Injuries And Accidents Research Paper

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Everybody is at risk for incurring an injury, although some individuals or populations may have greater risk than others. Injuries are consistently among the contributors to disabilities and death, lost years of productivity and potential life at all ages, resulting in incalculable costs and pain to victims and families around the world (Barss et al. 1998). As the impact of infectious disease on death rates was lessened over time due to vaccines, antibiotics, and improved hygiene, unintentional injuries rose as the leading causes of death and disability, especially for the first four decades of human life. Among the leading causes of injury are the categories of motor vehicle passenger and pedestrian, drowning, poisoning, falls, firearms, and suffocation (Baker et al. 1992). Numerous commissions and expert panels in the international community since the 1970s have issued reports indicting injuries as the most important public health problem (Her Majesty’s Stationery Office 1992, Committee on Trauma Research et al. 1985, National Committee 1989, U.S. Public Health Service 1991, 2000, World Health Organization 1999).

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1. Scientific Study Of Injuries

Social scientists from disciplines of psychology, public health, and sociology, among others, emphasize the term ‘unintentional injuries’ because the historical and layperson use of the term ‘accidental injury’ implies the effect of uncontrollable chance, fate, or other capricious events that cannot be avoided. Professionals now believe that the circumstances resulting in injuries can be subjected to scientific study, and therefore injury outcomes are thought to be explicable and preventable (Roberts and Brooks 1987, Robertson 1998). Additionally, unintentional injuries should be distinguished from intentional harm such as child abuse, homicide, or suicide.

William Haddon, Jr., a physician, was the major contributor to the scientific study into the nature and control of injuries across the lifespan. Haddon’s model organized the public health approach to examining the interactive aspects of injuries: the host, the environment, and the agent (Haddon and Baker 1981). For example, Haddon proposed comprehensive strategies for changing the deleterious transfer of injury-causing energy from agent to host. Such strategies include, for example, not creating hazardous producing energy in the first place to reduce injury potential, keeping separate energy sources from the host (i.e., the human victim) in either time or space, or developing the host’s resistances to damage. Haddon’s influence continues to be felt in this field (National Committee 1989, Robertson 1998). Because human behavior is also involved directly in injuries, science disciplines examining behavior contribute greatly to the understanding and controlling of injuries and death.

2. Methodologies To Study Injuries

Professionals studying injuries utilize several empirical methodologies to gain an understanding of the precursors to an injurious event, of the nature or circumstances of the event itself, and of the aftermath or consequences of an injury.

2.1 Epidemiology

The epidemiological method relies on population-wide statistics about the prevalence and incidence of in- juries. These analyses are often specific to certain characteristics such as type and cause (e.g., burns, drowning, firearm wounds, or motor vehicle occupant), demographic variables (e.g., age, sex, socioeconomic class of the injured victim), and injury circumstances (e.g., where the injury occurred: street, house, school; how it occurred: fall, car collision, fire). These epidemiological analyses can convey some aspects of injury development in order to suggest where attention is needed to prevent or control injuries (Baker et al. 1992, Robertson 1998). Epidemiology studies have established that motor vehicles contribute to the most injuries of any cause, indicating that speed, road conditions, passenger seatbelt use, driver’s alcohol consumption, for example, are related to these injuries and deaths. Different types of injuries vary in predominance at various ages. For children, a developmental relationship of behavior, ability, and environment has been noted: toddlers are injured in falls and ingestion of poisons; school children are hit by cars as pedestrians; adolescents are injured in car collisions as drivers or passengers, in sports activities, and by firearms. The elderly are injured in falls.

2.2 Behavior Analysis

Psychologists often utilize techniques of behavior analysis to study the antecedent—behavior— consequences sequential chain of events to determine how injuries are produced. For instance, some analyses implicate lack of parental supervision in certain children’s injuries and impulsive darting into streets after lost balls. By understanding the behavioral circumstances, prevention focused on behavior change can be undertaken such as providing prompts to engage in a safety behavior or issuing rewards for taking safety actions (Roberts et al. 1987). Other psychologists conduct cognitive development research to determine how children and adults perceive hazards and understand warning labels in order to improve their safety actions or develop educational programs for injury prevention.

2.3 Personality Trait Research

Research into personality traits or relatively stable patterns of behavior leading to injuries has not consistently identified an ‘accident prone’ type, although some people appear more likely to be injured than others. Some sex and age characteristics of the injured victim often are identified (e.g., younger children, adolescents, males) as being at higher risk for certain types of injuries. Temperament type and activity level have been linked to greater injury risks. Contrary to this line of thinking, according to some scientists, identification of individual differences may not lead to effective injury control (Robertson 1998). More universal precautions for all people will have greater impact in preventing injuries than selecting individuals with identified markers for an intervention effort.

