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A Data Book of Child and Adolescent Injury Prepared by Children's Safety Network
Supported by the Maternal and Child Health Bureau, Health Resources and Services Administration,
Public Health Service, U.S. Department of Health and Human Services
Published by the National Center for Education in Maternal and Child Health
Washington, D.C.
1l.S. Department of Justice National Institute of Justice
150177
This document has been reproduced exactly as received from the person or organization originating It. Points of view or opinions stated in this document are those of the authors and do not necessarily represent the official position or policies of the NatlCJnal institute of Justice.
Permission to reproduce this 1'1 "e'. ' material has been gralFflh'lic Domain/U. S. Dept. -ef Health & Human Services
to the National Criminal Justice Reference Service (NCJRS).
Further reproduction outside of the NCJRS system requires permission of the ~ owner.
NCJRS
SEP 21 1994
ACQURSn1iUOWS
"'~"'-..\:i..Y"~~~~~"-""~~-+~"".Y.>'-~~~itMt'.I-ri>~~~~.l~·~~~~J'!'~~1(~ll'~-h~~,*"~"~~~~~~~~1"."~~"".~~4~1o;.".~~~'~'4\>"'IAo)'~'-":'~"""':'
Cite as: Children's Safety Network. (1991). A Data Book of Child alld Adolescent InjlllY. Washington, D.C.: National Center for Education in Maternal and Child Health.
A Data Book of Child and Adolescent InjU/y is not copyrighted. In accordance with accepted publishing standards, the National Center for Education in Maternal and Child Health (NCEMCH) requests acknowledgement in print of any information reproduced in another publication.
The Children's Safety Network (CSN) provides technical assistance in developing programs to reduce unintentional injuries and violence. You can contact the Children'S Safety Network through:
National Center for Education in Maternal and Child Health 38th and R Streets, N.W. Washington, DC 20057 (202) 625-8400
CSN staff contributing to A Data Book of Child and Adolescent InjU/y:
Education Develo\ unent Center, Inc. 55 Chapel Street Newton, MA 02160 (617) 969-7100
Washington site: Susan Brink, Dr.P.H., Lamie Duker, M.P.P.M., Laura Kavanagh, and Sue Lindsay. Newton site: Alison Dana, M.P.H., Susan Gallagher, M.P.H., and Chris Miara, M.S. Graphic design by Dan Halberstein.
Published by: National Center for Education in Maternal and Child Health 38th and R Streets, N.W. Washington, DC 20057 (202) 625-8400
Available in limited quantities from: National Maternal and Child Health Clearinghouse (NMCHC) 38th and R Streets, N.W. Washington, DC 20057 (202) 625-8410 or (703) 821-8955 ext. 254
This publication has beel! produced by NCEMCH under its cooperative agreement (MCU-I17007) with the Maternal alld Child Health Bureau, Health Resources and Services Administration, Public Health Service, U.S. Department vf Health alld Humall Services.
[---l ----------------------------------------~I~_J'-----------------------------------------
CONTENTS
How TO USE THIS BOOK .......................•...........•..................•..... , .. , ...................................................... IV
ACKNOWLEDGMENTS .............................................................................................................................. V
INTRODUCTION ..................................................................................................................................... VII
SECTION I: OVERVIEW ........................................................................................................................... 1
SECTION II: MORTALITY .......................................................................................................................... 7
SECTION III: UNINTENTIONAL INJURY ..................................................................................................... 15
SECTION IV: ViOLENCE ........................................................................................................................ 41
SECTION V: INTERVENTIONS ................................................................................................................. 57
REFERENCES ...................................................................................................................................... 63
ApPENDIX A: INJURY MORTALITY RATES ................................................................................................ 69
;·~tI~~~~~·~~j~~~~;l:;.,~~ ........ .F'~~~';)"~¥'?''i~)~~~ ...... ~:~»<~,,~~~~~~~~~j;:~~~~~~~~.-"" .. _~~:~Il'-""¥lt.~~~'i~~;t~j:~~.;':':~"t':~~F~ ....... ""~O;';:""~~~'\~
"'J~/~~~"4".6-.~j...""''a~);,k';'J~~.".;.~,,~~~~~~'>''J\.j.,. (~."_.~!/:04"""""'~"'V='~~~~~~~~~"'~.-~~~""'-"'""'~"'I'!"'~~.'i,,>.,;II"f~~~"'W'~~"'~~--'."'~""'''':f><''(-'''''V>"'"f
How To USE THIS BOOK
The charts in this book are not under copyright. Individuals are encour
aged to make copies and use tpem in injury prevention .~ e]"orts.
The charts are designed to compare groups within the chart but not across charts. In
Sections III and IV, the scales used on individual charts differ dramatically. Charts are presented in these sections so that the reader may make comparisons between age groups, sex or race, within each injury category. Citations are listed at the back of the b'bok. Mortality rate
charts do not address injuries in infants under 1 year, because available population estimates used to calculate rates reflect all live births rather than the actual number for that age category, thereby affecting the calculation of the rates.
This book was developed by the Children's Safety Network (CSN), a
national resource for child and adolescent injury and violence
-PJ;§vention supported by the M;ternal and Child Health Bureau. Special appreciation goes to Sue Lindsay for her work in coordinating the gathering of information and data display.
This publication d'laws on the work and experience of a
ACKNOWLEDGMENTS
number of individuals and agencies, without which the data would not be available. The 'N ational Center for Health Statistics of the Centers for Disease Control provided the analysis of the 1988 vital statistics, information from the National Health Interview Survey, and the National Hospital Discharge Survey. The data on the use of safety belts and car seats were obtained
through the National Highway Traffic Safety Administration (NHTSA). The Consumer Product Safety Commission, the Department of Justice and the National Institute for Occupational Safety and Health were also supportive of this effort.
The data presented here have been gathered from a multitude of sources. The interpretation of the data is the responsibility of the Children's Safety Network.
-C~~~-":-""-""'_W~~~~~"''''!t~7'~''''''''.:.'fo'''''~U:~~~"f!~~~'''')I!''.~~~+!?r!J(~~,:.:..c..,,,",,,-'.~.~,,,,,~,~"""""'~"""~"~~"'~~~lW"~~~.~~:"~T"'"~~".,.,.. ..... ~~.....,..._~,~: .... ~
I njury is the most significant health problem affecting the Nation's children and ado
lescents, however it is measured-number of deaths, dollar costs for treatment, or relative rankings with other health problems-as this report makes abundantly clear. However, injury need not maim and kill so many of our children. This is an epidemic that we can control, as both prior successes and the international comparisons illustrate. Targeted prevention strategies that have proven effective include flame retardant fabrics
"' --, , ,
INTRODUCTION
for children's sleepwear, child safety seats, smoke detectors, and child-resistant medicine bottles. Other promising strategies have yet to be implemented and evaluated.
Injury includes, but is not limited to, the following categories: motor vehicle crashes, burns, poisonings, drownings, pedestrian and bicycle crashes, homicides, assaults, rapes, suicides and suicide attempts, and child abuse. The National Committee for Injury Prevention and Control defines injury as "any unintentional or intentional
damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen" eN ational Committee for Injury Prevention and Control, 1989). Injury is thus a biophysical event.
Contributing factors and prevention strategies for violence and unintentional injury are sometimes the sa..1lle. For example, alcohol and other drugs are often implicated in many types of inj uries, especially those affecting adolescents. Likewise,
·~1:;,;';;>~1't~oe~~~~~!'~.~,;(""'~l""'~."~~_~IM~~~~"f-~~.I""":i"lI"""~"""""_~~1j.~~~.~tr-~.~it>-'9"""","*~~~~1.~~~,~~-t~;';-~\i.~':'~~"""'l~
~ ___ ;~~'~~'~_'~~~~~~'~~~~I~~~~~'~~'~~~~ __ '~~~ __ ~M_~'~ __ ~¥~~--------~~~-~-~~~"~'~>-W--'~~~~~-~~~"~~-~~'~l
VIII
poverty is a strong risk factor for both
violence and unintentional childhood
and adolescent injuries (Baker et at,
1991). Safety improvements to firearms
and limitations on access to them, reduc
tions in tap water temperature, and sup
ports of various kinds to multi-need
families, can reduce injuries, regardless
of intent.
While we have had successes in
injury prevention, it is vital that we do
beUer. Too many children are dying or
becoming disabled and the costs are
high. In this report, information is pro
vided on the substantial dollar costs of
childhood injury to our society, but the
most significant costs are ones we can
not depict graphically, those of child and
family pain. The loss of life or function
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
experienced by a child or adolescent is a
terrible burden for a family to sustain.
Guilt, rage, grief, blame and despair are
common family reactions to a serious
injury of a child, not infrequently lead
ing to divorce, severe depression of par
ents or siblings, and even suicide.
Medical care costs may sometimes
result in family impoverishment (Rice
and MacKenzie, 1989). Thus, one of the
i~ltangible costs of child and adolescent
injury is that of family suffering and
even disintegration.
Healthy People 2000 ( USDHHS,
1991), the government document that
outlines the strategy for improving the
Nation's health over the decade, empha
sizes the need to prevent the thousands
of needless child and adolescent injuries
that occur annually. Numerous injury
reduction objectives for children and
adolescents are specified. Most impor
tantly, the key target objective for both
children and adolescents is to reduce the
overall death rate; this will require a
reduction in the injury rate. As a nation,
we have made a commitn,~nt through
the year 2000 objectives to more sys
tematically address the problem of
injury as it affects children, adolescents,
and families.
To do so successfully will require a
multi-disciplinary and multi-agency
approach. Public health agencies must
work together with environmental, crim
inal justice, traffic safety, education,
social services, and other agencies, as
well as with coalitions of private groups.
INTRODUCTION
To reduce the incidence of injury in
America, we must learn to combine
legislative, technological and behavioral
strategies, change norms that regard
most injuries as inevitable, and actively
address the causes of violence on our
streets and in our homes. A problem of
this magnitude requires the talents and
hard work of a variety of dedicated
individuals representing many fields and
working together for a common goal.
Only then can we meet the challenge
before us.
Maternal and Child Health Bureau
October 1991
IX
0 1-4 years wd C1l 5-9 years
80 [I 10-14 years
70~ears >. :::: 60 ro 1:: 0 :2
~ 50
'0 40 C (])
~ 30 (])
D..
