Biomedical subjects
Publications and source records attributed to A K Lund.
Psychologists are inadequately represented in the injury control field, despite the size of the problem and the importance of behavioral factors in injury. Using motor vehicle injuries as an example, this article discusses modern injury control principles and the role psychologists can play in injury reduction.
Passive alcohol sensors are screening devices designed to sample nonintrusively the exhaled breath of a person to determine whether or not it contains alcohol and if so approximately how much. Two production passive alcohol sensors (NPAS passive alcohol sensor and the Life-Loc PBA 2000) were evaluated in a laboratory environment to establish appropriate threshold measurements that indicate probable alcohol impairment. The laboratory evaluation was conducted using both instrument types with 12 drinking subjects. Both sensors were able to identify alcohol in exhaled breath with sufficient accuracy to identify persons with high blood alcohol concentrations (BACs). The accuracy of both sensors was related to the distance from the subject's mouth: the further away they were from a subject's mouth the greater the chance that high BACs would not be detected. Under ideal conditions, it was estimated that the Life-Loc sensor could be expected to correctly detect 80% of drivers at 0.10% BAC (99% at 0.15% BAC) as being impaired while incorrectly identifying only about one in eight drivers with BACs of 0.02% (false positives). In comparison, the NPAS sensor could be expected to correctly detect about 75% of drivers at 0.10% BAC (97% at 0.15% BAC) while incorrectly identifying one in five drivers at 0.02% BAC.
Injuries to front seat occupants in tow-away crashes in the Charlottesville, Va, area were compared for 1 year before and 1 year after Virginia's seat belt use law took effect. Vehicle and occupant data were combined to examine crash and injury patterns. Reported seat belt use in crashes increased after the law, and there were substantial decreases in injuries. Front seat occupants were less likely to receive medical treatment following a crash in the postlaw period. The reduction in the number of injuries was greater for passengers in the right front seat than for drivers and for frontal crashes than for other types of crashes. The injury reduction effects occurred primarily through reductions in the number of head and face injuries, particularly those that occur from contact with windshields and instrument panels.
Drivers who had been observed wearing or not wearing shoulder belts were compared using vehicle registration data, driver records, and telephone interviews. The observations were made on the New York Thruway during a special seat belt publicity and enforcement program, which achieved a 75% overall belt use. The results showed that those drivers who still did not wear a shoulder belt despite New York law and the special Thruway program were more likely to be male, to be driving older vehicles, to have more prior traffic convictions, to have more prior injury crash involvements, and to say they are more likely to take risks than others. Although drivers reported that assessing points against the drivers license for belt law violations could increase belt use, citations for belt use law violations were very rare, and enforcement would probably have to increase before any new penalty could be effective.
Studies of motor vehicle fatality data have indicated that alcohol involvement in fatal crashes has declined substantially in the United States since 1980. To determine the actual incidence of alcohol-impaired drivers on U.S. roads, a national roadside survey using portable breath-testing devices was carried out in 32 localities in the spring of 1986. The same sampling design and survey procedures used in a 1973 national roadside survey were followed as much as possible. The 1986 survey found 3.1% of the late-night weekend drivers to have a blood alcohol concentration (BAC) of 0.10% or more, compared to 4.9% of drivers in 1973. Similarly, 8.3% of the 1986 drivers were at or above 0.05% BAC, compared to 13.5% in 1973. The data indicate that the incidence of alcohol-impaired driving on weekend nights has fallen by one-third or more in the United States since 1973 and that the decline affected most population subgroups.
Several U.S. cities have curfew ordinances that limit the late night activities of minor teenagers in public places including highways. Detroit, Cleveland, and Columbus, which have curfew ordinances, were compared to Cincinnati, which does not have such an ordinance. The curfew ordinances were associated with a 23% reduction in motor vehicle related injury for 13- to 17-year-olds as passengers, drivers, pedestrians, or bicyclists during the curfew hours. It was concluded that city curfew ordinances, like the statewide driving curfews studied in other states, can reduce motor vehicle injury to teenagers during the particularly hazardous late night hours.
Examined persistence in the daily use of fluoride mouthrinse among adolescents as a function of an induced-choice manipulation concerning self-management strategies and freedom to participate in the program. Seventh-grade boys and girls from urban and suburban schools were randomly assigned to a series of either high- or low-choice decisional control manipulations; their daily, home use of fluoride was monitored over a 20-week period. In order to ameliorate the relatively lower persistence rates found previously among suburban (vs. urban) students, all students were given self-management and action instructions as per previous studies. Although suburban students still declined in persistence relative to urban students, female students who received high choice persisted at a higher rate than girls who received low choice. Boys, for the most part, were unaffected by the manipulation. In addition, students' self-reported work orientation was also positively associated with persistence.
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.
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.
Usage of the automatic belt systems supplied by six large-volume automobile manufacturers to meet the federal requirements for automatic restraints were observed in suburban Washington, D.C., Chicago, Los Angeles, and Philadelphia. The different belt systems studied were: Ford and Toyota (motorized, nondetachable automatic shoulder belt), Nissan (motorized, detachable shoulder belt), VW and Chrysler (nonmotorized, detachable shoulder belt), and GM (nonmotorized detachable lap and shoulder belt). Use of automatic belts was significantly greater than manual belt use in otherwise comparable late-model cars for all manufacturers except Chrysler; in Chrysler cars, automatic belt use was significantly lower than manual belt use. The automatic shoulder belts provided by Ford, Nissan, Toyota, and VW increased use rates to about 90%. Because use rates were lower in Ford cars with manual belts, their increase was greater. GM cars had the smallest increase in use rates; however, lap belt use was highest in GM cars. The other manufacturers supply knee bolsters to supplement shoulder belt protection; all--except VW--also provide manual lap belts, which were used by about half of those who used the automatic shoulder belt. The results indicate that some manufacturers have been more successful than others in providing automatic belt systems that result in high use that, in turn, will mean fewer deaths and injuries in those cars.
