Preventing Unintentional Childhood Injury FY 2014 Background Document

Preventing Unintentional Childhood Injuries Saves Lives

Injuries to children at home and at play are not accidents, and they can be prevented. The Centers for Disease Con trol and Prevention’s National Center for Injury Prevention and Control (CDC Injury Center) focuses on the sci ence behind making children safe – working to prevent leading causes of injuries, including motor vehicle crashes, drowning, falls, fires, suffocation and poisoning. Preventing injuries also saves money and benefits society. The number of children dying from injury dropped nearly 30% over the last decade. However, injury is still the number one (1) cause of death among children. More can be done to keep our children safe.

Public Health Problem

In the United States, unintentional injuries are the leading cause of death among children and adolescents ages 19 and younger. Each day, 33 children under 19 years of age die from an unintentional injury, such as those caused by motor vehicle crashes, drowning, burns, poisoning, falls, and sports and recreation injuries.

• Every hour, one child dies from an injury

• One in five child deaths is due to an injury

• Every four seconds, a child is treated for an injury in an emergency department

In addition to the physical and emotional toll of these injuries, there is a significant economic toll. Injury treatment is the leading cause of medical spending on children. The lifetime medical and work loss costs associated with a single year of child injury account for more than $87 billion. Investments in childhood injury prevention are cost-effective. Child safety seat distribution programs for children ages 0-4 provide cost-savings of approximately $2,200 per $55 seat. A $13 bicycle helmet for children ages 3-4 is estimated to

1 save society $580. The total benefits include the dollar value of medical costs, work loss, and lost quality of life costs.

Strategies that Work

Strategies to prevent childhood injuries can be classified as either changes to the environment (e.g., safer cars, ro adways, homes) or changes in behavior (e.g. wearing a helmet or refraining from texting while driving). Speci fic strategies will vary by the cause of injury. For instance, motor vehicle crashes are responsible for about hal f of all childhood unintentional injury deaths. Interventions to prevent these include: child occupant protectio n (child safety and booster seats), sidewalks/cross walks, bike helmets, among others. Strategies to advance t hese interventions can include behavioral and environmental changes through policies and education. For ins tance, to prevent drowning among children, studies show environmental interventions are effective such as f encing residential pools or having a lifeguard, as well as behavioral interventions such as teaching swimming skill and supervising children around water. These can be influenced by both policy and educational efforts.

Unique Role of the CDC Injury Center in Child Injury Prevention

The CDC Injury Center’s specific role in child injury prevention is to conduct research into risk factors and effective prevention measures, and to disseminate effective programs to ultimately save lives of children and reduce the number and severity of unintentional injuries among children. The CDC Injury Center often works with federal agencies, state and local health departments, nonprofit organizations, professional associations, businesses, and research institutions to identify and implement best practices to reduce child injury.

CDC’s Injury Center also acts as the convener of diverse organizations to advance child injury prevention. Key examples of this convening role include the development of the National Action Plan for Child Injury Prevention (NAP) , created with more than 60 stakeholder organizations across the nation to raise awareness about the problem of child injury; highlight prevention solutions; unite stakeholders around a common set of goals and strategies and mobilize action on a national, coordinated effort to reduce child injury. Additionally, the CDC Injury Center’s work on Heads Up, a national concussion awareness campaign, brought together a unique partnership with the National Football League among others in educating parents, coaches and schools to prevent, recognize, and respond to concussions sustained by youth athletes.

Childhood Injury Prevention in Action The CDC Injury Center’s efforts focus on improving the understanding of the problem of child injury, providing parents and caregivers with helpful resources, and creating a framework for the future based on evidence based strategies to prevent child injuries. 2 Child Injury Vital Signs In April 2012, the CDC Injury Center released a Vital Signs package highlighting trends in unintentional injury deaths among children to accompany the release of the National Action Plan. This report analyzed trends in deaths by mechanism, age group and state. It identified successes in preventing deaths from motor vehicle crashes, drowning, falls, and fires and burns; however, increases in deaths from teen poisoning and infant suffocation were also highlighted.

Improving Understanding of Drowning The May 2012 Morbidity and Mortality Weekly Report (MMWR), Drowning – United States, 2005- 2009, highlighted that drowning is responsible for more deaths in children one (1) to four (4) years than any other cause of death except birth defects. It also features updated recommendations from the American Academy of Pediatrics recognizing recent research suggests early swimming lessons among those 1-4 years can reduce the risk of drowning.

