Health and Financial Fragility: Evidence from Car Crashes and Consumer Bankruptcy

This paper assesses the importance of adverse health shocks as triggers of bankruptcy filings. We view car crashes as a proxy for health shocks and draw on a large sample of police crash reports linked to hospital admission records and bankruptcy case files. We report two findings: (i) there is a strong positive correlation between an individual\u27s pre-shock financial condition and his or her likelihood of suffering a health shock, an example of behavioral consistency; and (ii) after accounting for this simultaneity, we are unable to identify a causal effect of health shocks on bankruptcy filing rates. These findings emphasize the importance of risk heterogeneity in determining financial fragility, raise questions about prior studies of medical bankruptcy, and point to important challenges in identifying the triggers of consumer bankruptcy

A Core Outcome Set for Pediatric Critical Care

Objectives: More children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs.Design: A two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% “critical” and less than 15% “not important” advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components.Setting: Multinational survey.Patients: Stakeholder participants from six continents representing clinicians, researchers, and family/advocates.Measurements and Main Results: Overall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% “critical” and less than 15% “not important” and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set—extended.Conclusions: The PICU core outcome set and PICU core outcome set—extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families

Ticketing aggressive cars and trucks (TACT): How does it work on city streets?

<p><b>Objective</b>: The purpose of this study was to determine the feasibility of modifying the Ticking Aggressive Cars and Trucks (TACT) program, originally designed to work on state highways, within a metropolitan area to reduce unsafe interactions and their related crashes between drivers of large trucks and passenger vehicles.</p> <p><b>Methods</b>: Using crash data, the driving behaviors most commonly associated with large truck and passenger vehicle crashes were identified. A public awareness campaign using media messaging and increased law enforcement was created targeting these associated behaviors. The frequency of these behaviors both before and after the public awareness campaign was determined through observation of traffic at 3 specific locations within the city. Each location had a sufficient volume of large truck and passenger traffic to observe frequent interactions. Pre- and postintervention data were compared using negative binomial regression with generalized estimating equations to evaluate whether the campaign was associated with a reduction in the identified driving behaviors.</p> <p><b>Results</b>: A comparison between crash data from before, during, and after the campaign and crashes during the same time periods in previous years did not show a significant difference (<i>P</i> =.081). The number of large trucks observed in traffic remained the same during pre- and postintervention periods (<i>P</i> =.625). The rates of negative interactions per 100 large trucks decreased for both large trucks and passenger vehicles after the intervention, with calculated rate ratios of 0.58 (95% confidence interval [CI], 0.48, 0.70) and 0.31 (95% CI, 0.20, 0.47). The greatest reduction was seen in passenger vehicles following too close, with a rate ratio of 0.21 (95% CI, 0.15, 0.30).</p> <p><b>Conclusions</b>: Although designed for reducing crashes on highways, the TACT program can be an effective approach for improving driver behaviors on city streets.</p

Health and Financial Fragility: Evidence from Car Crashes and Consumer Bankruptcy

This paper assesses the importance of adverse health shocks as triggers of bankruptcy filings. We view car crashes as a proxy for health shocks and draw on a large sample of police crash reports linked to hospital admission records and bankruptcy case files. We report two findings: (i) there is a strong positive correlation between an individual\u27s pre-shock financial condition and his or her likelihood of suffering a health shock, an example of behavioral consistency; and (ii) after accounting for this simultaneity, we are unable to identify a causal effect of health shocks on bankruptcy filing rates. These findings emphasize the importance of risk heterogeneity in determining financial fragility, raise questions about prior studies of medical bankruptcy, and point to important challenges in identifying the triggers of consumer bankruptcy

Health and Financial Fragility: Evidence from Car Crashes and Consumer Bankruptcy

This paper assesses the importance of adverse health shocks as triggers of bankruptcy filings. We view car crashes as a proxy for health shocks and draw on a large sample of police crash reports linked to hospital admission records and bankruptcy case files. We report two findings: (i) there is a strong positive correlation between an individual\u27s pre-shock financial condition and his or her likelihood of suffering a health shock, an example of behavioral consistency; and (ii) after accounting for this simultaneity, we are unable to identify a causal effect of health shocks on bankruptcy filing rates. These findings emphasize the importance of risk heterogeneity in determining financial fragility, raise questions about prior studies of medical bankruptcy, and point to important challenges in identifying the triggers of consumer bankruptcy

Injury mortality in American Indian, Hispanic, and non-Hispanic white children in new Mexico, 1958-1982

