Reducing the Burden of Injury Advancing Prevention and Treatment (1999) / Chapter Skim
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4 Prevention Research
4 Prevention Research
Pages 82-114
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From page 82... ...
Over the past quarter century, research has contributed in this way to actual reductions in injury mortality rates (Baker et al., 1992) , most clearly in relation to motor vehicle injuries (see Chapter 5~.
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From page 83... ...
RESEARCH ACCOMPLISHMENTS Prevention research has garnered numerous accomplishments over the past 30 years in terms of understanding risk factors, injury mechanisms, and effective ways to reduce injuries. The greatest research progress has been made with motor vehicle and traffic safety, an area with the longest period of sustained federal support for research and prevention programs (see Chapter 5~.
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From page 84... ...
This study controlled for long-term safety trends and changes in consumption of prescription drugs. The overall strategy of combining regulation and community-based intervention through poison control centers has been used as a case study of effective injury prevention (National Committee, 1989~.
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From page 85... ...
The overall decline thus obscures the continued need to reduce unintentional injury fatalities related to falls, poisonings, drownings, suffocations, and fires and burns, particularly in special populations such as children and the elderly. BOX 4.1 Harlem Hospital Injury Prevention Program A program in New York City is a model injury prevention program whose creation epitomizes many of the aspects of prevention research described in this chapter.
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From page 86... ...
Research also has identified environmental and social risk factors, including access to firearms, problems of social adjustment, serious medical illness, living alone, recent bereavement, family history of completed suicide, and others (Shaffer et al., 1988; U.S. Preventive Services Task Force, 1996~.
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(1996) Motor vehicle Safety belts; air bags; child safety Baker-Dickman (1987~; crashes seats; sobriety checkpoints; Womble (1988~; Henry et minimum legal drinking age laws al.
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From page 88... ...
less effective, but individuals did not resort to other means (Kreitman, 1976; Brown, 1979~. Much of the subsequent progress in suicide prevention research has been made in identifying risk factors for suicide, as this is one of the first steps toward prevention.
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From page 89... ...
DHHS, 1986; Mercy et al., 1993~. Viewing violence prevention as a public health goal calls attention to the measurable health consequences of assaultive injuries, highlights the role of the health sector in identifying and reducing the violence embedded in situations and relationships, and highlights the potential utility of epidemiologic tools in identifying risk factors and designing interventions that lie outside the usual sphere of crime prevention and control.
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From page 90... ...
Evaluation research is needed for a number of prevention interventions, including peer mediation, social skills training, comprehensive community initiatives, shelter programs and other services for victims of domestic violence, child fatality review panels, mental health and counseling services for child maltreatment and domestic violence, child witness to violence prevention and treatment programs, and elder abuse services (NRC, 1998~. Finally, the committee believes that, from the perspective of violence research, a high priority is to strengthen the health system databases for monitoring nonfatal injuries.
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From page 91... ...
Individual Behavior Behavioral research has demonstrated that many injury interventions require changes in human behavior, either to reduce the exposure or vulnerability of potential victims to injury-causing events or to reduce the risk that one person will become the agent or instrument of harm to another. Behavior change can be achieved by incentives and deterrence, education, and persuasion.
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From page 92... ...
that travels without such restraints and has twice the risk of death and injury as those who use safety seats (SAFE KIDS, 1998~. Research on protecting children who travel without restraints may be more useful than cataloging all the forms of misuse.
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From page 93... ...
This area of research is in need of greater attention, particularly the safety effects of tort liability; here, public health proponents typically assume that expansive liability rules are safety enhancing, whereas skeptics believe that the existing liability scheme tends to reduce safety by retarding innovation or inducing override behavior (Sugarman, 1990; Rose-Ackerman, 1991; Viscusi, 1992; Viscusi and Magat, 1995; Dewees et al., 1996~.
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From page 94... ...
