National Center For Injury Prevention And Control Research Articles

Guiding prevention initiatives by applying network analysis to systems maps of adverse childhood experiences and adolescent suicide

Abstract Suicide is a leading cause of death in the United States, particularly among adolescents. In recent years, suicidal ideation, attempts, and fatalities have increased. Systems maps can effectively represent complex issues such as suicide, thus providing decision-support tools for policymakers to identify and evaluate interventions. While network science has served to examine systems maps in fields such as obesity, there is limited research at the intersection of suicidology and network science. In this paper, we apply network science to a large causal map of adverse childhood experiences (ACEs) and suicide to address this gap. The National Center for Injury Prevention and Control (NCIPC) within the Centers for Disease Control and Prevention recently created a causal map that encapsulates ACEs and adolescent suicide in 361 concept nodes and 946 directed relationships. In this study, we examine this map and three similar models through three related questions: (Q1) how do existing network-based models of suicide differ in terms of node- and network-level characteristics? (Q2) Using the NCIPC model as a unifying framework, how do current suicide intervention strategies align with prevailing theories of suicide? (Q3) How can the use of network science on the NCIPC model guide suicide interventions?

Innovations in Interpersonal Violence Prevention: Research, Collaboration and Opportunities

Intimate partner and sexual violence (IPV and SV) remain significant public health problems for young women and men, and both IPV and SV have short and long-term psychological and physical health impacts for all. Through consistent direction and support from Centers for Disease Control’s National Center for Injury Prevention and Control (NCIPC), IPV/SV violence prevention research has shown its potential to prevent these forms of violence. This change is highly significant; many did not believe it was possible to prevent rape and intimate partner violence. In recognition of this emerging field of study, the 2013 Campus Sexual Violence Elimination Act required US public colleges to provide bystander-based training to reduce sexual violence, yet no requirement for evaluation of this recommendation was included in this law. Further, while bystander approaches are recognized as “promising prevention strategies” by the 2014 White House Task Force to Protect Students from Sexual Assault, few rigorous and sufficiently powered studies evaluate the efficacy of bystander programs to reduce violence victimization and perpetration at college and community levels. The papers in this special issue catalogue methods, measures, and outcomes to guide successful implementation and investigations of bystander prevention programs, considering demographic and situational contexts that have traditionally been understudied. Lessons learned from these investigations provide a roadmap of strategies to guide the next generation of researchers, program developers, and policymakers toward effective interpersonal violence prevention.

An Ecological Study on the Spatially Varying Relationship between County-Level Suicide Rates and Altitude in the United States

Suicide is a serious but preventable public health issue. Several previous studies have revealed a positive association between altitude and suicide rates at the county level in the contiguous United States. We assessed the association between suicide rates and altitude using a cross-county ecological study design. Data on suicide rates were obtained from a Web-based Injury Statistics Query and Reporting System (WISQARS), maintained by the U.S. National Center for Injury Prevention and Control (NCIPC). Altitude data were collected from the United States Geological Survey (USGS). We employed an ordinary least square (OLS) regression to model the association between altitude and suicide rates in 3064 counties in the contiguous U.S. We conducted a geographically weighted regression (GWR) to examine the spatially varying relationship between suicide rates and altitude after controlling for several well-established covariates. A significant positive association between altitude and suicide rates (average county rates between 2008 and 2014) was found in the dataset in the OLS model (R2 = 0.483, p < 0.001). Our GWR model fitted the data better, as indicated by an improved R2 (average: 0.62; range: 0.21–0.64) and a lower Akaike Information Criteria (AIC) value (13,593.68 vs. 14,432.14 in the OLS model). The GWR model also significantly reduced the spatial autocorrelation, as indicated by Moran’s I test statistic (Moran’s I = 0.171; z = 33.656; p < 0.001 vs. Moran’s I = 0.323; z = 63.526; p < 0.001 in the OLS model). In addition, a stronger positive relationship was detected in areas of the northern regions, northern plain regions, and southeastern regions in the U.S. Our study confirmed a varying overall positive relationship between altitude and suicide. Future research may consider controlling more predictor variables in regression models, such as firearm ownership, religion, and access to mental health services.

