|
CDC awards cooperative agreements and grants to state health departments, injury prevention units within large city or municipal health authorities, and universities to conduct community-based unintentional injury prevention programs throughout the United States. During 2000–2001, programs addressed residential fires, child passenger safety, falls among older adults, and dog bite injuries.
Fire-Related Injury Prevention Programs
The United States currently has the third highest overall fire death rate of all industrialized countries. Residential fires are the most important cause of fire-related mortality. In 2000, approximately 85% of all U.S. fire deaths occurred in homes. That year, fire departments responded to 368,000 home fires in the United States that claimed the lives of an estimated 3,420 people and injured another 16,975. Residential fires disproportionately affect young children, older adults, African Americans, and Native Americans. During 2000, residential fires accounted for more than $5 million in direct property damage.
Functional smoke alarms cut the chances of dying in a house fire by 40% to 50%. However, at least one-quarter of U.S. households lack working smoke alarms.
 Smoke Alarm Installation and Fire-Safety Education
Based on the success of previous programs, in October 2001, CDC awarded five-year cooperative agreements to 13 states—Alabama, Alaska, Georgia, Kansas, Kentucky, Minnesota, Mississippi, New York, North Carolina, Oklahoma, South Carolina, Virginia, and Washington—to install long-lasting, lithium-powered smoke alarms and to provide fire-safety education in homes in high-risk communities. High-risk communities are those with fire death rates higher than state and national averages and median household incomes below the poverty level. Homes with children and older adults—those at highest risk—are especially targeted for inclusion in the program.
CDC funded 14 states for three years (1998–2000) to implement similar measures in high risk communities. Program staff canvassed nearly 160,000 homes and installed more than
116,000 smoke alarms. Fire safety messages have reached nearly 7.5 million people as a result of these programs. An estimated 346 lives potentially have been saved when alarms installed in program homes gave residents early warning of a fire.
Success Stories
In Arkansas, three children had been left home alone for only a few minutes when a fire started. The two older children, ages 5 and 9, heard the smoke alarm and followed the escape plan they had learned through the CDC-funded fire safety and smoke alarm program. The youngest child, age 4, crawled under a bed; neighbors who heard the smoke alarm rushed in and saved the child.
In Virginia, the life of an 83-year-old woman was spared, thanks to a smoke alarm installed through the CDC-funded program. On an August night just two weeks after installation, the smoke alarm woke the woman, who was home alone. The alarm’s warning gave her enough time to escape the fire without injury.
In Washington, through the CDC-funded program, firefighters installed a smoke alarm in the mobile home of a Shoreline mother and her 3-year-old son. Weeks later, the alarm woke the mother, who found a portion of her home ablaze. She grabbed her sleeping child and escaped before the home became fully engulfed. She was treated for smoke inhalation and released; her son was unharmed.
In Oklahoma, a young boy awoke to the sound of the smoke alarm that had been installed in his home the year before through the CDC-funded program. A candle that had been left burning near a recliner had set the chair on fire. Upon hearing the alarm, the boy awakened his mother and they both escaped without injury. The fire destroyed the house; the smoke alarm saved its residents.
Falls Among Older Adults
Falls are the leading cause of injury death for Americans 65 years and older. Each year, about 35% to 40% of adults 65 and older fall at least once. In 1999, more than 10,000 people ages 65 and older died from fall-related injuries. Direct costs from this type of injury are high. The estimated cost of fall-related injuries among older adults was $20.2 billion in 1994; by 2020, it may reach $32.4 billion.
More than 330,000 older adults—80% of them women—were hospitalized for hip fractures in 1999. Hip fractures result in more hospital admissions than any other injury, and 12% to
20% of older adults who sustain hip fractures die within a year. Of hip fracture patients who survive, most experience decreases in their mobility or their ability to function indepen-dently. Only half of the healthy, community-dwelling older adults who suffer fall-related hip fractures are able to live independently one year later.
Who is most at risk? Women are three times more likely than men to be hospitalized for fall-related injuries. However, older men are 22% more likely than older women to die as the result of a fall. This may be because men 65 and older have more chronic conditions than do women of the same age or because they engage in risky behaviors, such as climbing on ladders. Older adults who have fallen previously or who stumble frequently are two to three times more likely to fall within a year, as compared with older adults who have not fallen or do not stumble regularly. Frail adults—those with impaired strength and balance—are three times more likely to fall as healthier persons of the same age, and they sustain more severe injuries when they fall.
Multifaceted Program to Prevent Falls
CDC funds the California State Health Department to design, implement, and evaluate the “No More Falls!” program, a community-based fall prevention demonstration project for older adults. This program includes four elements: education, exercise to increase strength and balance, home assessment and modification, and medication review. Results of the program’s evaluation will help guide future efforts to develop multifaceted fall prevention programs.
Preventing Fire- and Fall-Related Deaths Among Older Adults
Persons ages 65 years and older are at higher risk for injury and death from falls and fires than the population at large. To reduce injury from fire and falls among older adults, CDC is funding five states to implement and evaluate Remembering When: A Fire and Fall Prevention Program for Older Adults, a program that teaches life-saving lessons. It includes lesson plans, brochures, fact sheets, game cards, and more. This program was developed by the National Fire Protection Association (NFPA), with assistance from the U.S. Consumer Product Safety Commission, CDC and other partners.
Child Passenger Safety
 Motor vehicle crashes continue to be the leading cause of death among children in the United States. In 2000, motor vehicle crashes took the lives of more than 2,000 child passengers ages 15 and younger and seriously injured another 327,500. Many of these injuries could have been prevented. Of the children fatally injured, more than two-thirds were not in age-appropriate restraints or were completely unrestrained. Child safety seats reduce the risk of death by about 70% for infants and 55% for toddlers ages 1 to 4, and booster seats decrease injuries for children ages 4 to 8 years when compared with seat belt use alone. For children 9 years and older, seat belts reduce the risk of death by about 50%.
A Boost for Children Ages 4 to 8
CDC funds state health departments in Colorado, Kentucky, and New York to develop, implement, and evaluate community-based programs to increase booster seat use among children ages 4 to 8. During 2001, these grantees collected baseline data, assessed barriers to booster seat use, developed program materials, and began building partnerships with state and local organizations. In Colorado, program staff developed and aired two radio PSAs about the importance of booster seats. In Kentucky, program staff established a booster seat help-line and posted billboards in a high-traffic area of the intervention community. In New York, staff commissioned two songs to be used in the elementary school–based component of the program and adapted them for use in radio PSAs. Program evaluations, expected in 2003, will help guide future efforts to increase booster seat use.
Kids in the Back for a Safer Ride
Seating position is another key safety consideration for child passengers. All children ages 12 years and younger should ride in the back seat every time they ride in a vehicle. This greatly reduces the injury risk when front passenger-side airbags deploy and places children
in the safest part of the vehicle in the event of a crash. Riding in the back seat is associated with a 46% reduction in the risk of fatal injury in cars with a front passenger-side airbag and at least a 30% reduction in the risk of fatal injury in cars with no front passenger-side airbag. A 2000 telephone survey found that 24% of children ages 0 to 12 years rode in the front seat at least half the time. And unfortunately, as children became older, they were increasingly likely to ride in the front seat.
With CDC funding, the Center for Risk Analysis at the Harvard School of Public Health developed and implemented the “Kids in the
Back/Niños Atrás” program. This three-year, community-based intervention aims to increase the number of children ages 12 and younger who ride properly restrained in the back seat of motor vehicles. Project investigators organized a community task force, developed educational materials for both English-
and Spanish-speaking parents and children, and implemented an incentive program to further motivate parents and children to adopt the desired behavior. Investigators are currently collecting follow-up data and evaluating the program.
Success Story
A New York family took part in a CDC-funded education program about the importance of booster seats. The program also provided the family a free booster seat for their child. Soon after, the family’s mini-van was totaled in a severe car crash—but the child riding in the new booster seat was unharmed.
Bicycle Safety
Bicycle-related injuries are a significant public health problem. Bicycle-related head injuries alone account for about 500 deaths, 17,000 hospitalizations, and 153,000 emergency room visits each year. Two key risk factors for bicycle-related injuries are age and gender. Children ages 5 to 15 show the highest bicycle-related injury rates, and the rate of death from bicycle-related injuries is highest among children ages 10 to 14 years. On any given bicycle trip, males are 2.4 times more likely than females to be killed. Helmet use can significantly reduce bicycle-related injuries and deaths. Universal helmet use could save one life each day, and prevent one head injury every four minutes.
CDC supports efforts to promote bicycle safety in a hard-to-reach population—teens and young adults. Research has shown that middle school, high school, and university students have the lowest helmet use rates (a mere 3%), and they frequently disobey traffic laws while cycling. In October 2000, CDC funded researchers in Phoenix to conduct a three-year program to increase bicycle safety and helmet use among these populations. A theoretical model, Stages of Change, is being applied to bicycle safety practices in this age group to determine participants’ readiness for behavior change. Findings will guide development of bike safety interventions for these groups.
Dog Bites
Every 40 seconds, someone in the United States seeks medical attention for a dog bite– related injury. Each year, more than 4.7 million people are bitten by dogs, and nearly 800,000 seek medical care for the bite. Children, especially boys ages 5 to 9, have the highest incidence rate of emergency department visits resulting from dog bites. Many children do not know how to behave around a dog. Children’s small size and inability to fend off an attack may put them at additional risk. CDC supports research and programs to prevent these injuries from “man’s best friend.”
CDC is funding the Georgia Division of Public Health to conduct a dog bite prevention campaign in Chatham, Bullock, and Effingham counties. During 2001, program staff used the Community Readiness Model to complete a needs assessment. In 2002, program staff will use educational materials and media outreach to teach children, parents, dog owners, health care providers, and other adults about the risk of dog bite–related injuries and about strategies for preventing such injuries. Project staff will evaluate whether the campaign changes people’s beliefs and actions and reduces the number of dog bite–related injuries occurring in the three counties. Results of this effort will guide future efforts to prevent dog bites and associated injuries and deaths.
|
