Category Archives: Injury
Faces of Public Health: Q&A with Andrea Gielen, the Johns Hopkins Center for Injury Research and Policy
The U.S. Centers for Disease Control and Prevention (CDC) recently awarded $4 million to the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School of Public Health to further fund its work on injury prevention research and policy development. According to the CDC, injuries are the leading cause of death in the United States among people ages 1 to 44, costing the country $406 billion each year. And across the globe, 16,000 people die from largely preventable injuries every day.
“This funding will allow us to advance our work in closing the gap between research and practice in new and innovative ways,” said Andrea Gielen, ScD, ScM, the center’s director. “Whether fatal or non-fatal, injuries take an enormous toll on communities. Our faculty, staff and students are dedicated to preventing injuries and ameliorating their effects through better design of products and environments, more effective policies, increased education and improved treatment.”
The five-year grant will support several innovative research projects on key issues, including evaluating motor vehicle ignition interlock laws, studying universal bicycle helmet policies, testing m-Health tools to reduce prescription drug overdose and evaluating programs to prevent falls among older adults. The center will also continue to offer training and education to public health students and practitioners, as well as to new audiences that can contribute to injury prevention.
NewPublicHealth recently spoke with Gielen about the CDC grant
NewPublicHealth: What are the goals for each of the four research areas for which you’ve received funding?
Andrea Gielen: Each of the four is a full research projects with specific aims. For example, with ignition interlock laws—which are car ignitions that can’t start unless a breathalyzer confirms that a driver is sober—there’s been a little bit of evidence that they reduce alcohol-related motor vehicle crash injuries and deaths, but there are two gaps. There has never been a national study of the impact of these laws, and we don’t know a whole lot about how they’re implemented. What is it about ignition interlock policies and how they’re implemented that’s really related to their impact on reducing fatal crashes?
We want to look at all four projects in the same way: We’ll be looking at barriers and facilitators to how policies that we think are effective are adopted and implemented, and what it is about that adoption and implementation of the processes that make these policies effective.
The start of the school year also means a return to team sports. There’s no question that playing a team sport provides clear benefits for kids, including the opportunity to develop physical fitness and other healthy habits, good sportsmanship, self-esteem and self-discipline. Kids who play sports are also less likely to engage in risky behaviors such as smoking or substance abuse.
But there is a potential dark side: An increased risk of sports-related injuries, with concussions at the top of the list of current concerns. Each year nearly 250,000 kids go to emergency departments for suspected sports-related concussions and there’s growing recognition that continuing to play with a concussion can lead to long-term effects on the brain, especially for kids. Girls also now have a higher rate of sports-related concussions than do boys, according to the Children’s Safety Network.
Because of all of these reasons there’s a major push underway to prevent concussions in all youth sports, not just in football, since concussions also commonly occur in girls’ and boys’ soccer, lacrosse, basketball and other sports, according to the American Academy of Pediatrics. In May, the White House hosted the first-ever Healthy Kids & Safe Sports Concussion Summit to promote and expand research on sports-related concussions among kids and raise awareness of steps that can be taken to help prevent, identify and respond to concussions in young athletes.
Meanwhile, the U.S. Centers for Disease Control and Prevention (CDC) launched the Heads Up: Concussion in High School Sports initiative to help coaches, athletes and parents take steps to prevent concussions and respond appropriately if they occur. Among the prevention measures being introduced are modifications to protective gear (including new helmet technology for various sports), rule changes (such as limits on heading drills in soccer practices and tackling drills in football), identifying athletes who are at risk (by looking for genetic markers of risk) and educating everyone involved with youth sports about the dangers of concussions.
There are also stricter guidelines about when it’s appropriate for athletes to return to play after a concussion, based on their physical and cognitive symptoms; concussion history; and adherence to a step-by-step process for returning to the field or court. The CDC now recommends that coaches and parents consider whether their league or school should conduct baseline testing—a pre-season exam to assess an athlete’s balance and brain function—so that if a concussion is suspected to have occurred, the baseline results can help establish the extent of the head injury.
“Players, coaches and parents are demanding that we find a way to reduce concussion risk in sports,” said Michael Sims, head athletic trainer for football at Baylor University and a board member of the National Operating Committee on Standards for Athletic Equipment. “But equipment can’t do it alone. It’s critical that safe play and return to play practices are enforced.”
Public Health Campaign of the Month: National Crime Prevention Council, AAP Campaigns Urge Firearm Safety
NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to email@example.com.
Two national multimedia campaigns are urging precautions and safe practices when it comes to firearms and children.
