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Biomedical subjects

D T Levy

Publications and source records attributed to D T Levy.

33 records · Page 2Linked to original sources
PubMed2000

Expert opinions on optimal enforcement of minimum purchase age laws for tobacco.

A questionnaire on how youth access laws should be enforced was sent to 20 experts who had administered and/or evaluated a youth access enforcement program. Respondents agreed on the need for a high level of retail compliance, checkers representative of the community, checks at least twice per year, a graduated penalty structure with license revocation, and bans on self-service and vending machines. Respondents indicated the need for research on the effects of ID use, frequency of checks, penalty structures, and the effects on smoking rates of youth access policies alone and in conjunction with other tobacco control policies.

Adolescent↗
PubMed2000

A simulation model of tobacco youth access policies.

Empirical studies have found that policies aimed at reducing youth access to tobacco have been successful at increasing retail compliance, but their effects on actual tobacco use are mixed. This article presents a model of youth access policies that helps explain the apparently conflicting results in the extant literature, provides a framework for future empirical studies, and suggests implications for public policy. Our model highlights the interaction of components in a well-designed policy, including sufficient compliance checks, penalties, and community involvement. It also illustrates why it will be difficult to eliminate all of youth supply. Nonretail sources, such as borrowing or stealing from parents and siblings and purchasing from older peers through black markets, are an important component of youth supply and become more important as retail access is reduced. The analysis is limited to policies that affect the retail supply of cigarettes but suggests the need for other policies that affect the demand for cigarettes, such as taxes and cessation policies, in order to further reduce youth smoking rates.

Adolescent↗
PubMed2000

A simulation of the effects of youth initiation policies on overall cigarette use.

OBJECTIVES: We developed a simulation model to predict the effects of policies aimed at reducing smoking initiation by youths younger than 18 years. METHODS: The model projected the number of smokers, never smokers, and ex-smokers by age, sex, and racial/ethnic group and the effects of reductions in youth initiation. RESULTS: The model predicted that even if tobacco policies eliminated youth initiation, the number of smokers would not be halved for more than 30 years. If initiation were halved and some of the initiation were delayed rather than eliminated, substantially smaller reductions would result. CONCLUSIONS: Policies that increase cessation rates are needed to reduce the number of current smokers and the more near-term health problems.

Adolescent↗
PubMed1999

Geographic variation in expenditures for Workers' Compensation hospitalized claims.

OBJECTIVE: Past literature finds considerable variation in the cost of physician care and in the utilization of medical procedures. Variation in the cost of hospitalized care has received little attention. We examine injury costs of hospitalized claims across states. DESIGN: Multivariate regression analysis is used to isolate state variations, while controlling for personal and injury characteristics, and state characteristics. SETTING: Injuries to workers filing Workers' Compensation lost workday claims. PARTICIPANTS: About 35,000 randomly sampled Workers' Compensation claims from 17 states filed between 1979 and 1988. MAIN OUTCOME MEASURE: Medical payments per episode of three injury groups: upper and lower extremity fractures and dislocations, other upper extremity injuries, and back strains and sprains. RESULTS: Statistical analyses reveal considerable variation in expenditures for hospitalized injuries across states, even after controlling for case mix and state characteristics. A substantial portion of the variation is explained by state rate regulations; regulated states have lower costs. CONCLUSIONS: The large variation in costs suggests a potential to affect the costs of hospitalized care. Efforts should be directed at those areas that have higher costs without sufficient input price, quality, or case mix justification.

Arm Injuries↗
PubMed1999

How intoxicated are drivers in the United States? Estimating the extent, risks and costs per kilometer of driving by blood alcohol level.

This study develops and applies an algorithm with international applicability for estimating vehicle kilometers (kms) driven by blood alcohol level (BAL) from police crash report data. In the United States, an estimated one in 120 kms was driven with BAL > or = 0.10% in 1992-1993. The ratio increased to 1 in 7 kms driven on weekend evenings. The estimated cost per vehicle km driven with BAL > or = 0.08% was $3.40 compared to $0.07 per sober km. Males, those age 21-29 and those driving between 22:00 and 04:00 had the greatest percentage of driving with BAL > or = 0.08%. These estimates are computed, in part, from early 1960s data on crash odds by driver BAL and assume crash odds by BAL relative to sober do not vary with driver age and sex. Preliminary investigation indicates that the method provides reliable estimates of alcohol-positive kms from roadside surveys at night, but seems to over-estimate high-BAL kms. Direct field validation is highly desirable.

Accidents, Traffic↗
PubMed1997

Geographic variation in expenditures for workers' compensation physician claims.

We examine interstate variations in the cost of claims for physician care using injury claims from Worker's Compensation, and consider some of the factors that may explain cost differences. Multivariate regression analysis is used to isolate state variations, while controlling for personal and injury characteristics, and state characteristics. Statistical analyses reveal considerable variation in expenditures for physician care of injuries across states, even after controlling for case mix and state characteristics. We also find that the presence of HMOs and of general practitioners as a percent of physicians are associated with lower claims, and that the percent of the state that is urban is associated with higher claims. The large variation in costs suggests a potential to affect the costs of physician care for work-related injuries.

Geography↗
PubMed1995

Relationship between driver's license renewal policies and fatal crashes involving drivers 70 years or older.