Recent reviewers of well-controlled driver improvement program evaluations have suggested that some programs result in measurable reductions in violations but not crashes. A comprehensive review of 65 studies evaluating driver improvement activities was conducted to determine the generality of these findings and to explore possible explanations of the lack of correspondence between violation and crash effects. Nineteen studies evaluating 59 driver improvement activities were found to be methodologically adequate. The major findings of the review are: (1) that driver improvement activities generally do result in reductions in violations; (2) there is an unpredictable and sometimes undesirable effect on crashes even in the presence of desirable violation effects; and (3) the lack of correspondence between violation and crash effects is not explained by lack of statistical power or by the types of violations affected. Further examination of driver improvement interventions revealed no strong evidence for different effects related to characteristics such as direct vs. indirect participant contact and group vs. individual contact.
As of April 1987, states were permitted to raise the speed limit on rural interstates to 65 mph without incurring federal sanctions; 38 states elected to do so in 1987. Fatality data for the months when the new limit was in effect in 1987 were compared with fatalities in the same months of 1982-86 on rural interstates and other rural roads. Fatalities on rural interstates in the states with increased speed limits in 1987 were conservatively estimated to be 15 percent higher than they would have been if the states had retained the 55 mph limit (95% CI = 6, 24). Among states that retained the 55 mph limit, fatalities on rural interstates were 6 percent lower than expected (95% CI = -23, 13).
It is estimated that in 1985 about 1,560 fewer drivers were involved in fatal crashes because of three types of drinking-driving laws. The laws studied were per se laws that define driving under the influence using blood alcohol concentration (BAC) thresholds; laws that provide for administrative license suspension or revocation prior to conviction for driving under the influence (often referred to as "administrative per se" laws); and laws that mandate jail or community service for first convictions of driving under the influence. It is estimated that if all 48 of the contiguous states adopted laws similar to those studied here, and if these new laws had effects comparable to those reported here, another 2,600 fatal driver involvements could be prevented each year. During hours when typically at least half of all fatally injured drivers have a BAC over 0.10 percent, administrative suspension/revocation is estimated to reduce the involvement of drivers in fatal crashes by about 9 percent; during the same hours, first offense mandatory jail/community service laws are estimated to have reduced driver involvement by about 6 percent. The effect of per se laws was estimated to be a 6 percent reduction during hours when fatal crashes typically are less likely to involve alcohol. These results are based on analyses of drivers involved in fatal crashes in the 48 contiguous states of the United States during the years 1978 to 1985.
Belt use among drivers traveling on limited access highways was observed before and after New York's mandatory seat belt use law. The results showed that high-speed drivers had lower belt use rates before the law and increased their belt use less in response to the law. Belt use rates before the law were 25%, 29%, and 28% for the high-, medium-, and low-speed groups as compared with 51%, 64%, and 57%, respectively, after the law. High-speed drivers also had inferior previous driving records, confirming their higher risk of motor vehicle crash involvement.
Blood or urine samples or both were obtained from 317 of 359 randomly selected tractor-trailer drivers asked to participate in a driver health survey conducted at a truck weighing station on Interstate 40 in Tennessee. Altogether, 29% of the drivers had evidence of alcohol, marijuana, cocaine, prescription or nonprescription stimulants, or some combination of these, in either blood or urine. Cannabinoids were found in 15% of the drivers' blood or urine; nonprescription stimulants such as phenylpropanolamine were found in 12%; prescription stimulants such as amphetamine were found in 5%; cocaine metabolites were found in 2%; and alcohol was found in less than 1%. These results provide the first objective information about the use of potentially abusive drugs by tractor-trailer drivers. The extent of driver impairment attributable to the observed drugs is uncertain because of the complex relationship between performance and drug concentrations.
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Analyses of motor vehicle fatality counts in New York and several comparison states for the years 1980 through 1985 indicate that New York's seat belt use law reduced fatalities by about nine percent during the first nine months of the law. This estimate is preliminary, and the estimated long-term effect of the law could change as more sophisticated analyses are applied to the data and as belt use changes (it had declined to less than 50 percent over most of the state by the end of the first year of the law). In addition, New York's law is one of the strongest in terms of enforceability, and the effect may be smaller in states with weaker laws. However, the estimated effect in New York is consistent with the experience of other countries with seat belt use laws.
This study assessed the effects of New York State's recently adopted mandatory seat belt use law on teenage drivers. Teenage drivers were observed as they entered high school parking lots before the law was adopted, after it was adopted but before it was effective, one month after the effective date, and again five months after the effective date. The results showed that 14% of the teenage drivers were wearing either shoulder or lap belts or both prior to adoption of the law. This increased to 22% after adoption of the law, 60% one month after the effective date of the law, and 63% five months after the effective date. Teenagers using seat belts were more often female, were younger, had completed driver education and had a longer trip from home to school. Both before and after the law, teenage belt use was similar to, but typically lower than, belt use in the community in which the school was located.