Death rates are high in low-income areas for most types of unintentional injuries and for homicide; however, for suicide, there is little relationship between injury death rate and per capita income (Baker et al., 1992~. Racial disparities in childhood unintentional injury rates are associated more with living in impoverished environments that with ethnicity (Singh and Yu, 1996; SAFE KIDS, 1998)
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From page 95... ...
Further attention to this issue will help policy makers design the most promising ways of deploying legal changes together with educational messages to promote safe behavior, such as safe storage of firearms and other dangerous articles. RESEARCH OPPORTUNITIES Broadening the Scope of Prevention Research Once an injury problem is identified through surveillance or other means, research is brought to bear to identify causes, circumstances, and risk factors, as well as to develop and evaluate interventions.
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Such integration of approaches from multiple disciplines is crucial to injury prevention research. Injury Biomechanics Injury biomechanics has been a fundamental discipline in experimental studies of injury, especially injury causation.
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Although there are other areas of biomechanics research (e.g., severe maxillofacial, thoracic, abdominal, and internal organ injuries) , neurotrauma to the head resulting in traumatic brain injury continues to be a critical area.
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From page 98... ...
In the future, the role of modeling will continue to grow as an important tool for understanding injury causation and may also represent an effective proactive prevention tool by identifying harmful environments, harmful products, or at-risk populations before injuries occur. However, animal and cadaver research will continue to be an important component because it will be needed to establish the fidelity of computer models and to provide accurate measures of response to injury in children and small adults.
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From page 99... ...
Behavioral Sciences The importance of behavioral research to injury prevention was highlighted more than three decades ago by William Haddon in his early publications on preventing motor vehicle injuries (Haddon et al., 1964~. The behavioral sciences contribute to injury research by developing knowledge about psychosocial de
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From page 100... ...
Adolescent males, for example, represent one of the groups at greatest risk of injury, especially for motor vehicle and firearm injuries (Fingerhut and Warner, 1997~. Behavioral sciences, using a combination of empirical and theoretical approaches, help to explain why gender, developmental age, and ethnicity are important.
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From page 101... ...
Epidemiology The tools of epidemiology may be used to design studies to elucidate the nature or cause of injury and to determine the effectiveness of interventions. Over the past decade, epidemiologic studies have advanced the injury field by quantifying the relationship between risk factors and injury.
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with those who are not injured (controls) in order to determine what characteristics are associated with the injury (e.g., lack of safety belt use in severe motor vehicle crashes)
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Studies with comparison groups are the only scientifically valid method of quantifying the extent to which indirect risk factors contribute to injury causation. The committee strongly recommends the utilization of rigorous analytical methods in injury research.
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than that for job-related illnesses (Leigh et al., 19971. The committee recommends the expansion of research training op portunities by the relevant federal agencies (e.g., NCIPC, NIOSH, and the National Highway Traffic Safety Administration [NHTSAl)
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From page 105... ...
Additionally, NHTSA research publications are often not published in the peer-reviewed literature and can be located only through the National Technical Information Service's database of government reports. Other databases that index scientific literature relevant to the injury field include PsychLIT, Sociological Abstracts, Criminal Justice Periodical Index, National Criminal Justice Reference Service, EMBASE, and Transportation Research Information Services.
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From page 106... ...
. Such an organization could sponsor annual research conferences, where injury researchers would present the results of new and encouraging research, and could support the development of an injury prevention research journal and electronic networks and work to solve the problems associated with database linkages.
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1997. The management of severe traumatic brain injury.
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1996. Prospective countywide evaluation of the effects of motor vehicle safety device use on hospital resource use and injury severity.
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1995. Recent advances in biomechanics of brain injury research: A review.
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The Effects of Center lIigh-Mounted Stop Lamp on Vans and Trucks. Washington, DC: National Highway Traffic Safety Administration.
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Journal of Orthopaedic Research 15:450~55. NHTSA (National Highway Traffic Safety Administration)
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1995. Evidence of apoptotic cell death after experimental traumatic brain injury in the rat.
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1992. Risk factors for fatal residential fires.
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1989. Injury biomechanics research: An essential element in the prevention of trauma.
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