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Objective: To describe the trends in recreational sports injury in Perth, Western Australia.Design: A prospective cohort study of sports injuries during the 1997 winter season (May to September).Setting: Sample of Australian football, field hockey, basketball, and netball players from the Perth metropolitan area, Western Australia.Methods: A cohort of sports participants was followed over the five month winter sports season. Before the season, participants completed a baseline questionnaire and during the season were interviewed every four weeks by telephone.Results: Overall, 92% of participants (n = 1391) who completed a baseline questionnaire completed at least one follow up telephone interview. About half (51%) of the cohort sustained one or more injuries during the winter season accounting for a total of 1034 injuries. Most injuries were of moderate (58%, n = 598) or minor (40%, n = 412) severity, with only 3% (n = 24) requiring emergency department treatment or a hospital stay. The injury incidence rate was greatest for football (20.3/1000 hours of participation), similar for field hockey and basketball (15.2/1000 hours and 15.1/1000 hours respectively), and lowest for netball (12.1/1000 hours). The incidence of injury was greatest in the first four weeks of the season, and participants aged between 26 and 30 years had about a 55% greater risk of injury than those aged less than 18 years.Conclusions: This is one of the first studies to show that recreational sports are safe. Although the likelihood of injury was greatest in the first month of the season, few injuries required admission to hospital or emergency department treatment. A greater emphasis on prevention in the early part of the season should help to reduce the elevated incidence of injury found at this time. [ABSTRACT FROM AUTHOR]

Objectives. This study was conducted to estimate (1) the proportion of U.S. homes with installed smoke alarms and fire escape plans, and (2) the frequency of testing home smoke alarms and of practicing the fire escape plans.Methods. The authors analyzed data on smoke alarms and fire escape plans from a national cross-sectional random-digit dialed telephone survey of 9,684 households.Results. Ninety-five percent of surveyed households reported at least one installed smoke alarm and 52% had a fire escape plan. The prevalence of alarms varied by educational level, income, and the presence of a child in the home. Only 15% tested their alarms once a month and only 16% of homes with an escape plan reported practicing it every six months.Conclusion. While smoke alarm prevalence in U.S. homes is high, only half of homes have a fire escape plan. Additional emphasis is needed on testing of installed smoke alarms and on preparedness for fire escape plans. [ABSTRACT FROM AUTHOR]

Hopelessness is associated with suicide. Hopelessness has been associated with life experiences, social-environmental, and biological factors. Racial differences exist in these factors and in coping behaviors. Better understanding racial differences in hopelessness and suicide may result in more effective interventions to slow the increasing Black American suicide rate. Data from a case-control study of nearly lethal suicide attempters were analyzed. Interaction results from logistic regression suggest that the effect of hopelessness on a nearly lethal suicide attempt may differ for Black and White Americans. Hopelessness was strongly associated with a nearly lethal suicide attempt for Blacks and Whites, but the odds were greater for Blacks than Whites. Interventions may need to be adjusted to address the difference. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Most surveillance and research efforts focus on severe violence, especially on homicides. Because less extreme forms of violence may be precursors to more extreme forms, the authors analyzed data from a national survey to describe the extent of nonfatal physical violence in the US. METHODS: The authors generated weighted national estimates from responses to a random-digit-dialed telephone survey. Respondents were asked if they had been 'hit, slapped, pushed, or kicked by another person or hit with an object or weapon' in the preceding 12 months. Respondents were also asked how many times such incidents had occurred and, for the last such episode, their relationship with the perpetrator, whether they had been injured, and, if so, whether they had sought medical treatment. RESULTS: The authors estimate that approximately 15 million people, or 8% of the US adult population, experienced nonfatal physical violence, as defined for this study, during a 12-month period. Male gender, the 18-24-year-old age group, never having been married, being out of work or a student, and heavy drinking were associated with a higher likelihood of being assaulted. An estimated 75% of assaults were by a known person and 26% by a stranger. Women were more likely than men to be assaulted by current or former intimate partners; men were more likely than women to be assaulted by strangers. An estimated 18% of incidents resulted in injuries, and an estimated 7% required medical attention. CONCLUSIONS: Nonfatal physical violence is fairly common in the US and may lead to more than one million medical encounters each year. [ABSTRACT FROM AUTHOR]