20
10
0
1955 1967 1988
Figure 1.1 Injury as a Percentage of Total MOl1ality Among Children 1-19: 1955, 1967, 1988.
Source: Fingerhut, NCHS, 1988.
·SEC1IONI OVERVIEW
.·C·· i .. hildhobdinjury is ...•.....•.•.•....... · ... >th. e. p.ri.l1.C.lp.al p.··.Ubli .. ·C
. . . health problemm ;. America today. causil1g
more deaths than all child .. hood diseases combined and contributing greatly to childhood disability. In 1988, injury claimed the lives of more than 22AOO children 19 and under in the United States and. accounted for 80% of deaths in the 15-19 year old age group.
~~~l':~~~~~~~'" t>\lf*'"4·,:~~Al:-~~i':<.=.""!~-'''~::o'"......;.'>#''''~~~~~~f.<!!~~--~~'~~-~:'''~-o>rl~~'-'~~~~~'f"~!T,.c~
2
H istorically, there has been a dra
matic reduction in child mortal
ity due to natural causes (diseases,
including congenital anomalies)
while the percentage of mortality due
to injury has steadily increased.
For children ages 1-19, injuries
far exceed cancer and congenital
anomalies as the leading cause of
death.
"If a disease were killing
our children in the proportions that
injuries are, people would be
outraged and demand that this killer
be stopped. "
-former Surgeon General
C. Everett Koop, M.D.
25,000 L
20,000
15,000
10,000
5,000
o 1-19 Years
Figure 1.2
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
1-4 Years
• Injuries
III Cancer
o Congenital Anomalies
5-9 Years 10-14 Years 15-19 Years
Deaths Due to Injuries vs. Deaths from Cancer and Congenital Anomalies, 1988. Source: Fingerhut, NCHS, 1988.
OVERVIEW
180
160
140
0) -* injury f-
\ I
---$- ",Mal "'"'" _
0 120 \ \
--i 0 0 ci 0 ~ 100 Q)
iii a: £ 80 rn 1:: 0 ~ 60
40
20
~
\ \ ~ -~ - V---'~ -""'" -
\ -- ~
~ - "
- ~ i---\i;)
0
1933 1950 1967 1988
Figure 1.3 Mortality Rate/1 00, 000 Due to Natural Causes vs. Injury: 15-19 Year Olds, 1933-1988. Source: National Center for Health Statistics, 1989; Fingerhut, NCHS, 1988.
I
3
A doles cents are a particularly
.rt. high-risk population for
injury-related deaths. Figure 1.3
shows the significant decline in
mortality due to natural causes for
this age group while the mortality
rate due to injury has increased. In
1988, a 15-19 year old was four
times more likely to be killed by
injury than by natural causes.
".",.·~ •• "",''''''''~~~,WU:...v..2>,:~_~-<>r~.~~ .......... ~~";~ .. ''''''~4:it~w4~.~..., ...... ~..",,,~,,;...,,.~~"'~""'J-/'--.a';~~~~"';;lo~~~~~":M~~~~~~"~"'!1""i"iH't':~~W\~~~~~~r....,,..J.>.f;)_!"~~""'"
4
Child m0l1ality rates in the
United States are higher than
those in other industrialized nations
similar to our own in culture and
history. "This excess in mortality is
not due to a difference in death
rates from all natural causes; rather,
all the excess mortality among U.S.
children can be attributed to injury"
(Rosenberg et aI., 1990). Figure 1.4
compares injury mortality rates for
five countries, including uninten
tional injury and violence.
About 75% of the U.S. child
mortality due to injury is caused by
unintentional injury (motor vehicle
collisions are the leading cause of
unintentional childhood death). The
other 25% is caused by violence,
including homicide and suicide.
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
o 5 10 15 20 25 30 35
Mortality Rate/100,000
Figure 1.4 International Injury Mortality Rates/100,OOO Including Violence: Ages 0-24. Source: World Health Organization, 1991.
40 45
OVERVIEW
United States
Canada
France
Federal Republic of Germany
United Kingdom
o 2 4 6 8 10
Homicide Rate/100,000
Figure 1.5 International Homicide Rates/100,OOO by Age Group. Source: World Health Organization, 1991.
12 14 16
5
T he United States is a nation
plagued by violence. In 1988
there were 5,718 deaths due to
homicide in the United States
among 15-24 year oids. During the
same time period there were only
411 homicide-related deaths in this
age group in the countries of
Canada, France, Germany, Spain,
the Netherlands, Switzerland,
Finland and the United Kingdom
combined, despite a total
population of 15-24 year olds very
similar in size to our own.
U.S. children are 10 times more
likely than German children, 11
times more likely than French chil
dren, and 15 times more likely than
English child::-en to be victims of
homicide.
Falls
Poisoning
Motor Vehicle Bicycle
Unintentional Firearms
Fire/burns
Motor Vehicle Pedestrian
Drowning
Suicide*
Other Motor Vehiclet
Homicide
Motor Vehicle Occupant
o
476
1,341
1,711
~"-'" .. 1,714
.• j< .<
-. .' , , _',' 'I
500 1,000 1,500 2,000
Number of Deaths
0
0
LJ .. •
2,296
2,345
2,500
Under 1
Ages 1-4
Ages 5-9
Ages 10-14
Ages 15-19
'I
, 5,896 J l
6,000 3,000
* Suicide statistics are only tabulated for persons 10 and older.
t "Other motor vehicle" includes deaths involving motorcycles, mopeds, snowmobiles, and all-terrain vehicles.
Figure 2.1 Total Number of Deaths by Cause and Age Group: U.S. Children 0-19, 1988.
Source: Fingerhut, NCHS, 1988
SECTION II MORTALITY
F igure 2.1 shows the leading causes of injury-related
deaths by age group. The patterns of childhood injury deaths are shaped significantly by developmental stage and the kinds of activities in which children participate. To be effective, any injury prevention strategy must first examine the link between developmental stage and cause of injury.
~=~""''';'ia~'!l;i.~~~i~msr~~~:~~~~~~.''I'1!1'>~~,::,~~o;rl;u~~",j:.'(J~<r~~~~~~~'''''''''~'~~~~~~","-"':~~~J~"~~""'"'''''''''''-i''''ml.-~~~Y'''.iI'''''''''''''~o:.:-.
8
Ages 1-4
W hen viewed together, motor
vehicle-related injuries (oc
cupant, pedestrian, bicycles, and
"other") were the number one cause
of death in all age groups. Because
interventions differ for each of
these injury categories, the figures
in this section present these four
injury types separately.
In 1988, fires and burns caused
the greatest number of injury
deaths to toddlers and preschoolers
(ages 1-4), with drowning second,
pedestrian injuries third, and motor
vehicle occupant injuries fourth.
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
MV Bicycles
Unintentional Firearms
Poisoning
Falls
MV Other ._98 Homicide _-------381
MV Occupant •.......... 438 MV Pedestrian •........... 453
Drowning pillllllllllllllllllllllllllllllllllllllll1l620 Fire/Burns ~ : : I , ? ~6~
o 100 200 300 400 500 Number of Deaths
Rates/tOO,OOO are included in Appendix A.
Figure 2.2 Number of Deaths by Cause, Toddlers and Preschoolers: Ages 1-4, 1988. Source: Fingerhut, NCHS, 1988.
600 700
MORTALITY
Poisoning
Falls
Unintentional Firearms
MV Other
MV Bicycles
Homicide
Drowning
Fire/Burns
MV Occupant
MV Pedestrian I , I , ~3~ o 100
Figure 2.3
200 300 400 500 Number of Deaths
Rates/tOO,OOO are included in Appendix A.
600
Number of Deaths by Cause, Elementary School-Aged Children: Ages 5-9, 1983. Source: Fingerhut, NCHS, 1988.
700
9
Ages 5-9
T he four leading causes of
injury death to school-aged
children (ages 5-9) in 1988 were
motor vehicle pedestrian, motor ve
hicle occupant, firelburns and
drowning. Motor vehicle pedestrian
deaths reflect the increased mobility
and independence of this age group.
Motor vehicle pedestrian and occu
pant injuries account for nearly 40%
of all deaths in this age group.
~~"""'''''''~_~'''''/O~~~>,l~'~~'''''''-ZI;./;'''''~~~''~~'':~~~-';$<'''~'''''''~~~>!/'f;;;:~~·~''''~~~~';:;,~H';!Il,t<;W~~fjf~~~~~t;Oii~~ .... ~ ... ~~·-.,~~
~,-~ ............. ~~.,.. .... :;r~~~~~~J~~~~~M~~""'1m-\'Jf~eo~~~'f!~~"t""'~~~""~~~4~~>!"~.J?«!,'*"'''''''''''''.\I'",,~~ ...... !;:_t'IO-_'~~~'''~~1¥,''''~'.'~~ .. '.
10
Ages 10-14
O nce children reach middle
school (ages 10-14), the three
leading causes of injury death are
motor vehicle occupant, motor
vehicle pedestrian and homicide,
closely followed by suicide and
drowning. Intentional injuries
account for almost 20% of the total
injury deaths for these children.
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Falls
Poisoning
Fire/Burns
MV Bicycles
Unintentional Firearms
MV Other
Drowning
Suicide
Homicide
MV Pedestrian
MV Occupant I, I, I, ,i, I , ~5~ ,I
o 100 200 300 400 500 Number of Deaths
Rates/tOO, 000 are included in Appendix A.
Figure 2.4 Number of Deaths by Cause, Middle School Aged Children: Ages 10-14, 1988. Source: Fingerhut, NCHS, 1988.
600 700
MORTALITY
Falls
Fire/Burns
MV Bicycles
Poisoning
Unintentional Firearms
MV Pedestrian _.406 Drowning
_._487 MV Other
Suicide
Homicide
MV Occupant l ,9 ' I ~ I
o 500
Figure 2.5
1,000 1,500 2,000
Number of Deaths
Rates/tOO,OOO are included in Appendix A.
Number of Deaths by Cause, High School Aged Children: Ages 15-19, 1988. Source: Fingerhut, NCHS, 1988.
