88

would clarify the public health implications ofthe association found in this report.

It may be premature to consider changes inthe legal approach to cellphone use in cars(although some countries require that the carbe pulled over and stopped while doing so;others ban car telephone use outright, whileothers ban only hand-held phones). At the veryleast this study should suggest to cellulartelephone service providers and users that

unnecessary use of these devices while drivingshould be discouraged. Although it is difficultto imagine a situation where the use of atelephone while driving is necessary, shouldthis arise extreme caution is needed.

1 Redelmeier DA, Tibshirani RJ. Association between cellular-telephone calls and motor vehicle collisions. NEnglJMed1997; 336: 45-8.

2 Maclure M. The case-crossover design: a method for studyingtransient effects on the risk of acute events. Am YEpidemiol 1991; 133: 144-53.

International Society for Child and Adolescent Injury PreventionWe invite you to join the International Society for Child and Adolescent Injury Prevention(ISCAIP). ISCAIP was created in 1993 for injury professionals around the world. The goalof ISCAIP is to reduce the number and severity of injuries to children and adolescentsthrough international collaboration.

Membership feeThe annual membership fee for ISCAIP, including a subscription to Injury Prevention, is:£80 for individuals£125 for non-profit or charity institutions£250 for corporate institutions

If you would like to receive a brochure describing ISCAIP in greater detail, please write tothe address below.

How to joinPlease complete this form and return it to ISCAIP,London EC1R 3AU, UK

c/o CAPT, 18- 20 Farringdon Lane,

Name (Mr/Mrs/Ms/Miss/Dr):

Title/position:

Institution:

Address (plus postal/zip code)

Telephone/fax/e-mail

Type of membership (ring one)Individual/non-profit charity/corporate

Visa/Mastercard number*

Expiry date

Name as it appears on the cardCard billing address (if different from above)

Amount to be chargedSignature of cardholder

*When paying by credit card, the account will be charged in pounds sterling and convertedaccordingly (we much prefer this method of payment).

Platt

93An international study of the exposure of children to traffic

non-respondent 9 year olds in Umea bicycled,then the prevalence ofbicycling would be 18%,still substantially greater than the other cities.Finally, our analyses ofthe proportions walkingto school and the total streets crossed bytertiles of school based response rates did notshow any clear relationship between pedestrianactivity and response rates.

Because travel patterns were determined byself report, the validity of these data is open toquestion. The validity of interview reportedpedestrian activity was studied by Routledge etal who observed a child's pedestrian activityone day and interviewed the same child thefollowing day.9 The results showed that pedes-trian exposure to risk was slightly under-reported-86% of the number of roads ob-served to be crossed were reported. Similarresults were obtained in a validation study inPerth.10 Under-reporting of pedestrian activityis probably due to children forgetting roadcrossings. In our study, we attempted tominimise under-reporting by asking childrento complete the questionnaire with theirparents in the evening after systemicallyreviewing their road crossings for that day.Through its effect on travel patterns, the

urban transport infrastructure may influenceboth injury risk and levels of physical activity.World wide, traffic volume is predicted toincrease well into the next century."I This studyprovides a baseline against which future changes

in childhood travel patterns can be judged. Incities everywhere, differential exposure to trafficis a major contributor to socioeconomic gradi-ents in childhood mortality.

The study was funded by the following organisations: FederalOffice of Road Safety (Melbourne), the Western AustralianHealth Promotion Foundation (Healthways) (Perth), AccidentRehabilitation and Compensation Insurance Corporation(Auckland), National Health Research and DevelopmentProgram (Montreal), and the Swedish National Public HealthInstitute and Swedish National Road Administration (Umea).The help of the participating schools at each of the study sites isgratefully acknowledged.

1 Rivara FP. Child pedestrian injuries in the United States. AmJ Dis Child 1990; 144: 692 - 6.

2 Roberts I. The primary prevention of child pedestrianinjuries. BMJ 1995; 310: 413-4.

3 Department of Health. The health of the nation: more people,more active, more often. London: Department of Health,1995.

4 Anonymous. Young and unfit [editorial]. Lancet 1992; 340:19-20.

5 Roberts I. International trends in pedestrian injury mortality.Arch Dis Child 1993; 68: 190-2.

6 Guyer B, Talbot AM, Pless IB. Pedestrian injuries tochildren and youth. Pediatr Clin North Am 1985; 31:163-74.

7 Kish L. Survey sampling. New York: John Wiley and Sons,1965.

8 Dougherty G, Pless IB, Wilkins R. Social class and theoccurrence of traffic injuries and deaths in urban children.Can J Public Health 1990; 81: 204- 9.

9 Routledge DA, Repetto-Wright R, Howarth CI. Thecomparison of interviews and observations to obtainmeasures of children's exposure to risk as pedestrians.Ergonomics 1974; 17: 623-38.

10 Stevenson MR. The validity of children's self reportedexposure to traffic. Accid Anal Prev (in press).

11 Houghton J. Transport and the environment. (18th report.)London: HMSO, 1994.

By Thomas Bevick (with thanks to Hugh Jackson).

Characteristics and outcomes of sel inflicted pediatric injuries

injury in children based on population baseddata, including etiologic factors and long termoutcomes. Of special importance are studiesthat evaluate the cost effectiveness of differentsuicide prevention programs, such as mentalhealth promotion by improving the socialadjustment of high risk children, and restric-tion of access of children to firearms througheducation and legislation.

This research was supported in part by a FIRST Award(R29AA09963) from the National Institute on Alcohol Abuseand Alcoholism (GL and SS), by Grant R49/CCR302486 fromthe Centers for Disease Control and Prevention (GL and SPB),and by Grant H133850006 from the National Institute onDisability and Rehabilitation Research (CdiS). We thank twoanonymous reviewers for helpful comments.

1 Baker SP, O'Neil B, Ginsburg MJ, Li G. The injury fact book.2nd Ed. New York, NY: Oxford University Press, 1992:65 -77.

2 Centers for Disease Control and Prevention. Injury mortal-ity: national summary of injury mortality data, 1986-1992.Atlanta, GA: National Center for Injury Prevention andControl, Centers for Disease Control and Prevention,1995.

3 National Center for Health Statistics. Vital statistics of theUnited States, 1991. Vol II, mortality, part B. Washington,DC: Public Health Service, 1995.

4 Centers for Disease Control and Prevention. Suicide amongchildren, adolescents, and young adults-United States,1980-1992. MMWR 1995; 44: 289-91.

5 Boyd JH. The increasing rate of suicide by firearms. N EnglJ3Med 1983; 308: 872-4.

6 Moscicki EK, Boyd JH. Epidemiologic trends in firearmsuicides among adolescents. Pediatrician 1985; 12: 52-62.

7 Kachur SP, Potter LB, Powell KE, Rosenberg ML. Suicide:epidemiology, prevention, treatment. Adolescent Medicine:State-of-Art Reviews 1995; 6: 171 - 82.

8 Tepas JJ, Ramenofsky ML, Barlow B, et al. NationalPediatric Trauma Registry. J Pediatr Surg 1989; 24:156-8.

9 Tepas JJ, Ramenofsky ML, Barlow B, DiScala C, Gans BM.Mortality from head injury: the pediatric perspective. JfPediatrSurg 1990; 25: 92-6.