The National Crime Prevention Council (NCPC)—in partnership with the Ad Council and funded by the Bureau of Justice Assistance—has launched the Safe Firearms Storage campaign to encourage owners to make safe firearms storage a priority. According to a study by the RAND Corporation, about 1.4 million homes have firearms stored in a way that makes them accessible to children, at–risk youth, potential thieves and people who could harm themselves or others.
“We teach all drivers to buckle up in case of accidents and to lock their cars,” said Ann M. Harkins, President and CEO of the NCPC. “The same logic applies to this campaign; we want owners to lock up their firearms to prevent accidents and keep them out of the wrong hands. Safe storage ensures that owners are doing their part to increase public safety.”
In addition to a website, the NCPC campaign features television, radio, print, outdoor and online PSAs that call on firearms owners to use safety devices such as trigger locks, as well as to store ammunition in a separate locked container. A “Snapguide” illustrates options for properly storing a firearm in a household, and the website also offers resources to help firearm owners talk with their children about firearm safety.
The American Academy of Pediatrics (AAP), in partnership with the Brady Center to Prevent Gun Violence, is also making a beginning-of-summer push as part of its ongoing ASK campaign—“Asking Saves Kids”—to remind parents to ask whether there is an unlocked, loaded gun in a home before a child goes on a play date. A response of “yes” should be followed with questions about where the gun is and whether the children will be supervised. Concerned parents should then not be afraid to suggest the children play somewhere else, such as a playground or another home without a gun.
This week Maryland became one of more than a dozen states to ban sales of grain alcohol, also known as extreme-strength alcohol. The drink, which includes the brand name Everclear, is 95 percent pure alcohol. It has no color, taste or smell and so easily mixes—without detection—into juices, soda and punch, making it an effective date rape tool, according to college health officials. And it’s cheap. A whole bottle can cost $15, which is a price easily shared among college or younger students.
Banning extreme-strength alcohol is among several initiatives a growing number of states are taking to try to reduce college student deaths, injuries and assaults linked to campus alcohol use. A report published in September by The Maryland Collaborative to Reduce College Drinking and Related Problems, which was formed in 2013 to address problems associated with excessive alcohol consumption on ten college campuses across the state, found that alcohol use of any kind on campuses across the country each year results in 1,800 deaths; 600,000 injuries; 700,000 assaults by someone under the influence; and nearly 1 million rapes and sexual assaults.
Many states, including Maryland, have declared college campus drinking to be a public health emergency that goes well beyond the campus because of the noise, vandalism, car crashes and community injuries and deaths linked to campus drinking each year. Banning grain alcohol was the Maryland Collaborative’s first initiative because college students who are binge drinkers—a serious and dangerous issue on campuses, according to the U.S. Centers for Disease Control and Prevention (CDC)—are 36 times more likely to drink grain alcohol than are non-binge drinkers, according to David H. Jernigan, the director of the Center on Alcohol Marketing and Youth at Johns Hopkins' Bloomberg School of Public Health in Baltimore, Md.
But some research shows that banning extreme strength alcohol can actually exacerbate the problem by raising awareness of the drink to students who may not have been aware of it before. This can push students in search of grain alcohol to find other high-octane sources, such as privately made moonshine, which can be even more highly concentrated than commercially available grain alcohol and can contain other contaminants, said Laura Forbes, an associate professor of health education at the University of Alabama/Birmingham and chair of the American College Health Association’s Alcohol, Tobacco and Other Drugs Coalition.
According to Forbes, what is desperately needed is a campus culture change on alcohol just like the culture change that has reduced smoking on campus; many campuses bans tobacco use outright. Forbes said reaching that goal requires collaborations—such as the one in Maryland—that bring together campus administrators, businesses, student leaders, law enforcement, public health and the community.
“The way to change the culture,” she said, “is to start to have a conversation that with students about why they’re drinking and to include administrations, faculty, alumni and others in the talks.”
Forbes said the culture change won’t be a suddenly dry campus. “It will be incremental over time, but each campus has to start the change to where they want to move.”
- The Maryland Collaborative has released a best practices guide for reducing campus drinking that includes both individual and campus-wide interventions.
- The CDC recently updated its Alcohol and Public Health website, which now includes new infographics and links to videos, webinars, e-cards and podcasts, as well as a fact sheet on preventing excessive alcohol use, which highlights evidence-based strategies such as those recommended by the Community Preventive Services Task Force.
This Saturday, April 26, is The National Prescription Drug Take-Back Day, an effort led by the U.S. Drug Enforcement Administration (DEA) for the eighth time in three years to safely dispose of potentially dangerous expired, unused and unwanted prescription drugs.