2,500 4,500
11
Ages 15-19
F or high school aged youth
(ages 15-19), motor vehicle
occupant injuries are by far the
leading cause of injury-related
death. Twice as many 15-19 year
olds die as occupants of motor
vehicles than from any other cause.
After motor vehicle occupant
deaths, homicide, suicide and other
motor vehicle deaths far exceed all
other causes of death.
12
I· n all injury causes males are
consistently at higher risk for
death due to injury than females.
Males are .tlmost four times more
likely than females to commit sui
cide, 2.5 times more likely to be
victims of homicide, almost 3
times more likely to drown and 6.5
times more likely to be the victim
of an unintentional firearm
discharge.
12
10
8 o o o 6
10.2.
~ .6.3 en
"* 6 a: .c iii Q)
o
10.3
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
1·1 Females
Males
6.5
Figure 2.6 Death Rates/ 100,000 by Gender: Ages 19 and Under, 1988. Source: Fingerhut, NCHS, 1988.
4.8
41 ili 3.5
2..7 _ 2..6
2
o MV Occ
MV Suicide Homicide Fire! Drowning Unint Falls MV MV Ped Burns Firearms Bicycles Other
MORTALITY
Figure 2.7 Pyramid of Childhood Injury. Source: Gallagher, personal communication, 1991.
13
Childhood injury mortality fig
ures are shocking. However,
mortality is only a small part of the
total injury picture. The pyramid in
Figure 2.7 compares the number of
unintentional and intentional injury
deaths to hospitalizations to emer
gency room visits in a population
based study in Massachusetts.
Interventions targeted solely
at injury deaths may neglect fre
quent injuries that are costly, and
cause children to be treated in
hospitals and perhaps left
permanently disabled.
'f'<""~~~~~"""),1.~~~"""'~.f.l."":""~/""':~~~"""""""~~~~f-"_"'~~'¢~'-~1,.",~_~"",~1.-~~~~-;:~"",'''~~1'--I'''''f,f~>#''d'~~~~ .......... w
Unintentional injuries
. result from the complex interaction of the
child's developmental stage, parental awareness of a child's abilities, and a product or environment. For example, injuries caused by motor vehicles represent a concern at all ages. However, the most frequent cause of injury by motor vehicle differs by the child's age, with infants injured as occupants, preschoolers injured as occupants and often as
SECTION III UNINTENTIONAL INJURY
a-",:-:~
pedestrians in driveways, elementary school children injured on streets as pedestrians and bi-
cycle riders and adolescents injured as drivers and passengers-often with alcohol involvement.
Attention to the developmental differences in children will help in the design of prevention strategies. Reduction of unintentional injuries to children and adolescents will require not only legislative and regulatory ini-
tiatives, but also changes in products, the environment and individual behavior.
./-:,:u"-"<.~~~~""",~~","."~~~~~<f<~~')I~ykl"'~'I;"~""" __ ~~~':"~~"""'~~.t:i~~~~~l'f*'+7.i~~.,(~~~""'I~:W':;:,"",
UNINTENTIONAL INJURY
Ages 15-19 65.0% (6785)
<1 2.1% (215)
Ages 1-4 9.6%
(1005)
Ages 5-9
11.3% (1176)
Ages 10-14 12.0% (1241)
Figure 3.1 Children Killed in Motor Vehicle Crashes by Age Group, 1988.
Source: Fingerhut, NCHS, 1988.
17
Motor Vehicles
On average, more than 28
children and adolescents die
in motor vehicle-related incidents
every day. This is equal to almost
3 school buses full of children ev
ery week. In 1988, adolescents
ages 15-19 accounted for 65% of
the 10,428 motor vehicle deaths to
children and youth.
~~~~~-V~."M .... ;,~~~~~(~ ..... ~.~~uwu~~~~,~~t:.ItI~~"'i. .. ~~~t~ .. 'f."1~~~~~~~~1>1'~~~~~~~*,;t\
~~':~';";;f'f"M~~~~~~-~:d. "'~~;t~~;~~I!~~~~~~~.'n-M;.~~~""[~""".-¢*J~~~"",,~~ ... ,..~-\..:r~~~"',·~I~"&~~~~q.
18
Motor Vehicle Occupants
F or motor vehicle occupants, the
death rates of males and
females are very similar across an
age groups until ages 15-19, when
the male fatality rate exceeds the
female rate by almost 2 to 1. The
death rate for adolescents ages
15-19 is more than 5 times the rate
for any other age group.
Two out of three teenage passen-
ger deaths occur in crashes in which
another teenager is driving (Fleming,
1990).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
35
30 -::J- Male
a 25 _ Female a a c5 ~ 20 Q)
T!! g 15 C1l 1:: 0 ~
10
5
0 Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 3.2 Motor Vehicle Occupant Mortality Rates/10o, 000 by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
UNINTENTIONAL INJURY
Figure 3.3
50.4%
Blood Alcohol Content
D BAC=O.OO
D BAC=.01 %-.09%
• BAC~.10%
Adolescents Ages 15-20 and Alcohol Use in Fatal Motor Vehicle Crashes, April to June 1990. Source: Centers for Disease Control, 1991.
19
Adolescents, Alcohol and Motor Vehicles
During the past seven years
NHTSA has shown that the
proportion of intoxicated drivers
involved in fatal motor vehicle
crashes has decreased in all age
groups including adolescents.
Nevertheless, during one 3-month
period in 1990, it was found that
just under one-half of adolescent
motor vehicle fatalities involved ai
cohol. Of adolescents invo]ved in a
fatal crash, one in every three had a
blood alcohol concentration greater
than or equal to 0.10%, the legal
limit of intoxication in most states.
;,~~~;",rn-:~:;:!''''-~~~"-M~~~>i!~~l:~~~';>~'#''''''~~''''::'''''''''';'~~~~~'¥-~'~ri~~?~l>,~/?"",$;.yJ~~~f!oo':"""'~~,...".m~""+,,,--,,~,k~'~")\~~~k-,.~~~~~r~~~~~~'.
20 A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Safety Belts
I ncreased usage of safety belts in
the last decade is one of the
most dramatic victories of the
injury prevention movement to
date. From 1983-1989 the use of
safety belts saved an estimated
20,086 lives and prevented approxi
mately 523,100 moderate to severe
injuries (NHTSA, 1991a).
Although safety belt use in gen
eral has increased dramatically from
11 % in 1982 to 49% in 1990 (NHT
SA, 1991 a), adolescents continue to
wear safety belts less often than old
er drivers. In a nationwide survey of
adolescents, 41 % reported that they
wore a safety belt the last time they
rode in a vehicle. However, fewer
than one quarter of the students
(22%) reported that most of their
friends usually wear a safety belt
(American School Health
Association et aI., 1989).
Healthy People 2000 states a
goal of increasing use of occupant
protection systems to at least 85%
of motor vehicle occupants (USD
HHS, 1991). As ofJuly 1991 only
40 states and the District of
Columbia have safety belt use laws
(IIHS, 1991), and as of June 1990
only 8 states allowed police to write
tickets for safety belt violations
alone, without citing for another
moving violation (Fleming, 1990).
UNINTENTIONAL INJURY
1 .;~¥;:
"J'v)
" .
-~~
,1/' .• /~/~ ~ ~ '~ ',.,,~,. ,~ .. '.
~{ ~
/
f '" ""'~
21
Child Safety Seats
P ropedy installed and used,
child safety seats reduce the
risk of death and serious injury to
children by 70%. The use of safety
seats in 1989 saved the lives of
over 200 children ages 4 and under
and prevented 28,000 injuries.
Tragically, 336 unrestrained chil
dren under age 4 died in passenger
cars in the same year (NHTSA,
1991a).
The year 2000 objective for
child restraint usage is 95% for
children ages 4 and under
(USDHHS, 1991). The CUl1'ent
usage rate is estimated to be
approximately 83% (NHTSA,
1991 a). While this rate appears
high, improper installation and use
of child safety seats are widespread
problems. Research suggests that
80% of child safety seats are
misused in some way (NHTSA,
1990). Correct use of child safety
seats could prevent about 500
deaths and 53,000 injuries every
year (NHTSA, 1991a).
Although all states have child
occupant protection laws, their
scope varies widely. Many laws
exempt children beyond a certain
age or allow children to ride unre
strained in the back seat. Meeting
the year 2000 objective will require
closing legal loopholes and
stringently enforcing existing laws.
~'Ji."~~~~-A~~;.~~~~,""~f~~","\~~.!,~~..,....,,~.,;;_~~b~~~~~'~iJ--!--~t~:,,~~~,,:;,~~ .. ~~i"'~~~~~~~~~~~~""":.;:~~""''''''''''~
22
Pedestrians
P edestrian deaths account for
16% of all the motor vehic1e
related deaths to children ages 19
and under. Males accounted for 2
out of 3 childhood pedestrian
deaths in 1988. The age groups at
highest risk were the 1--4 and 5-9 year olds.
Pedestrian death rates for black
children are consistently higher than
for white children across all age
groups except for male adolescents
6
5
o 4 25 cS o ~
l 3 £ til t:: o ~ 2
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
-+- Black Males --[}- Black Females
--e-- White Males --.- White Females
'-. ...
ages 15-19. Fewer neighborhood 0 -II---------.-----~------,-----~
off-street play areas may put poor
children at higher risk of pedestrian
injury (Malek et aI., 1990).
Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 3.4 Child Pedestrian Mortality Rates/100, 000 by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
UNINTENTIONAL INJURY
-~v .. _.... 4a .
......->1".;;. ¥' ..... ~c.,.""'-"t '''~,...:.,! .. ,_~.j.'':, ':'~~~~~_'~ " '~, .. ,-.~
"'''-.
t;.:;"lL;.,~~~A.L.'~~_''' •. ~"".~~~;_A.._ '.::~ -::. , -'"'~l'illilM!'~~
, . . ,;{ r~ ~ ,....-""': 4'~'/~" ",:,.,' . I'.'V' .,..",.. , ( ~ ,
'~-)
23
Pedestrians
I n 1988, 1,711 children and
youth died as a result of pedes
trian injuries. Children ages 5-9 were far more likely to die as
pedestrians (531 or 45% of all mo
tor vehicle-related deaths) than as
occupants of motor vehicles (389
or 33% of all motor vehicle-related
deaths). Young children have
difficulty judging distance and the
speed at which cars are moving.