10 Osberg JS, DiScala C, Gans BM. Utilization of inpatientrehabilitation services among traumatically injured chil-dren discharged from pediatric trauma centers. Am 7 PhysMed Rehabil 1990; 69: 66-72.

11 Osberg JS, DiScala C. Morbidity among pediatric motorvehicle crash victims: the impact of seatbelts. Am 7 PublicHealth 1992; 82: 422-5.

12 Lescohier I, DiScala C. Blunt trauma in children: causesand outcomes ofhead versus extracranial injury. Pediatrics1993; 91: 721-5.

13 Li G, Baker SP, Fowler C, DiScala C. Factors related to thepresence ofhead injury in bicycle-related pediatric traumapatients. Jf Trauma 1994; 38: 871 - 5.

14 Laraque D, Barlow B, Durkin M, et al. Children who areshot: a 30-year experience. J7 Pediatr Surg 1995; 30:1072 -6.

15 SAS Institute Inc. SASISTAT user's guide. Version 6 ed.Cary, NC: SAS Institute Inc, 1989.

16 Holinger PC, Luke K. The epidemiologic patterns of self-destructiveness in childhood, adolescence, and youngadulthood. In: Sudak HS, Ford AB, Rushforth NB, eds.Suicide in the young. Littleton, MA: John Wright, 1984:97-114.

17 Brent DA, Perper JA, Moritz G, Baugher M, Schweers J,Roth C. Firearms and adolescent suicide: a communitycase-control study. Am Jf Dis Child 1993; 147: 1066 - 71.

18 Trautman PD, Shaffer D. Treatment of child and adoles-cent suicide attempts. In: Sudak HS, Ford AB, RushforthNB, eds. Suicide in theyoung. Littleton, MA: John Wright,1984: 307-23.

19 Boor M. Methods of suicide and implications for suicideprevention. Jf Clin Psychol 1981; 37: 70-5.

20 Frederick C. Current trends in suicidal behavior in theUnited States. Am Jf Psychother 1978; 32: 172 - 200.

21 Brent DA, Perper JA, Allman CJ, Moritz GM, WartellaME, Zelenak JP. The presence and accessibility offirearms in the homes of adolescent suicides. JAMA1991; 266: 2989-95.

22 Kellermann AL, Rivara FP, Somes G, et al. Suicide in thehome in relation to gun ownership. N Engl J7 Med 1992;327: 467-72.

23 Centers for Disease Control and Prevention. Fatal andnonfatal suicide attempts among adolescents-Oregon,1988-1993. MMWR 1995; 44: 312-21.

24 Trinkoff AM, Baker SP. Poisoning hospitalizations anddeaths from solids and liquids among children andteenagers. Am Public Health 1986; 76: 657 -60.

Editorial Board Member: brief biography

IAN ROBERTSIan Roberts is Director of theChild Health MonitoringUnit at the Institute of ChildHealth. He became inter-ested in child injury preven-tion after becoming a parent,and as a result of his experi-ences while working as a

paediatrician in an intensivecare unit. From 1991 to 1994he worked as a research

I _ g.fellow in the Injury Preven-2 1 tion Research Centre at the

University of Auckland. Hewas co-principal investigator

with Dr Robyn Norton on the Auckland Child PedestrianInjury Study, a case-control study of risk factors for childpedestrian injury. In 1995 he spent a postdoctoral year atMcGill University working with Professor Barry Pless atthe Department of Community Paediatric Research. He iscurrently Co-ordinating Editor of the Cochrane Brain andSpinal Cord Injury Group. This Collaborative ReviewGroup has been established in order to produce systema-tic, periodically updated reviews of the evidence for theeffectiveness of interventions in the prevention, treatment,and rehabilitation of brain and spinal cord injury.

119

123Assessment of disabilities after child and adolescent injuries

Internal consistency-reliability was relativelyhigh mainly for the short term disabilities andpersisted across categories of the sociodemo-graphic variables. Thus, the scale is suitable forpopulations of different educational and socio-cultural backgrounds. It compares favourablywith the generic 10 item scale tested by Zamanet al to study disabilities among 2- 9 year oldsin a general population.26The scale also has face validity, because it

includes basic and personal care activitiesperformed by children in most cultures. Thecorrelation with the comprehensive 25 itemscale'6 was high, and a significant associationwas found with the ISS, a score that measuresthe severity of the injury but not impairmentsor disabilities resulting from it.'8 Constructvalidity is acceptable, mainly for the short termdisabilities. Sensitivity and specificity werelower than the 10 item scale,26 where aprofessional's diagnosis served as the goldstandard. The decrease in the prevalence ofdisabilities six months after the injury, and theinclusion of disabilities regardless of theirseverity, affected the sensitivity of the longterm scale. The scale was categorized as 0 and1+ throughout the study. It might be of valueto look at a more detailed categorization in alarger population, because the present one wastoo small for such an analysis.

In conclusion, the seven item disability scalecould be used to assess disabilities after injuryamong children and adolescents in differentcultures. It involves a simple method, that doesnot require expert personnel. Its use may bemore effective to detect disabilities shortly afterthe injury, or to determine period prevalence ofdisabilities, than for those disabilities persistingafter six months. For the purpose of injuryprevention, this scale can be used in additionto measures of frequency and severity to definehigh risk groups and priorities for intervention.

We are grateful to Tamar Hass MPH, for her contributionduring data collection.The study was partially funded by the Joint Research Fund of

the Hebrew University and Hadassah.

1 Rivara FP, Calogne N, Thompson RS. Population-basedstudy of unintentional injury incidence and impact duringchildhood. Am J Public Health 1989; 79: 990-4.

2 Barker M, Power C, Roberts I. Injuries and the risk ofdisability in teenagers and young adults. Arch Dis Child1996; 75: 156-8.

3 Collins JG. Persons injured and disability days due to injuies.United States, 1980-81. Hyattsville, MD: US Departmentof Health and Human Services. Public Health Service.

National Center for Health Statistics. Series 10, No 149,1985.

4 World Health Organization. International dassification ofimpairments, disabilities and handicaps. Geneva: WHO,1980.

5 Msall ME, DiGaudio K, Duffy LC, LaForest S, Braun S,Granger CV. WeeFIM. Normative sample of an instru-ment for tracking functional independence in children.Clin Pediatr (Phila) 1994; 33: 431-8.

6 Eisen M, Donald CA, Ware JE, Brook RH. Conceptualizationand measurement ofhealth for children in the health insurancestudy. Santa Monica, CA: Rand Corporation, 1985.

7 Thorburn MJ, Desai P, Durkin M. A comparison of efficacyof the key informant and community survey methods inthe identification of childhood disability in Jamaica. AnnEpidemiol 1991; 1: 255-61.

8 Young LY, Yoshida K, Williams JI, Bombardier C, WrightJG. The role of children in reporting their physicaldisability. Arch Phys Med Rehabil 1995; 76: 913-8.

9 Yates DW, Heath DF, Mars E, Taylor RJ. A system formeasuring the severity of temporary and permanentdisability after injury. Accid Anal Prey 1991; 23: 323-9.

10 States JD, Viano DC. Injury impairment and disability scalesto assess the permanent consequences of trauma. AccidAnal Prey 1990; 22: 151 - 60.

11 Haley SM, Coster WJ, Ludlow LH, Haltiwanger J,Andrellos P. Pediatric evaluation of disability inventory(PEDI). Version I: development, standardization andadministration manual. Boston, MA: New England Med-ical Center-PEDI Research Group, 1992.