Objectives. This study was designed to estimate the percentage of young children in the United States who have been tested for lead and the percentage of dwellings in the United States in which the paint has been tested for lead. Methods. A national random digit dial telephone survey of 5238 households was conducted in 1994. Weighted national estimates and 95% confidence intervals for outcomes of interest were calculated. Results. About 24% of U.S. children ages 0 to 6 years were estimated to have been tested for lead. Higher rates of testing were reported for children living in homes constructed prior to 1960, those living in homes with low household income, those living in rental units, and those living in the Northeast. Lead paint testing was performed for only an estimated 9% of U.S. housing units. Older homes were not more likely to have been tested than newer ones. Conclusion. A high proportion of pre-school children have apparently not been screened for lead exposure, even among subgroups at increased risk. Most dwellings of pre-school children have not been tested for lead paint. These data suggest that most at-risk children are not being reached by current approaches to lead poisoning prevention. [ABSTRACT FROM AUTHOR]

The article looks at the U.S. Centers for Disease Control and Prevention's statistics on injuries and fatalities from falls among older people. According to the article, falls in older adults can lead to disability, nursing-home admission, increased medical costs, and death. The article discusses the rates of fatal falls, hospitalizations for hip fractures, and nonfatal fall injuries. During the time periods examined it was found that rates of falls resulting in death were highest in men and whites.

OBJECTIVES: The purpose of this work was to provide recent national prevalence estimates of pediatric injury-prevention counseling by health care providers, to compare these latest findings with those from a similar survey conducted in 1994, and to ascertain the association between counseling and safety behaviors. METHODS: We conducted a cross-sectional, list-assisted random-digit-dial telephone survey of randomly selected children in English- or Spanish-speaking households in all 50 US states and the District of Columbia. The main outcome measures were respondents' reports that they or their children received injury-prevention counseling from their child's health care provider in the 12 months preceding the interview, children's practices of safety behaviors, and the association of injury-prevention counseling and such behaviors. RESULTS: The overall proportion of US children receiving any injury-prevention counseling (42.4%) remained relatively unchanged, whereas counseling on selected injury-prevention topics increased significantly compared with reports based on the 1994 survey. Topic-specific injury-prevention counseling was positively associated with the posting of the poison control center telephone number in homes with children <6 years of age and with bicycle-helmet use among children 5 to 14 years of age. CONCLUSIONS: Although the prevalence of pediatric injury-prevention counseling remains low, such counseling was associated with safer behaviors. This suggests the importance of pediatric injury-prevention counseling and indicates the need for health care providers to increase pediatric injury-prevention counseling in clinical practices. [ABSTRACT FROM AUTHOR]

A letter to the editor retracting data printed in the article "Suicide after natural disasters," by E. G. Krug et al., in the February 5, 1998 issue.

In spring 1999, the authors evaluated the effectiveness of a 1997 Florida law requiring helmet use by all bicyclists younger than age 16 years. Sixty-four counties in Florida had enacted the bicycle helmet-use law, while the other three counties had opted out. Using a cross-sectional study design, the authors conducted unobtrusive observations at bicycle racks at public elementary schools statewide. Florida children riding bicycles in counties where the state helmet-use law was in place were twice as likely to wear helmets as children in counties without the law. In counties where the state law was in place, 16,907 (79%) of 21,313 riders observed wore a helmet, compared with only 148 (33%) of 450 riders in counties where no such law was in place (crude prevalence ratio = 2.4, 95% confidence interval: 2.1, 2.8). Helmet use by children of all racial groups exceeded 60% under the law. No significant difference in use by gender was found. These data support the positive influence of a law on bicycle helmet use among children. The data reinforce the Healthy People 2010 objective that all 50 states adopt such a law for children in order to increase helmet use and consequently reduce brain injury.

