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1.  The effects of feedback and incentive-based insurance on driving behaviours: study approach and protocols 
Injury Prevention  2017;24(1):89-93.
Background
Road injury is the leading cause of death for young people, with human error a contributing factor in many crash events. This research is the first experimental study to examine the extent to which direct feedback and incentive-based insurance modifies a driver's behaviour. The study applies in-vehicle telematics and will link the information obtained from the technology directly to personalised safety messaging and personal injury and property damage insurance premiums.
Methods
The study has two stages. The first stage involves laboratory experiments using a state-of-the-art driving simulator. These experiments will test the effects of various monetary incentives on unsafe driving behaviours. The second stage builds on these experiments and involves a randomised control trial to test the effects of both direct feedback (safety messaging) and monetary incentives on driving behaviour.
Discussion
Assuming a positive finding associated with the monetary incentive-based approach, the study will dramatically influence the personal injury and property damage insurance industry. In addition, the findings will also illustrate the role that in-vehicle telematics can play in providing direct feedback to young/novice drivers in relation to their driving behaviours which has the potential to transform road safety.
doi:10.1136/injuryprev-2016-042280
PMCID: PMC5800338  PMID: 28073949
2.  Developing predictive models for return to work using the Military Power, Performance and Prevention (MP3) musculoskeletal injury risk algorithm: a study protocol for an injury risk assessment programme 
Injury Prevention  2016;24(1):81-88.
Background
Musculoskeletal injuries are a primary source of disability in the US Military, and low back pain and lower extremity injuries account for over 44% of limited work days annually. History of prior musculoskeletal injury increases the risk for future injury. This study aims to determine the risk of injury after returning to work from a previous injury. The objective is to identify criteria that can help predict likelihood for future injury or re-injury.
Methods
There will be 480 active duty soldiers recruited from across four medical centres. These will be patients who have sustained a musculoskeletal injury in the lower extremity or lumbar/thoracic spine, and have now been cleared to return back to work without any limitations. Subjects will undergo a battery of physical performance tests and fill out sociodemographic surveys. They will be followed for a year to identify any musculoskeletal injuries that occur. Prediction algorithms will be derived using regression analysis from performance and sociodemographic variables found to be significantly different between injured and non-injured subjects.
Discussion
Due to the high rates of injuries, injury prevention and prediction initiatives are growing. This is the first study looking at predicting re-injury rates after an initial musculoskeletal injury. In addition, multivariate prediction models appear to have move value than models based on only one variable. This approach aims to validate a multivariate model used in healthy non-injured individuals to help improve variables that best predict the ability to return to work with lower risk of injury, after a recent musculoskeletal injury.
Trial registration number
NCT02776930.
doi:10.1136/injuryprev-2016-042234
PMCID: PMC5800339  PMID: 27884941
3.  Surveillance of paediatric exposures to liquid laundry detergent pods in Italy 
Injury Prevention  2017;24(1):5-11.
Objective
To analyse paediatric exposures to pod and traditional laundry detergents in Italy and changes in exposure trends.
Methods
Analyses of a series of patients aged <5 years and exposed to laundry detergents between September 2010 and June 2015, identified by the National Poison Control in Milan.
Results
In comparison with patients exposed to traditional laundry detergents (n=1150), a higher proportion of those exposed to pods (n=1649) were managed in hospital (68% vs 42%), had clinical effects (75% vs 22%) and moderate/high severity outcomes (13% vs <1%). Exposure rates were stable over time for traditional detergents (average 0.65 cases/day), but an abrupt decline in major company pods was seen in December 2012, 4 months after the introduction of opaque outer packaging (from 1.03 to 0.36 cases/day and from 1.88 to 0.86 cases/million units sold). The odds of clinical effects was higher for exposure to pods than for traditional detergents (OR=10.8; 95% CI 9.0 to 12.9). Among patients exposed to pods, the odds of moderate/high severity outcomes was four times higher for children aged <1 years than for the other age groups (OR=3.9; 95% CI 2.2 to 7.0). Ten children exposed to laundry detergent pods had high severity outcomes while no children exposed to traditional laundry detergents developed high severity effects.