12 Jennett B, Teasdale G, Braakman R, et al. Prognosis ofpatients with severe head injury. Neurosurgery 1979; 4:283-9.

13 Furrie AD. The Canadian data base on disability issues: anational application of the ICIDH. Disabil Rehabil 1995;17: 344-9.

14 Durkin MS, Wang W, Shrout PE, et al. Evaluating a tenquestions screen for childhood disability: reliability andinternal structure in different cultures. J Clin Epidemiol1995; 48: 657-66.

15 Langley JD, Stanton WR, McGee RO, Murdoch JC.Disability in late adolescence I: introduction, methodsand overview. Disabil Rehabil 1995; 17: 35-42.

16 Gofin R, Hass T, Adler B. The development of disabilityscales for childhood and adolescent injuries. J ClinEpidemiol 1995; 48: 977-84.

17 World Health Organization. International dassification ofdiseases. 9th Revision (ICD-9-CM). Geneva: WHO,1978.

18 Association for the Advancement of Medicine. The abbre-viated injuty scale. 1990 Revision. Des Plaines, IL: AAM,1990.

19 SPSS Inc. SPSSIPC+V2.0 base manual. Chicago, IL: SPSSInc, 1988.

20 Gallingher PM, Abramson JH. Computer program forepidemiological analysis-PEPI version 2. Stone Mountain,GA: USD Inc, 1995.

21 National Injury Surveillance Unit. National minimum datasetfor injury surveillance. Australian Institute of Health andWelfare, Version 1.1, 1994.

22 Lund J. Integrated data collection systems at hospitals.Proceedings of the International Seminar on Accident Data.Rogman W, Schurman M, eds. Baden (near Vienna) 13 -

14 April, 1989.23 World Health Organization. Prevention of accidents. A basic

data set and guidelines for its use. (EUR/ICP/APR1130657j.) Geneva: WHO, 1988.

24 Minimum basic data set (MBDS), unintentional injuries.Proceedings of the Intemational Collaborative Effort on InjuryStatistics. Volume I. US Department of Health andHuman Services. Public Health Service. Centers forDisease Control and Prevention. National Center forHealth Statistics. DHHS Publication No (PHS) 95-1252.Hyattsville, MD, 1995: 34-1-34-4.

25 Gorter KA. Survey methods for the assessment of physicaldisability among children. Disabd Rehabil 1993; 15: 47-51.

26 Zaman SS, Khan NZ, Islam S, et al. Validity of the 'tenquestions' for screening serious childhood disability:results from urban Bangladesh. Int J Epidemiol 1990;19: 613-20.

Birthday boy dies jumping for joyA boy who liked to use his bunk bed as a trampoline broke his neck when he fell off andcrashed into a safety net made by his parents. The boy was found dead by his mother on theday that the family was to hold his 11th birthday party.

His bed stood 4'2" off the ground and was made from scaffolding poles because he hadbroken three previous beds using them as trampolines. His father, an electronics researchengineer from Northumberland, said: 'He was so excited about his party. He was such alivewire, always rushing around. Everyone who knew him would tell how full of energy hewas. It is terrible that he died like this. It looks as though he had been trying to do backsomersaults on his bed and something went horribly wrong. He used to enjoy climbingabout in his bedroom, making dens and caves around the furniture' (The Times, November1996).

125Program evaluation for prevention projects

Knowing when to begin the evaluation iscritical in the planning. Too often, evaluationis only considered during or after the programis implemented. By considering your evalua-tion questions before you begin, feedback canbe attained throughout the planning cycle toassist with the assessment.'0

Selecting the method of evaluation waschallenging because of the need to balancethe issues of time and money against rigor.Being creative and flexible allowed us to stayon time, within budget, and be reasonablycredible.As a team, we outlined our goals and key

research questions. It was beneficial havingcommittee members provide different perspec-tives as we formed our questions. Needsassessments or focus groups can also be usedto help define the tools, process, and timelinerequired to get the information you need." Weagreed to collect telephone interview informa-tion from Albertans who had purchased amanual. To ensure our method would capturethe information efficiently, we conducted asmall pretest, and then modified the question-naire. The evaluation consultant coordinatedthe interviews. Over a two week period, wemade 141 contacts and completed 89 inter-views, using the playground guide database,maintained by the local Rotary Club. Theinformation collected was reviewed by theevaluation team and they provided an outlinefor the report drafted by the consultant.A record of the administrative process and

decisions made were kept by the lead agency aswe progressed. This proved helpful when itcame time to create the final report, as well asserving a record for future studies.

Disseminating resultsThe value of a program evaluation is notrealized unless the results are disseminatedand used. Findings can be shared in a numberof ways. Publishing results in journals is thegoal of academic researchers and should bepursued by program evaluations. However, toomany projects have been evaluated but remainunknown to others in the field because theyhave not been published. Yet, do not under-estimate the value of distributing the executivesummary to a list of key people in yourcommunity.'2 Our results were sent to agen-cies, government officials, educational institu-tions, current and potential funders, industry,and the media. Because the media is a main

source of consumer health information, thisvenue should not be forgotten.'3 Their assis-tance in communicating our results andrecommendations extended the life and reachof our report. It also raised the community'sawareness of the need for ongoing assessmentand maintenance of playgrounds. Throughmedia exposure of our results our partnersrenewed their involvement in playgroundsafety; funding was secured to produce asecond edition of the guide; and sales in-creased. The evaluation recommendationswere reviewed by the team and a workinggroup incorporated these changes into thesecond edition. Feedback was also providedto agencies and others how the program wasmodified as a result of the evaluation. This wasdone through a standard slide presentation byeach partner, and an article in local publica-tions.Our experience shows that lack of resources

to evaluate safety programs can be overcome.Adopt a strategy that includes the neededtechnical expertise, secure some funds, andallocate personnel wisely. Make a plan; do it;and use it!

1 Gorsky RD, Teutsch SM. Assessing the effectiveness of diseaseand injury prevention programs: cost and consequences.Atlanta, Georgia: Centers for Disease Control, 1996;44: 1-10.

2 Thompson JC. Program evaluation within a health promo-tion framework. Can JPublic Health 1992; 83: 67-71.

3 Sanson-Fischer R, Redman S, Hancock L, et al. Developingmethodologies for evaluating community wide healthpromotion. Health Promotion International 1996; 11: 227 -36.

4 Benson A. The evaluation of community based injuryprevention activity: the UK perspective. Injury Prevention1995; 1: 116-8.

5 Green LW, Lewis FM. Data analysis in evaluation of healtheducation research: toward standardization of proceduresand terminology. Health Education Research 1987; 2:215-21.

6 Human Services Consulting Groups. Child Passenger restrainteducation and enforcement pilot project evaluation report.Edmonton, Alberta: SAFE KIDS, 1996.

7 Tengs TO, Adams ME, Pliskin JS, et al. Five hundred lifesaving interventions and their cost effectiveness. RiskAnalysts 1995; 51: 369-89.

8 Saunders LD, Wanke M. Toward a framework for healthservice research. Healthcare Management Forum 1996; 9:28-34.

9 Rossi PH, Freeman HE. Evaluation: a systematic approach.4th Ed. Newbury Park, California: Sage, 1989.

10 Vries H, Weijts W, Dijkstra M, Kok G. The utilization ofqualitative and quantitative data for health educationprogram planning implementation and evaluation: aspiral approach. Health Educ Q 1992; 19: 101 - 15.