Altitude is a risk factor for completed suicide in bipolar disorder

Bipolar disorder (BD) is a severe brain disease that is associated with a significant risk for suicide. Recent studies indicate that altitude of residence significantly affects overall rate of completed suicide, and is associated with a higher incidence of depressive symptoms. Bipolar disorder has shown to be linked to mitochondrial dysfunction that may increase the severity of episodes. The present study used existing data sets to explore the hypothesis that altitude has a greater effect of suicide in BD, compared with other mental illnesses. The study utilized data extracted from the National Violent Death Reporting System (NVDRS), a surveillance system designed by the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (NCIPC). Data were available for 16 states for the years 2005–2008, representing a total of 35,725 completed suicides in 922 U.S. counties. Random coefficient and logistic regression models in the SAS PROC MIXED procedure were used to estimate the effect of altitude on decedent’s mental health diagnosis. Altitude was a significant, independent predictor of the altitude at which suicides occurred (F=8.28, p=0.004 and Wald chi-square=21.67, p<0.0001). Least squares means of altitude, independent of other variables, indicated that individuals with BD committed suicide at the greatest mean altitude. Moreover, the mean altitude at which suicides occurred in BD was significantly higher than in decedents whose mental health diagnosis was major depressive disorder (MDD), schizophrenia, or anxiety disorder. Identifying diagnosis-specific risk factors such as altitude may aid suicide prevention efforts, and provide important information for improving the clinical management of BD.

CURRENT FALL PREVENTION ACTIVITIES AT THE US CENTERS FOR DISEASE CONTROL AND PREVENTION

BackgroundFalls are the leading cause of both fatal and nonfatal injuries among adults aged ≥65 years. In the US in 2009, older adult falls resulted in 20 422 deaths and...

History of Injury and Violence as public health problems and emergence of the National Center for Injury Prevention and Control at CDC

Injuries and violence are among the oldest health problems facing humans. Only within the past 50years, however, has the problem been addressed with scientific rigor using public health methods. The field of injury control began as early as 1913, but wasn't approached systematically or epidemiologically until the 1940s and 1950s. It accelerated rapidly between 1960 and 1985. Coupled with active federal and state interest in reducing injuries and violence, this period was marked by important medical, scientific, and public health advances. The National Center for Injury Prevention and Control (NCIPC) was an outgrowth of this progress and in 2012 celebrated its 20th anniversary. NCIPC was created in 1992 after a series of government reports identified injury as one of the most important public health problems facing the nation. Congressional action provided the impetus for the creation of NCIPC as the lead federal agency for non-occupational injury and violence prevention. In subsequent years, NCIPC and its partners fostered many advances and built strong capacity. Because of the tragically high burden and cost of injuries and violence in the United States and around the globe, researchers, practitioners, and decision makers will need to redouble prevention efforts in the next 20years. This article traces the history of injury and violence prevention as a public health priority – including the evolution and current structure of the CDC's National Center for Injury Prevention and Control.

Laying tracks of hope: Kentucky's involvement in the EMPOWER program

While a nationwide grassroots movement has worked to end sexual violence (SV) for the past three decades, historically the focus of these efforts has largely been on services for victims. In 2001, CDC's National Center for Injury Prevention and Control (NCIPC) began administering the Rape Prevention and Education (RPE) Program that was established by the Violence Against Women Act in 1994. In 2004, Kentucky's sexual violence services community was asked by a commissioner of social services in the state, “What do you need to prevent violence in Kentucky?” The community of providers questioned whether it was possible to prevent sexual violence. Could they imagine a world with no victims of this crime? The question and the hope it created were the genesis of Kentucky's journey to prevent sexual violence, but it was participation in the EMPOWER program that provided the framework, tools, and cross state learning that was truly transformative to Kentucky. Language: en

Preventing violence against children and youth

The National Center for Injury Prevention and Control (NCIPC) has a focus on preventing interpersonal violence against children and youth. Prevention of violence against children and youth involves fostering healthy relationships and building healthy environments in which young people can flourish. We review NCIPC's work over the past 20years that has contributed to this goal by highlighting surveillance systems that identify the magnitude of violence, etiological research that identifies risk and protective factors that are associated with violence, evaluation research that has expanded the evidence base of what works to prevent violence, and comprehensive, broad-based programs that engage and empower communities to prevent violence. NCIPC's work demonstrates that violence is preventable and the Center is working to move the promise of effective prevention into practice. These efforts all work toward protecting the health and well-being of children and youth and set the stage for NCIPC's future work.

NCIPC's contribution to global injury and violence prevention: Past, present, and future

Injuries and violence impact millions across the globe each year. For the past 20years, the National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC) has assembled the largest cadre of injury and violence prevention experts in the world to reduce the burden of injuries and violence domestically and to inform global injury and violence prevention efforts. This article focuses on NCIPC's global injury and violence prevention work that involves: increasing awareness of the preventability of injury and violence, partnerships to promote injury research and best practices; establishing standards and guidance for data collection; building capacity through training and mentoring; and supporting evidence-based strategies. To decrease the global burden, the authors propose priority setting to maximize the development and sustainability of financial and human resources for injury and violence prevention. Impact on Industry: The authors call for increased capacity and resources for global injury and violence prevention.

