Deborah C. Girasek

Epidemiology of burn injuries II: Psychiatric and behavioural perspectives

Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with ‘intentional’ burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.

A Systematic Process to Prioritize Prevention Activities: Sustaining Progress Toward the Reduction of Military Injuries

BACKGROUND To sustain progress toward injury reduction and other health promotion goals, public health organizations need a systematic approach based on data and an evaluation of existing scientific evidence on prevention. This paper describes a process and criteria developed to systematically and objectively define prevention program and policy priorities. METHODS Military medical surveillance data were obtained and summarized, and a working group of epidemiology and injury experts was formed. After reviewing the available data, the working group used predefined criteria to score leading military unintentional injury causes on five main criteria that assessed factors contributing to program and policy success: (1) importance of the problem, (2) effectiveness of existing prevention strategies, (3) feasibility of establishing programs and policies, (4) timeliness of implementation and results, and (5) potential for evaluation. Injury problems were ranked by total median score. RESULTS Causes with the highest total median scores were physical training (34 points), military parachuting (32 points), privately-owned vehicle crashes (31 points), sports (29 points), falls (27 points), and military vehicle crashes (27 points). CONCLUSIONS Using a data-driven, criteria-based process, three injury causes (physical training, military parachuting, and privately owned-vehicle crashes) with the greatest potential for successful program and policy implementation were identified. Such information is useful for public health practitioners and policymakers who must prioritize among health problems that are competing for limited resources. The process and criteria could be adapted to systematically assess and prioritize health issues affecting other communities.

The Effectiveness of Injury Prevention Strategies: What Does the Public Believe?

This article is based on a random digit dialed telephone survey in which adults were asked to name effective strategies for preventing deaths due to motor vehicle crashes, falls, drowning, fires/burns, and poisoning. A majority of the 943 respondents could name prevention techniques, although they were least likely to do so for fatal falls. Participants at highest risk for not naming a countermeasure were those with fewer years of education. The strategy cited most often for preventing deaths due to falls, poisoning, and drowning was safety education. These findings suggest that more advantaged members of the public feel they know how to prevent Americas leading causes of injury death. They may not fully appreciate, however, the options of creating health-promoting environments and safer products. This work makes it very clear that people with less education also need to be exposed to the breadth of effective injury countermeasures.

Would society pay more attention to injuries if the injury control community paid more attention to risk communication science

“If a disease were killing our children at the rate unintentional injuries are, the public would be outraged and demand that this killer be stopped.” Former US Surgeon General, C Everett Koop Whenever injury control professionals gather, it doesn’t take long for the conversation to turn to one topic: “Why is it that more attention and resources aren’t devoted to injuries, the leading cause of death for children and young adults?” One early hypothesis—that people think injuries cannot be prevented—has not held up to scientific scrutiny.1–6 Another possible explanation, however, may be found in the risk communication literature. Since the 1980s, corporate and government officials have turned to risk communication experts for help with a problem contrary to our own: why do communities “overreact” to hazards that pose minimal risk from an epidemiological perspective?7 In such situations, environmental engineers and safety experts characterize lay people’s views as irrational or ignorant.8 For example, in a national (US) survey, more than twice as many parents worried about their children being kidnapped than being involved in an “automobile accident”.2 Many professionals assumed that if they shared more data with the public, enlightenment would follow. The risk communication literature suggests, however, that scientists may also benefit from enlightenment.8 Most Americans know that injuries are a leading cause of death,9,10 yet they display little concern for injury prevention. In trying to explain this disconnect between vital statistics and public support, psychometric researchers have identified qualitative dimensions of risk not captured by epidemiologic methods. Sandman conceptualizes Risk, as it is perceived by the public, as a function of Hazard + Outrage.8 His “hazard” refers to the statistical calculation of risk that professionals generally rely on. “Outrage”, on the other hand, is more emotional and predicts an issue’s …

‘It was a freak accident’: an analysis of the labelling of injury events in the US press

Objectives Given that the news media shape our understanding of health issues, a study was undertaken to examine the use by the US media of the expression ‘freak accident’ in relation to injury events. This analysis is intended to contribute to the ongoing consideration of lay conceptualisation of injuries as ‘accidents’. Methods LexisNexis Academic was used to search three purposively selected US news sources (Associated Press, New York Times and Philadelphia Inquirer) for the expression ‘freak accident’ over 5 years (2005–9). Textual analysis included both structured and open coding. Coding included measures for who used the expression within the story, the nature of the injury event and the injured person(s) being reported upon, incorporation of prevention information within the story and finally a phenomenological consideration of the uses and meanings of the expression within the story context. Results The search yielded a dataset of 250 human injury stories incorporating the term ‘freak accident’. Injuries sustained by professional athletes dominated coverage (61%). Fewer than 10% of stories provided a clear and explicit injury prevention message. Stories in which journalists employed the expression ‘freak accident’ were less likely to include prevention information than stories in which the expression was used by people quoted in the story. Conclusions Journalists who frame injury events as freak accidents may be an appropriate focus for advocacy efforts. Effective prevention messages should be developed and disseminated to accompany injury reporting in order to educate and protect the public.