OBJECTIVE: To assess the relationship between state driver's license renewal policies and fatal crashes involving drivers aged 70 years or older (seniors). DESIGN AND ANALYSIS: Poisson regression methods were used to isolate the relationship between different state policies mandating vision tests, knowledge tests, or road tests for driver's license renewal and fatal crashes involving senior drivers. The analysis controlled for differences among states, other than their renewal policies, likely to influence senior motor vehicle crashes. SETTING: United States, 1985 through 1989. PARTICIPANTS: All fatal crashes identified in the National Highway Traffic Safety Administration Fatal Accident Reporting System involving at least one driver aged 70 years or older. MAIN OUTCOME MEASURE: The number of fatal crashes per state in which at least one of the drivers was aged 70 years or older. When a single fatal crash involved more than one senior driver, each was included. RESULTS: State-mandated tests of visual acuity, adjusted for license renewal period, were associated with lower fatal crash risk for senior drivers (relative risk, 0.93; 95% confidence interval, 0.89 to 0.97). Knowledge tests, when added to vision tests and applied only to seniors, provided a nonsignificant reduction in the senior fatal crash risk (relative risk, 0.91; 95% confidence interval, 0.79 to 1.05). CONCLUSION: Tests of vision and knowledge for senior drivers at license renewal merit further attention as a means of improving senior traffic safety.

Accidents, Traffic↗
PubMed1995

The effect of regional trauma care systems on costs.

OBJECTIVE: To assess cost savings from regional trauma care systems. DESIGN: Multivariate regression analysis is used to isolate the effects of regional trauma care systems on medical costs while controlling for personal and injury characteristics and other factors likely to influence medical costs. Percentage reductions in costs are translated into dollar cost savings with corrections for excluded costs and losses from premature death. SETTING: Injuries to workers filing workers' compensation lost workday claims. PARTICIPANTS: Randomly sampled workers' compensation claims from 17 states filed between 1979 and 1988 (N = 217,000). MAIN OUTCOME MEASURE: Medical payments per episode of four injury groups: lower-extremity fractures and dislocations, upper-extremity fractures and dislocations, other upper-extremity injuries, and back strains and sprains. We distinguish hospitalized from nonhospitalized claims. RESULTS: Statistical analyses reveal that states with trauma care systems have 15.5% lower costs per hospitalized injury episode. Savings average $1025 per case in 1988 dollars. Costs per episode for disabling nonhospitalized injury are 10% lower in states with trauma care systems, with savings averaging $75 per case. The largest savings are for back injuries. CONCLUSIONS: Extending trauma care systems nationwide could lower annual medical care payments by $3.2 billion. Including productivity losses due to premature death, the savings could total $10.3 billion, 5.9% of national injury costs.

Arm Injuries↗
PubMed1995

The relationship of age and state license renewal policies to driving licensure rates.

We employ regression analysis to examine the relationship of state driver's license renewal requirements, population characteristics, and driving conditions to state driving licensure rates. Licensure rates are examined for the years 1985 through 1989. We separately examine all-age and senior licensed drivers. We find that license renewal requirements as well as population characteristics and driving conditions have systematic relationships to licensure rates. In particular, license renewal tests are associated with lower senior driving licensure rates.

Adolescent↗
PubMed1995

A cost-benefit analysis of enforcement efforts to reduce serving intoxicated patrons.

OBJECTIVE: We conducted a cost-benefit analysis of a pilot program of increased enforcement of laws forbidding service to intoxicated patrons. This study provides an example of the issues that typically arise in cost-benefit analysis applied to a program directed at alcohol abuse. We provide a methodology for translating reported DWIs into cost savings. We also present benefit measures that distinguish pain and suffering from productive loss, that distinguish social costs from losses internalized by the individual and that allow for substitution of other unsafe activity. METHOD: The analysis is based on a case study conducted in Washtenaw, Michigan. We used data from police files on sources of DWIs before and after implementation of a program aimed at enforcement of alcohol server laws. To estimate the dollar value of benefits from reducing DWIs, we use incidence data and a number of different recently developed measures of alcohol-involved crash costs. Our study, however, provides the component costs of alcohol-involved crashes and distinguishes external costs from other costs. RESULTS: Our estimates indicate that the Washtenaw SIP program provides benefits that greatly exceed its costs. This result holds under a variety of different assumptions about the appropriate measurement of social benefits. CONCLUSIONS: Although the benefits are in all cases large relative to the costs, they are highly sensitive to whether the savings include personal losses and losses borne directly by intoxicated drivers, and whether harmful activity is diverted to other costly activities. Thus, our study highlights the importance of underlying assumptions that are commonly made in conducting cost-benefit analyses of programs aimed at substance abuse.

Alcohol Drinking↗
PubMed1990

Youth and traffic safety: the effects of driving age, experience, and education.

This paper examines the effect of driving age, driving experience, and mandatory driver's education on traffic fatalities of youth. Data are examined for 47 states, nine years and for ages 15-17. It is found that the age of drivers is an important determinant of fatalities, and that the propensity toward fatalities is greater at younger ages. This age effect is not offset to any major degree by the lack of experience of new drivers at later ages.

Accidents, Traffic↗
PubMed1988

The effects of driving age, driver education, and curfew laws on traffic fatalities of 15-17 year olds.

This study examines the effect of state driving age, learning permit, driver's education, and curfew laws on 15-17-year-old driver fatality rates. A multivariate regression model is estimated for 47 states and nine years. The minimum legal driving age and curfew laws are found to be important determinants of fatalities. Driver's education and learning permits have smaller effects. The relationship between rates of licensure and driving age, education, and curfew laws is also examined. In each case, a more restrictive policy is found to reduce licensure of 15-17 year olds. The results suggest that the imposition of curfew laws and higher minimum driving ages are particularly effective traffic safety policies.

Accidents, Traffic↗