Last October, Americans turned in more than 647,000 pounds of prescription drugs at more than 4,100 sites operated by the DEA in partnership with state and local law enforcement offices. More than 3.4 million pounds of pills have been collected since the initiative began. The goal is to help reduce the huge cache of prescription pills that pose a risk of poisoning and death for young children, as well as the potential for abuse, overdose and death by the millions of people who take prescription drugs not prescribed for them in an effort to get high.
Every state has put resources into reducing prescription drug abuse in the last few years and recent surveys indicate abuse rates are dropping—though the problem is still significant. The 2013 National Survey on Drug Use and Health produced by the Substance Abuse and Mental Health Services Administration found that that 5.3 percent of young adults used prescription drugs for nonmedical purposes in the past month, similar to rates in several previous years, but lower than 2009, when 6.4 percent of young adults used prescription drugs for nonmedical purposes.
DEA studies show that a majority of abused prescription drugs are obtained from family and friends, often from home medicine cabinets. Contributing to the pileup is the fact that people are advised not to put many drugs in the trash or down the toilet so as to avoid contaminating water supplies and harming animals.
New laws are being proposed in many states to help families and facilities more easily get rid of unused drugs. Health departments in many communities, including the State of Colorado, can refer people to sites that will accept some unused prescription pills—though often not narcotics—at various times of the year for disposal.
Earlier this month U.S. Department of Transportation Secretary Anthony Foxx kicked off April’s National Distracted Driving Awareness Month by announcing the department’s first-ever national advertising campaign and law enforcement crackdown in states with distracted driving bans. That effort ended last week, but through individual interactions with drivers by law enforcement and through ads on television, radio and online, the effort raised attention to the dangers—and penalties—of distracted driving, according to the National Highway Traffic Safety Administration (NHTSA.) According to NHTSA 3,328 people were killed and an estimated 421,000 were injured in distraction-related crashes in 2012, the latest year for which data is available.
"This campaign puts distracted driving on par with our efforts to fight drunk driving or to encourage seatbelt use," said Foxx.
According to NHTSA, the national campaign built upon the success of federally funded distracted driving state demonstration programs in California and Delaware, “Phone in One Hand, Ticket in the Other.” Over three enforcement waves, California police issued more than 10,700 tickets for violations involving drivers talking or texting on cell phones, and Delaware police issued more than 6,200 tickets. Observed hand-held cell phone use dropped by approximately a third at each program site, from 4.1 percent to 2.7 percent in California, and from 4.5 percent to 3.0 percent in Delaware.
Currently 43 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands ban text messaging for drivers of all ages; 12 states, Washington, D.C., Puerto Rico, Guam and the U.S. Virgin Islands prohibit drivers of all ages from using hand-held cell phones while driving; and 37 states and D.C. ban cell phone use by new drivers.
More state campaigns are expected to be launched, according to NHTSA. To find out more about the ability of public health laws such as laws aimed at reducing distracted driving to improve health and save lives, NewPublicHealth recently spoke with Kathleen Hoke, director of the Network for Public Health Law, Eastern Region. The Network is a program of the Robert Wood Johnson Foundation.
NewPublicHealth: In his announcement of the campaign, Secretary Foxx said that the national distracted driving reduction efforts show how public health laws can be transformative. What public health does this build on? Could this have been done if there hadn’t been a history of using laws to help improve the public’s health?
Kathleen Hoke: I think there is kind of a cycle that we see in public health using law to effectuate improvements in public health, particularly injury prevention. I know we can’t think today that there was a time that children weren’t in car seats, but there was. And what happened was there was an education campaign much like the Department of Transportation’s current campaign that was all about encouraging folks to put their children in safety seats. The law took it to a certain level, so we went from roughly 20 percent of people putting their kids in car seats to maybe 60 percent of people putting their kids in car seats.
A recent report from the Institute of Medicine found that young athletes in the United States face a "culture of resistance" to reporting when they might have a concussion and to complying with treatment decisions. That culture can result in students heading back to school too quickly—when they should be resting their brains to prevent short- and long-term complications.
"The findings of our report justify the concerns about sports concussions in young people," said Robert Graham, chair of the committee and director of the national program office for Aligning Forces for Quality, at George Washington University, Washington, D.C. (Aligning Forces is a program of the Robert Wood Johnson Foundation.) "However,” says Graham, “there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."