This study sought to determine the association between nearly lethal suicide attempts and exposure to the suicidal behavior of parents, relatives, friends, or acquaintances and to accounts of suicide in the media. The authors conducted a population-based case-control study in Houston, Texas, from November 1992 through July 1995. They interviewed 153 victims of attempted suicide aged 13--34 years who had been treated at emergency departments in Houston and a random sample of 513 control subjects. After controlling for potentially confounding variables, the authors found that exposure to the suicidal behavior of a parent (adjusted OR = 1.5; 95% CI: 0.6, 3.6; p = 0.42) or a nonparent relative (adjusted OR = 1.2; 95% CI: 0.7, 2.0; p = 0.55) was not significantly associated with nearly lethal suicide attempts. Both exposure to the suicidal behavior of a friend or acquaintance (adjusted OR = 0.6; 95% CI: 0.4, 1.0; p = 0.05) and exposure to accounts of suicidal behavior in the media (adjusted OR = 0.2; 95% CI: 0.1, 0.3; p = 0.00) were associated with a lower risk of nearly lethal suicide attempts. Exposure to accounts of suicidal behavior in the media and, to a lesser extent, exposure to the suicidal behavior of friends or acquaintances may be protective for nearly lethal suicide attempts, but further research is needed to better understand the mechanisms underlying these findings.

In case-control studies, determination of alcohol consumption by cases immediately prior to the injury event is often conceptually straightforward. However, determination of consumption status by controls is difficult because they lack a reference point, especially when cases and controls are not individually matched. We describe a method of assigning alcohol consumption status to controls using a 24-hour drinking history, the distribution in time of case events, and the random assignment of a specific time period to each control subject. This methodology offers a practical approach for determining alcohol consumption status among control subjects immediately prior to a case event, when controls lack a reference point and have not been individually matched to cases. Published in 2001 by John Wiley & Sons, Ltd.

Teenagers and young adults are very mobile and mobility has been identified as a potential risk factor for suicidal behavior. We conducted a population-based, case-control study of nearly lethal suicide attempts with 153 cases and 513 controls. Study participants were asked about changing residence over the past 12 months. Results indicate that moving in the past 12 months is positively associated with a nearly lethal suicide attempt (adjusted odds ratio of 2.1, with 95% confidence interval of 1.4-3.3), as are specific characteristics of the move (e.g., frequency, recency, distance, and difficulty staying in touch). These findings confirm and extend prior ecologic research by demonstrating a relationship, at the individual level, between the geographic mobility of adolescents and young adults and nearly lethal suicide attempts.

We conducted a case-control study of the association between nearly lethal suicide attempts and facets of alcohol consumption; namely, drinking frequency, drinking quantity, binge drinking, alcoholism, drinking within 3 hours of suicide attempt, and age began drinking. Subjects were 13-34 years of age. In bivariable analyses, all measures were associated with nearly lethal suicide attempts. Odds ratios ranged from 2.4 for alcoholism to 7.0 for drinking within 3 hours of attempt. All exposure variables except age began drinking exhibited a J-shaped relationship between alcohol exposure and nearly lethal suicide attempt. After controlling for potential confounders and other measures of alcohol exposure, drinking within 3 hours of attempt remained most strongly (odds ratios > 6) associated. Alcoholism remained significantly associated in most models, but at lower strength.

The association between help-seeking and nearly lethal suicide attempts was evaluated using data from a population-based, case-control study of 153 13- to 34-year-old suicide attempt case-patients treated at emergency departments in Houston, Texas, and a random sample of 513 control-subjects. Measures of help-seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case-patients were less likely than control-subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3-0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95%CI = 0.29-0.8). Among those who sought help, case-patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2-5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2-43.2). Our findings suggest that efforts to better understand the role of help-seeking in suicide prevention, including help sought from family and friends, deserves further attention.

Physical illness has been studied as a risk factor for suicidal behavior, but little is known about this relationship among younger persons. We conducted a population-based, case-control study in Houston, Texas, from November 1992 through September 1995. The final sample consisted of 153 case- and 513 control-subjects aged 13 to 34 years. Case patients were identified at hospital emergency departments and met criteria for a nearly lethal suicide attempt. Control subjects were recruited via a random-digit-dial telephone survey. Case patients were more likely than controls to report having any serious medical conditions (crude OR = 3.23; 95% CI = 2.12-4.91). After controlling for age, race/ethnicity, alcoholism, depression, and hopelessness, the adjusted odds ratio for men was 4.76 (95% CI = 1.87-12.17), whereas the adjusted odds ratio for women was 1.60 (95% CI-0.62-4.17), suggesting that young men with medical conditions are at increased risk for nearly lethal suicide attempts. Increased efforts to identify and appropriately refer these patients are needed.

