with 35% of plantar shapes being misclassified compared with measured arch height, especially among individuals with higher BMI.

BACKGROUND: This study examined whether assigning running shoes based on the shape of the bottom of the foot (plantar surface) influenced injury risk in Air Force Basic Military Training (BMT) and examined risk factors for injury in BMT. METHODS: Data were collected from BMT recruits during 2007; analysis took place during 2008. After foot examinations, recruits were randomly consigned to either an experimental group (E, n=1042 men, 375 women) or a control group (C, n=913 men, 346 women). Experimental group recruits were assigned motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. Control group recruits received a stability shoe regardless of plantar shape. Injuries during BMT were determined from outpatient visits provided from the Defense Medical Surveillance System. Other injury risk factors (fitness, smoking, physical activity, prior injury, menstrual history, and demographics) were obtained from a questionnaire, existing databases, or BMT units. RESULTS: Multivariate Cox regression controlling for other risk factors showed little difference in injury risk between the groups among men (hazard ratio E/C.=1.11, 95% CI=0.89-1.38) or women (hazard ratio E/C.=1.20, 95% CI= 0.90-1.60). Independent injury risk factors among both men and women included low aerobic fitness and cigarette smoking. CONCLUSIONS: This prospective study demonstrated that assigning running shoes based on the shape of the plantar surface had little influence on injury risk in BMT even after controlling for other injury risk factors. Language: en

Introduction Military parachuting has been shown to result in injuries. This investigation systematically reviewed studies examining the influence of the parachute ankle brace (PAB) on injuries during military parachuting and performed a cost-effectiveness analysis. Evidence acquisition Parachute ankle brace studies were obtained from seven databases, personal contacts, and other sources. Investigations were reviewed if they contained original, quantitative information on PAB use and injuries during parachuting. Meta-analysis was performed using a general variance-based meta-analysis method that calculated summary risk ratios (SRR) and 95% CIs. Evidence synthesis Five studies met the review criteria. Compared with PAB users, PAB non-users had a higher risk of ankle injuries (SRR=2.1, 95% CI=1.8–2.5); ankle sprains (SRR=2.1, 95% CI=1.4–3.1); ankle fractures (SRR=1.8, 95% CI=1.1–2.9); and all parachuting injuries combined (SRR=1.2, 95% CI=1.1–1.4). The PAB had little effect on lower body injuries exclusive of the ankle (SRR [no PAB/PAB]=0.9, 95% CI=0.7–1.2). Cost-effectiveness analysis estimated that, for every dollar expended on the PAB, a savings of about $7 to $9 could be achieved in medical and personnel costs. Conclusions The PAB reduces ankle injuries by about half and is a cost effective device that should be worn during military airborne operations to reduce injury risk.

INTRODUCTION: This investigation examined risk factors for injuries during military parachute training and solicited attitudes and opinions regarding a parachute ankle brace (PAB) that has been shown to protect against ankle injuries. METHODS: Male Army airborne students (N = 1677) completed a questionnaire after they had successfully executed 4 of the 5 jumps necessary for qualification as a military paratrooper. The questionnaire asked about injuries during parachute descents, demographics, lifestyle characteristics, physical characteristics, physical fitness, airborne recycling (i.e., repeating airborne training because of failure to qualify on a previous attempt), PAB wear, problems with aircraft exits, and injuries in the year before airborne school. A final section of the questionnaire solicited open-ended comments about the PAB. RESULTS: Increased risk of a parachute-related injury occurred among students who had longer time in service, were older, taller, heavier, performed fewer push-ups, ran slower, were airborne recycles, did not wear the PAB, had an aircraft exit problem, and/or reported an injury in the year prior to jump school. Among students who wore the brace, most negative comments about the PAB had to do with design, comfort, and difficulties during parachute landing falls. CONCLUSIONS: This study supported some previously identified injury risk factors (older age, greater body weight, and not using a PAB) and identified a number of new risk factors. To address PAB design and comfort issues, a strap is being added over the dorsum of the foot to better hold the PAB in place. Language: en