Most injuries occur when a child
darts out into the street in the mid
dle of the block. Children under the
age of 5 are often fatally injured in
home driveways or parking lots
(Brison et aI., 1988).
24
Motor Vehicle Injuries
T he Massachusetts Statewide
Comprehensive Injury Pre
vention Program (SCIPP) calculat
ed annual motor vehicle injury
morbidity rates. As with deaths,
adolescent occupants and pedestri
ans ages 6-12 had the highest risk
of injury from motor vehicles.
Deaths represent only a small
fraction of the outcomes of motor
vehicle injuries. In a study of
injuries at 55 pediatric trauma cen
ters, 38% of the trauma cases seen
in emergency rooms were motor
vehicle related (DiScala, 1991).
The vast majority of these injuries
were non-fatal.
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
200
180 -0- Occupant
160 -e- Pedestrian
140 0 0 0 cS 120 ..-"2 ~ 100 ~ '5 :0 80-0 2
60
40
20 r::'\
G------- (J --E) 0
Ages 0-5 Ages 6-12 Ages 13-19
Figure 3.5 Motor Vehicle-Related Morbidity (Occupant and Pedestrian) by Age Group, 1979-1982. Source: Guyer and Gallagher, 1988.
UNINTENTIONAL INJURY
18~ 1.6
~- Males
1.41 -.- Females
0 1.2 0 0 a 0 ~
Oi 1ii c: £' 0.8 <ii t 0 :2 0.6
0.4
0.2j / ------------- ~ o -I Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 3.6 Motor Vehicle-Related Bicycle Mortality Rates/100, 000, 1988. Source: Fingerhut, NCHS, 1988.
25
Bicycles
As many as 90% of bicycling
fatalities involve mOlor vehi
cles (Kraus et aI., 1987). Children
ages 10-14 are at greatest risk and
males over the age of 5 are at much
greater risk than females of motor
vehicle bicycle fatalities.
The majority of bicycling deaths
are due to head injuries. Riders
who wear bicycle helmets reduce
their risk of head injury by 85%
(Thompson et aI., 1989), yet it has
been estimated that less than 10%
of recreational bicyclists of all ages
wear helme.s (Wasserman et aI.,
1988).
·t~~~~~~~~~~'~~""""'~~'"2r.-"'''''''''''''<l\'~~~W.'''~~.,o.&J,~~_~~~~~~~~~'i.'~;''' .f·~'~:., ti':tt .. ~~~""i~~}5!~4J!#S'j":;!~"'~~~~_~~!~'t';~~'''~~~'''''.'i
.. t'~>\:~';"'~lt..~~;",m""~~~~.....;.;J.:';;~""~"h"~~~"-~~~"';~~~~"""W)i~~-,*,",~","':""~~~~~i-Pr-... ~",~~n.,~.,.\ ... ':"'.ti<>¥,Jj: ,.~_.~," ,t~ .. ~.;·
26
Drowning
APproximately 1,700 children
and youth were victims of
drowning in 1988. Males account
for over 3 out of 4 childhood
drowning deaths. Black males have
particularly high drowning rates in
all age groups. Children ages 1-4
and male adolescents are at greatest
risk for drowning. In 18 states
drowning is the leading cause of
death for children ages 1-4 (Baker
and Waller, 1989).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
7 ~ ~
----:] \ / -0-0 0 0 0 41 II ~ -r- ).J --ir-0 \ ... ID 1ii a: 3l , \ / £ -+-lii 1:: 0 ~ 2
o I
Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 3.7 Mortality Rates/1oo, 000 Due to Drowning by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
Black Males
White Males
Black Females
White Females
UNINTENTIONAL INJURY
" . .'::::>.
(",y-r-' _. <.;...~>
"f""~,::,:;-::::::,;:z;;::::.:<·,,; ... '").
r:-:'_J> ".,.,~~7
".:"".~.~ ..
.>;,:.1;:"
0~'
;,);:1>
:1\_ -pr;' '
, ~~, )~ -.;y.:><;; .... ' ''' .. ~
"
,: .... ~..-,:-"'.( ~.--
,'.-!>
,.'
..:t .. ' -<.-,
;?p.' f
'-"/'
<,;'1
>('~' 'u'" ~ '~""- /'. " ~ \//"
, 'V; , "
,,~
,/'. , ~f.~:"" ~-""~J
~::~~T.': 'j
-I
27
Drowning and Near Drowning
Y oung children, under age 5,
are more likely to drown in
pools and standing household wa
ter; adolescents drown most often
in open bodies of water. For every
drowning death, approximately
2-10 children are hospitalized and
8-40 are seen in emergency rooms
and released (Spyker, 1985). Approximately 5-20% of children
who are hospitalized for near
drowning sustain severe, permanent
brain damage (Pearn et aI., 1979).
~';';~)<i"';':"-~~~J~#Jh~~~~".,.~~~~~~'e~~~~~ .. ~,~i~"!~~~t4-;~~~lI""'~~~~~~f~~:",..r.;"""~~~~~~~-I'O"~~.~~",,
28
Fires and Burns
F or children ages 1-4, black
males are 4 times more likely
than white males and black females
are 4.5 times more likely than white
females to die from fire or burn
injuries. Income and the quality of
housing are more likely explana
tions for these differences than
race per se.
While fire causes the greatest
number of deaths, scalds are the
leading cause of burn morbidity
(McLoughlin and Crawford, 1985).
In 1989,21,000 children and youth
under 20 years old were admitted to
hospitals to be treated for burn
injuries nationwide (Kozak, 1991).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
16
14 --- Black Male
12 a a
-0- White Male
a 810 ~
ID -..tr- Black Female
1li 8 a: £ "iii 6 t
-+- White Female
0 ~
4
2
0 Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 3.8 Mortality Ratesl100, 000 Due to Fires and Burns by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
UNINTENTIONAL INJURY
2.5
2
. -'" 1.5 CIl
iI Q)
> ~ ID a:
0.5 e-----a w
0 r---- --------r- - I
Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
'The population as a whole has a relative risk of 1.
Figure 3.9 Relative Risk of Death Due to Fire vs. Risk of Injury Due to Fire by Age Group, 1987. Source: United States Fire Administration, 1990.
29
Fires and Burns
Seventy-four percent of fire
related deaths occur in residences
with the majority of these in one
and two-family dwellings (United
States Fire Administration, 1990).
Children under the age of 5 have
2.5 times the relative risk of any
other childhood age group of dying
in a fire (the population as a whole
has a relative risk of 1). As children
get older, the risk of death decreas
es but the risk of suffering non-fatal
fire-related injuries increases, peak
ing at ages 15-19.
30
Unintentional Firearms
U nintentional firearm injuries
killed 543 U.S. children in
1988. The availability and accessi
bility of firearms presents a high
risk for children of aU ages, but
especially for male adolescents
ages 10-19.
About] of every 3 deaths from
unintentional firearm discharges
could be prevented by a firearm
safety device such as a trigger lock
or loading indicator. A study of au
topsy and police reports determined
that a child-resistant trigger lock
could have prevented every incident
in which children under age 6 killed
themselves or others (U.S. General
Accounting Office, 1991).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
3
251 -II- Males
--e- Females
0 2 0
0 ci 0 ..-
1 1.5
.~ rn 1:: 0 :2
0.5
0 Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 3.10 Unintentional Firearm Mortality Rates/100,OOO by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
UNINTENTIONAL INJURY
1.6 - Male
14i --- Female
1.2
0 0 0 c5 0 T""
CD rn 0.8 0:
.~ (ij 1:: 0.6 0 ~
0.4
0.2
0
Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 3.11 Unintentional POisoning Mortality Rates/100,OOO, by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
31
Unintentional POisoning
Since 1970 legislation requiring
child-resistant closures on many
products, poisoning deaths have de
creased dramatically, particularly
among children under 5 years old.
In 1988,322 children died from
unintentional poisoning. Rates were
highest for adolescents 15-19;
many of these deaths are thought to
be undetected suicides. Adolescent
males are 2.5 times more likely than
females, and black children ages 9
and under are 3 times more likely
than their white counterparts, to die
from unintentional poisoning. An
estimated 69,000 children and youth
were hospitalized in the U.S. in 1989
due to poisoning (Kozak, 1991) .
..-"'-.,. .. ~~~#\ol~~.:;;;M..~I"'~ .... """"'~~t~~ ... ~.~""""''l,~~,,~~.J<~'>'''''''''' ..... ~,,~~ ~~~ ... ;-u&lp.:.~~~~~;~)~....,:4-~I"I.,N~I\I>~~~P~f.~~M..~~~'951t:'!!~~~~~4~~m1""~':"'<f'":'.w~~,.,.~ ... ~"",~~~
~~.;~W!:r~0;~~Pi-~~~~~"'a,..!r.¥~~~~~~'''~'''''~~~~~~~~''I''''''~'!;$'''.~~~~'~''''''''''''''-~~."~~~~"",,,,~~~.,.~r.--"-'",
32
Fans
D eaths due to falls are most
prevalent among males under
J and ages 15-19. Among toddlers,
fatal faDs occur most often from
windows and on stairs. Risk-taking
behaviors put adolescents at risk for
death from falls.
Most falls do not result in death,
but may result in serious injuries.
Falls in children are most often as
sociated with stairs, furniture,
strollers, high chairs, walkers,
changing tables and playground
equipment (Gallagher et aI., 1984).
An estimated 100,000 children are
treated in emergency rooms each
year for playground-related falls
(U.S. CPSC, 1990a).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
0.9
0.8
0.7
0 0 0.6 0 0 0 .-2 0.5 (1J
a: £' 0.4 til 1:: 0 0.3 ~
0.2
0.1
0
Ages 1-4 Ages 5-9 Ages 10-14
Figure 3.12 Mortality Rates/100, 000 Due to Falls, by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
Ages 15-19
UNINTENTIONAL INJURY
Drowning/Suffocation
Falls
Blunt Force
Homicide
Electric Current
Machinery
Motor Vehicle
Other'
Figure 3.13
o 50 100 150 200 250 300 350 400 450 500
Number of Deaths
* Other includes air/water transport, nature/environment, suicide, explosion, fires, missiles/firearms, cutting/piercing, hot substances, and unknown.
