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Biomedical subjects

J J Sacks

Publications and source records attributed to J J Sacks.

At least 37 records · Page 2Linked to original sources
PubMed1997

Evaluation of a statewide bicycle helmet law via multiple measures of helmet use.

OBJECTIVES: To evaluate an Oregon law requiring bicyclists younger than 16 year to wear a helmet and to compare methods of measuring helmet use. DESIGN: Four prelaw and postlaw statewide helmet use surveys: (1) statewide observations, (2) middle school observations, (3) classroom self-report surveys, and (4) a statewide adult telephone survey. SETTING: Oregon. SUBJECTS: Statewide observations, 3313 child bicyclists at 13 sites; middle school observations, 995 child bicyclists at 33 randomly selected middle schools; classroom self-report surveys, fourth, sixth, and eighth graders in 448 classrooms (ie, 8955 students) before the law was effected and 456 classrooms (ie, 9811 students) after the law was effected in 66 randomly selected schools; and statewide telephone survey, 1219 randomly called parents of 1437 children younger than 16 years. MAIN OUTCOME MEASURES: Prelaw and postlaw helmet use and ownership and knowledge and opinion about the law. RESULTS: Observed helmet use among youth was 24.5% before the law was effected and 49.3% after the law was effected. School-observed use increased from 20.4% to 56.1%. Classroom survey self-reported "always" use of helmets increased from 14.7% to 39.4%; reported use on the day of the survey increased from 25.8% to 76.0%. Telephone survey-reported "always" helmet use increased from 36.8% to 65.7%. Younger children and girls were more likely to use helmets. Most students (ie, 87.8%) and parents (ie, 95.4%) knew about the law; however, only 42.6% of children thought the law was a good idea. CONCLUSIONS: We conclude that (1) the law increased helmet use; (2) although use estimates differ, all helmet surveys showed similar degrees of prelaw and postlaw change; and (3) half of child bicyclists are still not wearing helmets, indicating a need for additional promotion of helmet wearing. Laws seem to be an effective way to increase helmet use.

Adolescent↗
PubMed1997

Estimating intruder-related firearm retrievals in U.S. households, 1994.

To estimate the frequency of firearm retrieval because of a known or presumed intruder, the authors analyzed data from a 1994 national random digit dialing telephone survey (n = 5,238 interviews). Three mutually exclusive definitions of firearm retrieval were constructed: (1) retrieved a firearm because there might be an intruder, (2) retrieved a firearm and saw an intruder, and (3) retrieved a firearm, saw an intruder, and believed the intruder was frightened away by the gun. Of 1,678 (34%) households with firearms, 105 (6%) retrieved a firearm in the previous 12 months because of an intruder. National projections based on these self-reports reveal an estimated 1,896,842 (95% CI [confidence interval] = 1,480,647-2,313,035) incidents in which a firearm was retrieved, but no intruder was seen; 503,481 (95% CI = 305,093-701,870) incidents occurred in which an intruder was seen, and 497,646 (95% CI = 266,060-729,231) incidents occurred in which the intruder was seen and reportedly scared away by the firearm. Estimates of the protective use of firearms are sensitive to the definitions used. Researchers should carefully consider both how these events are defined and the study methods used.

Adult↗
PubMed1996

Effect of a state law on reported bicycle helmet ownership and use.

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

Adolescent↗
PubMed1996

Dog bites: how big a problem?

OBJECTIVE: To estimate the magnitude of the dog bite problem in the US. METHODS: Data on dog bites were gathered as part of a 1994 national telephone survey of 5,238 randomly dialed households. Data were weighted to provide national estimates. RESULTS: The weighted total number of dog bites was 4,494,083 (estimated incidence = 18/1,000 population); of these, 756,701 persons sustained bites necessitating medical attention (incidence rate = 3/1,000). Children had 3.2 times higher medically attended bite rates than adults (6.4/1,000 children v 2/1,000 adults). CONCLUSIONS: More attention and research needs to be devoted to the prevention of dog bites. Potential prevention strategies include: educational programs on canine behavior, especially directed at children; laws for regulating dangerous or vicious dogs; enhanced animal control programs; and educational programs regarding responsible dog ownership and training. Unfortunately, the relative or absolute effectiveness of any of these strategies has not been assessed. Continuing surveillance for dog bites will be needed if we are to better understand how to reduce the incidence of dog bites and evaluate prevention efforts.

