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Injury Prevention Plan: Oregon Injury and Violence Prevention Program

Injury is the third leading cause of death in Oregon, behind only cancer and heart disease. It is also among the leading causes of hospitalization. It is typical to consider some causes of death—cancer, heart disease, stroke—as mainly affecting Oregonians in older age groups. However, everyone is affected by injury, regardless of age, sex, race, or ethnicity. In fact, injury is the leading cause of death among Oregonians 1 to 44 years of age. In 2015, 3,009 Oregonians died as a result of injury.

It is common to consider injuries as accidents or random events. However, this implies that injuries are unpredictable and unpreventable. Many injuries are preventable.

Injuries are preventable at the population level through public health actions like policy change or interventions.

The Public Health Approach to Injury

Public health is a population-based health approach where health issues are addressed primarily at the community level, versus at the individual level. Prevention of adverse outcomes, rather than treatment after outcomes have already occurred, is a primary goal of this approach. Therefore, efforts to prevent adverse outcomes (i.e. injuries), target communities over individuals. Since the whole community is the focus of prevention, many different solutions to preventing injuries can be applied to the many different types of injury.

The public health approach to injury prevention is a process that involves:

  1. Identifying and defining the problem
  2. Identifying risk and protective factors
  3. Developing and testing prevention strategies
  4. Assuring widespread adoption of effective strategies

Rather than address injuries that occur among individuals on a one-to-one basis, broad causes and prevention solutions are the focus of injury prevention in public health. Instead of focusing on individuals and the treatment of individual injuries as they arise, it is the whole community, the community’s whole health, and community-level prevention which defines the public health approach.

Sometimes, prevention at the community level involves changing the environment in which injuries occur—for example: installing traffic signals at intersections, or requiring certain products to be fire safe. At other times, prevention at the community level involves education—such as informing school sports programs about preventing head injuries, or providing information to guide changes in health policies or laws. Although the public health workforce may not always directly provide prevention services, public health agencies identify the important conditions and patterns that contribute to injury at the community level, and identify and leverage solutions through community partnerships to promote prevention.

Many organizations, institutions, agencies and individuals work toward injury and violence prevention. Many people working on similar issues in injury prevention might seem to complicate prevention efforts; however, this is actually beneficial to prevention. Here’s why: the most effective means of reducing the burden of injury relies on levels of action from the individual all the way up to the public policies implemented to prevent injuries. This is sometimes called the ecological model of prevention. Although individuals are at the heart of the model, the other levels of the model—relationships, community, and societal context all influence the choices made by individuals, as well as interact with other levels in the model. It takes efforts and actions at all levels to really have an impact on the burden of injury.

The Oregon Injury Prevention Program works with an Injury Community Implementation Group (ICIG) to identify areas where prevention can be effective. Partnerships made up of diverse organizations and individuals help to bridge communication between levels of prevention, further benefiting prevention efforts.

The state Injury Prevention Program has a unique role in injury prevention, designed to:

  • Build a solid infrastructure for injury and violence prevention in Oregon
  • Collect and analyze injury and violence data
  • Design, implement, and evaluate programs
  • Provide technical support and training for partners in prevention
  • Affect injury prevention policy

​Injury prevention requires relevant and timely data to identify where and how injuries occur in the community. Tracking injuries by time and place can help identify where trends occur or where more effort is needed to improve prevention efforts. This tracking of injuries is called public health surveillance, and is a key component of injury prevention efforts. Tracking injuries requires defining injuries by type. Injuries are often classified by the intent (intentional, unintentional, etc.) and manner of the injury (motor vehicle. fall, etc.).

While unintentional injuries often result from a rapid transfer of energy from object to person (e.g. being struck by a motor vehicle), intentional injuries are the result of intentional harm imposed upon one person by another, or upon oneself (e.g. suicide). In other words, injury includes violence. 

Each year, about 3,000 Oregonians die and 18,000 are hospitalized as a result of injury. While injury is the 3rd leading cause of death in Oregon, it is the leading cause of potential years of life lost.

There are many types of injury, and limited resources to adress the burden of injuries in the communty. Prevention usually requires prioritizing which injuries will receive the most focus and effort to prevent. The Oregon Injury and Violence Prevention Program (IVPP) closely follows the injury priorities set out by the Centers for Disease Control and Prevention (CDC), in conjunction with those prioritized by the Oregon Injury Community Implementation Group (ICIG). Injury prevention priorities change over time, as some types of injury decrease at the population level, and other new injury problems emerge. Priority areas have been identified based on national injury priorities and on the overall impact of different types of injury in Oregon.

