**National Center for Injury Prevention and Control (NCIPC or CDC Injury
Center) Update: October-November 2006**

The purpose of this Monthly Listserv Update is to keep NCIPC's partners
and colleagues informed about the Center's programs, research, and
initiatives. The current Listserv Update highlights:

-   NCIPC's Partner Meetings: Advancing the Field of Injury Prevention

-   Update on STIPDA ISW4 and Fall Consensus Recommendations

-   Choose Respect Launch Highlights

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-   Recent Publications, Reports, Meetings and Presentations involving
    NCIPC

We welcome your input and response to these updates.

**NCIPC's Partner Meetings: Advancing the Field of Injury Prevention**

CDC's Injury Center Partner Meetings were held in Washington, D.C. from
October 16-18. Partner organizations from the areas of Child
Maltreatment Prevention, Residential Fire Injury Prevention, and
Prevention Falls Among Older Adults were in attendance. The Injury
Center recognizes that all of our partners play a critical role in our
ability to affect change, and that only through collaboration with
organizations are we able to improve the health and well being of the
public. Due to space constraints, NCIPC was limited to the number of
invitations it could extend for these meetings. However, we will be
following up with organizations that were not able to attend in an
effort to involve them on our plans. The results of these productive
meetings will be captured in our future plans for addressing NCIPC's key
priority goals.

The Injury Center had several goals in hosting the Partner Meetings. The
first was to give an overview of NCIPC and inform our partner
organizations about our priority-setting process and our definition of
'priority.' It's important for all to understand that while we have set
these priorities, we are not paying attention to these issues alone. The
three topic areas represented at our Partner Meetings are our areas of
focus for the next three years. The Injury Center remains committed to
addressing other key injury and violence prevention issues, and at the
same time building the foundations for future priority areas.

Another goal for the Partner Meetings was to engage partners and to
encourage collaboration among each other and with CDC. We asked our
partners to think about where we can collectively go as a field and
where CDC, in particular, can contribute. Within each of the three
partner meetings there were important conversations around identifying
gaps and assets, developing strategies to address these gaps, and
prioritizing the strategies to address these gaps. Our partners
discussed next steps in the research, development and dissemination of
programmatic interventions, as well as surveillance and communication
activities that are needed in these important areas, and identified
joint activities where CDC and partners can coordinate efforts beginning
in the 2008 fiscal year.

Some of the partners who attended the Child Maltreatment Prevention
Partner Meeting were the National Center on Shaken Baby Syndrome,
National Child Abuse Coalition, National Center for Shared Leadership,
National Association of City and County Health Officials, Prevent Child
Abuse America, National Alliance of Child Trust and Prevention Fund,
Center for the Study of Social Policy, Society for Advancement of
Violence and Injury Research, American Academy of Pediatrics, Parents
Anonymous, Association of State and Territorial Health Officials,
National Scientific Council on the Developing Child, Stop It Now, Family
Violence Prevention Fund, State and Territorial Injury Prevention
Directors Association, YMCA, and Children's Safety Network.

Partners attending the meeting on Residential Fire Injury Prevention
included the Home Safety Council, United States Fire Administration,
Association of State and Territorial Health Officials, Underwriters Lab-
Fire Protection Division, Society for Advancement of Violence and Injury
Research, National Association of City and County Health Officials,
National Fire Protection Association, Association of Fire Chiefs, State
and Territorial Injury Prevention Directors Association, National Safety
Council, Meals on Wheels of America, U.S. Consumer Product Safety
Commission, Property Casualty Insurers Association, and International
Code Council.