Suicide attempts often are impulsive, yet little is known about the characteristics of impulsive suicide. We examined impulsive suicide attempts within a population-based, case-control study of nearly lethal suicide attempts among people 13-34 years of age. Attempts were considered impulsive if the respondent reported spending less than 5 minutes between the decision to attempt suicide and the actual attempt. Among the 153 case-subjects, 24% attempted impulsively. Impulsive attempts were more likely among those who had been in a physical fight and less likely among those who were depressed. Relative to control subjects, male sex, fighting, and hopelessness distinguished impulsive cases but depression did not. Our findings suggest that inadequate control of aggressive impulses might be a greater indicator of risk for impulsive suicide attempts than depression.

This article details the research methods and measurements used in conducting a population-based, case-control study of nearly lethal suicide attempts among persons aged 13-34 years, residing in Houston, Texas. From November 1992 to July 1995, we interviewed 153 case subjects presenting at one of three participating hospital emergency departments and used random digit dialing to identify 513 control subjects residing in the same catchment area in which cases were enlisted. Unlike most research in this area, this study was designed to extend our understanding of suicidal behavior and prevention activities beyond identification and treatment of depression and other mental illnesses. We discuss the overall strengths and weaknesses of our study design and conclude that this methodology is well suited for studying rare outcomes such as nearly lethal suicide.

Study Objective: To characterize differences in the lethality of firearm-related injuries in selected demographic subgroups using national representative data on fatal and nonfatal firearm-related injuries. We also characterize the lethality of firearm-related injuries by intent of injury and anatomic location of the gunshot wound., Methods: We analyzed case-fatality rates (CFRs) of firearm-related injuries in the United States by using death data from the National Vital Statistics System and data on nonfatal injuries treated in US hospital emergency departments from the National Electronic Injury Surveillance System. National estimates of crude and age-adjusted CFRs are presented by sex, race/ethnicity, age, intent, and primary body part affected., Results: Each year during the study period (July 1992 through December 1995), an estimated 132,687 persons sustained gunshot wounds that resulted in death or treatment in an ED. The overall age-adjusted CFR among persons who sustained firearm-related injuries was 31.7% (95% confidence interval [CI] 27.7 to 35.6). The age-adjusted CFR for persons who were alive when they arrived for treatment in an ED (11. 3%; 95% CI 9.4 to 13.2) was about one third as large as the overall CFR. The age-adjusted CFR varied by sex, race/ethnicity, and age, but these differences depended on intent of injury. For assaultive injuries, the age-adjusted CFR was 1.4 times higher for females (28. 7%) than males (20.6%). For intentionally self-inflicted injuries, the age-adjusted CFR was 1.1 higher for males (77.7%) than females (69.1%). For assaults, the age-adjusted CFR was 1.5 times higher for whites (29.5%) than blacks (19.2%). For assaultive and intentionally self-inflicted injuries among persons 15 years and older, the age-specific CFR increased with age. Persons shot in the head (age-adjusted CFR, 61.0%) were 3.3 times as likely to die as those shot in other body parts (age-adjusted CFR, 18.7%)., Conclusion: The lethality of firearm-related injuries was influenced strongly by the intent of injury and body part affected. The high lethality of firearm-related injuries relative to other major causes of injury emphasizes the need to continue prevention efforts and efforts to improve access to care and treatment (including emergency medical and acute care services) to reduce the number and increase survivability of firearm-related injuries.

