In the 15th in a series of assessments of Healthy People
2010, Acting Assistant Secretary for Health Cristina Beato
chaired a focus area Progress Review on Injury and Violence Prevention.
In conducting the review, Dr. Beato was assisted by staff of the
Centers for Disease Control and Prevention (CDC), the lead agency
for this Healthy People 2010 focus area. Also participating
were representatives of other offices and agencies within the U.S.
Department of Health and Human Services, including the Health Resources
and Services Administration (HRSA), the National Institutes of Health
(NIH), the Administration for Children and Families (ACF), the Administration
on Aging, the Agency for Healthcare Research and Quality, the Indian
Health Service, and the Office on Disability. Representatives of
the Department of Transportation (DOT) and the U.S. Consumer Product
Safety Commission (CPSC) took part, as well.
The complete text for the Injury and Violence Prevention focus
area of Healthy People 2010 is available at www.healthypeople.gov/document/html/volume2/15injury.htm.
The meeting agenda, data presentation (tables and charts), and other
materials for the Progress Review can be found at
http://www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa15-injury.htm.
Data Trends
In providing a status overview for this Healthy People 2010
focus area, Edward Sondik, Director of CDC’s National Center
for Health Statistics, addressed the 2010 objectives for Injury
and Violence Prevention under three headings. In the category of
injury prevention, improvement since the baseline year/period is
evident for nonfatal spinal cord injury hospitalizations and nonfatal
firearm-related injuries. However, several other objectives reveal
a worsening trend, including hospitalizations for nonfatal head
injury, emergency department visits caused by injuries, nonfatal
poisonings, poisoning deaths, and suffocation deaths. In the category
of unintentional injury prevention, the most recent data present
a mixed picture. Favorable trends are shown by objectives relating
to hip fractures, deaths from drowning, nonfatal motor vehicle injuries,
safety belt use, child restraint use, pedestrian deaths, and emergency
department visits for dog bite injuries. The trend is in the wrong
direction for unintentional injury deaths, motor vehicle crash deaths,
nonfatal pedestrian injuries, and motorcycle helmet use. In the
category of violence and abuse prevention objectives, the overall
picture is favorable. Trends indicate improvement in the objectives
for child maltreatment, physical assaults, physical assault by intimate
partners, rape and attempted rape, sexual assault other than rape,
physical fighting among adolescents, and weapon carrying by adolescents
on school property. However, the trend is away from the 2010 targets
for child maltreatment fatalities and for homicides.
Dr. Sondik gave detailed updates on data for the three objectives
selected for highlighting during the Progress Review. In 2001, the
age-adjusted rate of deaths from motor vehicle crashes for the total
population was 14.9 per 100,000, which also was the rate for non-Hispanic
whites (Obj. 15-15a). Rates for Hispanics and for blacks were within
0.6 of that mark,while the rate for American Indians/Alaska Natives
was the highest of five racial and ethnic groups at 25.1 per 100,000.
The death rate from motor vehicle crashes was lowest for Asians
at 7.9 per 100,000. The level of education completed was a large
factor in fatal crashes: people who had not completed high school
died at three times the rate of people who had at least some college
(25.6 compared with 8.2 per 100,000). High school graduates had
a rate of 20.6. Males continue to die from crashes at roughly twice
the rate of females. However, the death rate for males aged 15 to
24 years—the group at highest risk—has declined by one-third
over the past two decades, from 68.7 per 100,000 in 1979 to 37.0
per 100,000 in 2001. The 2010 target of 9.2 per 100,000 was met
by five states in 2001.
Death rates from residential fires have shown a slow but steady
decline for more than two decades. The largest decline over that
period among whites and blacks was registered by black males, whose
death rate from fires fell from 11.1 in 1997 to 3.8 per 100,000
in 2001, representing an almost threefold decrease over that time
period. That rate was still at least twice the rates for black females,
white males, and white females in 2001. The residential fire death
rate for blacks overall in 2001 was 2.7 per 100,000, compared with
1.0 for whites, 1.8 for American Indians/Alaska Natives, and 3.1
for people older than 65 years of age. The target is 0.2 per 100,000
(Obj. 15-25), which would require a sixfold reduction from the 2001
rate of 1.2 per 100,000 for the total population. In general, the
highest death rates from residential fires occur in the southern
and more southerly midwestern states.
Trends are less evident in recent data on child maltreatment, which
occurred in 2001 at a rate of 12.4 incidents per 1,000 population
younger than 18. The target is 10.3 per 1,000 population under 18
years of age (Obj. 15-33a). The incidence of child maltreatment
declined as the age group of the child increased, with the highest
incidence, 16.1 per 1,000, occurring among children younger than
4 years of age. By type of maltreatment, neglect (including medical
neglect) accounted for 52 percent of the incidents in 2001, compared
with 16 percent for physical abuse, 8 percent for sexual abuse,
and 6 percent for psychological maltreatment. Between 1998 and 2001,
the fatality rate among children subjected to maltreatment increased
from 1.6 to 1.8 per 1,000 younger than 18. The target is 1.4 per
1,000 (Obj. 15-33b). The principal causes of these fatalities in
2001 were neglect (including medical neglect)—36 percent;
physical abuse—26 percent; and physical abuse combined with
neglect—22 percent.