Occupational Deaths to Adolescents Ages 16-19, 1980-1986. Source: National Traumatic Occupational Fatality Database, 1991.
L =::J 33
[ ~. ::::J
Occupational Injuries
U.s. adolescents are severely in
jured and die in a wide variety
of occupational settings. From
1980-1986, 2,l37 adolescents ages
16-19 died at work as reported to
the National Traumatic Occupa
tional Fatality data base. Males ac
counted for 93.4% of the deaths.
The top two causes of death were
motor vehicles and machinery. The
industries (when provided) in
which adolescents were most likely
to die were construction (312),
fishing (213), public administration
(56), transportation (41), manu
facturing (134), retail trade (128),
and services (121).
34
Occupational Injuries
E stimates of occupational injuries to
adolescents are underreported due to
several factors: death certificates are
often not accurately coded as work
related (Colorado Department of Health,
1988), surveys of occupational injuries
do not ask the age of the victim, and agri
cultural and transportation injuries and
homicides are often not reported as occu
pational injuries (Suruda and Emmett,
1988). Injuries that do not result in death
are even less likely to be reported. One
population-based study of adolescents
ages 14-19 found that 24% of all hospital
and emergency room treated injuries
were job-related, and resulted in a greater
median length of stay than for other ado
lescent injuries (Anderka et aI., 1985).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
UNINTENTIONAL INJURY
Ages 15-19
Ages 10-14
Ages 5-9
Ages 1-4
o
Figure 3.14
20 40 60 80 100
Number of Children
• Non-Hospitalized Injuries
o Hospitalizations
D Deaths
120 140
Agricultural Injuries to Iowa Children and Youth Ages 19 and Under, 1990. Source: Jones, 1990.
160
35
Farm Injuries
C hildren are particularly suscep
tible to agricultural injmies be
cause they ride on or work with farm
machinery at a young age and often
live on the same site where work is
performed. Federal labor laws do not
apply to the family farm.
One surveillance study of work
and leisure-related agricultural
injuries to all children in Iowa
found that 369 children were
injured but not hospitalized, 57
were hospitalized and 13 died in
1990. Males accounted for 81 % of
the injuries, and children were most
often injured by machinery,
animals, falls/slips, and striking
against something (Jones, 1990).
',<,',o~""'·~~"'''''''~~''''''''''-'''~r.If<\l'o·~'f'''~~~~~'-~~~~~~~'''''t<;o .. ~~~~ ..... ~j,.,~~~~''Jt>'~~:'!~:1:'ffl-'~~~-Y'~",",~,--,,~,*,p~
~~'e.~G;t"""~'''''''''I"'''''';''''~ri,'Mf!~~~~~~~i6*;.,,.,';.ll:''-;~';';!~}.m';.'%';!I~~~~~~~.~~~~=-tI'!r'!...,.",..~~~~~~~;h"""~~~"'""""'''''''~~''''''';'P''fi~~~~,M;~~~'''''''f'I',
36
Sports Injuries
T he risk of injury through par
ticipation in sports and recre
ational activities mcreases as a
child grows older. The injury rates
in a Massachusetts study of child
hood injuries indicate that 1 in ev
ery 14 adolescents will be seen in
an emergency room (ER) or hospi
talized for a sports-related injury
annuany. Twice as many males are
injured in sports-related activities
as females. In the Massachusetts
study, 17% of aU injuries treated in
emergency rooms and 16% of all
hospitalizations for injuries were
related to sports and recreational
activities (Guyer et aI., 1990).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Ages 13-19
Ages 6-12
Under Age 6 15
o 100 200 300 400 500 600 700
Morbidity Rate/10,000
Figure 3.15 Annual Sports-Related Morbidity/10,OOO in Massachusetts by Age Group, 1979-1982. Source: Guyer and Gallagher, 1988.
703
800
UNINTENTIONAL INJURY
Swimming 2%
Ice Skating 2%
Roller Skating 9%
Unknown 9%
Individual Sports 40%
Figure 3.16
Other Team Sports 4%
4%
Basketball 14%
Team Sports 51 %
Percentage of Sports Injuries by Cause: Children 0-19 in Massachusetts, 1979-1982. Source: Massachusetts Department of Public Health, 1983.
37
Sports Injuries
Sports are the most frequent
cause of injury for both male
and female adolescents. While in
juries from team sports are more
frequent, injuries resulting from
recreation and individual sports are
generally more severe. Track and
field, bicycling, horseback riding
and ice skating entail higher risks
for head injuries than contact team
sports such as football. Sports
related injuries incur greater direct
costs than other injuries due to a
high rate of hospi talization and
emergency room visits (Listernick
et aI., 1983).
'''''4W ... ~!",~..u~4'~~·~-~.~~~";,"t~~''''':Jioj<¥~~;,..~,,,,~~~,.9~~~'M·~~,,"I~''~~~#'''-''''''~~''''''..'l\'lfi~~~~~~fl~"'If\'''t~''7';;~~~~,?",7>.~_~rt+-~-~\W:o~
m-..:-.r.-~~?:'O~"'~·~~~!:t.li~~~~~~~iO,...J'~~~fl}~.~'~~.~t&'\r~.r,p; • ..m~r,;~~'lmI>M~~~~'l"-~~~"...".~~~,_.;.~~~'I._""""""'~~~~~~,,",*"""a'''''''''-''\';'~.
38
Toys
From January 1989 to Septem
ber 1990, 33 toy-related deaths
were reported to the U.S. Con
sumer Product Safety Commission.
Twenty of these deaths were chok
ing incidents, nine involving
balloons (a high-risk toy for young
children). Toys that are hazardous
to children include those with sharp
edges and points, with small parts
presenting a choking hazard or
cords that can cause strangulation.
In 1989, an estimated 122,500
children under 15 years old were
treated in emergency rooms for
toy-related injuries. Three out of
five of these injuries were to
children under the age of 5.
Riding Toys (5) 15%
Toy Chests (5) 15%
Figure 3.17
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Mobiles (1) 3%
Small Parts (5) 15%
Balloons (9) 28%
Reported Toy-Related Deaths by Type of Toy, January 1989-September 1990. Source: U.S. Consumer Product Safety Commission, 1.990b.
Because of their far greater magnitude, bicycle injuries are not included in this graph. They are depicted in Figure 3.6.
Figure 3.18 National Estimates of Injury Associated with Child and Youth Recreational Equipment, 1990. Source: U.S. Consumer Product Safety Commission, 1990c.
39
Recreational Equipment
Riding toys (scooters, tricycles,
wagons, etc.) were associated
with over one-third of all toy
related injuries. Children ages 5-14
are particularly vulnerable. Many
of these injuries reflect a young
child's lack of coordination, motor
skills and cognitive ability to use
such products safely.
An estimated 45,000 children,
adolescents and young adults were
injured riding all terrain vehicles
(ATVs) in 1990. Most injuries in
volved the head and neck. Young
people under age 16 should never
ride adult-sized ATVs and should
always wear a helmet.
&---------------------~
1 ~
V iolence has been defined as the use of force with the
intent to harm oneself or another. Violence takes many forms including homicide, suicide, rape, domestic violence and child abuse. Most acts of violence occur between family, friends and acquaintances.
Historically, violence has been studied almost exelusively from the perspective of criminal justice with
'---I
SECTION IV VIOLENCE
most efforts concentrated on attempts to curb violence or punish offenders. However, violence is now recognized as a major threat to the health and welfare of our Nation, particularly our Nation's children.
Public health professionals in all settings need to recognize the benefits of incorporating violence prevention strategies into their roles and settings.
""!~."'~~~~"'~~~""W'~,\>~~/<.A}"''M~=-w~.~~~ .... ~..u..m''''''~~~~~.~~~~11!'!'!.~.':t4.~.f...s1 .. ~/w:~~~
~.:~ ...... ~.~"'k!t\~~~iliP'~¥.i'Q:.~~~~~~~~~~~~"'~~~<~'~~~~"""'~';<;> .4 . ... --.,.,......""""~-..":.~r:f'~..,... .. ~ .. ~_~,~~~_~ .... ~
42
Homicide
HomiCide is the second leading
cause of injury death among
children and adolescents. In 1988,9
children a day (3,290 children/year)
were victims of homicide in the
United States. Childhood homicides
show two distinct patterns. Children
under the age of 5 have a high homi-
cide rate primarily due to parental
and caretaker abuse and neglect.
Adolescents have an extremely high
rate resulting from arguments and
crime involving peers,
acquaintances and gangs
(Christoffel, 1990).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
12
10
a 8 a a
o· a ..-]l Cll 6 a: Ql '0 '0 'E 0 4 I
2 C'---------- ~~J ~J
0
Ages 1-4 Ages 5-9 Ages 10-14 Ages 15-19
Figure 4.1 Homicide Ratesl100, 000 by Age Group: Children and Adolescents Ages 19 and Under, 1988. Source: Fingerhut, NCHS, 1988.
VIOLENCE
1-4
5-9
10-14
15-19
1-4
5-9
10-14
15-19
o 10 20
Figure 4.2
30 40 50 Homicide rate/100,OOO
[If Black Females
o White Females
• Black Males
D White Males
60 70
Homicide Rates/100,OOO by Gender, Race and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
..,..., 80
Homicide
[_=:J 43
[= "I
M ales are at a much greater
risk for homicide than
females. In 1988, among all
children ages 19 and under, 7 out
of 10 homicides involved males.
Overall, the homicide rate for
black children is 6 times that for
white children and is higher for all
age groups regardless of gender.
In no age group is this difference
more staggering than males ages
15-19. Black males ages 15-19 are
almost 10 times more likely to be
victims of homicide than their
white male counterparts.
"-"---"~'-''''''''-''~-.,-....,,,~,,,,,".,~.,.,,,,---,-~,-,,,,,--,,---... ",,,,------'-"""""'--"""~-~'-----';'.~'~·--~' ___ "'''_4~'''''·'·''_'''''-''''''''''"''''· ~l'~-fo\~~~~~~I~·~"'1t>.>;.