3. Injury Control

Injury control (prevention of injury) seeks to avoid the occurrence of a potential injury by changing the conditions and the behavior leading to injury, or by reducing the degree of damage when an event occurs. Prevention interventions can target (a) the person who is at risk for injury (child or adult), (b) the authority who makes decisions affecting that person (e.g., a parent, teacher, employer), or (c) the environment to limit possibility of injuries (e.g., through legislation and regulation). Two important approaches to these targets of prevention are structural and behavioral interventions.

3.1 Environmental Modifications To Achieve Safety

Structural interventions are those that modify the environment in order to change potential hazards so that people do not encounter them. For example, fence barriers keep people out of swimming pools, abandoned mines, and quarries. Expandable door gates help keep young children from falling down stairs, while landscaped berms and elevated crosswalks separate pedestrians from street traffic. Covers and guards on moving parts in industrial machinery protect workers. Childproof caps on medicine bottles keep children from potential poisons. Another structural approach is to reduce the degree of injury from an unmodifiable hazard when a person is inadvertently exposed to it, such as automatic seat belts or airbags in cars when in a collision and sprinkler systems in buildings when a fire starts. Environmental change is also conceptualized as passive prevention in that injuries are prevented or reduced in degree without the individual having to take safety actions themselves. Legislation or regulation on consumer products is frequently required to achieve environmental change, such as limiting the size of small objects that could cause choking and suffocation in toys marketed for young children.

In some countries, agencies are given some responsibility to review the safety features of consumer products being marketed to the public. In the USA, the Consumer Product Safety Commission implements a number of regulatory acts with demonstrated effectiveness in improving children’s safety. For example, legislative requirements to alter the environment of children to be safer include changing the packaging of poisons and medications such that the number of inadvertent poisonings was reduced; legislation for children’s sleepwear to be flame retardant reduced burn injuries; crib and refrigerator safety regulations have reduced suffocation and strangulation deaths. This commission has also issued guidelines for construction of toys and places warnings on toys with small parts that might choke young children (these types of warnings have less evidence of effectiveness than the environmental interventions). Very few products are regulated or reviewed by governmental agencies, but the public erroneously believes only safe products can be sold. Structural changes are sometimes limited in the potential effectiveness when political will or power is not brought to bear on the issue. For example, because of political and car manufacturer resistance, over 30 years passed before automatic air bags were fully implemented in cars in the USA from the date they were first mandated. Other legislation mandating safety have been similarly resisted by those affected (e.g., mandatory motorcycle helmet laws, legal restrictions on handguns, speed limit laws). Indeed, while some countries have little or no commitment to safety as a cultural value or as a governmental concern, others have great acceptance (and lower injury rates across all ages).

3.2 Behavioral Modification To Achieve Safety

Behavioral research focuses primarily on those situations where structural or passive prevention is inapplicable or limited in effect (Finney et al. 1993). Behaviorally-based approaches typically involve active prevention measures in which individuals take action on their own behalf or for others in order to achieve protection. Deficient safety behaviors or excessive safety behaviors can be changed so that the injuryproducing sequence is altered. In these cases, for example, safe behaviors are taught systematically to children, their parents, and adults. Empirically supported procedures include rewards and punishments, modeling, prompting, skills training, and rehearsal. For example, in one American community-wide program, school children collected reward stickers and received prize coupons for riding to school properly secured in car safety seats or seat belts. A ‘safe playing’ program utilizing behavioral principles was implemented in New Zealand to teach children and their parents the safe limits of outdoor activities. Research has demonstrated the effectiveness of behavioral psychology interventions for changing home hazards such as too high temperatures in water heaters and frayed electrical cords, learning fire emergency escape plans, and wearing bicycle helmets (Roberts et al. 1987).

Alexander and Roberts (in press) offered several caveats about orienting injury prevention efforts targeted to the children themselves. All too often, they noted, parents make the assumption that children are protected once they have been trained in a safety behavior with a resulting decrease in the supervision the parents give to their children in a hazardous environment. A second problem occurs when children are assigned the responsibility for taking safety action when the adults in the children’s lives should be the appropriate agents because they have greater control over changing the environment than the children do. Finally, cognitive and motoric development may determine whether children have the skills and capacity to take safety actions and recognize when situations are appropriate or inappropriate for certain behaviors. Research has shown that parents often do not have adequate knowledge to make informed decisions about safety and frequently misperceive that their children are safe in unsupervised situations in the presence of hazards.

