Social cognitive determinants of the intention to wear safety gear among adult in-line skaters

Introduction

In-line skating is increasing in popularity with a concomitant raise in the number of injuries associated with this activity. Studies have emphasized the value of protective gears in reducing the incidence of injuries and the subsequent need to identify the factors and processes involved in decision making about safety gear-wearing. The present study examined the contribution of the theory of planned behaviour (TPB) variables, and perceived susceptibility to and perceived severity of skating injury on the safety gear-wearing intention of adult skaters.

Methods

Skaters (n = 181) completed a questionnaire assessing the constructs of the TPB, perceived susceptibility to and perceived severity of skating injuries, and intention to wear safety gear.

Results

Hierarchical regression analyses revealed significant contributions of instrumental attitude and subjective norm to the prediction of safety gear-wearing intention. In addition, perceived susceptibility to and perceived severity of injuries enhanced the prediction of intentions to wear safety gear over and above the contribution of TPB components.

Conclusion

As the TPB focuses only on behavioural evaluation, it seems promising to include threat perceptions in this theory as another aspect of health-related cognitions motivating intention formation about safety gear use. Practical implications for future campaigns and countermeasures are discussed.     

Psychosocial factors related to parental restraint of pre-school children in motor vehicles

While the use of safety restraints effectively reduces the risk of death or injury in accidents, many children still travel unrestrained in motor vehicles. Compulsory seat belt legislation in Australia increased rates of adult use dramatically, but did not have the same impact with children. In order to understand why levels of children's restraint use remain low, it is necessary to investigate parental factors related to use and non-use of restraints. This study assessed the rates of safety restraint use of parents and their pre-school children, and the sociodemographic, attitudinal and belief characteristics of parents which relate to children's restraint use, using the Health Belief Model as a basis for investigation. Restraint use for adults was substantially higher than for pre-school children. Children were more likely to be restrained if their parents were wearing seat belts, were married, were of high socioeconomic status, did not smoke, engaged in certain other preventive health behaviors on their children's behalf, traveled longer distances to pre-school and provided child seats for their children. In terms of the Health Belief Model, parents of restrained and unrestrained children differed in their evaluation of the "costs" and "benefits" of using restraints for their children, and in health locus of control. Parents of unrestrained children perceived the "costs" of restraint use, in terms of nuisance value, installation difficulty and financial cost, to be high. They were also less likely to believe that they could play a significant role in preventing injury to their children. Implications of these findings for safety restraint campaigns are discussed.     

Injuries associated with inline skating in the European region.

OBJECTIVES: To gain greater awareness and understanding of the circumstances leading to injuries associated with inline skating and to provide indices for determining preventive measures. METHODS: Data on injuries during inline skating were collected from seven member states of the European Union (EU) through the European Home and Leisure Accident Surveillance System (EHLASS). RESULTS: The mean incidence rate for injuries while inline skating is 17 per 100,000 inhabitants. In the EU in 1996, about 65,000 people were treated at an Emergency Department for an inline skate injury (excluding traffic injuries). About 60% of the victims are male, while the age group most at risk is 10-14 years old. Most injuries are due to a fall and wrist injuries are most common. CONCLUSIONS: The results of the analysis give indications for possible preventive measures. Although the features of the injuries often differ per country, the countries can learn from each other in preventing these types of injuries. Educational campaigns should be targeted at young teenagers, use of protective equipment (like wrist protectors) and skating techniques. EHLASS has potential for intercountry comparisons, but its value will improve if selecting hospitals and coding agreements will be standardised.     

The effect of seat belts on minor and severe injuries measured on the abbreviated injury scale

Following the implementation of seat belt wearing legislation in Victoria in December 1970, the Royal Australasian College of Surgeons established a survey to collect detailed injury and crash data from car accidents in that State. An analysis of the effect of seat belt wearing on severe injuries sustained by car occupants during the first two years of the survey was reported by Cameron and Nelson[1977]. Minor injuries were ignored in that analysis. Further work extended the file to cover 8537 occupants injured during the first three years of the survey and the injuries (including minor injuries) were coded on the Abbreviated Injury Scale. This paper examines the effect of seat belt wearing on both minor and severe injuries. Some comparisons of injury severity distributions in the Victorian data and in data collected by North American MDAI teams are also made. The paper concludes that the wearing of static three-point lap/sash belts by front outboard seat occupants of cars and car derivatives is associated with: (a) Reduced likelihood of severe-to-fatal injury to the head-face, thorax, lower torso and lower extremities when injured and not ejected in crashes in built-up areas and, for some body regions, in open road crashes, (b) Increased likelihood of minor injury to the thorax and lower torso when injured and not ejected in crashes in all locations and of minor injury to the neck (i.e. whiplash) when injured and not ejected in crashes in built-up areas. There are suggestions that the increased likelihoods of the minor injuries are not artefacts of the injury criterion for inclusion, nor of the reduced likelihood of severe injury to the trunk when seat belts are worn, but are due to the wearing of the seat belt.     

