David Sleet

On 28 October 2009, the International Code Council (ICC) met in Baltimore, Maryland (USA). The ICC, a membership association dedicated to building safety and fire prevention, develops the codes used to construct residential and commercial buildings. After much debate, the Council voted to reject a set of proposals to remove a provision specifying that all new onefamily and two-family homes be equipped with a home fire sprinkler system. The vote is a strong endorsement of sprinkler technology, and one that should be of interest to public health professionals. The attention within the ICC to residential sprinklers presents an opportunity for public health professionals who work in injury prevention to lend their expertise to the residential sprinkler effort at a critical point in the history of this technology. We here present a case in support of residential fire sprinkler codes, and offer Injury Prevention readers a brief overview of the ICC process concerning sprinklers for onefamily and two-family homes. Residential fires are a major source of injury worldwide, although rates of residential fire death vary among nations. In the USA, where the October ICC vote will have the most immediate impact (because most US localities that adopt codes use those developed by the ICC), more than 2700 people (0.91/ 100 000) died in a home fire in 2008. Comparable rates for Canada in 2002 (0.80), the UK in 2007 (0.54), and other industrialised countries suggest a need for action on this issue. Although the magnitude of the residential fire problem varies across countries, the potential of sprinkler technology to reduce these injuries in industrialised countries is clear, and the need to establish home fire sprinklers as a standard for new residential construction as countries move toward industrialisation is urgent. Evaluations of the technology point to reductions in fire deaths and property loss. 5 Once installed, sprinklers require little maintenance and offer occupants automatic protection early in the fire event. Despite the benefits of this intervention, public health professionals have been slow to embrace residential sprinkler technology, as evidenced by the dearth of research publications from our field and the absence of sprinkler abstracts at our professional meetings. The ICC decision about residential code requirements for sprinklers is part of the larger intersection between building codes and injury prevention, and one that is too often overlooked in modern times when evaluating how to most effectively intervene to prevent injury-related death and disability. Building codes with the potential to prevent injury offer tangible examples of the life-saving potential associated with changing the home environment. The Triangle Shirt Waist Factory fire in 1911 prompted, among other changes, a requirement that sprinklers be installed in specified factory spaces, and is cited as one of many tragic events that prompted a series of interventions to improve worker safety through the work environment. Almost 100 years later, attention to the safety of homes (where the risk of dying in a fire is greatest) is the focus in the current effort to bring the same protections we have come to expect at work to the built environment where people live. In 2008 sprinkler advocates prevailed at the ICC hearings in Minnesota, and sprinklers were added to the 2009 edition of the International Residential Code (IRC), the ‘‘model’’ code that sets the standards in the USA for one-family and two-family new home construction. In response to this addition, the National Association of Home Builders submitted a formal proposal to remove this provision from the 2012 edition of the IRC code through a formal proposal that prompted the October 2009 vote. Advocates on both sides of this issue participated in the Baltimore hearings where dues-paying ICC members cast their votes. With the votes cast, sprinkler advocates expect to retain the sprinkler provision in the IRC at a Final Action Hearing scheduled for May 2010. As the ICC process moves toward a final resolution on the matter of sprinklers in one-family and two-family homes, the experience provides a reminder of the important role that building codes, and the process of developing codes, has in injury prevention and public health. Home fire sprinklers are an effective strategy for preventing fire-related injury and death, 5 and efforts to advance this technology through research, advocacy and practice benefit from the perspective that our field brings. The residential sprinkler issue should be familiar territory for professionals in our field. We have a history of successfully advancing policy issues that are met by resistance from some in industry—for example, airbags in motor vehicles. Our experience with similar issues, the power of the population-based scientific perspective that we bring, and the presence of a strong set of natural, established allies in the fire service and their…

Few corporate-based health promotion programs address motor vehicle crashes as a major preventable cause of death and disability for employees. This report examines safety belt use of employees at Control Data Corporation, its relationship to other health behaviors, and the potential cost-savings from increasing safety belt use among employees. Survey data were collected on employee health status, health risks, and health care claims from 1982-1983. Safety belt users reported higher productivity, fewer sick days, fewer chronic conditions and better overall health practices than non-users. Participants in StayWell (a health promotion program) reported higher safety belt use than employees at control sites. A significant number of workers who completed two or more risk profiles reported improving their safety belt use from four to eight percent. Projected annual cost-savings to the corporation from the increase ranged from $9,210 to $38,785. Recommendations are made for further resear...