Problem/condition: Injuries and violence are major causes of disability and death among adults aged > or =65 years in the United States. Injuries impair older adults' quality of life and result in billions of dollars in health-care expenditures each year., Reporting Period: This report reviews 1987-1996 data regarding fall-related deaths, 1988-1996 data on hospitalizations for hip fracture, 1990-1997 data regarding motor vehicle-related injuries, 1990-1996 data on suicides, and 1987-1996 data on homicides., Description of Systems: Data on fall-related deaths, suicides, and homicides are from the National Center for Health Statistics annual mortality data tapes for 1987-1996. Homicide data are supplemented with information from the Federal Bureau of Investigation's Supplemental Homicide Reports for 1987-1996. Data on hospitalizations for hip fracture are from the 1988-1996 National Hospital Discharge Surveys. Information regarding motor vehicle-related injuries for 1990-1997 is from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and General Estimates System., Results: Rates of fall-related deaths for older adults increased sharply with advancing age and were consistently higher among men in all age categories. Men were 22% more likely than women to sustain fatal falls. A trend of increasing rates of fall-related deaths was observed from 1987 through 1996 in the United States, although rates were consistently lower for women throughout this period. Rates of hospitalizations for hip fracture differed by age and were higher for white women than for other groups. Rates increased with advancing age for both sexes but were consistently higher for women in all age categories. U.S. hospitalization rates for hip fracture increased for women from 1988 through 1996 while the rates for men remained stable. Rates of motor vehicle-related injuries increased slightly from 1990 through 1997, and marked variations in state-specific death rates were observed; in most states, older men had death rates approximately twice those for older women. Although suicide rates remain higher among older adults than among any other age group, rates of suicide among adults aged > or =65 years decreased 16% during the study period. Suicide rates among older adults varied by sex and age group. Homicide rates declined 36% among older adults. Homicide rates were highest for black men, followed by black women and white men; the homicide risk for blacks relative to whites decreased from 4.8 to 3.9 per 100,000 persons, indicating that the gap between rates for blacks and whites is closing. Half of the older homicide victims were killed by someone they knew., Interpretation: The increase in rates of fall-related deaths and hip fracture hospitalizations from 1988 through 1996 might reflect a change in the proportion of adults aged > or =85 years compared with those aged 65-84 years - a change that results, in part, from reduced mortality from cardiovascular and other chronic diseases. Fall-related death rates might be higher among older men because they often have a higher prevalence of comorbid conditions than women of similar age. Racial differences in hospitalization rates might have some underlying biologic basis; the prevalence of osteoporosis, a condition that contributes to reduced bone mass and increased bone fragility, is greatest among older white women. Compared with whites aged > or =65 years, blacks of comparable ages have greater bone mass and are less likely to sustain fall-related hip fractures. Additional studies are needed to determine why rates of motor vehicle-related injury have increased slightly among older adults and why these rates vary by state. Declining rates of suicide among older adults might be related to changes in the effect or type of risk factors traditionally observed in this age group. Research is needed to identify reasons for variations in suicide rates among older persons. Homicides among olde

Background: Because injuries are the leading cause of death in children, injury prevention counseling is recommended as part of routine pediatric care. Increasing such counseling is a national health objective. Estimating the proportion of US children who receive such counseling and assessing their compliance with safety recommendations may help improve counseling efforts., Methods: Respondents to a 1994 random digit-dial telephone survey of the US population were asked about receipt of age-appropriate injury prevention counseling at a medical visit and related safety practices for a randomly selected child 0 to 14 years of age in the household (N = 1596)., Results: Receiving any injury prevention counseling was reported for 39.3% of children 0 to 14 years old who had a medical visit in the past year and was more common among children who were younger, lived in urban areas, and lived in poverty. In general, receiving counseling was associated with safer behaviors. Counseling about ipecac was reported for 17.2% of children 0 to 6 years old; having ipecac in the home was more likely for those counseled (73.4% vs 32.0%). Counseling about posting the poison control number was reported for 24.9% of children 0 to 6 years old; posting this number was more common among those counseled (79.3% vs 52.6%). Counseling about bicycle helmets was reported for 18.6% of children 5 to 14 years old; a report of always wearing a helmet was more common among those counseled (43.9% vs 19.1%). Counseling about car seats and safety belts was reported for 25.4% of children 0 to 14 years old; a report of always using occupant restraints was more common among those counseled (89.0% vs 78.2%)., Conclusions: Injury prevention counseling is associated with reported preventive safety practices among US children, but a relatively small proportion of households with young children report receiving such counseling. Health care providers should increase efforts to provide injury prevention counseling. counseling, wounds and injuries, child, accident prevention.