11 Lovasik A, Saunders D, Stewart L, Vincenten J. Building asafer Alberta: Alberta action plan for injury prevention inAlberta for the year 2000. Edmonton, Alberta: InjuryPrevention Centre, 1994.

12 Saphire L. Comprehensive health promotion, opportunitiesfor demonstrating value added to the business. AmericanAssociation of Occupational Health Nursing Journal 1995;43: 570-3.

13 International Results Group. Survey results of awareness andparents' attitudes ofchildhood injuries in Alberta. Edmonton,Alberta: SAFE KIDS, 1994.

Toy store hit and runAn elderly member of the public was hit by a budding Damon Hill driving a batterypowered toy car. The store in question allows children, under close parental supervision, totry out such vehicles in the shopping aisles (Environmental Health News, November 1996).

Clarke, Frankish, Green

101 Jarvis 0, Boldt M. Death styles among Canadian Indians.Soc Sci Med 1992; 16: 1345- 52.

102 Dinges N, Duong-Tran Q. Stressful life events and co-occurring depression, substance abuse and suicidalityamong American Indian and Alaska Native adolescents.Culture Med Psychiatry 1993; 16: 487- 502.

103 Cooper M, Corrado R. Aboriginal suicide in BritishColumbia: an overview. Can Ment Health 1992; 40: 19-23.

104 Morrell S, Taylor R, Qunic S, Kerr C. Suicide andunemployment in Australia 1907-1990. Soc Sci Med1993; 36: 749-56.

105 Bechtold D. Cluster suicide in American Indian adoles-cents. Am Indian Alsk Native Ment Health Res 1988; 1:26-35.

106 Bechtold D. Indian adolescent suicide: clinical anddevelopmental considerations. Am Indian Alsk NativeMent Health Res 1994; 4: 71-80.

107 Rodgers D. Community crisis intervention in suicideepidemics. Arctic Med Res 1991; Suppl: 276 - 80.

108 Tower M. A suicide epidemic in an American Indiancommunity. Am Indian Alsk Native Ment Health Res 1994;3: 34-44.

109 Clayer J, Czechowicz A. Suicide by aboriginal people inSouth Australia. Med JAust 1991; 154: 683-5.

110 O'Neill T. 'Feeling worthless': an ethnographic investiga-tion of depression and problem drinking at the FlatheadReservation. Culture Med Psychiatry 1992; 316: 447-69.

111 Liu L, Slap G, Kinsman S, Khalid N. Pregnancy amongAmerican Indian adolescents: reactions and prenatal care.Jf Adolesc Health 1994; 15: 336 -41.

112 Harvey E. Mental health promotion among AmericanIndian children. Arctic Med Res 1995; 54: 101 - 6.

113 Waters D. Networks under the gun. Newsweek 1993, July12; 64-6.

114 Phillips D, Caratensen L. Clustering of teenage suicidesafter television news stories about suicide. N Engl J Med

1986; 315: 685-9.115 Phillips D, Paight D. The impact of televised movies about

suicide: a replicative study. N Engl J Med 1987; 317:809-11.

116 Phillips D. The influence of suggestion on suicide:substantive and theoretical implications of the Wertheffect. Am Sociological Rev 1974; 39: 340-54.

117 Gould M, Schaffer D. The impact of suicide in televisionmovies: evidence of imitation. N Engl J Med 1986; 315690-4.

118 Stack C. Celebrities and suicide: a taxonomy and analysis1948-1983. Am Sociological Rev 1987; 52: 401 - 12.

119 Rosenberg M, Mercy J, Houk V. Guns and adolescentsuicides. JAMA 1991; 4: 3030.

120 Brent D, Perper J, Allman C, Moritz G, Wartella M,Zelenak T. The presence and accessibility of firearms inthe homes of adolescent suicides. JAMA 1991; 266:2989-95.

121 Becker T, Samet J, Wiggins C, Key C. Violent death in thewest: suicide and homicide in New Mexico, 1958-1987.Suicide Life Threat Behav 1990; 20: 324-34.

122 Bouchard L. Suicides in the Quebec and Chaudiere-Appal-aches regions: a multifactorial approach for suicide prevention.The Second World Conference on Injury Control,Atlanta, GA, May 1993.

123 Lawlor D, Kosky R. Serious suicide attempts amongadolescents in custody. Aust N Z J Psychiatry 1993; 26:474-78.

124 McDonald D, Thomson N. Australian deaths in custody,1980-1989. Med JAust 1993; 159: 581-5.

125 Bland R, Newman S, Dyck R, Om H. Prevalence ofpsychiatric disorders and suicide attempts in a prisonpopulation. Can JPsychiatry 1990; 35: 407-13.

126 Duclos C, LeBeau W. American Indian adolescent suicidebehaviour in detention environments: cause for continuedbasic and applied research. Am Indian Alsk Native MentHealth Res 1994; 4: 189-221.

Editorial Board Member: brief biography

POLLY BIJURPolly Bijur, PhD, MPH isProfessor of Pediatrics andEpidemiology/Social Medi-cine at Albert Einstein Col-lege of Medicine, Bronx,New York. She is the Direc-tor of the Division of Epide-miology within theDepartment of Pediatrics.

dELi3 Dr Bijur received master'slevel training in biostatisticsat the Columbia UniversitySchool of Public Health anddoctoral training in epide-miology from Columbia Uni-

versity. She was the recipient of a National Institute ofMental Health fellowship in psychiatric epidemiologybetween 1977 and 1983. She has been a member of thefaculty at Albert Einstein College of Medicine since 1983.Her research has focused on the psychological and social

characteristics of children and their families that contributeto risk of injury and has also examined the psychosocialsequelae of injuries. She has carried out descriptiveanalyses of athletic injuries both in the general USpopulation and in the US military.

In addition to research, Dr Bijur teaches researchmethods to pediatric fellows and clinical epidemiology tomedical students. She also provides consultation to facultyand fellows within the Department of Pediatrics onresearch design, measurement, and data analysis. She hasbeen a member of a Special Emphasis Panel of the NIHstudy section-Epidemiology and Disease Control I since1993 and is a scientific advisor to the EpidemiologyBranch, Division of Epidemiology, Statistics, and Preven-tion Research at NICHD.

134

Behavioural antecedents of accidental injuries in early childhood

Table 1 Distibution of accidents by type of injury, age, and sex of twin

Fractures other Burns other Lacerations otherHead than head than head Intoxication than head Other

Age (years) M F M F M F M F M F M F Total

1-2 7 5 0 1 1 0 1 2 1 0 1 0 192-3 9 10 3 0 0 3 2 2 4 0 1 1 353-4 9 2 2 1 3 0 0 1 3 1 0 0 224-5 6 1 2 0 1 0 1 0 1 1 0 0 135-6 3 1 0 0 1 0 0 0 0 0 0 1 6

Total 34 19 7 2 6 3 4 5 9 2 2 2 95

RELATION BETWEEN ACCIDENTS ANDBEHAVIORIn order to relate the behavioral variables atone year and the accidents at subsequent years,each twin pair was categorized as to whethertwin A (or B) had more accidents or whetherthe twins had the same number of accidents.Of the 49 pairs of twins, there was only onepair in which the twins had an equal number ofaccidents.Each of the 3 behavioral variables, as well as

the accident variable, was paired with everyother variable and 2 x 2 X2 tests were performedto see whether twins maintained the samerelationship on both variables. That is, if twinA (or B) was reported as being more active,was he also reported as having more accidents?Or conversely, if one twin was reported ashaving a longer attention span, was he reportedas having fewer accidents? In the latter case,the relation between the behaviors would beinverse. Twin pairs concordant on each of thevariables were excluded from the X2 analysesbecause of sample size and the low frequencyof concordance.The x2 values indicate that the twins with

more accidents had been more active(p<0.01), temperamental (p<0.01), and lessattentive (p<0.05) than their co-twins whenreported on at one year of age. On thebehavioral variables, the amount of generalactivity was most strongly related to accidentfrequency. Among the 43 twin pairs discor-dant on activity and accident frequency, themore active infant twin accounted for 71 outof 89 accidents reported for those pairs. Toindicate the nature of the accidents reportedthe histories of two pairs of twins areillustrative.

