- SUICIDE TRENDS
- MEANS MATTER
- SUICIDE MONTH
- DRUG OVERDOSE
- AMERICAN INDIANS
- MILITARY DEPENDENTS
- TECH ENDS SUICIDE
- UPCOMING RESEARCH
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by E. Lenita Johnson (email@example.com)
Phenomenal and empowering are just two of the words attendees used to describe the 3rd Annual Innovations in Translating Injury Research into Effective Prevention Seminar sponsored by the Center for Injury Epidemiology and Research at Columbia University. The daylong event offered injury prevention colleagues the opportunity to network and learn about cutting edge research and best practices in injury prevention.
American College of Surgeons Committee on Trauma representative Glen Tinkoff, MD, FACS, FCCM says this seminar was paramount. “This is a major university and a major city with presentations made by professionals who understand the language, the need and the operations of injury prevention,” Tinkoff said during an interview prior to the seminar.
“It is paramount because we have not been in the public eye and that has been a problem with injury prevention with our outreach to our communities, our politicians, our legislators and our patients. We are not informing them well and so these venues are exceptionally important.”
Dr. Guohua Li, the Director of the Center for Injury Epidemiology and Prevention at Columbia University and the editor of The Springer Open-Access Journal, Injury Epidemiology understands the value of communication, partnerships, the Center and its work; and, he says the Center is doing what it can to contribute to change. “The significance of Columbia’s CDC funded Injury Control Research Center has been immeasurable. The Center has helped us to put injury prevention on the academic map of the University and the Mailman School of Public Health, develop well-structured coursework for Doctoral and Masters Students, add injury prevention to the mission statement of Columbia; and, most importantly when it comes to outreach, the Center helped expand and address priority areas of injury facing the nation and its most vulnerable population groups while strengthening collaborative efforts with colleagues at the University, in the region, in health departments, and in communities not only in this area but across the country.”
Barbara Barlow, MD, Columbia’s Injury Control Research Center Associate Director and Co-Director of Outreach says this is what the CDC wants. “The CDC wants you to have more than research and data. They want you to use the data to translate into action to improve community health and safety for children and their families,” Barlow says, “Most of the people attending the Columbia seminar like many health care professionals have never walked outside of their hospital walls, and that is what outreach is all about.” She went on to say the doctors, nurses and the community outreach workers need to walk outside the hospital walls and help the communities they serve in and help solve their health problems. “To just treat trauma and not try to prevent it is just absolutely immoral. As a physician you have an obligation not only to treat disease, sickness and injury but also to contribute to the community’s health and wellbeing.”
The Center, seminar and Injury Free outreach efforts are resources that could probably be of use to every injury prevention group in the Northeastern part of the country according to New York State Department of Health Bureau of Occupational Health and Injury Director Kitty Gelberg, PhD, MPH. “People need to recognize your existence, reach out to you and work with you. This wealth of experience and knowledge is not just State based,” she said. “If you go into injury prevention and you feel like you are alone doing this, it gets very overwhelming very quickly because of all of the different types of injuries. It helps to realize there are already people out there doing this, you are not alone, you don’t have to recreate the wheel, the template is there and you can follow it.” She says she believes that was the message for attendees and it came across very well.
Just over 60 people attended the event, and they heard from a variety of industry experts. In addition to having Kim Wiley-Schwartz, the Assistant Commissioner for Education and Outreach of the New York City Department of Transportation who spoke on The Vision Zero initiative: An update on New York City‘s approach to reducing traffic fatalities and injuries, and New York City Department of Health and Mental Hygiene Assistant Commissioner Hillary Kunins, MD, MPH, MS who spoke on Prescription drug initiatives in New York City, those in attendance heard from six physicians and injury prevention outreach professionals from the Injury Free Coalition for Kids®, a national injury prevention outreach program that is among the country’s premier injury prevention programs and the outreach arm of the Injury Center.
In addition to presentations, attendees had the opportunity to participate in roundtable discussions on a variety of injury topics including trauma center verifications, Department of Transportation and Department of Health injury prevention initiatives including violence and road safety. They also had the opportunity to talk about: child injury prevention, elderly falls, violence prevention initiatives, ACS Trauma Center certification and publishing and disseminating injury and injury prevention science.
“This seminar was great. I really enjoyed it and I learned a lot. The speakers are informative, enthusiastic and very knowledgeable,” Deborah Travis, Trauma Program Manager of St. Lukes Hospital said. “I am new to injury prevention and it has helped me to verify that I am on the right track and given me some new ideas.” Her sentiments were echoed by Dekeya Slaughter of Bellevue. “I have attended previous seminars, but in my new role as Injury Prevention Coordinator this one provided me contacts I can call. It has been great.”