~~~.~tJ~,..y.;WfJ.l:~~-J~~~~~~:~n,o~~~~I'~~~·~~'1~~"""'~""'-:~~~·"""'~~~#.~~~~~""
44 A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Homicide
F irearms playa significant role
in childhood mortality and
morbidity. In 1988, 77% of the
homicides in ~he 15-19 year old age
group involved a firearm.
It is estimated that there are cur
rently more than 200 million hand
guns, tifles and shotguns present in
our communities (Bureau of Ako
hoI, Tobacco and Fireanns, 1991).
In a national survey of school
students, 48.1 % of 10th grade
males and 33.6% of 8th grade
males answered yes when asked if
they could obtain a handgun
(American School Health
Association et al., 1989).
2500
20001 (f) Ql "0 :2 1500 E 0 :r: '0 '-Ql
..0 1000 E ::> z
500 Firearms
13% oftotaJ
"
0 Non-firearms
II Firearms
o -I b. sd Ages 1-4 Ages 5-9
Figure 4.3
Ages 10-14
Number of Firearm VS. Non-Firearm Homicides by Age Group, 1988. Source: Fingerhut et al., 1991.
Ages 15-19
VIOLENCE
0 0 0 0 0 ~
2 ~ CD
"0 '0 'E a I
70
60 -II- Firearm
50 ___ Non-Firearm
40
30
20
10 ---a . · . . . . . a
o I 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988
Figure 4.4 Firearm VS. Non-Firearm Homicide Rates/100,OOO: Black Males 15-19, 1979-1988. Source: Fingerhut et al., 1991.
45
Homicide
H omicide is the leading cause of
injury death for black males
ages 15-19. From 1984 to 1988, the
firearm-related homicide rate for
this group more than doubled.
Poverty and inequality are
thought to be major risk factors
for homicide. "In fact, when pover
ty is controlled for, the excess risk
among blacks virtually disappears"
(Runyan, 1989).
Violent crimes against adoles
cents often involve casual acquain
tances of the same gender, race and
age. Effective interventions target
ing this age group may thus benefit
both victims and assailants.
~"~~~~<;J"~'q~~"-';''''''''N<r~~''''~fMl..''l;.t;(i''rl~'''''~~~~''';';;'~ .. ~~~~1.~~ ......... ~'io<~~''''''~~~~""","l(.<"M#~~~~~"'::~J1-~J:t~~"";;,..",?~~~
~~I&!~~~f!!~~~~~~';~'~ii'iiR~~;,;..,~'~""p;.:.""'-'~~~~~~~!~~,"";;.1*~;~',,~j.¢l\!~""",j::m~~".,:;r..~~~.h""~'~M~'.,
46
Assault
The most recent National Crime
Survey reveals that America's
youth are more vulnerable than
adults to both violent and property
crime. "On average, every 1,000
teenagers experience 67 violent
crimes each year compared to 26 for
every 1,000 adults age 20 or older"
(Whitaker and Bastian, 1991).
In a population-based study in
Massachusetts, it was determined
that annually 1 in 132 children
(ages 0-19) received an intentional
injury that required medical atten
tion at a hospital. For every homi
cide there were 534 emergency
room visits and 33 hospital admis
sions (Guyer et aI., 1989).
a a C!. ..-Qj iii a:
40
35
30
25
20
15
10
5
o
Simple Assault
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
t Aggravated Assault
II 12-15
o 16-19
III 20 and over
Robbery
'Simple Assault is defined as an attack with the intent to inflict injury, without use of a weapon. tAggravated Assault is defined as an attack with the intent to inflict injury, usually with a weapon.
Figure 4.5 Average Annual Victimization Rate/1,OOO by Age Group and Type of Crime, 1985-1988. Source: Whitaker and Bastian, 1991.
VIOLENCE
15-19
~ J
~ '" .
10-14
en Ql Ol «
15-19
~ 10-14
I I I j I Iii I Iii I I
0 2 4 6 8 10 12
Suicide rate/100,OOO
Figure 4.6 Suicide Rates/100,OOO by Gender, Race, and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
0 White Females
IiI Black Females
0 White Males
• Black Males
I j
14 16 18
47
Suicide
I n 1988,2,296 U.S. children
(10-19 years old) committed
suicide. This averages to more than
six suicides per day throughout the
year. Ninety percent of these
suicides were among adolescents
ages 15-19. Almost as many 15-19
year olds committed suicide in
1988 (2,059) as were victims of
homicide (2,135).
White males ages 15-19 are a
particularly high-risk group for sui-
20 cide. This group is two times more
likely to commit suicide than black
males ages 15-19 and four times
more likely than white females
ages 15-19.
W::"'~Mi.,riM["'W;:'~~~.,;z;.,<".!.';:''lli~~!-,.;;~Idt;.:~~~~~~,..;:,.v~~~~"<l'~~''''-='·e''~fFl,"l~'~~'.,;,t~,.".-.~":tT-~""""'""'1'<~"""""'''~~~''''~"",r-~~~~''-'~-I''~\~~~_~~'''''1~',
48
Suicide
Suicide rates have shown
increases since 1960 among
both 10-14 year olds and 15-19
year olds. Between 1960 and 1988
the suicide rates for males and
females ages 15-19 increased
threefold. Suicide also occurs in
younger children (5-9 years) but
the rate is very low.
Suicide among children and
youth is often a very impulsive act
done with little or no planning. A
recent screening of adolescents
12-14 years old revealed that 1 in
25 males and 1 in 11 females expe
rienced significant suicidal
thoughts (Garrison et aI., 1991).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
18
.. ////. t.._ 10-14 Males
16
14 ,/"" 10-14 -+- Females
0 12 0 0 0 0 10 ..-CD "§ OJ 8
't:l '0 '5 en 6
/~ -./
L: .. -.~
15-19 Males
15-19 -+- Females
4
2
0
1960 1965 1970 1975 1980
Figure 4.7 Suicide Rates/100,000 by Gender and Age Group, 1988. Source: Fingerhut, NCHS, 1988; Leenaars and Lester, 1990.
1985 1988
VIOLENCE
1800
1600
'1400
Ul 1200 Q)
32 ()
'5 UJ 1000 '0 .... Q)
800 .0 E ::J
Z 600
400 L Firearms 57% of
200
0
Figure 4.8
total
Males Ages 10-14
D Non-Firearm
• Firearm
Firearms 46% of
total
Females Ages 10-14
Males Ages 15-19
Number of Firearm VS. Non-Firearm Suicides by Gender and Age Group, 1988. Source: Fingerhut et al., 1991.
Females Ages 15-19
Suicide
Almost two times as
many adolescent
49
females as males report actually
trying to hurt themselves (American
School Health Association et aI.,
1989). However, it is estimated that
females complete lout of every 25
suicide attempts while males
complete lout of 3 attempts
(Rosenberg et aI., 1990).
Non-fatal suicide attempts most
often involve intentional ingestions
and cutting or stabbing (Guyer et
aI., 1989). The most frequent
suicide methods among youth are
use of a firearm, hanging and inten
tional poisoning (Holinger, 1990).
·'~-"';';'~~~~i..;;:~~~"~"''''''''''''1:'"~Y~''''''''~~'''o<~~~~~i.-~~<.-"<~"~~~·~,.I-~,,",,,~~,o{~Alt!-~~~~~I'~~1""'-~J.>.,,,,,,,,,,,,~..,,,.~~~;;"
50
Child Abuse and Neglect
I n 1986, an estimated 1,100 U.S.
children died as a result of child
maltreatment. Eighty-nine percent
(approximately 1,000 children) were
2 years old or younger.
Child maltreatment is generally
divided into the two broad categories
of child abuse and child neglect per
petrated by a parent or caretaker.
Child abuse includes physical,
sexual, and emotional abuse. Child
neglect inclujes physical, emotional
and educational neglect.
Using conservative estimates,
more than 930,000 children nation
wide experienced abuse or neglect
in 1986.
o o 0_ o o ,... en Q)
ro a: >.
10
~ 0.8 1:: o :2 O.S
0.4
0.2
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
\ 01 9- ....... ~
Under Age 3 Ages 3-5 Ages 6-8 Ages 9-11 Ages 12-14 Ages 15-17
Figure 4.9 Estimated Mortality Rates1100,OOO Resulting from Child Maltreatment by Age Group, 1986. Source: National Center on Child Abuse and Neglect, 1988.
VIOLENCE
16
14~ -- Abuse - -
--- Neglect -j
12
10 a a C!. ~ 8 Q)
Cii a:
6
4
2
0
Under Age 3 Ages 3-5 Ages 6-8 Ages 9-11 Ages 12-14
Figure 4.10 Estimated Rates of Child Abuse and Neglect/t, 000 by Age Group, 1986. Source: National Center on Child Abuse and Neglect, 1988.
Ages 15-17
51
Child Abuse and Neglect
Rates of non-fatal child abuse
and neglect increase with age.
Research indicates that children
raised in abusive and neglectful en
vironments are at high risk for
physical and emotional health prob
lems as well as developmental de
lays and school-related problems
(Hochstadt et aI., 1987).
Child abuse is also strongly
linked to domestic violence. A
study of 906 children living in bat
tered women's shelters found that
nearly 50% of the children were
also victims of physical and sexual
abuse (Layzer et aI., 1986).
52
Child Abuse and Neglect
I t is estimated that over 820,000
children experienced non-fatal
injuries related to child maltreat
ment in 1986. Seventeen percent
sustained serious injuries involving
life-threatening conditions or
potential long-term impairments.
Moderate injuries persisted in ob
servable form for at least 48 hours.
Like the risk of maltreatment itself,
the rate of non-fatal injury due to
maltreatment increases with age.
Injury type is important in child
abuse documentation. Even without
an adequate injury history, child
abuse can often be confirmed based
on the nature of the injury and clin
ical symptoms (Kempe, 1962).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Figure 4.11 Estimated Injury Morbidity Rates/1000 as a Result of Child Maltreatment by Age Group, 1986. Source: National Center on Child Abuse and Neglect, 1988.
VIOLENCE
Emotional Abuse
3.5 Sexual Abuse
Physical Abuse
a 2 3
Rate/1000
Figure 4.12 Rate of Abuse/1,OOO by Type of Abuse and Gender, 1986. Source: National Center on Child Abuse and Neglect, 1986.
