1. The Relationship Between Social Problems And Injuries: Implications For Policy And Practice Angus H Thompson, PhD. Alberta Centre for Injury Control & Research University of Alberta Canadian Conference on Injury Prevention & Safety Promotion. Ottawa, Canada, November 24, 2003

2. ACKNOWLEDGEMENTS Kathy L Belton Co-Director Alberta Centre For Injury Control & Research Kim Borden Data Analyst Alberta Centre For Injury Control & Research

3. Source: Thompson AH, Borden K, Belton KL. (2003). The Relationship Between Unintentional & Intentional Injuries Across Alberta’s Health Regions. Unpublished manuscript. DO UNINTENTIONAL AND INTENTIONAL INJURIES BELONG TOGETHER?

4. Unintentional and intentional injuries involve very different contexts and interventions “Traditional public health injury control does not apply to violence.” L.Fisher ARGUMENTS AGAINST

5. “Whatever the form, in the end an injury is a health problem” B. Pless “... the evidence on shared risk factors among intentional and unintentional infant deaths warrants ‘convergence’ of effort rather than the compartmen- talization engendered by separation.” Overpeck and McLoughlin ARGUMENTS FOR

6. SII predicts later mortality due to natural causes, unintentional injuries, & violence Common parental factors exist for a variety of infant injury deaths, regardless of intent There is a relationship between falls, suicidal behaviour, & disease There is an overlap among predictors of death by suicide, accidents & natural causes. EVIDENCE FOR

7. THE CANADIAN SOCIAL PROBLEM INDEX (SPI)

8. Murder Attempted Murder Assault Sexual assault Suicide Robbery Divorce Alcoholism SPI COMPONENTS

10. Source: Thompson AH, Howard AW, Yin J (2001). A social problem index for Canada. Canadian Journal of Psychiatry 46, 45-51

12. THE ASSOCIATION BETWEEN SOCIAL PROBLEMS AND PSYCHIATRIC DIAGNOSES IN THE EDMONTON AREA EPIDEMIOLOGICAL STUDY OF PSYCHIATRIC DISORDERS Source: Thompson A & Bland RC (1995). Social dysfunction and mental illness in a community sample. Canadian Journal of Psychiatry 40, 15 – 20.

13. ECOLOGICAL EVIDENCE FROM ALBERTA’S HEALTH REGIONS

14. METHOD Comparison of injury rates (hospitalizations) across Alberta’s 17 health regions (in 1999) Analysis of the level of association among intentional and unintentional injuries Principal components analysis to search for an independent intentional injury factor

15. Unintentional Injuries Adverse Effects (Medical) Adverse Effects (Drug) Falls Motor Vehicle Crash Overexertion /Strain Late Injury Effects Poison Struck Object /Person Natural /Env. Causes Sports Related Cutting/Piercing Suffoc'n Foreign Body Machinery Fire/ Scalding Bike - Non-Traffic Undetermined Intent Pedestrian - Non Traffic Drowning Firearm (Unintentional) Legal Intervention Other Injury Other Transp. Related Unspec.Cause of Injury Intentional Injuries Suicide Attempt Assault ALBERTA INJURY GROUPINGS

16. Unintentional Injuries Adverse Effects (Medical) Adverse Effects (Drug) Falls Motor Vehicle Crash Overexertion /Strain Late Injury Effects Poison Struck Object /Person Natural /Env. Causes Sports Related Cutting/Piercing Suffoc'n Foreign Body Machinery Fire/ Scalding Bike - Non-Traffic Undetermined Intent Pedestrian - Non Traffic Drowning Firearm (Unintentional) Legal Intervention Other Injury Other Transp. Related Unspec.Cause of Injury Intentional Injuries Suicide Attempt Assault ALBERTA INJURY GROUPINGS

17. Unintentional Injuries Adverse Effects (Medical) Adverse Effects (Drug) Falls Motor Vehicle Crash Overexertion /Strain Late Injury Effects Poison Struck Object /Person Natural /Env. Causes Sports Related Cutting/Piercing Suffoc'n Foreign Body Machinery Fire/ Scalding Other Injury Other Transp. Related Unspec.Cause of Injury Intentional Injuries Suicide Attempt Assault ALBERTA INJURY GROUPINGS

18. Unintentional Injuries Adverse Effects (Medical) Adverse Effects (Drug) Falls Motor Vehicle Crash Overexertion /Strain Poison Struck Object /Person Natural /Env. Causes Sports Related Cutting/Piercing Suffoc'n Foreign Body Machinery Fire/ Scalding Intentional Injuries Suicide Attempt Assault RETAINED INJURY GROUPINGS (91.7% of Injury Hospitalizations)

20. (r = 0.81)

22. SOCIAL PROBLEMS AND INJURIES

25. REVISITS TO THE EMERGENCY ROOM AFTER SELF-INFLICTED INJURY

26. UTILIZATION OF THE EMERGENCY DEPARTMENT AFTER SELF-INFLICTED INJURY Source: Colman I, Dryden DM, Thompson AH, Chahal AM, Borden K, Rowe BH, Voaklander DC. In press. Academic Emergency Medicine. Record-linkage study of individuals admitted to an Edmonton ER for SII in fiscal year 1995/96 Comparison groups were those admitted for asthma and a random selection of the remaining patients Groups were matched on age and sex, and were of equal size (n = 478) Groups were compared on readmissions to any regional ER over the subsequent three years

28. WHAT DOES IT MEAN?

29. They do, at least at the ecological level. Proximal vs Distal: There may be less commonality in the proximal case, but this needs to be investigated. The association among social problems, mental illness, and injuries is suggestive of a common underlying, contributing cause. DO INTENTIONAL AND UNINTENTIONAL INJURIES BELONG TOGETHER?

30. SOME POSSIBILITIES 1. Child Development 2. Child Development 3. Child Development

31. SOME POSSIBILITIES Parenting & Supervision Community Self-Efficacy Social Capital (Democracy)

32. The End www.socialproblemindex.com