Injuries as a Community Health Problem

Chapter 15

Introduction

• Injury

• Unintentional injuries

• Intentional injuries

• Injury prevention/control

• Unsafe act

• Unsafe conditions/hazards

Cost of Injuries to Society

• Fatal injuries• Fifth leading cause of death in U.S.

• Disabling injuries• Great human burden attributed to injuries

• Significant economic costs

• Greatly contribute to premature death

Injury Deaths, United States, 2007

Burden of Injury, United States, 2007

Unintentional Injuries

• The cause of nearly two-thirds of all injury-related deaths in the U.S.

• A major community health problem

• Motor vehicle crashes

• Poisoning

• Falls

• Other unintentional injuries

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

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

Falls

• Third leading cause of unintentional injury death

• Leading cause of injury-related ED visits

• 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

• Age• Leading cause of death in children and

teenagers

• Falls leading cause of unintentional injury death for elders

• Gender• Males more likely to be involved in fatal

unintentional injuries

• Minority status

Injury-Related Visits to E.D.s by Age and Sex, 2006

Place

• Home• More occur in the home than anyplace else

• Highway• 2nd leading place for injuries and injury death

• Recreation/sports area

• Workplace

Injuries by Place of Occurrence, 2008

Time

• Seasonal variations in various causes of unintentional injuries

• Days of week

• Time of day

Alcohol Impairment for Drivers Killed

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

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

A Model for Unintentional Injuries

Prevention and Control Tactics

• Prevent accumulation of energy producing agent• Reducing speed limits, lowering settings on hot

water heaters

• Prevent inappropriate release of excess energy• Flame-retardant fabric, nonslip surfaces

• Placing barrier between host and agent• Sunscreen, non-heat handles on cookware

Community Approaches to Prevention

• 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

• Assaults, rapes, suicides, homicides

• Can be perpetrated against family members, community members, or complete strangers

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

• Homicide victimization rate for blacks significantly higher than whites• Most homicides committed with firearms

• Lower income associated with higher rate of being a victim of violence

• Except for rape and sexual assault, all violent crime victimization rate higher for males

• Less than half of all violent crimes committed are reported to police

Suicide and Attempted Suicide

• Suicide rate for men four times that for women

• Suicide rate for young people and elderly declined in recent years after significant increase from 1950-1995

• Older men eight times more likely to commit suicide than senior women

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

Firearm-Related Injury vs. All Causes

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

• 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?