4
• Males
o Females
5
5.4
6
53
Child Abuse and Neglect
F emales suffer higher rates of
abuse than males in all three
abuse categories. Females are near
ly 4 times more likely to be sexual
ly abused than males.
Analysis of national data found
no relationship between child
maltreatment and race, but low in
come is a significant risk factor for
both abuse and neglect. In 1986
children whose family income was
less than $15,000 were 4 times
more likely to be abused and over
7 times more likely to be neglected
than children in higher income
families.
l{'~~"'~"'Io\!i%*~~~~~,w~.-.t:~-..:~r~~~~~'ti-t~.;..~~tk~~~W4_~"""'~~""M',...Juj""W~"~~~"r..",",,\"':'~.~'l:.~""~~~~~~N"-;"'.,j~~.:>f~~ .. {.~_,",~
~r ... ;,# ... ~ ... \.l""h''''.·.'~'i~ •• ,.,tO<>I~l-~~'ojIj,-~~~~~~#l,.~~~~~,'P~~_~~'''''''''''''~''''''''Ih''<4I.~~~ .... ~~ • ..w'''~'~'''''''-'I'>rt.~~~~.kr~,o:<!I~~~~4~~,',
54
Rape
A ccurate rates of sexual assault
among adolescents are
extremely hard to obtain. One
nationwide study of 1,725
adolescents estimates a rate of 9.2
rapes or attempted rapes involving
violent force and/or the use of a
weapon per 1,000 females ages
13-19 in 1978 (Ageton, 1983).
The vast majority of adolescent
rapes occur between two people
who know each other. One study of
females ages 13-17 found that they
were most commonly raped by a
friend, acquaintance, or relative
(Massachusetts Department of
Public Health, 1990).
Friend/Acquaintance (40%)
Figure 4.13
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
/
Other (10%)
Other categOlY includes coworkers, school personnel and health professionals.
Other Relative (14%)
Parent/Step-parent (18%)
Relationship between Rape Victim (Ages 13-17) and Assailant, Massachusetts, 1985-1987. Source: Massach'usetts Department of Public Health, 1990.
Preventing Injury
Because children are at risk f~r different injuries at vanous ages, preven
tive efforts need to vary by age. Injuries to children ages 0 to 4
years usually occur in settings controlled by their parents. Making products and the environment safer, building parental knowledge, and supporting families to minimize abuse and neglect can reduce injury rates.
SECTION V INTERVENTIONS
For children, ages 5 to 9, and adolescents, ages 10 to 14, teaching skills that will keep them safe as pedestrians, bicycle riders and motor vehicle occupants will greatly reduce injuries. Other interventions include making school a safer place, providing safe play areas and protective sports equipment, including safety in neighborhood planning, and supporting families to minimize family violence.
For the mid to late adolescent, enforcing safety belt, motorcycle
helmet, workplace, and alcohol consumption laws, limiting access to firearms, and developing conflict resolution skills to minimize interpersonal violence are of most benefit
The prevention chart on the following pages gives an overview of where to intervene and on what topics. In conjunction with site-specific interventions, involving the general community and media will help to change societal norms to non-acceptance of injury and violence.
~~-r,~~~1l..~~~~l~"~~~'#j~"'~~"""'~~""*-",-Il~"'M"~~-~"j,"""'~~~!t.ffl..--;:":';'"..j;'.",\,~~",,,-~~~-",
58 A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Figure,5.1 lnterV~ntfpiiSltesa.ndTopjC$ forCl1ildhQOd Injury Prevention Prograrnming
Intervention Site Prenatal Care
Hospitals
WIC Parenting Classes
Prima'Y f1eallh Care Sellings
Homes
Schools
Day Care Centers
Worksiles
Social Services! Youth Services
Birth 14 Years
Parenl1ngSk.;UsTralnlng ~""'''.,.., .... .,=_'''' ...... §'''''''~.~''' . .,L,,''' .. W:!'''''''''''', .... ""''''''''''' ___ '''''''''''''''''''' ... ''''
~. : ~ i· ; :Sf*- Parent Seat Bells ''''''''''''''''::~'~::!:l::F :;.;:: :' :' ::. :'~! ..................................... """""" ........ _ ................... .... ~:;.: :: 2 :ll ! Infant Safety Seals Ed., Loans ! ,.e; I I I; 1:: 2 :;; :;:~
~ ;:m~HomeSafety~~~~
W~.~ .... ~.~·.·::::w.c~·Mm:>A!~K~.\'\"~.~ Infan~ Safety Seats Loans IMmr ; ; ; ww W ~ !:lmg . S .. J m::z.S$i'~~ Gales
~~ InfantandToddlerSafetySeats!;Wj';rSm;g*.,.WWMSm;SWitt~ K. .s: :}~~:. W(!$i'ITS'i'?S'$!!;.;:;::wzw w
~, fii'!W'ZX~rnmr-mmtToys~·· . wmr-mtrm ~w'~~HomeSafetymg;~p;;ZW:"i3H;::i~
Infant and Toddler Safety Seats 11 ~;: I~: ~1 ~@ n ·6::::· . H: ·:·:J.1l.;:~~PedestrianSafety~ ~HomeSafety~
~ i:·:ieW::m:·mW·D~StN:" HomeSafety.ToySafety~
~MotorVe!:lcleSafety~ ~$ »ilUlHl'Cl ~Products*g r M
~MW~ Playground Safety ftm"~ .:x .... ~~.-'.~;.~
W: . -i l?Sl::i I:: Infant Safety Seats ill:: : Ii;; h J!J:M)8b ... :wew:;::;;:;:::c mm:l'&!:~ W:i .: : E .. 'iI331i~ Toys, Home Safety~
Local Law Enforcement Infant and Toddler Safety Seat laW"' ~!. ::. ; W:':f~: 51-1 ; :.!:,::, ;: m~g~·
Code Enforcement
State and Federal Government
Local Community
Media
"3 ~w v ·H.n::;;;:m~ . W:;~W ~TapWalerAegl.llatorsl8uildlngCodesfZ:~ wsw: ~;ea:;~ • WI ~* ~! 'I Smoke Deteclors, Pool Fences, GatesW!.:r:i w .... ~~
~ ;;:: ~111 Infant Safety Seats m.::J!:itJW!:kW~ SIi&2:r.KiJ.:w.:;:m;a;~J ;::~~ ToddlerSeats~ .:sza;&:$~:Z;;Z;
INTERVENTIONS 59
",.-;;
5-9 Vears 10-14 Years
~i iM3'~BikeHelmets~ J;i:E;:mm;~~~;::W::W:::;:::;!iE: swam 2!::mm:m ~
~ "a M i ,5 b!S 2 : . ~ Bike i-I'3lmels 1W-...,j: m mm,;:,;::;;;:w lm<~w.<~~~~~~~*''«~AlterSchocl Programs xr fS:SR:m·"i"Ym"'t1t't ~
~w mll!'! m"'rffl:S Enforcement of Child Labor Legislation, Training for Adolescent Employees ~ !lS'.i:!
~Wl!~~ E7 ~~ Su;cldeCrisisC&nlers f2i& Z20L T liZil, 37'== .!'iil!!:
. I P; : lill: . i I Out-of·Home Care fMtmiBM i' lim l iW i
!;Imis;n:g:\"m;;~ rml: :9i~~~!3 em ~~m.PZ= FTI:I~TI7:F~ Soat Belt Laws W cws..-: S?J~F w !8<S2! ~, i : t~ Motor Cycle Helmet Laws ll:m I £ 1m :;c;s:s:us:
Alcohol SaleslConsumplion Laws 11:. m; Zf! ~ Handgun Storage and Control ::: .~
t: it e;:c;wwc;: dd ; ::m:smn ;:e
_:",","0.\; ____ *,"", '":"'"''''''''''"''''''''''", ",""",,,.;:;;;z:sa;;;::;.,..,,,,,m,,,,,,,",",",",",",",,,,,,,,,,,,,,,,_,,,,"'_,,,,,,:':::. 9:2am! ; . Reduce Televised Violence :~ Dover's Ucense at 18 ~3' ,::q:p.;szm
.""u"".",.'" = '""""'" """"""_ ' 'E' ,_M", .= m"Sil"''''','''''';.. a! ,PO,;!!',," ! !""~ .. ' _% ""ruE = Bike Trails, Sidewalks =-=, Handgun Conlrol ! l l "" , W" ~ Bike Helmet Legislation m:: W' : : re fuWl.1!id L 3~~b& 3 ~
.? S1* 8 :n:9?W =i
~lreW'('it ,~J!! tm:! :! ~ is<t!~£S:: ;;&2&1: ~...msou::! xwSeatBelts :~.~ ;!!~: : $Si:!f .)~
~~~~S:~~~_:!$S3HW;~~WZJ5UiGi% ~m Jte:;i;~Ie'·Sli~mmP.educeTelevisedVlolenceR:: w:i%' = sssnt .W! iBf~~'" ~ ~~)!s: ;:12H:iS !!: me?"'W! ~BikeHelmets ~ m:smm: ~
~~ Safe Play Areas ~m~~ 3~a:ms::ru:t ~ ii.Q\l cia m: .. tm Occupational Safety/Drinking and Driving ~
;~~tL .... ~,,~,.\~~~~~\~~~~,~~~~~~r>'t''''''f,,!~~,~,,"u~,,!~~~~ ... ~~~...,,~~''l"~~~~~"~~"""""-i~~~~"""-'''''.f$>\''''';,,,'>;''.'''!+'<:~''~~~~~~~~~1''!Z'''~''',~'.,
eo'
60
The Cost of Injury
The direct and immediate health
:::are costs of non-fatal injuries
to children have been estimated at
$5.1 billion annually in 1987 dollars
(Malek et aI., 1991).
Falls account for the highest pro
portion of costs through age 14; for
ages 5 through 14 many of the
incurred costs are related to leisure
time and sports activities. For older
adolescent,) the costs incurred result
primarily from motor vehicle occu
pant injuries and sports.
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Assault I'V;" ".> D 0-4 ,. 10-14
Suicide o 5-9 • 15-19 Unint firearms
Sports : ~ ~:: ... ,"t'.~., ~ .. o: ] -'1, _:; ~!!>:.":r, ,.. .. ,. ,..~
Poisonings 1 II
Burns 1 I .a FallSj
r-- ' ,. , ; ,~. ". ',' • •••• ~ f· , • • ..
