Changing mobility patterns and road mortality among pre-license teens in a late licensing country: an epidemiological study

Abstract Background Whereas the safety of teens in early licensing countries has been extensively studied, little is known about the safety of pre-license teens in late licensing countries, where these teens also may be at risk. This risk exists because of the combination of a) increasing use of travel modes with a high injury risk, such as bicycles and mopeds, b) inexperience, and c) teens’ developmental stage, known to be associated with risk taking and novelty seeking, especially among males. To explore the magnitude and nature of pre-license road risk, this study analysed epidemiological data from the Netherlands, and hypothesized that in this late licensing country, ‘independent travel’ and the use of riskier modes of transport increase among pre-license teens 10 to 17 years of age, resulting in higher fatality rates, with ‘experience’ and ‘gender’ as risk modifying factors. Method National travel and fatality data of pre-license adolescents in the Netherlands were analysed by traffic role (cyclist, pedestrian, car passenger and moped rider), and compared to a younger age group (0–9 years) and an older age group (18+ years). Results The study of travel data showed that teens migrate from being car occupants to being users of riskier modes of transport, specifically bicycles and mopeds. This migration resulted in a strong rise in road fatalities, illustrating the importance of mobility patterns for understanding changes in road fatalities in this age group. The data further suggested a protective role of early cycle experience for young adolescent cyclists, particularly for young males. But further study into the underlying mechanism is needed to confirm this relationship. Moped risk was extremely high, especially among young males, and even higher than that of young male car drivers. Conclusions The study confirmed the importance of changes in mobility patterns for understanding the rising road mortality when youngsters enter into their teens. The focus on fatalities has led to an underestimation of the magnitude of the problem because of the physical resilience of young adolescents that leads to high survival rates but probably also to long term disabilities. In addition, to explore the generalizability of these results, international comparisons among and between early and late licensing countries are necessary, especially in relation to moped riding as an alternative for car driving.http://deepblue.lib.umich.edu/bitstream/2027.42/112337/1/12889_2011_Article_5237.pd

Pretransplant varicella vaccination is cost-effective in pediatric renal transplantation

Because of the severe complications that may result from varicella zoster virus (VZV) infection following renal transplantation (Tx), transplanted varicella-susceptible children exposed to varicella are typically given varicella zoster immunoglobulin (VZIG) as prophylaxis or are admitted and treated with parenteral acyclovir if VZIG prophylaxis fails. As both VZIG and hospitalization are costly, prevention of varicella infection by vaccination could potentially result in significant cost savings in addition to decreasing morbidity and mortality. To test this hypothesis, we developed a decision-analysis model to evaluate the cost-effectiveness of vaccinating patients with chronic renal failure (CRF) against varicella prior to renal transplant. Under baseline assumptions, vaccination for varicella pretransplant was a cost-effective strategy, with a cost of $211 per patient vaccinated compared with$1,828 per patient not vaccinated. The magnitude of cost savings from vaccination was sensitive to variations in the cost of varicella vaccine, the percentage of patients hospitalized for treatment with acyclovir, and the percentage of patients exposed to varicella infection. One- and two-way sensitivity analyses confirmed that vaccination was the dominant cost-effective strategy under all conditions examined. We conclude that vaccination for varicella pretransplant is cost-effective for patients with CRF, and that the magnitude of cost savings is sensitive to the cost of hospitalization, the percentage of patients exposed to varicella, and the cost of varicella vaccination. Pending results of ongoing studies of the safety and efficacy of VZV vaccine in children with CRF, we recommend that VZV vaccine be given to all children with CRF.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73184/1/j.1399-3046.2001.00032.x.pd

Social Norms and Risk Perception: Predictors of Distracted Driving Behavior Among Novice Adolescent Drivers

AbstractPurposeAdolescent drivers are at elevated crash risk due to distracted driving behavior (DDB). Understanding parental and peer influences on adolescent DDB may aid future efforts to decrease crash risk. We examined the influence of risk perception, sensation seeking, as well as descriptive and injunctive social norms on adolescent DDB using the theory of normative social behavior.Methods403 adolescents (aged 16–18 years) and their parents were surveyed by telephone. Survey instruments measured self-reported sociodemographics, DDB, sensation seeking, risk perception, descriptive norms (perceived parent DDB, parent self-reported DDB, and perceived peer DDB), and injunctive norms (parent approval of DDB and peer approval of DDB). Hierarchical multiple linear regression was used to predict the influence of descriptive and injunctive social norms, risk perception, and sensation seeking on adolescent DDB.Results92% of adolescents reported regularly engaging in DDB. Adolescents perceived that their parents and peers participated in DDB more frequently than themselves. Adolescent risk perception, parent DDB, perceived parent DDB, and perceived peer DDB were predictive of adolescent DDB in the regression model, but parent approval and peer approval of DDB were not predictive. Risk perception and parental DDB were stronger predictors among males, whereas perceived parental DDB was stronger for female adolescents.ConclusionsAdolescent risk perception and descriptive norms are important predictors of adolescent distracted driving. More study is needed to understand the role of injunctive normative influences on adolescent DDB. Effective public health interventions should address parental role modeling, parental monitoring of adolescent driving, and social marketing techniques that correct misconceptions of norms related to around driver distraction and crash risk

Three-Dimensional Human Bronchial-Tracheal Epithelial Tissue-Like Assemblies (TLAs) as Hosts for Severe Acute Respiratory Syndrome (SARS)-CoV Infection

A three-dimensional (3-D) tissue-like assembly (TLA) of human bronchial-tracheal mesenchymal (HBTC) cells with an overlay of human bronchial epithelial (BEAS-2B) cells was constructed using a NASA Bioreactor to survey the infectivity of SARS-CoV. This TLA was inoculated with a low passage number Urbani strain of SARS-CoV. At selected intervals over a 10-day period, media and cell aliquots of the 3-D TLA were harvested for viral titer assay and for light and electron microscopy examination. All viral titer assays were negative in both BEAS-2B two-dimensional monolayer and TLA. Light microscopy immunohistochemistry demonstrated antigen-antibody reactivity with anti-SARS-CoV polyclonal antibody to spike and nuclear proteins on cell membranes and cytoplasm. Coronavirus Group 2 cross-reactivity was demonstrated by positive reaction to anti-FIPV 1 and anti-FIPV 1 and 2 antibodies. TLA examination by transmission electron microscopy indicated increasing cytoplasmic vacuolation with numerous electron-dense bodies measuring 45 to 270 nm from days 4 through 10. There was no evidence of membrane blebbing, membrane duplication, or fragmentation of organelles in the TLAs. However, progressive disruption of endoplasmic reticulum was observed throughout the cells. Antibody response to SARS-CoV specific spike and nucleocapsid glycoproteins, cross-reactivity with FIPV antibodies, and the cytoplasmic pathology suggests this HBTE TLA model is permissive to SARS-CoV infection

Alcohol Availability and Violence among Inner‐City Adolescents: A Multi‐Level Analysis of the Role of Alcohol Outlet Density

Researchers recognize that the connection between alcohol and peer violence may relate to community level ecological factors, such as the location of businesses that sell alcohol. Building on previous research among adults, this study examines the relationship between alcohol outlet density and violent behaviors among adolescents, taking into account demographic characteristics, individual alcohol use, and neighborhood level socioeconomic indicators. Data drawn from a diverse Emergency Department based sample of 1,050 urban adolescents, combined with tract level data from the state liquor control commission and U.S. Census, were analyzed. Results of multivariate multi‐level regression analysis indicate that alcohol outlet density is significantly related to adolescents' violent behaviors, controlling for demographic characteristics and individual alcohol use. Census tract level socioeconomic indicators were not significantly associated with youth violence. Findings suggest that alcohol outlet density regulation should be considered as part of broader violence prevention strategies for urban adolescents.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117032/1/ajcp9353.pd

Dating Violence: Outcomes Following a Brief Motivational Interviewing Intervention Among At‐risk Adolescents in an Urban Emergency Department