3.3 Health Education To Achieve Safety

Much of the injury prevention effort in many countries has been devoted to providing information to parents to change their child’s environment to be safer or for adults to be safer in work or recreation. This information provision may take place through lectures, pamphlets, or brochures about such things as securing storage of poisons above children’s reach, safe lifting practices in adults’ workplaces, using gates or locks on barriers to keep children away from stairways, buckling children into safety seats and seat belts in cars and in highchairs, and encouraging bicycle riders of all ages to wear helmets. Similarly, public service announcements are often used on radio and television to encourage seat belt use, or to swim safely, for example, or to discourage driving while drunk. There is little evidence to support injury control through providing such information as a sole intervention, although many professionals agree that information about safety is a necessary, but rarely sufficient aspect of effective injury prevention. Health education is not considered a singly effective intervention to prevent injuries, although it is typically the first approach taken. Information about hazards and what a person should do to avoid them can, however, set the stage for implementing both structural and behaviorally-based programs.

3.4 Community Interventions To Achieve Safety

Interventions made to change the attitudes and behavior of whole communities are rarely evaluated in empirical studies, but all too often are maintained because of popular perceptions of effectiveness or political support. Other community-based programs have demonstrated effectiveness when they rely on intense instruction, behavioral rehearsal, and strong community endorsement of safety and reduction of hazards through systematic rewards for safe behavior such as using seat belts and bicycle helmets (Roberts et al. 1987). Action in the community is required to achieve successful implementation of effective programs as established by research, whether directed at changing behaviors, individually or collectively, or instituting environmental modifications to be safer place for all (National Committee 1989). Increasing public attention to injury causes and changing perceptions about acceptable behavior coupled with recognition that such injuries are preventable has led to recent declines in deaths due to drunk driving and the increased use of seat belts.

4. Future Of Injury Research And Control

4.1 Research Questions

The National Committee for Injury Prevention and Control in the United States (1989), reflecting international advancements, outlined the significant questions to be answered through scientific research (pp. 35–6): ‘Who is being injured? How are these people being injured? Where are these injuries taking place? What are the circumstances under which these injuries occur? How serious are these injuries? How many of the injuries have occurred, and over what period of time? Which of these injuries is most significant in its personal and social consequences? Is the local injury rate from a particular type of injury higher or lower, than the national (or state) rate? What information will be needed to evaluate an intervention?’

4.2 Comprehensive, Integrated Efforts Are Needed

Fragmented injury prevention programs, all too often lacking in evidence of effectiveness, are the norm. These critical questions cannot be answered through a single approach or discipline but from a combination of scientific methodologies to gain a comprehensive view of injury causes and possible prevention control strategies. Thus, there are limitations on the effectiveness of a single approach to injury prevention whether a structural or active behavioral intervention. The most advanced thinking views an injury control approach as optimally emphasizing comprehensive combinations of structural passive and behavioral active prevention.

4.3 Increased Priority For Research And Prevention

Despite the pervasiveness of injuries, professionals frequently note the lack of social outrage to motivate comprehensive injury control efforts in all countries (National Committee 1989, Roberts and Brooks 1987). Although some selected actions have been successful (e.g., in curbing drunk driving in some countries), injuries at all ages and on all continents in the world remain an enormous societal and scientific issue for research and development of preventive interventions. Injury control needs to be made a higher priority in many countries, especially in the USA, where inadequate attention has been directed to this overall problem than to other health challenges. Enhanced injury surveillance systems or data collection can improve understanding of the nature and characteristics of injuries. Enhanced evaluation of prevention programs can improve modification and implementation of successful interventions. Related to unintentional injuries are interpersonal violence and suicide. These have similar issues of required improved understanding of the causes and development and, most importantly, for prevention and intervention.

As noted by Roberts and Brooks (1987), ‘injury prevention involves societal values and tradeoffs of public good versus individual freedom’ ( p. 8). Personal rights may be abridged when laws or regulations are passed to achieve safety benefit. Speed limits, mandatory motorcycle helmet laws, and requiring smoke detectors in residences, swimming pool fences, controls on gun ownership and use, enforcement of drunk driving laws, are examples of restrictions imposed on individuals in order to advance safer environments. Other regulations may affect economic decisions and profitability for businesses. For example, requiring cars and trucks to have seat belts, airbags, and enhanced rear brake lights restricts the automobile manufacturers. Some countries have a greater acceptance of regulation and governmental control over individuals and business. Culture and traditions play roles in the perception of the ‘common good.’ Affecting social attitudes are media presentations of hazardous environments and behavior. For example, risky behavior and violence are glorified and use of drugs and alcohol is portrayed as a social norm in music lyrics, videos, television programs, and movies (National Committee 1989).

Social science contributions continue to be made as methodology is applied to gain a better understanding of injury events and causes as well as to empirically evaluate the effectiveness of interventions to prevent or control injuries (Finney et al. 1993).


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