Partners attending the Older Adult Falls Prevention meeting included the
Association of State and Territorial Health Officials, Society for
Advancement of Violence and Injury Research, National Association of
City and County Health Officials, Administration on Aging, State and
Territorial Injury Prevention Directors Association, American Geriatrics
Society, National Safety Council, National Floor Safety Institute,
Visiting Nurse Association, National Council on Aging, Home Safety
Council, American Association of Homes and Services for the Aging,
Suicide Prevention Action Network, AARP, and Assisted Living Federated
of America

NCIPC is committed to serving in a leadership role within these
important areas and looks forward to working with other leaders in the
field of injury prevention and control in accomplishing our mission.

Should you like to talk with NCIPC about these meetings or next steps,
please contact Amy Harris at <abharris@cdc.gov>.

**Update on STIPDA ISW4 and Fall Consensus Recommendations**

The Injury Surveillance Workgroup on Falls (known as ISW4) recently
released its *Consensus Recommendations for Surveillance of Falls and
Fall-Related Injuries,* as part of an ongoing effort to establish a
consistent approach for tracking falls and their outcomes. The Division
of Unintentional Injury Prevention (DUIP) at CDC's Injury Center is
working to implement and act upon the important recommendations
published in ISW4's report.

ISW4 is a collaborative workgroup of individuals with experience in
surveillance and prevention of falls and fall-related injuries that has
met regularly since April 2004. The workgroup is designed to develop
consensus regarding injury surveillance issues and has served as a key
piece in the foundation of NCIPC's Injury Indicators, standardized
statistical markers used to monitor injury trends at state and national
levels.

ISW4 is comprised of members representing the following organizations:
the State and Territorial Injury Prevention Directors Association
(STIPDA), Council of State and Territorial Epidemiologists (CSTE),
National Center for Injury Prevention and Control, the Society for the
Advancement of Violence and Injury Research (SAVIR), Injury Control
Research Centers (ICRCs), and State Health Departments.

In the *Consensus Recommendations*, the ISW4 describes the public health
burden of falls, the challenges of fall surveillance, and the methods
and sources for identifying fall-related injuries. The publication makes
recommendations for improving fall and fall-related injury surveillance.
One key recommendation for CDC's Injury Center and partners is ISW4's
establishment of injury indicators for falls. For monitoring deaths, the
indicator suggested is *unintentional fall-related deaths*. For
monitoring fall-related injuries, ISW4 proposes two indicators:
*unintentional fall-related hospitalizations* and *hip fracture
hospitalizations in persons aged 65 years and older*.

In *Consensus Recommendations*, the ISW4 also establishes the following
standard definitions of falls and fall-related injuries, recommending
these for use in public health surveillance:

-   *Fall*: An event which results in a person coming to rest on the
    ground or other lower level precipitated by a misstep such as a
    slip, trip, or stumble; from loss of grip or balance; from jumping;
    or from being pushed, bumped, or moved by another person, animal or
    inanimate object or force.

-   *Fall-related injury*: An injury precipitated by a fall (as defined
    above) and caused by striking an injury-producing surface.

**Choose Respect Launch Highlights**

The Division of Violence Prevention (DVP) at CDC's Injury Center
launched the Choose Respect national initiative in 10 U.S. cities
beginning May 2006. Throughout the summer, Choose Respect has
experienced major successes at both local and national levels.

Choose Respect is a primary prevention effort developed from research
designed to motivate adolescents to challenge harmful beliefs about
dating abuse and take steps to form respectful relationships. The goal
of Choose Respect is twofold: adolescents are inspired to give and get
respect in all their relationships, and adolescents gain skills to make
other healthy, positive life choices along the way. Choose Respect's
message: "Respect. Give it. Get it." is supported by online games and
interactive learning tools, television and radio spots, activity ideas,
streaming video clips and clickable quizzes that inspire adolescents to
think about choosing respect. This innovative mix of interactive
learning tools also includes *Causing Pain*, a 30-minute video featuring
compelling stories of real teens who have experienced dating abuse.
*Causing Pain* recently won a 2006 Freddie Award, which honors
excellence in international health and medical media. These resources
and more can be accessed online at
[www.chooserespect.org](http://www.chooserespect.org/).