Using Framing Theory to Unite the Field of Injury and Violence Prevention and Response: Adding Power to Our Voices

The Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (NCIPC) sought to identify a new approach to communicating about injury and violence and develop a central message for all areas of injury. Objectives were to: (1) develop an overarching injury and violence prevention message for use in communications and to position injury as an important public health problem, and (2) reframe the public's understanding of injury and violence to create social and political will to lessen the burden of injury. NCIPC and ICF Macro, a research, marketing communications, and management consulting firm, used framing theory to develop messages that would have greater impact on the public's perceptions by presenting injury in a way that reflects deeply held societal values. Three distinct message sets were developed and tested through in-depth interviews with professionals working in injury response, violence prevention, and unintentional injury prevention and through nine focus groups with the general public on specific injury and violence issues. Most participants identified with the frame of living to one's “full potential.” Based on the findings, Adding Power to Our Voices, a framing guide, was developed giving specific guidance on how to incorporate the frame into injury prevention and response messages to aid communication among constituents, members, and supporters.

전, 후방 기울기각을 이용한 노인의 보행안정성 평가

The gait instability in the elderly has been associated with age-related deterioration in physical strength and reducing the potential for elderly falls requires regular exercise. In 2005, National Center for Injury Prevention and Control(NCIPC) reported that most elderly falls occur during activities in daily living(ADL). To better reveal biomechanic mechanisms underlying age-related degeneration in gait stability, and to enhance the assessment of falls risk, an accurate quantification of a person's balance maintenance during locomotion is needed. Instantaneous orientation of the line connecting COP and COM can characterize whole body position with respect to the supporting foot during gait and the angle between this line and the vertical line passing through the COP known as a good assessment to detect the elderly gait instability. Therefore the purpose of this study was to investigate a 6-month walking exercise effects in reducing elderly fall risk factors by using COP-COM inclination angles. Twenty-two community-dwelling elderly participated this study. The participants performed a walking exercise(3 times/week, 1 hour/visit) for 6 months. Laboratory kinematics during walking was assessed at months 0, 3 and 6. Significant increased in gait velocity was found among periods(p=.011, <TEX>$1.25{\pm}.03$</TEX>, <TEX>$1.32{\pm}.03$</TEX>, and <TEX>$1.39{\pm}.04\;m/s$</TEX> in 0-, 3-, and 6-month, respectively). Also, significant differences in anterior and posteriror inclination angles were found among the periods(p<.05; posterior inclination angles: <TEX>$12.8{\pm}2.2$</TEX>, <TEX>$11.0{\pm}2.9$</TEX>, & <TEX>$10.9{\pm}1.9$</TEX>; anterior inclination angles: <TEX>$13.7{\pm}1.7$</TEX>, <TEX>$14.6{\pm}3.2$</TEX>, & <TEX>$1.46{\pm}.21$</TEX> in 0month, 3month, & 6month, respectively). These findings provide evidence of significant reduced fall risk factors of community-living older adults associated with a systematic walking program.

Preface

Preface

The Public Health Approach to Traumatic Brain Injury

Every year, 50,000 people die with a traumatic brain injury (TBI). At least 5.3 million Americans live with long-term disabilities related to TBI. Through its TBI-associated research and programs, CDC's National Center for Injury Prevention and Control (NCIPC) seeks to reduce the adverse consequences of TBIs by ensuring that data, data systems, and public awareness about TBI are in place. The public health model provides a useful framework for identifying important efforts needed to reduce the impact of this potentially disabling injury.

Centers for Disease Control and Prevention injury research agenda: identification of acute care research topics of interest to the Centers for disease Control and Prevention--National Center for Injury Prevention and Control.

The purpose of this report is to identify the most important research questions pertaining to the acute care of the injured patient using a Web-based Delphi technique to achieve expert opinion consensus. Experts in trauma care from the United States and Canada (n =39) generated structured research questions and then ranked these questions in order of importance, using a Web-based survey for question generation, question ranking, and a Delphi technique of consensus. Guidelines for question construction and ranking specified that participants considered questions that fall within the interest and domain of the Centers for Disease Control (CDC)-National Center for Injury Prevention and Control (NCIPC). One hundred thirty-seven questions in 18 distinct categories of interest were initially generated. After two rounds of merging, collating, reassessing, and ranking by significance and importance, 25 research questions were deemed most important and significant in the care of the injured patient. Ten of these (40%) were considered to be appropriate issues for the CDC-NCIPC to address and fund, dealing with injury prevention strategies, trauma systems design and funding, the epidemiology of injury, and global outcome determinants. These 25 questions were also reviewed with consideration given to the most likely source of federal funding of investigations. This report identifies the areas of trauma care in which research efforts might best be directed. Fully 40% of the key research questions could be considered to fall under the interest and auspices of the CDC-NCIPC. The remaining questions cover a broad range of topics and likely funding sources, emphasizing the need for a coordinated oversight of research funding in trauma care.