Understanding children's injury-risk behavior: wearing safety gear can lead to increased risk taking

The present study examined whether school-age children show risk compensation and engage in greater risk taking when wearing safety gear compared to when not doing so when running an obstacle course containing hazards that could lead to physical injury. Because sensation seeking has been shown to influence risk taking, this child attribute was also assessed and related to risk compensation. Children 7-12 years of age were videotaped navigating the obstacle course twice, once wearing safety gear and once without safety gear, with reverse directions used to minimize possible practice effects. The time it took the child to run through the course and the number of reckless behaviors (e.g., falls, trips, bumping into things) that the child made while running the course were compared for the gear and no-gear conditions. Results indicated that children went more quickly and behaved more recklessly when wearing safety gear than when not wearing gear, providing evidence of risk compensation. Moreover, those high in sensation seeking showed greater risk compensation compared with other children. Implications for childhood injury prevention are discussed.     

Relationships between injuries at work and during leisure time

The aim of this study is to explore the relationships between injuries at work and during leisure time. Three independent but similar data sets based on the National Work and Health Survey were analyzed. A total of 2156 subjects participated this study in 1997, 2053 subjects in 2000, and 2335 subjects in 2003. In the interview the subjects reported their accidents at work, which had caused at least minor injury during the past 12 months. Workers involved in work injuries were significantly more often involved in leisure-time injuries (p<0.05). Less than 1% of the subjects were involved in both injuries at work and during leisure time during the past 12 months. We can conclude that involving in work injuries could increase the risk of leisure-time injuries.     

Identification and validation of a logistic regression model for predicting serious injuries associated with motor vehicle crashes

A multivariate logistic regression model, based upon National Automotive Sampling System Crashworthiness Data System (NASS-CDS) data for calendar years 1999–2008, was developed to predict the probability that a crash-involved vehicle will contain one or more occupants with serious or incapacitating injuries. These vehicles were defined as containing at least one occupant coded with an Injury Severity Score (ISS) of greater than or equal to 15, in planar, non-rollover crash events involving Model Year 2000 and newer cars, light trucks, and vans. The target injury outcome measure was developed by the Centers for Disease Control and Prevention (CDC)-led National Expert Panel on Field Triage in their recent revision of the Field Triage Decision Scheme (American College of Surgeons, 2006). The parameters to be used for crash injury prediction were subsequently specified by the National Expert Panel. Model input parameters included: crash direction (front, left, right, and rear), change in velocity (delta-V), multiple vs. single impacts, belt use, presence of at least one older occupant (≥55 years old), presence of at least one female in the vehicle, and vehicle type (car, pickup truck, van, and sport utility). The model was developed using predictor variables that may be readily available, post-crash, from OnStar^®-like telematics systems. Model sensitivity and specificity were 40% and 98%, respectively, using a probability cutpoint of 0.20. The area under the receiver operator characteristic (ROC) curve for the final model was 0.84. Delta-V (mph), seat belt use and crash direction were the most important predictors of serious injury. Due to the complexity of factors associated with rollover-related injuries, a separate screening algorithm is needed to model injuries associated with this crash mode.     

Field investigations of the performance of air bag deployments in frontal collisions

This paper documents field investigations of “air bag” crashes selected from a large group of air bag crashes in file at the University of Michigan Transportation Research Institute (UMTRI). A full range of crashes are presented with injury levels of AIS 1–2 to AIS 5–6. Most occupants sustained minor injuries. Those not wearing the lap-shoulder belt (3-point belt) had more minor injuries than the restrained. The occurrence of higher level injuries (AIS 2) was found more often in the nonbelted.     

Child restraint seat use behavior and attitude among Japanese mothers

OBJECTIVES: The purpose of the study was to assess associations between child restraint seat use and attitudes among Japanese mothers. MATERIALS AND METHODS: Mothers whose children were under 6 years of age were recruited through 11 kindergartens located in Kanagawa prefecture, Japan. Questions were developed based on the Health Belief Model and the Theory of Reasoned Action. Past use and future intentions to use, perceived risk of injury, knowledge of safety, attitudes toward use, subjective norms, and safety values related to safety seats were asked. RESULTS: A total of 552 complete questionnaires was obtained. Of 500 car owning households, 54.2% used child restraint seats inconsistently on short drives, and 36.4% did so on long drives. Three variables were associated with inconsistent use on short drives: frequent child resistance to sitting in a restraint seat; mothers' feeling hassled by child restraint seat use; and, mothers' agreement with the lack of need to use a restraint seat when another adult is in a car. Two variables were associated with inconsistent use on long drives: lower subjective norm of husband and frequent child resistance. CONCLUSIONS: In-car environmental modification and parent education need to be considered to increase child restraint seat use among Japanese households.     