Childhood fatalities from injuries are a serious public health problem in New Mexico, a state which ranks second in the nation in injury-related mortality rates. To determine the extent of injury mortality in children in this state, and to examine time trends and differences in mortality rates in New Mexico's American Indian, Hispanic, and non-Hispanic white children aged 0-14 years, we analyzed vital records collected from 1958 to 1982. American Indian children experienced the highest mortality rates from all external causes combined. Among all three major ethnic groups, children aged 0-4 years were at the highest risk for injury fatalities. Unintentional injuries accounted for 85% of all injury-related deaths. Motor vehicle crashes and drowning were the first and second leading causes of death in all three groups, while other important causes of death included fire, choking on food or other objects, poisoning, and homicide. Although the fatality rates on most types of injuries decreased over the 25-year period, childhood fatality rates for motor vehicle crashes and homicide increased in each ethnic group. Despite the overall decrease in injury mortality rates in New Mexican children, the rates are excessively high compared to other states, especially in American Indian children.cross-cultural comparison wounds and injuries Indians North American Hispanic Americans

Suicides and Suicide Attempts Following Homicide Victim–Suspect Relationship, Weapon Type, and Presence of Antidepressants

This study used linked, official data for population-based surveillance of homicides, suicides, and homicide–suicides in four U.S. states and four counties. Among 1,503 homicide incidents, less than 5% ( n = 74) were followed by the perpetrator's suicide and 1% ( n = 18) by a nonfatal suicide attempt. However, among men who killed their female intimate partner with a firearm, 59% also took their own life. Homicide–suicide perpetrators did not test positive for an antidepressant more often than other male suicide decedents (15% vs. 19%). Most (54%) perpetrators of nonfirearm homicides who attempted suicide lived; nearly all (93%) firearm perpetrators who attempted suicide died. Among men who killed their female intimate partner with a firearm, homicide–suicide was the norm. Better enforcement of existing laws designed to protect abuse victims by removing firearms from domestic abusers may also prevent abusers' suicides

Perceived social risk in medical decision-making for physical child abuse: a mixed-methods study

Abstract Background The medical literature reports differential decision-making for children with suspected physical abuse based on race and socioeconomic status. Differential evaluation may be related to differences of risk indicators in these populations or differences in physicians’ perceptions of abuse risk. Our objective was to understand the contribution of the child’s social ecology to child abuse pediatricians’ perception of abuse risk and to test whether risk perception influences diagnostic decision-making. Methods Thirty-two child abuse pediatrician participants prospectively contributed 746 consultations from for children referred for physical abuse evaluation (2009–2013). Participants entered consultations to a web-based interface. Participants noted their perception of child race, family SES, abuse diagnosis. Participants rated their perception of social risk for abuse and diagnostic certainty on a 1–100 scale. Consultations (n = 730) meeting inclusion criteria were qualitatively analyzed for social risk indicators, social and non-social cues. Using a linear mixed-effects model, we examined the associations of social risk indicators with participant social risk perception. We reversed social risk indicators in 102 cases whilst leaving all injury mechanism and medical information unchanged. Participants reviewed these reversed cases and recorded their social risk perception, diagnosis and diagnostic certainty. Results After adjustment for physician characteristics and social risk indicators, social risk perception was highest in the poorest non-minority families (24.9 points, 95%CI: 19.2, 30.6) and minority families (17.9 points, 95%CI, 12.8, 23.0). Diagnostic certainty and perceived social risk were associated: certainty increased as social risk perception increased (Spearman correlation 0.21, p < 0.001) in probable abuse cases; certainty decreased as risk perception increased (Spearman correlation (−)0.19, p = 0.003) in probable not abuse cases. Diagnostic decisions changed in 40% of cases when social risk indicators were reversed. Conclusions CAP risk perception that poverty is associated with higher abuse risk may explain documented race and class disparities in the medical evaluation and diagnosis of suspected child physical abuse. Social risk perception may act by influencing CAP certainty in their diagnosis

Rape Myth Acceptance Among College Students in the United States, Japan, and India

Rape myth acceptance is an important determinant of sexual assault behaviors. This study explored country and gender differences in rape myth acceptance among undergraduate students in the United States, Japan, and India. Male and female college students (N = 637) in these three countries participated in a self-administered survey in the fall of 2012 (the United States, n = 206; Japan, n = 215; and India, n = 216). The order of the countries arranged in increasing order of likelihood of disbelieving rape claim was as follows: the United States, Japan, and India. U.S. and Japanese students were less likely to disbelieve rape claims (p < .01) while U.S. students also were less likely to believe that victims are responsible for rape (p < .01). Overall, female participants were less likely to believe in the rape myth acceptance, disbelief of rape claim and victims are responsible for rape (p < .05). Acceptance of rape myth also varied by whether a participant knew about an organization or who do not believe they would seek help for sexual assault. Non-help seeking is associated with rape myth acceptance. This study, which used the same survey and data collection methods, provides comparative information on rape myth acceptance among college students in the United States, Japan, and India, which is not otherwise available, and contributes to providing fundamental knowledge to develop country-specific prevention programs