Study Objective: To characterize trends in annual estimates of nonfatal firearm-related injuries treated in US hospital emergency departments and to compare trends in quarterly rates of such injuries with those of firearm-related fatalities in the US population., Methods: Data on nonfatal firearm-related injuries were obtained from the National Electronic Injury Surveillance System (NEISS) by review of medical records for June 1, 1992, through May 31, 1995. Data on firearm-related fatalities were obtained from the National Vital Statistics System for January 1, 1985, through December 31, 1995. NEISS comprises 91 hospitals that represent a stratified probability sample of all hospitals in the United States and its territories that have at least six beds and provide 24-hour emergency service. The main outcome measures were numbers, percentages, and quarterly population rates for nonfatal and fatal firearm-related injuries., Results: An estimated 288,538 nonfatal firearm-related injuries (95% confidence interval [CI], 169,776 to 407,300) were treated in EDs during the 3-year study period. The annual number of non-fatal firearm-related injuries increased from 99,025 for June 1992 through May 1993 (95% CI, 58,266 to 139,784) to 101,669 for June 1993 through May 1994 (95% CI, 59,822 to 143,516), then decreased to 87,844 for June 1994 through May 1995 (95% CI, 51,687 to 124,001). Before the third quarter of 1993, quarterly nonfatal and fatal firearm-related injury rates in the total US population and quarterly nonfatal firearm assaultive injury and firearm homicide rates for males aged 15 to 24 years were observed to be on the rise. Since then, these rates have significantly declined., Conclusion: Analysis of national trends indicates that non-fatal and fatal firearm-related injuries are declining in the United States, although the rate of firearm-related deaths remains high, especially among males aged 15 to 24 years, in relation to other leading causes of injury death. An assessment of factors responsible for the decline in firearm-related injuries is needed to design further prevention efforts.

The Self-Inflicted Injury Severity Form (SIISF) was developed as an epidemiological research tool for identifying individuals in hospital emergency departments who have life-threatening self-inflicted injuries. Data were collected from 715 patients with self-inflicted injuries in two large hospitals. In 295 of these cases, a second set of data was independently collected for assessment of interrater reliability. Validity was assessed by comparing the SIISF results with simultaneously collected Risk-Rescue Ratings. Assessment of interrater reliability found that only 2.4% of physicians disagreed on the suicide method used. The kappa statistic for method used was .94, indicating excellent agreement. The SIISF was found to distinguish between severe and less severe injuries. Thus, it appears to provide a simple method to distinguish patients who have life-threatening self-inflicted injuries.

This study estimates bicycle helmet use among adults in the United States, examines factors associated with helmet use among adult bicyclists in 1994, and examines other safety-related practices. A telephone survey of 5238 randomly dialed households in the United States was conducted. The participants were randomly selected adult (aged > or = 18 years) respondents, and the main outcome measure was bicycle riding and helmet use in the last 30 days. We estimate that 20.2% of adults reported riding a bicycle in the 30 days preceding their interview. Of the bicyclists, 18.3% report they always wear their helmet when bicycling. Persons between the ages of 18 and 24 years had the highest proportion of bicycle riders for any adult age group (31.3%) but reported using helmets less than any other adult age group (5.1%). In univariate and multivariate analyses, age older than 24 years, female sex, higher educational level, and living in the west or northeast region of the country were associated with helmet use among adults. Helmet users were also more likely than nonusers to report a higher prevalence of other safety behaviors (ie, always wearing a safety belt, having a smoke detector in the house, and having a fire escape plan). Further efforts to increase the wearing of bicycle helmets by adults are necessary to meet the year 2000 objective of 50% helmet use. Adults should be targeted for increased helmet promotion efforts, especially those between the ages of 18 and 24 years. Increasing consistent use of helmets among adults may also help increase consistent use of helmets among children through role modeling.

