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Injury and Violence Prevention

A 1996 summer elective course offered in the MPH curriculum at the

University of Connecticut Health Center

Monday and Wednesday evening, 5:30 PM - 8:30 PM, 5/20 - 6/26/96

Instructor:

Garry Lapidus PA-C, MPH

Connecticut Childhood Injury Prevention Center

Connecticut Children's Medical Center

282 Washington Street

Hartford, CT 06106

Telephone: 545-9988

Fax: 545-9975

Course Description

Recognizing that injuries and violence are major preventable public health problems with predictable patterns, the purpose of this course is to familiarize the student with the epidemiological literature of intentional and unintentional injuries. The course is designed to focus on the knowledge and skills required to design, implement, and evaluate scientifically sound community injury prevention and control programs.

The course is divided into three parts. The first part provides an overview of the magnitude of the injury problem and provides a conceptual model to understand injury etiology and control strategies. Part two describes the "process" of injury prevention - a structure for moving from the early stages of getting started, to learning from and working with data, to program design, implementation, and evaluation. Part three explores what is known, who is at greatest risk, and the state of the art in interventions for a wide range of unintentional injuries (traffic, residential, recreational, occupational) and intentional injuries (abuse, homicide, and suicide).

Course Objectives

1. To recognize that injury and violence are major public health problems with predictable patterns and thus are often preventable

2. To understand the concepts of host, agent and environment in injury etiology, and recognize that each of these factors should be considered in targeting preventive measures.

3. To use the Haddon matrix to generate a range of options for prevention of a specific injury problem.

4. To understand the essential role of injury data in confirming, disproving, or refining an analysis of an injury problem and as an aid to the design, implementation, and evaluation of an effective injury prevention and control program.

5. To understand the importance of establishing injury program goals and outcome objectives based on a prior assessment of community needs and resources, as well as a thorough analysis of relevant injury data.

6. To familiarize the student with what is known, who is at greatest risk, and the state of the art in interventions for a wide range of unintentional injuries (traffic, residential, recreational) and intentional injuries (abuse, homicide, and suicide).

Readings

Required Text:

National Committee for Injury Prevention and Control. Injury Prevention: Meeting the Challenge. Oxford University Press, Supplement to the American Journal of Preventive Medicine, Vol. 5, November 1989.

Recommended texts on reserve in the library

Roberston, LS. Injury Epidemiology. Oxford University Press, 1992.

Wilson, Modena. Saving Children: A guide to injury prevention. Oxford University Press, 1991.

Baker, Susan. The Injury Fact Book, 2nd Edition. Oxford University Press, 1992.

Rosenberg, Mark. Violence in America: A Public Health Approach. Oxford University Press, 1991.

Christoffel, T. and Teret, S. Protecting the Public: Legal Issues in Injury Prevention. Oxford University Press, 1993.

The syllabus contains a set of required readings from the text listed above as well as selected journal articles. Students are expected to complete the readings and be prepared to discuss them in relation to the learning objectives.

Course Evaluation

Final exam 25%

Individual project 50%

In class participation 25%

Individual project: There will be a action oriented project that will require the student to focus on one injury problem, develop a methodology to collect data, analyze and summarize the data and discuss the results. A short paper (3 pages maximum) will summarize the project. In addition, students will provide a 10 minute oral presentation of their project in class following a scientific conference format.

Project methods might include conducting a: a) survey measuring attitudes, knowledge and/or behavior, b) medical chart review, conducting a field observation of a particular

safety behavior (car seat, helmet use), or c) safety inspection of a neighborhood playground or nursing home.

To ensure that you are making timely progress in your project, preliminary drafts will be due for my comments and suggestions periodically over the course period (these preliminary drafts will not be graded).

The key to developing a workable project is the development of clear, concise, narrowly conceived, and readily measured injury problem. Second, keep your project simple and feasible. Finally, ask for help if you have questions or problems, especially before putting a lot of work into a project you are unsure of.

A preliminary summary of your project is due for instructor review May 29,1996. This should be one paragraph and include the injury problem and methodology.

PART 1

MAGNITUDE & CHARACTERISTICS OF THE PROBLEM,

PREVENTION STRATEGIES

Monday, 5/20/96

Topics

1. Introduction to the Course

· introductions

· course objectives and format

· text and readings

· class format

- 15-25 minute discussion of newspaper article

- topical discussion 1 (1 hour review of key points in readings, offer practical examples)

- 15 minute break

- topical discussion 2

- student project or activity (optional)

· student evaluation

2. Introduction to Injury Control

3. Epidemiological Patterns of Injury

4. Conceptual Model of Injury Causation and Prevention

* homework assignment: calculating rates and presenting data

Learning objectives

1. To define injury and describe the categories of injury

2. To describe the history of injury prevention

3. To describe the magnitude and cost of the injury problem

4. To describe the epidemiological patterns of injury

5. To describe the Haddon Matrix as a conceptual model to understanding injury causation and prevention

Readings

1. National Committee for Injury Prevention and Control. Chapter 1 "Introduction: A History of Injury Prevention" Injury Prevention: Meeting the Challenge. p 4-18.

2. Chapters 1,2,3; in: Injury in America; pp 1-47.(Optional)

3. Chapter 1 in: Injury Epidemiology. (Optional)

4. Chapters 1,2,3 in The Injury Fact Book. (Optional)

5. Hazinski, M, Francescutti, L., Lapidus, G, et al. Pediatric Injury Prevention. Annals of Emergency Medicine. 22(2): 456-67, February, 1993 (Optional)

PART 2

THE PROCESS OF INJURY PREVENTION AND CONTROL

Wed., 5/22/96

Topics

1 Injury data sources

2. Working with injury data

· in-class activity: review rate calculations and data presentation

· case study: linking multiple data sources to understand child pedestrian injury

Learning objectives

1. To understand that injury data can confirm, disprove, or refine an analysis of an injury problem and are essential for the design, implementation and evaluation of an effective injury prevention program.

2. To describe the injury severity spectrum and to understand that an examination of an injury problem should consider both mortality and morbidity data because the causes of fatal and nonfatal injuries are different.

3. To state national, state and local sources from which injury data can be obtained and to describe each of these sources and their strengths and limitations.

4. To define injury surveillance.

5. To describe methods to improve injury morbidity data by promoting the use of E-codes (external cause of injury, ICD classification system).

6. To define data collection needs

7. To discuss case definition, sensitivity and specificity, variables, time and population considerations as they relate to injury control research

8. To understand that linking data from a number of different sources can reveal patterns that might not be apparent using data from a single source.

9. To understand that a data collection system should be sensitive to the needs and constraints of the data collectors as well as to the confidentiality concerns of cooperating institutions.

10. To calculate injury rates and years of potential life lost

11. To discuss the problem of the denominator and obtaining exposure measures

Readings

1. Chapter 2 "Learning from Data" Injury Prevention: Meeting the Challenge. p 35-47.

2. Chapter 3 "Working with Data" Injury Prevention: Meeting the Challenge. p 49-62.

3. Lapidus, G, Banco, L. Childhood Injuries in Hartford, Connecticut. Connecticut Medicine, 1990; 54(2): 51-55.

4. Lapidus, G., Braddock, M, Schwartz,R., et al. Misclassification of Fatal Motorcycle Injury on Death Certificates. Accident Analysis & Prevention. 26(4):535-542. 1994

Mon., 5/27/96

Topics

1. Program Design and Evaluation

· class exercise in goals and objectives (drowning)

2. Program Implementation

· coalition building

Learning objectives

1. To understand that relevant injury data and community assessment information must drive program design.

2. To understand the importance of selecting feasible goals, objectives and interventions and a narrowly defined injury type and target population are crucial to a program's success.

3. To understand that programs should select the most effective mix of available legislation/enforcement, education/behavior change, and engineering/technology interventions.

4. To understand that integrating interventions into existing program activities is frequently the most effective way to ensure their continuity.

5. To state that all injury prevention programs need process evaluation and some form of outcome evaluation. These processes determine whether and how a program has reached its goals and objectives.

6. To understand that evaluation findings must be translated into clear, non technical formats and then disseminated to a wide audience.

7. To understand that all program staff should receive training in the theory and practice of injury prevention.

8. To understand the importance of building and maintaining strong links with other agencies and organizations is the most effective way to prevent the development of turf conflicts.

9. To understand that the two primary ways in which programs evolve over time is by applying outcome and process evaluation data and responding to new opportunities in the community or state.

10. To understand that broad-based injury prevention coalitions have the potential to exert great influence on injury prevention policy and programming.

11. To understand that media attention to the injury problem and to prevention measures that work can be essential in reinforcing and supplementing a program's interventions.

12. To understand that institutionalization of injury prevention programs is essential: without comprehensive, long term responses to the injury problem, we will never significantly reduce injury death and disability.

Readings

1. Chapter 4 "Program Design and Evaluation" Injury Prevention: Meeting the Challenge. p 63-88.

2. Chapter 5 "Program Implementation" Injury Prevention: Meeting the Challenge. p 89-110.

3. Bergman, A, et al. The Seattle Children's Bicycle Helmet Campaign. AJDC (144), June 1990, 727-731.

Part 3: State of the Art of Injury Prevention and Control

Wed., 5/29/96

Topics

1. Traffic Injury I (Occupants)

· Teenage occupants

· "They're Coming" truck safety video (12-15 min)

Learning objectives

1. To state the magnitude and cost of motor vehicle occupant injury.

2. To state high risk groups, the role of alcohol, and patterns of motor vehicle occupant

injury

3. To understand how attitudes about motor vehicles contribute to traffic injury

4. To describe the interventions available to prevent motor vehicle occupant injury

Readings

1. Chapter 6 "Traffic Injuries" Injury Prevention: Meeting the Challenge. p 115-132.

2. Robertson, L. Highway Deaths: False PR on the Effects of PR. Journal of Public Health Policy, Winter, 1994.

3. Insurance Institute for Highway Safety. Status Report. Facts behind faces, 16 year-old crashes differ from crashes involving older drivers. 29(13), 1994;4-9.

Mon., 6/3/96

Topics

Traffic Injury II (motorcycles, pedestrians, bicyclists)

1. Motorcycles

· Video, "Helmet Laws: Whose Freedom?"

2. Pedestrians

· Child pedestrian injury in Hartford

3. Bicyclists

· Bicycle Injury in CT

Learning objectives

1. To understand the epidemiology and prevention of motorcycle, bicycle and pedestrian injury.

Readings

1. Braddock, M, Schwartz, R, Lapidus, G. et al. A Population Based Study on Motorcycle Injury and Costs. Annals of Emergency Medicine. 21: 273-278, March, 1992.

2. Council on Scientific Affairs, American Medical Association. Helmets and preventing motorcycle- and bicycle-related injuries. JAMA, 1994. 272(19):1535-1538.

3. Lapidus, G., Braddock, M., Banco, L., et al.. Child Pedestrian Injury: A Population Based Collision and Injury Severity Profile. J. Trauma. 31(8): 1110-1115, 1991.

4. Braddock, M., Lapidus, G., Cromley, E. et al. Utility of a Geographic Information System to Study Child Pedestrian Injury. American Journal of Public Health. 84(7):1158-1161. 1994.

5. Zavoski, R. Lapidus, G., et al. Bicycle Injury in Connecticut. Connecticut Medicine, 1995. 59(1):3-9.

Wed., 6/5/96

Topics

1. Residential Injuries

· Housefires

· Fall among the Elderly

2. Recreational Injuries

· (Sports Injuries )guest speaker: Dr. Robert Zavoski, MD, MPH,

Director of Research & Education, CT Childhood Injury Prevention Center

Learning objectives

1. To state the magnitude of the residential and recreational injury problem

2. To state high risk groups and patterns of the problem

3. To describe the interventions available to prevent residential and recreational injuries

Readings

1. Chapter 7 "Residential Injuries" Injury Prevention: Meeting the Challenge. p 145-162.

2. Rosewizc. U.S. Lab fights Furniture Fires with Fire. The Wall Street Journal, 8/13/93.

3. Gorman, R. et al. A Successful City-wide smoke detector giveaway program. Pediatrics, 1985. 75(1):14-18

4. Chapter 8 "Recreational Injuries" Injury Prevention: Meeting the Challenge. p 163-176.

Mon., 6/10/96

Topics

Occupational Injuries

· Overview of occupational injuries

· SafeTeen Work Project

· Video on child/adolescent occupational injuries (30 min)

Learning objectives

1. To state the magnitude of the occupational injury problem

2. To state high risk groups and patterns of the problem

Readings

1. Chapter 9 "Occupational Injuries" Injury Prevention: Meeting the Challenge. p 163-176.

2. Banco, L, Lapidus, G, and Braddock, M. Work-Related Injury Among Connecticut Minors. Pediatrics. 89(5): 957-960, May 1992

Wed., 6/12/96

Topics

1. Violence in America

2. Adolescent violence

· guest speaker: Ms. Stacey Miller, Coordinator,

Hartford Violence Prevention Project

Learning objectives

1. To define violence and describe the overlapping perspectives of public health, criminal justice and behavioral science

2. To recognize that violence is a public health problem and can be studied epidemiologically to identify high risk groups and develop and implement preventive strategies

3. To describe the wider context in which violence occurs: the social norms, attitudes and models that can encourage violence.

4. To state the magnitude of the assaultive injury problem

5. To state high risk groups/patterns of the assaultive injury problem

6. To describe the interventions available to prevent assaultive injuries

Readings

1. Chapter 10 "Violence and Injury" Injury Prevention: Meeting the Challenge. p 192-203.

2. Chapter 11 "Assaultive Injuries" Injury Prevention: Meeting the Challenge. p 192-203.

3 Zavoski, R. Lapidus, G., et al. A Population Based Study of Severe Firearm Injury. Pediatrics, 1995. 96(2):278-282

4. Lapidus, G, Braddock, M. Education & Training in Violence Prevention: A Public Health Model, in When Anger Governs, Preventing Violence in America. (edited by Hampton, R., Jenkins, P, and Gullotta, T.) Sage Publications, Thousand Oaks, CA

Mon., 6/17/96

Topics

1. Child Abuse

2. Domestic Violence

· guest speaker, Karen Carney, Coordinator

Hartford Hospital Domestic Violence Prevention Project

3. Rape and Sexual Assault

Learning objectives

1. To state the magnitude and characteristics of child homicide.

2. To define child abuse as a general term encompassing physical, psychological or emotional abuse, sexual abuse, and neglect.

3. To describe the magnitude and costs of the child abuse problem

4. To describe the risk factors for child abuse

5. To describe the interventions available to prevent child abuse

Learning objectives

1. To state the magnitude, costs, and risk factors of domestic problem

2. To describe the interventions available to prevent domestic violence

Readings

1. Chapter 12 "Child abuse" Injury Prevention: Meeting the Challenge. p 213-222

2. Lang, J. The short, unhappy life of Dale-Lyn Crenshaw. Northeast Magazine, Hartford Courant 1987 (Mar):12.

3. Chapter 13 "Domestic Violence" Injury Prevention: Meeting the Challenge. p 223-232

Wed., 6/19/96

Topics

1. Teen Suicide

· Don't Say Goodbye Program - West Hartford Youth Suicide Prevention Program

2. Firearm Injuries

· guest speaker: Dr. Robert Zavoski, MD,MPH,

Learning objectives

1. To describe the magnitude, risk factors, and interventions available to prevent youth suicide problem

2. To describe the magnitude, risk factors, and interventions available to prevent firearm injury

Readings

1. Chapter 16 "Suicide" Injury Prevention: Meeting the Challenge. p 252-260.

2. Chapter 17 "Firearm Injuries" Injury Prevention: Meeting the Challenge. p 261-267.

Mon., 6/24/96

Topics

1. Trauma care systems

2. Student Presentations

Learning objectives

1. To define trauma care systems

2. To state the important reasons for injury prevention practitioners to understand the role of specialists in trauma care and rehabilitation.

3. To describe the various components of trauma care and emergency medical services, the growth of emergency medical services, the barriers to the growth of trauma care systems

Readings

1. Chapter 18 "Trauma care systems" Injury Prevention: Meeting the Challenge. p 271-282.

Wed., 6/24/96

Topics

1. Exam
2. Student Presentations

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