Data are used to assess:

  • The alignment of injury prevention priorities in Oregon with national injury prevention priorities
  • Trends (concerning trends of increase)
  • The potential for reducing the impact of various types of injury through the application of specific evidence-based prevention efforts (where evidence-based prevention programs exist)
  • Capacity of the Injury and Violence Prevention Program and the prevention community to address particular injury issues

It is important that data inform injury prevention priorities, which is why public health surveillance for injuries forms the foundation of injury prevention. Without data to inform how prevention efforts are prioritized, the limited resources for injury prevention can be pulled in many directions.

The current prevention priority focus areas include:

  • Child maltreatment (abuse and neglect) 
  • Motor vehicle traffic injury prevention
  • Sexual violence and intimate partner violence prevention
  • Traumatic brain injury prevention

See below for details on each priority area.

Priority Areas

Background

Child maltreatment (abuse and neglect) refers to any act or failure to act on the part of a parent or a caregiver that results in harm, potential for harm, or threat of harm to a child. It includes physical, sexual, and emotional abuse, neglect, and endangerment. Child abuse and neglect causes direct suffering and long-term consequences for children and their communities.
Child maltreatment is a significant public health problem in terms of its magnitude, severity, and societal costs. CDC estimates that approximately 14% of children suffer from abuse.

In 2015-16, Oregon Department of Human Services, Child Protective Services received 76,668 reports of child abuse and neglect (2016 Child Welfare Data Book); over 38,000 reports were referred for investigation.

  • 7,677 referrals were founded for abuse or neglect—involving over 11,000 victims.
  • Nearly half of the victims (46%) were under 6 years old
  • 19 children died as result of abuse or negelect

The most severe outcomes of child maltreatment include assault injuries resulting in hospitalization and death. From 2003 to 2012, 88 child fatalities in Oregon were due to physical abuse. Among the 88 deaths, 15 children died from shaken baby syndrome.

  • 28.4 percent of deaths occurred among infants; more than half of the victims were under 3 years of age
  • 61% of children were killed by their biological parents; 23% of children were killed by a boyfriend/girlfriend of the child’s parent

In 2012-2014, the highest rate of assault hospitalization in Oregon was among infants (children < 1 year of age).

In a 2015 survey, about 23% percent of Oregon 11th graders reported that an adult intentionally hit or physically hurt them, at some point in their lives, and 5% reported that an adult had sexual contact with them at some point in their lives.

Child maltreatment and neglect cause long-term damage to physical and emotional wellbeing. Across the lifespan, experienced child abuse and neglect increase the risks of:

  • Emotional difficulties
  • Social maladjustment
  • Substance abuse
  • Adolescent pregnancy
  • Suicide attempts
  • Poor mental and physical health
  • Juvenile delinquency and adult criminality

Exposure to any form of child maltreatment is considered an “Adverse Childhood Experience” (ACE) which research shows can lead to immediate and enduring negative health consequences. Longer-term effects of childhood maltreatment include increased risks for mental illnesses such as depression, obesity, criminal behavior, and parenting difficulties. The negative physical and psychological impacts increase substantially as the number of adverse childhood experiences accumulate, and can include increased risk for chronic heart, lung and cancer diseases, even decades later.

It is difficult to assess the overall economic burden of child maltreatment, although it has been estimated to be approximately $124 billion in the US. Regardless of the economic burden of child maltreatment, it is impossible to overstate the tragic and avoidable consequences experienced by children that have been abused.

Data

Goals

  • Increase the reach and effectiveness of the state Nurse Family Partnership (NFP) Program to prevent child abuse/neglect and intimate partner violence

Strategies

  • Intra-agency agreement developed between IVPP and Maternal and Child Health section’s Nurse Family Partnership program (NFP) to provide technical data analyticassistance.
  • Develop a three phase project plan (evaluation design, implementation, and dissemination of findings) to determine barriers and facilitators to NFP program implementation and expansion.

Background

Motor vehicle traffic (MVT) injuries are one of the leading causes of death and hospitalization in Oregon. Every year, more than 300 Oregonians are killed in motor vehicle traffic incidents, and over 1,800 are hospitalized.

Motor vehicle traffic injuries include all those involving automobiles, trucks, vans, motorcycles and motorized cycles traveling on public roadways. The major categories of motor vehicle traffic involvement include vehicle occupants, motor cyclists, pedal cyclists, and pedestrians, depending specifically on the decedent’s or patient’s involvement.

In 2000, the mortality rate from MVT was 13.4 per 100,000. Since then, the mortality rate has decreased to 11.8 per 100,000 in 2015, and was as low as 8.3 deaths per 100,000 in 2013. In fact, major inroads have been made in preventing MVT-related deaths in Oregon, especially for at-risk age groups such as older drivers and teens.

