What is Injury Prevention?

About Injury and Violence Prevention

What is injury?

Injuries include unintentional injuries, such as those caused by motor vehicle crashes, drowning, falls, and fires, and intentional injuries, such as suicide and violence.

An injury is defined as "unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical or chemical energy, or from the absence of such essentials as heat or oxygen (CDC)."

Violence is further defined as the "threatened or actual use of physical force or power against another person, against oneself, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, or deprivation (CDC)."

What is injury prevention?

Injuries are preventable by changing the environment, individual behavior, products, social norms, legislation and governmental and institutional policies to reduce or eliminate risks and increase protective factors. Some useful frameworks for injury and violence prevention are the Haddon Matrix, the Spectrum of Prevention, the National Healthy People 2010 Objectives for Injury and Violence Prevention and the Virginia Violence Prevention Logic Model

Haddon Matrix

In choosing among potentially useful preventive measures, priority should be given to the ones most likely to effectively reduce injuries. In general, these will be measures that provide built-in, automatic protection, minimizing the amount and frequency of effort required of the individuals involved." (Haddon, 1974)

The Haddon Matrix developed by Dr. William Haddon, the first administrator of what is now the National Highway Traffic Safety Administration and the founder of the Insurance Institute For highway safety is a very useful tool for identifying injury prevention opportunities. According to this framework, injuries occur with a certain time sequence. The time before the event occurs would be the pre-event phase. The precise time of the injury would be the event phase. This would be followed by the post-event phase. Additionally, said there are other factors involved in injury occurrence. For instance, there's the host or the person who's involved in the injury, and the equipment (e.g vehicle, firearm) that's involved in the injury. There are also different environmental situations, physical and social, in which an injury might take place. Combining these two axes results in a matrix called the Haddon Matrix. Prevention can be focused in any cell of the Haddon's matrix. For example, interventions can address the host/pre-event cell (e.g. teaching people to change behavior to avoid injury) or the pre-event/equipment cell (e.g. improvements in vehicle safety such as antilock brakes). Interventions can also be implemented to change the physical environment that would reduce the risk of injury pre-event, during the event or post-event (e.g. absorbent cushioning to reduce head injury during a playground fall, removing trees from the edge of the road to minimize fatalities as a result of collisions if cars swerve off the road, improving the speed and skill of first responders to provide victims treatment earlier). Changes can also be made in the social environment (e.g. reducing bystander behavior that encourages bullying or changing social norms around sexual violence).

In addition to the matrix, Haddon identified ten strategies that, when combined with the matrix can be used to determine the best possible interventions for a given injury event:

1. Prevent the creation of the hazard in the first place (e.g. yard darts, three-wheel ATV's, "cop-killer" bullets)
2. Reduce the amount of the hazard that exists (e.g reduce vehicle horsepower, restrict motorcycle licensing to older drivers)
3. Prevent the release of the hazard (e.g. gun safes, trigger locks, childproof medicine containers)
4. Modify the rate of spatial distribution of release of a hazard from its source (e.g. breakaway baseball bases, ski bindings)
5. Separate people in time or space from the hazard and its release (e.g. bicycle and pedestrian pathways)
6. Separate people from the hazard by interposing a material barrier (e.g. raised median strips, guard rails)
7. Modify the relevant basic qualities of the hazard (e.g safer play equipment, softer surfaces, water setting below 120 degrees)
8. Make the person more resistant to damage (e.g physical conditioning of athletes)
9. Counter the damage already done (e.g. EMS services)
10. Stabilize, repair and rehabilitate the injured person (e.g. reconstructive surgery, physical therapy)

Examples taken from Quick Guide to Effective Injury Prevention, David Short

For more information, take a free introductory course on injury prevention and control, VINCENT (Violence and Injury Control through Education, Networking and Training on the World Wide Web), sponsored by the Injury Prevention Research Center at the University of North Carolina at Chapel Hill (http://www.ibiblio.org/vincentweb/toc.html).

Spectrum of Prevention

The spectrum of prevention is a tool for developing a multifaceted, comprehensive approach to injury and violence prevention across six interrelated action levels. Activities at each of these levels have the potential to support each other and promote overall community health and safety. http://www.preventioninstitute.org/spectrum_injury.html

Level of Spectrum	Definition of Level
1. Strengthening Individual Knowledge, Skills, and Protections	Enhancing an individual's capability of preventing injury or illness and promoting safety
2. Promoting Community Education	Reaching groups of people with information and resources to promote health and safety
3. Educating Providers	Informing providers who will transmit skills and knowledge to others
4. Fostering Coalitions and Networks	Bringing together groups and individuals for broader goals and greater impact
5. Changing Organizational Practices	Adopting regulations and shaping norms to improve health and safety
6. Influencing Policy Legislation	Developing strategies to change laws and policies to influence outcomes

Ecological Model

The ecological model supports a comprehensive public health approach that not only addresses an individual's risk factors, but also the norms, beliefs, and social and economic systems that create the conditions for sexual violence to occur. The examples presented in the below diagram are included to illustrate the levels of the ecological model for sexual violence. The examples of risk factors are from the chapter on sexual violence in the World Report on Violence and Health and are not a comprehensive list of risk factors for sexual violence perpetration. There is a lack of research on protective factors, so no such examples are presented in the model.

