1. Wisconsin Department of Health Services January 2014 P-00522I Healthiest Wisconsin 2020 Baseline and Health Disparities Report Injury and Violence

2. INJURY AND VIOLENCE Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthiest Wisconsin 2020 objectives and indicators Rationale Key points Data Youth risk behavior and exposure Adult risk behavior and exposure Injury mortality Injury-related hospitalization References Links to additional reports and resources Contacts Chapter Outline 2 Chapter outline

3. INJURY AND VIOLENCE Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf Report overview 3

4. INJURY AND VIOLENCE Report Format Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to –Decision-makers –Service providers –Community leaders –The public Sample annotated slide Report overview 4

5. INJURY AND VIOLENCE Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Report overview 5

6. INJURY AND VIOLENCE Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health care Report overview 6

7. INJURY AND VIOLENCE Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

8. INJURY AND VIOLENCE Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non- Hispanic. Report overview 8

9. INJURY AND VIOLENCE Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach Report overview 9

10. INJURY AND VIOLENCE Objective 1 By 2020, reduce the leading causes of injury (falls, motor vehicle crashes, suicide/self-harm, poisoning and homicide/assault) and violence through policies and programs that create safe environments and practices. Objective 1 Indicators Morbidity from falls, assaults, motor vehicle crashes, poisoning and self- harm. Mortality from falls, homicide, suicide, motor vehicle crashes and poisoning. Number of crash occupants (motor vehicles, trucks, motorcycles, bicycles, pedestrians with moving vehicle). Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile. Healthiest Wisconsin 2020 objectives and indicators 10 HW2020 objectives

11. INJURY AND VIOLENCE Objective 2 By 2020, increase access to primary, secondary and tertiary prevention initiatives and services that address mental and physical injury and violence. Objective 2 Indicators Reimbursement for preventive services related to injury and violence (Medicaid/BadgerCare, medical service billing codes). Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile. Healthiest Wisconsin 2020 objectives and indicators 11 HW2020 objectives

12. INJURY AND VIOLENCE Objective 3 By 2020, reduce disparities in injury and violence among populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status. Objective 3 Indicators Disparity ratios in hospitalizations from falls, poisoning and self- harm. Mortality from homicide, suicide, and motor vehicle crashes. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile. Healthiest Wisconsin 2020 objectives and indicators 12 HW2020 objectives

13. INJURY AND VIOLENCE Rationale “Injury and violence” encompasses a broad array of topics. Unintentional injuries are often referred to as accidents despite being highly preventable. Intentional injuries are those that were purposely inflicted, and often involve a violent act. Injuries are the leading cause of death among Wisconsin people aged 1-44 years and are a significant cause of morbidity and mortality at all ages. Injuries and violence occur in all ages, races, and socioeconomic classes. However, some groups are more affected. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile. 13 Rationale

14. INJURY AND VIOLENCE Key points Youth Risk Behavior and Exposure Significant disparities exist in the prevalence of youth risk behaviors for injury and exposure to violence. For example: o Black students were more likely to report being exposed to school violence, feeling unsafe at school, experiencing partner violence, rarely or never wearing a seat belt, and less likely to drink and drive than were their White counterparts. o White students had the lowest rate of feeling unsafe at school of all racial/ethnic groups. o Sexual minority students were more likely to be exposed to school violence, to be bullied, to feel unsafe at school, to experience partner violence, and to be forced into having sex. 14 Key points

15. INJURY AND VIOLENCE Key points Adult Risk Behavior and Exposure Approximately one-quarter of Wisconsin adults said they do not wear a seat belt when riding in a car. Significant disparities exist in the prevalence of adult risk behaviors related to seat belt use. The following groups were significantly more likely to not wear a seat belt than their counterparts: o Males compared to females. o Adults ages 18-24 compared to adults ages 65 and older. o Low-income adults compared to middle and high income adults. o Adults without a high school diploma compared to adults with a high school education or more. 15 Key points

16. INJURY AND VIOLENCE Key points Mortality Falls and suicide were the two leading causes of injury-related death in Wisconsin in 2010. The leading cause of injury-related death varied by age group: o Less than one year: Suffocation. o 1-4 years: Drowning. o 5-24 years: Motor vehicle crashes. o 25-64 years: Suicide. o 65+ years: Falls. For some of the causes of injury-related death, one or two racial and ethnic groups had significantly higher age-adjusted mortality rates than other racial and ethnic groups: o Falls: White. o Motor vehicle crashes: American Indian. o Unintentional poisoning: Black and American Indian. o Homicide: Black. o Suicide: American Indian. 16 Key points

