Adding Power to Our Voices

A Framing Guide for Communicating About Injury

Injury Prevention 

Adding Power to Our Voices

A Framing Guide for Communicating About Injury

National Center for Injury Prevention and Control

Atlanta, Georgia

2010

Version 2
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Adding Power to Our Voices

Acknowledgments

Adding Power to Our Voices: A Framing Guide for Communicating About 

Injury is a publication of the National Center for Injury Prevention and Control, 

Centers for Disease Control and Prevention, U.S. Department of Health and 

Human Services

We acknowledge and appreciate the thoughtful contributions of our Expert 

Workgroup, including Robin Argue, Susan Gallagher, Andrea Gielen, Allison 

Lowe Huff, Angela Mickalide, Jim Hmurovich, Al Race, Ellen Schmidt, Eric 

Tash, and Elizabeth Wilson. We would also like to acknowledge the work of CDC 

staff who contributed to this document, including Teri Barber, Christy Cechman, 

Paige Cucchi, Leslie Dorigo, Susan Dugan, Emily Eisenberg, Kendra Godbold, 

Amy Harris, Gail Hayes, Wendy Heaps, Michele Huitric, Jennifer Middlebrooks, 

Jane Mitchko, Sara Schmit, Amanda Tarkington, and Marsha Vanderford.

Finally, thanks also go to Carol Freeman, Lucinda Austin, Marcia Cram, Joanne 

Milne, and Holly Reynolds Lee of ICF Macro and to their expert consultant, 

Susan D. Kirby, Ph.D., for assisting in the publication of this guide. 

Suggested Citation: National Center for Injury Prevention and Control. 

Adding Power to Our Voices: A Framing Guide for Communicating About 

Injury. Atlanta, GA: US Department of Health and Human Services, Centers 

for Disease Control and Prevention; 2008 (revised March 2010). Available at: 

http://www.cdc.gov/injury.
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Contents

Preface......... ........................................................................................................................................ 5

Adding Power to Our Voices: A Framing Guide for Communicating About Injury.......... 7

Common Communication Challenges ................................................................................. 7

Leveraging Communication to Benefit All in the Injury Community .......................... 9

Adding Power to Our Voices................................................................................................... 9

The Bottom Line ....................................................................................................................... 9

Will You Add Your Voice?.............................................................................................................10

Message Development—Coordinated Messaging............................................................10

Making the Injury Issue Meaningful..................................................................................10

Message Framing—How It Works.......................................................................................10

Changing a Dominant Frame ................................................................................................11

Applying the Message Frame ................................................................................................11

A Tailored Message for Organizations Involved in Violence Prevention ...................13

Framing Tools ...........................................................................................................................14

Message Development Considerations........................................................................14

Social Math and Framing................................................................................................16

Injury Framing Tool.........................................................................................................17

Using the Injury Framing Tool.....................................................................................................17

Our Call to Action...........................................................................................................................29

Appendix A: NCIPC Coordinated Injury Communication: Message Frame 

 Testing Executive Summary.....................................................................................................30

Appendix B: Steps for Creating Social Math............................................................................ 33

Appendix C: Formative Research ............................................................................................... 41
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Preface

When the CDC Injury Center asked communication professionals working 

in injury and violence prevention and response about their communication 

challenges, it became clear that messages about injury and violence need to 

reach and appeal to a broader audience to change public perceptions and have 

an influence on social and political will. Discussions with these professionals led 

to an effort to collaborate and coordinate messaging to achieve the greater goal 

of successfully elevating public awareness of injury and violence prevention and 

response.

Through formative research with the public, one societal value stood out as one 

that could speak to not only those with an existing interest or relationship with 

injury and violence prevention, but also could reach those who may have little 

previous exposure to the topic. This value that all could embrace — “We want a 

society where people can live to their full potential” — resonated with the public 

and injury communication professionals. 

We took this information and created a guide that all injury and violence 

prevention and response professionals could use to develop messages that would 

benefit their injury-specific topic and the field as a whole. Adding Power to Our 

Voices: A Framing Guide for Communicating About Injury incorporates framing 

theory, message development techniques and vehicles for explaining public 

health statistics. When these tools are used to create messages for the public, 

your members or constituents, we anticipate these will prompt public interest 

and changes in perception and reaction to injury and violence prevention and 

response. 

By using a common frame and coordinated messaging across injury materials 

and outreach activities, we give the whole injury field a boost whenever any 

specific injury issue is in the spotlight. It is our hope that, over time, our efforts 

to modify how we frame information about our field will change perceptions, 

and we will see a positive evolution in personal and societal consideration of 

injury and violence prevention and response.

Sincerely, 

Ileana Arias, Ph.D. 

Principal Deputy Director

Centers for Disease Control and Prevention
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Adding Power to Our Voices:

A Framing Guide for 

Communicating About Injury

We each work to address sometimes very different injury issues (prevention, 

response, violence, neglect, and unintentional injuries of all types). Yet, 

we all want to live in a society that believes and engages in injury and violence 

prevention and response initiatives that allow people to have the opportunity to 

live to their full potential.

Our mission at CDC’s National Center for Injury Prevention and Control (CDC’s 

Injury Center) is to prevent injuries and violence and reduce their consequences. 

Adding Power to Our Voices is designed to help organizations involved in injury and 

violence prevention and response speak with a consistent voice in building the social 

and political will needed to save lives and reduce injuries. 

The purpose of this guide is to encourage the adoption and integration of a 

coordinated message strategy that is based on an overarching injury and violence 

prevention and response message frame and specific messages that link the injury or 

violence issue to the frame and are tailored to specific audiences. The guide provides 

framing and message development techniques and tools, including social math, to 

help injury and violence prevention and response programs create messaging that 

presents injury and violence in a way that reflects the broad and deeply held societal 

value of living life to its full potential. The coordinated message strategy can help us 

achieve a unified voice and increase the perceived value of injury and violence as an 

important public health problem, ultimately influencing the social and political will 

to lessen the burden of injury and violence.

Common Communication Challenges 

CDC’s Injury Center invited input from a variety of injury communication 

professionals to explore our common communication challenges (See Table 1). 

These challenges represent significant hurdles for each of us in communicating 

about our individual injury issues. Not all challenges are felt equally given 

the diverse injury and violence prevention issues that we face. Those in the 

unintentional injury field grapple with the challenge of the belief that injuries 

are unpredictable or unavoidable while those in violence prevention encourage 

individual responsibility for the prevention of violence without blaming victims of 

violence. Yet, as we discovered in our conversations, these challenges can also help 

bind us together and provide a common foundation for collaboration.

A coordinated message 

strategy can help 

change people’s 

perceptions of the 

value of preventing and 

responding to injury and 

violence. This is critical 

to creating the social 

and political will to more 

fully support injury and 

violence prevention and 

response.
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Adding Power to Our Voices

This guide aims to help everyone involved in injury and violence prevention and 

response communicate in ways that build awareness that injuries and violence 

can be prevented and the consequences minimized when they occur. 

The coordinated messaging tools in this guide can help to address many of the 

challenges that injury and violence prevention and response professionals have 

identified and build a strong infrastructure for injury communication that will 

last well into the future. The coordinated message strategy can help all injury 

and violence programs contribute to creating the change necessary to achieve 

the ambitious goal of a society where everyone can live to their full potential. 

These challenges 

can help bind us 

together and provide a 

common foundation for 

collaboration.

Table 1. 

Injury Communication Challenges When Communicating With the Public

Injury and violence is seen as the responsibility of several fields (criminal justice, 

first responders, transportation, and education), which leads to the fracturing of the 

search for solutions. 

Lack of understanding of the definition of injury and scope of the injury problem. 

Lack of knowledge that solutions exist to reduce the impact of injury and violence. 

Lack of individuals’ sense of control over their risk environment (e.g., homes, 

workplaces, and schools). 

Injury and violence is not understood as a public health issue.

Funding for injury programs is not commensurate with the magnitude of the problem. 

Stigma associated with several types of injury such as sexual violence and suicide 

hampers open discussion. 

Media coverage generally focuses on an individual event rather than the broader 

injury context. 