Recently, Righttime Medical Care, a chain of urgent care centers in Maryland, opened a number of HeadFirst sports injury and concussion centers in the state, staffed with health professionals who can assess injuries for concussions as well as evaluate students for return to play—in consolation with a team of experts who work with HeadFirst staff. HeadFirst will this year be presenting and publishing data on the more than 10,000 youth it has examined and treated for concussion in just the past two years.
NewPublicHealth recently spoke with Robert Graw, MD, head of Righttime and HeadFirst, about the need for better prevention, evaluation and treatment of concussions to prevent long-term health problems and disability.
NewPublicHealth: Why did Righttime add concussion care to the services provided?
Robert Graw: My son is an orthopedic surgeon and talked to me about the number of injuries he was seeing. We decided a few years ago that we’d learn as much as we could about preventing head injury and the consequences of head injury, and then promote that information through Righttime’s call center and through the visits that people made to our sites.
In the process of learning as much as we could we realized that the knowledge base of how people evaluate and manage concussions had changed drastically in the last five years as people have done more research. So, we then gathered together a group of consultant physicians and neuropsychologists to determine best practices. We met with them frequently, and then had them train our provider staff so that all of them became much more informed about what a concussion really is, the best way to evaluate them and the guidelines for management going forward.
We hate to be the bearers of buzz kill, but folks should think about adding “safety” to their holiday wish lists this year. Researchers at the Consumer Product Safety Commission say there are about 250 injuries a day during the holiday season. Last year the most frequently reported holiday accidents seen in emergency departments involved falls (34%), lacerations (11%) and back strains (10%). And from 2009 through 2011, fire departments nationwide responded to an average of 200 fires in which the Christmas tree was the first item ignited—resulting in 10 deaths, 20 injuries and $16 million in property loss for those years. Candle-related fires during holidays between 2009 and 2011 resulted in an estimated 70 deaths, 680 injuries and $308 million in property loss.
Best tips for avoiding Holiday fires: discard sets of holiday lights with evidence of damage such as broken sockets and bare wires; water Christmas trees frequently; and always extinguish candles before leaving a room.
Here are our top five safety tips for the holidays culled from the websites of the Consumer Product Safety Commission, the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the Food and Drug Administration:
Use of tourniquets—a piece of tightly tied cloth used to keep a victim with an arm or leg wound from bleeding to death—has been discouraged over the last few decades out of concern that the method can save the life, but lose the limb. But a new article in The Wall Street Journal finds that multiple examples of successful use of tourniquets on battle fields in Iraq and Afghanistan, as well as after the bombing at the Boson Marathon earlier this year, has reopened the debate. The pros and cons of tourniquet use is on the agendas of several upcoming medical meetings and preparedness conferences.
Read the full story here.
>>Bonus Link: Read a NewPublicHealth post on new approaches to teaching more people CPR.
Home fires account for 85 percent of fire deaths in the United States, yet the majority of family homes lack fire sprinklers. Since the late 1970s, a grassroots movement has successfully promoted close to 400 local ordinances that mandate fire sprinklers in all new residential construction. In response, the homebuilding industry has sought out state preemption of local authority, a strategy used by other industries as well, in an effort to reduce costs and shield profits. A new study just published in the American Journal of Public Health looks at grassroots public health movements, including the one mobilized to push back against preempting residential fire sprinklers.
To learn more about how preemption can have a negative impact on public health, NewPublicHealth spoke with Marjorie Paloma, MPH, senior policy adviser and senior program officer for the Robert Wood Johnson Foundation’s Health Group, and a co-author of the new AJPH article on preemption, grassroots efforts and public health.
NewPublicHealth: How does the effort to increase installed sprinklers in the U.S. add to the conversation on the grassroots public health movement?
Marjorie Paloma: The residential fire sprinkler story illustrates the power of grassroots movements and the chilling effect preemption can have. I use power very explicitly because when you look at the residential sprinklers movement, over time, you see how much power people have when they come together and act. Families who lost someone to fire, fire officials and others came together first in local communities and then across the nation to advocate sprinklers and save lives. The new article in the American Journal of Public Health shows that over three decades, 34 states passed legislation on this — over 350 local ordinances — and I think that this example shows you the arc of a grassroots movement. This example also shows how powerful preemptive legislation is on a grassroots movement. In those two years between 2009 and 2011, 13 states passed preemptive legislation and that essentially pulled the wind out of the sails of advocates who had been working on this issue. And, it shows you how that tactic, that strategy of preemption can really deflate, thwart, and potentially kill a movement.
NPH: How does the grassroots movement intervene and explain what the impact of preemption is on movements that promote health?