MV Bicycles ,,,, _
MV Other
M::;::::~:~ j_ CJWI.!, ,'j" _",' ,,' '1',' _,,~,,; , I " "'7"" . 'I ." • ,',' '
o 200 400 600 800 1000
Annual Direct Cost in Millions of 1987 Dollars
Figure 5.2
1200
Annual Direct Medical Costs of Non-Fatal Childhood Injuries, by Age in Millions of 1987 Dollars. Source: Malek et al., 1991.
J,.q";nowi~~~~f~~;"';~~':"«',I'i';;·'-'·id!'!lfi~tJio:<.ffi~·~~·~~~.~,,..;J,I~~~~.~.~~~I'I'='~It?";~"'''''''~~;.l',,~.~,~wm.~~.~~~~~f'I'''~~'_.~'
INTERVENTIONS 61
What You Can Do to Prevent Child and Adolescent Injury
As shown in this book, our children, and especially our adolescents, are at risk of dying or sustaining a long-tenn disability from
preventable injuries. Reducing the shocking number of fatal and non-fatal injuries to our children, however, will require the
concerted efforts of many sectors of the community. Our children need a safe place to develop and grow; we cannot accept less.
Effective interventions for injury prevention require:
Planning and Prioritizing
A broad-based coalition represent
ing the community of interest;
surveillance tools and methods to ,;, identify and monitor the number of
injuries;
the use of E codes to aid in the as
certainment of injury causes; and
p selection of priority areas for injury ,,')
control.
Comprehensive Multifaceted Approach
Evaluation of preventi;, strategies
to determine effectiveness;
i'" dissemination and universal implei'}
mentation of effective strategies;
targeting of high-risk groups, such
as low income; and
incorporation of prevention
messages and efforts into service
systems for children and adolescents.
Institutionalization and Acceptance
Coordination oflocal, State and
Federal efforts;
, institutionalization of injury preven-"~
tion programming;
enforcement of existing legislation
protecting children; and
development of a societal norm of a
'safe childhood and adolescence.'
·"",*"1~~~~~~4~~~~\iqri'il~~~~~~~1~"~"""""'''''''''''''''''''''_~_'''''''''~~i"'''.~~~''''''&Il\~~~''''',~'lI">~'~~,.~"!"
I~---i
--------------------------------.----~ ~-------------------------------------L_~
Ageton, S. (1983). Sexual assault among adolescents. Lexington, MA: D.C. Heath.
American School Health Association (ASHA), Association for the Advancement of Health Education, and Society for Public Health Education, Inc. (1989). The national adolescent student health survey: A report on the health of America's youth. Oakland: Third Party Publishing Company.
Anderka, M., Gallagher, S., and Azzara, C. (November 1985). Adolescent workrelated injuries. Paper presented at the annual meeting of the American Public Health Association, Washington, DC.
Baker, S., O'Neill, B., Ginsburg, M., and Li, G. (In press). The injll1y fact book (second edition). New York: Oxford University Press.
FIEFERENCES
Baker, S., and Waller, A. (1989). Childhood injwy state-by-state mortality facts. Baltimore, MD: The Johns Hopkins Injury Prevention Center.
Brison, R., Wickland, K., and Mueller, B. (1988). Fatal pedestrian injuries to young children: A different pattern of injury. American Journal of Public Health 78 (7): 793-95.
Bureau of Alcohol, Tobacco and Firearms. (1991). Personal communication, Les Stafford, Public Relations.
Christoffel, K. 0.990). Violent death and injury in U.S. children and adolescents. American Journal of Diseases of Children 144: 697-706.
Colorado Department of Health. (1988). Colorado population-based occupational
injury and fatality surveillance system report 1982-1984. Denver, CO: Colorado Department of Health, Health Statistics Section.
Centers for Disease Control. (June 21, 1991). Quarterly table reporting alcohol involvement in fatal motor-vehicle crashes. Morbidity and Mortality Weekly Report 40: 24.
DiScala, C. (March 1991). National Institute on Disability and Rehabilitation Research Pediatric Trauma RegistryPhase 2. Boston, MA: New England Medical Center.
Fingerhut, L., and National Center for Health Statistics (NCHS). (Unpublished). 1988 Vital Statistics, Mortality Statistics for ages 0-19.
r.\~~~~~~t~~~~~~~~~T'§"<~~~i'-M""'t~l'!"M-~~~~~~~M~~n~I!',~-"":'I'wlrr<~~"''''''''''''''f.I:<:6:-~~~_~ __ A"'<"'_~~~">'>'IlWl,"}.~~~~~pt~''''''i'>'''~''''-'''''''c,
64
Fingerhut, L., Kleinman, J., Godfrey, E., and Rosenberg, H. (1991). Firearm mortality among children, youth and young adults 1-34 years of age, trends and cun'ent status: United States, 1979-88. Monthly vital statistics report (39)11(suppl.).
Fleming, A., (ed). (1990). Facts: 1990 editioll. Arlington, VA: Insurance Institute for Highway Safety.
Gallagher, S. (1991). Personal communication.
Gallagher, S., Finison, K., Guyer, B., and Goodenough, S. (1984). The incidence of injuries among 87,000 Massachusetts children and adolescents: Results of the 1980-81 statewide childhood injury prevention program surveillance system. American Journal of Public Health 10: 1340-47.
Garrison, C., Jackson, K., Addy, C., McKeown, R. and Waller, 1. (1991).
A DATA BOOK OF CHILD AND ADOLESCENT INJURY
Suicidal behaviors in young adolescents. American Journal of Epidemiology 133 (10): 1005-14.
Guyer, B., Berenholz, G., and Gallagher, S. (1990). Injury surveillance using hospital discharge abstracts coded by external cause of injury (E code). Journal of Trauma 30 (4): 470-73.
Guyer, B. and Gallagher, S. (1988). Childhood injuries and their prevention. In Wallace, H. , Ryan, G. and Oglesby, A. (eds.). Maternal and Child Health Practices (third edition). Oakland, CA: Third Pmty Publishing Company.
Guyer, B., Lescohier, I., Gallagher, S., Hausman, A., and Azzara, C. (1989). Intentional injuries among children and adolescents in Massachusetts. New England Journal of Medicille. 321 (23): 1584-89.
Hochstadt, N., Jaudes, P., Zimo, D., and Sch.:lcter, J. (1987). The medical and
psychosocial needs of children entering foster care. Child Abuse alld Neglect 11: 53-62).
Holinger, P. (1990). The causes, impact and preventability of childhood injuries in the United States: Childhood suicide in the United States. American JOllrnal of Diseases of Children 144: 670-76.
Insurance Institute for Highway Safety (lIHS). (August 1991). Personal communication, Shelly Montgomery.
Jones, S. (1990). Sentinel Project Researching Agricu ltural Inj ury Notification Systems (SPRAINS). Des Moines, IA: Iowa Department of Public Health.
Kempe, H. (1962). The battered-child syndrome. Journal of the American Medical Association 181: 17.
Kozak, J. (1991). Estimated discharges of patients under 20 years of age discharged
'ii. .... ·~~q#I',.;{-.}...;.,'''''~N~~~:..!~J;~~'*-'~~,~ ........ ,,;.~Ji.''i'e.~.~~!~~,....,~.:~..,..,..:...~}:>>4''''il',.,~".......".~~,...m'~~~~,~ .. ""'~""'...,;:J,.)f'.Ilfo¥-~;,;..:.m·"""'.,;:;.;-~f~~~~ .... ~~~.-
REFERENCES
from short-stay non federal hospitals with a first-listed diagnosis of injury or poisoning: United States, 1989. Unpublished data.
Kraus, J., Fife, D., and Conroy, C. (1987). Incidence, severity and outcomes of brain injuries involving bicycles. American Joul7lal of Public Health 77: 76-78.
Layzer, J., Goodson, B., and deLange C. (1986). Children in shelters. Children Today 15 (2): 6-11.
Leenaars, A. and Lester, D. (1990). Suicide in adolescents: A comparison of Canada and the United States. Psychological Reports 67: 867-73.
Listemick, D., Finison, K., Gallagher, S., and Hunter, P. (1983). The problem of sports and recreational injuries. SCIPP Reports 4 (2).
Malek, M., Chang, B., Gallagher, S., and Guyer, B. (1991). The cost of medical care
for injuries to children. Annals of Emergency Medicine 20(9): 997-1005.
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~;';"-~-;<~<:i~>To(""~-.J;"4;~~~~~~~';<";f.~"tfi'~~.i<":'r,.~ ... ~.,....,'t,~i;(.~4'~---.t'1.~M~~I"~~:~~':.t~""""~~f'!I!'~"'~~~~~~~~~~~~~.~~".~"A>'.
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A DATA BOOK OF CHILD AND ADOLESCENT INJURY
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67
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ApPENDIX A: INJURY MORTALITY RATES
Figure A Mortality Rates/100,OOO Population by Injury Type and Age Group, 1988. Source: Fingerhut, NCHS, 1988.
Category of Injury (E Code) 1-4
All Injury Deaths (ESOO-9t:19) 22.6
Motor Vehicle Occupant (ES1 0-S25 [.0,.1, .S]) 3.0
Homicide (E960-97S) 2.6
Other Motor Vehicle (ES10-S25 [.2-6, .9]) 0.7
Suicide (E950-959) NA Drowning (E910,S30,S32) 4.2
MV Pedestrian (ES10-S25 [.7]) 3.1
Fire/Burns (ES90-S99, 924) 4.6
Unintentional Firearms (E922) 0.3
MV Bicycle (ES10-S25[.6]) 0.1
Poisoning (ES50-S5S) 0.4
Falls (ES80-888) 0.4
Age Group
5-9 10-14
12.S 16.1
2.2 3.3
1.0 1.7
0.6 1.3
NA 1.4
1.6 1.4
2.9 1.S
1.6 O.S
0.3 1.1
O.S 1.1
0.1 0.2
0.1 0.2
15-19
70.5
23.S
11.7
10.5
11.3
2.7
2.2
0.7
1.5
0.7
1.0
0.6
, i