There's safety in numbers.

The articles in this series and the unique report, Injuries in the Military: A Hidden Epidemic1 that generated them, not only make the problem of injuries visible but give it dimension for an entire population, the U.S. military. Part I of this series of articles illustrates the value of data in determining the existence of a public health problem and defining its magnitude, the first step of the public health approach to prevention.2,3 Part II shows how research can further identify populations at risk and modifiable causes and risk factors for the problem, which are necessary for prevention, the second step of the approach. The articles demonstrate some of the great successes of the military services in preventing injuries, the third and fourth steps of the public health approach. The series also provides clear direction for improving surveillance, research, and prevention activities that should be of interest not just to military commanders, policymakers, and service members, but to all of us who are interested in preventing injuries. Various articles in this series highlight not only some of the differences between military and civilian populations but also commonalities. Off-duty military personnel do the same things that lead to injuries as other young Americans. They drive cars, ride motorcycles, play football and basketball, and do household chores and maintenance. On duty, many have jobs similar to civilian workers—jobs such as truck drivers, clerks, physicians, nurses, and wheeled-vehicle mechanics. The underlying causes and risk factors for most injuries must be the same for military personnel and civilians; so as this series of articles illustrates, much can be learned from the rich data sources and research of the military services. What the first sequence of articles does that is unusual is to provide a context for seeing how truly large the problem of injuries is for the military services measured against other causes of morbidity and mortality. It has been recognized for some time that injuries occur frequently among military personnel, but most commonly past reports have looked at a single data source to define the problem (e.g., fatalities, hospitalizations, or outpatient visits). Frequently, such reports examine only injuries, and therefore do not convey an appreciation of the relative size of the injury problem compared to diseases or health conditions. Part I of the series systematically examines the importance of injuries across the spectrum of health starting with the most serious injuries, those resulting in deaths.4 Then it successively looks at the less serious but more common injuries resulting in disabilities,5 hospitalization,6 and outpatient treatment.7 Each sequential piece of the puzzle shows that for this young military population, injuries are the most important health problem relative to others.3 What emerges when all the pieces are fit together at the end of the first sequence of articles is a picture of an injury problem that is much bigger than previously realized from examination of single data sources, such as deaths. In addition to revealing the true size of the problem of injuries for the military, Part I of this series also shows that, as with other young populations, much of the injury problem for the military stems from motor vehicle crashes, falls, and sports. Interestingly, these were the leading causes of morbidity and mortality for the Army in the Persian Gulf War (Operation Desert Shield/Desert Storm) and other deployments in the 1990s.3,8 The civilian experts who made up the work group that produced the first series of articles evaluated each database not only to determine the important causes of injuries in the military, but more importantly, to determine how the available information sources could best be utilized for injury prevention in the future. The major recommendations from the panel of experts were (1) that a comprehensive military medical surveillance system be established, and (2) that the data from that system be used to prioritize prevention and research activities.1 The research articles in Part II of this series should be of equal interest to those concerned with preventing injuries in military and civilian populations. Papers in the second series investigate causes, risk factors, and populations at risk with general relevance to public health and safety. Some of the topics explored include: ● The association of seat belt use, alcohol use, and age on the likelihood of hospitalization.9 ● The association of smoking cigarettes with higher risks of training-related injuries in Army trainees.10 ● The risks of disabling occupational knee injuries among different demographic groups11 and the early impact of prior knee injuries on disability and discharge from the military.12 From the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia Address correspondence to: Mark L. Rosenberg, MD, MPP, Director, Collaborative Center for Child Well-Being, Task Force for Child Survival and Development, Suite 400, 750 Commerce Drive, Decatur, GA 30030. E-mail: mrosenberg@taskforce.org. Dr. Rosenberg is currently affiliated with The Task Force for Child Survival and Development, Decatur, Georgia.