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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?