Simulation gaming is defined: a learning innovation which employs surrogate role taking in a game format designed to facilitate decision-making skills. A simulation game is any activity which combines the characteristics of a game (competition, rules, clear outcome) with those of a simulation (replication of real-life phenomena, social interaction, problem solving). Simulation gaming in safety education is outlined, including its advantages, available models, and an eight-step process for design and use. Simulation gaming shifts the emphasis of instruction from information acquisition to skill application. It improves safety education programs in several ways: increased motivation for learning about safety, improved student-teacher interaction, increased student interaction, application of knowledge to personal life, relevance of knowledge to accident prevention, opportunity for guided practice, and explicit performance feedback. Driver training simulators are probably the single be...

The numerous health benefits of physical activity have been well documented, resulting in public health support of regular physical activity and exercise. Although beneficial, exercise also has corresponding risks, including musculoskeletal injuries. The incidence and risk factors for exercise-related injury have been poorly assessed in women. Many civilian exercise activities (e.g., jogging, walking, and erobics) have corollaries in military physical training; injury incidence and risk factors associated with military physical training have been more thoroughly studied. Injury risks increase as the amount of training increases (increased xposure). The same exercise parameters that can be modified to enhance physical fitness (i.e., frequency, duration, and intensity) also influence the risk for injury in a dose-response manner. Higher levels of current physical fitness (aerobic fitness) protect the participant against future injury. A history of previous injury is a risk factor for ...

This study was directed toward the identification of components of wellness in adolescents ages 12-17. Content for wellness-learning games aimed at youth was derived from the professional judgment of an advisory panel composed of experts in preventive medicine, health education, and adolescent development. The panel was polled by mail in a Delphi-like series of structured inquiries to gather information about the physical, social, and emotional characteristics of healthy adolescents and to identify the knowledge, attitudes, and behaviors appropriate to the promotion or support of those characteristics. The study resulted in a consensus of 39 attributes considered important in the development of healthy adolescents.

To estimate how frequently adults in the United States drive while impaired by alcohol. Telephone survey. The 49 states (and the District of Columbia) that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 1993. A total of 102,263 noninstitutionalized adults aged 18 years or older. The percentage of respondents who reported alcohol-impaired driving; number of episodes of alcohol-impaired driving per 1000 adult population; and total number of episodes of alcohol-impaired driving-each by age, sex, race, level of education, and state. Overall, 2.5% of adults reported an estimated 123 million episodes of alcohol-impaired driving in 1993. This corresponds to 655 episodes of alcohol-impaired driving for each 1000 adults (range among states per 1000 adults, 165-1550). Alcohol-impaired driving was most frequent among men aged 21 to 34 years (1739 episodes per 1000 adults) and was nearly as frequent among men aged 18 to 20 years (1623 episodes per 1000 adults), despite legislation in all states that prohibited the sale of alcohol to persons younger than age 21 years in 1993. Alcohol-impaired driving is common even among underage persons. Strict enforcement of laws that discourage alcohol-impaired driving is needed along with community and patient education to reduce the prevalence of alcohol-impaired driving and prevent injuries and deaths from alcohol-related motor vehicle crashes. Data from the BRFSS, an ongoing source of national and state-specific data on the number of episodes of alcohol-impaired driving, are potentially useful for monitoring trends and evaluating the effect of future efforts to reduce alcohol-impaired driving.

This chapter focuses on the potential of the ecological model for understanding the antecedent causes of unintentional injuries and the guiding intervention for their prevention and control. It discusses the scope and impact of unintentional injuries in USA, especially those ...

Change, whether in an individual's health behavior or in an institutional food service operation, does not have to be haphazard. Kurt Lewin's method of force-field analysis is designed to facilitate change by providing a systematic problem-solving model that can be widely generalized. This model was applied to a campaign opposing the intrusion of a fast-food chain on San Diego State University's campus food services. By using a four-step process of analyzing the situation, determining the changes required, making the changes indicated and stabilizing the new situation, students were successful in reversing the Student Council's decision to permit McDonald's Corporation to operate a food service facility on campus. The outcome resulted in significant progress toward improved food services for students on campus. This experience suggests that changes in food service options can be directed and controlled if appropriate analysis of factors contributing to improvement is conducted. These changes are viewed as having a positive influence on health behavior and social welfare.