17. INJURY AND VIOLENCE Youth risk behavior and exposure 17

18. INJURY AND VIOLENCE Motor vehicle risk behaviors among Wisconsin high school students, by race/ethnicity, 2007-2011 Youth risk behavior and exposure Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 18

19. INJURY AND VIOLENCE Motor vehicle risk behaviors among Wisconsin high school students by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Youth risk behavior and exposure 19

20. INJURY AND VIOLENCE Exposure to school violence among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Youth risk behavior and exposure 20

21. INJURY AND VIOLENCE Exposure to school violence among Wisconsin high school students, by sexual minority status, 2007-2011 Youth risk behavior and exposure Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 21

22. INJURY AND VIOLENCE Bullying and perception of school violence among Wisconsin high school students, by race/ethnicity, 2007-2011 Youth risk behavior and exposure Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 22

23. INJURY AND VIOLENCE Bullying and perception of school violence among Wisconsin high school students, by sexual minority status, 2007-2011 Youth risk behavior and exposure Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 23

24. INJURY AND VIOLENCE Perceptions of school safety among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Youth risk behavior and exposure 24

25. INJURY AND VIOLENCE Perceptions of school safety among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Youth risk behavior and exposure 25

26. INJURY AND VIOLENCE Partner violence among Wisconsin high school students, by race/ethnicity, 2007-2011 Youth risk behavior and exposure Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. 26

27. INJURY AND VIOLENCE Partner violence among Wisconsin high school students, by sexual minority status, 2007-2011 Youth risk behavior and exposure Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 27

28. INJURY AND VIOLENCE Adult risk behavior and exposure 28

29. INJURY AND VIOLENCE Non-use of seat belts and fall-related injuries among Wisconsin adults, by sex, 2010 and 2011 Adult risk behavior and exposure Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Note: Questions were asked in 2010 and 2011. 29

30. INJURY AND VIOLENCE Non-use of seat belts among Wisconsin adults, by age, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Note: Questions were asked in 2010 and 2011. Adult risk behavior and exposure 30

31. INJURY AND VIOLENCE Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by race/ethnicity, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Adult risk behavior and exposure 31

32. INJURY AND VIOLENCE Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by household income, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older. Adult risk behavior and exposure 32

33. INJURY AND VIOLENCE Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by level of urbanization, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older. Adult risk behavior and exposure 33

34. INJURY AND VIOLENCE Age-adjusted rate of seat belt non-use among Wisconsin adults, by disability status, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted. Adult risk behavior and exposure 34

35. INJURY AND VIOLENCE Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by sexual orientation, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population45 and older. Adult risk behavior and exposure 35

36. INJURY AND VIOLENCE Injury mortality 36

37. INJURY AND VIOLENCE Injury deaths (leading causes), age-adjusted rates per 100,000, Wisconsin, 2010 Falls Motor vehicle crashes Poisoning Suicide Homicide Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Injury mortality Unintentional injury Intentional injury 37

38. INJURY AND VIOLENCE Leading causes of injury death by age, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: Age groups were collapsed when the three leading causes were the same. * Number of deaths was too small to indicate cause. CauseTotal deaths, 2008-2010Annual average Falls2,850950 Suicide2,253751 Motor vehicle crashes (MVC)1,677559 Poisoning1,503501 Injury mortality 38

39. INJURY AND VIOLENCE Unintentional injury deaths (leading causes) by race/ethnicity, age- adjusted rates per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines. Injury mortality 39

40. INJURY AND VIOLENCE Intentional injury deaths by race/ethnicity, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Injury mortality 40

41. INJURY AND VIOLENCE Unintentional injury deaths by county, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Falls Motor vehicle crashes Statewide rate = 14 per 100,000 Statewide rate = 10 per 100,000 Injury mortality 41

42. INJURY AND VIOLENCE Unintentional injury deaths by county, age-adjusted rates per 100,000, Wisconsin, 2008-2010 (continued) Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Poisoning Statewide rate = 9 per 100,000 Injury mortality 42