Case reportsCASE 1In a male pair, twin B was the more active,temperamental, and inattentive twin at one yearofage. During subsequentvisits, hewas reportedto have suffered ahead injury (4 stitches taken) at33 months, burned his foot on a vaporizer at 47months, broken his collar bone at 48 months,and broken his collarbone again at 56 months.His less active twin had suffered no seriousaccidents at the time of study.

CASE 2In a female pair, twin A was reported as beingmore active, temperamental but less attentiveat 12 months. Prior to her sixth birthday, shehad a head concussion from a fall down thebasement steps, had her stomach pumpedbecause of aspirin ingestion, and had brokena finger. Twin B had suffered no accidentsduring this period.

CommentThe results from this study add support to thehypothesis that some children are prone tohave more accidents than others. Althoughenvironmental hazards, quality caretaking, andother factors cannot be ignored for their rolesin the production of accidents, the concept ofthe accident-prone child appears to be a viableone.

1 Meyer RJ, Roelofs HA, Redmond S. Accidental injury to thepreschool child. J Pediatr 1963; 63: 95.

2 Krall V. Personality characteristics of accident repeatingchildren. J Soc Psychol 1953; 99.

3 Manheimer DI, Mellinger G. Personality characteristics ofthe child accident repeater. Child Dev 1967; 38: 491.

4 Haddon W, Suchman EA, Klein D. Accident research methodsand approaches. New York: Harper and Row, 1964.

Novel approach to teen drinking and drivingPolice in Weymouth, MA, are now towing cars of teenagers who are drinking and partyingin the woods, forcing the kids to find another way home and forcing them or their parents topay $55 to get the car back. 'That's a pretty expensive can of beer', notes Officer Gomes(Patriot Ledger, 30 April 1996).

Louisiana upholds minmum drinking ageThe Louisiana Supreme Court upheld a state law setting the minimum drinking age at 21years, thus preserving its eligibility for federal highway funds, in conformity with theNational Minimum Drinking Age Act of 1988, New York Times, 3 July 1996).

145

The Connecticut Childhood Injury Prevention Center

necticut to be the third state in the US to passsuch a law.4 An improved child restraint law,legislation eliminating any acceptable alcohollevel for adolescent drivers and implementinggraduated licensure, the establishment andfunding of a dedicated section of injuryprevention within the state Department ofHealth strengthened playground safety stan-dards, and a childhood injury preventionlicense plate to raise funds for injury preven-tion work, have all been enacted during thepast six years.We believe that the ability to do significant

work primarily involves collaboration. In orderto develop a track record, take on small, doableprojects. Deliver the goods....you can't sellyourself more than once or twice if the effortdoesn't deliver. You must be competent andappear competent in whatever you take on.Each project involves different collaborators,but soon, if you do a few, you have a networkthat becomes synergistic. And last, get noticed.This includes not only within the scientificcommunity, but also in the lay community,through the media, community events, appear-ances at group functions etc.As a result of laying this kind ofgroundwork,

we now find that many groups, agencies, andindividuals approach us with ideas and re-quests. We have just piloted a teen suicideprevention project, an area which is completelynew to us, because the state Department ofHealth said that it wanted to spend a smallamount ofmoney in this area and were familiarwith our work on other injury preventionprojects.The State of Connecticut also stepped

forward to fund violence prevention activitiesat the termination of our initial grant. Theirfamiliarity with our work and our extensivecoalition building activities clearly led them toapproach us! The Department of ConsumerProtection of our state has intimately involvedus in their work with the US ConsumerProducts Safety Commission (CPSC). As aresult, one of us was the only health careprovider at a recent national meeting organizedby CPSC regarding product safety. Schoolsystems throughout the state, which five yearsago refused to acknowledge their problem withstudent violence, now routinely approach usfor training and help with program develop-ment. And we are now frequently approachedby our local television, radio, and newspapercorrespondents for commentary regardingchild injury related stories. Our collaboratorscross all lines-some have traditionally not

worked together before, and some have evenseen each other as adversaries. For our SafeTeen Work Project to reduce cutting injuriesamong teenage workers, the state Departmentof Labor collaborated with a regional grocerystore chain.56 For the mapping of pedestrianinjuries, an eclectic group evolved, includingwhat has become a permanent relationshipwith the University of Connecticut departmentof medical geography.7-9 For adolescent vio-lence prevention, four diverse communitygroups and agencies found common ground.'0Our center now has a staff of eight indivi-

duals, including the Safe Kids Coordinator forConnecticut. Most of our budget is supportedby grants, contracts, and ongoing fund raising,in addition to base support and housing at theConnecticut Children's Medical Center. Wealso sell some of our services, including somecontinuing education services to professionalgroups.We believe that our model of a collaborative,

community focused, data driven injury pre-vention center is successful primarily becauseof the commitment of individuals. It is feasibleon a low start-up budget, takes considerabletime and energy, but can lead to substantialreward over time. We believe that our story canhelp define a path for others to travel in theirown communities if they wish to establishsimilar programs.

Presented in part at the Third International Conference onInjury Control, Melbourne, Australia, February, 1996.

1 Banco L, Lapidus G, Zavoski R, Braddock M. Burn injuriesamong children in an urban emergency department.Pediatr Emerg Care 1994; 10: 98-101.

2 Banco L, Remington L, Lapidus G, Braddock M. A profileof burn injuries in an urban primary care population[abst]. Am J Dis Child 1992; 146: 478.

3 Burke G, Lapidus G, Banco L, Zavoski R, Wallace L.Evaluation of the effectiveness of a pavement stencil inpromoting safe behavior among elementary schoolchildren at school bus stops. Pediatrics 1996; 97: 520-30.

4 Zavoski R, Lapidus G, Lerer T, Banco L. Bicycle injury inConnecticut. Conn Med 1995; 59: 3-9.

5 Banco L, Lapidus G, Braddock M. Work related injuriesamong Connecticut minors. Pediatrics 1992; 89: 957-60.

6 Banco L, Lapidus G, Monopoli J, Zavoski R. The Safe TeenWork Project: a study to reduce cutting injuries amongyoung and inexperienced workers. Am 7 Ind Med (inpress).

7 Lapidus G, Braddock M, Banco L, et al. Child pedestrianinjury: a population based collision and injury severityprofile. J Trauma 1991; 31: 1 -6.

8 Braddock M, Lapidus G, Gregorio D, et al. Populationincome and ecological correlates of child pedestrianinjury. Pediatrics 1991; 88: 1242-7.

