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A Data Book of Child and Adolescent Injury Prepared by Children's Safety Network

Supported by the Maternal and Child Health Bureau, Health Resources and Services Administration,

Public Health Service, U.S. Department of Health and Human Services

Published by the National Center for Education in Maternal and Child Health

Washington, D.C.

1l.S. Department of Justice National Institute of Justice

150177

This document has been reproduced exactly as received from the person or organization originating It. Points of view or opinions stated in this document are those of the authors and do not necessarily represent the official position or policies of the NatlCJnal institute of Justice.

Permission to reproduce this 1'1 "e'. ' material has been gralFflh'lic Domain/U. S. Dept. -ef Health & Human Services

to the National Criminal Justice Reference Service (NCJRS).

Further reproduction outside of the NCJRS system requires permission of the ~ owner.

NCJRS

SEP 21 1994

ACQURSn1iUOWS

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Cite as: Children's Safety Network. (1991). A Data Book of Child alld Adolescent InjlllY. Washington, D.C.: National Center for Education in Maternal and Child Health.

A Data Book of Child and Adolescent InjU/y is not copyrighted. In accordance with accepted publishing standards, the National Center for Education in Maternal and Child Health (NCEMCH) requests acknowledgement in print of any information reproduced in another publication.

The Children's Safety Network (CSN) provides technical assistance in developing programs to reduce unintentional injuries and violence. You can contact the Children'S Safety Network through:

National Center for Education in Maternal and Child Health 38th and R Streets, N.W. Washington, DC 20057 (202) 625-8400

CSN staff contributing to A Data Book of Child and Adolescent InjU/y:

Education Develo\ unent Center, Inc. 55 Chapel Street Newton, MA 02160 (617) 969-7100

Washington site: Susan Brink, Dr.P.H., Lamie Duker, M.P.P.M., Laura Kavanagh, and Sue Lindsay. Newton site: Alison Dana, M.P.H., Susan Gallagher, M.P.H., and Chris Miara, M.S. Graphic design by Dan Halberstein.

Published by: National Center for Education in Maternal and Child Health 38th and R Streets, N.W. Washington, DC 20057 (202) 625-8400

Available in limited quantities from: National Maternal and Child Health Clearinghouse (NMCHC) 38th and R Streets, N.W. Washington, DC 20057 (202) 625-8410 or (703) 821-8955 ext. 254

This publication has beel! produced by NCEMCH under its cooperative agreement (MCU-I17007) with the Maternal alld Child Health Bureau, Health Resources and Services Administration, Public Health Service, U.S. Department vf Health alld Humall Services.

[---l ----------------------------------------~I~_J'-----------------------------------------

CONTENTS

How TO USE THIS BOOK .......................•...........•..................•..... , .. , ...................................................... IV

ACKNOWLEDGMENTS .............................................................................................................................. V

INTRODUCTION ..................................................................................................................................... VII

SECTION I: OVERVIEW ........................................................................................................................... 1

SECTION II: MORTALITY .......................................................................................................................... 7

SECTION III: UNINTENTIONAL INJURY ..................................................................................................... 15

SECTION IV: ViOLENCE ........................................................................................................................ 41

SECTION V: INTERVENTIONS ................................................................................................................. 57

REFERENCES ...................................................................................................................................... 63

ApPENDIX A: INJURY MORTALITY RATES ................................................................................................ 69

;·~tI~~~~~·~~j~~~~;l:;.,~~ ........ .F'~~~';)"~¥'?''i~)~~~ ...... ~:~»<~,,~~~~~~~~~j;:~~~~~~~~.-"" .. _~~:~Il'-""¥lt.~~~'i~~;t~j:~~.;':':~"t':~~F~ ....... ""~O;';:""~~~'\~

"'J~/~~~"4".6-.~j...""''a~);,k';'J~~.".;.~,,~~~~~~'>''J\.j.,. (~."_.~!/:04"""""'~"'V='~~~~~~~~~"'~.-~~~""'-"'""'~"'I'!"'~~.'i,,>.,;II"f~~~"'W'~~"'~~--'."'~""'''':f><''(-'''''V>"'"f

How To USE THIS BOOK

The charts in this book are not under copyright. Individuals are encour

aged to make copies and use tpem in injury prevention .~ e]"orts.

The charts are designed to compare groups within the chart but not across charts. In

Sections III and IV, the scales used on individual charts differ dramatically. Charts are presented in these sections so that the reader may make comparisons between age groups, sex or race, within each injury category. Citations are listed at the back of the b'bok. Mortality rate

charts do not address injuries in infants under 1 year, because available population estimates used to calculate rates reflect all live births rather than the actual number for that age category, thereby affecting the calculation of the rates.

This book was developed by the Children's Safety Network (CSN), a

national resource for child and adolescent injury and violence

-PJ;§vention supported by the M;ternal and Child Health Bureau. Special appreciation goes to Sue Lindsay for her work in coordinating the gathering of information and data display.

This publication d'laws on the work and experience of a

ACKNOWLEDGMENTS

number of individuals and agencies, without which the data would not be available. The 'N ational Center for Health Statistics of the Centers for Disease Control provided the analysis of the 1988 vital statistics, information from the National Health Interview Survey, and the National Hospital Discharge Survey. The data on the use of safety belts and car seats were obtained

through the National Highway Traffic Safety Administration (NHTSA). The Consumer Product Safety Commission, the Department of Justice and the National Institute for Occupational Safety and Health were also supportive of this effort.

The data presented here have been gathered from a multitude of sources. The interpretation of the data is the responsibility of the Children's Safety Network.

-C~~~-":-""-""'_W~~~~~"''''!t~7'~''''''''.:.'fo'''''~U:~~~"f!~~~'''')I!''.~~~+!?r!J(~~,:.:..c..,,,",,,-'.~.~,,,,,~,~"""""'~"""~"~~"'~~~lW"~~~.~~:"~T"'"~~".,.,.. ..... ~~.....,..._~,~: .... ~

I njury is the most significant health problem affecting the Nation's children and ado

lescents, however it is measured-number of deaths, dollar costs for treatment, or relative rankings with other health problems-as this report makes abundantly clear. However, injury need not maim and kill so many of our children. This is an epidemic that we can control, as both prior successes and the international comparisons illustrate. Targeted prevention strategies that have proven effective include flame retardant fabrics

"' --, , ,

INTRODUCTION

for children's sleepwear, child safety seats, smoke detectors, and child-resistant medicine bottles. Other promising strategies have yet to be implemented and evaluated.

Injury includes, but is not limited to, the following categories: motor vehicle crashes, burns, poisonings, drownings, pedestrian and bicycle crashes, homicides, assaults, rapes, suicides and suicide attempts, and child abuse. The National Committee for Injury Prevention and Control defines injury as "any 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" eN ational Committee for Injury Prevention and Control, 1989). Injury is thus a biophysical event.

Contributing factors and prevention strategies for violence and unintentional injury are sometimes the sa..1lle. For example, alcohol and other drugs are often implicated in many types of inj uries, especially those affecting adolescents. Likewise,

·~1:;,;';;>~1't~oe~~~~~!'~.~,;(""'~l""'~."~~_~IM~~~~"f-~~.I""":i"lI"""~"""""_~~1j.~~~.~tr-~.~it>-'9"""","*~~~~1.~~~,~~-t~;';-~\i.~':'~~"""'l~

~ ___ ;~~'~~'~_'~~~~~~'~~~~I~~~~~'~~'~~~~ __ '~~~ __ ~M_~'~ __ ~¥~~--------~~~-~-~~~"~'~>-W--'~~~~~-~~~"~~-~~'~l

VIII

poverty is a strong risk factor for both

violence and unintentional childhood

and adolescent injuries (Baker et at,

1991). Safety improvements to firearms

and limitations on access to them, reduc

tions in tap water temperature, and sup

ports of various kinds to multi-need

families, can reduce injuries, regardless

of intent.

While we have had successes in

injury prevention, it is vital that we do

beUer. Too many children are dying or

becoming disabled and the costs are

high. In this report, information is pro

vided on the substantial dollar costs of

childhood injury to our society, but the

most significant costs are ones we can

not depict graphically, those of child and

family pain. The loss of life or function

A DATA BOOK OF CHILD AND ADOLESCENT INJURY

experienced by a child or adolescent is a

terrible burden for a family to sustain.

Guilt, rage, grief, blame and despair are

common family reactions to a serious

injury of a child, not infrequently lead

ing to divorce, severe depression of par

ents or siblings, and even suicide.

Medical care costs may sometimes

result in family impoverishment (Rice

and MacKenzie, 1989). Thus, one of the

i~ltangible costs of child and adolescent

injury is that of family suffering and

even disintegration.

Healthy People 2000 ( USDHHS,

1991), the government document that

outlines the strategy for improving the

Nation's health over the decade, empha

sizes the need to prevent the thousands

of needless child and adolescent injuries

that occur annually. Numerous injury

reduction objectives for children and

adolescents are specified. Most impor

tantly, the key target objective for both

children and adolescents is to reduce the

overall death rate; this will require a

reduction in the injury rate. As a nation,

we have made a commitn,~nt through

the year 2000 objectives to more sys

tematically address the problem of

injury as it affects children, adolescents,

and families.

To do so successfully will require a

multi-disciplinary and multi-agency

approach. Public health agencies must

work together with environmental, crim

inal justice, traffic safety, education,

social services, and other agencies, as

well as with coalitions of private groups.

INTRODUCTION

To reduce the incidence of injury in

America, we must learn to combine

legislative, technological and behavioral

strategies, change norms that regard

most injuries as inevitable, and actively

address the causes of violence on our

streets and in our homes. A problem of

this magnitude requires the talents and

hard work of a variety of dedicated

individuals representing many fields and

working together for a common goal.

Only then can we meet the challenge

before us.

Maternal and Child Health Bureau

October 1991

IX

0 1-4 years wd C1l 5-9 years

80 [I 10-14 years

70~ears >. :::: 60 ro 1:: 0 :2

~ 50

'0 40 C (])

~ 30 (])

D..

20

10

0

1955 1967 1988

Figure 1.1 Injury as a Percentage of Total MOl1ality Among Children 1-19: 1955, 1967, 1988.

Source: Fingerhut, NCHS, 1988.