Conclusions
The study confirms that exposure to laundry detergent pods is more dangerous than exposure to traditional detergents. In Italy, 4 months after the introduction of opaque outer packaging by a major company, product-specific exposure rates decreased sharply, suggesting that reducing visibility of laundry detergent pods may be an effective preventive measure. Further efforts are needed to improve safety.
doi:10.1136/injuryprev-2016-042263
PMCID: PMC5800340  PMID: 28188147
4.  The benefits of data linkage for firefighter injury surveillance 
Injury Prevention  2017;24(1):19-28.
Background
While survey data are available for national estimates of fire events and firefighter fatalities, data on firefighter injury at the national and local levels remain incomplete and unreliable. Data linkage provides a vehicle to maximise case detection and deepen injury description for the US fire service.
Methods
By linking departmental Human Resources records, despatch data, workers' compensation and first reports of injury, researchers were able to describe reported non-fatal injuries to 3063 uniformed members of the Philadelphia Fire Department (PFD), for the period of 2005 through 2013.
Results
Among all four databases, the overall linkage rate was 56%. Among three of the four databases, the linkage rate was 88%. Because there was duplication of some variables among the datasets, we were able to deeply describe all the linked injuries in the master database. 45.5% of uniformed PFD members reported at least one injury during the study period. Strains, falls, burns and struck-by injuries were the most common causes. Burns resulted in the highest lost time claim payout, and strains accounted for the highest medical claim cost. More than 70% of injuries occurred in the first 15 years of experience.
Discussion
Data linkage provided three new benefits: (1) creation of a new variable—years of experience, (2) reduction of misclassification bias when determining cause of injury, leading to more accurate estimates of cost and (3) visualisation of injury rates when controlling for the number of fire department responses, allowing for the generation of hypotheses to investigate injury hot spots.
doi:10.1136/injuryprev-2016-042213
PMCID: PMC5800341  PMID: 28196830
5.  Preventing deaths and injuries from house fires: a cost–benefit analysis of a community-based smoke alarm installation programme 
Background
Operation Installation (OI), a community-based smoke alarm installation programme in Dallas, Texas, targets houses in high-risk urban census tracts. Residents of houses that received OI installation (or programme houses) had 68% fewer medically treated house fire injuries (non-fatal and fatal) compared with residents of non-programme houses over an average of 5.2 years of follow-up during an effectiveness evaluation conducted from 2001 to 2011.
Objective
To estimate the cost–benefit of OI.
Methods
A mathematical model incorporated programme cost and effectiveness data as directly observed in OI. The estimated cost per smoke alarm installed was based on a retrospective analysis of OI expenditures from administrative records, 2006–2011. Injury incidence assumptions for a population that had the OI programme compared with the same population without the OI programme was based on the previous OI effectiveness study, 2001–2011. Unit costs for medical care and lost productivity associated with fire injuries were from a national public database.
Results
From a combined payers’ perspective limited to direct programme and medical costs, the estimated incremental cost per fire injury averted through the OI installation programme was $128,800 (2013 US$). When a conservative estimate of lost productivity among victims was included, the incremental cost per fire injury averted was negative, suggesting long-term cost savings from the programme. The OI programme from 2001 to 2011 resulted in an estimated net savings of $3.8 million, or a $3.21 return on investment for every dollar spent on the programme using a societal cost perspective.
Conclusions
Community smoke alarm installation programmes could be cost-beneficial in high-fire-risk neighbourhoods.
doi:10.1136/injuryprev-2016-042247
PMCID: PMC5550354  PMID: 28183740
7.  An economic evaluation of anonymised information sharing in a partnership between health services, police and local government for preventing violence-related injury 
Objective
To assess the costs and benefits of a partnership between health services, police and local government shown to reduce violence related injury.
Methods
Cost benefit analysis
Results
Anonymised information sharing and use led to a reduction in wounding recorded by the police that reduced the economic and social costs of violence by £6.9 million in 2007 compared to the costs the intervention city, Cardiff UK, would have experienced in the absence of the programme. This includes a gross cost reduction of £1.25 million to the health service and £1.62 million to the criminal justice system in 2007. In contrast, the costs associated with the programme are modest: setup costs of software modifications and prevention strategies were £107,769, while the annual operating costs of the system were estimated as £210,433 (2003 UK Pound). The cumulative social benefit/cost ratio of the programme from 2003 to 2007 was £82 in benefits for each pound spent on the programme, including a benefit cost ratio of 14.8 for the health service and 19.1 for the criminal justice system. Each of these benefit/cost ratios is above 1 across a wide range of sensitivity analyses.
Conclusions
An effective information sharing partnership between health services, police, and local government in Cardiff, UK, led to substantial cost savings to the health service and the criminal justice system compared with 14 other cities in England and Wales designated as similar by the UK government where this intervention was not implemented.
doi:10.1136/injuryprev-2012-040622
PMCID: PMC5779858  PMID: 24048916
Violence; Economic evaluation; Cost-benefit analysis; Prevention
8.  Expression of concern: car safety seats for children: rear facing for best protection 
Injury Prevention  2017;ip.2006.015115eoc1.
doi:10.1136/ip.2006.015115eoc1
PMCID: PMC5761202  PMID: 28667167
injury diagnosis; amputation; concussion
9.  Attitudes towards requiring ignition interlocks for all driving while intoxicated offenders: findings from the 2010 HealthStyles Survey 
Ignition interlocks are effective in reducing recidivism among driving while intoxicated (DWI) offenders while installed on their vehicles. However, the devices are not widely used in the USA. This survey gauged public support for requiring ignition interlocks for all convicted DWI offenders including first-time offenders. 69% of respondents supported such a policy. Support was lowest (38%) among persons who reported drinking and driving in the past 30 days. Multivariate regression analysis indicated that support varied little by region, community size or most measured individual characteristics. Persons who did not drink and drive were 80% more likely to support the requirement than those who drink and drive. These findings suggest that laws requiring ignition interlocks for all convicted DWI offenders may face the most opposition in communities with high levels of drinking and driving.
doi:10.1136/injuryprev-2012-040367
PMCID: PMC5752141  PMID: 22773020
11.  Paid family leave’s effect on hospital admissions for pediatric abusive head trauma 
Pediatric abusive head trauma (AHT) is a leading cause of fatal child maltreatment among young children. Current prevention efforts have not been consistently effective. Policies, such as paid parental leave could potentially prevent AHT, given its impacts on risk factors for child maltreatment. To explore associations between California’s 2004 paid family leave (PFL) policy and hospital admissions for AHT, we used difference-in-difference analyses of 1995–2011 US state-level data before and after the policy in California and seven comparison states. Compared to seven states with no PFL policies, California’s 2004 PFL showed a significant decrease of AHT admissions in both < 1 and < 2year-olds. Analyses using additional data years and comparators could yield different results.
doi:10.1136/injuryprev-2015-041702
PMCID: PMC4981551  PMID: 26869666
child abuse; shaken baby syndrome
12.  Low back pain among office workers in three Spanish speaking-countries: findings from the CUPID study 
Objectives
To assess differences in the prevalence and incidence of low back pain (LBP) and associated disability among office workers in Costa Rica, Nicaragua and Spain.
Methods
Data were collected at baseline (n=947, 93% response) in November 2007 and at follow-up after 12 months (n=853, 90% response). Six outcome measures were examined: baseline prevalence of (1) LBP in past 12 months, (2) LBP in past month, and (3) disabling LBP in past month; and at follow-up: (4) incidence of new LBP in the past month, (5) new disabling LBP, and (6) persistent LBP. Differences in prevalence by country were characterized by odd ratios (ORs) with 95% confidence intervals (95%CIs), before and after adjustment for covariates.
Results
Prevalence of LBP in the past month among office employees in Costa Rica (46.0%) and Nicaragua (44.2%) was higher than in Spain (33.6%). Incidence of new LBP was 37.0% in Nicaragua (OR=2.49; 95% CI: 1.57-3.95), 14.9% in Costa Rica (OR=0.74; 95% CI: 0.41-1.34), and 19.0% in Spain (reference). Incidence of new disabling LBP was higher in Nicaragua, 17.2% (OR=2.49; 95% CI: 1.43-4.34) and Costa Rica, 13.6% (OR=1.89; 95% CI: 1.03-3.48) than Spain (7.7%), while persistence of LBP was higher only in Nicaragua.
Conclusions
Prevalence of LBP and disabling LBP was higher in Costa Rican and Nicaraguan office workers than in Spain, but incidence was higher mainly in Nicaragua. Measured sociodemographic, job-related and health-related variables only partly explained the differences between countries, and further research is needed to explore reasons for the remaining differences.
doi:10.1136/injuryprev-2016-042091
PMCID: PMC5531253  PMID: 27585564
Cross-national studies; Longitudinal; Musculoskeletal pain; Risk factors
13.  Paediatric emergency department-based carbon monoxide detector intervention: a randomised trial 
Background
Although non-fire-related carbon monoxide (CO) poisoning is almost entirely preventable, over 400 people die and 20 000 people are injured each year in the USA from unintentional CO poisoning. Thus, there is a critical need for evidence-based interventions for preventing CO poisoning and increasing the proper use and installation of CO detectors.
Methods
A randomised, controlled trial (Project CODE, a Carbon Monoxide Detector Education intervention) with 2-week and 6-month follow-up home observations was conducted in 299 parents of children aged ≤18 years recruited in the emergency department of a level 1 paediatric trauma centre. The intervention group received an educational tool, a spiral-bound, laminated booklet that resembled a CO detector containing theory-based safety messages based on the precaution adoption process model, a plug-in CO detector and 9 V battery. The control group received a one page flyer on CO poisoning prevention.
Results
Although the difference was not statistically significant, mean CO knowledge score increased at a greater rate for the intervention group than the control group. Intervention group parents were more likely to exhibit ‘safe’ CO detector use than control group parents at the 2-week follow-up (RR: 2.75; 95% CI 2.06 to 3.69) and 6-month follow-up (RR: 2.78; 95% CI 2.06 to 3.76), after adjusting for self-reported CO detector use behaviour at enrolment and annual per capita income.
Conclusions
An emergency department-delivered intervention containing a theory-based educational tool paired with a CO detector can be an effective method for increasing knowledge about CO poisoning, for prevention and for appropriate use of a CO detector.
Trial registration number
NCT00959478.
doi:10.1136/injuryprev-2016-042039
PMCID: PMC5644346  PMID: 28007971
14.  Uncovering a missing demographic in trauma registries: epidemiology of trauma among American Indians and Alaska Natives in Washington State 
Background
The objectives of this study were to evaluate racial misclassification in a statewide trauma registry and to describe the epidemiology of trauma among the Washington American Indian and Alaska Native (AI/AN) population.
Methods
We performed probabilistic record linkage between the Washington Trauma Registry (2005–2009) and Northwest Tribal Registry, a dataset of known AI/AN. AI/AN patients were compared with caucasians on demographic, injury and clinical outcome factors. A multivariable model estimated odds of mortality.
Results
Record linkage increased ascertainment of AI/AN cases in the trauma registry 71%, from 1777 to 3039 cases. Compared with caucasians, AI/AN trauma patients were younger (mean age=36 vs 47 years, p<0.001) and more commonly male (66.5% vs 61.2%, p<0.001). AI/AN experienced more intentional injuries (suicide or homicide: 20.1% vs 6.7%, p<0.001), a higher proportion of severe traumatic brain injury (20.7% vs 16.8%, p=0.004) and were less likely than caucasians to use safety equipment such as seat belts/airbags (53.9% vs 76.7%, p<0.001). ISSs were similar (ISS >15: 21.4% vs 20.5%, p=0.63), and no difference was observed in mortality after adjustment for covariates (p=0.58).
Conclusions
Linkage to a state trauma registry improved data quality by correcting racial misclassification, allowing for a comprehensive description of injury patterns for the AI/AN population. AI/AN sustained more severe injuries with similar postinjury outcomes to caucasians. Future efforts should focus on primary prevention for this population, including increased use of seat belts and child safety seats and reduction of interpersonal violence and suicide.
doi:10.1136/injuryprev-2014-041419
PMCID: PMC5603226  PMID: 25924945
15.  [No title available] 
PMCID: PMC5495145  PMID: 26759347
16.  We have the programme, what next? Planning the implementation of an injury prevention programme 
Injury Prevention  2016;23(4):273-280.
Background and aim
The impact of any injury prevention programme is a function of the programme and its implementation. However, real world implementation of injury prevention programmes is challenging. Lower limb injuries (LLIs) are common in community Australian football (community-AF) and it is likely that many could be prevented by implementing exercise-based warm-up programmes for players. This paper describes a systematic, evidence-informed approach used to develop the implementation plan for a LLI prevention programme in community-AF in Victoria, Australia.
Methods
An ecological approach, using Step 5 of the Intervention Mapping health promotion programme planning protocol, was taken.
Results
An implementation advisory group was established to ensure the implementation plan and associated strategies were relevant to the local context. Coaches were identified as the primary programme adopters and implementers within an ecological system including players, other coaches, first-aid providers, and club and league administrators. Social Cognitive Theory was used to identify likely determinants of programme reach, adoption and implementation among coaches (eg, knowledge, beliefs, skills and environment). Diffusion of Innovations theory, the Implementation Drivers framework and available research evidence were used to identify potential implementation strategies including the use of multiple communication channels, programme resources, coach education and mentoring.
Conclusions
A strategic evidence-informed approach to implementing interventions will help maximise their population impact. The approach to implementation planning described in this study relied on an effective researcher-practitioner partnership and active engagement of stakeholders. The identified implementation strategies were informed by theory, evidence and an in-depth understanding of the implementation context.
doi:10.1136/injuryprev-2015-041737
PMCID: PMC5537515  PMID: 26787739
17.  Occupational injury among migrant workers in China: a systematic review 
Objectives
This review considers the state of occupational injury surveillance and prevention among migrant workers in China and suggests areas of focus for future research on the topic.
Methods
Bibliographic databases were searched for qualitative and quantitative studies on surveillance of and interventions to prevent occupational injury among migrant workers in mainland China. Additional abstracts were identified from the citations of relevant articles from the database search. Studies fitting the inclusion criteria were evaluated, and findings were extracted and summarised.
Results
The search uncovered 726 studies in the English-language databases searched, and 3109 in the Chinese database. This article analyses a total of 19 research articles that fit the inclusion criteria with qualitative or quantitative data on occupational injury surveillance and prevention of migrant workers in China. Despite evidence of the vulnerability of migrant workers in the workplace, there is little systematic surveillance of occupational injury and few evaluated interventions.
Conclusions
Migrant workers account for a disproportionate burden of occupational injury morbidity and mortality in China. However, data are inconsistent and inadequate to detail injury incidence or to evaluate interventions. The following are suggestions to decrease injury incidence among migrants: strengthen the national system of occupational injury surveillance; focus surveillance and interventions on high-risk occupations employing migrants such as construction, manufacturing and small mining operations; improve occupational safety training and access to appropriate safety equipment; evaluate recent changes in occupational health and safety and evaluate outcome of multi-party interventions to reduce occupational injury among migrant workers.
doi:10.1136/injuryprev-2012-040578
PMCID: PMC5523447  PMID: 23710065
18.  The association of road safety knowledge and risk behaviour with paediatric road traffic injury in Guangzhou, China 
Background
This study describes road traffic injuries among school-aged children in Guangzhou, China, and examines the effect of road safety knowledge and risk behaviours on road traffic injuries.
Methods
A stratified cluster sample of 3747 children from six primary schools and six middle schools in Guangzhou, China, was surveyed. Data were collected on sociodemographic factors and road traffic injuries during the past year. Knowledge about road safety rules was assessed using a 14-item road safety knowledge index, and risky road safety behaviours were measured using a 25-item road safety behaviour index.
Results
A total of 403 (10.8%) students reported having at least one road traffic injury during the past 12 months. A high proportion of injuries was found among children who were boys, in primary school and from the suburbs. Bicycle-related injuries were the most common (46.0% of all injuries). Motor vehicle-related injuries had higher hospitalisation rates and worse psychological impact than bicycle or pedestrian injuries. Children with low and medium road safety knowledge had 1.5 to 3 times the odds of injury compared with students with high road safety knowledge. Students with high scores on the risky road behaviour index had twice the odds of injury (OR 2.04, 95% CI 11.47 to 2.84) compared with students with low scores.
Conclusion
Better road safety knowledge and the avoidance of walking or cycling-related risk behaviours are protective factors for road traffic injuries among Chinese school children. More injury prevention programmes are needed to improve road safety knowledge and reduce risk behaviours.
doi:10.1136/ip.2010.027540
PMCID: PMC5507585  PMID: 20876769
19.  Epidemiology of pedestrian–MVCs by road type in Cluj, Romania 
Objective
Pedestrian–motor vehicle (PMV) crash rates in Romania are among the highest in all of Europe. The purpose of this study was to examine the characteristics of pedestrian–MVCs in Cluj County, Romania, on the two major types of roadways: national or local.
Methods
Cluj County police crash report data from 2010 were used to identify pedestrian, driver and crash characteristics of pedestrian–MVCs. Crashes with available location data were geocoded and road type (national or local) for each crash was determined. Distributions of crash characteristics were examined by road type and multivariable logistic regression models were built to determine predictors of crash road type.
Results
Crashes occurring on national roads involved more teenagers and adults, while those on local roads involved more young children (0–12) and older adults (65+) (p<0.01). Crashes on national roads were more likely to have marked pedestrian crossings and shoulders compared with local crashes. Pedestrian–MVCs that involved a moving violation by the motorist were more likely to occur on national roadways (adjusted OR=1.93, 95% CI 1.07 to 3.49).
Conclusions
Pedestrian–MVCs pose a considerable health burden in Romania. Results from this study suggest that factors leading to PMV crashes on national roads are more likely to involve driver-related causes compared with local roads. Intervention priorities to reduce pedestrian crashes on national roads should be directed towards driver behaviour on national roads. Further examination of driver and pedestrian behaviours related to crash risk on both national and local roads, such as distraction and speeding, is warranted.
doi:10.1136/injuryprev-2014-041266
PMCID: PMC5504526  PMID: 25178278
20.  The role of intersection and street design on severity of bicycle-motor vehicle crashes 
Injury Prevention  2016;23(3):179-185.
Background
Safety concerns are a major barrier to cycling. Intersection and street design variables such as intersection angles and street width might contribute to the severity of crashes and the safety concerns. In this study we examined whether these design variables were associated with bicycle-motor vehicle crashes (BMVC) severity.
Methods
Using the geographical information system and latitudes/longitudes recorded by the police using a global positioning device, we extracted intersection angles, street width, bicycle facilities, posted speed limits and annual average daily traffic from 3266 BMVC data from New York City police records. Additional variables about BMVC, including age and sex of the bicyclist, time of the day, road surface conditions, road character, vehicle type and injury severity, were obtained from police reports. Injury severity was classified as severe (incapacitating or killed) or non-severe (non-incapacitating, possible injury). The associations between injury severity and environment design variables were examined using multivariate log-binomial regression model.
Findings
Compared with crashes at orthogonal intersections, crashes at non-orthogonal intersections had 1.37 times (95% CI 1.05 to 1.80) and non-intersection street segments had 1.31 times (95% CI 1.01 to 1.70) higher risk of a severe injury. Crashes that involved a truck or a bus were twice as likely to result in a severe injury outcome; street width was not significantly associated with injury severity.
Conclusion
Crashes at non-orthogonal intersections and non-intersection segments are more likely to result in higher injury severity. The findings can be used to improve road design and develop effective safety interventions.
doi:10.1136/injuryprev-2016-042045
PMCID: PMC5502254  PMID: 27881469
Outcome of Injury
21.  EFFECTS OF BRIEF INTERVENTION ON SUBGROUPS OF INJURED PATIENTS WHO DRINK AT RISK LEVELS 
Introduction
Alcohol-related injuries are a major source of admission for trauma care. Screening and brief intervention (SBI) for injured patients can result in decreased drinking and risk behaviors. It is not clear SBI is equally beneficial for all injured patients.
Methods
A secondary data analysis of 553 patients admitted to two Level-1 trauma centers was conducted. Latent class analysis was used to identify patient subgroups based on injury-related risks and consequences of alcohol use. Intervention effects on drinking were examined among subgroups.
Results
Five subgroups were identified. Drinking improved in patients reporting multiple risks and injuries/accidents and drinking and driving. Patients that reported drinking and driving and taking foolish risks or fighting while drinking and taking foolish risks did not show improvements.
Conclusions
Trauma centers may benefit from targeting interventions based on injury-related risks and consequences of alcohol use. Further research is needed to test bedside approaches for tailored interventions.
doi:10.1136/injuryprev-2015-041596
PMCID: PMC4726485  PMID: 26124071
Traumatic injury; risk level alcohol use; patient identification
22.  Gun ownership and social gun culture 
We assessed gun ownership rates in 2013 across the USA and the association between exposure to a social gun culture and gun ownership. We used data from a nationally representative sample of 4000 US adults, from 50 states and District of Columbia, aged >18 years to assess gun ownership and social gun culture performed in October 2013. State-level firearm policy information was obtained from the Brady Law Center and Injury Prevention and Control Center. One-third of Americans reported owning a gun, ranging from 5.2% in Delaware to 61.7% in Alaska. Gun ownership was 2.25-times greater among those reporting social gun culture (PR=2.25, 95% CI 2.02 to 2.52) than those who did not. In conclusion, we found strong association between social gun culture and gun ownership. Gun cultures may need to be considered for public health strategies that aim to change gun ownership in the USA.
