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Journal: Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention


OBJECTIVES: The objective of the present work was to study the impact of technological and social distraction on cautionary behaviours and crossing times in pedestrians. METHODS: Pedestrians were observed at 20 high-risk intersections during 1 of 3 randomly assigned time windows in 2012. Observers recorded demographic and behavioural information, including use of a mobile device (talking on the phone, text messaging, or listening to music). We examined the association between distraction and crossing behaviours, adjusting for age and gender. All multivariate analyses were conducted with random effect logistic regression (binary outcomes) and random effect linear regression (continuous outcomes), accounting for clustering by site. RESULTS: Observers recorded crossing behaviours for 1102 pedestrians. Nearly one-third (29.8%) of all pedestrians performed a distracting activity while crossing. Distractions included listening to music (11.2%), text messaging (7.3%) and using a handheld phone (6.2%). Text messaging, mobile phone use and talking with a companion increased crossing time. Texting pedestrians took 1.87 additional seconds (18.0%) to cross the average intersection (3.4 lanes), compared to undistracted pedestrians. Texting pedestrians were 3.9 times more likely than undistracted pedestrians to display at least 1 unsafe crossing behaviour (disobeying the lights, crossing mid-intersection, or failing to look both ways). Pedestrians listening to music walked more than half a second (0.54) faster across the average intersection than undistracted pedestrians. CONCLUSIONS: Distracting activity is common among pedestrians, even while crossing intersections. Technological and social distractions increase crossing times, with text messaging associated with the highest risk. Our findings suggest the need for intervention studies to reduce risk of pedestrian injury.

Concepts: Observation, Behavior, Human behavior, Mobile phone, Text messaging, Pedestrian, Distraction, Instant messaging


The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country.

Concepts: Health economics, Epidemiology, Posttraumatic stress disorder, Pharmacoeconomics, Global health, Quality-adjusted life year, Disability-adjusted life year, Disease burden


This report uses an enhanced conceptualisation of self-injury mortality (SIM), which comprised registered or known suicides by any method and estimated non-suicide deaths from opioid and other drug self-intoxication. SIM surpassed diabetes as a cause of death in the USA in 2015. The gap expanded in 2016 with respective rates of 29.1 and 24.8 per 100 000 population. Facing similar social and psychologically complex health problems to SIM, the USA has initiated and sustained successful broad-based prevention efforts that have reduced deaths from cardiovascular diseases, smoking-related lung cancer, HIV and motor vehicular injury-given both necessary epidemiological understanding to define the problem and sufficient political will to address it. Development of strategies to prevent SIM will be facilitated by focusing on factors that are common risks for diverse outcomes. Like premature mortality frequently associated with diabetes, deaths from self-injurious behaviours are preventable.


Most analysis of road injuries examines the risk experienced by people using different modes of transport, for instance, pedestrian fatalities per-head or per-km. A small but growing field analyses the impact that the use of different transport modes has on other road users, for instance, injuries to others per-km driven.


Twenty miles per hour (32 km/hour) or 30 km/hour speed limits represent a potential strategy to reduce urban road injuries and are becoming increasingly widespread. However, no study has conducted a robust evaluation of the effects of city-wide 20 mph speed limits on road injuries. This study reports the effects of such an intervention, based on a natural experiment that took place in Bristol, UK. Based on a stepped-wedge design using count data, negative binomial regressions showed that between 2008 and 2016, the 20 mph speed limit intervention was associated with a city-level reduction of fatal injuries of around 63% (95% CI 2% to 86%), controlling for trends over time and areas. There was also a general trend of reduction of the total number of injuries at city level and in 20 mph roads. These findings highlight the potential benefits of city-wide 20 mph speed limits. We hypothesise that this city-wide approach may encourage a general behaviour change in drivers that, in turn, may contribute to reducing injuries across the city.


We assessed gun ownership rates in 2013 across the USA and the association between exposure to a social gun culture and gun ownership. We used data from a nationally representative sample of 4000 US adults, from 50 states and District of Columbia, aged >18 years to assess gun ownership and social gun culture performed in October 2013. State-level firearm policy information was obtained from the Brady Law Center and Injury Prevention and Control Center. One-third of Americans reported owning a gun, ranging from 5.2% in Delaware to 61.7% in Alaska. Gun ownership was 2.25-times greater among those reporting social gun culture (PR=2.25, 95% CI 2.02 to 2.52) than those who did not. In conclusion, we found strong association between social gun culture and gun ownership. Gun cultures may need to be considered for public health strategies that aim to change gun ownership in the USA.

Concepts: United States, Sociology, U.S. state, Firearm, United States House of Representatives, Gun, Gun politics in the United States, Gun Control Act of 1968


BACKGROUND: This study examined the impact of transportation infrastructure at intersection and non-intersection locations on bicycling injury risk. METHODS: In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case-crossover design compared the infrastructure of injury and control sites within each injured bicyclist’s route. Intersection injury sites (N=210) were compared to randomly selected intersection control sites (N=272). Non-intersection injury sites (N=478) were compared to randomly selected non-intersection control sites (N=801). RESULTS: At intersections, the types of routes meeting and the intersection design influenced safety. Intersections of two local streets (no demarcated traffic lanes) had approximately one-fifth the risk (adjusted OR 0.19, 95% CI 0.05 to 0.66) of intersections of two major streets (more than two traffic lanes). Motor vehicle speeds less than 30 km/h also reduced risk (adjusted OR 0.52, 95% CI 0.29 to 0.92). Traffic circles (small roundabouts) on local streets increased the risk of these otherwise safe intersections (adjusted OR 7.98, 95% CI 1.79 to 35.6). At non-intersection locations, very low risks were found for cycle tracks (bike lanes physically separated from motor vehicle traffic; adjusted OR 0.05, 95% CI 0.01 to 0.59) and local streets with diverters that reduce motor vehicle traffic (adjusted OR 0.04, 95% CI 0.003 to 0.60). Downhill grades increased risks at both intersections and non-intersections. CONCLUSIONS: These results provide guidance for transportation planners and engineers: at local street intersections, traditional stops are safer than traffic circles, and at non-intersections, cycle tracks alongside major streets and traffic diversion from local streets are safer than no bicycle infrastructure.

Concepts: Risk, Cycling, Road, Vehicle, Automobile, Lane, Bicycle, Utility cycling


Anecdotal evidence suggests that people coming into contact with cattle while participating in outdoor pursuits can sustain severe, even fatal injuries. This has negative implications for farmers, cattle and the public. This study outlines findings from a review of published literature, UK media reports and internet guidelines currently available to the UK public for walking near cattle. A total of 54 cattle attacks were reported in the UK media from 1 January 1993 to 31 May 2013; approximately one-quarter resulted in fatality and two-thirds involved dogs. Walking with dogs among cows, particularly with calves present, was a problematic context. Twenty pieces of commonly occurring advice were found within various guidelines. However, there are no definitive approved guidelines, no published studies describing the prevalence of cattle attacks on members of the public and no system in place to document them. Attacks by cattle are underinvestigated and further work should assess their public health impact.

Concepts: United Kingdom, Cattle, Veal, Evidence, Scientific evidence, Calf, Anecdotal evidence, Immigration to the United Kingdom since 1922


To understand and ultimately prevent injury and behavioural health outcomes associated with masculinity, we assessed the influence of masculine discrepancy stress (stress that occurs when men perceive themselves as falling short of the traditional gender norms) on the propensity to engage in stereotypically masculine behaviours (eg, substance use, risk taking and violence) as a means of demonstrating masculinity. Six-hundred men from the USA were recruited via Amazon’s Mechanical Turk (MTurk) online data collection site to complete surveys assessing self-perceptions of gender role discrepancy and consequent discrepancy stress, substance use/abuse, driving while intoxicated (DWI) and violent assaults. Negative binomial regression analyses indicated significant interactive effects wherein men high on gender role discrepancy and attendant discrepancy stress reported significantly more assaults with a weapon (B=1.01; SE=0.63; IRR=2.74; p=0.05) and assaults causing injury (B=1.01; SE=0.51; IRR=2.74; p<0.05). There was no association of discrepancy stress to substance abuse, but there was a protective effect of gender role discrepancy for DWI among men low on discrepancy stress (B=-1.19, SE=0.48; IRR=0.30; p=0.01). These findings suggest that gender role discrepancy and associated discrepancy stress, in particular, represent important injury risk factors and that prevention of discrepancy stress may prevent acts of violence with the greatest consequences and costs to the victim, offender and society.

Concepts: Gender, Sociology, Gender role, Gender identity, Man, Masculinity, Masculism, Gender studies


The city of Winnipeg was the first among several jurisdictions in Manitoba, Canada, to introduce breed specific legislation (BSL) by banning pit-bull type dogs in 1990. The objective of the present work was to study the effectiveness of BSL in Manitoba.

Concepts: Provinces and territories of Canada, Canada, Calgary, Manitoba, Canadian Pacific Railway, Canadian National Railway, Winnipeg, Breed-specific legislation