9 Braddock M, Lapidus G, Cromley E, Cromley R, Burke G,Banco L. Using a geographic information system tounderstand child pedestrian injury. Am J Public Health1994; 84: 1158-61.

10 Zavoski RW, Lapidus GD, Lerer TJ, Banco LI. Apopulation based study of severe firearm injury amongchildren and youth. Pediatrics 1995; 96: 278-82.

Baby stuckA newborn baby had to be cut free by firefighters after his head became wedged between hiscot and a foldaway table on which his mother was changing him in Birmingham Women'sHospital. The boy was unhurt, but was described as very distressed (The Times, December1996).

Editor's note: I would have thought the hospital would not have been very happy either!

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day to ban outright any further manufactureor sale of antipersonnel mines. Now that'swhat I call NEWS!

DAVID BASSDirector, CAPFSA,

Department of Paediatric Surgery,Red Cross War Memorial Children's Hospital,

Rondebosch 7700, South Africa

Europe

The EURORISC Project

An ambitious international research projectknown by the acronym EURORISC (Eur-opean Review of Injury Surveillance andControl) was launched in January 1997.Funded by the European Commission as partof the biomedicine and health research andtechnological development programme,EURORISC is a concerted action coordi-nated by the Paediatric Epidemiology andCommunity Health (PEACH) Unit of theDepartment of Child Health, University ofGlasgow. The essence of EURORISC is thecreation of a collaborative partnership ofinjury experts in the European Union sup-ported by a network resource in the form of aclearinghouse.

Injury surveillance is widely acknowledgedas one of the critical features of an effectiveprogramme of injury prevention. Severalinjury surveillance systems operate in Europe,notably the transnational EHLASS (EuropeanHome and Leisure Accident SurveillanceSystem). While EHLASS undoubtedly repre-sents a formidable administrative and techno-logical achievement, it nevertheless hasconsiderable unfulfilled potential.

The EURORISC project is unprecedentedin that it aims to undertake a comprehensivereview of current practice and future needs forinjury surveillance and control (ISC) in theEuropean Union. It comprises three phases,each lasting one year:

Phase 1: The reality-a survey of the currentposition-describing the contemporary epide-miology of injury in the countries of theEuropean Union, and identifying current ISCactivities throughout the European Union.

Phase 2: The ideal-a consensus Statementof Good Practice-developing criteria for theevaluation of ISC, reviewing the world litera-ture on ISC, and articulating a Statement ofGood ISC Practice.

Phase 3: The future-overcoming obstacles toeffective ISC-comparing current ISC in theEuropean Union with the Statement of GoodPractice, and recommending measures de-signed to improve the efficiency and effective-ness of ISC in the European Union in the nextcentury.A highly successful Introductory Workshop

was held in Glasgow on 10 January 1997 atwhich preliminary data were presented. Out-put from the project will be disseminatedwidely including via a EURORISC News-letter. EURORISC has participants fromseven European Union countries: Greece,Italy, France, Netherlands, Sweden, Ireland,and the United Kingdom. The EURORISCheadquarters is located in Glasgow and is runby two full time staff members who serve boththe needs of the consultation and the clearing-house. Further information about EURO-RISC may be obtained from Dr DavidStone, EURORISC Project Leader, PEACHUnit, University of Glasgow, Yorkhill Hospi-tal, Glasgow G3 8SJ, UK (tel +44 141 201

0178, fax +44 141 201 0837, e-mail D.H.Stone(clinmed.gla.ac.uk).

DAVID STONEGlasgow

BOOKREVIEW

Safety and First Aid Book-A PracticalGuide to Emergency First Aid, Safety,Injuries, Illnesses. By Jennifer Brown andTony Walker. (Pp 150; $A16.95.) LothianBooks, 1996. Available from the Royal Chil-dren's Hospital Safety Centre, FlemingtonRoad, Parkville, Victoria 3052, Australia.

There must be literally hundreds of books ofthis sort now in circulation. Probably everymajor safety group has produced one, but thisstands head and shoulders above most of itscompetitors. Although normally book reviewsin this journal deal with scientific publica-tions, an exception is warranted because ofthe journal's mandate. Our job is to bringimportant material to all our readers, many ofwhom are in the trenches and not scientists.

What makes this book special is threefeatures. First, it is comprehensive, withoutbeing unduly large. Second, it is beautifullyillustrated with a great use of colour anddrawings. And third, the messages arestraightforward and to the point. A criticallyimportant bonus is the care that has obviouslybeen taken to ensure that the level of thelanguage used is accessible to most readers.Another essential point is that, so far as I canjudge, the advice provided is invariablyaccurate and up-to-date.An especially appealing aspect is the

organization of each section. Many begin witha vignette or case history, accompanied by acolour photo, presumably of the victim. Thisis followed by a section presenting the facts,another on prevention, and a third, on firstaid. Inside the foldout cover is a summary of'life threatening emergencies' organized alongdevelopmental lines: baby, small child, largechild.

The injuries covered include: bites andstings, bleeding, bone, muscle and jointinjuries, burns, choking, drowning, eye in-juries, head injuries, needlestick injuries,poisoning, teeth injuries, and traffic accidents.In addition, there is a section on commonchildhood illnesses. It includes a good index,and inside the back cover there is a section forentering emergency phone numbers.

There are, of course, some shortcomings.It is intended primarily for Australian readers,so that, for example, the listing of poisonousplants include many that are not found inother parts of the world. Nevertheless, inalmost every other respects, it is useful forEnglish reading parents world wide. I was alsoa bit disappointed not to find much that urgesparents to engage in advocacy as a way tomake their homes and playgrounds safer, butperhaps this is a bit unfair, given the inten-tions of the authors. And, of course, I wouldhave preferred to see less of the awful 'A'word.

But these are truly trivial concerns and onlyintended to show that I read it carefully. It isan excellent book; undoubtedly, one of thebest of its kind. Despite its modest cost,

whether parents who need it most will actuallyrush out to buy it will depend, in part, on howstrongly it is endorsed by health professionalsand those in child safety programmes.

Safety and First Aid Book is a publication ofthe Melbourne's Royal Children's HospitalSafety Centre. The authors are a safetyconsultant (Jennifer Brown) and an intensivecare paramedic (Tony Walker).

I BARRY PLESSEditor, Montreal

CALENDAR

25 February-I March 1998, Safety in Action1998, Melboume, Australia: this is a con-ference for researchers in safety and hygiene,health and safety professionals, public healthworkers, consumer organisations, and govern-ment representatives and will look at how asafer society can be created, including taking afresh look at designing and delivering safesystems. Themes include the latest develop-ments in safety science and engineering,trends in hygiene, ergonomics and healthscience which apply to safety and demonstrat-ing practical solutions to safety problems atwork, on the road, in the home, and duringsports and leisure activities. Further details:Safety in Action, Suite 17, 51-55 City Road,Southbank, Victoria 3006, Australia.

15-19 October 1997, Sixth InternationalConference on Safe Communities: Consoli-dating communities against violence, Johan-nesburg, South Africa. Further details:SafeComm6, Conference Secretariat, Confer-ences and Promotions, PO Box 411177,Craighall, Johannesburg 2024, South Africa(tel +27 11 422 6111, fax +27 11 442 5927, e-mail candp(global.co.za).