doi:10.1136/injuryprev-2015-041586
PMCID: PMC4809774  PMID: 26124073
23.  Compliance to two city convenience store ordinance requirements 
Background
Robbery-related homicides and assaults are the leading cause of death in retail businesses. Robbery reduction approaches focus on compliance to Crime Prevention Through Environmental Design (CPTED) guidelines.
Purpose
We evaluated the level of compliance to CPTED guidelines specified by convenience store safety ordinances effective in 2010 in Dallas and Houston, Texas, USA.
Methods
Convenience stores were defined as businesses less than 10 000 square feet that sell grocery items. Store managers were interviewed for store ordinance requirements from August to November 2011, in a random sample of 594 (289 in Dallas, 305 in Houston) convenience stores that were open before and after the effective dates of their city’s ordinance. Data were collected in 2011 and analysed in 2012–2014.
Results
Overall, 9% of stores were in full compliance, although 79% reported being registered with the police departments as compliant. Compliance was consistently significantly higher in Dallas than in Houston for many requirements and by store type. Compliance was lower among single owner-operator stores compared with corporate/franchise stores. Compliance to individual requirements was lowest for signage and visibility.
Conclusions
Full compliance to the required safety measures is consistent with industry ‘best practices’ and evidence-based workplace violence prevention research findings. In Houston and Dallas compliance was higher for some CPTED requirements but not the less costly approaches that are also the more straightforward to adopt.
doi:10.1136/injuryprev-2015-041582
PMCID: PMC4775448  PMID: 26337569
24.  State injury prevention policies and variation in death from injury 
Objectives
Death from injury is frequently preventable, but injury remains a leading cause of death in the USA. While evidence-based strategies exist to prevent many types of injuries, effective policies for implementing these strategies at the population level are needed to reduce injury deaths. We identified promising injury prevention policies and evaluated their association with injury death rate (IDR).
Methods
We identified 11 injury prevention policies and accessed data on 2013 state and county IDRs. States were divided into strong, moderate and weak tertiles based on total number of policies in place. Adjusted regression modelling compared the strength of state prevention policies with IDRs at the state level and then at the county level to account for variability within states.
Results
The strength of state prevention policies (tertile) was not significantly associated with IDR in US states. However, counties in strong policy states had a 11.8-point lower IDR compared with those in weak policy states (p=0.001).
Conclusions
States with more injury prevention policies in place have lower rates of death from injury, particularly when evaluated at the county level. Implementing recommended prevention policies holds potential to prevent injury death in the USA.
doi:10.1136/injuryprev-2015-041762
PMCID: PMC4803587  PMID: 26586719
25.  Data visualisation in surveillance for injury prevention and control: conceptual bases and case studies 
Background
The complexity of current injury-related health issues demands the usage of diverse and massive data sets for comprehensive analyses, and application of novel methods to communicate data effectively to the public health community, decision-makers and the public. Recent advances in information visualisation, availability of new visual analytic methods and tools, and progress on information technology provide an opportunity for shaping the next generation of injury surveillance.
Objective
To introduce data visualisation conceptual bases, and propose a visual analytic and visualisation platform in public health surveillance for injury prevention and control.
Methods
The paper introduces data visualisation conceptual bases, describes a visual analytic and visualisation platform, and presents two real-world case studies illustrating their application in public health surveillance for injury prevention and control.
Results
Application of visual analytic and visualisation platform is presented as solution for improved access to heterogeneous data sources, enhance data exploration and analysis, communicate data effectively, and support decision-making.
Conclusions
Applications of data visualisation concepts and visual analytic platform could play a key role to shape the next generation of injury surveillance. Visual analytic and visualisation platform could improve data use, the analytic capacity, and ability to effectively communicate findings and key messages. The public health surveillance community is encouraged to identify opportunities to develop and expand its use in injury prevention and control.
doi:10.1136/injuryprev-2015-041812
PMCID: PMC4833094  PMID: 26728006

Results 1-25 (1641)