To start a national dialogue for the launch, DVP centered its efforts on
using newly released surveillance data to draw media attention to the
problem of dating abuse and to Choose Respect as an intervention. On May
19, 2006 DVP published a study in *Morbidity and Mortality Weekly
Report* (MMWR) that showed a link between physical dating violence and
selected behaviors that can place adolescents' health and well-being at
risk. Through MMWR and subsequent press releases, this study reached
over 900,000 public health professionals, community leaders, media
professionals, and medical practitioners and garnered public attention
through print, online, radio and television media.

The Choose Respect launch was an integrated communications effort
incorporating a mix of creative materials, media and public relations,
promotional partnerships, community collaborations, technical assistance
and training, and community events and activities. The launch reached 55
million people by newspaper coverage, exposing 5.8 million people
through the national media tour, and attracting 60,000 people to attend
Choose Respect community events. By organizing events such as a youth
rap session and by developing partnerships with local organizations,
community partners influenced many youth and adults with the Choose
Respect messages.

Establishing partnerships with well-known organizations and businesses
was a key strategy to extend the influence of Choose Respect messages.
Central to the initiative was a national partnership formed with the
Women's National Basketball Association (WNBA). WNBA--Choose Respect
Game Nights and various season-long activities were effective venues to
reach youth, parents, educators, and other caregivers.

Additionally, the community partners took the initiative to cultivate
collaborations that augmented Choose Respect efforts. Local partners
included the Houston Astros, Verizon Wireless, AVON, *Lifetime*
television, Union Bank, Ben and Jerry's Ice Cream, Liz Claiborne, and
the Community Health Network.

DVP supplied Choose Respect press materials to community partners, which
enabled them to better secure media coverage with professional tools.
These included a media access guide and press release templates -- all
of which were designed to engage the media effectively. And using a "hip
and edgy" look intended to grab the attention of adolescents, CDC
created a variety of resources for community partners to customize at
their local levels, including posters, pocket guides, radio and
television public service announcements, educational videos and a
website.

**Recent Publications, Reports, Meetings and Presentations Involving
NCIPC**

([Non]{.underline}-CDC Injury Center names are in *italics*.)

**[Journal and Book Publications]{.underline}**

##### Date: October 2006 (Vol. 12; Pgs. 290-295)

##### Journal: Injury Prevention

##### Title: The Costs of Fatal and Nonfatal Falls Among Older Adults

##### Authors: Judy A. Stevens, PhD; Phaedra S. Corso, PhD; Eric A. Finkelstein, PhD; Ted R. Miller, PhD

##### This study estimated the incidence and direct medical costs for fatal and nonfatal fall injuries among U.S. adults aged \>65 years in 2000, for three treatment settings stratified by age, sex, body region, and type of injury. Direct medical costs totaled \$0.2 billion dollars for fatal and \$19 billion dollars for nonfatal injuries.  Of the nonfatal injury costs, 63% (\$12 billion) were for hospitalizations, 21% (\$4 billion) were for emergency department visits, and 16% (\$3 billion) were for treatment in outpatient settings. Medical expenditures for women, who comprised 58% of the older adult population, were two to three times higher than for men for all medical treatment settings. Fractures accounted for just 35% of nonfatal injuries but 61% of costs. It is clear that fall-related injuries among older adults, especially among older women, are associated with substantial economic costs. Implementing effective intervention strategies could appreciably decrease the incidence and health care costs of these injuries.

**Date: October 2006 (Vol. 96, No. 10; Pgs. 1755-1757)**

**Publication: American Journal of Public Health**

**Title: Sharp Rise in Opioid Analgesic Involvement in Drug Abuse Deaths
in American Metropolitan Areas**

**Author: Leonard J. Paulozzi, MD, MPH**

This study measured the role of opioid analgesics in drug-abuse-related
deaths in a consistent panel of 28 metropolitan areas from the Drug
Abuse Warning Network. The number of reports of opioid analgesics
increased 96.6% from 1997--2002. Methadone, oxycodone, and unspecified
opioid analgesics accounted for 74.3% of the increase. Oxycodone counts
increased 727.8% over these years. By 2002, opioid analgesics were noted
more frequently than either heroin or cocaine. Continuing, dramatic
increases in the availability of such opioids have made their abuse a
major, growing problem.