·SEC1IONI OVERVIEW

.·C·· i .. hildhobdinjury is ...•.....•.•.•....... · ... >th. e. p.ri.l1.C.lp.al p.··.Ubli .. ·C

. . . health problemm ;. America today. causil1g

more deaths than all child .. hood diseases combined and contributing greatly to childhood disability. In 1988, injury claimed the lives of more than 22AOO children 19 and under in the United States and. accounted for 80% of deaths in the 15-19 year old age group.

~~~l':~~~~~~~'" t>\lf*'"4·,:~~Al:-~~i':<.=.""!~-'''~::o'"......;.'>#''''~~~~~~f.<!!~~--~~'~~-~:'''~-o>rl~~'-'~~~~~'f"~!T,.c~

2

H istorically, there has been a dra

matic reduction in child mortal

ity due to natural causes (diseases,

including congenital anomalies)

while the percentage of mortality due

to injury has steadily increased.

For children ages 1-19, injuries

far exceed cancer and congenital

anomalies as the leading cause of

death.

"If a disease were killing

our children in the proportions that

injuries are, people would be

outraged and demand that this killer

be stopped. "

-former Surgeon General

C. Everett Koop, M.D.

25,000 L

20,000

15,000

10,000

5,000

o 1-19 Years

Figure 1.2


1-4 Years

• Injuries

III Cancer

o Congenital Anomalies

5-9 Years 10-14 Years 15-19 Years

Deaths Due to Injuries vs. Deaths from Cancer and Congenital Anomalies, 1988. Source: Fingerhut, NCHS, 1988.

OVERVIEW

180

160

140

0) -* injury f-

\ I

---$- ",Mal "'"'" _

0 120 \ \

--i 0 0 ci 0 ~ 100 Q)

iii a: £ 80 rn 1:: 0 ~ 60

40

20

~

\ \ ~ -~ - V---'~ -""'" -

\ -- ~

~ - "

- ~ i---\i;)

0

1933 1950 1967 1988

Figure 1.3 Mortality Rate/1 00, 000 Due to Natural Causes vs. Injury: 15-19 Year Olds, 1933-1988. Source: National Center for Health Statistics, 1989; Fingerhut, NCHS, 1988.

I

3

A doles cents are a particularly

.rt. high-risk population for

injury-related deaths. Figure 1.3

shows the significant decline in

mortality due to natural causes for

this age group while the mortality

rate due to injury has increased. In

1988, a 15-19 year old was four

times more likely to be killed by

injury than by natural causes.

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4

Child m0l1ality rates in the

United States are higher than

those in other industrialized nations

similar to our own in culture and

history. "This excess in mortality is

not due to a difference in death

rates from all natural causes; rather,

all the excess mortality among U.S.

children can be attributed to injury"

(Rosenberg et aI., 1990). Figure 1.4

compares injury mortality rates for

five countries, including uninten

tional injury and violence.

About 75% of the U.S. child

mortality due to injury is caused by

unintentional injury (motor vehicle

collisions are the leading cause of

unintentional childhood death). The

other 25% is caused by violence,

including homicide and suicide.


o 5 10 15 20 25 30 35

Mortality Rate/100,000

Figure 1.4 International Injury Mortality Rates/100,OOO Including Violence: Ages 0-24. Source: World Health Organization, 1991.

40 45

OVERVIEW

United States

Canada

France

Federal Republic of Germany

United Kingdom

o 2 4 6 8 10

Homicide Rate/100,000

Figure 1.5 International Homicide Rates/100,OOO by Age Group. Source: World Health Organization, 1991.

12 14 16

5

T he United States is a nation

plagued by violence. In 1988

there were 5,718 deaths due to

homicide in the United States

among 15-24 year oids. During the

same time period there were only

411 homicide-related deaths in this

age group in the countries of

Canada, France, Germany, Spain,

the Netherlands, Switzerland,

Finland and the United Kingdom

combined, despite a total

population of 15-24 year olds very

similar in size to our own.

U.S. children are 10 times more

likely than German children, 11

times more likely than French chil

dren, and 15 times more likely than

English child::-en to be victims of

homicide.

Falls

Poisoning

Motor Vehicle Bicycle

Unintentional Firearms

Fire/burns

Motor Vehicle Pedestrian

Drowning

Suicide*

Other Motor Vehiclet

Homicide

Motor Vehicle Occupant

o

476

1,341

1,711

~"-'" .. 1,714

.• j< .<

-. .' , , _',' 'I

500 1,000 1,500 2,000

Number of Deaths

0

0

LJ .. •

2,296

2,345

2,500

Under 1

Ages 1-4

Ages 5-9

Ages 10-14

Ages 15-19

'I

, 5,896 J l

6,000 3,000

* Suicide statistics are only tabulated for persons 10 and older.

t "Other motor vehicle" includes deaths involving motorcycles, mopeds, snowmobiles, and all-terrain vehicles.

Figure 2.1 Total Number of Deaths by Cause and Age Group: U.S. Children 0-19, 1988.

Source: Fingerhut, NCHS, 1988

SECTION II MORTALITY

F igure 2.1 shows the leading causes of injury-related

deaths by age group. The patterns of childhood injury deaths are shaped significantly by developmental stage and the kinds of activities in which children participate. To be effective, any injury prevention strategy must first examine the link between developmental stage and cause of injury.

~=~""''';'ia~'!l;i.~~~i~msr~~~:~~~~~~.''I'1!1'>~~,::,~~o;rl;u~~",j:.'(J~<r~~~~~~~'''''''''~'~~~~~~","-"':~~~J~"~~""'"'''''''''''-i''''ml.-~~~Y'''.iI'''''''''''''~o:.:-.

8

Ages 1-4

W hen viewed together, motor

vehicle-related injuries (oc

cupant, pedestrian, bicycles, and

"other") were the number one cause

of death in all age groups. Because

interventions differ for each of

these injury categories, the figures

in this section present these four

injury types separately.

In 1988, fires and burns caused

the greatest number of injury

deaths to toddlers and preschoolers

(ages 1-4), with drowning second,

pedestrian injuries third, and motor

vehicle occupant injuries fourth.


MV Bicycles


Poisoning

Falls

MV Other ._98 Homicide _-------381

MV Occupant •.......... 438 MV Pedestrian •........... 453

Drowning pillllllllllllllllllllllllllllllllllllllll1l620 Fire/Burns ~ : : I , ? ~6~

o 100 200 300 400 500 Number of Deaths

Rates/tOO,OOO are included in Appendix A.

Figure 2.2 Number of Deaths by Cause, Toddlers and Preschoolers: Ages 1-4, 1988. Source: Fingerhut, NCHS, 1988.

600 700

MORTALITY

Poisoning

Falls


MV Other

MV Bicycles

Homicide

Drowning

Fire/Burns

MV Occupant

MV Pedestrian I , I , ~3~ o 100

Figure 2.3

200 300 400 500 Number of Deaths


600

Number of Deaths by Cause, Elementary School-Aged Children: Ages 5-9, 1983. Source: Fingerhut, NCHS, 1988.

700

9

Ages 5-9

T he four leading causes of

injury death to school-aged

children (ages 5-9) in 1988 were

motor vehicle pedestrian, motor ve

hicle occupant, firelburns and

drowning. Motor vehicle pedestrian

deaths reflect the increased mobility

and independence of this age group.

Motor vehicle pedestrian and occu

pant injuries account for nearly 40%

of all deaths in this age group.

~~"""'''''''~_~'''''/O~~~>,l~'~~'''''''-ZI;./;'''''~~~''~~'':~~~-';$<'''~'''''''~~~>!/'f;;;:~~·~''''~~~~';:;,~H';!Il,t<;W~~fjf~~~~~t;Oii~~ .... ~ ... ~~·-.,~~

~,-~ ............. ~~.,.. .... :;r~~~~~~J~~~~~M~~""'1m-\'Jf~eo~~~'f!~~"t""'~~~""~~~4~~>!"~.J?«!,'*"'''''''''''''.\I'",,~~ ...... !;:_t'IO-_'~~~'''~~1¥,''''~'.'~~ .. '.

10

Ages 10-14

O nce children reach middle

school (ages 10-14), the three

leading causes of injury death are

motor vehicle occupant, motor

vehicle pedestrian and homicide,

closely followed by suicide and

drowning. Intentional injuries

account for almost 20% of the total

injury deaths for these children.


Falls

Poisoning

Fire/Burns

MV Bicycles


MV Other

Drowning

Suicide

Homicide

MV Pedestrian

MV Occupant I, I, I, ,i, I , ~5~ ,I

o 100 200 300 400 500 Number of Deaths

Rates/tOO, 000 are included in Appendix A.

Figure 2.4 Number of Deaths by Cause, Middle School Aged Children: Ages 10-14, 1988. Source: Fingerhut, NCHS, 1988.

600 700

MORTALITY

Falls

Fire/Burns

MV Bicycles

Poisoning


MV Pedestrian _.406 Drowning

_._487 MV Other

Suicide

Homicide

MV Occupant l ,9 ' I ~ I

o 500

Figure 2.5

1,000 1,500 2,000

Number of Deaths


Number of Deaths by Cause, High School Aged Children: Ages 15-19, 1988. Source: Fingerhut, NCHS, 1988.

2,500 4,500

11

Ages 15-19

F or high school aged youth

(ages 15-19), motor vehicle

occupant injuries are by far the

leading cause of injury-related

death. Twice as many 15-19 year

olds die as occupants of motor

vehicles than from any other cause.

After motor vehicle occupant

deaths, homicide, suicide and other

motor vehicle deaths far exceed all

other causes of death.

12

I· n all injury causes males are

consistently at higher risk for

death due to injury than females.

Males are .tlmost four times more

likely than females to commit sui

cide, 2.5 times more likely to be

victims of homicide, almost 3

times more likely to drown and 6.5

times more likely to be the victim

of an unintentional firearm

discharge.

12

10

8 o o o 6

10.2.

~ .6.3 en

"* 6 a: .c iii Q)

o

10.3


1·1 Females

Males

6.5

Figure 2.6 Death Rates/ 100,000 by Gender: Ages 19 and Under, 1988. Source: Fingerhut, NCHS, 1988.

4.8

41 ili 3.5

2..7 _ 2..6

2

o MV Occ

MV Suicide Homicide Fire! Drowning Unint Falls MV MV Ped Burns Firearms Bicycles Other

MORTALITY

Figure 2.7 Pyramid of Childhood Injury. Source: Gallagher, personal communication, 1991.

13

Childhood injury mortality fig

ures are shocking. However,

mortality is only a small part of the

total injury picture. The pyramid in

Figure 2.7 compares the number of

unintentional and intentional injury

deaths to hospitalizations to emer

gency room visits in a population

based study in Massachusetts.

Interventions targeted solely

at injury deaths may neglect fre

quent injuries that are costly, and

cause children to be treated in

hospitals and perhaps left

permanently disabled.

'f'<""~~~~~"""),1.~~~"""'~.f.l."":""~/""':~~~"""""""~~~~f-"_"'~~'¢~'-~1,.",~_~"",~1.-~~~~-;:~"",'''~~1'--I'''''f,f~>#''d'~~~~ .......... w

Unintentional injuries

. result from the complex interaction of the

child's developmental stage, parental awareness of a child's abilities, and a product or environment. For example, injuries caused by motor vehicles represent a concern at all ages. However, the most frequent cause of injury by motor vehicle differs by the child's age, with infants injured as occupants, preschoolers injured as occupants and often as

SECTION III UNINTENTIONAL INJURY

a-",:-:~

pedestrians in driveways, elementary school children injured on streets as pedestrians and bi-

cycle riders and adolescents injured as drivers and passengers-often with alcohol involvement.

Attention to the developmental differences in children will help in the design of prevention strategies. Reduction of unintentional injuries to children and adolescents will require not only legislative and regulatory ini-

tiatives, but also changes in products, the environment and individual behavior.

./-:,:u"-"<.~~~~""",~~","."~~~~~<f<~~')I~ykl"'~'I;"~""" __ ~~~':"~~"""'~~.t:i~~~~~l'f*'+7.i~~.,(~~~""'I~:W':;:,"",

UNINTENTIONAL INJURY

Ages 15-19 65.0% (6785)

<1 2.1% (215)

Ages 1-4 9.6%

(1005)

Ages 5-9

11.3% (1176)

Ages 10-14 12.0% (1241)

Figure 3.1 Children Killed in Motor Vehicle Crashes by Age Group, 1988.

Source: Fingerhut, NCHS, 1988.

17

Motor Vehicles

On average, more than 28

children and adolescents die

in motor vehicle-related incidents

every day. This is equal to almost

3 school buses full of children ev

ery week. In 1988, adolescents

ages 15-19 accounted for 65% of

the 10,428 motor vehicle deaths to

children and youth.

