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

2. Introduction Definitions Injury Unintentional injuries Intentional injuries

3. Cost of Injuries to Society Leading cause of death and disability in the world ~5.8 million people die from injuries each year Cost of injuries $500+ billion annually Fatal injuries Disabling injuries

4. Injury Deaths, United States, 2011

5. Burden of Injury, United States, 2011

6. 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 Motor vehicle crashes Poisonings Falls Other types of unintentional injuries

7. Motor Vehicle Crashes Leading type of unintentional injury death Leading cause of nonfatal unintentional injury Majority of those killed are Drivers Passengers Motorcycle riders Pedestrians Pedalcyclists

8. Poisonings Second leading cause of unintentional injury death 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

9. Falls Third leading cause of unintentional injury death Leading cause of injury-related ED visits Most occur in the home Disproportionately affect elders

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

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

12. Injury-Related Visits to E.D.s by Age and Sex, 2010

13. Place Home More occur in the home than anyplace else Recreation/sports area Highway Workplace

14. Unintentional Injury Deaths by Class, 2011

15. Time Seasonal variations in various causes of unintentional injuries Days of week Time of day

16. Alcohol and Other Drugs as Risk Factors Alcohol may be most important factor contributing to injuries Involved in high amount of motor vehicle crashes Related to speeding, seat belt use, and other behaviors

17. Alcohol Impairment for Drivers or Motorcycle Operators Killed

18. Prevention through Epidemiology Early contributors for injury prevention and control John Gordon William Haddon, Jr. Model for unintentional injuries - triangle Environment, host, and energy producing agent

19. A Model for Unintentional Injuries

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

21. 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

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

23. 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

24. 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

25. 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 2005-2010: only 36% of rapes and sexual assaults reported to police

26. Suicide and Attempted Suicide Suicide rate for men four times that for women Suicide rate for young people increased from 2009-2010 to highest rate in 10+ years Suicide rates for elder men are highest for any population subgroup

27. 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

28. 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

29. 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

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

31. 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?