43. INJURY AND VIOLENCE Injury mortality Intentional injury deaths by county, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Suicide Homicide Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Statewide rate = 13 per 100,000 Statewide rate = 3 per 100,000 43 20

44. INJURY AND VIOLENCE Injury-related hospitalization 44

45. INJURY AND VIOLENCE Injury Pyramid Source: World Health Organization, Violence and Injury Prevention. Injury-related hospitalization 45

46. INJURY AND VIOLENCE Injury hospitalizations (leading causes), age-adjusted rates per 100,000, Wisconsin, 2010 Source: Wisconsin Interactive Statistics on Health (WISH), Injury Hospitalizations Module, hospital inpatient discharge database Unintentional injury Intentional injury Falls Motor vehicle crashes Poisoning Self-harm Assault Injury-related hospitalization 46

47. INJURY AND VIOLENCE Primary payer for injury-related hospitalizations, Wisconsin, 2010 Source: Wisconsin Interactive Statistics on Health (WISH), Injury Hospitalizations Module, hospital inpatient discharge database N = 24,312 N = 3,882N = 2,738N = 5,495 N = 1,266 Injury-related hospitalization 47

48. INJURY AND VIOLENCE 1.University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach http://www.countyhealthrankings.org/our-approach 2.Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 3.LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 4.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ 5.Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf 6.Centers for Disease Control and Prevention (CDC). Injury Prevention and Control: Motor Vehicle Safety. Teen Drivers. http://www.cdc.gov/motorvehiclesafety/teen_drivers/index.html http://www.cdc.gov/motorvehiclesafety/teen_drivers/index.html 7.CDC. About School Violence http://www.cdc.gov/violenceprevention/youthviolence/schoolviolence/index.html http://www.cdc.gov/violenceprevention/youthviolence/schoolviolence/index.html References 48 References

49. INJURY AND VIOLENCE 8.CDC. Understanding School Violence. http://www.cdc.gov/violenceprevention/pdf/schoolviolence_factsheet-a.pdf http://www.cdc.gov/violenceprevention/pdf/schoolviolence_factsheet-a.pdf 9.CDC. Understanding Bullying. http://www.cdc.gov/violenceprevention/pdf/bullying_factsheet-a.pdf http://www.cdc.gov/violenceprevention/pdf/bullying_factsheet-a.pdf 10.CDC. Teen Dating Violence. http://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence. html http://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence. html 11.CDC. Understanding Teen Dating Violence. http://www.cdc.gov/ViolencePrevention/pdf/TeenDatingViolence2012-a.pdf http://www.cdc.gov/ViolencePrevention/pdf/TeenDatingViolence2012-a.pdf 12.Wisconsin Department of Health Services (DHS). The Burden of Injury in Wisconsin. http://www.dhs.wisconsin.gov/publications/P0/P00283.pdf http://www.dhs.wisconsin.gov/publications/P0/P00283.pdf 13.DHS. Wisconsin Interactive Statistics on Health: Injury-related Mortality Module. http://www.dhs.wisconsin.gov/wish/main/InjuryMortality/InjuryMortality_home.htm http://www.dhs.wisconsin.gov/wish/main/InjuryMortality/InjuryMortality_home.htm 49 References

50. INJURY AND VIOLENCE Links to additional reports and resources The Burden of Injury in Wisconsin (2011): http://www.dhs.wisconsin.gov/publications/P0/P00283.pdf The Burden of Falls in Wisconsin (2010): http://www.dhs.wisconsin.gov/health/injuryprevention/pdffiles/FINAL_BOF_0 80210.pdf The Burden of Suicide in Wisconsin (2008): http://www.dhs.wisconsin.gov/health/injuryprevention/pdffiles/bosfinal9%205.pdf http://www.dhs.wisconsin.gov/health/injuryprevention/pdffiles/bosfinal9%205.pdf Centers for Disease Control and Prevention (CDC). Injury, violence, and safety: http://www.cdc.gov/InjuryViolenceSafety/ 50 Links

51. INJURY AND VIOLENCE Contact Susan LaFlash, BSN Injury and Violence Prevention Program Bureau of Community Health Promotion Division of Public Health Wisconsin Department of Health Services Email: Susan.LaFlash@dhs.wisconsin.govSusan.LaFlash@dhs.wisconsin.gov 51 Contacts