~~~~~-V~."M .... ;,~~~~~(~ ..... ~.~~uwu~~~~,~~t:.ItI~~"'i. .. ~~~t~ .. 'f."1~~~~~~~~1>1'~~~~~~~*,;t\

~~':~';";;f'f"M~~~~~~-~:d. "'~~;t~~;~~I!~~~~~~~.'n-M;.~~~""[~""".-¢*J~~~"",,~~ ... ,..~-\..:r~~~"',·~I~"&~~~~q.

18

Motor Vehicle Occupants

F or motor vehicle occupants, the

death rates of males and

females are very similar across an

age groups until ages 15-19, when

the male fatality rate exceeds the

female rate by almost 2 to 1. The

death rate for adolescents ages

15-19 is more than 5 times the rate

for any other age group.

Two out of three teenage passen-

ger deaths occur in crashes in which

another teenager is driving (Fleming,

1990).


35

30 -::J- Male

a 25 _ Female a a c5 ~ 20 Q)

T!! g 15 C1l 1:: 0 ~

10

5

0 Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19

Figure 3.2 Motor Vehicle Occupant Mortality Rates/10o, 000 by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.


Figure 3.3

50.4%

Blood Alcohol Content

D BAC=O.OO

D BAC=.01 %-.09%

• BAC~.10%

Adolescents Ages 15-20 and Alcohol Use in Fatal Motor Vehicle Crashes, April to June 1990. Source: Centers for Disease Control, 1991.

19

Adolescents, Alcohol and Motor Vehicles

During the past seven years

NHTSA has shown that the

proportion of intoxicated drivers

involved in fatal motor vehicle

crashes has decreased in all age

groups including adolescents.

Nevertheless, during one 3-month

period in 1990, it was found that

just under one-half of adolescent

motor vehicle fatalities involved ai

cohol. Of adolescents invo]ved in a

fatal crash, one in every three had a

blood alcohol concentration greater

than or equal to 0.10%, the legal

limit of intoxication in most states.

;,~~~;",rn-:~:;:!''''-~~~"-M~~~>i!~~l:~~~';>~'#''''''~~''''::'''''''''';'~~~~~'¥-~'~ri~~?~l>,~/?"",$;.yJ~~~f!oo':"""'~~,...".m~""+,,,--,,~,k~'~")\~~~k-,.~~~~~r~~~~~~'.

20 A DATA BOOK OF CHILD AND ADOLESCENT INJURY

Safety Belts

I ncreased usage of safety belts in

the last decade is one of the

most dramatic victories of the

injury prevention movement to

date. From 1983-1989 the use of

safety belts saved an estimated

20,086 lives and prevented approxi

mately 523,100 moderate to severe

injuries (NHTSA, 1991a).

Although safety belt use in gen

eral has increased dramatically from

11 % in 1982 to 49% in 1990 (NHT

SA, 1991 a), adolescents continue to

wear safety belts less often than old

er drivers. In a nationwide survey of

adolescents, 41 % reported that they

wore a safety belt the last time they

rode in a vehicle. However, fewer

than one quarter of the students

(22%) reported that most of their

friends usually wear a safety belt

(American School Health

Association et aI., 1989).

Healthy People 2000 states a

goal of increasing use of occupant

protection systems to at least 85%

of motor vehicle occupants (USD

HHS, 1991). As ofJuly 1991 only

40 states and the District of

Columbia have safety belt use laws

(IIHS, 1991), and as of June 1990

only 8 states allowed police to write

tickets for safety belt violations

alone, without citing for another

moving violation (Fleming, 1990).


1 .;~¥;:

"J'v)

" .

-~~

,1/' .• /~/~ ~ ~ '~ ',.,,~,. ,~ .. '.

~{ ~

/

f '" ""'~

21

Child Safety Seats

P ropedy installed and used,

child safety seats reduce the

risk of death and serious injury to

children by 70%. The use of safety

seats in 1989 saved the lives of

over 200 children ages 4 and under

and prevented 28,000 injuries.

Tragically, 336 unrestrained chil

dren under age 4 died in passenger

cars in the same year (NHTSA,

1991a).

The year 2000 objective for

child restraint usage is 95% for

children ages 4 and under

(USDHHS, 1991). The CUl1'ent

usage rate is estimated to be

approximately 83% (NHTSA,

1991 a). While this rate appears

high, improper installation and use

of child safety seats are widespread

problems. Research suggests that

80% of child safety seats are

misused in some way (NHTSA,

1990). Correct use of child safety

seats could prevent about 500

deaths and 53,000 injuries every

year (NHTSA, 1991a).

Although all states have child

occupant protection laws, their

scope varies widely. Many laws

exempt children beyond a certain

age or allow children to ride unre

strained in the back seat. Meeting

the year 2000 objective will require

closing legal loopholes and

stringently enforcing existing laws.

~'Ji."~~~~-A~~;.~~~~,""~f~~","\~~.!,~~..,....,,~.,;;_~~b~~~~~'~iJ--!--~t~:,,~~~,,:;,~~ .. ~~i"'~~~~~~~~~~~~""":.;:~~""''''''''''~

22

Pedestrians

P edestrian deaths account for

16% of all the motor vehic1e

related deaths to children ages 19

and under. Males accounted for 2

out of 3 childhood pedestrian

deaths in 1988. The age groups at

highest risk were the 1--4 and 5-9 year olds.

Pedestrian death rates for black

children are consistently higher than

for white children across all age

groups except for male adolescents

6

5

o 4 25 cS o ~

l 3 £ til t:: o ~ 2


-+- Black Males --[}- Black Females

--e-- White Males --.- White Females

'-. ...

ages 15-19. Fewer neighborhood 0 -II---------.-----~------,-----~

off-street play areas may put poor

children at higher risk of pedestrian

injury (Malek et aI., 1990).

Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19

Figure 3.4 Child Pedestrian Mortality Rates/100, 000 by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.


-~v .. _.... 4a .

......->1".;;. ¥' ..... ~c.,.""'-"t '''~,...:.,! .. ,_~.j.'':, ':'~~~~~_'~ " '~, .. ,-.~

"'''-.

t;.:;"lL;.,~~~A.L.'~~_''' •. ~"".~~~;_A.._ '.::~ -::. , -'"'~l'illilM!'~~

, . . ,;{ r~ ~ ,....-""': 4'~'/~" ",:,.,' . I'.'V' .,..",.. , ( ~ ,

'~-)

23

Pedestrians

I n 1988, 1,711 children and

youth died as a result of pedes

trian injuries. Children ages 5-9 were far more likely to die as

pedestrians (531 or 45% of all mo

tor vehicle-related deaths) than as

occupants of motor vehicles (389

or 33% of all motor vehicle-related

deaths). Young children have

difficulty judging distance and the

speed at which cars are moving.

Most injuries occur when a child

darts out into the street in the mid

dle of the block. Children under the

age of 5 are often fatally injured in

home driveways or parking lots

(Brison et aI., 1988).

24

Motor Vehicle Injuries

T he Massachusetts Statewide

Comprehensive Injury Pre

vention Program (SCIPP) calculat

ed annual motor vehicle injury

morbidity rates. As with deaths,

adolescent occupants and pedestri

ans ages 6-12 had the highest risk

of injury from motor vehicles.

Deaths represent only a small

fraction of the outcomes of motor

vehicle injuries. In a study of

injuries at 55 pediatric trauma cen

ters, 38% of the trauma cases seen

in emergency rooms were motor

vehicle related (DiScala, 1991).

The vast majority of these injuries

were non-fatal.


200

180 -0- Occupant

160 -e- Pedestrian

140 0 0 0 cS 120 ..-"2 ~ 100 ~ '5 :0 80-0 2

60

40

20 r::'\

G------- (J --E) 0

Ages 0-5 Ages 6-12 Ages 13-19

Figure 3.5 Motor Vehicle-Related Morbidity (Occupant and Pedestrian) by Age Group, 1979-1982. Source: Guyer and Gallagher, 1988.


