Hank Weiss Principal Investigator
Background: It is recommended by medical and transportation safety authorities in many countries that pregnant women traveling in motor-vehicles should wear properly fitted seat belts for the well-being of both mother and fetus. While a better understanding of the nature of fetal risks from severe crashes among belted occupants and long term outcomes of fetal trauma exposure remains to be elucidated, it is clear that lack of restraint use results in increased risk of fetal death and adverse birth outcomes. Despite this knowledge, several, but an uncertain number of countries, continue to have dangerous and outdated seat belt use exemptions or medical exclusions for pregnant women.

Specific Aims: The aims of this project are to survey the specific number and characteristics of occupant exemptions to national seat belt laws in different countries around the globe, with a particular focus on pregnancy-related clauses. Another goal is to estimate the number of pregnancies potentially impacted by these exemptions.

Methods: The lack of a complete and accurate international census of national and local agencies responsible for developing and enforcing seat belt laws makes it very difficult to target agencies and individuals for a survey. This international investigation will rely on multiple means of identifying credible compilations of exemption regulations from national and international traffic-safety agencies and other governmental organizations, non-governmental organizations, search engine reports of the World-wide web, personal contacts, related internet list servers, and conference registration lists. Data will be collected through a web-based survey instrument supplemented by electronic mail and hard copy (postal) distribution of the 16 question two-page survey instrument. Results will be made available online, at international traffic safety and injury control meetings and in published reports.

Significance: The findings from this survey will be useful for bringing the issue of unwarranted and dangerous pregnancy-related seat belt exemptions to the international medical community and the traffic and safety agencies of the respective countries examined. By singling out those countries with such exemptions it is hoped that advocates, agencies and the legislative bodies of each country will be made aware of the need to remove these exemptions, thereby leading to safer mothers and healthier babies across the globe.

back to top

Anthony Fabio Principal Investigator
There is a large body of evidence linking alcohol use to violence; however, the exact connection has not been clarified beyond a simple relationship. Prior research has been based on population surveys, experimental laboratory studies on aggression, and studies of violent victimization in trauma centers. In surveys, the association between alcohol and violence found to date have been correlational in nature, the measure of alcohol intake is often subjective, and the measurements between violence and alcohol intake often span months rather than being proximal. Although cross-sectional surveys assess socially important, “real world” situations, they utilize limited data of prior history of alcohol use and aggression, and often do not adjust for important confounders, such as age and race. Experimental studies have assessed the proximal link between alcohol use and simulated aggression, but not in “real world” situations, and almost always lack data on individuals’ history of alcohol use and aggression. Studies that have used data from trauma centers also lack adequate information on individual history. Also, laboratory studies and trauma center studies have failed to distinguish between victims of violence, perpetrators of violence and those who fall in both categories. The distinction is important - in violent encounters, chance often plays a role in determining who becomes a victim or perpetrator of violence.

In order to overcome past limitations, we are developing a study that combines the best elements of survey and trauma center studies. Currently we are developing the methods and collecting pilot data for the development of an NIAAA grant application. The application will propose to link longitudinal survey data to data from trauma centers on the same individuals treated for injury. Specifically, we will propose to link data from the Pittsburgh Youth Study (PYS) with data from trauma centers in and around Pittsburgh. The PYS contains 14 years of longitudinal information on the developmental pathways of delinquency. Trauma registry data contain information on the intentionality of injuries along with an objective measure of blood alcohol content (BAC) for a large majority of serious injuries in the city of Pittsburgh. This linkage has three major benefits: First, the survey data will provide information of detailed longitudinal data on the history of alcohol use and aggression, along with a significant number of other variables that can be used to control confounding. Second, trauma center data provides a proximal and objective measure of alcohol, as well as socially relevant circumstances. Third, better knowledge about the characteristics of individuals with a prior history of violent offending and/or violent victimization will help to design and improve screening measures that can be used in trauma centers to identify those who are at highest risk for revictimization in the future. We see this as a first step in improving prevention interventions based in trauma centers.