Low levels of personal relevance or connections to injury.

Enduring beliefs of unintentional injury as unpredictable and not preventable.

Consequences of violence go beyond physical injury.
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Leveraging Communication to Benefit All in 

the Injury Community

For this effort to succeed, we must build upon the existing communication work 

of all organizations working in injury and violence. We must engage those highly 

dedicated stakeholders, partners, volunteers, and staff members to continue to 

support their cause and be willing to connect their cause to the larger injury 

problem. Specific injury issues need to continue to thrive through tailored 

outreach that effectively reaches specific audiences. 

Increasing understanding of injury and violence and the commitment to more 

fully address prevention and response can be accomplished by building on the 

hard-won visibility for specific injuries that has grown over the past few decades. 

Coordinated messaging is a foundation that can support and connect many 

different specific injury programs, while not taking anything away from each 

specific injury topic’s unique messages. 

Adding Power to Our Voices

The injury and violence field is small in comparison to other health fields. 

However, together we can have a louder voice than each can alone. Most 

stakeholders, especially the public, focus on one issue at a time (e.g., helping 

women, protecting children or fire safety). What if a brochure about older adult 

falls ends up in the hands of a traumatic brain injury prevention supporter? 

A coordinated message about how injury prevention, as a whole, can help 

people live to their full potential may give that supporter one more reason to 

support community programs that impact both traumatic brain injury and falls 

prevention. By using a coordinated messaging strategy based on a common 

injury frame and supporting messaging across injury and violence materials 

and outreach activities, we give the whole injury field a boost whenever any 

specific injury issue is in the spotlight.

The Bottom Line 

If all injury and violence prevention and response programs adopt and integrate 

the coordinated message strategy, we can repeatedly convey the value-based full 

potential injury frame and specific injury and violence messages over time and 

across multiple outreach activities. As a result, the public can begin to better 

understand and value that preventing and responding to injuries can help people 

live to their full potential. This guide provides framing information and message 

development techniques, including social math, to help injury and violence 

programs and partners implement the coordinated communication strategy. 

If all injury programs 

convey the same 

value message of “full 

potential” over time 

and across multiple 

outreach activities, 

the public will come to 

understand and value 

the fact that preventing 

and responding to 

injuries can help people 

achieve their full 

potential.
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Adding Power to Our Voices

Will You Add Your Voice?

Message Development—Coordinated Messaging 

We can start to change public perceptions about injury and violence with the 

use of a coordinated message strategy. The strategy includes the integration of a 

broad overarching statement that expresses a core value held by many individuals 

in our society. We call this a concept frame. The concept frame can be adapted 

and integrated into injury and violence specific communication. This can be 

done by creating audience specific messages that link a specific injury or violence 

issue to the concept frame. The concept frame does not necessarily have to be 

the first statement you use. In fact, Injury Center supported focus groups show 

that audience response is greater when given dramatic statements up front to 

grab audience members’ attention (See Appendix A). The use of a coordinated 

messaging strategy can be used with other communication techniques and 

approaches such as social marketing. 

Making the Injury Issue Meaningful

Feedback from injury communication professionals and other research suggests that 

the public does not value injury and violence prevention and response as much as 

some other public health issues. Framing theory suggests that this difference may 

occur because the public and other audiences do not see how addressing injuries 

reflects their strongly held values or is a priority for achieving the kind of community 

they want to live in. 

People’s perceptions of an issue are created largely by what they already know and 

associate with that issue. This knowledge base has usually been cultivated over a 

long period of time through a variety of communication channels such as advertising, 

news media, TV, movies, word-of-mouth, internet, e-mails, and direct experience. 

These mental shortcuts, or dominant frames, allow individuals to quickly understand 

issues and interrelated facts. Many of the communication challenges we noted 

earlier represent dominant frames that make it difficult for individuals to hear and 

value messages about injury and violence prevention and response. 

CDC’s Injury Center used message framing theory and communication research to 

identify a core societal value that would change how people value preventing and 

responding to a wide range of injury and violence prevention issues. The research 

findings and consultation with partners indicate that the value of “we want a society 

where people can live to their full potential” is a frame that resonates across the 

spectrum of injury and violence issues. 

Message Framing—How It Works

Message framing can help connect people to issues with a new perspective and 

establish new associations, thus changing the dominant frame. There are many 

facets to successfully framing an issue. Once identified, a new frame must be 

Research findings 

suggested the message 

frame, “We want a 

society where people 

can live to their full 

potential” received the 

most support overall as 

a strong cultural value 

statement.
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established through consistent, repetitive, strong, and broad-based communication, 

usually over a number of years. Linking an issue to a widely held core value helps 

start the framing process by resonating with the audience and increasing interest in 

learning more about how the issue connects with this core societal value. 

Changing a Dominant Frame 

A few decades back, the dominant frame in driving under the influence of alcohol 

or drugs might have included thoughts like, “It’s those impaired drivers who have 

the problem.” For a new frame, communication materials, tools, activities, and 

outreach would have to identify a new value statement that would make individuals 

think differently about driving under the influence and engage them to want to 

learn more and become involved. In the example of driving under the influence, 

the old dominant or concept frame of “we live in a society where individuals are 

responsible for their own actions” was changed over the years to “wanting to live in 

a society that cares about each other.” In this case the frame was used to promote 

a program where friends share responsibility for preventing impaired driving. 

This new frame of caring and shared responsibility was communicated through 

TV show sitcoms, dramas, and even talk shows. Music and advertising reinforced 

the new frame. A more dominant message today is that “friends don’t let friends 

drive drunk.” It may seem daunting, but over time, with consistent and repetitive 

messaging, dominant frames can be changed for the better.

Applying the Message Frame

The remainder of this guide provides information and tools to help you craft 

injury specific messages that link your injury issue to the full potential frame. 

Tables 2 and 3 provide an example of coordinated messaging using the full 

potential frame. You can insert your specific injury into the text and adapt 

language to reflect how your injury issue and work in injury and violence 

prevention and response best connects with the overarching frame of wanting 

all individuals to live to their full potential. The Injury Framing Tool on page 

19 provides a template for applying the full potential frame, while pages 14-16 

provide message development techniques, including social math, to help you 

create messages that will resonate with your intended audiences. For additional 

examples of framing in use, visit the Injury Framing Collaborative Workspace: 

http://www.injuryframing.safestates.org. The Injury Framing Collaborative Space 

is a tool for professionals working in injury and violence prevention and response 

to share materials, resources, and best practices relating to injury framing. 

CDC’s Injury Center is using the “full potential” frame in its communication. For 

example, the frame was incorporated into fall prevention communication and 

appears on the CDC website (http://www.cdc.gov/ncipc/preventingfalls). 

We want a society where older adults can live to their full potential. While falls are 

a threat to the health and independence of older adults and can significantly limit 

their ability to remain self-sufficient, the opportunity to reduce falls among older 

adults has never been better. Today, there are proven interventions that can reduce 

falls and help older adults live better and longer. 
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Table 2. “Full Potential” Message Concept

Concept Frame

(Societal Value)

We want a society where people 

can live to their full potential.

Short Expression: Organizations, communities, and individuals should work 

together to help all Americans live healthier, more productive 

lives. We can take steps to lower the risk of injuries and 

violence and help those who are injured achieve full 

recovery. 

Sample “Elevator 

Speech”*:

My organization is part of a movement to reduce the risk 

of injuries and improve the immediate response to those 

who are injured so that everyone can live his or her life to 

their full potential. Each year, injuries resulting from a wide 

variety of physical and emotional causes—including motor 

vehicle crashes, sports trauma, violence, [insert injury] or 

neglect—keep millions of adults and children from achieving 

their goals and making the most of their talents and abilities. 

But thanks to the discoveries of science and injury research, 

there are steps that [communities and individuals] can 

take—including [specific program(s)]—that can stop injuries 

before they happen and increase the likelihood for full 

recovery when they do. By incorporating these strategies 

into the community and everyday activities, we can improve 

the opportunity for all individuals to lead active, useful, and 

fulfilling lives. 