Effective Legislation Producing Realized Health Services

Effective Legislation Producing Realized Health Services

The study designed by a committee: Design of the Multisite Violence Prevention Project

Abstract This article describes the research design of the Multisite Violence Prevention Project (MVPP), organized and funded by the National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC). CDC's objectives, refined in the course of collaboration among investigators, were to evaluate the efficacy of universal and targeted interventions designed to produce change at the school level. The project's design was developed collaboratively, and is a 2 × 2 cluster-randomized true experimental design in which schools within four separate sites were assigned randomly to four conditions: (1) no-intervention control group, (2) universal intervention, (3) targeted intervention, and (4) combined universal and targeted interventions. A total of 37 schools are participating in this study with 8–12 schools per site. The impact of the interventions on two successive cohorts of sixth-grade students will be assessed based on multiple waves of data from multiple sources of information, including teachers, students, parents, and archival data. The nesting of students within teachers, families, schools and sites created a number of challenges for designing and implementing the study. The final design represents both resolution and compromise on a number of creative tensions existing in large-scale prevention trials, including tensions between cost and statistical power, and between internal and external validity. Strengths and limitations of the final design are discussed.

Through a public health lens. Preventing violence against women: an update from the US Centers for Disease Control and Prevention.

Over the past two decades, the Centers for Disease Control and Prevention (CDC) has been a key contributor to the growing public health effort to prevent violence. Although CDC and its partners are proud of their many successes, much work remains to be done. Violence continues to be a leading cause of death worldwide for people aged 15-44. Moreover, although many forms of violence garner national concern and resources, much more violence occurs in private domains and receives less attention. These hidden health hazards silently drain our nation's human, economic, and health resources. In this paper, we highlight the current efforts of the Division of Violence Prevention (DVP), housed within CDC's National Center for Injury Prevention and Control (NCIPC), to use a public health approach to the prevention of one key hidden health hazard: violence against women (VAW). Building from a recently developed strategic plan and a research agenda, we explain how four core public health principles--emphasizing primary prevention, advancing the science of prevention, translating science into effective programs, and building on the efforts of others--drive current programmatic activities in VAW prevention. Several current programs and projects are described. Finally, we conclude with recommendations for future prevention work by deepening our vision of leadership, expanding our partnerships, pursuing comprehensive approaches, and using evidence-based strategies.

Systematic reviews of injury-prevention strategies for occupational injuries: An overview

Background: Information on which strategies have been shown to be effective, which are ineffective, and which strategies have been inadequately evaluated is important for both public policy and future research. Objective: The objective of this study was to provide systematic reviews of the literature on important strategies to prevent occupational, including agricultural, injuries. Methods: The Injury Control Research Centers (ICRCs) funded by the National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, and Centers for Agricultural Injury funded by the Division of Safety Research, the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, identified 12 important occupational and agricultural injury-prevention strategies or areas of research. Systematic reviews of the literature were conducted to identify relevant controlled trials and studies. These were critically reviewed and summarized. Results: A total of 12 reviews were conducted on a range of topics in the occupational injury field. Few randomized controlled trials were found; most controlled studies were either comparisons over time and/or across different populations. In several areas we were limited to summarizing the descriptive literature. Nevertheless, summaries of these studies provide meaningful conclusions about the effectiveness of various interventions to decrease morbidity and mortality from selected occupational and agricultural injuries. Conclusions: A large body of literature on occupational, public health, or injury prevention interventions exists. The summary of this literature provides a framework to both direct policy and guide future research efforts.

Data available from National Center for Injury Prevention and Control

On average, violent and accidental injuries claim the life of at least one adolescent every hour. And for every death, there are an additional 1,100 emergency room visits and 41 hospitalizations, according to the National Center for Injury Prevention and Control (NCIPC). Within the Centers for

A Partisan Assault on Science — The Threat to the CDC

One of the agencies singled out for elimination in the recent spate of Congressional budget cutting was the National Center for Injury Prevention and Control (NCIPC), a part of the Centers for Dise...