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BOSTON UNIVERSITY
Specific Aims of the Course:Injuries are a major cause of death and disability. They are the leading cause of lost years of potential life in the United States. This 4 credit course provides an overview of the human, economic and social costs of injuries in the United States. An emphasis will be placed on identification of risk factors for specific types of injuriesfor example, motor vehicle crashes, violence/intentional injuries, and drowning. Intervention strategies and models for identifying intervention opportunities will also be discussed in detail. Upon completion of this course, you will have a basic understanding of the significance of, and risk factors for, major types of injuries. In addition you will be familiar with relevant sources of information and data about injuries and know their limitations. You will be able to apply injury research models, such as the Haddon matrix, for analysis of injury events and identification of intervention opportunities. You will also be aware of the various intervention approaches or strategies for preventing injuries including passive versus active interventions, educational, political and legal efforts, and you will be able to identify examples of each. You will also be able to apply these models and epidemiologic techniques to identify injury causes and trends. Course Requirements:I. READINGS A. One Text will be read in full:
Baker, S., O'Neill, B., Ginsburg, M., and Guohua, L. The Injury Fact Book, 2nd Edition. New York, NY; 1992 (343).
II. WRITTEN WORK A. Take Home Mid-Term Exam due on October 30
III. Grading A. Mid-Term ........................ 25%
COURSE OUTLINE
SB837 A1 INJURIES: CAUSES, CONSEQUENCES AND CONTROLS Fall 1995
1. September 4 Topics: Introduction to Injuries and their Public Health Significance. Epidemiologic approach to identifying intervention opportunities. Host/human factors and patterns of injury Speaker: Nicole Bell Readings: The Injury Fact Book, chps. 1-3 Waller, JA Reflections on a half century of injury control, AJPH, 84(4):664-670, 1994. Exercise: Theories regarding injury trends and demographic patterns
2. September 11 Topic: The Study of Gender and Race in Injury Research: Issues of Measurement and Ethics Speakers: Nicole Bell Readings: Schnitzer, PG, Runyan, CW Injuries to women in the United States: An Overview. Women Health 23(1):9-27, 1995. Wagener, D. and Winn, D. "Injuries in working populations: Black-white differences" AJPH 81(11):1408-1414, 1991. Hahn, R. and Stroup, D. "Race and ethnicity in public health surveillance: Criteria for the scientific use of social categories" Pub. Hlth Rep. 109(1):7-15, Jan-Feb. 1994. Verbrugge, L. "The twain meet: empirical explanations of sex differences in health and mortality" J. of Health and Soc. Beh. 30:282-304, 1989. Recommended reading: Lanese, R., Strauss, R., Leizman, D. and Rotondi, A. "Injury and disability in matched men's and women's intercollegiate sports" AJPH 80(12):1459-1462, Dec. 1990. Hutchinson, MR, Ireland, ML Knee injuries in female athletes Sports Med 19(4):288-302, 1995.
3. September 18 Topic: Identifying and measuring injury problemssources of data, strengths and limits, and data collection approaches. Speakers: Nicole Bell Readings: The Injury Fact Book, chp 22 Cummings, P, Koepsell, TD, Mueller, BS "Methodological challenges in injury epidemiology and injury prevention." Annu Rev Public Health 16:381-400, 1995. Langlois, JA, Buechner, JS, O'Connoer, EA, Nacar, EQ, Smith, GS "Improving the Ecoding of hospitalizations for injury: do hospital records contain adequate documentation?" AJPH 85(9):1261-1265, 1995. Dijkhuis, H, Zwerling, C, Parrish, G, Bennett, T, Kemper, HC "Medical examiner data in injury surveillance: a comparison with death certificates." Am J Epidemiol 139(6):637-643, 1994. Clark, DE "Development of a statewide trauma registry using multiple linked sources of data." Proc Annu Symp Comput Appl Med Care, 654-658, 1993. Ozonoff, VV, Tan-Torres, S, Barber, CW "Assessment of E-coding practices and costs in Massachusetts hospitals." Public Health Rep, 108(5):633-636, 1993. Recommended Readings: Robertson, Leon Injury Epidemiology, NY: Oxford University Press, chps. 1-3. Williams, JM, Furbee, PM, Prescott, JE, Paulson, DJ "The emergency department log as a simple injury-surveillance tool." Emerg Med, 25(5):686-691, 1995.