18~ 1.6

~- Males

1.41 -.- Females

0 1.2 0 0 a 0 ~

Oi 1ii c: £' 0.8 <ii t 0 :2 0.6

0.4

0.2j / ------------- ~ o -I Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19

Figure 3.6 Motor Vehicle-Related Bicycle Mortality Rates/100, 000, 1988. Source: Fingerhut, NCHS, 1988.

25

Bicycles

As many as 90% of bicycling

fatalities involve mOlor vehi

cles (Kraus et aI., 1987). Children

ages 10-14 are at greatest risk and

males over the age of 5 are at much

greater risk than females of motor

vehicle bicycle fatalities.

The majority of bicycling deaths

are due to head injuries. Riders

who wear bicycle helmets reduce

their risk of head injury by 85%

(Thompson et aI., 1989), yet it has

been estimated that less than 10%

of recreational bicyclists of all ages

wear helme.s (Wasserman et aI.,

1988).

·t~~~~~~~~~~'~~""""'~~'"2r.-"'''''''''''''<l\'~~~W.'''~~.,o.&J,~~_~~~~~~~~~'i.'~;''' .f·~'~:., ti':tt .. ~~~""i~~}5!~4J!#S'j":;!~"'~~~~_~~!~'t';~~'''~~~'''''.'i

.. t'~>\:~';"'~lt..~~;",m""~~~~.....;.;J.:';;~""~"h"~~~"-~~~"';~~~~"""W)i~~-,*,",~","':""~~~~~i-Pr-... ~",~~n.,~.,.\ ... ':"'.ti<>¥,Jj: ,.~_.~," ,t~ .. ~.;·

26

Drowning

APproximately 1,700 children

and youth were victims of

drowning in 1988. Males account

for over 3 out of 4 childhood

drowning deaths. Black males have

particularly high drowning rates in

all age groups. Children ages 1-4

and male adolescents are at greatest

risk for drowning. In 18 states

drowning is the leading cause of

death for children ages 1-4 (Baker

and Waller, 1989).


7 ~ ~

----:] \ / -0-0 0 0 0 41 II ~ -r- ).J --ir-0 \ ... ID 1ii a: 3l , \ / £ -+-lii 1:: 0 ~ 2

o I


Figure 3.7 Mortality Rates/1oo, 000 Due to Drowning by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.

Black Males

White Males

Black Females

White Females


" . .'::::>.

(",y-r-' _. <.;...~>

"f""~,::,:;-::::::,;:z;;::::.:<·,,; ... '").

r:-:'_J> ".,.,~~7

".:"".~.~ ..

.>;,:.1;:"

0~'

;,);:1>

:1\_ -pr;' '

, ~~, )~ -.;y.:><;; .... ' ''' .. ~

"

,: .... ~..-,:-"'.( ~.--

,'.-!>

,.'

..:t .. ' -<.-,

;?p.' f

'-"/'

<,;'1

>('~' 'u'" ~ '~""- /'. " ~ \//"

, 'V; , "

,,~

,/'. , ~f.~:"" ~-""~J

~::~~T.': 'j

-I

27

Drowning and Near Drowning

Y oung children, under age 5,

are more likely to drown in

pools and standing household wa

ter; adolescents drown most often

in open bodies of water. For every

drowning death, approximately

2-10 children are hospitalized and

8-40 are seen in emergency rooms

and released (Spyker, 1985). Approximately 5-20% of children

who are hospitalized for near

drowning sustain severe, permanent

brain damage (Pearn et aI., 1979).

~';';~)<i"';':"-~~~J~#Jh~~~~".,.~~~~~~'e~~~~~ .. ~,~i~"!~~~t4-;~~~lI""'~~~~~~f~~:",..r.;"""~~~~~~~-I'O"~~.~~",,

28

Fires and Burns

F or children ages 1-4, black

males are 4 times more likely

than white males and black females

are 4.5 times more likely than white

females to die from fire or burn

injuries. Income and the quality of

housing are more likely explana

tions for these differences than

race per se.

While fire causes the greatest

number of deaths, scalds are the

leading cause of burn morbidity

(McLoughlin and Crawford, 1985).

In 1989,21,000 children and youth

under 20 years old were admitted to

hospitals to be treated for burn

injuries nationwide (Kozak, 1991).


16

14 --- Black Male

12 a a

-0- White Male

a 810 ~

ID -..tr- Black Female

1li 8 a: £ "iii 6 t

-+- White Female

0 ~

4

2


Figure 3.8 Mortality Ratesl100, 000 Due to Fires and Burns by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.


2.5

2

. -'" 1.5 CIl

iI Q)

> ~ ID a:

0.5 e-----a w

0 r---- --------r- - I


'The population as a whole has a relative risk of 1.

Figure 3.9 Relative Risk of Death Due to Fire vs. Risk of Injury Due to Fire by Age Group, 1987. Source: United States Fire Administration, 1990.

29

Fires and Burns

Seventy-four percent of fire

related deaths occur in residences

with the majority of these in one

and two-family dwellings (United

States Fire Administration, 1990).

Children under the age of 5 have

2.5 times the relative risk of any

other childhood age group of dying

in a fire (the population as a whole

has a relative risk of 1). As children

get older, the risk of death decreas

es but the risk of suffering non-fatal

fire-related injuries increases, peak

ing at ages 15-19.

30


U nintentional firearm injuries

killed 543 U.S. children in

1988. The availability and accessi

bility of firearms presents a high

risk for children of aU ages, but

especially for male adolescents

ages 10-19.

About] of every 3 deaths from

unintentional firearm discharges

could be prevented by a firearm

safety device such as a trigger lock

or loading indicator. A study of au

topsy and police reports determined

that a child-resistant trigger lock

could have prevented every incident

in which children under age 6 killed

themselves or others (U.S. General

Accounting Office, 1991).


3

251 -II- Males

--e- Females

0 2 0

0 ci 0 ..-

1 1.5

.~ rn 1:: 0 :2

0.5


Figure 3.10 Unintentional Firearm Mortality Rates/100,OOO by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.


1.6 - Male

14i --- Female

1.2

0 0 0 c5 0 T""

CD rn 0.8 0:

.~ (ij 1:: 0.6 0 ~

0.4

0.2

0


Figure 3.11 Unintentional POisoning Mortality Rates/100,OOO, by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.

31

Unintentional POisoning

Since 1970 legislation requiring

child-resistant closures on many

products, poisoning deaths have de

creased dramatically, particularly

among children under 5 years old.

In 1988,322 children died from

unintentional poisoning. Rates were

highest for adolescents 15-19;

many of these deaths are thought to

be undetected suicides. Adolescent

males are 2.5 times more likely than

females, and black children ages 9

and under are 3 times more likely

than their white counterparts, to die

from unintentional poisoning. An

estimated 69,000 children and youth

were hospitalized in the U.S. in 1989

due to poisoning (Kozak, 1991) .

..-"'-.,. .. ~~~#\ol~~.:;;;M..~I"'~ .... """"'~~t~~ ... ~.~""""''l,~~,,~~.J<~'>'''''''''' ..... ~,,~~ ~~~ ... ;-u&lp.:.~~~~~;~)~....,:4-~I"I.,N~I\I>~~~P~f.~~M..~~~'951t:'!!~~~~~4~~m1""~':"'<f'":'.w~~,.,.~ ... ~"",~~~

~~.;~W!:r~0;~~Pi-~~~~~"'a,..!r.¥~~~~~~'''~'''''~~~~~~~~''I''''''~'!;$'''.~~~~'~''''''''''''''-~~."~~~~"",,,,~~~.,.~r.--"-'",

32

Fans

D eaths due to falls are most

prevalent among males under

J and ages 15-19. Among toddlers,

fatal faDs occur most often from

windows and on stairs. Risk-taking

behaviors put adolescents at risk for

death from falls.

Most falls do not result in death,

but may result in serious injuries.

Falls in children are most often as

sociated with stairs, furniture,

strollers, high chairs, walkers,

changing tables and playground

equipment (Gallagher et aI., 1984).

An estimated 100,000 children are

treated in emergency rooms each

year for playground-related falls

(U.S. CPSC, 1990a).


0.9

0.8

0.7

0 0 0.6 0 0 0 .-2 0.5 (1J

a: £' 0.4 til 1:: 0 0.3 ~

0.2

0.1

0

Ages 1-4 Ages 5-9 Ages 10-14

Figure 3.12 Mortality Rates/100, 000 Due to Falls, by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.

Ages 15-19


Drowning/Suffocation

Falls

Blunt Force

Homicide

Electric Current

Machinery

Motor Vehicle

Other'

Figure 3.13

o 50 100 150 200 250 300 350 400 450 500

Number of Deaths

* Other includes air/water transport, nature/environment, suicide, explosion, fires, missiles/firearms, cutting/piercing, hot substances, and unknown.

Occupational Deaths to Adolescents Ages 16-19, 1980-1986. Source: National Traumatic Occupational Fatality Database, 1991.

L =::J 33

[ ~. ::::J

Occupational Injuries

U.s. adolescents are severely in

jured and die in a wide variety

of occupational settings. From

1980-1986, 2,l37 adolescents ages

16-19 died at work as reported to

the National Traumatic Occupa

tional Fatality data base. Males ac

counted for 93.4% of the deaths.

The top two causes of death were

motor vehicles and machinery. The

industries (when provided) in

which adolescents were most likely

to die were construction (312),

fishing (213), public administration

(56), transportation (41), manu

facturing (134), retail trade (128),

and services (121).

34

Occupational Injuries

E stimates of occupational injuries to

adolescents are underreported due to

several factors: death certificates are

often not accurately coded as work

related (Colorado Department of Health,

1988), surveys of occupational injuries

do not ask the age of the victim, and agri

cultural and transportation injuries and

homicides are often not reported as occu

pational injuries (Suruda and Emmett,

1988). Injuries that do not result in death

are even less likely to be reported. One

population-based study of adolescents

ages 14-19 found that 24% of all hospital

and emergency room treated injuries

were job-related, and resulted in a greater

median length of stay than for other ado

lescent injuries (Anderka et aI., 1985).



Ages 15-19

Ages 10-14

Ages 5-9

Ages 1-4

o

Figure 3.14

20 40 60 80 100

Number of Children

• Non-Hospitalized Injuries

o Hospitalizations

D Deaths

120 140

Agricultural Injuries to Iowa Children and Youth Ages 19 and Under, 1990. Source: Jones, 1990.

