This study examined the incidence of alcohol and drugs in a sample of seriously injured motor vehicle collision victims, and differences related to pre-crash use of alcohol and/or other drugs on demographic variables, injury severity measures, and crash variables. The sample selected were all motor vehicle collision admissions to the Regional Trauma Unit at the Sunnybrook Health Science Centre in Toronto, Ontario, over a 37-month period (N = 854). Prospective demographic and injury-related information were collected from hospital charts, and crash data were collected from motor vehicle collision police reports. Blood samples were routinely collected on admission and tested for blood alcohol concentration (BAC). We found 32.0% of the BAC-tested motor vehicle collision admissions and 35.5% of drivers tested positive for blood alcohol. The drivers' mean BAC on admission was found to be 145.2 mg/100 ml, and the mean estimated BAC at crash time was 181 mg/100 ml. Drug screens were performed on a two-year subsample (n = 474), of whom 339 were drivers. Drug screens revealed that 41.3% of drivers tested positive for other drugs in body fluids, and 16.5% were positive for alcohol in combination with other drugs. Other than alcohol, the drugs most frequently detected in the drivers were cannabinoids (13.9%), benzodiazepines (12.4%), and cocaine (5.3%). Investigation of differences on demographic, injury, and crash characteristics related to precrash use of alcohol and/or drugs yielded significant findings. In the drug screened sample we found sex, admission type, and occupant status were related to precrash alcohol use. Also, use of drugs was found to interact with admission type and mean BAC on admission. Elapsed time was found to be significantly different for BAC by other drug use, with a greater length of elapsed time found for the subjects testing other drug positive but BAC negative. We found that BAC-positive drug-screened drivers were significantly more likely to be male, involved in a single-vehicle collision, not wearing a seat belt, ejected from the vehicle, and travelling at higher speeds than BAC negative drivers. No significant differences were found between BAC and/or other drug use on injury severity measures.
The deterrent impact of Ontario's 12-hour licence suspension law, a law intended to mete out swift punishment is evaluated. A process model of deterrence is included. Time series analyses of the monthly log odds of number of positive B.A.C. fatalities over the number of negative B.A.C. fatalities indicated a small, short-term effect. The intermediate measures of four surveys of media coverage, Toronto residents, Ontario residents, and police forces supported these results, and affirmed the potential validity of the process model of deterrence. The results suggest that laws to increase the celerity and certainty of punishment will have little deterrent impact without enforcement and publicity of the new laws.
Motor vehicle crashes remain a leading cause of death and injury in the industrialized world. Alcohol consumption is implicated as a major factor in fatal motor vehicle crashes (MVCs), but only poor estimates of blood alcohol concentrations among nonfatally injured crash victims are available. A 3-year study was undertaken at a Regional Trauma Unit to determine the demographics, injury severity, and alcohol positivity of motor vehicle crash victims. Between August 1, 1986 and July 31, 1989, 825 motor vehicle crash victims were available for study; 368 drivers were admitted to the unit within a period of 4 hours. Of 715 patients tested for alcohol, 31.0% were positive. A total of 333 drivers were tested for blood alcohol; 128 (38.4%) were positive. The mean blood alcohol concentration (BAC) at admission for the drivers was 145.6 mg/100 ml; the estimated mean BAC at crash was 180.9 mg/100 ml. The mean age of BAC positive drivers was 31.4 years, compared to a mean age in the BAC negative drivers of 35.2 years (p less than 0.02). Male patients represented 76.6% of the drivers, yet represented 83.6% of the BAC positive drivers (p less than 0.05). There was a marked seasonal variation in BAC positivity, with 46.1% of drivers positive during the summer months. Alcohol appears to be a significant factor in nonfatal MVCs.
To describe the self-reported prevalence and patterns of self-care and health care use for colds and flu.
Using the expert panel method, a questionnaire was developed to explore self-care practices, attitudes, pharmaceutical use, and health care use for a range of cold and flu symptoms.
London and Windsor, Ont.
Using a random-digit-dialing survey method, 210 residents were interviewed between November and December 1993. Of 1484 telephone numbers called, 1179 calls were ineligible. Two hundred ten questionnaires were completed for 305 eligible respondents.
