Injuries as a Community and Public Health Problem Chapter 15 Injuries as a Community and Public Health Problem

Chapter Objectives (1 of 2) After studying this chapter, you will be able to: Describe the importance of injuries as a community and public health problem. Explain why the terms accidents and safety have been replaced by the currently more acceptable terms unintentional injuries, injury prevention, and injury control when dealing with such occurrences. Briefly explain the difference between intentional and unintentional injuries and provide examples of each. List the four elements usually included in the definition of the term unintentional injury. Summarize the epidemiology of unintentional injuries; that is, when, where, and to whom injuries occur. List strategies for the prevention and control of unintentional injuries. Explain how education, regulation, automatic protection, and litigation can reduce the number and seriousness of unintentional injuries.

Chapter Objectives (2 of 2) Define the term intentional injuries and provide examples of behavior that results in intentional injuries. Describe the significance of intentional injuries as a community and public health problem in the United States. Name the victims and perpetrators of domestic violence. Discuss the types of injuries that result from domestic violence. List some contributing factors to domestic violence and some strategies for reducing it. Define the term youth gang and explain how they finance themselves. Explain why some young people join these gangs. List ways communities can reduce youth gang activity. Discuss local, state, and national resources available to communities for reducing the number and severity of international injuries resulting from violence in the community.

Introduction Definitions Injury Unintentional injuries

Cost of Injuries to Society (1 of 3) Leading cause of death and disability in the world Over 5 million people die from injuries each year Fatal injuries Disabling injuries

Cost of Injuries to Society (2 of 3) Centers for Disease Control and Prevention, Injury Prevention and Control: Data & Statistics (WISQARSTM) (2015). “Fatal Injury Reports.” Available at: http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html Injury deaths: United States, 2014.

Cost of Injuries to Society (3 of 3) Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2014. Available at http://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2014_SHS_Table_P-8.pdf Centers for Disease Control and Prevention (2014). “Youth Risk Behavior Surveillance—United States, 2013.” Morbidity and Mortality Weekly Report, 63(SS-4)1-168. Available at http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf. Data from: Centers for Disease Control and Prevention, Injury Prevention and Control: Data & Statistics (WISQARSTM) (2015). “Fatal Injury Reports.” Available at: http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html Centers for Disease Control and Prevention, National Centers for Health Statistics (2015). Burden of injury, United States, 2014.

Unintentional Injuries The cause of nearly two-thirds of all injury-related deaths in the U.S. Injury prevention or injury control Unsafe act and unsafe condition Types of unintentional injuries Poisonings Motor vehicle crashes Falls Other types of unintentional injuries

Poisonings Leading cause of unintentional injury death in 2014 Unintentional ingestion of fatal doses of medicines and drugs Consumption of toxic foods Exposure to toxic substances in the workplace or elsewhere Most occur in the home

Motor Vehicle Crashes Second leading type of unintentional injury death Majority of those killed are Drivers Passengers Motorcycle riders Pedestrians Pedalcyclists

Falls Third leading cause of unintentional injury death Leading cause of injury-related medically consulted injury Most occur in the home Disproportionately affect elders

Epidemiology of Unintentional Injuries Account for large number of early deaths in U.S. Incapacitation significant problem High economic impact

Person (1 of 2) Age Gender Minority status Leading cause of death in children and ages 1-44 Gender Males more likely to be involved in fatal unintentional injuries Minority status

Rates of medically consulted injuries by age and sex, 2013. Person (2 of 2) Centers for Disease Control and Prevention, Injury Prevention and Control: Data & Statistics (WISQARSTM) (2015). “Nonfatal Injury Reports.” Available at: http://www.cdc.gov/injury/wisqars/nonfatal.html Rates of medically consulted injuries by age and sex, 2013.

Place (1 of 2) Home Highway Recreation and sports venues More occur in the home than anyplace else Highway Recreation and sports venues School, child care center, or preschool Workplace

Unintentional injury deaths by class, Place (2 of 2) National Safety Council (2015). Injury Facts, 2015 Edition. Itasca, IL. Author. Unintentional injury deaths by class, United States, 2014.

Time Seasonal variations in various causes of unintentional injuries Day of week Time of day

Alcohol and Other Drugs as Risk Factors (1 of 2) Alcohol may be most important factor contributing to injuries Involved in high number of motor vehicle crashes Related to speeding, seat belt use, and other behaviors

Alcohol and Other Drugs as Risk Factors (2 of 2) U.S. Department of Transportation, National Highway Traffic Safety Administration (2015). Traffic Safety Facts 2013: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System (DOT HS 812 139). Washington, DC: U.S. DOT. Alcohol impairment for vehicle operators killed in single vehicle crashes

Prevention through Epidemiology (1 of 2) Early contributors for injury prevention and control John Gordon William Haddon, Jr.

Prevention through Epidemiology (2 of 2) Model for unintentional injuries - triangle Environment, host, and energy-producing agent

Prevention and Control Tactics Based on the Model Prevent accumulation of energy producing agent Prevent inappropriate release of excess energy Place barrier between host and agent Separate host from potentially dangerous sources of energy Other tactics

Community Approaches to Prevention of Unintentional Injuries Education – process of changing people’s health-directed behavior Regulation – enacting and enforcing laws to control conduct Automatic protection – modifying products or environments to reduce risk Litigation – seeking justice for injury through courts

Intentional Injuries Outcome of self-directed or interpersonal violence Staggering community health problem in the U.S.

Types of Intentional Injuries Assaults, rapes, suicides, homicides Can be perpetrated against family members, community members, or complete strangers Costly due to loss of life and productivity, and economic cost to community

Epidemiology of Intentional Injuries Interpersonal violence disproportionately affects those frustrated, hopeless, jobless, living in poverty, with low self-esteem More acts committed by males Firearms increasingly involved Alcohol and drug use contributes Perpetrators more likely to have been abused or neglected as children or exposed to violence

Homicide, Assault, Rape, and Property Crimes Males, blacks, and young people experience highest rates of violent victimization Less than half of all violent crimes committed are reported to police 2014: only 34% of rapes and sexual assaults reported to police

Suicide and Attempted Suicide Suicide rate for men four times that for women Suicide rate for young people increased between 2009-2013 to highest rate in 10+ years Suicide rates for elder men are highest for any population subgroup

Firearm Injuries and Injury Deaths Intentional and unintentional acts, firearms third leading cause of injury death Highest risk for homicide and suicide involving firearms are teenage boys and young men Guns on college campuses Absence of detailed federally supported reporting system

Violence in Our Society and Resources for Prevention Individuals and violence Family violence and abuse Child maltreatment Child abuse Child neglect Prevention of child maltreatment Elder maltreatment and prevention Intimate partner violence Prevention of intimate partner violence

Violence in Schools Victimization rates have remained steady in recent years Fighting and weapon carrying Zero tolerance policies Bullying and being bullied Safe Schools/Healthy Students Initiative Youth violence after school

Violence in Our Communities Youth gang violence Costs to the community Community response State response Federal response

Discussion Questions What levels of prevention can be most effective in reducing violence in communities? How can unintentional injury rates continue to decline in the coming decades?