160

35

Farm Injuries

C hildren are particularly suscep

tible to agricultural injmies be

cause they ride on or work with farm

machinery at a young age and often

live on the same site where work is

performed. Federal labor laws do not

apply to the family farm.

One surveillance study of work

and leisure-related agricultural

injuries to all children in Iowa

found that 369 children were

injured but not hospitalized, 57

were hospitalized and 13 died in

1990. Males accounted for 81 % of

the injuries, and children were most

often injured by machinery,

animals, falls/slips, and striking

against something (Jones, 1990).

',<,',o~""'·~~"'''''''~~''''''''''-'''~r.If<\l'o·~'f'''~~~~~'-~~~~~~~'''''t<;o .. ~~~~ ..... ~j,.,~~~~''Jt>'~~:'!~:1:'ffl-'~~~-Y'~",",~,--,,~,*,p~

~~'e.~G;t"""~'''''''''I"'''''';''''~ri,'Mf!~~~~~~~i6*;.,,.,';.ll:''-;~';';!~}.m';.'%';!I~~~~~~~.~~~~=-tI'!r'!...,.",..~~~~~~~;h"""~~~"'""""'''''''~~''''''';'P''fi~~~~,M;~~~'''''''f'I',

36

Sports Injuries

T he risk of injury through par

ticipation in sports and recre

ational activities mcreases as a

child grows older. The injury rates

in a Massachusetts study of child

hood injuries indicate that 1 in ev

ery 14 adolescents will be seen in

an emergency room (ER) or hospi

talized for a sports-related injury

annuany. Twice as many males are

injured in sports-related activities

as females. In the Massachusetts

study, 17% of aU injuries treated in

emergency rooms and 16% of all

hospitalizations for injuries were

related to sports and recreational

activities (Guyer et aI., 1990).


Ages 13-19

Ages 6-12

Under Age 6 15

o 100 200 300 400 500 600 700

Morbidity Rate/10,000

Figure 3.15 Annual Sports-Related Morbidity/10,OOO in Massachusetts by Age Group, 1979-1982. Source: Guyer and Gallagher, 1988.

703

800


Swimming 2%

Ice Skating 2%

Roller Skating 9%

Unknown 9%

Individual Sports 40%

Figure 3.16

Other Team Sports 4%

4%

Basketball 14%

Team Sports 51 %

Percentage of Sports Injuries by Cause: Children 0-19 in Massachusetts, 1979-1982. Source: Massachusetts Department of Public Health, 1983.

37

Sports Injuries

Sports are the most frequent

cause of injury for both male

and female adolescents. While in

juries from team sports are more

frequent, injuries resulting from

recreation and individual sports are

generally more severe. Track and

field, bicycling, horseback riding

and ice skating entail higher risks

for head injuries than contact team

sports such as football. Sports

related injuries incur greater direct

costs than other injuries due to a

high rate of hospi talization and

emergency room visits (Listernick

et aI., 1983).

'''''4W ... ~!",~..u~4'~~·~-~.~~~";,"t~~''''':Jioj<¥~~;,..~,,,,~~~,.9~~~'M·~~,,"I~''~~~#'''-''''''~~''''''..'l\'lfi~~~~~~fl~"'If\'''t~''7';;~~~~,?",7>.~_~rt+-~-~\W:o~

m-..:-.r.-~~?:'O~"'~·~~~!:t.li~~~~~~~iO,...J'~~~fl}~.~'~~.~t&'\r~.r,p; • ..m~r,;~~'lmI>M~~~~'l"-~~~"...".~~~,_.;.~~~'I._""""""'~~~~~~,,",*"""a'''''''''-''\';'~.

38

Toys

From January 1989 to Septem

ber 1990, 33 toy-related deaths

were reported to the U.S. Con

sumer Product Safety Commission.

Twenty of these deaths were chok

ing incidents, nine involving

balloons (a high-risk toy for young

children). Toys that are hazardous

to children include those with sharp

edges and points, with small parts

presenting a choking hazard or

cords that can cause strangulation.

In 1989, an estimated 122,500

children under 15 years old were

treated in emergency rooms for

toy-related injuries. Three out of

five of these injuries were to

children under the age of 5.

Riding Toys (5) 15%

Toy Chests (5) 15%

Figure 3.17


Mobiles (1) 3%

Small Parts (5) 15%

Balloons (9) 28%

Reported Toy-Related Deaths by Type of Toy, January 1989-September 1990. Source: U.S. Consumer Product Safety Commission, 1.990b.

Because of their far greater magnitude, bicycle injuries are not included in this graph. They are depicted in Figure 3.6.

Figure 3.18 National Estimates of Injury Associated with Child and Youth Recreational Equipment, 1990. Source: U.S. Consumer Product Safety Commission, 1990c.

39

Recreational Equipment

Riding toys (scooters, tricycles,

wagons, etc.) were associated

with over one-third of all toy

related injuries. Children ages 5-14

are particularly vulnerable. Many

of these injuries reflect a young

child's lack of coordination, motor

skills and cognitive ability to use

such products safely.

An estimated 45,000 children,

adolescents and young adults were

injured riding all terrain vehicles

(ATVs) in 1990. Most injuries in

volved the head and neck. Young

people under age 16 should never

ride adult-sized ATVs and should

always wear a helmet.

&---------------------~

1 ~

V iolence has been defined as the use of force with the

intent to harm oneself or another. Violence takes many forms including homicide, suicide, rape, domestic violence and child abuse. Most acts of violence occur between family, friends and acquaintances.

Historically, violence has been studied almost exelusively from the perspective of criminal justice with

'---I

SECTION IV VIOLENCE

most efforts concentrated on attempts to curb violence or punish offenders. However, violence is now recognized as a major threat to the health and welfare of our Nation, particularly our Nation's children.

Public health professionals in all settings need to recognize the benefits of incorporating violence prevention strategies into their roles and settings.

""!~."'~~~~"'~~~""W'~,\>~~/<.A}"''M~=-w~.~~~ .... ~..u..m''''''~~~~~.~~~~11!'!'!.~.':t4.~.f...s1 .. ~/w:~~~

~.:~ ...... ~.~"'k!t\~~~iliP'~¥.i'Q:.~~~~~~~~~~~~"'~~~<~'~~~~"""'~';<;> .4 . ... --.,.,......""""~-..":.~r:f'~..,... .. ~ .. ~_~,~~~_~ .... ~

42

Homicide

HomiCide is the second leading

cause of injury death among

children and adolescents. In 1988,9

children a day (3,290 children/year)

were victims of homicide in the

United States. Childhood homicides

show two distinct patterns. Children

under the age of 5 have a high homi-

cide rate primarily due to parental

and caretaker abuse and neglect.

Adolescents have an extremely high

rate resulting from arguments and

crime involving peers,

acquaintances and gangs

(Christoffel, 1990).


12

10

a 8 a a

o· a ..-]l Cll 6 a: Ql '0 '0 'E 0 4 I

2 C'---------- ~~J ~J

0


Figure 4.1 Homicide Ratesl100, 000 by Age Group: Children and Adolescents Ages 19 and Under, 1988. Source: Fingerhut, NCHS, 1988.

VIOLENCE

1-4

5-9

10-14

15-19

1-4

5-9

10-14

15-19

o 10 20

Figure 4.2

30 40 50 Homicide rate/100,OOO

[If Black Females

o White Females

• Black Males

D White Males

60 70

Homicide Rates/100,OOO by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.

..,..., 80

Homicide

[_=:J 43

[= "I

M ales are at a much greater

risk for homicide than

females. In 1988, among all

children ages 19 and under, 7 out

of 10 homicides involved males.

Overall, the homicide rate for

black children is 6 times that for

white children and is higher for all

age groups regardless of gender.

In no age group is this difference

more staggering than males ages

15-19. Black males ages 15-19 are

almost 10 times more likely to be

victims of homicide than their

white male counterparts.