Objectives A recent study demonstrated the efficacy of the SafERteens intervention in reducing peer violence among adolescents presenting to the emergency department (ED). The objective of this study was to determine the efficacy of this ED‐based brief intervention (BI) on dating violence 1 year following the ED visit among the subsample of adolescents in the original randomized controlled trial reporting past‐year dating violence. Methods Patients (aged 14 to 18 years) at an ED were eligible for inclusion if they had past‐year violence and alcohol use. Participants were randomized to one of three conditions (BI delivered by a computer [CBI], BI delivered by a therapist and a computer (T+CBI), or control) and completed follow‐ups at 3, 6, and 12 months. In addition to content on alcohol misuse and peer violence, adolescents reporting dating violence received a tailored module on dating violence. The outcome of interest was frequency of moderate and severe dating violence victimization and aggression (baseline and 3, 6, and 12 months after ED visit). Results Among eligible adolescents, 55% ( n  = 397) reported dating violence and were included in these analyses. Compared to the control group (who received a resource brochure only), participants in the CBI showed reductions in moderate dating victimization at 3 months (inter‐rater reliability [IRR] = 0.71; 95% confidence interval [CI] = 0.51 to 0.99; p < 0.05) and 6 months (IRR = 0.56; 95% CI = 0.38 to 0.83; p < 0.01). Models examining interaction effects were significant for the CBI on moderate dating victimization at 3 months (IRR = 0.81; 95% CI = 0.67 to 0.98; p < 0.05) and 6 months (IRR = 0.81; 95% CI = 0.66 to 0.99; p < 0.05). Significant interaction effects were found for the T+CBI on moderate dating violence victimization at 6 months (IRR = 0.81; 95% CI = 0.69 to 0.96; p < 0.01) and 12 months (IRR = 0.76; 95% CI = 0.63 to 0.90; p < 0.001) and severe dating violence victimization at 3 months (IRR = 0.76; 95% CI = 0.59 to 0.96; p < 0.05). Conclusions ED‐based BIs tailored to address multiple risk behaviors (i.e., peer violence, alcohol use, and dating violence) show promise for reducing moderate and severe dating victimization for up to 1 year following an ED visit. Resumen La Violencia de Pareja: Resultados tras una Intervención mediante una Entrevista Breve Motivacional entre los Adolescentes en Riesgo en un Servicio de Urgencias Urbano Objetivos Un estudio reciente demostró la eficacia de la intervención SafERteens en reducir la violencia entre los adolescentes que acuden al servicio de urgencias (SU). El objetivo de este estudio fue determinar la eficacia de esta intervención breve (IB) en los SU en la violencia de pareja al año tras la visita al SU en una muestra de adolescentes del ensayo clínico original controlado y aleatorizado que documentó la violencia de pareja del pasado año. Metodología Se incluyeron los pacientes entre 14 y 18 años de edad del SU que tenían antecedentes de violencia o consumo de alcohol en el pasado año. Los participantes fueron aleatorizados a una de las tres situaciones: IB realizada por un ordenador (IBO), IB realizada por un terapeuta y un ordenador (IBO + T), o control; y completaron 3, 6, y 12 meses de seguimiento. Además de contener abuso de alcohol y violencia entre iguales, los adolescentes que documentaron la violencia de pareja recibieron un módulo adaptado en violencia de pareja. El resultado de interés fue la frecuencia de violencia de pareja moderada o grave como víctima y agresor (basal, 3, 6 y 12 meses tras la visita). Resultados Entre los adolescentes elegibles, el 55% (n=397) documentó datos de violencia de pareja y fueron incluidos en estos análisis. En comparación con el grupo control (que recibieron sólo el recurso de un folleto informativo), los participantes en la IBO mostraron una reducción en la violencia de pareja moderada como víctima a los 3 meses (concordancia entre evaluadores [K] 0,71; IC 95% = 0,51 a 0,99; p < 0,05) y a los 6 meses (K 0,56; IC 95%= 0,38 a 0,83; p < 0,01); los modelos que examinaron los efectos de interacción fueron significativos para la IBO en la violencia de pareja moderada como víctima a los 3 meses (K 0,81; IC 95% = 0,67 a 0,98; p < 0,05) y a los 6 meses (K 0,81; IC 95% = 0,66 a 0,99; p < 0,05). Se hallaron efectos de interacción significativos para la IBO+T en la violencia de pareja moderada como víctima a los 6 meses (K 0,81; IC 95% = 0,69 a 0,96; p < 0,01) y a los 12 meses (K 0,76; IC 95% = 0,63 a 0,90; p < 0,001), y en la violencia de pareja grave como víctima a los 3 meses (K 0.76; IC 95% = 0,59 a 0,96; p < 0,05). Conclusiones Las IB en el SU adaptadas para valorar múltiples comportamientos de riesgo (ej: violencia entre iguales, consumo de alcohol y violencia de pareja) son prometedores para reducir la violencia de pareja moderada y grave como víctima hasta un año tras la visita al SU.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98214/1/acem12151.pd