A Qualitative Study of Post-Settlement Influences on State Tobacco Control Funding

State settlements with the tobacco industry increased the availability of funds that might be used for improving health outcomes and increased scrutiny of tobacco control funding overall. This research identified potential explanatory factors for state tobacco control funding and developed a conceptual framework to guide further exploration. Key informant interviews with 14 tobacco policy professionals were conducted to augment the information available in the scientific literature on funding influences. Interviews yielded a comprehensive list of 26 factors that were returned to key informants for ratings of importance using a modified Delphi process. Results indicate that the top funding influences are budgetary constraints, lobbying, advocacy, tobacco economy, legislative priorities, public opinion, and leadership by the governor or state legislators. A conceptual diagram is presented of all factors clustered into three categories. Further research is planned to quantify these factors and assess their explanatory value

Parents of fatally injured children discuss taking part in prevention campaigns: an exploratory study.

This qualitative study explores how a small group of parents who have lost children to accidental injuries feel about taking part in prevention campaigns. Prospective participants were identified through a state medical examiners office. Six mothers and 5 fathers of children who had died 3-5 years earlier agreed to be interviewed. All participants thought that it was appropriate to approach bereaved parents about such opportunities, after the most disabling phase of grief had subsided. Yet they raised cognitive, emotional, and practical barriers to engaging in prevention work. The appealing aspects of becoming a safety advocate included preventing emotional and physical injuries to others, as well as advancing their own recovery. It is very possible that the volunteers we spoke with held more positive views on participation than the many mothers and fathers who chose not to participate in our study. Nonetheless, their comments give us our first insights into how collaborating on prevention may feel to those for whom prevention has failed.

Evaluation of a Brief Intervention Designed to Increase CPR Training among Pregnant Pool Owners.

This study evaluated whether a brief videotape could motivate pregnant pool owners to be trained in infant/child cardiopulmonary resuscitation (CPR). Women were recruited from prenatal classes in South Florida. Eligible volunteers were randomized to view a video or receive standard treatment, after completing a questionnaire. The video explained toddler drowning risk, as well as the value of isolation pool fencing and CPR training. Women were contacted by phone 6 months after giving birth to complete a follow-up survey. Sixty-one percent of eligible mothers agreed to study enrollment and 92% of those completed a follow-up interview (n = 101). At baseline, there was no significant difference between the proportion of mothers with current CPR training in the treatment and control groups. At follow-up, 48% of those in the intervention group reported CPR instruction versus 28% of the control group (x(2) = 3.93, P = 0.03). Video viewers were also more likely to report significant changes in perceptions that favored CPR training. Health care facilities located in communities with high rates of toddler drowning may want to screen prenatal students for pool ownership and encourage at-risk families to be trained in infant/child CPR. Such programs should, however, emphasize the primacy of isolation fencing as a preventive measure.

Understanding hikers who approached a hazardous river in Yosemite National Park

Objectives To understand the perceptions and motivations of hikers who approached a swift river at locations that have been associated with drowning in the past. Methods A survey was completed by 399 adults who had been observed getting ‘too close’ to the Merced River. The questionnaire covered trail familiarity, information sources, timing and motivation of their decision, perceived safety, knowledge and opinion of park rules. Results Sixty-eight per cent of invited hikers agreed to participate. Almost all had received advance information about their hike, but most often that did not include a river warning. Most respondents were observed in the risk zone by the footbridge, and their most frequent motivation was to ‘cool off’. Ninety-two per cent of hikers reported feeling very or somewhat safe by the river. Their risk perceptions did not correlate with expert ratings of danger. Males, younger subjects and those who had hiked the trail before were more likely to enter the most hazardous parts of the risk zone. Eleven per cent of people at the footbridge and 43% at the top of the waterfall thought that the park should not allow visitors to go where they had been. The most common reason they gave for this view was that the location was unsafe. Conclusions While this needs assessment identified channels for informing hikers of drowning risk, there are indications that they might not personalise such warnings. Another option would be to explore cooling alternatives that could compete with the swift water that runs along many hiking trails.

A Systematic Process to Prioritize Prevention Activities

BACKGROUND To sustain progress toward injury reduction and other health promotion goals, public health organizations need a systematic approach based on data and an evaluation of existing scientific evidence on prevention. This paper describes a process and criteria developed to systematically and objectively define prevention program and policy priorities. METHODS Military medical surveillance data were obtained and summarized, and a working group of epidemiology and injury experts was formed. After reviewing the available data, the working group used predefined criteria to score leading military unintentional injury causes on five main criteria that assessed factors contributing to program and policy success: (1) importance of the problem, (2) effectiveness of existing prevention strategies, (3) feasibility of establishing programs and policies, (4) timeliness of implementation and results, and (5) potential for evaluation. Injury problems were ranked by total median score. RESULTS Causes with the highest total median scores were physical training (34 points), military parachuting (32 points), privately-owned vehicle crashes (31 points), sports (29 points), falls (27 points), and military vehicle crashes (27 points). CONCLUSIONS Using a data-driven, criteria-based process, three injury causes (physical training, military parachuting, and privately owned-vehicle crashes) with the greatest potential for successful program and policy implementation were identified. Such information is useful for public health practitioners and policymakers who must prioritize among health problems that are competing for limited resources. The process and criteria could be adapted to systematically assess and prioritize health issues affecting other communities.