Discrepancy in bicycle helmet use among college students between two bicycle use purposes: Commuting and recreation

Objectives

The purpose of the study was to examine associations between bicycle helmet use and attitudes among U.S. college students. Bicycle helmet use was assessed for two different bicycle use purposes: commuting to school and recreation.

Materials and methods

Student bicycle riders were recruited on the campus of a large public university in Colorado. Questionnaire development was guided by the Theory of Reasoned Action and Health Belief Model. Bicycle use and helmet use for the two purposes, attitudes toward helmet use and bicycle helmet regulations on campus, perceived risk of bicycle-related injury, subjective norms were asked. Bicycle helmet use was defined by current behaviors and intentions for the future, based on the Stages of Change model.

Results

A total of 192 questionnaires collected from students who rode bicycles for both commuting and recreation was used for the analysis. Bicycle helmet use differed depending on purposes of bicycle riding: 9.4% of bicycle riders wore bicycle helmets every time for commuting, while 36.5% did so for recreation. Different variables were associated with bicycle helmet use for commuting and recreation in logistic regression models, suggesting that psychosocial structures behind bicycle helmet use behaviors might differ between two bicycle use purposes, commuting and recreation.     

A review of research on the protection afforded to occupants of cars by seat belts which provide upper torso restraint

The paper presents a critical review and summary of research on the protection afforded to car occupants by seat belts which provide upper torso restraint. The nature and causes of the injuries which occur even when seat belts are worn are then considered, and methods of reducing injuries still further are suggested.

Summaries are given of 8 selected European and American papers on seat belts in accidents. The estimated reductions in serious injuries varied from 45 to 70%, and reasons are suggested for the occurrence of these differences. Evidence of the reduction in deaths, as opposed to serious injuries, when seat belts are worn is scanty, but Australian experience of the results of compulsory seat belt wearing suggest that the wearing of seat belts with upper torso restraint reduces deaths of car occupants by at least 40%.

In non-fatal accidents to belted occupants, head, chest and leg injuries give rise to the largest numbers of severe injuries (AIS >3). In fatalities to belted occupants, however, while head injury retains its premier position, abdominal injury is at least as important as chest injury.

Modifications to the design of lap and diagonal seat belts are suggested, (a) to restrict loads on the abdomen and chest to levels which will not result in serious injury, and (b) to reduce forward movement of the head so as to lessen the risk of head injury.     

Sex and age distribution in transport-related injuries in Tehran

Intercountry or regional differences in patterns of injury by the road user type have significant implication for prevention policies. In order to have an estimate from the existing conditions of transport-related injuries (TRIs) and especially to evaluate sex and age distribution of traffic accident victims, we analyzed information of 8426 hospitalized trauma patients during 13 months of data gathering process. Forty-five percent of the injuries were related to car accidents and men/women ratio in these patients was 4.2/1. The highest men/women ratio was (16/1) for motorcyclists, while the lowest ratio (1/1), was for rear seat car passengers. Mean (+/-S.D.) age of the patients was 31 (+/-18), and men were nearly 2 years younger than women (33 versus 31). Sixty-seven percent of the females' and 44% of the males' injuries were related to pedestrian crashes. Motorcycle-related injuries in men and car passenger related injuries in women were the second most common type of crash (42 and 22%, respectively). The use of protective devices in our population was worrisome. In only 6% of the male motorcyclists helmet use was reported, and 3% of the male car occupants had used seatbelts at the time of the accident. The condition in the female population was much worse and no use of the protective devices was reported in this group of the patients. Crude mortality rate in men was nearly two times that of women (6.2% versus 3.8%). After adjustment for age, injury severity score (ISS) and category of the road users, men and women had similar mortality rate.     