"-"---"~'-''''''''-''~-.,-....,,,~,,,,,".,~.,.,,,,---,-~,-,,,,,--,,---... ",,,,------'-"""""'--"""~-~'-----';'.~'~·--~' ___ "'''_4~'''''·'·''_'''''-''''''''''"''''· ~l'~-fo\~~~~~~I~·~"'1t>.>;.

~~~.~tJ~,..y.;WfJ.l:~~-J~~~~~~:~n,o~~~~I'~~~·~~'1~~"""'~""'-:~~~·"""'~~~#.~~~~~""


Homicide

F irearms playa significant role

in childhood mortality and

morbidity. In 1988, 77% of the

homicides in ~he 15-19 year old age

group involved a firearm.

It is estimated that there are cur

rently more than 200 million hand

guns, tifles and shotguns present in

our communities (Bureau of Ako

hoI, Tobacco and Fireanns, 1991).

In a national survey of school

students, 48.1 % of 10th grade

males and 33.6% of 8th grade

males answered yes when asked if

they could obtain a handgun

(American School Health

Association et al., 1989).

2500

20001 (f) Ql "0 :2 1500 E 0 :r: '0 '-Ql

..0 1000 E ::> z

500 Firearms

13% oftotaJ

"

0 Non-firearms

II Firearms

o -I b. sd Ages 1-4 Ages 5-9

Figure 4.3

Ages 10-14

Number of Firearm VS. Non-Firearm Homicides by Age Group, 1988. Source: Fingerhut et al., 1991.

Ages 15-19

VIOLENCE

0 0 0 0 0 ~

2 ~ CD

"0 '0 'E a I

70

60 -II- Firearm

50 ___ Non-Firearm

40

30

20

10 ---a . · . . . . . a

o I 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988

Figure 4.4 Firearm VS. Non-Firearm Homicide Rates/100,OOO: Black Males 15-19, 1979-1988. Source: Fingerhut et al., 1991.

45

Homicide

H omicide is the leading cause of

injury death for black males

ages 15-19. From 1984 to 1988, the

firearm-related homicide rate for

this group more than doubled.

Poverty and inequality are

thought to be major risk factors

for homicide. "In fact, when pover

ty is controlled for, the excess risk

among blacks virtually disappears"

(Runyan, 1989).

Violent crimes against adoles

cents often involve casual acquain

tances of the same gender, race and

age. Effective interventions target

ing this age group may thus benefit

both victims and assailants.

~"~~~~<;J"~'q~~"-';''''''''N<r~~''''~fMl..''l;.t;(i''rl~'''''~~~~''';';;'~ .. ~~~~1.~~ ......... ~'io<~~''''''~~~~""","l(.<"M#~~~~~"'::~J1-~J:t~~"";;,..",?~~~

~~I&!~~~f!!~~~~~~';~'~ii'iiR~~;,;..,~'~""p;.:.""'-'~~~~~~~!~~,"";;.1*~;~',,~j.¢l\!~""",j::m~~".,:;r..~~~.h""~'~M~'.,

46

Assault

The most recent National Crime

Survey reveals that America's

youth are more vulnerable than

adults to both violent and property

crime. "On average, every 1,000

teenagers experience 67 violent

crimes each year compared to 26 for

every 1,000 adults age 20 or older"

(Whitaker and Bastian, 1991).

In a population-based study in

Massachusetts, it was determined

that annually 1 in 132 children

(ages 0-19) received an intentional

injury that required medical atten

tion at a hospital. For every homi

cide there were 534 emergency

room visits and 33 hospital admis

sions (Guyer et aI., 1989).

a a C!. ..-Qj iii a:

40

35

30

25

20

15

10

5

o

Simple Assault


t Aggravated Assault

II 12-15

o 16-19

III 20 and over

Robbery

'Simple Assault is defined as an attack with the intent to inflict injury, without use of a weapon. tAggravated Assault is defined as an attack with the intent to inflict injury, usually with a weapon.

Figure 4.5 Average Annual Victimization Rate/1,OOO by Age Group and Type of Crime, 1985-1988. Source: Whitaker and Bastian, 1991.

VIOLENCE

15-19

~ J

~ '" .

10-14

en Ql Ol «

15-19

~ 10-14

I I I j I Iii I Iii I I

0 2 4 6 8 10 12

Suicide rate/100,OOO

Figure 4.6 Suicide Rates/100,OOO by Gender, Race, and Age Group, 1988. Source: Fingerhut, NCHS, 1988.

0 White Females

IiI Black Females

0 White Males

• Black Males

I j

14 16 18

47

Suicide

I n 1988,2,296 U.S. children

(10-19 years old) committed

suicide. This averages to more than

six suicides per day throughout the

year. Ninety percent of these

suicides were among adolescents

ages 15-19. Almost as many 15-19

year olds committed suicide in

1988 (2,059) as were victims of

homicide (2,135).

White males ages 15-19 are a

particularly high-risk group for sui-

20 cide. This group is two times more

likely to commit suicide than black

males ages 15-19 and four times

more likely than white females

ages 15-19.

W::"'~Mi.,riM["'W;:'~~~.,;z;.,<".!.';:''lli~~!-,.;;~Idt;.:~~~~~~,..;:,.v~~~~"<l'~~''''-='·e''~fFl,"l~'~~'.,;,t~,.".-.~":tT-~""""'""'1'<~"""""'''~~~''''~"",r-~~~~''-'~-I''~\~~~_~~'''''1~',

48

Suicide

Suicide rates have shown

increases since 1960 among

both 10-14 year olds and 15-19

year olds. Between 1960 and 1988

the suicide rates for males and

females ages 15-19 increased

threefold. Suicide also occurs in

younger children (5-9 years) but

the rate is very low.

Suicide among children and

youth is often a very impulsive act

done with little or no planning. A

recent screening of adolescents

12-14 years old revealed that 1 in

25 males and 1 in 11 females expe

rienced significant suicidal

thoughts (Garrison et aI., 1991).


18

.. ////. t.._ 10-14 Males

16

14 ,/"" 10-14 -+- Females

0 12 0 0 0 0 10 ..-CD "§ OJ 8

't:l '0 '5 en 6

/~ -./

L: .. -.~

15-19 Males

15-19 -+- Females

4

2

0

1960 1965 1970 1975 1980

Figure 4.7 Suicide Rates/100,000 by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988; Leenaars and Lester, 1990.

1985 1988

VIOLENCE

1800

1600

'1400

Ul 1200 Q)

32 ()

'5 UJ 1000 '0 .... Q)

800 .0 E ::J

Z 600

400 L Firearms 57% of

200

0

Figure 4.8

total

Males Ages 10-14

D Non-Firearm

• Firearm

Firearms 46% of

total

Females Ages 10-14

Males Ages 15-19

Number of Firearm VS. Non-Firearm Suicides by Gender and Age Group, 1988. Source: Fingerhut et al., 1991.

Females Ages 15-19

Suicide

Almost two times as

many adolescent

49

females as males report actually

trying to hurt themselves (American

School Health Association et aI.,

1989). However, it is estimated that

females complete lout of every 25

suicide attempts while males

complete lout of 3 attempts

(Rosenberg et aI., 1990).

Non-fatal suicide attempts most

often involve intentional ingestions

and cutting or stabbing (Guyer et

aI., 1989). The most frequent

suicide methods among youth are

use of a firearm, hanging and inten

tional poisoning (Holinger, 1990).

·'~-"';';'~~~~i..;;:~~~"~"''''''''''''1:'"~Y~''''''''~~'''o<~~~~~i.-~~<.-"<~"~~~·~,.I-~,,",,,~~,o{~Alt!-~~~~~I'~~1""'-~J.>.,,,,,,,,,,,,~..,,,.~~~;;"

50

Child Abuse and Neglect

I n 1986, an estimated 1,100 U.S.

children died as a result of child

maltreatment. Eighty-nine percent

(approximately 1,000 children) were

2 years old or younger.

Child maltreatment is generally

divided into the two broad categories

of child abuse and child neglect per

petrated by a parent or caretaker.

Child abuse includes physical,

sexual, and emotional abuse. Child

neglect inclujes physical, emotional

and educational neglect.

Using conservative estimates,

more than 930,000 children nation

wide experienced abuse or neglect

in 1986.

o o 0_ o o ,... en Q)

ro a: >.

10

~ 0.8 1:: o :2 O.S

0.4

0.2


\ 01 9- ....... ~

Under Age 3 Ages 3-5 Ages 6-8 Ages 9-11 Ages 12-14 Ages 15-17

Figure 4.9 Estimated Mortality Rates1100,OOO Resulting from Child Maltreatment by Age Group, 1986. Source: National Center on Child Abuse and Neglect, 1988.

VIOLENCE

16

14~ -- Abuse - -

--- Neglect -j

12

10 a a C!. ~ 8 Q)

Cii a:

6

4

2

0

Under Age 3 Ages 3-5 Ages 6-8 Ages 9-11 Ages 12-14

Figure 4.10 Estimated Rates of Child Abuse and Neglect/t, 000 by Age Group, 1986. Source: National Center on Child Abuse and Neglect, 1988.

Ages 15-17

51


Rates of non-fatal child abuse

and neglect increase with age.

Research indicates that children

raised in abusive and neglectful en

vironments are at high risk for

physical and emotional health prob

lems as well as developmental de

lays and school-related problems

(Hochstadt et aI., 1987).

Child abuse is also strongly

linked to domestic violence. A

study of 906 children living in bat

tered women's shelters found that

nearly 50% of the children were

also victims of physical and sexual

abuse (Layzer et aI., 1986).

52


I t is estimated that over 820,000

children experienced non-fatal

injuries related to child maltreat

ment in 1986. Seventeen percent

sustained serious injuries involving

life-threatening conditions or

potential long-term impairments.

Moderate injuries persisted in ob

servable form for at least 48 hours.

Like the risk of maltreatment itself,

the rate of non-fatal injury due to

maltreatment increases with age.

Injury type is important in child

abuse documentation. Even without

an adequate injury history, child

abuse can often be confirmed based

on the nature of the injury and clin

ical symptoms (Kempe, 1962).


Figure 4.11 Estimated Injury Morbidity Rates/1000 as a Result of Child Maltreatment by Age Group, 1986. Source: National Center on Child Abuse and Neglect, 1988.

VIOLENCE

Emotional Abuse

3.5 Sexual Abuse

Physical Abuse

a 2 3

Rate/1000

Figure 4.12 Rate of Abuse/1,OOO by Type of Abuse and Gender, 1986. Source: National Center on Child Abuse and Neglect, 1986.

4

• Males

o Females

5

5.4

6

53


F emales suffer higher rates of

abuse than males in all three

abuse categories. Females are near

ly 4 times more likely to be sexual

ly abused than males.

Analysis of national data found

no relationship between child

maltreatment and race, but low in

come is a significant risk factor for

both abuse and neglect. In 1986

children whose family income was

less than $15,000 were 4 times

more likely to be abused and over

7 times more likely to be neglected

than children in higher income

families.

l{'~~"'~"'Io\!i%*~~~~~,w~.-.t:~-..:~r~~~~~'ti-t~.;..~~tk~~~W4_~"""'~~""M',...Juj""W~"~~~"r..",",,\"':'~.~'l:.~""~~~~~~N"-;"'.,j~~.:>f~~ .. {.~_,",~

~r ... ;,# ... ~ ... \.l""h''''.·.'~'i~ •• ,.,tO<>I~l-~~'ojIj,-~~~~~~#l,.~~~~~,'P~~_~~'''''''''''''~''''''''Ih''<4I.~~~ .... ~~ • ..w'''~'~'''''''-'I'>rt.~~~~.kr~,o:<!I~~~~4~~,',

54

Rape

A ccurate rates of sexual assault

among adolescents are

extremely hard to obtain. One

nationwide study of 1,725

adolescents estimates a rate of 9.2

rapes or attempted rapes involving

violent force and/or the use of a

weapon per 1,000 females ages

13-19 in 1978 (Ageton, 1983).

The vast majority of adolescent

rapes occur between two people

who know each other. One study of

females ages 13-17 found that they

were most commonly raped by a

friend, acquaintance, or relative

(Massachusetts Department of

Public Health, 1990).

Friend/Acquaintance (40%)

Figure 4.13


/

Other (10%)

Other categOlY includes coworkers, school personnel and health professionals.

Other Relative (14%)

Parent/Step-parent (18%)

Relationship between Rape Victim (Ages 13-17) and Assailant, Massachusetts, 1985-1987. Source: Massach'usetts Department of Public Health, 1990.

Preventing Injury

Because children are at risk f~r different injuries at vanous ages, preven

tive efforts need to vary by age. Injuries to children ages 0 to 4

years usually occur in settings controlled by their parents. Making products and the environment safer, building parental knowledge, and supporting families to minimize abuse and neglect can reduce injury rates.

SECTION V INTERVENTIONS

For children, ages 5 to 9, and adolescents, ages 10 to 14, teaching skills that will keep them safe as pedestrians, bicycle riders and motor vehicle occupants will greatly reduce injuries. Other interventions include making school a safer place, providing safe play areas and protective sports equipment, including safety in neighborhood planning, and supporting families to minimize family violence.

For the mid to late adolescent, enforcing safety belt, motorcycle

helmet, workplace, and alcohol consumption laws, limiting access to firearms, and developing conflict resolution skills to minimize interpersonal violence are of most benefit

The prevention chart on the following pages gives an overview of where to intervene and on what topics. In conjunction with site-specific interventions, involving the general community and media will help to change societal norms to non-acceptance of injury and violence.

~~-r,~~~1l..~~~~l~"~~~'#j~"'~~"""'~~""*-",-Il~"'M"~~-~"j,"""'~~~!t.ffl..--;:":';'"..j;'.",\,~~",,,-~~~-",


Figure,5.1 lnterV~ntfpiiSltesa.ndTopjC$ forCl1ildhQOd Injury Prevention Prograrnming

Intervention Site Prenatal Care

Hospitals

WIC Parenting Classes

Prima'Y f1eallh Care Sellings

Homes

Schools

Day Care Centers

Worksiles

Social Services! Youth Services

Birth 14 Years

Parenl1ngSk.;UsTralnlng ~""'''.,.., .... .,=_'''' ...... §'''''''~.~''' . .,L,,''' .. W:!'''''''''''', .... ""''''''''''' ___ '''''''''''''''''''' ... ''''

~. : ~ i· ; :Sf*- Parent Seat Bells ''''''''''''''''::~'~::!:l::F :;.;:: :' :' ::. :'~! ..................................... """""" ........ _ ................... .... ~:;.: :: 2 :ll ! Infant Safety Seals Ed., Loans ! ,.e; I I I; 1:: 2 :;; :;:~

~ ;:m~HomeSafety~~~~

W~.~ .... ~.~·.·::::w.c~·Mm:>A!~K~.\'\"~.~ Infan~ Safety Seats Loans IMmr ; ; ; ww W ~ !:lmg . S .. J m::z.S$i'~~ Gales

~~ InfantandToddlerSafetySeats!;Wj';rSm;g*.,.WWMSm;SWitt~ K. .s: :}~~:. W(!$i'ITS'i'?S'$!!;.;:;::wzw w

~, fii'!W'ZX~rnmr-mmtToys~·· . wmr-mtrm ~w'~~HomeSafetymg;~p;;ZW:"i3H;::i~

Infant and Toddler Safety Seats 11 ~;: I~: ~1 ~@ n ·6::::· . H: ·:·:J.1l.;:~~PedestrianSafety~ ~HomeSafety~

~ i:·:ieW::m:·mW·D~StN:" HomeSafety.ToySafety~

~MotorVe!:lcleSafety~ ~$ »ilUlHl'Cl ~Products*g r M

~MW~ Playground Safety ftm"~ .:x .... ~~.-'.~;.~

W: . -i l?Sl::i I:: Infant Safety Seats ill:: : Ii;; h J!J:M)8b ... :wew:;::;;:;:::c mm:l'&!:~ W:i .: : E .. 'iI331i~ Toys, Home Safety~

Local Law Enforcement Infant and Toddler Safety Seat laW"' ~!. ::. ; W:':f~: 51-1 ; :.!:,::, ;: m~g~·

Code Enforcement

State and Federal Government

Local Community

Media

"3 ~w v ·H.n::;;;:m~ . W:;~W ~TapWalerAegl.llatorsl8uildlngCodesfZ:~ wsw: ~;ea:;~ • WI ~* ~! 'I Smoke Deteclors, Pool Fences, GatesW!.:r:i w .... ~~

~ ;;:: ~111 Infant Safety Seats m.::J!:itJW!:kW~ SIi&2:r.KiJ.:w.:;:m;a;~J ;::~~ ToddlerSeats~ .:sza;&:$~:Z;;Z;

INTERVENTIONS 59

",.-;;

5-9 Vears 10-14 Years

~i iM3'~BikeHelmets~ J;i:E;:mm;~~~;::W::W:::;:::;!iE: swam 2!::mm:m ~

~ "a M i ,5 b!S 2 : . ~ Bike i-I'3lmels 1W-...,j: m mm,;:,;::;;;:w lm<~w.<~~~~~~~*''«~AlterSchocl Programs xr fS:SR:m·"i"Ym"'t1t't ~

~w mll!'! m"'rffl:S Enforcement of Child Labor Legislation, Training for Adolescent Employees ~ !lS'.i:!

~Wl!~~ E7 ~~ Su;cldeCrisisC&nlers f2i& Z20L T liZil, 37'== .!'iil!!:

. I P; : lill: . i I Out-of·Home Care fMtmiBM i' lim l iW i

!;Imis;n:g:\"m;;~ rml: :9i~~~!3 em ~~m.PZ= FTI:I~TI7:F~ Soat Belt Laws W cws..-: S?J~F w !8<S2! ~, i : t~ Motor Cycle Helmet Laws ll:m I £ 1m :;c;s:s:us:

Alcohol SaleslConsumplion Laws 11:. m; Zf! ~ Handgun Storage and Control ::: .~

t: it e;:c;wwc;: dd ; ::m:smn ;:e

_:",","0.\; ____ *,"", '":"'"''''''''''"''''''''''", ",""",,,.;:;;;z:sa;;;::;.,..,,,,,m,,,,,,,",",",",",",",,,,,,,,,,,,,,,,_,,,,"'_,,,,,,:':::. 9:2am! ; . Reduce Televised Violence :~ Dover's Ucense at 18 ~3' ,::q:p.;szm

.""u"".",.'" = '""""'" """"""_ ' 'E' ,_M", .= m"Sil"''''','''''';.. a! ,PO,;!!',," ! !""~ .. ' _% ""ruE = Bike Trails, Sidewalks =-=, Handgun Conlrol ! l l "" , W" ~ Bike Helmet Legislation m:: W' : : re fuWl.1!id L 3~~b& 3 ~

.? S1* 8 :n:9?W =i

~lreW'('it ,~J!! tm:! :! ~ is<t!~£S:: ;;&2&1: ~...msou::! xwSeatBelts :~.~ ;!!~: : $Si:!f .)~