Key Challenges
Participants in the review further defined the national dimensions
of injury and violence and identified a number of obstacles to achieving
the three highlighted objectives:
Unintentional injury is the leading cause of death in
all age groups from aged 1 to 34 years.
There is a pressing need to reorient the nation’s
consciousness of injury and violence from a focus on isolated incidents,
as is too often the case in media portrayals, to a focus on issues,
especially prevention.
Approximately 40,000 people in the United States die each
year from injuries suffered in motor vehicle crashes. More than
40 percent of these crashes are alcohol-related.
In 2001, residential fires accounted for 77 percent of fire-related
injuries and 84 percent of fire-related deaths, claiming the lives
of an estimated 3,140 people.
Both males and females who have experienced maltreatment
as children are at increased risk for experiencing intimate partner
violence as adults. For males, this risk triples; for females, it
more than doubles. Moreover, parents who were abused as children
are more likely to abuse their own children.
Households headed by single female parents older than 19
are at greatest risk for maltreatment and violence directed at children.
The likelihood that such maltreatment will occur increases with
the number of children in the household.
In terms of the risk of fatality from maltreatment, the
first day of a child’s life is the most hazardous. The risk
of fatality from this cause peaks again at around age 3.
Current Strategies
Discussions during the review addressed a range of activities under
way to meet these challenges, including the following:
A systematic evaluation of experience in states that had
enacted laws making it illegal to operate a motor vehicle at or
above a blood alcohol concentration (BAC) level of 0.08 percent
found that doing so had led to a median decrease of 7 percent in
fatal alcohol-related motor vehicle crashes. An estimated 400 to
600 lives per year could be saved if all states enacted such BAC
laws.
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DOT’s National Highway Traffic Safety Administration
(NHTSA) sponsors Click It or Ticket, under which law
enforcement agencies mobilized twice in 2003 in 43 states to
conduct safety belt checkpoints and issued nearly one-half million
citations for non-use. As a result, the national safety belt
use rate increased from 75 to 79 percent, with each percentage-point
increase saving an estimated 270 lives.
CDC is planning steps for using World Health Day 2004, which
has road traffic safety as its theme, as an opportunity to refocus
attention on the topic in this country.
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HRSA’s Maternal and Child Health Bureau joined with NHTSA
to promote their impaired driving initiatives—Zero
Tolerance Means Zero Chances (aimed at teens); Friends
Don’t Let Friends Drive Drunk (aimed at adults);
and You Drink & Drive—You Lose (national
crackdown involving 13 key states).
In a CDC-supported program carried out in Oklahoma City
over a 4-year period in the early 1990s, injuries from residential
fires decreased by 80 percent in homes in which smoke alarms had
been installed. In homes without alarms, injuries increased by 8
percent. It is estimated that approximately 400 lives were saved
by the program, which also saved $30 for every $1 spent.
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The Fire Safety Council (FSC) combines the efforts of CDC,
CPSC, the U.S. Fire Administration, and other partners in working
toward the national goal of eliminating residential fires by
2020. An outgrowth of the Healthy People 2000 initiative,
the FSC provided $5 million for the launching of a new fire
data system in mid-2003, which will provide a better information
base for activities in public education about fire and safety.
Early childhood home visitation by trained personnel to
high-risk families has been shown to result in a reduction of approximately
40 percent in the incidence of child maltreatment.
CDC is funding the University of South Carolina to examine
the effectiveness of a successful Australian program called Triple
P (Positive Parenting Program) to determine whether it is replicable
in communities in the United States.
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Following its launch of the Child Abuse Prevention Initiative
at the Summit on Prevention in April 2003, ACF’s Children’s
Bureau has embarked on a number of innovative activities. These
activities include the issuance of the report titled Emerging
Practices in the Prevention of Child Abuse and Neglect,which
provides examples of effective programs in place across the
country that were selected through a national nomination process.
In 1997, the NIH Child Abuse and Neglect Working Group was
formed at the request of Congress and focuses on three areas of
need in the field: training researchers, defining and classifying
child abuse and neglect, and researching child neglect. Core members
of the Working Group include representatives from eight NIH Institutes
and the Office of Behavioral and Social Science Research.
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The new Presidential initiative, Safe and Bright Futures
for Children, aims to reduce the consequences of domestic
violence, especially the aftereffects on children.
Contacts for information about Healthy People 2010
focus area 15—Injury and Violence Prevention:
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Centers for Disease Control and Prevention— Melissa Graham
(Injury Center Coordinator), msg7@cdc.gov
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Office of Disease Prevention and Health Promotion (coordinator
of the Progress Reviews)—Emmeline Ochiai (liaison to the
focus area 15 workgroup), eochiai@osophs.dhhs.gov
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Cristina V. Beato, M.D.
Acting Assistant Secretary for Health
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