JOURNALCITATIONS

Editor's note: these citations have been culledfrom the following databases: Medline, Cur-rent Contents, Psych Abstracts, and SocialScience Citation Index, Cinahl. Your com-ments are welcome, as well as suggestionsabout other pertinent databases.

MethodsFrohlich N, Mustard C. A regional comparison of

socioeconomic and health indices in a Canadianprovince. Soc Sci Med 1996; 42: 1273 - 81.

Hartzog TH, Timerding BL, Alson RL. Pediatrictrauma: enabling factors, social situations, andoutcome. Acad Emerg Med 1996; 3: 213- 20.

Osberg JS, Brooke MM, Baryza MJ, Rowe K, LashM, Kahn P. Impact of childhood brain injury onwork and family finances. Brain Injury 1997; 11:11-24.

Potts R, Runyan D, Zerger A, Marchetti K. Acontent analysis of safety behaviors of televisioncharacters: implications for children's safety andinjury. J Pediatr Psychol 1996; 21: 517-28.

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Rutter M. Epidemiological testing of causal hypoth-esis: the case of mild head injury [commentary].J Dev Behav Pediatr 1996; 17: 183 - 5.

Wills KE, Tanz RR, Christoffel KK, et al. Super-vision in childhood injury cases-a reliabletaxonomy. Accid Anal Prev 1997; 29: 133 - 7.

GeneralAgran PF, Winn DG, Anderson CL, Del Valle CP.

Pediatric injury hospitalization in Hispanicchildren and non-Hispanic white children insouthern California [review]. Arch Pediatr Ado-lesc Med 1996; 150: 400 - 6.

Bijur PE. Cognitive outcomes. J? Dev Behav Pediatr1996; 17: 186.

Bijur PE, Haslum M, Golding J. Cognitive out-comes of multiple mild head injuries in children.J Dev Behav Pediatr 1996; 17: 143 - 8.

Bowen JM, Clark E, Bigler ED, et al. Childhoodtraumatic brain injury-neuropsychological sta-tus at the time of hospital discharge. Dev MedChild Neurol 1997; 39: 17 - 25.

Burke W, Thompson R. Childhood accident pre-vention: putting audit into practice. Nurs Stand1996; 10: 46-8.

Christensen AM, Lignugaris-Kraft B, Fiechtl BJ.Teaching pairs of preschoolers with disabilitiesto seek adult assistance in response to simulatedinjuries: acquisition and promotion of observa-tional learning. Education and Treatment ofChildren 1996; 19: 3-18.

Collins BC, Griffen AK. Teaching students withmoderate disabilities to make safe responses toproduct warning labels. Education and Treatmentof Children 1996; 19: 30-45.

Crawley T. Childhood injury: significance andprevention strategies [review]. Jf Pediatr Nursing1996; 11: 225-32.

Furnival RA, Woodward GA, Schunk JE. Delayeddiagnosis of injury in pediatric trauma. Pediatrics1996; 98: 56-62.

Hansen K, Wong D, Young PC. Do the Framing-ham safety surveys improve injury preventioncounselling during pediatric health supervisionvisits? [see comments]. Jf Pediatr 1996; 129:494-8.

Huber G, Marchand-Martella NE, Martella RC, etal. A survey of the frequency of accidents'injuries for preschoolers enrolled in an inner-city Head Start program. Education and Treat-ment of Children 1996; 19: 46- 54.

Kim HJ, Graves M. Nonfatal injuries among USchildren. Am J Public Health 1996; 86: 892 - 3.

Maitra AK, Sweeney G. Are schools safer forchildren than public places? J Accid Emerg Med1996; 13: 196 - 7.

Mannebach MS, Hargarten SW, Phelan MB.Alcohol use among injured patients aged 12 to18 years. Acad Emerg Med 1997; 4: 40 -4.

Max JE, Smith WL, Sato Y, et al. Traumatic braininjury in children and adolescents-psychiatricdisorders in the first three months. J Am AcadChild Adolesc Psychiatry 1997; 36: 94- 102.

Siegel CD, Graves P, Maloney K, Norris JM,Calonge BN, Lezotte D. Mortality from inten-tional and unintentional injury among infants ofyoung mothers in Colorado, 1986 to 1992. ArchPediatr Adolesc Med 1996; 150: 1077 - 83.

Wirrell EC, Camfield PR, Camfield CS, Dooley JM,Gordon KE. Accidental injury is a serious risk inchildren with typical absence epilepsy. ArchNeurol 1996; 53: 929-32.

Wright P, Williams J, Currie C. Left-handednessincreases injury risk in adolescent girls. PerceptMot Skills 1996; 82: 855 - 8.

Wyatt JP, Beard D, Gray A, Busuttil A, RobertsonCE. Rate, causes and prevention of deaths frominjuries in south-east Scotland. Injury 1996; 27:337-40.

TrafficAbularrage JJ, Deluca AJ, Abularrage CJ. Effect of

education and legislation on bicycle helmet usein a multiracial population. Arch Pediatr AdolescMed 1997; 151: 41-4.

Anonymous. Update-fatal air bag-related injuriesto children-United States, 1993- 1996. JAMA1997; 277: 372.

Anonymous. Economic impact of motor-vehiclecrashes involving teenaged divers-Kentucky,1994. MMWR-Morbidity and Mortality WeeklyReport 1996; 45: 715-9.

Burke GS, Lapidus GD, Zavoski RW, Wallace L,Banco L. Evaluation of the effectiveness of apavement stencil in promoting safe behaviouramong elementary school children boardingschool buses. Pediatrics 1996; 97: 520-3.

Carey MJ, Aitken ME. Motorbike injuries inBermuda: a risk for tourists. Ann Emerg Med1996; 28: 424-9.

Conrad P, Bradshaw, Laftsudin R, Kasniyah N, etal. Heimets, injuries and cultural definitions:motorcycle injury in urban Indonesia. AccidAnal Prev 1997; 28: 200.

Ferguson SA, LeafWA, Williams AF, Preusser DF.Differences in young driver crash involvement instates with varying licensure practices. AccidAnal Prev 1996; 28: 171-80.

Finvers KA, Strother RT, Mohtadi N. The effect ofbicycling helmets in preventing significant bi-cycle-related injuries in children. Clin J SportMed 1996; 6: 102-7.

Lee P, Orsay E, Lumpkin J, Ramakrishman V,Callahan E. Analysis of Hispanic motor vehicletrauma victims in Illinois, 1991-1992 [seecomments]. Acad Emerg Med 1996; 3: 221 - 7.

McCarthy M. Controversy: children and cyclehelmets: the case against. Child Care HealthDev 1996; 22: 105-11.

Ni HY, Sacks JJ, Curtis L, Cieslak PR, Hedberg K.Evaluation of a statewide bicycle helmet law viamultiple measures of heimet use. Arch PediatrAdolesc Med 1997; 151: 59 -65.

Scuffham PA, Langley JD. Trends in cycle injury inNew Zealand under voluntary helmet use. AccidAnal Prev 1997; 29: 1 - 9.

Sibert J. Controversy: children and cycle helmets:the case for. Child Care Health Dev 1996; 22:99-103.

Tyano S, Iancu I, Solomon Z. Seven-year follow-upof child survivors of a bus-train collision. J AmAcad Child Adolesc Psychiatry 1996; 35: 365 - 73.

Winston FK Update-fatal air bag-related injuriesto children-United States, 1993-1996. JAMA1997; 277: 11-2.