Few would question the need for more seminars like this one. Tinkoff says most recent research shows there are only so many lives we can save in acute care and injury prevention is the new frontier in reducing the burden of injury in the US and worldwide. He concluded the interview by saying until it is better addressed injury will remain the biggest killer of our population between the ages of 1 and 44 and it will continue to rob the population with more years of life lost than any other entity that we have.
The course Director was Joyce Pressley, PhD, MPH Associate Professor of Epidemiology and Health Policy and Management at CUMC, and Center for Injury Epidemiology and Prevention at Columbia University, Outreach Co-Director.
The Injury Free Coalition for Kids joined forces with the Allstate Foundation to build a safe place for the children in the Village of Freeport, New York, to play. More than 150 volunteers came together to build a Little Hands playground that was destroyed by Hurricane Sandy just over a year ago.
“It is really important for children to have safe places to play,” explained Dr. Barbara Barlow, Associate Director of the Center for Injury Epidemiology and Prevention at Columbia University, and Founder and Director of the Injury Free Coalition for Kids. She went on to say playgrounds provide outlets for children to exercise, express themselves, and to be healthy both physically and emotionally.
Young people played a role throughout this process. Winners of an art contest from the Freeport Recreation Center’s Summer Camp provided the inspiration for four panels of artwork on the playground.
Although young people were not allowed in the build area, Girl Scouts from Brownie Troop 2328 kept workers hydrated by handing out bottles of water. It was Troop Leader Carole James, an Allstate Insurance employee, who prepared the proposal for the Foundation to install the playground.
Among other joining Injury Free to build the playground were close to 80 Allstate agents, claims representatives, accountants, owner Agents, and other employees of the Corporation. The Friends of Freeport, an organization made up of neighbors helping neighbors after the storm, also worked throughout the day. Everything was done under the direction of Vanessa Martelli of Universal Play Systems.
This playground is one of more than 50 the Allstate Foundation and Injury Free have built across the country. At least 10 of them were constructed to give children safe places to play after natural disasters. The playground was dedicated October 31, 2013.
A new study published in Accident Analysis & Prevention (November 2013) shows that drug use is associated with a significantly increased risk of fatal crash involvement, particularly when used in combination with alcohol.
The case-control study was led by Dr. Guohua Li, professor of epidemiology and director of the Center for Injury Epidemiology and Prevention at the Columbia University’s Mailman School of Public Health.
Read more about the study’s results in recent media coverage.
You may also download the full text of the article.
A WNYC radio interview of Center faculty focused on the threat motor vehicles pose to New York City’s 1.1 million children as they travel to and from school. According to state DMV data, about 1,800 kids are hit by cars and trucks in New York City each year.
“In large cities like New York City, clearly the most important danger to children walking to school are motor vehicles, cars,” said Charles DiMaggio an Associate Professor at Columbia University who studies public health. “Kids really are the most unpredictable pedestrians,” he said, “which puts the responsibility for their safety much more squarely on the shoulders of adults and drivers.”
A child walking or biking to school has a lot to contend with: busy commercial streets, no sidewalks, speeding cars, and other hazards. Today traffic injuries are the leading cause of injury-related death among children, according to the Centers for Disease Control and Prevention.
In 2011, only 13 percent of children risked the trip to school by foot or bike, according to a study of children ages 5 to 14—a dramatic drop from 1969 when that number was 48 percent. Parents cite fear of safety as their No. 1 reason for not allowing their children to walk to school, according to the CDC—particularly their safety as pedestrians.
“Some of the barriers include stray dogs—especially in the low-income communities, lack of sidewalks—children walking at a very early age by themselves,” says Jason Jackman, a program planner analyst at the University of South Florida’s Center for Urban Transportation Research in Tampa, Fla.
Making the walk to school safer has been for the last seven years a goal of a popular federal program administered by the Department of Transportation called Safe Routes to School, a program that now faces an uncertain fate. While the federal government has long played a major role in funding for state and local highways, it had before Safe Routes largely left school pedestrian safety measures up to states–such as creating slow zones, new sidewalks and bus traffic stop laws.
That may become the norm again. This year, the U.S. House of Representatives’ passed a 2012 transportation bill that ended dedicated funding for Safe Routes, a move that will put school safety improvements at much greater discretion of the states.
Between 2005 and 2012, Safe Routes dedicated $1.1 billion in federal money to “traffic-calming measures” around schools, such as narrowing streets, building speed bumps, converting two-way streets to one-way streets, and creating sidewalks. With the new transportation bill, Safe Routes now falls under a larger umbrella of “Transportation Alternatives” programs that will have to compete for funding against the likes of bike lanes and environmental mitigation projects—the kinds of projects Safe Routes boosters would tend to support.
In New York City, child pedestrian injury during school hours dropped 44 percent in areas where there were Safe Routes changes, according to the most comprehensive study of the program, published earlier this year by Drs. Charles DiMaggio and Guohua Li, who are epidemiologists at Columbia University’s Mailman School of Public Health.