• Individual level influences are biological and personal history factors that increase the likelihood of an individual becoming a victim or perpetrator of violence. For example, factors such as alcohol and/or drug use; attitudes and beliefs supportive of sexual violence; impulsive and other anti-social tendencies; preference for impersonal sex; hostility towards women; childhood history of sexual abuse or witnessing family violence may influence an individual's behavior choices that lead to perpetration of sexual violence (Dahlberg and Krug, 2002). Interventions for individual-level influences are often designed to target an individual's social and cognitive skills and behavior and include approaches such as counseling, therapy, and educational training sessions (Powell et al., 1999).
• Interpersonal relationship level influences are factors that increase risk as a result of relationships with peers, intimate partners, and family members. A person's closest social circle-peers, partners and family members-has the potential to shape the individual's behavior and range of experience (Dahlberg and Krug, 2002). Interventions for interpersonal relationship level influences could include family therapy, bystander intervention skill development, and parenting training (Powell et al., 1999).
• Community level influences are factors that increase risk based on community and social environments where an individual has experiences and relationships such as schools, workplaces, and neighborhoods. For example, lack of sexual harassment policies in the workplace can send a message that sexual harassment is tolerated, and there may be few or no consequences for those who harass others. Interventions for community level influences are typically designed to impact the climate, systems, and policies in a given setting.
• Societal level influences are larger, macro-level factors that influence sexual violence such as gender inequality, religious or cultural belief systems, societal norms, and economic or social policies that create or sustain gaps and tensions between groups of people. For example, rape is more common in cultures that promote male sexual entitlement and support an ideology of male superiority (Dahlberg and Krug, 2002). Interventions for societal level influences typically involve collaborations of multiple partners to change laws and policies related to sexual violence or gender inequality. Another intervention would be to determine societal norms that accept violence and identify strategies for changing those norms (Powell et al., 1999).

National Healthy People 2010 Injury Prevention Objectives

Injury Prevention Web

Virginia Violence Prevention Logic Model

Additional Resources for Learning about Injury Prevention

• The Society for Public Health Education provides a good overview of injuries and prevention
• An excellent textbook on injury prevention is Injury Prevention and Public Health: Practical Knowledge, Skills, and Strategies By Tom Christoffel and Susan Scavo Gallagher , Aspen Publishers, 1999. This book is a guide to understanding and preventing unintentional and violence-related injury from a public health perspective. It provides a synthesis of three major elements: the nature and magnitude of injury, the basic concepts of injury prevention, and practical strategies and resources for planning, implementing, and evaluating prevention programs.

States are involved in injury prevention

State health department injury prevention programs, including the Center for Injury and Violence Prevention, use the public health approach "to learn about injury problems and decide what to do about them, and then put in place the necessary programs, infrastructure, trained staff, and policies that will prevent injuries, deaths and disabilities in the future." This approach involves five components:

1. Collecting and Analyzing Injury Data
2. Designing, Implementing, and Evaluating Interventions (i.e. behavioral, engineering, environmental)
3. Building a Solid Infrastructure for Injury Prevention
4. Providing Technical Support and Training
5. Affecting Public Policy

The State Injury Prevention Directors' Association has developed a comprehensive document that further describes state health department injury prevention approaches.

Communities are involved in injury prevention

Communities are encouraged to identify community needs and engage in diverse but proven injury prevention practices including: providing age appropriate injury, suicide and violence related anticipatory guidance; coordinating education, dissemination and/or installation of safety devices in homes or cars; convening or participating in community coalitions or work groups to identify and rectify hazardous environments; and implementing community or school based education and training about injury prevention, risk and protective behaviors. http://www.vahealth.org/Injury/community/projects.htm

• Local Virginia SAFE KIDS Coalitions
• Virginia Injury Prevention Network: Click to join vainjuryprevention

Schools are involved in injury prevention

There are many roles for schools in injury prevention including providing safe transportation and safe physical, emotional and social environments, providing students with injury and violence prevention knowledge and life skills and getting them involved in community injury and violence prevention.

Health Providers are Involved in Injury Prevention

Physicians can do much to prevent injury in the areas of screening, counseling, referral and community involvement.

• Youth Violence Screening and Counseling Guides and FISTS Cards
• Domestic Violence Screening and Counseling Tools
• American Academy of Pediatrics Safety Resources

Best Practices in Injury and Violence Prevention

A number of national research centers and other organizations have identified what works in injury and violence prevention

• SOPHE Injury and Violence Prevention Website
• Lists of Effective and Promising Violence Prevention Programs. At least ten different lists of effective and promising interventions for drug and violence prevention have been sponsored by the federal government
• Effective substance abuse and mental health programs reviewed by the National Registry of Evidence-based Programs and Practices (NREPP)
• Harborview Injury Prevention and Research Center Best Practices Overview
• CDC National Center for Injury Prevention and Control offers web on a variety of injury and violence areas and information on effective prevention
• SafetyLit, the online source for recent research about injury prevention.
• Best Practices in Injury Prevention (Minnesota Department of Health)
• Best Practices (Colorado Department of Health)
• Guide to Community Preventive Services - Systematic Reviews and Evidence Based Recommendations
• Injury Prevention Journal
• The ASTHO Injury and Violence Prevention Project disseminates best practices and model programs that exemplify the ways State Health Officials can impact policy and help to reduce the burden of injuries in their states
• Community-based childhood injury prevention interventions: what works?
  
• Virginia Youth Violence Project - Prevention Works
• The National Youth Violence Prevention Resource Center offers 4 essential research-based reports covering the scope, causes, and prevention of youth violence
• National Institutes of Justice Violence Prevention Studies
• Virginia Youth Violence Prevention Best Practices in School-Based Violence Prevention
  

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