INTRODUCTION: This study examined the injury prevention effectiveness of the parachute ankle brace (PAB) while controlling for known extrinsic risk factors. METHODS: Injuries among airborne students who wore the PAB during parachute descents were compared with injuries among those who did not. Injury risk factors from administrative records included wind speed, combat loads, and time of day (day/night). Injuries were collected in the drop zone. RESULTS: A total of 596 injuries occurred in 102,784 parachute descents. In univariate analysis, students not wearing the PAB (Controls) were 2.00 [95% confidence interval (95% CI) = 1.32-3.02] times more likely to experience an ankle sprain, 1.83 (95% CI = 1.04-3.24) times more likely to experience an ankle fracture, and 1.92 (95% CI = 1.38-2.67) times more likely to experience an ankle injury of any type. PAB wearers and Controls had a similar incidence of lower body injuries exclusive of the ankle [risk ratio (Control/PAB) = 0.92, 95% CI = 0.65-1.30]. After accounting for known extrinsic injury risk factors, Controls were 1.90 (95% CI = 1.24-2.90) times more likely than PAB wearers to experience an ankle sprain, 1.47 (95% CI = 0.82- 2.63) times more likely to experience an ankle fracture, and 1.75 (95% CI = 1.25-2.48) times more likely to experience an ankle injury of any type. The incidence of parachute entanglements that persisted until the jumpers reached the ground were similar among PAB wearers and Controls IRR (Control/PAB) = 1.17, 95% CI = 0.61-2.29]. CONCLUSION: After controlling for known injury risk factors, the PAB protected against ankle injuries, and especially ankle sprains, while not influencing parachute entanglements or lower body injuries exclusive of the ankle. Language: en

Objective To examine the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries. Data Sources/Study Setting Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer. Study Design Cox proportional hazard regression is used to estimate the association between time to RTW and receipt of guideline-discordant care. We test the robustness of our findings to an omitted confounding variable. Data Collection Collected by the insurer from the time an injury was reported, through recovery or last follow-up. Principal Findings Receiving guideline-discordant care was associated with slower RTW for only some guidelines. Early receipt of care, and getting less than the recommended amount of care, were correlated with faster RTW. Excessive physical therapy, bracing, and injections were associated with slower RTW. Conclusions There is not a consistent relationship between performance on CPGs and RTW. The association between performance on CPG and RTW is difficult to measure in observational data, because analysts cannot control for omitted variables that affect a patient's treatment and outcomes. CPGs supported by observational studies or randomized trials may have a more certain relationship to health outcomes.

For truck drivers, distracted driving is a workplace behavior that increases occupational injury risk. We propose safety climate as an appropriate lens through which researchers can examine occupational distracted driving.Using a mixed methods study design, we surveyed truck drivers using the Safety Climate Questionnaire (SCQ) complemented by semi-structured interviews of experts on distracted driving and truck safety. Safety climate was assessed by using the entire SCQ as an overall climate score, followed by factor analysis that identified the following safety climate factors: Communications and Procedures; Management Commitment; and Work Pressure.In multivariate regression, the overall safety climate scale was associated with having ever experienced a crash and/or distraction-involved swerving. Interview participants described how these SCQ constructs could affect occupational distracted driving.To reduce distraction-related crashes in their organizations, management can adhere to safe policies and procedures, invest in engineering controls, and develop safer communication procedures.

Objective Safety climate has previously been associated with increasing safe workplace behaviours and decreasing occupational injuries. This study seeks to understand the structural relationship between employees’ perceptions of safety climate, performing a safety behaviour (ie, wearing slip-resistant shoes) and risk of slipping in the setting of limited-service restaurants. Methods At baseline, we surveyed 349 employees at 30 restaurants for their perceptions of their safety training and management commitment to safety as well as demographic data. Safety performance was identified as wearing slip-resistant shoes, as measured by direct observation by the study team. We then prospectively collected participants’ hours worked and number of slips weekly for the next 12 weeks. Using a confirmatory factor analysis, we modelled safety climate as a higher order factor composed of previously identified training and management commitment factors. Results The 349 study participants experienced 1075 slips during the 12-week follow-up. Confirmatory factor analysis supported modelling safety climate as a higher order factor composed of safety training and management commitment. In a structural equation model, safety climate indirectly affected prospective risk of slipping through safety performance, but no direct relationship between safety climate and slips was evident. Conclusions Results suggest that safety climate can reduce workplace slips through performance of a safety behaviour as well as suggesting a potential causal mechanism through which safety climate can reduce workplace injuries. Safety climate can be modelled as a higher order factor composed of safety training and management commitment.

Objective To describe the law enforcement officer (LEO), encounter, perpetrator and victim characteristics of domestic disturbance-related LEO homicides in the USA from 1996 to 2010. Methods Narrative text analysis was conducted on the Federal Bureau of Investigation9s annual report ‘Law Enforcement Officers Killed and Assaulted’. Potential cases were confirmed if the narrative included the term ‘domestic disturbance’ or a domestic disturbance situation was described. Results 116 LEOs were killed while responding to domestic disturbance calls. Ninety-five per cent of these homicides were committed with a firearm. Sixty-seven per cent of LEOs were wearing body armour when killed; however, 52% received the fatal wound to the head/neck. Sixty-one per cent of suspects had a criminal history mentioned within the narratives and perpetrators of intimate partner violence (IPV) were more likely to be killed by LEOs than suspects involved in other forms of domestic violence. Victims of the domestic disturbance were killed in 21% of the IPV-related LEO homicide cases as opposed to only 5% of other domestic disturbance calls. A firearm was the most common weapon used in the murder of a domestic disturbance victim (86%). Conclusions This study describes domestic disturbance-related LEO homicides. Future research in this area should further examine the dangers unique to domestic disturbance calls. A longitudinal analysis could provide greater understanding of the injury and mortality risks faced by LEOs, in order to inform homicide prevention among law enforcement.

Purpose Fourteen US states and the District of Columbia have banned handheld phone use for all drivers. We examined whether such legislation was associated with reduced handheld phone conversations among drivers aged younger than 25 years. Methods Data from the 2008 to 2013 National Occupant Protection Use Survey were merged with states' legislation. The outcome was roadside-observed handheld phone conversation at stop signs or lights. Logistic regression was used. Results A total of 32,784 young drivers were observed. Relative to drivers who were observed in states without a universal handheld phone ban, the adjusted odds ratio of phone conversation was 0.42 (95% confidence interval, 0.33–0.53) for drivers who were observed in states with bans. The relative reduction in phone conversation was 46% (23%, 61%) for laws that were effective less than 1 year, 55% (32%, 70%) for 1–2 years, 63% (51%, 72%) for 2 years or more, relative to no laws. Conclusions Universal handheld phone bans may be effective at reducing handheld phone use among young drivers.

To identify age and gender differences among teen drivers in fatal crashes, we analyzed FARS data for 14,026crashes during 2007-2009. Compared with female teenagers, crashes of male teenagers were significantly more likely to involve BACs of 0.08% or more (21% vs. 12%), speeding (38% vs. 25%), reckless driving (17% vs. 14%), night driving (41% vs. 36%) and felony crashes (hit-and-run, homicide, or manslaughter) (8% vs. 6%) (all χ(2) p0.001). Conversely, crashes of female teenagers were more likely to involve right angle ("t-bone") crashes (23% vs. 17%). Some crash characteristics associated with males and known to play a major role in crash causation also are more common in the youngest teenagers; for example, crashes of drivers age 15 or 16 were more likely than crashes of older teens to involve speeding or reckless driving. Crashes of drivers with BACs of 0.08% or higher increased with age in both genders. Some age effects differed by gender: for example, the proportion of crashes of female teens that involved speeding dropped from 38% to 22% between ages 15 and 19, while for males about 38% of crashes at each age involved speeding. The gender and age differences observed in teen drivers suggest opportunities for targeted driver training - for example, simulator training modules specifically tailored for male or female teenagers. Technology-based tools could also be developed to help parents to focus on the reckless driving tendencies of their sons. Insurance companies should consider ways to incentivize young males to drive more responsibly.

Background A one-year prospective examination of injury rates and injury risk factors was conducted in Federal Bureau of Investigation (FBI) new agent training. Methods Injury incidents were obtained from medical records and injury compensation forms. Potential injury risk factors were acquired from a lifestyle questionnaire and existing data at the FBI Academy. Results A total of 426 men and 105 women participated in the project. Thirty-five percent of men and 42% of women experienced one or more injuries during training. The injury incidence rate was 2.5 and 3.2 injuries/1,000 person-days for men and women, respectively (risk ratio (women/men) = 1.3, 95% confidence interval = 0.9-1.7). The activities most commonly associated with injuries (% of total) were defensive tactics training (58%), physical fitness training (20%), physical fitness testing (5%), and firearms training (3%). Among the men, higher injury risk was associated with older age, slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the physical fitness test (PFT), lower self-rated physical activity, lower frequency of aerobic exercise, a prior upper or lower limb injury, and prior foot or knee pain that limited activity. Among the women higher injury risk was associated with slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the PFT, and prior back pain that limited activity. Conclusion The results of this investigation supported those of a previous retrospective investigation emphasizing that lower fitness and self-reported pain limiting activity were associated with higher injury risk among FBI new agents.

Background A retrospective examination was conducted of injuries, physical fitness, and their association among Federal Bureau of Investigation (FBI) new agent trainees. Methods Injuries and activities associated with injuries were obtained from a review of medical records in the medical clinic that served the new agents. A physical fitness test (PFT) was administered at Weeks 1, 7 and 14 of the 17-week new agent training course. The PFT consisted of push-ups, sit-ups, pull-ups, a 300-meter sprint, and a 1.5-mile run. Injury data were available from 2000 to 2008 and fitness data were available from 2004 to early 2009. Results During the survey period, 37% of men and 44% of women experienced one or more injuries during the new agent training course (risk ratio (women/men) = 1.18, 95% confidence interval = 1.07-1.31). The most common injury diagnoses were musculoskeletal pain (not otherwise specified) (27%), strains (11%), sprains (10%), contusions (9%), and abrasions/lacerations (9%). Activities associated with injury included defensive tactics training (48%), physical fitness training (26%), physical fitness testing (6%), and firearms training (6%). Over a 6-year period, there was little difference in performance of push-ups, sit-ups, pull-ups, or the 300-meter sprint; 1.5-mile run performance was higher in recent years. Among both men and women, higher injury incidence was associated with lower performance on any of the physical fitness measures. Conclusion This investigation documented injury diagnoses, activities associated with injury, and changes in physical fitness, and demonstrated that higher levels of physical fitness were associated with lower injury risk.

Background Footwear characteristics can influence, fatigue, comfort, injuries and energy cost. Members of the United States Army Band have hundreds of performances a year and these performances often include prolonged standing and marching in footwear. Objective The purposes of this paper are to: (1) determine injury rates before and after wearing a shoe with presumed greater cushioning and ventilation among US Army Band members, and (2) identify risk factors associated with foot pain/discomfort. Methods To potentially reduce injuries and improve comfort, 112 band members received shoes with an advertised increase in cushioning and ventilation. Results Injury incidence determined from medical records was 55% in the year before and 57% in the year during which band members wore the new shoes ( p =0.78). Higher risk of foot pain was associated with band unit (odds ratio (OR Ceremonial unit/other units =8.6), 95% confidence interval (CI): 1.2–60.2), shoe cushioning rating (OR poor/good =11.8, 95% CI: 1.5–89.7), orthotic use (OR yes/no =18.5, 95% CI: 2.9–120.3), and how often band members replaced their shoes (OR ≤1 year/>2 years =11.5, 95% CI: 1.4–95.4). Conclusions The new shoes did not lower injury incidence, although specific risk factors associated with foot pain/discomfort were identified. To potentially increase the cushioning and comfort, insoles may be considered.

Popular running magazines and running shoe companies suggest that imprints of the bottom of the feet (plantar shape) can be used as an indication of the height of the medial longitudinal foot arch and that this can be used to select individually appropriate types of running shoes. This study examined whether or not this selection technique influenced injury risk during United States Army Basic Combat Training (BCT). After foot examinations, BCT recruits in an experimental group (E: n = 1,079 men and 451 women) selected motion control, stability, or cushioned shoes for plantar shapes judged to represent low, medium, or high foot arches, respectively. A control group (C: n = 1,068 men and 464 women) received a stability shoe regardless of plantar shape. Injuries during BCT were determined from outpatient medical records. Other previously known injury risk factors (e.g., age, fitness, and smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference in injury risk between the E and C groups among men (risk ratio (E/C) = 1.01; 95% confidence interval = 0.88-1.16; p = 0.87) or women (risk ratio (E/C) = 1.07; 95% confidence interval = 0.91-1.25; p = 0.44). In practical application, this prospective study demonstrated that selecting shoes based on plantar shape had little influence on injury risk in BCT. Thus, if the goal is injury prevention, this selection technique is not necessary in BCT.

Background The rate of fatal injuries for small underground coal mines (≤20 employees) has consistently been greater than the rate at larger mines. Despite differences between small and large mine characteristics, questions remain regarding reasons for the fatality differences. Objective Explore whether small mines operated more intermittently than large mines, to determine if operational instability contributes to fatalities. Methods A case control study using data from the U.S. Mine Safety and Health Administration from 1983 to 2006. Case mines (fatality; n = 139) were identified by the quarter in which a fatality occurred. Control mines (no fatality) were randomly selected (5:1), without replacement, and were matched with case mines if they were operating during the quarter in which the fatality occurred. Student9s matched t-test was used to analyze differences between cases and controls for each of the four quarters prior to the fatality for key factors. Matched logistic regression analyses were also used. Results There were no significant differences between cases and controls in the number of employees, hours per employee, or productivity for any of the four quarters prior to the fatality. Recent periods of low productivity, followed by the addition of new workers and an increase in hours worked, were found to be associated with an increased risk of fatality. Significance Results support the implications of a sudden increase in workforce size, overtime, and workload, presumably, to respond to increased needs for coal. Prevention strategies and policies are needed to address risks from operational instability and excess production.