Objective: To evaluate the effect of a state law on reported bicycle helmet ownership and use., Design: Multistage cluster random-digit-dialing telephone survey., Setting: Georgia, June through November 1993., Participants: Adults who reported the behavior of bicyclists 4 through 15 years old., Intervention: State law mandating helmet use after July 1, 1993, for all bicyclists aged younger than 16 years., Main Outcome Measures: Bicycle helmet ownership and use., Results: Reported helmet ownership increased from 39% before the law took effect to 57% afterward (+ 46%, P = .06). Reported use increased from 33% before to 52% afterward (+ 58%, P < .05). About 7% of riders changed from "never-wearing" to "always-wearing" behavior. After the law took effect, in those households in which the law was known, 69% of riders owned and 64% used a helmet. By comparison, in those households in which the law was not known, only 30% owned and 25% used a helmet (P < .01). Reported ownership and use were 93% concordant, inversely related to rider age, and directly related to household income. Multivariable analysis indicated that race was an effect modifier of reported helmet ownership and use. In black riders, knowledge of the law appeared to be highly associated with both reported helmet ownership and use but was not significant in white riders. In white riders, though age and income were significantly associated with reported helmet ownership and use., Conclusions: This law appeared important in increasing reported helmet ownership and use, particularly in black riders. Since knowledge of the law was associated with increased ownership and use, additional publicity about the law might further increase helmet use. Because most riders who owned helmets used them, give-away programs targeting areas of low ownership may also increase use.

Objectives: To conduct the first nationwide investigation of violent deaths associated with schools in the United States, to quantify the risk of school-associated violent death, and to identify epidemiologic features of these deaths., Design: Descriptive case series., Setting: United States, July 1, 1992, through June 30, 1994., Methods: School-associated violent deaths were identified by study collaborators and through 2 online news databases. Police reports, medical examiners' records, and interviews with police and school officials provided detailed information about each case., Results: In a 2-year period, 105 school-associated violent deaths were identified. The estimated incidence of school-associated violent death was 0.09 per 100 000 student-years. Students in secondary schools, students of minority racial and ethnic backgrounds, and students in urban school districts had higher levels of risk. The deaths occurred in communities of all sizes in 25 different states. Homicide was the predominant cause of death (n = 85 [80.9%]), and firearms were responsible for a majority (n = 81 [77.1%]) of the deaths. Most victims were students (n = 76 [72.4%]). Both victims and offenders tended to be young (median ages, 16 and 17 years, respectively) and male (82.9% and 95.6%, respectively). Approximately equal numbers of deaths occurred inside school buildings (n = 31 [29.5%]), outdoors but on school property (n = 37 [35.2%]), and at off-campus locations while the victim was in transit to or from school (n = 37 [35.2%]). Equal numbers of deaths occurred during classes or other school activities (n = 46 [43.8%]) and before or after official school activities (n = 46 [43.8%])., Conclusions: School-associated violent deaths were more common than previously estimated. The epidemiologic features of these deaths were similar to those of homicides and suicides that occur elsewhere. A comprehensive approach that addresses violent injury and death among young people at school and elsewhere in the community is suggested.

Objectives: To measure the incidence of playground fall injuries among children attending licensed US day care centers and to evaluate how injury incidence varies with center characteristics and with the regulatory and enforcement climate in which centers operate., Design: Telephone surveys of directors of day care centers and enforcement agencies and review of written day care regulations., Setting: Probability sample of licensed day care centers in 50 states and the District of Columbia., Participants: Children attending day care centers with playgrounds., Main Outcome Measures: Medically attended playground fall injuries., Results: Among the 1740 day care centers studied, a weighted total of 89.2 injuries occurred during the 2-month study period (0.25/100,000 child-hours in day care). The most important risk factor for injury was height of the tallest piece of climbing equipment on the playground in both bivariate (P = .01) and multivariate (P = .02) analyses. Neither regulations addressing playground safety or playground surfaces nor enforcement patterns were associated with lower injury rates., Conclusions: Additional effort is needed to develop and evaluate regulations and enforcement that reduce injury risks for children while minimizing burden on day care centers. In the meantime, limiting climbing equipment heights may reduce playground injury rates.