Demographic data, typical self-care practices, actual practice during respondents' last cold, opinions on appropriate practices, and knowledge of how to treat colds.
Self-care was respondents' treatment of choice, and most respondents use over-the-counter drugs. Prescription drug use was low. Only 1% reported seeing a physician for their last cold. As the number of symptoms increased, however, reported use of over-the-counter drugs and calls or visits to doctors increased.
Results are congruent with other studies showing that the health care practices of most respondents are consistent with low use of the health care system and high levels of self-care for colds and flu.
Cites: Med Care. 1972 Mar-Apr;10(2):143-635015412
Cites: N Engl J Med. 1979 Mar 8;300(10):535-7763254
Cites: Med Care. 1979 Nov;17(11):1139-45502616
Cites: Soc Sci Med A. 1981 Sep;15(5):673-877034214
Cites: Med Care. 1984 Oct;22(10):950-666492904
Cites: J Chronic Dis. 1985;38(1):27-363972947
Cites: J Fam Pract. 1998 Nov;47(5):366-99834772
Cites: Health Educ Q. 1992 Spring;19(1):1-81568869
Cites: Br J Gen Pract. 1992 Aug;42(361):313-61457150
Cites: Can Fam Physician. 1993 Oct;39:2215-6; 2219-208219868
Cites: Health Educ Q. 1993 Winter;20(4):569-838307773
Cites: Fam Pract. 1996 Feb;13(1):75-838671107
Cites: Health Educ Res. 1998 Mar;13(1):33-4610178337
In the last few years, the continuing increases in health care expenditures have led to a call for greater accountability in health care and have spurred evaluative research into the area of health care policy. Yet the challenge has been to develop health care policy evaluations that maximize the rigor of the evaluation process within the constraints and limitations of evaluation milieus. This paper describes the principles of evaluation research and, using the example of a study evaluating the impact of hospital bed closures on community health status in Winnipeg, Canada, demonstrates the epistemological, methodological and interpretive problems that can occur when these principles are not followed. The conclusions are that studies which fail to outline the causal links between policy actions and outcomes, and use designs and methods which threaten internal and external validity, are limited in their abilities to elucidate the impact of health care policy changes.
Comment In: J Public Health Policy. 1997;18(4):469-71; author reply 472-49519622
Self-rated health is a commonly used measure of physical health status. While the development of one's perception of self-rated health likely occurs during childhood and adolescence, its development has been largely unexplored. This study addresses this issue by examining the relationship between adolescent self-rated health and personal (sex, age) and situation (family structure, family income) factors at five different time intervals to identify inter- and intra-cohort effects as well as concomitant changes in adolescent health compromising behaviour, specifically substance use. Five waves between 1989 and 1997 of the biennial Ontario Student Drug Use Survey (OSDUS) by the Addiction Research Foundation (ARF) consisting of 19,512 cases were examined. The results indicate the presence of both inter- and intra-cohort effects on self-rated health. In addition, health-compromising behaviours had a varied effect on self-rated health across grade. This analysis confirms some previous findings but also presents contradictory evidence by identifying the complexity of relationships among these factors and self-rated health.
The purpose of the study was to evaluate an Ontario Ministry of Health (MOH) cold/flu self-care public education campaign to reduce unnecessary patient visits to doctors. The MOH campaign consisted of an information booklet delivered to every household in an Ontario city, newspaper ads and radio spots. The program ran during January-March 1994. The evaluation consisted of: (1) 2x2 telephone survey in London (experimental area) and Windsor (comparison area), before and during the campaign; and (2) a telephone survey of London family practitioners during the campaign. In addition, data on the incidence of cold/flu visits to three hospital emergency departments and a sample of family physicians' offices were gathered. The data suggest that program rationale may have been questionable because the majority of the surveyed public were knowledgeable and self-reported appropriate doctor visits for cold/flu. Campaign evaluation showed limited impact. Message penetration was low; only one-third of London residents knew of the campaign or read the booklet. Only two of 10 questions showed increases in knowledge in London and no changes were found for beliefs, attitudes, acquisition of new health practices or self-reported visits to the doctor. The physician survey, emergency room and family physician office visit data were consistent with the public survey findings.