Sample Press 

Release Copy:

Injuries and violence are a significant and largely 

preventable problem. Injury prevention research has 

provided new information and new tools to address this 

problem and help millions of people live to their fullest 

potential. Many of the injuries that keep adults and children 

from enjoying fulfilling, productive lives—such as [specific 

injuries]—can be prevented using known prevention 

measures—including [specific injury programs]. When 

injuries occur, chances for a full recovery can be improved 

with specialized emergency care, such as [specific injury 

program]. Organizations, communities, and individuals 

should work together in a coordinated effort to promote and 

adopt these kinds of programs to ensure that every person 

enjoys the highest possible quality of life. 

*An elevator speech is an overview of an idea for a product, service, or project. The name reflects the fact that 

an elevator pitch can be delivered in the time span of an elevator ride (say, 30 seconds or 100 to 150 words). 
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A Tailored Message for Organizations 

Involved in Violence Prevention

CDC’s Injury Center understands the difficulty in developing coordinated 

messaging that encompasses the broad spectrum of injury issues and that will 

resonate with people who work daily to alleviate the suffering caused by those 

injuries. Through our research, individuals involved with violence prevention 

expressed the importance of a message that also contained the concept of 

freedom from fear of violence. Participants across the spectrum of injury also 

liked the firm and direct statement that, “Injuries and violence are significant 

and largely preventable,” because the statement is clear and because injuries 

and violence are not 100 percent preventable. Table 3 presents some additional 

message points for violence prevention.

Table 3. Additional Message Points for Organizations in Violence Prevention

Concept Frame

(Societal Value):

We want a society where people 

can live to their full potential.

Sample Press 

Release Copy:

In order for adults and children to realize their full potential, 

they must have safe places to live, work, and play where 

they can enjoy every aspect of their lives without worry 

about violence or injury. Programs that use the science of 

injury prevention to reduce the risk of violence, injury, and 

their associated consequences are available—including 

[specific programs]. When individuals and communities join 

forces with business and government to implement these 

violence prevention measures, we can help people live 

fulfilling lives, safe from hurt and harm. 
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Adding Power to Our Voices

Framing Tools

Message Development Considerations 

Integrating coordinated messaging into your communication materials is easier 

than you might think. First, consider the full potential injury frame and then 

create messages that link your specific injury issue to the frame. The following 

message development considerations will help you create messages that have a 

greater impact with your intended audience. The considerations were identified 

through research with the public.1,2

1. Make a strong and dramatic statement about the injury problem. 

a. “Injuries are the leading cause of death in the first four decades of life, 

but they don’t have to be—many injuries are preventable.” 

2. Include lists of a wide range of injuries that might seem unrelated to your 

specific injury issue, but can help frame the injury field as one field. This 

approach will also help audiences understand which specific types of health 

problems fit under the umbrella we call “injury.” 

a. “Injuries result from a wide variety of physical and emotional causes—

including motor vehicle crashes, sports trauma, violence, or neglect.” 

3. Use positive, action-oriented statements to present solutions early in the 

message. 

a. “There are steps that communities and individuals can take that are 

proven to stop injuries before they happen.” 

b. “Injury and violence prevention research has provided new information 

and new tools to address this problem.” 

4. Use inserts of specific injury issues and programs to customize the message 

to your injury area.

a. “Many of the injuries that keep adults and children from enjoying 

fulfilling, productive lives—including [specific injuries]—can be avoided 

or reduced by using prevention measures—including [specific injury 

programs].” 

b. “When injuries occur, chances for a full recovery can be improved with 

specialized emergency care, such as [specific injury program].” 

1 National Center for Injury Prevention and Control. (2007). Executive summary of audience research 

recommendations for coordinated communication message frame and dissemination. Centers for Disease 

Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA. 

2

Austin, L., Mitchko, J., Freeman, C., Kirby, S., & Milne, J. (2009). Using framing theory to unite the field of 

injury and violence prevention and response: “Adding Power to Our Voices.” Social Marketing Quarterly, 

15(S1), 35-54. 
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5. Highlight the value of personal responsibility and community action—

characterize organizations as partners.

a. “Individuals can live healthier, more fulfilling lives by taking steps to 

protect themselves from injuries and prevent violence from occurring.” 

b. “When individuals and communities join forces with business and 

government to implement these prevention measures, we can help 

people live fulfilling lives, safe from hurt and harm.” 

6. Reinforce the science of injury and violence prevention (without the use of 

jargon).

a. “Thanks to the discoveries of science and injury and violence research, 

there are steps that communities and individuals can take.”

b. “Injury and violence prevention research has provided new information 

and new tools to address this problem.”

7. Ensure that the message includes an “ask” or call to action.

a. “Organizations, communities, and individuals can work together in a 

coordinated effort to promote and adopt these kinds of programs to 

ensure that every person enjoys the highest possible quality of life.”

8. End by reinforcing the value message and reminding individuals that the 

actions they take can help achieve the value message (full potential) and 

create the kind of world that they want. This reinforcement of the value 

message is critical. 

a. “When individuals and communities join forces with business and 

government to implement these violence prevention measures, we can 

help people live fulfilling lives, safe from hurt and harm.”

9. Remember that this work is designed to help create the social and political 

will to address injury and violence prevention through the socio-ecological 

model2

. Sometimes different elements of the social ecology will be the focus 

of our messages to build awareness of and desire for solutions to injury and 

violence issues. While it may be appropriate to focus messages on what 

individuals can do to protect themselves from unintentional injuries (e.g., 

use of safety belts), violence prevention requires greater focus on individual 

responsibility for refraining from violence and on community-level change. 

We must ensure that our messages do not have the unintended consequence 

of implying that victims of violence are to blame.

CDC uses a four-level 

social-ecological 

model to better 

understand injury and 

violence and the effect 

of potential prevention 

strategies. This model 

considers the complex 

interplay between 

individual, relationship, 

community, and societal 

factors. It allows us 

to address the factors 

that put people at risk 

for experiencing or 

perpetrating injuries and 

violence.
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10. Words of caution when integrating coordinated messaging: 

a. Frame preventive and response actions as giving people more freedom 

to live to their full potential because they will be injury-free and able to 

pursue their goals. 

b. Do not dwell on the injury problem and provide exhaustive lists of the 

statistics of the problem. People want to know about solutions, how they 

will be accomplished, and what they will cost. 

c. Do not describe injury problems using a single situation (e.g., a specific 

child abuse case). Instead, describe the context around how injury and 

violence happens over the long term and not as a single event. 

Social Math and Framing3

Social math is “the practice of translating statistics and other data so they 

become meaningful to the audience”4

—it makes the statistics and numbers 

surrounding an issue meaningful to people by vividly communicating those 

numbers. When combined with other frame elements, social math is a tool 

that can help guide people to think about the social and built environments 

surrounding the behavioral choices that individuals make. Social math helps 

messages resonate with the target audience by referencing or comparing the 

issue numbers to: 

u Familiar numbers or costs (e.g., cost of car payment) 

Dramatic events (e.g., the number of residents displaced following Hurricane 

Katrina) 

Costs that are smaller and understandable (e.g., the program would cost less 

than the cost of a cup of coffee each day) 

Current numbers from other issues (e.g., it’s more than one-third of what we 

spend on prescription medication each year). 

As an example, a message can state that over 1.6 million people experience a 

traumatic brain injury each year. That is pretty abstract and gives the reader 

no comparison to things they know and understand in daily life. But if the 

message states that more people experience a brain injury each year than can 

fill Boston Red Sox’ Fenway Park 35 times, the reader then has some visual cue 

and dramatic reminder of the size of the problem. Without using social math, 

communicators will try to convey a lot of abstract numbers to people who are 

already overloaded with information. 

3, 4 Dorfman, L., Woodruff, K., Herbert, K., & Ervice, J. (2004). Making the case for early care and education: 

A message development guide for advocates (pp. 112-114). Berkeley, CA: Berkeley Media Studies Group. 

Available at www.bmsg.org/documents/YellowBookrev.pdf.
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Social math helps audiences remember important facts and helps those facts 

become more salient. When using social math, it is critical to select a social math 

fact that is 100 percent accurate, visual if possible, dramatic, and appropriate for 

the target audience. Using a baseball social math fact for a target audience that 

does not know about or connect with baseball would be ineffective. Appendix 

B of this guide provides more information on using social math as well as 

additional examples.

Injury Framing Tool

The Injury Framing Tool is intended to help you apply a coordinated message 

strategy to your own injury or violence issues. The tool is designed to help you 

create effective messages that link to the injury frame “We want a society where 

people can live to their full potential.” These messages can then be integrated into 

all of your communications (e.g., websites, fact sheets, publications, and press 

releases). Before you begin to craft your injury or violence specific messages, 

you need to identify your intended audience, that is, who you want to reach and 

influence with your communications. 

Effective messages should be tailored to your audience. To help tailor your 

messages, you should consider your audience’s current knowledge, attitudes, and 

behaviors relating to your injury issue. You can gather information about your 

audience through secondary data collection (literature reviews, existing studies) 

or primary data collection (interviews, focus groups, and surveys). If possible, 

you should test your frame-based messages with members of your target 

audience. Refer to Formative Research Appendix C for additional information. 

We encourage you to create messages for your injury or violence issue and 

organization and share your work with others in the field. You can share 

examples of your work with other injury and violence professionals using the 

Injury Framing Collaborative Space: http://www.injuryframing.safestates.org. 

Using the Injury Framing Tool:

The Injury Framing Tool is divided into three sections: 

What Broad Statement Can You Make To Link Your Injury Issue to the Full 

Potential Frame and the Coordinated Message Strategy?

u This section is designed to help you develop statements or messages that 

link your specific injury or violence issue to the societal value of believing 

that everyone should have the opportunity to achieve their full potential. 

You should develop injury or violence specific messages linking to the 

full potential frame for each audience you intend to reach. The message 

development techniques on pages 14-16 can help you craft messages that will 

resonate with your target audiences. 

Social Math Examples

• 

• 

Every 35 minutes an 

older adult dies from a 

fall-related injury. 

Nationwide 

implementation of 

effective school-based 

programs to prevent 

youth violence could 

result in 187,000 fewer 

fight-related injuries 

among high school 

students. That’s 

equivalent to nearly 

7,500 classrooms of 

students.
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What Do You Want to Say About Your Injury Issue? 

u This section is designed to help you communicate the size and scope of your 

injury or violence issue and its influence on your audience’s lives. This is 

where social math comes into play. Refer to pages 33-39 for social math tips.

What Action Do You Want to Tell Your Audience to Take? 

u This section offers specific recommendations and protective actions one can 

take to prevent injuries and violence. This is your call to action. To change 

the frame of injury, we must change the way the public considers their 

participation in preventing injuries. Although not all injuries are preventable 

or predictable, many can be influenced by policies, community initiatives, and 

personal and societal responsibility.

Pulling It All Together 

u This section will help you write your final message once you’ve identified all 

your message components. Refer to the message development tools in the 

Framing Guide to help you create the most effective messages. 

Following the Injury Framing Tool template, you will find examples for various 

injury and violence prevention and response issues.5

5 The examples provided in this section are for illustrative purposes only. The messages have not been 

tested with members of the intended audience.
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Adding Power to Our Voices

Injury Framing Tool

T

his tool is designed to help you create effective messages that incorporate the message development 

strategies in the Framing Guide and link your injury issue to the overarching injury frame: 

We want a society where people can live to their full potential. 

Injury Issue: ___________________________________________________________________

Intended Audience: ____________________________________________________________

Intended Outcome (Communication Goal): _____________________________________

What broad statement can you make to link your injury issue to the full potential frame and the 

coordinated message strategy? 

• 

• 

For each of your audiences, what message will link or associate your specific injury issue to the injury field as a 

whole and to the idea that injuries and violence can be prevented?

What can you say that will link your injury issue to the societal value of believing everyone should have the 

opportunity to achieve their full potential?

Write your linking statement(s) below. Refer to additional message development techniques in the Framing Guide.
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Adding Power to Our Voices

What do you want to say about your injury issue? 

• 

• 

• 

How can you help your audience understand the size and scope of your injury issue?

How can your translate your statistics and data so they are interesting and meaningful to your audience? What 

social math examples can you use? (Refer to the social math section of the Framing Guide for social math tips.)

What can you say that will describe your specific programs or activities as a way to address the injury issue (as a 

solution to the problem)? What is the science or evidence base for the programs/activities suggested?

Write your statements and social math facts below.

What action do you want your audience to take?

• 

• 

• 

What actions do you suggest that your audience take relating to your specific program or activity?

If focused on individual behavior change, what do you want your audience to know they can do to protect 

themselves?

What is your call to action?

Write your action-oriented statements below.

Pulling It All Together

• Now that you’ve identified the message components above, it’s time to create a message that will move your 

audience to action. The message development tools in the Framing Guide can guide you in creating the most 

effective message for your audience. 

Write your final message below.
21

Adding Power to Our Voices

Injury Framing Tool Example

T

his tool is designed to help you create effective messages that incorporate the message development 

strategies in the Framing Guide and link your injury issue to the overarching injury frame: 

We want a society where people can live to their full potential. 

Injury Issue: Child Maltreatment

Intended Audience: Community Based Organizations

Intended Outcome (Communication Goal): Increase support at the community level for programs and policies 

that promote positive parent child interactions

What broad statement can you make to link your injury issue to the full potential frame and the 

coordinated message strategy? 

• 

• 

For each of your audiences, what message will link or associate your specific injury issue to the injury field as a 

whole and to the idea that injuries and violence can be prevented?

What can you say that will link your injury issue to the societal value of believing everyone should have the 

opportunity to achieve their full potential?

Write your linking statement(s) below. Refer to additional message development techniques in the Framing Guide.

• 

• 

• 

• 

Injuries and violence are significant and largely preventable public health problems. 

We all want a community where people, especially our children, can live to their full potential. 

Child abuse and neglect is a substantial public health issue with short- and long-term negative effects on health and behavior. 

Research shows us healthy relationships act as a buffer against harmful childhood experiences.
22

Adding Power to Our Voices

• 

• 

What do you want to say about your injury issue? 

• How can you help your audience understand the size and scope of your injury issue?

• 

• 

How can your translate your statistics and data so they are interesting and meaningful to your audience? What 

social math examples can you use? (Refer to the social math section of the Framing Guide for social math tips.)

What can you say that will describe your specific programs or activities as a way to address the injury issue (as a 

solution to the problem)? What is the science or evidence base for the programs/activities suggested?

Write your statements and social math facts below.

• 

• 

• 

Children who are abused or neglected are at a higher risk for health problems as adults, including alcoholism, smoking, 

suicide, and certain chronic illnesses, as well as aggressive behavior, adolescent delinquency, adult criminality, and the 

transgenerational perpetration of abuse and neglect.

In 2008, Child Protective Services confirmed 905,000 cases of child abuse and neglect. Confirmed cases are considered only a 

fraction of the problem, yet this number is still greater than the entire population of Delaware.

Evidence based prevention programs and policies that encourage and promote positive parent interactions and improve 

parenting skills can provide parents and caregivers with the skills they need to better manage behavior before abuse or neglect

can occur.

What action do you want your audience to take?

• 

• 

• 

What actions do you suggest that your audience take relating to your specific program or activity?

If focused on individual behavior change, what do you want your audience to know they can do to protect 

themselves?

What is your call to action?

Write your action-oriented statements below.

As community based organizations, you can ensure that young people in your area live healthier more fulfilling lives by 

supporting programs and policies that help parents enhance their ability to foster safe, stable, and nurturing relationship with 

their children. 

Every community can take steps to help assure safe, stable, and nurturing relationships for children. The costs are small 

compared with the benefits that can be realized in dollars saved, in the revitalized lives children can live now, and in the 

contributions these young people can make in the future. 
23

Adding Power to Our Voices

Pulling It All Together

• Now that you’ve identified the message components above, it’s time to create a message that will move your 

audience to action. The message development tools in the Framing Guide can guide you in creating the most 

effective message for your audience. 

Write your final message below.

Imagine the impact on society if every person in the State of Delaware experienced problems such as alcoholism, 

smoking, suicide, certain chronic illnesses, aggression, and violent behavior. Fortunately, this isn’t a real life scenario, 

but it could be. Children who are abused or neglected are at a high risk of developing just such problems, and 

last year’s confirmed cases of child abuse and neglect topped 905,000—a number greater than the population of 

Delaware. 

Thanks to research on injury and violence prevention, we know there are proven steps that communities and 

individuals can take before abuse or neglect can occur. In fact, evidence-based prevention programs and policies 

that encourage and promote positive parent interactions and enhance parenting skills can provide parents with the 

skills they need to better manage behavior.

As community based organizations, you can ensure that children in your community live healthier more fulfilling lives 

by supporting programs that help parents become better parents. Encourage widespread adoption of evidence-based 

prevention strategies. Every community can take steps to help assure safe, stable, and nurturing relationships for 

children. The costs are small compared with the benefits that can be realized in dollars saved, in the enhanced lives 

children can live now, and in the contributions these young people can make in the future. 
24

Adding Power to Our Voices

• 

• 

• 

• 

• 

Injury Framing Tool Example

T

his tool is designed to help you create effective messages that incorporate the message development 

strategies in the Framing Guide and link your injury issue to the overarching injury frame: 

We want a society where people can live to their full potential. 

Injury Issue: Older Adult Falls

Intended Audience: Older Adults

Intended Outcome (Communication Goal): Reduce older adult falls by teaching prevention techniques 

What broad statement can you make to link your injury issue to the full potential frame and the 

coordinated message strategy? 

For each of your audiences, what message will link or associate your specific injury issue to the injury field as a 

whole and to the idea that injuries and violence can be prevented?

What can you say that will link your injury issue to the societal value of believing everyone should have the 

opportunity to achieve their full potential?

Write your linking statement(s) below. Refer to additional message development techniques in the Framing Guide.

Injuries and violence—including injuries to older adults from fires, motor vehicle crashes, and falls—are significant and largely 

preventable. 

Thanks to research, we know we can take actions to prevent injuries and premature deaths from falls.

Preventing falls from happening in the first place can help older adults live longer and enjoy a better quality of life. 
Adding Power to Our Voices

25

What do you want to say about your injury issue? 

• 

• 

• 

How can you help your audience understand the size and scope of your injury issue?

How can your translate your statistics and data so they are interesting and meaningful to your audience? What 

social math examples can you use? (Refer to the social math section of the Framing Guide for social math tips.)

What can you say that will describe your specific programs or activities as a way to address the injury issue (as a 

solution to the problem)? What is the science or evidence base for the programs/activities suggested?

Write your statements and social math facts below.

• 

• 

• 

• 

Each year almost 2.1 million older Americans are seen in emergency departments for falls. If instead these older adults were 

practicing Tai Chi or taking exercise classes, they would fill more than 140,000 classrooms.

Every 35 minutes an older adult dies from a fall-related injury.

Many of the injuries caused by falls that keep older adults from enjoying healthy and independent lives can be avoided by 

prevention measures such as exercise, vision correction, and medication adjustment.

These proven steps can help reduce health care costs and greatly improve older adults’ quality of life. 

What action do you want your audience to take?

• 

• 

What actions do you suggest that your audience take relating to your specific program or activity?

If focused on individual behavior change, what do you want your audience to know they can do to protect 

themselves?

• What is your call to action?

Write your action-oriented statements below.

• 

• 

• 

As an older adult, you can help prevent falls by exercising, talking to your doctor or pharmacist about your medications, and 

ensuring your vision is properly corrected.

Talk to your doctor to make sure it’s safe for you to take an exercise class.

For more information, visit the CDC website at www.cdc.gov/injury.
26

Adding Power to Our Voices

Pulling It All Together

• Now that you’ve identified the message components above, it’s time to create a message that will move your 

audience to action. The message development tools in the Framing Guide can guide you in creating the most 

effective message for your audience. 

Write your final message below.

Every 35 minutes an older adult dies from a fall related injury. But the fact is, many of the injuries that keep older 

adults from enjoying fulfilling, productive lives—motor vehicle crashes, fires and, yes, falls—can be avoided. 

Thanks to research, we now know that you can lower your chance of falling by exercising, making proper medication 

adjustments, and ensuring your vision is properly corrected. These simple steps can help save health care costs and 

greatly improve your quality of life.

So make an appointment with your doctor to review your medication, check your vision, and ask what types of 

exercise are best for you. Falling isn’t a natural part of getting older. You can take control of your quality of life by 

taking these simple steps to prevent falls.

For more information, visit the CDC website at www.cdc.gov/injury.
27

Adding Power to Our Voices

Injury Framing Tool Example

T

his tool is designed to help you create effective messages that incorporate the message development 

strategies in the Framing Guide and link your injury issue to the overarching injury frame: 

We want a society where people can live to their full potential. 

Injury Issue: Traumatic Brain Injury from sports and recreation-related activities

Intended Audience: Family members of people who ride bicycles and/or participate in other sports and 

recreational activities 

Intended Outcome (Communication Goal): Decrease the incidence of injury by increasing usage of bicycle helmets 

and other protective sports equipment. that promote positive parent child interactions 

What broad statement can you make to link your injury issue to the full potential frame and the 

coordinated message strategy? 

• 

• 

For each of your audiences, what message will link or associate your specific injury issue to the injury field as a 

whole and to the idea that injuries and violence can be prevented?

What can you say that will link your injury issue to the societal value of believing everyone should have the 

opportunity to achieve their full potential?

Write your linking statement(s) below. Refer to additional message development techniques in the Framing Guide.

• 

• 

• 

Injuries and violence are a significant and largely preventable public health problem.

Thanks to a range of injury and violence prevention work that is taking place today, Americans are more able to reach their full 

potential in the world.

By taking steps to prevent injuries that might result from a wide variety of causes—including motor vehicle crashes and 

collisions or falls during bike riding or sports activities—we can all live healthier and more fulfilling lives.
28

Adding Power to Our Voices

• 

• 

What do you want to say about your injury issue? 

• 

• 

• 

How can you help your audience understand the size and scope of your injury issue?

How can your translate your statistics and data so they are interesting and meaningful to your audience? What 

social math examples can you use? (Refer to the social math section of the Framing Guide for social math tips.)

What can you say that will describe your specific programs or activities as a way to address the injury issue (as a 

solution to the problem)? What is the science or evidence base for the programs/activities suggested?

Write your statements and social math facts below.

• 

• 

More than 200,000 people visit U.S. emergency departments each year for sports and recreation-related traumatic brain 

injuries—that’s enough to fill the 2010 Super Bowl stadium close to 3 times. And these don’t include participants who are seen 

by other health care providers outside of the emergency department.

With the findings from scientific research, we know that bicycle helmets and other sports helmets can prevent or reduce the 

severity of brain injuries.

What action do you want your audience to take?

• 

• 

• 

What actions do you suggest that your audience take relating to your specific program or activity?

If focused on individual behavior change, what do you want your audience to know they can do to protect 

themselves?

What is your call to action?

Write your action-oriented statements below.

You can help ensure that the ones you love have every opportunity to lead active, fulfilling lives—encourage your loved ones 

to use a properly fitted helmet and other appropriate protective gear every time they ride a bike or participate in sports where 

helmets are recommended.

To find out more information on preventing this and other injuries, visit www.cdc.gov/injury.

Pulling It All Together

• Now that you’ve identified the message components above, it’s time to create a message that will move your 

audience to action. The message development tools in the Framing Guide can guide you in creating the most 

effective message for your audience. 

Write your final message below.

Each year more than 200,000 people are treated in U.S. emergency departments each year for sports- and recreationrelated traumatic brain injuries. That’s enough people to fill the 2010 Super Bowl stadium close to 3 times. This doesn’t 

mean we need to stop being active, though. 

By taking steps to prevent injuries that might result from a wide variety of causes—including collisions or falls during 

bike riding or sports activities—we can all live life to its full potential. With the discoveries of scientific research, we 

know that wearing a bicycle helmet and other sports helmets can prevent or reduce the severity of brain injuries.

You can help ensure that the ones you love have every opportunity to lead active, fulfilling lives. Encourage your loved 

ones to use a properly fitted helmet or other protective gear every time they ride a bike or participate in sports where 

helmets are recommended. To find out more information about preventing sports and recreation-related brain injuries, 

visit http://www.cdc.gov/TraumaticBrainInjury.
29

Adding Power to Our Voices

Our Call to Action 

T

he public sees and hears a variety of safety, health, and wellness messages 

every day. Still, many members of the public do not believe that injuries and 

violence are preventable if individuals and communities work together. Table 

1 on page 8 highlights some of the communication challenges of the injury and 

violence prevention field. By addressing the challenges through a coordinated 

frame, we help the injury field as a whole, and, when our overarching injury and 

violence prevention and response messages get through to a wider audience, we 

all benefit. The public becomes more aware of all that is “injury,” the injury field 

gains more visibility, and we all benefit from positive responses that lead us toward 

living our lives to the fullest potential. 

To accomplish this vision and have a widespread impact, we need to take these 

actions:

u Adopt and integrate the full potential frame into our injury specific 

communication,

Develop and use messages that link our specific injury issues to the full 

potential frame, and 

Repeat our specific injury messages across all injury areas, channels, and 

audiences.

Let’s add power to our voices by using the framing approach. 
30

Adding Power to Our Voices

Appendix A

NCIPC Coordinated Injury 

Communication: Message Frame 

Testing Executive Summary6

The Centers for Disease Control and Prevention’s National Center for Injury 

Prevention and Control and ICF Macro conducted message testing research through 

in-depth policymaker interviews and focus groups with the general public. Research 

explored NCIPC’s “full potential” concept frame and other message characteristics 

that could be used for coordinated communication about injury and violence 

Research at a Glance

Participants Injury-Specific Messages Methods

Older adults 65+ Older adult falls 4 online/telephone focus 

groups (5-7 participants each)

Parents of youth under 18 Child maltreatment 4 online/telephone focus 

groups (5-7 participants each)

Both older adults 65+ and 

parents of youth under 18

TBI 4 online/telephone focus 

groups (5-7 participants each)

State-level policymakers Older adult falls

Child maltreatment

TBI

7 phone interviews (randomly 

selected injury topics)

prevention and response. A concept 

frame, as identified in CDC’s framing 

guide, Adding Power to Our Voices, 

is a “broad overarching statement 

expressing a core value held by many 

individuals in our society” (p. 10).7

Injury areas identified as NCIPC 

priorities included:

u Child maltreatment

Older adult fall prevention

Traumatic brain injury (TBI).

Research Questions

1. How is the injury frame of “living to one’s full potential” perceived by the public 

and policymakers?

2. How can specific injury messages be crafted using the injury frame to contribute 

to the public and policymakers’ understanding of injury issues and motivate them 

to take action?

Additional research question to assist the Division of Violence Prevention:

3. How can research on the “full potential” frame also inform the Division of 

Violence Prevention’s efforts to communicate about “safe, stable, and nurturing 

relationships” (SSNRs)?

6 National Center for Injury Prevention and Control. (2009). NCIPC Coordinated Injury Communication: Message 

frame testing research report. Centers for Disease Control and Prevention, U.S. Department of Health and Human 

Services, Atlanta, GA. 

7 National Center for Injury Prevention and Control. (2008). Adding Power to Our Voices: A Framing Guide 

for Communicating About Injury. Centers for Disease Control and Prevention, U.S. Department of Health and 

Human Services, Atlanta, GA. 
31

Adding Power to Our Voices

Methods

Twelve online/telephone, 90-minute focus groups (5 to 7 members each, 66 

participants total) were

conducted with:

1. Older adults ages 65+ 

2. Parents of youth under age 18. 

Seven in-depth, 30-minute phone interviews were conducted with state-level 

policymakers. Each focus group and interview participant received a message on 

the “full potential” concept and two messages on a specific injury (see chart on 

right).

Findings and Recommendations

Research findings were compared to findings in the earlier phase of research and 

the coordinated messaging concepts in the Adding Power to Our Voices framing 

guide. 

Findings were similar to previous findings and recommendations in the framing 

guide in that:

u Participants identified with the “full potential” concept frame.

Participants liked the social math examples, especially those that they could 

strongly identify with, and they wanted to see this information early on in 

the message.

Participants preferred strong and dramatic statements about the injury 

problem.

Participants liked concise and action-oriented messages with a clear call to 

action.

Participants liked positive messages that described tangible benefits to them.

Participants wanted specific injury information customized to one specific 

injury area.

Participants liked the focus on community action and needed more 

reinforcement about the responsibility for injury and violence prevention 

and response.

Participants, particularly policymakers, wanted science-driven information.
32

Adding Power to Our Voices

In a few areas, research findings also differed from previous research findings 

and the recommendations in the framing guide:

u Participants desired attention-getting information at the beginning of the 

messages. Because the concept frame is a commonly-accepted cultural norm, 

this was not dramatic or attention-getting for many as a stand-alone message.

Participants advocated for strong and dramatic language, but they did not 

identify with the examples of strong language statements from the framing 

guide.

Participants did not like or understand a wide list of seemingly unrelated 

injury areas.

To incorporate these new findings into the existing coordinated messaging 

considerations, the following actions may be taken:

u The beginning of any message should use proven social marketing 

techniques to capture attention, such as strong statements and social 

math facts. Communicators should work to incorporate the concept frame 

throughout the entire message set.

Wording connected to living to one’s “full potential” should be stronger to 

capture audience members’ attention. Language about the problem of injury 

and violence prevention should be stronger. Avoid general, nonspecific 

language in messages where appropriate.

Because individuals have a hard time seeing how multiple injuries and 

violence are related, messages that list multiple injury topics should include 

more language to highlight the connection. As communicators continue to 

reference multiple types of injury and violence topics, audiences can better 

understand the types of health problems related to injury and violence as 

a field. For specific contexts where the listing of multiple injury might be 

too distracting, communicators may also consider connecting their specific 

injury issue to a larger statement about injury overall. 

A few additional message characteristics were also important:

u Participants identified most strongly with the concept frame of “full potential” 

when expressed in language that resonated with them (e.g., older adults 

identify more with the words “quality of life” as full potential and parents 

identify more with “full potential” when messages concern their children).

Messages should focus on the preventability of injury as individuals still 

don’t see how injuries are preventable, particularly ones resulting from 

violence.

Messages should help audience members to identify with how particular 

injuries may affect them or their loved ones.

The SSNR frame was perceived positively and similarly to the full potential 

frame—both frames can be integrated into violence prevention and response 

messages for cohesive communication.
Adding Power to Our Voices

33

Appendix B

Steps for Creating Social Math8

Steps for Creating Social Math 

1. Consider the Frame

Look at the selected frame and the research supporting it, and review the 

message testing research culminating in the final message. This is the main focus 

when developing the social math, so keep this frame in mind throughout. The 

frame we’ve developed for those who work in the field of injury is—“we want a 

society where people can live to their full potential.”

To incorporate social math successfully into an overall communication strategy, 

look at what the research says the frame needs to accomplish. Social math can 

then help set a new frame by:

u Connecting two or more things together

Comparing the size of things

Functioning as a metaphor.

2. Consider Relevant Injury Examples

Consider specific, relevant injury examples that will resonate with the public 

and the media. Consider using injury issues, such as children’s bicycle helmets, 

teenagers’ drinking and driving incidents, child abuse and neglect, traumatic 

brain injury, falls among older adults, or motor vehicle crashes, which clearly 

reflect the value of the frame.

3. Consider Relevant Statistics for the Injury Issues9

It is critical that you select numbers that best support your goal and those 

that would be compelling. Keep the overall number of statistics you use in 

interviews, graphs, and other media-related materials to a minimum. Also use 

statistics in slide presentations, briefings, town meetings, podcasts, and other 

communication vehicles.