The economic burden of injury: Health care and productivity costs of injuries in the Netherlands

BackgroundDetailed information on health care costs and productivity costs for the whole spectrum of injuries is lacking. We measured the total costs of injuries by external-cause, injury groupings, age and sex.MethodInjury patients visiting an Emergency Department in the Netherlands were included. Health service use and work absenteeism were estimated with national database data and a prospective follow-up study. Health care costs (direct costs) and productivity costs (indirect costs) were determined using the incidence-based Dutch Cost of Injury Model.ResultsTotal costs of injuries were €3.5 billion annually (€210/capita and €4300/patient); €2.0 billion healthcare costs and €1.5 billion productivity costs. Home and leisure injury subcategory falls caused 41% of total costs. Traffic injury was prominent in the 15–54 age group, mainly due to bicycle injuries. Sports injuries, in special football/soccer injuries, resulted in high costs in the 15–24 age group. Although costs per patient were comparable between males and females, health care costs were higher in females, whereas males have more than twice as high productivity costs. Health care costs were highest for hip fractures (€20,000/patient). Extremity fractures had high costs due to high incidences and high productivity costs per patient.ConclusionOur detailed cost model identified known risk groups, such as elderly females with hip fractures resulting from falls, as well as less obvious important high risk groups, such as young children falling from furniture, young males who sustained football/soccer injuries and bicycle injuries among all ages. This information is essential to assess additional priority areas for prevention.     

Rollover crashes: predicting serious injury based on occupant, vehicle, and crash characteristics

The purpose of this research was to determine occupant, vehicle, and crash characteristics predicting serious injury during rollover crashes. We compared 27 case occupants with serious or greater severity injuries with 606 control occupants without injury or with only minor or moderate injury. Odds ratios (OR) for individual variables and logistic regression were used to identify predictive variables for serious injury associated with rollovers. Cases more often had thorax, spine, or head injury compared to controls that more often had extremity injuries. Intrusion (especially roof rail or B-pillar intrusion) at the occupant's position, the vehicle interior side and roof as sources of injury, and improper safety belt use were significantly associated with serious injury. Even when safety belt use or proper use was controlled for, occupants with greater magnitude of intrusion at their seat position were about 10 times more likely to receive serious injury. Although prevention of rollover crashes is the ultimate goal, it is important to develop safer vehicles and safety systems to better protect occupants who are involved in rollover crashes. This also requires improvement in data collection systems documenting these types of crashes.     

Method to evaluate the effect of safety belt use by rear seat passengers on the injury severity of front seat occupants

Although the effectiveness of seat belts for reducing injury to rear seat passengers in traffic accidents has been well documented, the ratio of rear-seat passengers restrained by seatbelts remains lower than that of drivers or passengers in front seats. If passengers in rear seats do not wear seat belts, they may sustain unexpected injury to themselves when involved in accidents, and also endanger front occupants (drivers or front seat passengers). This paper focuses on the tendency of front seat occupants to sustain severer injuries due to forward movement of passengers in rear seats at the moment of frontal collisions, and evaluates the effectiveness of rear passengers' wearing seat belts in reducing injuries of front seat occupants. Since the occurrence of occupant injuries depends considerably on the crash severity, we proposed to use pseudo-delta V in regression analysis to represent velocity change during a collision when analyzing statistical accident data. As the crash severity can be estimated from pseudo-delta V, it becomes possible to make appropriate estimations even when the crash severity differs in data. The binary model derived from the ordered response model was used to evaluate the influence on the injury level based on pseudo-delta V, belted or unbelted status, gender and age. Occupants in cars with a hood in the case of car-to-car frontal collisions were extracted from the statistical data on accidents in Japan. Among 81,817 cars, where at least one passenger was present, a total of 6847 cars in which all passengers sustained injuries and which had at least one rear seat passenger aboard were analyzed. The number of killed or seriously injured drivers is estimated to decrease by around 25% if rear seat occupants come to wear seat belts. Also, the number of killed or seriously injured passengers in front seats is estimated to decrease by 28% if unbelted rear seat occupants come to wear seat belts. Thus, wearing of seat belts by previously unbelted rear seat passengers is considered effective in reducing not only injuries to the rear seat passengers themselves but also injuries to front seat occupants.     

Predictors of injury among younger and older adults in fatal motor vehicle crashes

With 2003 Fatality Analysis Reporting System data, we examined relationships among predictors of motor vehicle injury/fatality outcomes for younger (35–54 years) and older (65 years and older) drivers. Using the Precede-Proceed Model of Health Promotion as an organizing framework, we classified variables into person, vehicle and environment domains and conducted a multinomial logistic regression.Significant risk factors for older driver injuries were impact crashes at 1–3 o’clock (OR = 1.65; CI: 1.05–2.59), 7–9 o’clock angles (OR = 2.59; CI = 1.45–4.63), and driving with one passenger (OR = 2.25; CI: 1.58–3.20). Previous other motor vehicle convictions were significantly associated with reduced risk of injury (OR = 0.55; CI = 0.34–0.90). The 7–9 o’clock angle (OR = 3.06; CI: 1.83–5.12), and driving in daylight hours were risk factors for fatality among older drivers.Many risk factors (e.g., female gender, non-seatbelt use, rollover crashes, and vehicle body type), and protective factors (e.g., number of lanes and non-airbag deployment) were relevant for younger and older drivers. Findings showed relevant factors for drivers from both age groups, with some pointing to older adults, and set the stage for further research to develop injury and fatality prevention programs.     