Accident Prevention↗
PubMed1996

Bicycle helmet use among American children, 1994.

OBJECTIVE: To estimate ownership and use of bicycle helmets among children in the US in 1994. METHODS: As part of a 1994 national telephone survey of 5,238 randomly dialed households, adult respondents reported data on bicycle helmet ownership and helmet use among 1,645 child bicyclists. Data were weighted to provide national estimates. RESULTS: It is estimated that 72.7% of children 5-14 year olds ride bicycles, that is, 27.7 million child bicyclists. Of the bicyclists, 50.2% have a helmet and 25.0% reportedly always wore their helmet when cycling. Reported helmet ownership and use increased with income and educational level and decreased with age. Among regions of the US, those with the highest proportion of states with helmet use laws in 1994 also had the highest proportion of helmet use among children. Among child bicyclists who had been seen by a health care provider in the preceding 12 months, 43.9% of those counseled to wear a bicycle helmet were reported to comply compared with 19.1% of those seen by a provider but not so counseled (p < 0.001). CONCLUSIONS: To meet the year 2000 objective of 50% of bicyclists wearing helmets, use among American children will have to double. Concerted and increased efforts to promote the wearing of bicycle helmets are necessary.

Adolescent↗
PubMed1996

Fatal dog attacks, 1989-1994.

OBJECTIVES: To update data on fatal dog bites and see if past trends have continued. DESIGN: To merge data from vital records, the Humane Society of the United States, and searches of electronic news files. SETTING: United States. SUBJECTS: U.S. residents dying in the U.S. from 1989 through 1994 from dog bites. RESULTS: We identified 109 dog bite-related fatalities, of which 57% were less than 10 years of age. The death rate for neonates was two orders of magnitude higher than for adults and the rate for children one order of magnitude higher. Of classifiable deaths, 22% involved an unrestrained dog off the owner's property, 18% involved a restrained dog on the owner's property, and 59% involved an unrestrained dog on the owner's property. Eleven attacks involved a sleeping infant; 19 dogs involved in fatal attacks had a prior history of aggression; and 19 of 20 classifiable deaths involved an unneutered dog. Pit bulls, the most commonly reported breed, were involved in 24 deaths; the next most commonly reported breeds were rottweilers (16) and German shepherds (10). CONCLUSIONS: The dog bite problem should be reconceptualized as a largely preventable epidemic. Breed-specific approaches to the control of dog bites do not address the issue that many breeds are involved in the problem and that most of the factors contributing to dog bites are related to the level of responsibility exercised by dog owners. To prevent dog bite-related deaths and injuries, we recommend public education about responsible dog ownership and dog bite prevention, stronger animal control laws, better resources for enforcement of these laws, and better reporting of bites. Anticipatory guidance by pediatric health care providers should address dog bite prevention.

Adolescent↗
PubMed1996

Pediatric head injuries and deaths from bicycling in the United States.

OBJECTIVE: To estimate the potential benefit of increasing bicycle helmet use among children and adolescents in the United States. DESIGN: All bicycle-related deaths (Multiple Cause-of-Death Public Use Data Tapes, 1989 through 1992) and bicycle-related injuries treated in sampled emergency departments (National Electronic Injury Surveillance System, 1989 through 1993) were used to calculate traumatic brain injury-associated death and head injury rates per 1,000,000 US residents. Preventable injuries and deaths were estimated by calculating the population-attributable risk of head injury due to nonuse of bicycle helmets. PATIENTS: US residents aged 0 through 19 years who were injured or who died as a result of a bicycle crash. RESULTS: An average of 247 traumatic brain injury deaths and 140,000 head injuries among children and adolescents younger than 20 years were related to bicycle crashes each year in the United States. As many as 184 deaths and 116,000 head injuries might have been prevented annually if these riders had worn helmets. An additional 19,000 mouth and chin injuries were treated each year. The youngest age groups had the highest proportions of both head and mouth injuries. CONCLUSION: There continues to be a need to advocate for greater use of bicycle helmets, particularly among young children. Helmet design changes should be considered to prevent mouth injuries.

Adolescent↗
PubMed1995

Injuries from falls on playgrounds. Effects of day care center regulation and enforcement.

