Faces of Public Health: Q&A with Andrea Gielen, the Johns Hopkins Center for Injury Research and Policy

Sep 12, 2014, 11:48 AM

Faces of Public Health

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. 

I think that our center is uniquely positioned to do that kind of research and to say: we know these things have promise, how do we get them widely adopted so everyone is protected?

NPH: What makes this kind of research different from other kinds of medical research?

Gielen: That’s really one of the great things about injury as a public health problem. We know lots of things that work to reduce injuries. It’s not like we have to find a gene. We have a lot of evidence about what works, but what we don’t know is how we get these effective strategies widely disseminated across the population, and in particular to populations that are disproportionately affected by injuries.

NPH: How do you do that dissemination?

Gielen: We do that in a number of ways. We have a commitment to where we are geographically located to Baltimore, Md., and the region around our state, so we do a lot of work with local stakeholders by giving them the evidence they need for policies and programs that they can implement locally and regionally. We do that by providing technical assistance, getting them access to the best evidence that they need for a particular problem and testifying locally.

But we also have a real mission to do that nationally. We’re a national resource, and so we have partners. We often work with the National Conference of State Legislatures, for example, and with Trust for America’s Health (TFAH). With TFAH, we’ve worked on two reports, the top ten injury prevention policies that states should have, and then most recently on their prescription pain medication report.

With those reports I also did some of the media tours to answer questions on the evidence and policies. And our faculty writes op-eds and letters to the editor. We always try to do a lot more than just publish our results in our peer-reviewed journals, which of course we do a great deal of. But with this new funding, one of the things we’re really excited about being able to do is something that we’re calling a translation symposium and compendium. In the translation compendium our goal is to have one place that people in the practice community can go to for things like op-eds, press releases and policy briefs on the topics we’re investigating.

And then, building on that, we’re going to have a symposium. Initially, it will be a regional injury and violence prevention translation symposium that people can participate in on campus or access virtually online. We’re going to identify best-available research evidence and have conversations with practitioners about what is it that we know and ask participants what it is that we don’t know that, if we could find it out for you, would be helpful.

One of the key things that we say about our center is that we tried to close the gap between research and practice, and we try to do that not just by pushing out the research, but by trying to find ways to listen to practitioners in health departments and hospitals, as well as policymakers.

NPH: What is a good example of an area where research has been effective in preventing injury?

Gielen: Motorcycles is a great one because there is evidence that on an individual basis, motorcyclists have less of a chance of a head injury if they’re wearing a helmet. But also, research on a population level was clearly showing that having laws requiring motorcycle helmet use was associated with population-wide reductions in injuries and deaths to motorcyclists. And that has such an interesting history because there’s the evidence that it works. There are laws that are passed. There are people who don’t like those laws so the laws get rescinded, and what happened with the motorcycle helmet story is that because we knew individually and on a population basis that helmets and laws about helmets were effective, but even more dramatically, when those laws were rescinded in states, you could actually see the increase in motorcyclist injuries and deaths after the law was taken away.

That’s a clear example of the critical importance of research and surveillance in trying to, first, identify effective strategies and then to look at what happens when they’re applied to populations. That same is true of graduated driver licensing policies for new drivers, which has the same kind of history where we have solid evidence that it saves kids’ lives.

Motor vehicle safety is called one of the greatest public health achievements of the last century, and scholars who have looked at that repeatedly identify points along that way where research informed both how we communicated with the public and educated the public and, importantly, the policies that were put in place to reduce alcohol-related driving, to increase the use of seatbelts and to increase the use of child restraint devices. There’s a great story there about the need for, in addition to those things, improving the environment so that we made cars safer. We made roads safer. We educated the public and we passed laws, and through that whole process all of those things were evidence informed, and we were able to monitor and track what was working and what wasn’t working.

That’s injury research. That’s our history. That’s what we do.

NPH: What’s your next milestone?

Gielen: There are so many things that we’re focusing on. One of the key reasons it’s so important to have this center and the new funding is because it gives us the infrastructure to bring together faculty, students, and staff who cover everything from engineering to law and policy and behavior and communication, so we have this enormous breadth as well as depth of disciplines that are really needed to identify the next big hazards. So, for example, recently our portfolio has increased to include work on prescription drug overdose. And because we have the infrastructure and the wide range of different areas of expertise, we’re really able to be nimble and to stay on top of what is the new hazard because every time you turn around, there is a new hazard.

Another new thing that we’ve been working on is pedestrian safety. That sounds like an old topic, but the hazards have changed. We now have an enormous problem with distracted walking, and the rates of people getting injured while they’re on a cell phone crossing the street, have doubled in the past few years.

We’re able to make sure that we are positioned to respond to these emerging threats as they occur.

NPH: How does injury prevention help move us toward a culture of health?

Gielen: If you look at what largely preventable injuries cost us every year, it’s a staggering toll—not just for the pain and suffering of individuals and their families, but financially on the country. Injury is front and center in thinking about the population’s health. It’s an expensive, largely preventable health condition that everyone has a stake in. For example, the big push on reducing obesity and promoting physical activity is really important and something that obviously we have to be doing, but that’s a good example of how injury prevention can contribute to that because the last thing we want to do is turn couch potatoes into trauma patients.

And, if we don’t have a safe environment and if people don’t know how to be physically active in ways that also protect them that can happen. You need to make sure people have bike helmets if they’re going to go out and bicycle. You need to know that pedestrians who want to increase their walking have safe places to walk.

We have talked about the culture of safety in work places and protecting workers, so I think the culture of health is a great umbrella that covers health and safety. 

This commentary originally appeared on the RWJF New Public Health blog.