Understanding risk compensation in children: Experience with the activity and level of sensation seeking play a role

The aims of this study were to determine if children 7–12 years show risk compensation when engaging in ecologically valid recreational sports tasks, and to explore how experience with the activity and extent of sensation seeking influence this. Children were positioned up on a platform, on a bike or wearing rollerblades, and they were presented varying heights and inclines from which they selected the greatest one they go down when wearing and not wearing safety gear appropriate to the activity; when making their ratings they anticipated actually doing the task. Results revealed that children engaged in significantly more risk taking when wearing safety gear, thereby demonstrating risk compensation, and this was significantly greater for the activity with which they had greater experience. However, children high in sensation seeking demonstrated significantly more risk compensation in both the high and low experience activities, although the injury risk appraisals that predicted risk compensation varied with experience level. Implications for the design of injury prevention programs and directions for future research are discussed.     

Injury to recreational and professional cricket players: Circumstances,type and potential for intervention

This paper describes injury (circumstances and type) experienced by sub-populations at all levels of cricket and, where possible, the type of protective equipment used. The sample differs to that generally examined in the literature in that it is not restricted to evaluation of elite and professional players only. Over a 6-year period (2000–2005), 498 cases were identified. The average age of injury was 27 years and 86% of those injured were male. The population incidence rate was 2.3 per 100,000 per year, and participation incidence rate 39 per 100,000 per year. Over all age groups upper limb (36%) and lower limb (31%) were most commonly injured. Fracture was the main type of injury. Differences among age groups were identified. Children (<10 years) most commonly suffered head injury (contact with the bat); 10–19 year olds, head, upper and lower limb injury (in similar proportions) generally from contact with bat/ball; those over 20 years mainly had upper and lower limb injuries. Contact with the bat/ball was the dominant mechanism of injury for those under 50 years of age while overexertion, strenuous or repetitive movements, slips and falls were the mechanisms for those over 50. The large number of head injuries to children is of concern and both these, and the substantial number of injuries to the hand/phalanges (63% of all upper limb injuries), are important targets for injury prevention. The difference in injury patterns between children and adults is indicative of a need to develop, and use, different types of PPE at different skill/age levels.     

Near miss and minor injury information--can it be used to plan and evaluate injury prevention programmes?

AIM: To assess the usefulness of collecting information on near miss and minor injuries for use in planning and evaluating injury prevention programmes for children aged under 5 years in the home environment. METHOD: The research was set within the context of a controlled intervention study based in 36 general practices across Nottingham. All parents of children aged between 3 and 12 months who had completed the intervention study questionnaire (n = 1594) were used as the sampling frame for the diary study. A diary, developed specifically for the main intervention study, was administered to a systematically assigned sample of 434 parents. Information provided by the Home Accident Surveillance System on 252 randomly selected children, of the same age and sex, who had attended an accident and emergency department, was used to compare the circumstances surrounding near miss and minor injuries with those of medically attended injuries. The children whose parents had completed a diary were followed over a two year time period. The children who had had a medically attended injury were identified from a search of the child's general practice records and the Queens Medical Centre accident and emergency records. The definition of a near miss used in the study was: A near miss incident is something your child does or that happened to your child which could have resulted in him/her being hurt, but fortunately it did not. RESULTS: Overall two hundred and thirty one (53%) diaries were completed and returned. Three hundred and fifty incidents were recorded of which 207 were near misses and 143 minor injuries. The circumstances surrounding near miss and minor injuries, although not identical when compared to medically attended injuries, were very similar. The relationship between the occurrence of near miss, minor injuries and future medically attended injuries appeared weak, for all categories the negative predictive value was higher than the positive predictive value. CONCLUSION: Although the circumstances surrounding all the incident categories were similar, the numbers were too small to see whether specific injury mechanisms predict future injuries of the same type. It appeared that near miss and minor injuries are of limited use in predicting medically attended injuries, however this hypothesis needs to be tested on a much larger sample.     

NIOSH national survey of long-haul truck drivers: Injury and safety

Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10 miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training.