Most of the nearly 1,000 fatal bicycle-related injuries annually could be prevented if riders used safety helmets. Helmet use by adult bicyclists has received relatively little attention because educational campaigns to promote helmet use generally focus on children. Helmet use by adult and child bicyclists at 120 suburban and rural sites in three Maryland counties was observed on two Saturdays in 1990-91 during an evaluation of the impact of a mandatory helmet law. Concordance or discordance of helmet use within various groups of bicyclists--adults only, adults with children, and children only--was recorded. Helmet use among 2,068 adult bicyclists was 49 percent, 51 percent, and 74 percent in the three counties. In two counties combined, 52 percent (365 of 706) of solo adult bicyclists wore helmets compared with only 5 percent (5 of 94) of solo child bicyclists (P < .001). Helmet use or nonuse was concordant among 87 percent of 277 adult-adult pairs, 94 percent of 50 child-child pairs, and 91 percent of 32 adult-child pairs of bicyclists observed. Concordance rates of helmet use or nonuse were similarly high among pairs of adult bicyclists of the same or mixed sexes. These data are consistent with the concept that both adults and children tend to adopt the helmet-wearing behaviors of their companions. Public health efforts focused on adults should encourage helmet use by adult bicyclists both to prevent head injuries and to provide a role model for children.

Although bicycle helmets are effective in preventing head injuries, use of helmets among children remains infrequent. In response to the bicycling deaths of two children, Howard County, Maryland, became the first US jurisdiction to mandate use of bicycle helmets for children. Schoolchildren were lectured by police about the law before its enactment. Prelaw and postlaw helmet use was observed in Howard County and two control counties: Montgomery (which sponsored a community education program) and Baltimore County (no helmet activities). Prelaw crude helmet use rates for children were 4% (95% confidence interval [CI] 0% to 10%) for Howard, 8% (95% CI 3% to 13%) for Montgomery, and 19% (95% CI 5% to 33%) for Baltimore. Postlaw rates were 47% (95% CI 32% to 62%), 19% (95% CI 11% to 27%), and 4% (95% CI 0 to 11%), respectively. The rate of bicycle helmet use by Howard County children is now the highest documented for US children. A similar increase in helmet use among children younger than 16 years nationwide could prevent about 100 deaths and 56,000 emergency-department-treated head injuries annually. Physicians and other health professionals should consider proposing and supporting the Howard County approach in their communities.

Family physicians in Vermont were surveyed to assess their attitudes and practices concerning the provision of dietary and nutritional advice to their patients. The response rate was 82%. Ninety-six percent of respondents considered that nutrition counseling was their responsibility, and the attitudes and beliefs of most of them concurred with the presently accepted relationships between diet and coronary artery disease. Sixty-five percent of respondents reported making dietary recommendations to less than 40% of their nondiabetic patients under the age of 40. Only 27% of respondents routinely took a dietary history, but those who did were significantly more likely to counsel a larger proportion of their patients than those who did not. Serum cholesterol was reported as being measured in about 35% of adults, and the average level of serum cholesterol at which dietary advice would be given was 237 +/- 15 mg/dL. Most reasons for not giving dietary advice were related to the physician's perception that the patient was not at risk for a diet-related disease. Perceived patient lack of interest and lack of compliance were also important reasons, but lacking time or not being reimbursed were much less frequently cited, although adequate financial reimbursement for giving such advice was considered a moderate or major problem by 45% of family physicians.

As part of an epidemiologic study of the health status of a randomly selected group of Vietnam veterans, we measured the semen characteristics of 324 Vietnam veterans and compared them with a similar group of 247 veterans who did not serve in Vietnam. The participation rate was 81% in both groups. Measurements of sperm concentration, movement characteristics, and head dimensions were performed, using the Cellsoft computer-assisted semen analysis system. We found that Vietnam veterans had significantly (p less than 0.05) lowered mean sperm concentrations (64.8 x 10(6) sperm/mL for Vietnam veterans vs 79.8 x 10(6) sperm/mL for non-Vietnam veterans), and Vietnam veterans were twice as likely to have sperm concentrations less than or equal to 20 million/mL (odds ratio = 2.7, 95% confidence interval = 1.3-5.7). Vietnam veterans also had a significantly lowered mean proportion of morphologically normal sperm heads (57.9% vs 60.8%), with significantly longer mean major axis length and head circumference. The proportion of motile cells, velocity, linearity, amplitude of lateral head displacement, and beat frequency were not different between the two groups. Despite differences in sperm characteristics, Vietnam and non-Vietnam veterans reported fathering similar numbers of children.