~~~~S:~~~_:!$S3HW;~~WZJ5UiGi% ~m Jte:;i;~Ie'·Sli~mmP.educeTelevisedVlolenceR:: w:i%' = sssnt .W! iBf~~'" ~ ~~)!s: ;:12H:iS !!: me?"'W! ~BikeHelmets ~ m:smm: ~

~~ Safe Play Areas ~m~~ 3~a:ms::ru:t ~ ii.Q\l cia m: .. tm Occupational Safety/Drinking and Driving ~

;~~tL .... ~,,~,.\~~~~~\~~~~,~~~~~~r>'t''''''f,,!~~,~,,"u~,,!~~~~ ... ~~~...,,~~''l"~~~~~"~~"""""-i~~~~"""-'''''.f$>\''''';,,,'>;''.'''!+'<:~''~~~~~~~~~1''!Z'''~''',~'.,

eo'

60

The Cost of Injury

The direct and immediate health

:::are costs of non-fatal injuries

to children have been estimated at

$5.1 billion annually in 1987 dollars

(Malek et aI., 1991).

Falls account for the highest pro

portion of costs through age 14; for

ages 5 through 14 many of the

incurred costs are related to leisure

time and sports activities. For older

adolescent,) the costs incurred result

primarily from motor vehicle occu

pant injuries and sports.


Assault I'V;" ".> D 0-4 ,. 10-14

Suicide o 5-9 • 15-19 Unint firearms

Sports : ~ ~:: ... ,"t'.~., ~ .. o: ] -'1, _:; ~!!>:.":r, ,.. .. ,. ,..~

Poisonings 1 II

Burns 1 I .a FallSj

r-- ' ,. , ; ,~. ". ',' • •••• ~ f· , • • ..

MV Bicycles ,,,, _

MV Other

M::;::::~:~ j_ CJWI.!, ,'j" _",' ,,' '1',' _,,~,,; , I " "'7"" . 'I ." • ,',' '

o 200 400 600 800 1000

Annual Direct Cost in Millions of 1987 Dollars

Figure 5.2

1200

Annual Direct Medical Costs of Non-Fatal Childhood Injuries, by Age in Millions of 1987 Dollars. Source: Malek et al., 1991.

J,.q";nowi~~~~f~~;"';~~':"«',I'i';;·'-'·id!'!lfi~tJio:<.ffi~·~~·~~~.~,,..;J,I~~~~.~.~~~I'I'='~It?";~"'''''''~~;.l',,~.~,~wm.~~.~~~~~f'I'''~~'_.~'

INTERVENTIONS 61

What You Can Do to Prevent Child and Adolescent Injury

As shown in this book, our children, and especially our adolescents, are at risk of dying or sustaining a long-tenn disability from

preventable injuries. Reducing the shocking number of fatal and non-fatal injuries to our children, however, will require the

concerted efforts of many sectors of the community. Our children need a safe place to develop and grow; we cannot accept less.

Effective interventions for injury prevention require:

Planning and Prioritizing

A broad-based coalition represent

ing the community of interest;

surveillance tools and methods to ,;, identify and monitor the number of

injuries;

the use of E codes to aid in the as

certainment of injury causes; and

p selection of priority areas for injury ,,')

control.

Comprehensive Multifaceted Approach

Evaluation of preventi;, strategies

to determine effectiveness;

i'" dissemination and universal implei'}

mentation of effective strategies;

targeting of high-risk groups, such

as low income; and

incorporation of prevention

messages and efforts into service

systems for children and adolescents.

Institutionalization and Acceptance

Coordination oflocal, State and

Federal efforts;

, institutionalization of injury preven-"~

tion programming;

enforcement of existing legislation

protecting children; and

development of a societal norm of a

'safe childhood and adolescence.'

·"",*"1~~~~~~4~~~~\iqri'il~~~~~~~1~"~"""""'''''''''''''''''''''_~_'''''''''~~i"'''.~~~''''''&Il\~~~''''',~'lI">~'~~,.~"!"