In Marin County, Calif., schools participating in Safe Routes reported a 64 percent increase in walking to school and a 114 percent increase in biking. At one school in automobile-heavy Atlanta, walking to school in the morning increased from 18 percent before a Safe Routes program was implemented in 2008 to 42 percent after, in 2010.
In the Tampa Bay area, where Jackman is the Safe Routes to School coordinator, program money has been used to install sidewalks in places where there used to be only grass and street, to fund local coordinator positions to encourage safe walking to school, and for a parent-led walk to school group, among other things.
While Safe Routes has evidently begun to improve safety in areas where injury numbers have been analyzed, there is still much more to be done.
As of March 2011, just 10 percent of schools in the United States have received Safe Routes money, according to a report by Safe Routes to School National Partnership, an advocacy network of organizations, government agencies and professional groups that support the program. Even during the program’s flushest period, states had to turn schools away because of funding limitations.
With the new funding arrangement, Safe Routes improvements will not necessarily end, but it is now up to states to decide how much—if anything—they want to put toward the program.
While some states such as Colorado and Ohio have said they will maintain Safe Routes as a program with dedicated funding, others like Utah and Missouri plan to transfer their Safe Routes funding to other projects, according to Margo Pedroso, the deputy director of the Safe Routes to School National Partnership.
Another hurdle is that localities must now put up around 20 percent of projects costs, like the majority of other federal transportation projects. Before, all of a project’s costs were eligible for federal money.
In Missouri, this will especially take a toll on small towns already strapped for cash, says Dr. Brent Hugh, the executive director of the Missouri Bicycle and Pedestrian Federation.
“The loss of 100 percent match is really going to hurt. In Missouri a huge majority of our Safe Routes money went to rural towns,” he says. “Those communities are not going to be able to come up with the match. It’s a very significant amount of money for a school district or a small rural town.”
In Florida, where more pedestrians are killed than in any other state, Transportation Secretary Ananth Presad has nonetheless indicated the state will not prioritize funding for non-highway projects like Safe Routes.
“We must give serious consideration to whether—when resources and dollars are at a premium—spending money on sidewalks, bike trails, beautification and other projects like this is the most prudent use of taxpayer money,” Presad said at a congressional hearing last year.
But critics say that Florida and so many other parts of the country already devote a significant amount to highway and road spending at the expense of pedestrian and bike travel.
“Florida wasn’t built for pedestrian travel. It was built for motor vehicles. Safe Routes to School was a great opportunity to teach the younger generation how to walk and bike safely,” says Jackman.
There are already signs that the 2012 transportation bill has affected Safe Routes funding.
State spending on Safe Routes programs in the first quarter of the 2013 fiscal year slowed from previous quarters, according to the Safe Routes to School National Partnership. About one-third of states did not set aside any funds to Safe Routes programs, according to the partnership.
State departments of transportation do not often realize how greatly these programs are valued at a local level, Pedroso says.
At Kimbell Elementary School in Tampa Florida, Safe Routes has brought more signage, patrol cars, and new sidewalks where they didn’t use to exist, and it has led to a transportation education program run by Jackman, who is the Safe Routes coordinator in that region. It has also led to a cultural change at the school, says Nikki Counce, the social worker at Kimbell.
“More parents let kids ride their bike, let kids walk,” she says “It creates a community. It helps other parents get to know each other as well. So that they’re looking out for other kids who live next to them. Parents have befriended each other.”
It also gives the kids opportunities to exercise, a benefit that supporters of the program frequently cite when they talk about its child obesity-fighting potential.
The likelihood that communities with Safe Routes projects have fixed all of their problems is “pretty slim,” says Pedroso.
“Local communities are clamoring for this money,” she says. “If all of the decisions were left to locals, we think these programs would be much more prioritized.”
Edited by Jordan Lite and Dana March. Additional research by Lauren Weisenfluh.
Top photo: A bike and walk to school program at Hunter’s Green Elementary in Tampa (credit: Jason Jackman)
The rate of drug overdose from prescription opioids increased seven-fold in New York City over a 16-year period and was concentrated especially among white residents of the city, according to latest research at the Mailman School of Public Health. The study is one of the earliest and most comprehensive analyses of how the opioid epidemic has affected an urban area.
There are two classes of prescription opioids: analgesics, or painkillers like Oxycontin (oxycodone), and methadone, which is used to treat heroin addiction but which carries a risk of overdose. Using data from the city’s Office of the Chief Medical Examiner for the period 1990-2006, the researchers examined the factors associated with death from prescription opioids versus heroin, which historically has been the most common type of opioid fatality in urban areas.