4. September 25 Topic: Legal and regulatory approaches to intervention; also, product safety, litigation and economic intervention strategies. Speakers: Allen Meyers, Nicole Bell Readings: Dowie, Mark "Pinto Madness." Mother Jones, Sept/Oct. 1977. Hemenway, David Prices and Choices, 2nd ed., Cambridge, MA: Ballinger, 1988, chp. 21. Bollier, David and Claybrook, Joan, "Safe Products: The Consumer Product Safety Commission" In: Freedom from Harm, Washington, D.C.: Public Citizen and Democracy Project (1986), pp. 163-187. Ross, H.L. and Foley, J.P. "Judicial disobedience of the mandate to imprison drunk drivers." Law and Society Review, 21(2):315-323, 1987. Lynxwiller, J., Shover, N., Clelland, D. "The organization and impact of inspector discretion in a regulatory bureaucracy." Social Problems, 30:379-382, 1983. Lowenstein, SR, Koziol-McLain, J, Satterfield, G and Orleans, M. "Facts versus values: why legislators vote against injurycontrol legislation." J Trauma 35(5):786-792, discussion 792-793, 1993. Recommended Readings: Huber, Peter "What is Deterred" (chp. 10) In: Liability: The Legal Revolution and Its Consequences New York: Basic books, 1988, 152-161. Hingson, R. Howland, J. and Levenson, S. "Effects of Legislative Reform to Reduce Drunken Driving and Alcohol-Related Traffic Fatalities." Public Health Reports, 103(5):659-667, 1988. Rock, SM "Risk compensation and the Illinois seat belt use law." Accid Anal Prev 25(5):537-544, 1993.
5. October 2 Topic: Intervention Strategies continued - Passive vs Active strategies. Also, educational, social, and engineering approaches. The Haddon Matrix. Speaker: Nicole Bell Readings: Haddon, William "The basic strategies for reducing damage from hazards of all kinds." Hazard Prevention, Sept/Oct 1980, 8-12. Mantak, FJ "Creating an alternative framework for preventing rape: applying Haddon's injury prevention strategies." J Public Health Policy, 16(1):13-28, 1995. "Haddon Matrix: Eliminating the mumbo jumbo" Insurance Institute for Highway Safety Status Report, 21(11):8, Sept. 9, 1986. Roberts, Michael "Public health and health psychology: Two cats of Kilkenny?" Professional Psychology: Research and Practice, 18(2):145-149, 1987. Chin, R and Benne K, "General strategies for effective change in human systems" In: Warren Bennis et al. (eds.) The Planning of Change, New York: Holt, Rinehart and Winston, Inc.32-59, 1969. Prochaska, JO "Assessing how people change." Cancer 1;67(3 Suppl) 805-807, 1991. Recommended Readings: Robertson, L. Injury Epidemiology. New York: Oxford Univ. Press, 1992, chps. 4, 5 Prochaska, JO "Why do we behave the way we do?" Can J Cardio,l 11 Suppl A:20A-25A, 1995. Exercise: Application of the Haddon Matrix.
6. October 9 Topic: Childhood injury and Recreational/Sports Injuries - Risk Factors and Intervention Strategies. Speakers: Nicole Bell Readings: Bijur, PE, Trumble, A, Harel, Y, Overpeck, MD, Jones, D, Scheidt, PC "Sports and recreational injuries in US children and adolescents." Arch Pediatr Adolesc Med, 149(9):10009-1016, 1995. Robertson, LS "Child injury control: surveillance and research questions." Am J Med Sci, 308(2):88-91, 1994. Kogan, MD, Overpeck, MD, Fingerhut, LA "Medically attended nonfatal injuries among preschool-age children: national estimates." Am J Prev Med, 11(2):99-104, 1995. Kann, L, Warren, CW, Harris, WA, Collins, JL, Douglas, KA, Collins, ME, Williams, BI, Ross, JG, Kolbe, LJ "Youth risk behavior surveillanceUnited States." 1993 MMWR CDC Surveill Summ 1995 Mar 24; 44(1):1-56. Schootman, M, Powell, JW and Torner, JC "Study designs and potential biases in sports injury research." Sports Med, 18(1):22-37, 1994. Recommended Readings: Wesson, D, Hu, X "The real incidence of pediatric trauma." SeminPediatr Surg, 4(2):83-87, 1995. Anda, D., Wojtys, E., Hankin, F. and Benedict, M. "Softball Sliding Injuries." JAMA, 259(12). Torg, J, Vegso, J, Sennett, B and Das, M "The National Footbal Head and Neck Injury Registry." JAMA, 254(24) 1985. Howland, J. et. al., "Barriers to Bicycle Helmet Use Among Children." AJDC, 143:741-744, June 1989.
7. October 16 Topic: Introduction to Motor Vehicle Fatalities and Injuries - Epidemiology and Intervention Strategies. Speakers: Nicole Bell Readings: The Injury Fact Book, chps 16, 17 & 19. Robertson, LS "Reducing death on the road: The effects of minimum safety standards, publicized crash tests, seat belts and alcohol." AJPH, 86(1):31-34, 1996. Runge, JW, Pulliam, CL, Carter, JM and Thomason, MH "Enforcement of drunken driving laws in cases involving injured intoxicated drivers." Ann Emerg Med, 27(1):66-72, 1996. Augustyn, M, Simons-Morton, BG "Adolescent drinking and driving: etiology and interpretation." J Drug Educ, 25(1):41-59, 1995. Levy, DT, Vernick, JS, Howard, KA "Relationship between driver's license renewal policies and fatal crashes involving drivers 70 years or older." JAMA 4;274(13):1026,1030, 1995. Hingson, R. et. al., "The Massachusett's Saving Lives Program; Six Cities Widening the Focus from Drunk Driving to Speeding Reckless,Driving, and Failure to Wear Safety Belts." J. of Traffic Med., 18(3):123-132, 1990. Recommended Readings: Hingson, R. et. al. "The Repeal of the Massachusetts Seat Belt Law." AJPH, 78:548-552, 1988. Graham, J. and Garber, S. "Evaluating the Effects of Automobile Safety Regulation." J. of Pol. Anal. & Manag., 3(2):206-224, 1984. NOTE: Paper Topics Due.
8. October 23 Topic: Intentional Injuryviolence and child abuse. Speakers: Nicole Bell Readings: The Injury Fact Book, chps. 5 & 6 Rosenburg, ML "Violence in America: an integrated approach to understanding and prevention." J Healthcare Poor Underserved 6(2):102-110, discussion, 111-112; 1995. Covington, DL, Maxwell, JG, Clancy, TY, Churchill, MP, Ahrens, WL "Poor hospital documentation of violence against women." J Trauma, 38(3):412-416, 1995. Rosenberg, ML "Prevention of family violence." Acad Med, 70(11):989-992, 1995. CDC "Violence-related attitudes and behaviors of high school studentsNew York City, 1992" 42(40): 773-777, Oct. 15, 1993. National Committee for Injury Prevention and Control Injury Prevention Meeting the Challenge New York: Oxford University Press, 1989 (Supplement to Amer. J. of Preventive Medicine, 5(3) 1989), pp. 194-198. Guidry, HM "Childhood sexual abuse: role of the family physician." Am Fam Physician, 1;51(2):407-414, 1995. Recommended Reading: Rivara, FP, Farrington, DP "Prevention of violence. Role of the pediatrician." Arch Pediatr Adolesc Med, 149(4):421-429, 1995. Rosenburg, M., Gelles, R., Holinger, P. et. al. "Violence, Homicide, Assault, Suicide", C.D.C., 1985, 1-5. NOTE: Take home mid-term exam
9. October 30
No Class
NOTE: Mid-Term Exam Due
10. November 6 Topic: Intentional Injury/Violence continued- Guns and Violent Crime and Intervention Strategies Speakers: David Hemenway Readings: Hemenway, D. "Phasers on Stun" J. of Pol. Anal. & Manag., 9(1):94-98, 1990. Weill, D. and Hemenway, D. "Loaded Guns in the Home", JAMA, 267:3033-3037, June 10, 1992. NRA "Gun Law Failures" (pamphlet), Washington, D.C.: NRA Institute for Legislative Action, 1986 (IL3N1046) (Based on 1976 July-Aug. In: RIFLE Magazine, Prescott, Arizona). Vernick, JS, Teret, SP "Firearms and health: the right to be armed with acurate information about the second amendments." AJPH, 83(12):1773-1777, 1993. Teret, SP, Wintemute, GJ "Policies to rpevent firearm injuries." Health Affairs (Millwood) 12(4):96-108, 1993. Hemenway, D, Solnick, SJ, Azrael, DR "Firearm training and storage." JAMA, 273(1):46-50, 1995. Recommended Readings: Fingerhut, Lois "Firearm mortality among children, youth and young adults, 1-34 years of age, trends and current status: United States, 1985-1990." Advance Data (CDC/NCHS: U.S. Department of Health and Human Services) No. 231, March 23, 1993.
11. November 13 Topic: Alcohol and injury with a focus on Drowning - Epidemiology and Intervention Strategies. Speakers: Nicole Bell Readings: The Injury Fact Book, Chp. 13. Howland, J., Smith, G., Mangione, T., Hingson, R., DeJong, W. and Bell, N. "Missing the Boat on Drinking and Boating." JAMA, 270(1):91-92;1993. Howland, Hingson, Mangione, Bell and Bak "Why are Most Drowning Victims Men? Sex differences in aquatic skills and behaviors." AJPH, 86(1):93-96, 1996. Vinson, DC, Mabe, N, Leonard, LL, Alexander, J, Becker, J Boyer, J, Moll, J "Alcohol and injury: a case-crossover study." Arch Fam Med, 4(6):505-511, 1995. Waller, JA, Skelly, JM, Davis, JH "Treatment charges, payment sources and disability from alcohol-related trauma." J Trauma, 39(5):963-967, 1995. Recommended Readings: Howland, J, Mangione, T, Hingson, R, Smith, G, Bell, N "Alcohol as a risk factor for drowning and other aquatic injuries". In: Drug and Alcohol Abuse Reviews, Vol. 7: Alcohol, Cocaine and Accidents (Ed) RR Watson. Totowa, NJ: Humana Press, inc. 1995 Hingson, R. and Howland, J. "Alcohol as a Risk Factor for Drowning: A Review of the Literature (1950-1985)" Accid. Anal. & Prev., 29:19-25, 1988. Howland, J. Hingson, R., Levenson, S., Winter, M. and Mangione, T. "Alcohol Use and Aquatic Activities - Massachusetts." JAMA, 264:19-20; 1990. Ellis, AA, Trent, RB "Hospitalizations for near drowning in California: incidence and costs." AJPH, 85(8 pt 1):1115-1118, 1995. 12. November 20 Topic: Fire/Burns - epidemiology and intervention strategies. Speakers: Jennifer Mieth (State Fire Marshall Office) Readings: The Injury Fact Book, chp. 12. O'Malley, B. "Cigarettes and Sofas: How the Tobacco Lobby Keeps the Home Fires Burning." Mother Jones, July 1979. Forjuoh, SN, Smith, GS "Case fatality rates by body part affected and trends in hospitalized burns in Maryland, 1981-1990." Burns 19(5):387-391, 1993. Herndon, DN, Rutan, RL, Rutan, TC "Management of the pediatric patient with burns." J Burn Care Rehabil 14(1):3-8, 1993. Ray, G "Burns in young children: a study of the mechanisms of burns in children aged 5 years and under in Hamilton, Ontario Burn Unit." Burns, 21(6):463-466, 1995. el Danaf A "Burn variables influencing survival: a study of 144 patients." Burns 21(7):517-520, 1995. Recommended Readings: Madden, MR, Mathwick, M,Valentino, L, Finkelstein, JL,Goodwin, CW "The epidemiology and prevention of burn injuries to firefighters." J Burn Care Rehabil 16(4):461-465, 1995. Hemenway, D., Wolfe, K. & Lange, J. "An Arson Epidemic." J. of Behav. Econ.; 15 (Fall), 1986. Hemenway, D. "The Smoldering Issue of Fire Fatalities." J. of Pol. Anal. & Manag., 4:593-597, 1985.
13. November 27
NO CLASS THANKSGIVING HOLIDAY
14. December 4 Topic: Falls - Epidemiology and Intervention Strategies. Speakers: Jonathan Howland Readings: The Injury Fact Book, chp. 10. Tinetti, ME, Doucette, J, Claus, E, Marotti, R "Risk factors for serious injury during falls by older persons in the community." J Am Geriatr Soc, 43(11)1214-1221, 1995. Commodore, DI "Falls in the elderly population: a look at incidence, risks, health care costs, and preventive strategies." Rehabil Nurs, 20(2):84-89, 1995. "Falls: epidemiology and strategies for prevention." J Trauma, 38(5):753-756, 1995. Walker, J. and Howland, J. "Falls and Fear of Falling Among Elderly Persons Living in the Community: Occupational Therapy Interventions." American J. of Occup. Ther., 45:119- 122, 1991. Recommended Readings: Hingson, R., & Howland, J. "Alcohol as Risk Factor for Injuries and Deaths Due to Falls: A Review of the Literature." J. of Stud. of Alcoh., 48(3): 212-219, 1987. NOTE: Papers due.
15. December 11 Topic: Occupational Injury - Risk Factors and Issues of Competing Rights & Putting it all together: using epidemiology to identify injury problem and risk factors, designing an inter vention, field testing the intervention, and developing policy. Speakers: Nicole Bell, Paul Amoroso Readings: The Injury Fact Book, chp. 9. Zielinski, Christine "The toxic trap" Personnel Journal, 40-49, February 1990. Knight, EB, Castillo, DN, Layne, LA "A detailed analysis of work-related injury among youth treated in emergency departments." Am J Ind Me,d 27(6):793-805, 1995. Kraus, JF, Blander, B, McArthur, DL "Incidence, risk factors and prevention. Strategies for work-related assault injuries: a review of what is known, what needs to be known, and countermeasures for interventio." Annu Rev Public Health, 16:355-379, 1995. Kraus, JF, Peek, C, Silberman, T, Anderson, C "The accuracy of death certificates in identifying work-related fatal injuries." Am J Epidemiol 15;141(10):973-979, 1995.
16. December 18
NOTE: In-Class Final Exam
Course Description
Injuries are the leading cause of lost years of potential life in the United States. This 4 credit course provides an overview of the human, economic and social costs of injuries. An emphasis will be placed on identification of risk factors for specific types of injuries, like motor vehicle crashes, violence/intentional injuries, and drowning. Intervention strategies and models for identifying intervention opportunities will also be discussed in detail. Skills for identifying risk factors, designing intervention approaches and measuring outcomes will also be addressed.
Detailed Description of Course Requirements:
A. Mid-Term Exam: This will be a take-home exam covering the first 8 lectures and reading assignments for the course. It will contribute to 25% of a student's grade for the course.
B. Final Exam: This will be an in-class exam which will cover all lectures and speaker presentations. Thirty percent of a student's grade will be based upon his or her final exam scores.
C. Paper: This will be an 10-15 page writing assignment that addresses a particular injury topic. For this paper students will be expected to do a literature review, to discuss th e public health significance of the problem, to identify potential risk factors/causes, and to suggest intervention options using the Haddon Matrix, and other intervention strategies described in the course (legal, educational, normative, economic and political). This is an exploratory exercise and an emphasis will be placed on identifying innovative and unexplored intervention options. They will also be asked to describe an appropriate method for evaluating the proposed intervention. The paper will contribute to 30% of the students' grades. D. Class Participation: Each student will be expected to attend all classes and to complete the reading assignments prior to the lectures. In addition, they will be expected to contribute to the class discussions and any in-class exercises. Participation will account for 15% of the student's grade.
Suggested Areas for Student Papers:
Contents of Paper (10-15 pages double spaced): Literature Review: What have others found out about this topic?
The Problem: What is known about the incidence of this problem, the costs, and the long-term sequelae or survivability?
Population at Risk: Discuss the demographics of the population at risk (gender, age, race, SES, geographic, night/day etc.). Are there important issues to consider in the measurement of these characteristics and or reporting of your findings? Use Haddon Matrix/injury epidemiologic triangle to identify intervention opportunities Using intervention strategies discussed in this course, suggest a few intervention options (Because this is exploratory please try to be creative in identifying interventions that are innovative) Identify and briefly describe an appropriate method for evaluating the intervention(s) you have suggested. Target Marketing:This course should be of interest to anyone in the public health area but may be of particular interest to those concerned with childhood or adolescent public health issues since injuries disproportionately affect the young. This course may also be useful for those who are interested in the health of other sub-populations particularly at risksuch as Native Americans, Black youth, and the elderly. Specific topical areas of potential interest include: violence prevention, occupational injuries, childhood injury, firearm injury prevention, behavior change strategies for injury prevention, prevention of falls, drownings, burn/fire injuries, and sports or recreational injuries. The focus of the course is on injuries in the U.S., though the concepts presented should be applicable to other countries, including developing countries. ***************************** Return to Menu of Syllabi Available Online |
Thanks to Chester S. Jones, Ph.D. for gathering
these syllabi.
If you have comments or suggestions,
e-Mail Lisa Hyde
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Revised:
July 14, 2004