I~---i

--------------------------------.----~ ~-------------------------------------L_~

Ageton, S. (1983). Sexual assault among adolescents. Lexington, MA: D.C. Heath.

American School Health Association (ASHA), Association for the Advancement of Health Education, and Society for Public Health Education, Inc. (1989). The national adolescent student health survey: A report on the health of America's youth. Oakland: Third Party Publishing Company.

Anderka, M., Gallagher, S., and Azzara, C. (November 1985). Adolescent workrelated injuries. Paper presented at the annual meeting of the American Public Health Association, Washington, DC.

Baker, S., O'Neill, B., Ginsburg, M., and Li, G. (In press). The injll1y fact book (second edition). New York: Oxford University Press.

FIEFERENCES

Baker, S., and Waller, A. (1989). Childhood injwy state-by-state mortality facts. Baltimore, MD: The Johns Hopkins Injury Prevention Center.

Brison, R., Wickland, K., and Mueller, B. (1988). Fatal pedestrian injuries to young children: A different pattern of injury. American Journal of Public Health 78 (7): 793-95.

Bureau of Alcohol, Tobacco and Firearms. (1991). Personal communication, Les Stafford, Public Relations.

Christoffel, K. 0.990). Violent death and injury in U.S. children and adolescents. American Journal of Diseases of Children 144: 697-706.

Colorado Department of Health. (1988). Colorado population-based occupational

injury and fatality surveillance system report 1982-1984. Denver, CO: Colorado Department of Health, Health Statistics Section.

Centers for Disease Control. (June 21, 1991). Quarterly table reporting alcohol involvement in fatal motor-vehicle crashes. Morbidity and Mortality Weekly Report 40: 24.

DiScala, C. (March 1991). National Institute on Disability and Rehabilitation Research Pediatric Trauma RegistryPhase 2. Boston, MA: New England Medical Center.

Fingerhut, L., and National Center for Health Statistics (NCHS). (Unpublished). 1988 Vital Statistics, Mortality Statistics for ages 0-19.

r.\~~~~~~t~~~~~~~~~T'§"<~~~i'-M""'t~l'!"M-~~~~~~~M~~n~I!',~-"":'I'wlrr<~~"''''''''''''''f.I:<:6:-~~~_~ __ A"'<"'_~~~">'>'IlWl,"}.~~~~~pt~''''''i'>'''~''''-'''''''c,

64

Fingerhut, L., Kleinman, J., Godfrey, E., and Rosenberg, H. (1991). Firearm mortality among children, youth and young adults 1-34 years of age, trends and cun'ent status: United States, 1979-88. Monthly vital statistics report (39)11(suppl.).

Fleming, A., (ed). (1990). Facts: 1990 editioll. Arlington, VA: Insurance Institute for Highway Safety.

Gallagher, S. (1991). Personal communication.

Gallagher, S., Finison, K., Guyer, B., and Goodenough, S. (1984). The incidence of injuries among 87,000 Massachusetts children and adolescents: Results of the 1980-81 statewide childhood injury prevention program surveillance system. American Journal of Public Health 10: 1340-47.

Garrison, C., Jackson, K., Addy, C., McKeown, R. and Waller, 1. (1991).


Suicidal behaviors in young adolescents. American Journal of Epidemiology 133 (10): 1005-14.

Guyer, B., Berenholz, G., and Gallagher, S. (1990). Injury surveillance using hospital discharge abstracts coded by external cause of injury (E code). Journal of Trauma 30 (4): 470-73.

Guyer, B. and Gallagher, S. (1988). Childhood injuries and their prevention. In Wallace, H. , Ryan, G. and Oglesby, A. (eds.). Maternal and Child Health Practices (third edition). Oakland, CA: Third Pmty Publishing Company.

Guyer, B., Lescohier, I., Gallagher, S., Hausman, A., and Azzara, C. (1989). Intentional injuries among children and adolescents in Massachusetts. New England Journal of Medicille. 321 (23): 1584-89.

Hochstadt, N., Jaudes, P., Zimo, D., and Sch.:lcter, J. (1987). The medical and

psychosocial needs of children entering foster care. Child Abuse alld Neglect 11: 53-62).

Holinger, P. (1990). The causes, impact and preventability of childhood injuries in the United States: Childhood suicide in the United States. American JOllrnal of Diseases of Children 144: 670-76.

Insurance Institute for Highway Safety (lIHS). (August 1991). Personal communication, Shelly Montgomery.

Jones, S. (1990). Sentinel Project Researching Agricu ltural Inj ury Notification Systems (SPRAINS). Des Moines, IA: Iowa Department of Public Health.

Kempe, H. (1962). The battered-child syndrome. Journal of the American Medical Association 181: 17.

Kozak, J. (1991). Estimated discharges of patients under 20 years of age discharged

'ii. .... ·~~q#I',.;{-.}...;.,'''''~N~~~:..!~J;~~'*-'~~,~ ........ ,,;.~Ji.''i'e.~.~~!~~,....,~.:~..,..,..:...~}:>>4''''il',.,~".......".~~,...m'~~~~,~ .. ""'~""'...,;:J,.)f'.Ilfo¥-~;,;..:.m·"""'.,;:;.;-~f~~~~ .... ~~~.-

REFERENCES

from short-stay non federal hospitals with a first-listed diagnosis of injury or poisoning: United States, 1989. Unpublished data.

Kraus, J., Fife, D., and Conroy, C. (1987). Incidence, severity and outcomes of brain injuries involving bicycles. American Joul7lal of Public Health 77: 76-78.

Layzer, J., Goodson, B., and deLange C. (1986). Children in shelters. Children Today 15 (2): 6-11.

Leenaars, A. and Lester, D. (1990). Suicide in adolescents: A comparison of Canada and the United States. Psychological Reports 67: 867-73.

Listemick, D., Finison, K., Gallagher, S., and Hunter, P. (1983). The problem of sports and recreational injuries. SCIPP Reports 4 (2).

Malek, M., Chang, B., Gallagher, S., and Guyer, B. (1991). The cost of medical care

for injuries to children. Annals of Emergency Medicine 20(9): 997-1005.

Malek, M., Guyer, B., and Lescohier, I. (1990). The epidemiology and prevention of child pedestrian injury. Accident Analysis and Prevention 22 (4): 301-13.

Massachusetts Department of Public Health. (February 1990). Shattering the myths: Sexual assault in Massachusetts 1985-1987. (Pub. No. 16, 367-62-1000-6- 90-CR). Boston: Women's Health Division, Bureau of Community Health Services.

McLoughlin, E., and Crawford, J. (February 1985). Bums. Pediatric Clinics of North America 32(1): 61-75.

National Center for Health Statistics, and L. Fingerhut. (1989). Trends and current status in childhood mortality, United States, 1900-85. (DHHS Publication No. [PHS] 89-1410.) Vital and Health

65

Statistics (3)26. Washington, D.C.: U.S. Government Printing Office.

National Center on Child Abuse and Neglect. (1988). Study findings-Study of national incidence and prevalence of child abuse and neglect: 1988 (technical amendments). U.S. Department of Health and Human Services. Personal communication, A. Sedlak, Project Director.

National Committee for Injury Prevention and Control. (1989). 1njury prevention: Meeting the challenge. New York: Oxford University Press.

National Institute on Disability and Rehabilitation Research. (March 25, 1991). Pediatric Trauma Registry-Phase 2. Carla Di Scala Ph.D., Data Manager, Department of Rehabilitation Medicine, New England Medical Center.

National Traumatic Occupational Fatality Database. (1991). Morgantown, West

~;';"-~-;<~<:i~>To(""~-.J;"4;~~~~~~~';<";f.~"tfi'~~.i<":'r,.~ ... ~.,....,'t,~i;(.~4'~---.t'1.~M~~I"~~:~~':.t~""""~~f'!I!'~"'~~~~~~~~~~~~~.~~".~"A>'.

66

Virginia: National Institute for Occupational Safety and Health, Division of Safety Research.

National Highway Traffic Safety Administration (NHTSA). (1990). Protecting our own: Community child passenger safety programs (second edition). Washington, D.C.: U.S. Department of Transportation, National Highway Traffic Safety Administration.

National Highway Traffic Safety Administration. (1991a). Idea sampler: Buckle lip America. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration.

National Highway Traffic Safety Administration. (1991 b). Fatal accident reporting system 1989: A decade of progress. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration.


Pearn, J., Wong, R.Y.K., Brown, J., et. al. (1979). Drowning and near drowning in children: A five-year total popUlation study from the city and county of Honolulu. American Journal of Public Health 69: 450-54.

Rice, D., MacKenzie, E. and Associates. (1989). Cost of injll1Y in the United States, A report to Congress. San Francisco: Institute for Health and Aging, University of California and Injury Prevention Center, Johns Hopkins University.

Rosenberg, M., Gelles, R., Holinger, P., Zahn, M., Stark, E., Conn, J., Fajman, N., and Karlson, T. (1987). Violence: Homicide, assault and suicide. In Amler, R., and Dull, H. (eds.). Closing the gap: The burden of unnecessary illness (pp. 164-177). New York: Oxford University Press.

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ApPENDIX A: INJURY MORTALITY RATES

Figure A Mortality Rates/100,OOO Population by Injury Type and Age Group, 1988. Source: Fingerhut, NCHS, 1988.

Category of Injury (E Code) 1-4

All Injury Deaths (ESOO-9t:19) 22.6

Motor Vehicle Occupant (ES1 0-S25 [.0,.1, .S]) 3.0

Homicide (E960-97S) 2.6

Other Motor Vehicle (ES10-S25 [.2-6, .9]) 0.7

Suicide (E950-959) NA Drowning (E910,S30,S32) 4.2

MV Pedestrian (ES10-S25 [.7]) 3.1

Fire/Burns (ES90-S99, 924) 4.6

Unintentional Firearms (E922) 0.3

MV Bicycle (ES10-S25[.6]) 0.1

Poisoning (ES50-S5S) 0.4

Falls (ES80-888) 0.4

Age Group

5-9 10-14

12.S 16.1

2.2 3.3

1.0 1.7

0.6 1.3

NA 1.4

1.6 1.4

2.9 1.S

1.6 O.S

0.3 1.1

O.S 1.1

0.1 0.2

0.1 0.2

15-19

70.5

23.S

11.7

10.5

11.3

2.7

2.2

0.7

1.5

0.7

1.0

0.6

, i

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