HomeHarrell Y. The effects of shopping cart design and

prior behavioral history on children's standing incart seats. Accid Anal Prev 1996; 28: 385-9.

Harrell WA. Epidemiology of shopping cart-relatedinjuries to children. Arch Pediatr Adolesc Med1997; 151: 105.

Kriel RL, Gormley ME, Krach LE, Luxenberg MG,Bartsh SM, Bertrand JR. Automatic garage dooropeners: hazard for children. Pediatrics 1996; 98:770-3.

Smith GA, Dietrich AM. Epidemiology of shoppingcart-related injuries to children [reply]. ArchPediatr Adolesc Med 1997; 151: 105 - 6.

Steiner RP, Vansickle K, Lippman SB. Domesticviolence. Do you known when and how tointervene? [review]. Postgrad Med 1996; 100:103-6.

Burns and scaldsBarillo DJ, Goode R. Fire fatality study: demo-

graphics of fire victims. Burns 1996; 22: 85 -8.Ghosh SJ, Shaw AD, McGregor JC. Bum injuries

caused by chip-pan fires: the Edinburgh experi-ence. Burns 1996; 22: 147-9.

McConnell CF, Leeming FC, Dwyer WO. Evalua-tion of a fire-safety training program for pre-school children. J Comm Psychol 1996; 24: 213 -27.

Poison and ingestionsDayan PS, Litovitz TL, Crouch BI, Scalzo AJ, Klein

BL. Fatal accidental dibucaine poisoning inchildren. Ann Emerg Med 1996; 28: 442- 5.

Harley EM, Collins MD. Liquid household bleachingestion in children-a retrospective review.Laryngoscope 1997; 107: 122-5.

DrowningEllis AA, Trent RB. Swimming pool drownings and

near-dro6vnings among California preschoolers.Public Health Rep 1997; 112: 73 - 7.

Noonan L, Howrey R, Ginsburg CM. Freshwatersubmersion injuries in children: a retrospectivereview of seventy-five hospitalized patients.Pediatrics 1996; 98: 368-71.

Oflaherty JE, Pirie PL. Prevention of pediatricdrowning and near-drowning-a survey ofmembers of the American Academy of Pedia-trics. Pediatrics 1997; 99: 169-74.

RecreationCollings P, Condon RG. Blood on the ice: status,

self-esteem, and ritual injury among Inuithockey players. Human Organization 1996; 55:253-62.

Drago DA, Winston FK, Baker SP. Clothing draw-string entrapment in playground slides andschool buses-contributing factors and potentialinterventions. Arch Pediatr Adolesc Med 1997;151: 72-7.

Gear AJL, Nguyen WD, Himel HN, Edlich RF.Flaming Dr Pepper-another cause of recrea-tional burn injury. Am J Emerg Med 1997; 15:108-11.

Gill TJ, Micheli U. The immature athlete. Com-mon injuries and overuse syndromes of theelbow and wrist [review]. Clin Sports Med 1996;15: 401-23.

Heller DR, Routley V, Chambers S. Rollerbladinginjuries in young people. J Paediatr Child Health1996; 32: 35-8.

Inklaar H, Bol E, Schmikli SL, Mosterd WL.Injuries in male soccer players: team riskanalysis. Int Y Sports Med 1996; 17: 229 - 34.

Pasternack JS, Veenema KR, Callahan CM. Base-ball injuries: a little league survey. Pediatrics1996; 98: 445-8.

Risser WL, Anderson SJ, Bolduc SP, et al. Partici-pation in boxing by children, adolescents, andyoung adults. Pediatrics 1997; 99: 134- 5.

Tormoehlen RL, Sheldon EJ. ATV use, safetypractices, and injuries among Indiana's youth.J Safety Res 27: 147 - 55.

Ytterstad B. The Harstad injury prevention study:the epidemiology of sports injuries. An 8 yearstudy. BrY Sports Med 1996; 30: 64- 8.

OccupationalAnonymous. Work-related injuries and illnesses

associated with child labor-United States,1993.JAMA 1996; 276: 16-7.

Kidd P, Townley K, Cole H, McKnight R, Piercy L.The process of chore teaching-implications forfarm youth injury. Fam Community Health 1997;19: 78-89.

Violence and suicideDurkin MS, Kuhn L, Davidson 1I, Laraque D,

Barlow B. Epidemiology and prevention ofsevere assault and gun injuries to children inan urban community. Y Trauma 1996; 41: 667-3.

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Eichelberger MR, Gotschall CS. Shotgun wounds inchildren-not just accidents [invited commen-tary]. Arch Surg 1997; 132: 62.

Gray MM, Foshee V. Adolescent dating violence-differences between one-sided and mutuallyviolent profiles. Journal of Interpersonal Violence1997; 12: 126-41.

Karger B, Wissmann F, Gerlach D, Brinkmann B.Firearm fatalities and injuries from huntingaccidents in Germany. Int Y Legal Med 1996;108: 252-5.

Lane-Reticker A, Weiner AL, Morgan AS, GriffinA. Violence prevention program targeting Con-neticut adolescents: description and preliminaryresults. Conn Med 1996; 60: 15 - 9.

Langley JD, Marshall SW, Norton RN. Nonfatalfirearm injuries in New Zealand, 1979-1992.Ann Emerg Med 1996; 28: 170-5.

Nance ML, Sing RF, Branas CC, Schwab CW.Shotgun wounds in children-not just acci-dents. Arch Surg 1997; 132: 58-61.

Powell EC, Sheehan KM, Christoffel KK. Firearm

violence among youth: public health strategiesfor prevention [review]. Ann Emerg Med 1996;28: 204-12.

Saltzman LE, Johnson D. CDC's family andintimate violence prevention team: basing pro-grams on science. J Am Med Wom Assoc 1996;51: 83-6.

Shuchman M, Silbernagel KH, Chesney MA,Villarreal S. Interventions among adolescentswho were violently injured and those whoattempted suicide. Psychiatric Services 1996; 47:755-7.

How did the hedgehog cross the road?Britain's Departnent of Transport has recently launched a new £500 000 roads safetycampaign aimed at reducing the number of children killed as pedestrians. The campaignfeatures a hedgehog and baby hedgehog trying to cross a busy road. But it is not universallypopular with the country's road safety officers. One, whose council is boycotting theinitiative, commented that hedgehogs are renowned for getting squashed, and criticised theuse of 'irrelevant, twee and fanciful pictures of hedgehogs'. The Minister responsible forroad safety, however, felt that children would identify with the cartoon characters'vulnerability. Britain has Europe's worst record on child pedestrian road safety with over130 child pedestrian fatalities in 1995. A newspaper reader in Northern Ireland reinforcedthe scepticism by commenting that 'most people's contact with this creature is limited toseeing a flat object with tyre marks across it'.

Don't microwave the pet!A microwave hot water bottle disguised as a teddy bear could spell trouble for the familypet. Children seeing parents warm up the comforter might think of doing the same thingwith a kitten or other small animal, say both the Royal Society for the Prevention of Crueltyof Animals and the Royal Society for the Prevention of Accidents. Matters are made worseby an American made video issued by the manufacturers. It refers to a cotton bag in whichthe bear should be placed before being put in the microwave as a 'sleeping bag' and theoven as its 'den'. The British distributors described claims that the toy was dangerous assensationalism, highlighting the warnings on the box, the toy itself and the instructionleaflet (Daily Mail, 27 January, 1997).

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