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

Accidental Falls↗
PubMed1994

Geographic patterns of fatal abuse or neglect in children younger than 5 years old, United States, 1979 to 1988.

OBJECTIVE: To examine geographic patterns of fatal child abuse or neglect (CAN) among children younger than 5 years old. DESIGN: A death certificate-based model to estimate the occurrence of fatal CAN. SETTING: United States, 1979 to 1988. PARTICIPANTS: The population of children younger than 5 years old. INTERVENTIONS: None. MAIN RESULTS: We estimate that from 868 to 1815 deaths annually occur among children younger than 5 years old from CAN. The lower figure is the estimate of confirmed CAN, and the higher is the estimate of the sum of confirmed, probable, and possible CAN. Death rates were highest in the South and West, intermediate in the North Central, and lowest in the Northeast. A threefold difference was noted between rates in the lowest- and highest-ranking states (ie, Connecticut, 2.9 to 5.2 per 100,000, and Nevada, 6.7 to 15.4 per 100,000, respectively). When the 39 largest metropolitan areas were ranked, a similar variation between the lowest and the highest was observed (ie, Boston, Mass, 2.7 to 5.5 per 100,000, and Phoenix, Ariz, 6.6 to 15.5 per 100,000, respectively). CONCLUSION: Understanding the sizable geographic variation in CAN deaths rates could lead to effective interventions. If the US fatality rate were reduced to that of Connecticut, between 434 and 908 fewer CAN deaths might occur annually.

Cause of Death↗
PubMed1994

Smoking and injuries: an overview.

BACKGROUND: Although the disease consequences of cigarette smoking are well documented, smoking may also be associated with increased risk of injury. Our purpose is to provide an overview of this potential association. METHODS: We conducted a literature review. RESULTS: Cigarettes are the leading cause of death from fire and the second leading cause of fire-related injury. Studies estimate that compared with nonsmokers, smokers appear 1.5 times more likely to have a motor vehicle crash, 1.4-2.5 times more likely to be injured at work, and 2.0 times more likely to suffer other unintentional injuries. A variety of reasons may explain an association between cigarette smoking and injuries; these include (a) direct toxicity; (b) distractibility; (c) smoking-associated medical conditions; and (d) confounding factors, including personality or behavioral characteristics. CONCLUSIONS: Smoking may be an independent risk factor for thermal, motor vehicle, occupational, and other unintentional injuries. Nonsmokers may be at increased risk of injury from the presence of smokers in their environments, e.g., from fires. Societal benefits from decreased smoking prevalence are likely to include reduction of both fatal and nonfatal injuries.

Accidents, Occupational↗
PubMed1994

The compliance of licensed US child care centers with national health and safety performance standards.

The American Public Health Association and the American Academy of Pediatrics recently published health and safety guidelines for child care centers. A survey was conducted to determine the extent to which practices in US child care centers are reflective of these guidelines. Compliance with 16 guidelines ranged from 19.5% to 98.6%, varied considerably by state, and was not consistently associated with selected center characteristics. Prevention efforts should focus on practices for which compliance is low and on those that have the greatest disease- and injury-reducing potential.

Child Day Care Centers↗
PubMed1994

A nationwide study of the risk of injury associated with day care center attendance.

OBJECTIVE: Because an increasing proportion of US children spends time in day care center environments, a national estimate of injury risks in day care centers is needed. METHODS: We interviewed directors of 1797 day care centers from every state and the District of Columbia from October to December 1990 and analyzed medically attended injuries and center characteristics reported by the directors. RESULTS: The centers were attended by 138,404 children. In the 2 months before the center directors were interviewed, 556 children sustained injuries requiring medical attention while attending the centers. The injury rate was 1.5 injuries per 100,000 child hours in day care. The most common injuries were cuts or lacerations (31%), bumps or bruises (15%), fractures (10%), and dental injuries (8%). Most injuries (51%) occurred on the playground. Many injuries (18%), and more than half of fractures and concussions (53%) were due to falls from climbing equipment. CONCLUSIONS: Day care center injury rates estimated by this study were relatively low. Many injuries that occur in this setting are probably minor. However, lowering the height of playground equipment and providing more resilient playground surfaces could further reduce injury risks in day care centers.

Child Day Care Centers↗