**Date: October 2006 (Vol. 96, No. 10; Pgs. 1849-1853**

**Publication: American Journal of Public Health**

**Title: Concordance Between Self-Reported Maltreatment and Court
Records of Abuse or Neglect Among Youth in Juvenile Detention**

**Authors: Monica Swahn, PhD; Dan Whitaker, PhD; Courtney Pippen, MPH;
Rebecca Leeb, PhD; *Linda Tepl; Karen Abram; Gary McClelland***

The authors examined the concordance between measures of self-reported
maltreatment and court records of abuse or neglect in a sample of
detained youth. Data shows that among detained youth, 16.6% of those who
reported any maltreatment, 22.2% of those with the highest level of
maltreatment, and 25.1% of those who required medical treatment due to
maltreatment had a court record of abuse or neglect.

**Date: September/October 2006 (Vol. 21, No. 5, Pgs. 375-378)**

**Publication: Journal of Head Trauma Rehabilitation**

**Title: The Epidemiology and Impact of Traumatic Brain Injury: A Brief
Overview.**

**Author: Wesley Rutland-Brown, MPH, Jean A. Langlois, ScD, MPH, Karen
E. Thomas, MPH, Yongli Lily Xi, MS**

Traumatic brain injury (TBI) is an important public health problem in
the United States and worldwide. The estimated 5.3 million Americans
living with TBI-related disability face numerous challenges in their
efforts to return to a full and productive life. This article presents
an overview of the epidemiology and impact of TBI.

**Date: October 18, 2006 (Vol. 296; Pgs. 1858-1866)**

**Publication: Journal of the American Medical Association**

**Title: National surveillance of emergency department visits for
outpatient adverse drug events**

**Authors: Daniel S. Budnitz, MD, MPH; Daniel A. Pollock, MD; Kelly N.
Weidenbach; MPH; Aaron B. Mendelsohn, PhD, MPH; Thomas J. Schroeder, MS;
J. Lee** **Annest, PhD**

The authors estimated that more than 700,000 individuals were treated in
US emergency departments for adverse drug events each year in 2004 and
2005. One in six of these individuals (16.7%) were hospitalized.
Individuals 65 years and older were more than twice as likely to
experience adverse drug events (RR=2.4) and nearly seven times more
likely to be hospitalized (RR=6.8) compared to younger persons. Among
patients 65 years or older, three drugs which typically require ongoing
monitoring (insulin, warfarin, and digoxin) were implicated in 33%
adverse drug events treated in emergency departments and over 42% of
subsequent hospitalizations. The findings of this investigation can help
target drug safety interventions.

**Date: October 2006 (Vol. 37, Is. 4; Pgs. 367-373)**

**Journal: Journal of Safety Research**

**Title: A Cost Analysis of a Smoke Alarm Installation and Fire Safety
Education Program**

**Authors: John E. Parmer, MSPP; *Phaedra S. Corso, PhD*; and Michael F.
Ballesteros, PhD**

While smoke alarm installation programs can help prevent residential
fire injuries, the costs of running these programs are not well
understood. The authors conducted a retrospective cost analysis of a
smoke alarm installation program in 12 funded communities across four
states. Costs included financial and economic resources needed for
training, canvassing, installing, and following-up, within four cost
categories: personnel, transportation, facility, and supplies. Local
cost per completed home visit averaged \$214.54, with an average local
cost per alarm installed of \$115.02. Combined state and local cost per
alarm installed across all four states averaged \$132.15. For every one
percent increase in alarm installation, costs per alarm decrease by
\$1.32. As more smoke alarms are installed, the average installation
cost per alarm decreases. By demonstrating effective economies of scale,
this study suggests that smoke alarm programs can be implemented
efficiently and receive positive economic returns on investment.

**Date: November 2006 (Vol. 31, No. 5; Pgs. 406-410)**

**Publication: American Journal of** **Preventive Medicine**

**Title: Can We Talk? Importance of Random Digit Dial Surveys for Injury
Prevention Research**

**Authors: Thomas R. Simon, PhD; James A. Mercy, PhD; and Lawrence
Barker, PhD**

This article introduces a special theme issue of the *American Journal
of Preventive Medicine*. Random digit dialing (RDD) surveys are a method
of obtaining representative self-report data. The RDD approach is
relatively cost-effective, handles non-English speaking households with
relative ease, and possesses a well-developed theory for constructing
sample weights. However, there are significant challenges to using RDD
surveys. This theme issue provides suggestions for how we can improve
the design and implementation of RDD surveys in a manner that is both
practical and ethical.

**Date: November 2006 (Vol. 31, No. 5; Pgs. 427-436)**

**Publication: American Journal of** **Preventive Medicine**

**Title: Nonresponse Error in Injury Risk Surveys**

**Authors: *Timothy P. Johnson, PhD; Allyson L. Holbrook, PhD; Young Ik
Cho, PhD;* and Robert M. Bossarte, PhD**

Nonresponse is a potentially serious source of error in epidemiologic
surveys concerned with injury control and risk. This study presents the
findings of a records matching approach to investigating the degree to
which survey nonresponse may bias indicators of violence-related and
unintentional injuries in a random digit-dialed (RDD) telephone survey.
The approach provides an effective and inexpensive tool for evaluating
nonresponse error in surveys of injury prevention and other
health-related conditions.

**Date: November 2006 (Vol. 31, No. 5; Pgs. 419-426)**

**Publication: American Journal of** **Preventive Medicine**

**Title: Sensitive Topics, Survey Nonresponse and Considerations for
Interviewer Training**

**Authors: *Eileen M. O'Brien, MS;* Michele C. Black, PhD, MPH; *Lisa R.
Carley-Baxter, MA;* and Thomas R. Simon, PhD**

This paper discusses current challenges in achieving higher survey
participation rates in random digit-dial telephone surveys and proposes
steps to address them through interviewer training to avoid refusals. It
describes features of surveys that contribute to respondent reluctance
to participate and offers a brief overview of current refusal aversion
training methods to reduce nonresponse. Recommendations are provided for
changes in refusal aversion training, standard survey introductions and
informed consent procedures. Further research is needed to identify
which methods best balance the need to improve response rates with
respondent safety and privacy in surveys with sensitive questions.

**Date: November 2006 (Vol. 31, No. 5; Pgs. 411-418)**

**Publication: American Journal of** **Preventive Medicine**

**Title: Incentives for Survey Participation: When Are They
"Coercive"?**

**Authors: *Eleanor Singer, PhD,* and Robert M. Bossarte, PhD**

Monetary incentives are increasingly used to help motivate survey
participation. This article summarizes several theories underlying the
use of incentives and briefly reviews research demonstrating their
intended and unintended effects on response rates, sample composition,
response bias, and response quality. It also considers the evidence for
effectiveness of incentives in reducing nonresponse bias. The article
reviews the ethical principles underlying the requirement for voluntary
informed consent as well as current regulations and a broad theoretical
and empirical literature bearing on this question, concluding that
incentives are never coercive. The article concludes with several
recommendations designed to assure the ethical use of incentives in
surveys on violence and injury.

**Date: November 2006 (Vol. 31, No. 5; Pgs. 444-450)**

**Publication: American Journal of** **Preventive Medicine**

**Title: The Future of Random-Digit Dialed Surveys for Injury Prevention
and Violence Research**

**Authors: Michael W. Link, PhD, and Marcie-Jo Kresnow, MS**

A central issue facing injury prevention research today is how to
collect self-reported data on injury and violence from a geographically
dispersed public quickly, cost-effectively, and with a reasonable degree
of confidence in the quality of the results. Questions about eroding
frame coverage, declining participation rates, and increasing potential
for bias have raised doubts about the long-term viability of
random-digit dialed (RDD) telephone surveys for injury prevention
research. The future of collecting self-reports of injury and injury
prevention data will be more complex and require considerable resources.

**[MMWR]{.underline}**

**Date: October 6, 2006**

**Title:** **Notice to Readers: Domestic Violence Awareness Month**

**Author: Jennifer Middlebrooks, MPH**

This notice to readers highlights Domestic Violence Awareness Month
activities and information.

**[Reports]{.underline}**

**Date: October 4-12, 2006**

**Publication: UN Secretary General's Study on Violence Against
Children**

Launch of this report took place in Geneva and New York. James Mercy,
PhD, served on the editorial board of the study.

**[Meetings]{.underline}**

**Date: October 4, 2006**

**Meeting: Decade for Change Summit** (Washington, DC)

Corinne Graffunder, MPH, participated on a panel addressing families and
relationships. The Summit was sponsored by the National Domestic
Violence Hotline and was the first in a series of meetings to be held to
facilitate development of a 10-year plan to reduce domestic violence in
America.

**Date: October 7-10, 2006**

**Conference: American Academy of Pediatrics** (Atlanta, GA)

Rodney Hammond, PhD, discussed violence prevention on a panel entitled,
*Hot Topics from the CDC: Tomorrow's Headlines.* Jane Mitchko, MEd,
presented about the development, implementation and evaluation of the
coaches' tool kit, *Heads Up: Concussion in High School Sports*.

**Date: October 8-13, 2006**

**Meeting: American College of Surgeons Committee on Trauma** (Chicago,
IL)

Richard C. Hunt, MD, FACEP, attended this meeting to provide an update
on CDC activities in acute injury care.

**Date: October 9-11, 2006**

**Meeting: WHO Editors Meeting, World Report on Child and Adolescent
Injury Prevention** (Amsterdam, The Netherlands)

Christine Branche, PhD, participated in a WHO-hosted first meeting of
invited editors for what will be a new world report on injuries among
children and adolescents.

**Date: October 15-18, 2006**

**Meeting: American College of Emergency Physicians Scientific
Assembly**

(New Orleans, LA)

Richard C. Hunt, MD, FACEP, participated in this educational meeting to
share information on the latest updates in emergency medicine. Kelly
Sarmiento, MPH, showcased the work of CDC Injury Center in a conference
exhibit.

**Date: October 16, 2006**

**Meeting: Doris Duke Charitable Foundation Grantee Meeting**
(Hillsborough, NJ)

Rodney Hammond, PhD, and Daniel Whitaker, PhD, discussed CDC's role in
child maltreatment prevention and will highlight current research and
programs.

**Date: October 19, 2006**

**Conference: Safe Kids Worldwide Leadership Conference: Perspectives on
Child Safety** (Washington, DC)

Christine Branche, PhD, provided the keynote address at this annual
conference. She was asked to describe unintentional injuries affecting
children globally. Ann M. Dellinger, PhD, MPH, presented a study of
nonfatal backover injury to children in the United States. J. Lee
Annest, Ph.D. presented on accessing data using CDC Injury Center's
Web-based Injury Statistics Query and Reporting System (WISQARS).

**Date: October 20, 2006**

**Meeting: National Older Driver Safety Advisory Council** (Boston, MA)

Ann M. Dellinger, PhD, MPH, attended as a member of the Council. The
Council will continue its efforts in improving the safety of older
drivers in the U.S.