8 The social math message examples provided in this section are for illustrative purposes only. The 

messages have not been tested with members of the intended audience nor pre-screened and cleared by 

NCIPC. Prior to using these messages, it is recommended that you pre-test the messages with members of 

your target audience.

9 Dorfman, L., Woodruff, K., Herbert, K., & Ervice, J. (2004). Making the case for early care and education: 

A message development guide for advocates (pp. 112-114). Berkeley, CA: Berkeley Media Studies Group. 

Available at: http://www.bmsg.org/documents/YellowBookrev.pdf.
34

Adding Power to Our Voices

Begin by selecting 5 to 10 key statistics that are related to the point you are trying 

to prove. As you will see below, these could be about the number of injuries, 

morbidity, mortality, funding, personnel or time spent on the issue, or almost 

anything as long as it relates back to the frame. Begin by focusing on the numbers 

of people, injuries, fatalities, or hours, rather than percentages, which can be 

more difficult to translate into social math. 

u Break the numbers down by time.

If you know the amount over a year, what does that look like per hour? 

Per minute? For example, the average annual salary of a childcare worker 

nationally is $15,430, roughly $7.42 per hour. While many people understand 

that an annual salary of $15,430 is low, breaking the figure down by the hour 

reinforces that point—and makes the need for some kind of intervention 

even more clear.

Break down the numbers by place.

Comparing a statistic with a well-known place can give people a sense of the 

statistic’s magnitude. For instance, approximately 250,000 children are on 

waiting lists for childcare subsidies in California. That’s enough children to 

fill almost every seat in every Major League ballpark in California. Such a 

comparison helps us visualize the scope of the problem and makes a solution 

all the more imperative. 

Provide comparisons with familiar things.

Providing a comparison to something that is familiar can have great impact. 

For example, “While Head Start is a successful, celebrated educational 

program, it is so underfunded that it serves only about three-fifths of eligible 

children. Applying that proportion to social security would mean that almost 

a million currently eligible seniors wouldn’t receive benefits.” 

Provide ironic comparisons.

For example, the average annual cost of full-time, licensed, center-based care 

for a child under age 2 in California is twice the tuition at the University of 

California at Berkeley. What’s ironic here is how out of balance our public 

conversation is. Parents and the public focus so much on the cost of college 

when earlier education is dramatically more expensive.

Localize the numbers.

Make comparisons that will resonate with community members. For 

example, saying, “Center-based childcare for an infant costs $11,450 per 

year in Seattle, Washington,” is one thing. Saying, “In Seattle, Washington, a 

father making minimum wage would have to spend 79 percent of his income 

per year to place his baby in a licensed care center,” is much more powerful 

because it illustrates why it is nearly impossible.
35

Adding Power to Our Voices

4. Finding Useful Comparison Statistics

Once you have an idea of what you want to say and how you want to say it, you 

will need to complete the cycle by filling in useful comparisons from outside 

the field of injury research. Avoid controversial topics for your comparison, 

including politics, crime, other health issues, or anything that could get twisted 

out of context. For example, one way to highlight a large amount of money is to 

compare it with the amount currently being spent on your issue. 

5. Fact Checking and Polishing for Presentation

Put all the pieces together in a simple, seamless statement, which clearly 

demonstrates your position. Double check the statistics for the comparison data. 

Have the data and formulas you used available for reference when presenting the 

social math examples.

Run your social math example by colleagues to make sure it is clear, compelling, 

and unoffensive. Ensure that your numbers have a strong scientific basis and do 

not detract from your point or damage your credibility. Pay careful attention to 

the accuracy of the claims you are making. If you are using math for advocacy, 

you must be able to understand and defend the data and the way you are 

presenting the information.

Five Lessons for Using Numbers More Effectively

1. Unless numbers are married to a story, they are unlikely to mean anything 

to the public.

u Provide the meaning first and then use the numbers to support that meaning.

What is the organizing principle or frame that the numbers support? 

2. Too often, numbers are used to tell one story—crisis.

u The crisis frame incapacitates people and does not engage them in fixing the 

problem.

Often the crisis frame describing a big problem is followed with a small 

solution, which seems meaningless or futile.

Ask instead, “What is the story that our numbers could be used to tell that 

allows people to see solutions?” Think “David and Goliath” (little triumphing 

over large) or the “Little Engine that Could” (succeeding in the face of great 

adversity).

3. Social math unifies the narrative and the numbers.

u Provide the framing cues that are missing in the raw numbers. For example, 

“Community residents near a gasoline refinery noted that the plant emits 

6 tons of pollutants per day— or 25 balloons full of toxic pollution for each 

school child in the town.”
36

Adding Power to Our Voices

u By explaining one number in terms of another, the problem gets defined—

pollutants (the issue) are “about” health and what’s at stake is our children 

(advocacy).

u Make sure you choose the right value for your comparison (can backfire 

otherwise). For example, “Americans spend more on pet food than on 

helmets and body protection equipment.”

4. Use numbers to support causal stories.

u Outline the story your numbers need to support as a chain of events in which 

the influences of each are apparent. For example, “Sea levels rise because our 

cars are pumping more carbon dioxide into the air, fish die in the oceans, and 

the food chain is disrupted. Here are the facts [insert math facts and statistics to 

support your statements above]. And here’s how it could work differently.”

Simple causal sequences are important in helping people understand context, 

human impacts, prevention, and the efficacy of solutions. 

5. Uninterpreted numbers tell a story of random mayhem.

u Random mayhem means that there is no room for human causality, 

prevention, or government responsibility.

Use numbers to describe what could have been done to prevent the problem.

Relating just the facts or the numbers does not inspire obligation from your 

reader to take action.

Social Math Examples

These injury-specific social math facts were developed by CDC’s National Center 

for Injury Prevention and Control Division of Injury Response:

 Acute Care

u “Each year, U.S. emergency departments treat more than 30 million nonfatal 

injuries. That is more than the populations of Montana, Nevada, New 

Mexico, and Texas combined.”

“If you are severely injured, getting care at a Level I trauma center can 

reduce your risk of death by 25 percent. For every 100,000 people who are 

severely injured, 2400 lives can be saved.”
37

Adding Power to Our Voices

Traumatic Brain Injury

u “As many as 3.8 million sports- and recreation-related concussions occur 

each year in the United States. That’s enough people to fill the 2008 super 

bowl stadium more than 50 times.” (University of Phoenix Stadium capacity 

is 73,719.)

❖ Or, “That’s equal to the current population of Oregon.”

❖ Or, “That’s equal to the current population of Los Angeles.”

“More than 1.6 million people are seen in an emergency department, are 

hospitalized, or die from a traumatic brain injury in the United States 

each year. That’s more than the number of people who live in the cities of 

Baltimore, MD, Washington, DC, and Richmond, VA combined.”

Alcohol Screening and Brief Intervention

u “In the United States, the third leading cause of preventable death and the 

leading risk factor for serious injury is alcohol misuse. It accounts for more 

than 75,000 deaths annually—one death every 7 minutes.”

These injury-specific social math facts were developed by CDC’s National Center 

for Injury Prevention and Control, Division of Unintentional Injury Prevention:

Falls Prevention

u “Based on 2006 mortality data, every 35 minutes an older adult dies from a 

fall-related injury.”

“Every day 5,000 adults age 65 and above are hospitalized due to fall-related 

injuries.”

“In 2008, falls accounted for 64% or 2.1 million nonfatal injuries treated in 

emergency departments. In other words, every 15 seconds, an older adult 

was treated in an emergency department for a fall.”

Motor Vehicle Injury Prevention

u “Every 15 minutes, a 16- to 19-year-old teen is admitted to an emergency 

department because of motor vehicle crash-related injuries.” 

“Every day, an average of 12 teenagers between ages 16 and 19 die as a result 

of a motor vehicle crash.”

“Only 1 in 10 teens buckles up when riding in a vehicle with someone else. 

Teenagers’ passengers are less likely to wear their safety belts than any other 

age group.”