They found that the increase in the rate of drug overdose was driven entirely by analgesic overdoses, which were 2.7 per 100,000 persons in 2006 or seven times higher than in 1990. Meanwhile, methadone overdoses remained stable, and heroin overdoses declined.
Whites were much more likely to overdose on analgesics than blacks or Hispanics. By 2006, the fatality rate among white males was almost two times higher than the rate among Latinos and three times higher than the rate among blacks.
Deaths were mostly concentrated in neighborhoods with high-income inequality but lower-than-average rates of poverty.
“A possible reason for the concentration of fatalities among whites is that this group is more likely to have access to a doctor who can write prescriptions,” says Magdalena Cerdá, DrPH, assistant professor of epidemiology and the lead author on the study. “However, more often than not, those who get addicted have begun using the drug through illicit channels rather than through a prescription.”
Price may also play a role, since heroin costs less than analgesics. Additionally, users of prescription opioids may perceive they are safer than other drugs.
Although methadone overdose rates did not increase overall, fatalities among whites increased almost nine-fold while, among blacks, deaths decreased by 2%. This shift may reflect a change in the nature of methadone use, from a treatment for heroin addiction to a treatment for chronic non-cancer pain.
The study suggests that the profile of a recreational prescription opioid user is very different from the heroin consumer, with less involvement in street-based forms of drug-trafficking and use of other drugs such as cocaine. Because of the different demographics between heroin and prescription opioid users, a different public health approach is needed to target the latter group, say the authors. “It’s a different type of drug with a different profile, and we need a different type of response to it,” said Dr. Cerdá.
Over the last 20 years, prescription drug overdoses have risen dramatically in the U.S. By 2006, overdose fatalities exceeded the number of suicides, and by 2009, they exceeded the number of motor vehicle deaths.
Most studies on recreational opioid use have focused on rural areas, which have been hit the hardest by the epidemic, but this study suggests that urban areas are contending with a growing health burden from opioid use. Researchers plan additional studies that will look at more recent data on prescription drug abuse.
The authors recommend regulating the aggressive marketing of potent drugs like Oxycontin, controlling over-prescribing of analgesics, and taking stricter measures to regulate sales. They also say there should be more law enforcement measures to identify illicit networks of distribution of these drugs and education outreach for physicians and patients.
The research was supported by grants from the National Institute on Drug Abuse (DA06534, T32 DA007233, and K01 DA030449-01), and a grant from the National Center for Injury Prevention and Control at the Centers for Disease Control to the Columbia University Center for Injury Epidemiology and Prevention (1 R49 CE002096-01).
Details of the study can be found:
The national Safe Routes to School (SRTS) program was funded by Congress in 2005 in an effort to create safe environments for American children to walk or bike to school. Has the program been effective? In New York City, most definitely, according to a new study conducted at Columbia University’s Mailman School of Public Health that evaluated the program here. Researchers found that the annual rate of injury to school-age pedestrians ages 5-19 fell 44% during the peak times for walking to school, in neighborhoods where the program was implemented. Significantly, the injury rate did not drop in parts of the city where the SRTS safety program was not in place.
Findings of the report are published online in Pediatrics.
The researchers analyzed motor vehicle crash data for 169,000 pedestrian injuries between 2001 and 2010 for different age groups and neighborhoods with and without SRTS interventions to assess the program’s effectiveness.
Interventions for reducing pedestrian injury included new traffic and pedestrian signals, the addition of exclusive pedestrian crossing times, speed bumps, speed boards, high-visibility crosswalks, and new parking regulations. More than 120 NYC schools were selected by the NYC Department of Transportation for the interventions because they had the highest rates of pedestrian injury.
The researchers created a school-travel time indicator variable to further identify crashes that occurred during days and hours when school-aged children would be traveling to or from school. This time period was defined as 7 AM to 9 AM or 2 PM to 4 PM, Monday through Friday between September and June.
“Our data show that interventions to make the built environment safer can greatly reduce injuries to children as they walk to school”, says the lead author of the study, Charles DiMaggio, PhD, associate professor of Epidemiology and research director of the Center for Injury Epidemiology and Prevention at Columbia.
The Safe Routes to School program was funded through 2012, and is now in place in all 50 states at approximately 10% of elementary and secondary schools. Under the current federal transportation bill, MAP-21, the Safe Routes program will no longer have dedicated funding. It is now one of a number of possible programs eligible for funding based on state and local priorities, making it “even more important to evaluate and demonstrate the effectiveness of programs like Safe Routes to School”, according to Dr. DiMaggio.
“Our study provides compelling empirical evidence that is essential to guiding policy makers,” says senior author Guohua Li, MD, DrPH, Mailman School professor of Epidemiology and Anesthesiology and director of the Center for Injury Epidemiology and Prevention. “It indicates that the Safe Routes to School program has made a marked difference in improving the safety of school-age children in New York City.”
Local and national media coverage: