Seat belt use among drinking drivers in Minnesota.

OBJECTIVES. Among the reasons cited for recent declines in alcohol-related traffic fatalities is the enactment of seat belt use laws by most states. It is suspected that drinking drivers are less likely to comply with such laws, although evidence on the relationship between belt use and drinking by drivers is sparse and conflicting. The purpose of this study was to examine the relationship of drinking to driver seat belt use. METHODS. Observational, self-report, and chemical breath test data were collected on nighttime drivers in 16 Minnesota communities during September, 1990. RESULTS. Drivers with an illegal blood alcohol concentration (> or = 100 mg/dL) were substantially less likely to be wearing a seat belt (odds ratio [OR] = 2.17). Belt use was also more common among females (OR = 2.02) and before midnight (OR = 1.47). Males who had been drinking were less likely to be belted. Belt use was related to drinking before, but not after, midnight. Belt use was not related to drinking status among college graduates, but it was strongly related to drinking status among those with less education. CONCLUSIONS. The present findings provide further argument for rapid implementation of passive countermeasures (airbags) and for development of creative, carefully focused interventions to target high-risk populations.     

Cannabis use and mood disorders: patterns of clinical presentations among adolescents in a developing country

Notwithstanding the increase use of cannabis among adolescents in both developing and developed countries, few studies have looked at cannabis use and mood disorders. In a series of case studies, this research project seeks to investigate patterns of clinical presentations seen among cannabis users in psychiatric outpatients in Trinidad. Five clinical patterns of presentations are identified among cannabis users and abusers based on variables of dosing, age of initial use, duration of use, tolerance and reverse tolerance and poly-drug abuse. All patients in these case studies were standardized for method of use and potency of cannabis used. Patients were screened by urine tests to determine co-morbid use of other substances. Other variables such as environmental factors and genetic vulnerability were reviewed as far as possible from historical accounts of family members. The five patterns described are low, controlled use with mild euphoria and heightened awareness, moderate use with mixed depressive symptoms and suicidal behaviour, heavy, short term use with manic symptoms, long term incremental use with psychotic symptoms due to the trumping of depressive symptoms and cannabis mixed with other substances resulting in florid psychosis. Mood disorders appear to be a common finding among adolescents using cannabis. Sensitization to symptomatic presentation and early detection of cannabis use in young adolescents are necessary. Further research is needed on the effect of cannabinoids on emotions, behaviour and thinking and its relationship to mental disorders. This study is useful as a guideline for the implementation of public health strategies and legislation concerning the use of cannabis in youths.     

Seat belt use among teenagers in two Israeli family practices

Motor vehicle accidents are the leading cause of deaths among Israeli teenagers. Despite the efficacy of seat belt use in reducing mortality, and legislation requiring seat belt use in all car positions, a large proportion of Israeli adolescents do not consistently use seat belts. Differential data regarding front and rear seat belt use in this population are not available. The objective of this study was to determine the rates of front and rear seat belt use among a sample of Israeli teenagers in the primary care setting. Seventy-eight teenagers attending preventive adolescent health visits in two Israeli family practice clinics completed questionnaires that included questions regarding seat belt use. Structured counseling by the family nurse was provided following completion of the questionnaire. Sixty-four percent of the teenagers reported using front seat belts all of the time, while only 8% used rear seat belts all of the time. Infrequent or non-use of rear seat belts was more prevalent among 10th than among 7th graders. It is concluded that public health strategies in addition to legislation are needed to optimize seat belt use among Israeli teenagers. Health education regarding seat belt use--with an emphasis on rear seat belts--can and should be incorporated into adolescent preventive health visits in the primary care setting.     

Obesity among pre-adolescent and adolescents of a developing country (India)

There are very few reports from the developing world on the prevalence of obesity among children even though in developed countries it has reached epidemic proportions. The objective of this study was to determine the prevalence of obesity in pre-adolescent and adolescent children in a developing country (India) using WHO guidelines for defining obesity and overweight. This cross-sectional study was carried out on 2008 school-children aged 9-15 years. Approximately half the subjects belonged to a school attended by children of well to do families while the rest belonged to two schools from middle and lower socio-economic background. Weight and height were taken for all children and the body mass index (BMI) calculated. Children whose BMI was >85th percentile for age and sex were defined as overweight. Triceps skin fold thickness (TSFT) was measured for all overweight children and those with TSFT >90th percentile for age and sex were defined as obese. The overall prevalence of obesity and overweight was 11.1% and 14.2% respectively. The prevalence of obesity as well as overweight was higher in boys as compared to girls (12.4% vs 9.9%, 15.7% vs 12.9%). Prevalence of obesity decreased significantly with age, from 18.5% at 9 years to 7.6% at 14 years, rising at 15 years to 12.1%. Significantly more children from higher socio-economic status were obese and overweight than those from lower socio-economic status groups. No significant gender difference for obesity prevalence was seen among children from a less privileged background, however, amongst children from affluent families, significantly more boys were obese as compared to girls. Pediatric obesity is an emerging problem in developing countries, especially among higher socio-economic status groups. Significant gender disparity is seen, with boys of affluent background having a higher prevalence.     

Seat belt use among American Indians/Alaska Natives and non-Hispanic whites

BACKGROUND: Accidents (including motor vehicle injuries) are a leading cause of death among American Indians/Alaskan Natives (AI/AN). The purpose of this study was to examine geographic variation and the existence of a seat belt law on seat belt use among AI/AN and non-Hispanic whites (NHW). METHODS: Self-reported seat belt behavior data from the 1997 and 2002 Behavioral Risk Factor Surveillance System were analyzed in 2006-2007 and were restricted to AI/AN (n=4,310 for 2002, and n=1,758 for 1997) and NHW (n=193,617 for 2002, and n=108,551 for 1997) aged 18 years and older. RESULTS: Seat belt non-use varied significantly across geographic regions for both AI/AN and NHW. For example, AI/AN living in the Northern Plains (odds ratio [OR]=12.4, 95% confidence interval [CI]=6.5-23.7) and Alaska (OR=10.3, 95%CI=5.3-19.9) had significantly higher seat belt non-use compared to AI/AN living in the West. In addition, compared to those residing in urban areas, those living in rural areas were 60% more likely in NHW and 2.6 times more likely in AI/AN not to wear a seat belt. Both AI/AN and NHW living in states without primary seat belt laws were approximately twice as likely to report seat belt non-use in 2002 as those living in states with primary laws. In states with primary laws enacted between 1997 and 2002, AI/AN experienced greater decline in seat belt non-use than NHW. CONCLUSIONS: Seat belt use among AI/AN and NHW varied significantly by region and urban-rural residency in 2002. Primary seat belt laws appear to help reduce regional and racial disparities in seat belt non-use.     

Seat belt law enforcement and racial disparities in seat belt use

BACKGROUND: Numerous reports have documented a lower prevalence of seat belt use among blacks in the United States, compared with whites. Limited data suggest that black-white disparities in states with primary seat belt laws (motorists can be stopped and cited solely for violating a seat belt law) are less marked than in states with secondary laws (motorists can be cited for violating a seat belt law only if stopped for another offense). METHODS: Data from the Fatality Analysis Reporting System were analyzed in 2005 to compare seat belt use among 11,574 blacks and 73,639 whites aged 16 or more years killed in crashes from 1999 to 2003 in 33 states with a primary or secondary adult seat belt law and annual reporting of race for 80% or more of decedents. After stratification of states by type of seat belt law, logistic regression was used to calculate odds ratios and 95% confidence intervals (CIs) for seat belt use among blacks, relative to whites, with adjustment for age, gender, seat position, urban/rural region, and income. RESULTS: Odds ratios and 95% CIs for seat belt use among blacks were 1.05 (0.97-1.13) and 0.89 (0.83-0.95), in primary- and secondary-law states, respectively. CONCLUSIONS: Black-white disparities in seat belt use were mitigated in states with primary seat belt laws. Only 24 states have primary laws. Enacting primary laws in other states might reduce or eliminate racial disparities in seat belt use.     

Seat belt use and social inequality in Belgium

BACKGROUND: To search for and quantify the importance of socio-economic inequality in seat belt use in young Belgians (15-24 years old). METHODS: Using the data of the National Health Survey of Belgium (1997), socio-economic indicators were constructed combining characteristics of the individual and the household to which s/he 'belongs' (equivalent household income, employment, poverty, subjective poverty, and socio-economic insecurity) and the corresponding concentration curves and indices were calculated. RESULTS: Significant differences were found in seat belt use related to young people's socio-economic status. The failure to buckle up was concentrated most heavily in the least favoured socio-economic groups. Such inequality was a constant finding, although its magnitude varied according to the socio-economic indicator used, going from -0.142 for the variable 'occupational category of the household' to -0.028 for the variable 'poverty'. CONCLUSIONS: This finding of true socio-economic inequality in the use of seat belts by 15-24 year olds should prompt special vigilance in health promotion approaches aimed at changing behaviour. It also underlines the importance of being attentive to the socio-economic indicators that are chosen to quantify such inequality in intra- and inter-country comparisons.     

Seat belt use on interstate highways.

More than 5,000 miles of limited-access highways in the eastern United States and Canada were traveled to observe seat belt use. Overall belt use was 58 percent in the United States and 79 percent in Canada. The data indicate that belt use in the United States follows a different pattern on interstate highways than on other streets and roads, with relatively high belt use rates (over 50 percent) appearing to be somewhat independent of belt use law provisions.     

Seat belt use among rear passengers: validity of self-reported versus observational measures

Background  

The effects of seat belt laws and public education campaigns on seat belt use are assessed on the basis of observational or self-reported data on seat belt use.     

Seat belt use in cars with air bags.

Seat belt use was observed in 1,628 cars with air bags and manual belts and 34,223 cars with manual seat belts only. Sixty-six percent of drivers in cars with air bags wore seat belts compared to 63 percent of drivers in cars with manual belts only. The study found no evidence for the speculation that drivers with air bags will reduce their seat belt use because they believe an air bag alone provides sufficient protection.     

Rational use of cytotoxic drugs in a developing country

Malignant disease poses a major problem in Africa. To managepatients with cancer satisfactorily, sophisticated facilitiesand trained personnel are needed, and the cost of treatmentis high. The concept of essential drug lists with guidelinesfor treatment is of undoubted value and such programmes havebecome increasingly widespread. In Zimbabwe a committee hasbeen formed to formulate both a list of appropriate cy-totoxicdrugs and a national policy for the management of patients withmalignant conditions. To date a drug list has been drawn upand a number of policy principles agreed. There will be twomain centres for oncology treatment in the country, and drugutilization will be carefully monitored so as to keep withinthe separate oncology drug budget. Limited resources permitonly a limited number of patients to be treated, and to facilitateselection of patients who will derive maximum benefit, the malignantdiseases have been divided into three categories. The majorityof cytotoxic agents will be utilized in category 1 which listsconditions in which remission rates are high or in which long-termeffective palliation is possible. Protocols outlining investigationsand management in various conditions are being designed. Thistype of unified standardized approach will lead to the mostefficient use of available resources and provide an acceptablelevel of care for the patient with cancer. It is proposed thata pocket-sized manual of drug list, policy, protocols and variousother aspects of cancer care will be published.     

Screening for tuberculosis among orphans in a developing country

BACKGROUND: There has been a recent resurgence of tuberculosis (TB) as a worldwide public health concern. It is a well-documented health problem in Haiti, where the reported prevalence is 123.9 per 100,000 population. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) policy papers for the eradication of TB recommend screening in shelters, prisons, and other congregate-living facilities, screening in institutional orphanages is not specifically mentioned. METHODS: A total of 445 orphans with no documentation of Bacillus Calmette-Guerin (BCG) vaccine at six orphanages representing urban, suburban, and rural Haiti were screened for TB using standardized purified protein derivative (PPD). An inoculum of 0.1 cc was introduced intradermally, with site checks for induration at 48-72 hours after inoculation. Induration >5 mm was recorded as positive. Active cases of TB were defined by symptoms such as fever, night sweats, cough greater than 1 month, or signs of extrapulmonary TB (like scrofula or Pott's disease). RESULTS: The number of positive PPD tests was 170 of the 445 children tested, or 38,202 per 100,000; there were 10 active cases. The overall prevalence of tuberculin positivity in the three orphanages with one or more active cases was 44%, compared to 13% in the three with no identified active cases. CONCLUSIONS: The data indicate that TB prevalence among the orphans screened was 1123 per 100,000. This is substantially greater than that reported for the general Haitian population. These data thus suggest children living in orphanages as a previously unidentified high-risk group for TB infection. Further investigation of TB is recommended for orphans in developing countries.     

Running on empty: health care energy use in a developing country

Health care systems require reliable energy for high-quality services. Rising fossil fuel prices globally limit the capacity of developing countries to provide continuous and essential health care services. Global health care projects should focus on energy innovation for health care use.