Fire Injury Prevention

u “People who don’t have working smoke alarms in their homes are twice as 

likely to die in a fire than those with working alarms.” 
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Adding Power to Our Voices

These violence-specific social math facts were developed by CDC’s National Center 

for Injury Prevention and Control, Division of Violence Prevention:

Violence Prevention

u “Nationwide implementation of effective school-based programs to prevent 

youth violence could result in 187,000 fewer fight-related injuries among high 

school students. That’s equivalent to nearly 7,500 classrooms of students.”

“Over 5 percent of high school students report missing school at least once 

in the past 30 days because of safety concerns. This is the equivalent of 

approximately 25,000 classrooms of high school students missing school 

because of fear.”

“Each year over 91,000 infants less than 1 year old are victims of 

substantiated child maltreatment. If we were to place these infants’ cribs 

end-to-end, the line of cribs would stretch for 78 miles.” 

“The number of homicide victims in the United States each year could fill 32 

Boeing 747 airplanes. Can you imagine how much concern there would be if 

32 airplanes fell out of the sky in the U.S. in a given year?”

“If all low- income families in the United States received nurse home 

visitation services, 300,000 cases of child maltreatment could be prevented 

each year.” 

“There are over 32,000 suicides each year in the United States—this means 

that there is a suicide every 16 minutes.” 

The following are general social math facts:

u “In 1969, for many students, walking to school was as easy as walking down 

the street because their school was in their neighborhood. By 2001, most 

schools were farther away from their students, and walking or biking to 

school was the equivalent of doing a 5K race or more— twice a day.”

“Exercise is something that children need every day, but half of all students 

attend schools that have reduced their physical education class to just 1 or 2 

days per week. Part-time fitness is no more effective than part-time reading 

or math instruction.”

“Coca-Cola and Pepsi alone spend 100 times more on advertising than the 

Federal Fruits & Veggies—More Matters healthy diet campaign.”

“Between 1971 and 2002, the Trust for Public Land’s work in cities resulted 

in the acquisition of 532 properties totaling 40,754 acres. That’s like adding 

park space equivalent to 326,000 soccer fields. What a terrific opportunity to 

engage in healthy activities that influence one’s full potential.” 

 “In 1991, U.S. college students consumed 430 million gallons of alcoholic 

beverages per year at a cost of $5.5 billion. Enough alcohol was consumed 

by college students to fill 3,500 Olympic-size swimming pools, about one on 

every campus in the United States.”
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Adding Power to Our Voices

u “In 1991, U.S. college students consumed 430 million gallons of alcoholic 

beverages per year at a cost of $5.5 billion. The overall amount spent on 

alcohol per student exceeded the dollars spent on books and was far greater 

than the combined amount of fellowships and scholarships provided to 

students.”

“The alcohol industry spends more than $2 billion every year to advertise 

and promote consumption. This amounts to approximately $225,000 every 

hour of every day.”

“Health benefit costs of the employees who build tractors costs more than 

the steel that goes into a tractor.” 

Sources

Social Math Fact Sources

u Center for Health Improvement

http://www.chipolicy.org/pdf/TA5.pdf

Department of Community Medicine, University of Connecticut Health 

Center

http://www.commed.uchc.edu/healthservices/mediaadvoc/sld001.htm

InfoPlease

http://www.infoplease.com/us.html

Census Bureau Quick Facts

http://quickfacts.census.gov/qfd/index.html

FrameWorks Example of “How-To”

http://www.frameworksinstitute.org/ezine39.html

http://www.frameworksinstitute.org/ezine40.html

Table 1 on Page 8

Adapted from the NCIPC Injury Communication Planning Tools

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

January 2007

Injury Framing Tool sources

u Traumatic Brain Injury 

Rutland-Brown, W., Langlois. J. A., Thomas, K. E., Xi, Y. L. (2006). Incidence 

of traumatic brain injury in the United States, 2003. Journal of Head Trauma 

Rehabilitation, 21, 544-548. 

Langlois, J. A., Rutland-Brown, W., Wald, M. (2006). The epidemiology and 

impact of traumatic brain injury: A brief overview. Journal of Head Trauma 

Rehabilitation, 21(5), 375-378.
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Adding Power to Our Voices

u Field Triage. 

MacKenzie, E. J., Rivara, P., Jurkovich, G., et al. (2006). A national evaluation 

of the effort of trauma-center care on mortality. New England Journal of 

Medicine, 354(4):366-378.

Older Adult Falls

Grisso, J. A., Kelsey, J. L., Strom, B. L., Chiu, G. Y., Maislin, G., O’Brien, L. A., et al. 

(1991). Risk factors for falls as a cause of hip fracture in women: The Northeast Hip 

Fracture Study Group. New England Journal of Medicine, 324(19):1326–1331.

Fire Prevention

National Fire Protection Association

http://www.nfpa.org/categoryList.asp?categoryID=278&URL= 

Research%2&%20Reports/Fact%20sheets/Smoke%20alarms

Intimate Partner Violence Prevention

U.S Department of Justice 

http://www.ojp.usdoj.gov/bjs/homicide/intimates.htm

Youth Violence Prevention

Centers for Disease Control and Prevention 

http://www.cdc.gov/ncipc/dvp/YVP/YVP-data.htm

Child Abuse and Neglect

http://www.cdc.gov/ncipc/pub-res/parenting/ChildMalT-Briefing.pdf

http://www.cdc.gov/ncipc/dvp/CMP/child_maltreatment.htm
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Adding Power to Our Voices

Appendix C

Formative Research 

T

he frame developed for this publication was created from discussions 

with injury communication professionals and was tested through focus 

groups with members of the public. CDC’s Injury Center sought to identify an 

overarching message frame that individuals and organizations involved in injury 

and violence prevention and response would be willing to use and that would 

also resonate with the public.

In focus groups conducted by CDC’s Injury Center and the Hawaii State 

Department of Health, members of the public reviewed and provided feedback 

on the messages. The groups were intended to identify the frame that would 

have the greatest impact and the messages that would support the frame. These 

focus groups offered the opportunity to see and hear the immediate reactions to 

the proposed messages and then probe for reasons behind these reactions. We 

listened carefully to the thoughts, opinions, and experiences of the participants, 

which, in turn, provided insight into how the messages would be received and 

ultimately how they might motivate behavior change or action.

CDC’s Injury Center believes more research is needed with members of the 

public to provide a greater depth of understanding about how this message 

frame can be used effectively across the breadth of injury and violence 

prevention issues. Those interested in conducting focus groups should consider 

the guidelines described below.

Recruitment of participants will require development of eligibility criteria and a 

recruitment screener. It may be that focus group participants should reflect the 

general population so that the screening results in participants who represent 

a broad spectrum of racial and ethnic populations and educational and income 

levels. Research that focuses on audiences susceptible to, or particularly 

concerned with, an area of injury or violence prevention will also be important.

The moderator guide should include a variety of open-ended questions that 

explore reactions to the frame and the messages being tested. The questions 

below provide examples of the type of information you are trying to gather:

u What does this message mean to you? 

What is clear or unclear about this message? 

Tell me how this message gets you to think more about injuries and how they 

can be prevented and responded to. What part specifically? 

How well do you think these different messages convey the value statement 

of wanting to live in a society where people can live to their full potential? 
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Adding Power to Our Voices

u Which one of the messages elicits the greatest emotional reaction? 

Tell me about the message you prefer. 

Tell me about the message, if any, you dislike? 

Tell me about the part of the message you can relate to the most. 

Tell me about how the message makes you want to get involved in doing 

something about injury in your community or in your home. Which parts 

specifically?

This message suggests different benefits of living in a society where 

individuals can live to their full potential. Which message provides the most 

valuable benefit to you? To your community? 

To take full advantage of the opportunity to hear from participants, a 

professionally trained moderator and a note taker should be engaged for each 

group. Focus groups should be audio-recorded and, if possible, transcribed so 

researchers can review the actual words spoken in their analysis of themes and 

development of findings. 

So that everyone working to develop coordinated messages on injury and 

violence prevention and response can improve communication, researchers are 

encouraged to share their findings.

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

National Center for Injury Prevention and Control

www.cdc.gov/Injury

We Want a Society Where People Can Live to Their Full Potential.