Sports-related concussion (SRC) is a common sports injury in children and adolescents. With the vast amount of youth sports participation, an increase in awareness of concussion and evidence that the injury can lead to consequences for school, sports and overall quality of life, it has become increasingly important to properly diagnose and manage concussion. SRC in the student athlete is a unique and complex injury, and it is important to highlight the differences in the management of child and adolescent concussion compared with adults. This review focuses on the importance of developing a multimodal systematic approach to diagnosing and managing pediatric sports-related concussion, from the sidelines through recovery.

Emerging evidence shows that homelessness continues to be a chronic public health problem throughout Canada. The Bridge Healing Program has been proposed in Edmonton, Alberta, as a novel approach to combat homelessness by using hospital emergency departments (ED) as a gateway to temporary housing. Building on the ideas of Tiny Villages, the Bridge Healing Program provides residents with immediate temporary housing before transitioning them to permanent homes. This paper aims to understand effective strategies that underlie the Tiny Villages concept by analyzing six case studies and applying the lessons learned to improving the Bridge Healing Program. After looking at six Tiny Villages, we identified four common elements of many successful Tiny Villages. These include a strong community, public support, funding with few restrictions, and affordable housing options post-graduation. The Bridge Healing Program emphasizes such key elements by having a strong team, numerous services, and ...

Injuries and violence among young people have a substantial emotional, physical, and economic toll on society. Understanding the epidemiology of this public health problem can guide prevention efforts, help identify and reduce risk factors, and promote protective factors. We examined fatal and nonfatal unintentional injuries, injuries intentionally inflicted by other (i.e., assaults and homicides) among children ages 0-19, and intentionally self-inflicted injuries (i.e., self-harm and suicides) among children ages 10-19. We accessed deaths (1999-2015) and visits to emergency departments (2001-2015) for these age groups through the Centers for Disease Control and Prevention's (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS), and examined trends and differences by age, sex, race/ethnicity, rural/urban status, and injury mechanism. Almost 13,000 children and adolescents age 0-19 years died in 2015 from injury and violence compared to over 17,000 in 1999. While...

Older adults are at high risk for stroke and falls, both of which require a large amount of informal caregiving. However, the economic burden of informal caregiving associated with stroke and fall history is not well known. Using the 2010 Health and Retirement Study, data on non-institutionalized adults aged ≥65 years (N=10,129) in 2015-2017 were analyzed. Two-part models were used to estimate informal caregiving hours. Based on estimates from the models using a replacement cost approach, the authors derived informal caregiving hours and costs associated with falls in the past 2 years for stroke and non-stroke persons. Both the prevalence of falls overall and of falls with injuries were higher among people with stroke than those without (49.5% vs 35.1% for falls and 16.0% vs 10.3% for injurious falls, p<0.01). Stroke survivors needed more informal caregiving hours than their non-stroke counterparts, and the number of informal caregiving hours was positively associated with non-in...

Motorcyclists account for 23% of global road traffic deaths and over half of fatalities in countries where motorcycles are the dominant means of transport. Wearing a helmet can reduce the risk of head injury by as much as 69% and death by 42%; however, both child and adult helmet use are low in many countries where motorcycles are a primary mode of transportation. In response to the need to increase helmet use by all drivers and their passengers, the Global Helmet Vaccine Initiative (GHVI) was established to increase helmet use in three countries where a substantial portion of road users are motorcyclists and where helmet use is low. The GHVI approach includes five strategies to increase helmet use: targeted programs, helmet access, public awareness, institutional policies, and monitoring and evaluation. The application of GHVI to Vietnam, Cambodia, and Uganda resulted in four key lessons learned. First, motorcyclists are more likely to wear helmets when helmet use is mandated and e...

Motorcycle crashes account for a disproportionate number of motor vehicle deaths and injuries in the U.S. Motorcycle helmet use can lead to an estimated 42% reduction in risk for fatal injuries and a 69% reduction in risk for head injuries. However, helmet use in the U.S. has been declining and was at 60% in 2013. The current review examines the effectiveness of motorcycle helmet laws in increasing helmet use and reducing motorcycle-related deaths and injuries. Databases relevant to health or transportation were searched from database inception to August 2012. Reference lists of reviews, reports, and gray literature were also searched. Analysis of the data was completed in 2014. A total of 60 U.S. studies qualified for inclusion in the review. Implementing universal helmet laws increased helmet use (median, 47 percentage points); reduced total deaths (median, -32%) and deaths per registered motorcycle (median, -29%); and reduced total injuries (median, -32%) and injuries per registered motorcycle (median, -24%). Repealing universal helmet laws decreased helmet use (median, -39 percentage points); increased total deaths (median, 42%) and deaths per registered motorcycle (median, 24%); and increased total injuries (median, 41%) and injuries per registered motorcycle (median, 8%). Universal helmet laws are effective in increasing motorcycle helmet use and reducing deaths and injuries. These laws are effective for motorcyclists of all ages, including younger operators and passengers who would have already been covered by partial helmet laws. Repealing universal helmet laws decreased helmet use and increased deaths and injuries.

The aim of this study was to highlight the differences in injury rates between populations through a descriptive epidemiological study of population-level trends in injury mortality for the high-income countries of Australia, Canada and the United States. Mortality data were available for the US from 2000 to 2014, and for Canada and Australia from 2000 to 2012. Injury causes were defined using the International Classification of Diseases, Tenth Revision external cause codes, and were grouped into major causes. Rates were direct-method age-adjusted using the US 2000 projected population as the standard age distribution. US motor vehicle injury mortality rates declined from 2000 to 2014 but remained markedly higher than those of Australia or Canada. In all three countries, fall injury mortality rates increased from 2000 to 2014. US homicide mortality rates declined, but remained higher than those of Australia and Canada. While the US had the lowest suicide rate in 2000, it increased b...

Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future. To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries. Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n = 26) for rating content validity, and cognitive interviewing of TBI family members (n = 9) for assuring item clarity. The Safety Assessment Measure is comprised of 6 primary scales - Cognitive Capacity, Visuomotor Capacity, Wheelchair Use, Risk Perception, Self-Regulation, and Compliance Failures with Safety Recommendations - in which family caregivers or clinicians rate the risk for unintentional injury or harm in adults who ...

... Peterson L, Saldana L, Schaffer C. Maternal intervention strategies in enforcing children's bicycle helmet use. Journal of Health Psychol-ogy. 1997;2:225-230. Memorial contributions to her life and work can be made to the Lizette Peterson-Homer Graduate Fellowship Fund ...

ABSTRACT Discusses behavioral principles used to encourage protective behaviors such as wearing safety belts and using child safety seats when riding in an automobile. The most successful programs have used a combination of rewards, feedback, guidance, contingency management, and modeling to increase low use rates. More research is needed on the influence of schedules of reinforcement, social support, mandatory use laws, and in-vehicle behavioral feedback systems in increasing occupant protection. It is suggested that in the future, health promotion/disease prevention specialists may turn to behavioral psychology for answers to questions of how best to modify self-protective behavior in automobiles. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The relationship between norepinephrine and stress caused by life changes was assessed using urinary norepinephrine levels and responses to a 57-item stress questionnaire interview obtained from 21 post-myocardial infarction and 27 healthy control male and female subjects. High correlations between norepinephrine and duration of present stress and duration and severity of life changes, and moderate correlations between norepinephrine and anxiety and depression were found among the post-infarction group. No significant correlations were found in the control group. Post-infarction subjects with elevated norepinephrine had significantly higher scores on duration of present stress and duration and severity of life changes than did post-infarction subjects with normal norepinephrine levels. Control subjects with normal and elevated norepinephrine did not differ significantly on any of the comparison variables. Standard risk factors failed to add significantly to the prediction of norepinephrine in either group. However, 68.3 percent of the variance in norepinephrine was accounted for by a single predictor, the duration of present stress.

Each year, an estimated 270,000 pedestrians die from road traffic-related injuries, (worldwide) and children are among the most vulnerable. Child pedestrian injuries occur primarily in residential areas, often on the same street or in close proximity to the child’s home, and 90% of injured child pedestrians are unaccompanied by an adult at the time of the injury. The cause of these injuries is a complex combination of factors related not only to characteristics of the child but also the built environment, the road configuration, features of the motor vehicle that might reduce injury, and driver behavior. Accordingly, effective interventions must incorporate education, technology, and improved infrastructure. The medical practitioner can not only provide the necessary education but can also be a powerful voice for changes in pedestrian infrastructure that make walking safer. This article explores the current state of childhood pedestrian injuries using examples from the United States...