Three-month Follow-up of Brief Computerized and Therapist Interventions for Alcohol and Violence Among Teens

Alcohol use and violent behaviors are well documented among adolescents and have enormous effects on morbidity and mortality. The authors hypothesized that universal computer screening of teens in an inner-city emergency department (ED), followed by a brief intervention (BI), would be 1) feasible (as measured by participation and completion of BI during the ED visit) and well received by teens (as measured by posttest process measures of intervention acceptability) and 2) effective at changing known precursors to behavior change such as attitudes, self-efficacy, and readiness to change alcohol use and violence.Adolescent patients (ages 14–18 years) at an urban ED were approached to complete a computerized survey. The survey was conducted daily from 12 noon to 11  pm from September 2006 through November 2008. Adolescents reporting both alcohol use and violence in the past year were randomized to a control group or a 35-minute BI delivered by a computer or therapist as part of the SafERteens study. Validated measures were administered, including demographics, alcohol use, attitudes toward alcohol and violence, self-efficacy for alcohol and violence, readiness to change alcohol and violence, and process questions, including likeability of intervention.A total of 2,423 adolescents were screened. Thirteen percent of those approached refused. The population was 45% male, 58% African American, and 6.2% Hispanic. Of those screened, 637 adolescents (26%) screened positive; 533 were randomized to participate, and 515 completed the BI prior to discharge. The BIs were well received by the adolescents overall; 97% of those randomized to a BI self-reported that they found one intervention section “very helpful.” At posttest, significant reductions in positive attitudes for alcohol use and violence and significant increases in self-efficacy related to alcohol/violence were found for both therapist and computer interventions. At 3-month follow-up there was 81% retention, and generalized estimating equations (GEE) analysis showed that participants in both interventions had significant reductions in positive attitudes for alcohol use (therapist p = 0.002, computer p = 0.0001) and violence (therapist p = 0.012, computer p = 0.007) and significant increases in self-efficacy related to violence (therapist p = 0.0.04, computer p = 0.002); alcohol self-efficacy improved in the therapist BI condition only (therapist p = 0.050, computer p = 0.083). Readiness to change was not significantly improved.This initial evaluation of the SafERteens study shows that universal computerized screening and BI for multiple risk behaviors among adolescents is feasible, well received, and effective at altering attitudes and self-efficacy. Future evaluations of the SafERteens study will evaluate the interventions’ effects on behavioral change (alcohol use and violence) over the year following the ED visit.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78665/1/j.1553-2712.2009.00513.x.pd

Experimental Effects of Injunctive Norms on Simulated Risky Driving Among Teenage Males

Objective: Teenage passengers affect teenage driving performance, possibly by social influence. To examine the effect of social norms on driving behavior, male teenagers were randomly assigned to drive in a simulator with a peer-aged confederate to whom participants were primed to attribute either risk-accepting or risk-averse social norms. It was hypothesized that teenage drivers would engage in more risky driving behavior in the presence of peer passengers than no passengers, and with a risk-accepting compared with a risk-averse passenger. Method: 66 male participants aged 16 to18 years holding a provisional driver license were randomized to drive with a risk-accepting or risk-averse passenger in a simulator. Failure to Stop at a red light and percent Time in Red (light) were measured as primary risk-relevant outcomes of interest at 18 intersections, while driving once alone and once with their assigned passenger. Results: The effect of passenger presence on risky driving was moderated by passenger type for Failed to Stop in a generalized linear mixed model (OR = 1.84, 95% CI [1.19, 2.86], p \u3c .001), and percent Time in Red in a mixed model (B = 7.71, 95% CI [1.54, 13.87], p \u3c .05). Conclusions: Exposure of teenage males to a risk-accepting confederate peer increased teenage males’ risky simulated driving behavior compared with exposure to a risk-averse confederate peer. These results indicate that variability in teenage risky driving could be partially explained by social norms

Measurement of Alcohol Use and Misuse in a Cohort of Students Followed from Grade 6 Through Grade 12

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66189/1/j.1530-0277.1994.tb00938.x.pd