“Protect the Ones You Love” Initiative In an effort to raise parents’ awareness about the leading causes of childhood injury in the United States and the life-saving role parents have, the Injury Center launched the Protect the Ones You Love initiative. Protect the Ones You Love is dedicated to sharing information on the steps parents can take to make a positive difference. The Injury Center developed a variety of resources, including fact sheets, podcasts, e-cards, and media and event planning guides.

“Heads Up” Initiative Injury Center research has identified a growing problem of youth concussions and mild Traumatic Brain Injury (TBI), which can cause a wide range of functional short- or long-term changes affecting thinking, sensation, language, or emotions. To address this, the Injury Center developed Heads Up. This innovative and widely disseminated project is a collection of evidence-based educational and training materials for parents, students, coaches, older adults, and others designed to increase awareness of methods to prevent, recognize, and respond to TBIs. Supporting State Prevention Efforts The CDC Injury Center funds 20 states through the Core Violence and Injury Prevention Program (CORE VIPP) to develop improved capacity in injury prevention research and programs. Each state identifies priority areas in which they are asked to develop and implement an action plan. The priority areas often cross age groups but many specifically address injury among children, including child passenger safety, teen driving, TBI and sports concussion, drowning, child falls, and sudden unexpected infant death including suffocation.

National Action Plan (NAP) for Child Injury Prevention The National Action Plan for Child Injury Prevention (NAP), released in April 2012, was developed by the CDC Injury Center and more than 60 stakeholder organizations to spark coordinated action across the nation to prevent child injury. The Action Plan is built around six (6) domains containing goals and actions based on what we know, where we need to go, and how we can get there—at the broadest level. These six (6) domains include: data and surveillance, research, communication, education and training, health systems and health care, and policy. The CDC Injury Center has recently funded nine organizations to test the feasibility of implementing specific aspects of the NAP. These include efforts designed to strengthen collaboration of key stakeholders, provide tools for the field to improve data and consistency in program execution, showcase the promise of evidence-based programs on high burden topics, and build capacity in hospital settings and among employer networks. Funded organizations include:

3  Eastern Virginia Medical School  American College of Preventive Medicine

 Safe Kids Worldwide

 Education Development Center, Inc.

 Children’s Hospital Association

 National Safety Council

 Child Injury Prevention Alliance

 Children’s Hospital of Wisconsin

 SAVIR & Colorado School of Public Health

Successes Recent successes in preventing childhood injury prevention include:

 Helping to define the problem of child injury through the release of two ground-breaking reports: Child Injury Vital Signs documenting trends in child injury deaths by mechanism, age group, and state; and recent fatal and nonfatal drowning data.  Providing technical assistance to the Core VIPP grantees in Colorado and Georgia on graduated drivers licensing and child booster seat laws. The laws were ultimately passed by state legislatures enhancing safety among teen drivers and child passengers.  Supporting the YMCA’s efforts toward zero drownings through learn-to-swim efforts, focusing on high-risk populations (e.g., African Americans), and revamping and rereleasing the lifeguard training to improve recognition of distressed swimmers.  Helping to support implementation of concussion in sports policies in 40 states through the Heads Up online training modules for coaches and health care professionals. To date over 800,000 coaches have been trained.

Future Goals The CDC Injury Center will continue its efforts to lead and support child injury prevention by:

Short-Term Next Steps  Assisting the nine (9) funded partners on the implementation projects to begin addressing specific strategies from the National Action Plan. These projects examine the feasibility of specific strategies and results will guide future efforts. Project areas include:  Strengthening collaboration of key stakeholders.  Providing tools for the field to improve data and consistency in program execution.  Showcasing the promise of evidence-based programs on high burden topics.  Building capacity in non-traditional settings (e.g., employers, insurers).  Strengthening state efforts by providing funding, technical assistance, and subject matter expertise to Core VIPP-funded states focused on preventing child injury. 4  Continuing partnerships with federal agencies and national organizations to prevent child injury. Increasing partnerships will accelerate the downward trajectory of child injuries, by helping further disseminate what we know works.

Long-Term Goals • Defining the burden as well as risk and protective factors for unintentional child injuries by risk factor research. • Empowering parents and communities to take action to reduce the burden of child injuries through coordinated and effective communication efforts. • Raising visibility of child injury in the context of other health issues by collaborating with national organizations and relevant federal agencies. By leveraging other efforts and public health initiatives, we can save more lives. • Developing and accelerating the adoption of evidence-based interventions to prevent child injury through implementation and integration research. • Decreasing the death and disability rates for child injury:  Motor Vehicle – further promote child passenger safety;  Suffocation – partner around efforts to promote safe sleep environments; and  Drowning – disseminate more widely learn- to- swim efforts, fencing use, and effective supervision.

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