May 22 2012

Injury Prevention: NewPublicHealth Q&A with Andrea Gielen

file Andrea Gielen, Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health

A new report on the burden of injuries in the United States, The Facts Hurt: A State-By-State Injury Prevention Policy Report, finds that 26 states scored a five or lower on a set of 10 key injury prevention indicators. Two states, California and New York, received the highest score of nine out of a possible 10, while three states scored the lowest—Kentucky, Montana and Ohio, with two out of 10.

Injuries are the third leading cause of death nationally, and they are the leading cause of death for Americans between the ages of one and 44.

The Facts Hurt report was issued by Trust for America’s Health and the Robert Wood Johnson Foundation, and concludes that millions of injuries could be prevented each year if more states adopted additional research-based injury prevention policies, and if programs were fully implemented and enforced.

NewPublicHealth will be posting a series of injury prevention interviews with experts on issues such as motor vehicle safety and violence prevention. We recently spoke with Andrea Gielen, ScD, director of the Johns Hopkins Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health, about the importance of evidence-based research to help prevent.

NewPublicHealth: What studies are there to show that injuries can actually be prevented or reduced?

Andrea Gielen: I think that’s one of the things that’s very exciting about this report because answering that question is the backbone of the report. There are so many aspects of injury prevention where we have strong evidence. We know car seats, booster seats, motorcycle helmets, smoke alarms and seatbelts work. We know what kinds of legislation increase use and then increase protection, and therefore, will work to reduce injuries.

That’s what’s really exciting about looking forward is that injury prevention is at a place in its history where the science and the evidence and the practice are really there to say, look, if we have these kinds of strong laws and we enforce them and we make the public aware of them, we can really show a decrease in injuries. I think residential sprinklers and smoke alarms for fire safety is another example where we have a technology that we know works and recommendations that they be placed in all homes. So, how do we make that happen is still an important area that we should see more research around.

NPH: What is the hope for how this report will be used?

Andrea Gielen: Policy-makers have a lot on their plate. They’re looking for solutions that will save lives, save dollars, and help society—and injury prevention scores high on all three of those. If we can get that message to policy-makers in a way that is appealing and easy for them get their arms around, we’re certainly hoping that that will be the message that gets communicated.

NPH: Why do you think some states are still lagging in the kind of preventions that your own research has shown to be so effective?

Andrea Gielen: Perhaps it’s because they have been focused on other issues. There’s no shortage of important public health problems, but I think this report is saying that it’s time to make safety the priority that it should be and we hope that the report will generate interest in increasing the priority given to injury prevention in all the states.

NPH: A lot of your research has been around motor vehicle-related injuries. What progress had been made in reducing or preventing these injuries?

Andrea Gielen: It’s a really interesting story. Reductions in motor vehicle related deaths was called one of the ten greatest public health achievements of the 20th century by the Center for Disease Control and Prevention because the death rate per vehicle miles traveled, and across the population in general, has gone down dramatically, even as people are driving more. So, it’s really quite a wonderful story of how we can reduce injuries through a very comprehensive approach in which the environment changed, cars got safer, roads got safer and people’s behavior changed in terms of wearing seatbelts, using car seats and reducing drunk driving. All of this was made possible through policy changes at the state and federal level as well as education to raise public awareness about the issues.

NPH: Is wearing seatbelts a relatively new social norm that might be a good example of what could happen next in injury prevention?

Andrea Gielen: Yes, that’s exactly kind of the approach that injury prevention has taken with many of its success stories in that when we increase public awareness, we increase policies that can enforce the safer behavior or make environments safer, and then it becomes the social norm. And actually, that’s one of the big functions of policy changes, is to create a new norm that can really protect people.

NPH: What does the evidence show us that might be most effective for emerging concerns, such as texting while driving and prescription drug abuse?

Andrea Gielen: I think with texting and driving, looking at technologies that make it impossible to actually do that when the car is running might be an area of interest to look into in terms of a strategy. For prescription drug abuse, the thing that people are really looking at right now are these prescription drug monitoring programs at the state level which allow us to highlight where there are problems in terms of inappropriate prescribing or inappropriate use of medication. There’s an effort now to evaluate those prescription drug monitoring programs to really find out what is working and what are the elements that need to be in place.

NPH: What other emerging injury prevention issues are you focused on?

Andrea Gielen: Pedestrian, bicycling and outdoor play safety are all important emerging issues. The public health community is really trying hard to increase physical activity to address the obesity epidemic in the country, and so we really need to think about how do we use those spaces in a way that increases physical activity without increasing injury risk. So, looking at how roads and neighborhoods can be safe for pedestrians and bicyclists is really important. Looking at how playgrounds comply with existing safety standards for reducing injury risk to kids are really up and coming areas that are going to need more attention in the future, not to mention the use of bicycle helmets. You can’t talk about increasing bicycling without talking about making sure that people have access to bicycle helmets.

NPH: Do find that the study of injury prevention is becoming a robust and growing area for the research workforce—including medical, law and policy, safety and built environment researchers?

Andrea Gielen: Yes, I do. We definitely need more people, but it’s interesting that this year is the 20th anniversary of the National Center for Injury Prevention and Control at the CDC, and they have been a focal point for injury prevention at a national level. Through their work, and of course, the work of all the other people you mentioned that are essential to injury control, we’ve really made a lot of progress. They’ve funded research at major academic institutions, they’ve established injury control research centers, 11 of them in the country, where people come together to do the kinds of multi-disciplinary research that we need to do to advance the field. They also provide academic training so that the next generation of injury researchers and practitioners are trained in the field.

The report also talks about collaboration between injury control state programs and injury control researchers, and that has been, I think, critically important to the success that we’ve had. We’ve been able to do research that really has real-world applications because we’ve been working in partnership with practitioners. And then they’ve been helping us to translate our research into policy programs that really make a difference. So, it’s critically important and I hope this report will stimulate people to think about what resources are being put into funding the kind of research and the kind of practice that we need to take advantage of what we already know.

NPH: What other critical injury prevention issues does the report cover?

Andrea Gielen: We’ve spent a lot of time on motor vehicle, and that’s really important, but I wouldn’t want us to lose sight of the violence side of the report as well. When people think about injuries, I don’t think they think necessarily think about domestic violence. In the injury field we are sort of one in the same. The report talks about injuries and violence, homicide, suicide and unintentional injuries because the science that we do and the strategies or messages that we have to address the problem are often very similar in terms of the approaches. You’ll see in the report, we spend a fair bit of time on both unintentional and violence-related injuries, and I think that’s really important to keep in mind.

>>Read more about the report.

>>Follow our series on injury prevention.

Tags: Centers for Disease Control and Prevention, Injury Prevention, Q&A, Safety, Transportation, Violence