The current burden of mortality is not the same across the population. The rate of motor vehicle traffic mortality is significantly higher for males overall compared to females. The death rates among teens and older adults are still higher than the general population.

Risk factors for MVT injury include:

  • Alcohol impaired driving/substance use
  • Aggressive driving
  • Speeding
  • Inexperienced driving
  • Distracted driving
  • Hazardous road conditions
  • Failure to use safety equipment (i.e. seat belts)
  • Dementia and other impairments
  • Sleep deprivation
  • Visual impairments
  • Low pedestrian visibility

Data

Some basic facts about MVT injuries in Oregon:

  • The rate of MVT death among males is more than twice that of females.
  • The highest MVT mortality rates occur among teens and older adult males.
  • 33.5% of Oregon MVT fatalities in 2013 involved alcohol

Goals

  • Increase the reach and effectiveness the state interlock program to prevent driving while intoxicated.

Strategies

  • Participate in and coordinate with the Governor's Advisory Committee on DUII to address barriers to effective implementation of state interlock program.
  • Support proposed policy recommendations or legislative concepts that emerge from Governor's Advisory Committee on DUII.

Background

Sexual violence (SV) includes forms of behavior that range from rape to verbal sexual harassment. SV is prevalent. In the US, 1 in 3 women and 1 in 6 men experience contact sexual violence in their lifetime. Women in Oregon experience contact sexual violence (47.5%), stalking (19.7%), and intimate partner violence (39.8%) at higher rates than the national average (36.3%, 15.8%, and 37.3%, respectively. Results from the 2010-2012 National Intimate Partner and Sexual Violence Survey)

SV starts early in the life course, and so upstream prevention must be a core feature of sexual violence prevention efforts. About half (51.1%) of female rape victims in Oregon report first being raped when younger than 18—a rate higher than national average of 41.3% (results from the 2010-2012 National Intimate Partner and Sexual Violence Survey). In addition, SV is associated with a range of risk factors, including a history of physical and/or sexual abuse, acceptance of violence, poverty and inequality, exposure of social norms supportive of SV, and several others. Protective factors include increased emotional health and connectedness.

Increasing the reach and effectiveness of programs based on evidence or best practices can help stop SV. Several strategies that can stop SV have been identified:

  • Promote social norms that protect against violence
  • Teach skills to prevent sexual violence
  • Provide opportunities to empower and support women and girls
  • Create protective environments
  • Support victims to lessen harms

Data

  • Sexual Violence Prevention Data/Resource Map - This map has been developed by IVPP and the Injury Community Implementation Group (ICIG) to show risk factors, protective factors, and outcomes related to sexual violence, teen dating violence, healthy relationship development, sexual abuse, and sexual health education (i.e. K-12 education in communties focusing on sexual health and sexual violence prevention).

Goals

  • Increase the reach, effectiveness and adoption of sexual violence and domestic violence/IPV prevention programs.
  • Increase the use of evidence-based or best-practice curricula employed by school districts that teach sexual violence prevention through sexual education programs.

Strategies

  • Convene sexual violence (SV) prevention summit to develop inventory of evidence-based prevention programs.
  • Engage stakeholders to determine barriers and facilitators to implementing best evidence-based SV/domestic violence (DV) prevention programs.
  • Engage stakeholders to evaluate implementation of school sexual violence prevention/sexual health education curricula.
  • Engage Injury Community Implementation Group (ICIG) workgroup to increase the reach and effectiveness of sexual violence prevention interventions.
  • Integrate Rape Prevention & Education (RPE) program staff and advisory expertise into the Sexual Violence Prevention ICIG workgroup.
Resources

Background

A traumatic brain injury (TBI) is a type of head injury caused by a jolt, bump or blow to the head, or a penetrating head injury that harms normal brain function. TBIs can be "mild" (altering consciousness short-term) to severe. Some TBIs result in death. Nationally, TBIs contribute to about 30% of all injury deaths.

TBI is a serious public health problem in Oregon and the United States. Each year in Oregon, traumatic brain injuries contribute to a substantial number of deaths, hospitalizations, emergency room visits, and cases of permanent disability. In Oregon in 2014, 847 TBI-related deaths and over 2,700 hospitalizations occurred either as isolated injuries or along with other injuries. The number of TBIs that don't result in death or hospitalization are estimated to be far greater in number, yet still impact the health of individuals and communities.

  • TBI mortality rates generally increase with age. This is in some part due to the association between falls among older adults and TBI.
  • Males are more than twice as likely as females to die from TBI-associated injuries.
  • Firearms are the most frequent cause of TBI-related death, falls are the most frequent cause of TBI hospitalization.
  • American Indian and Alaska Natives had the highest rates of TBI-related death and hospitalizations between 2012-2014.
  • Among children, the highest rate of TBI hospitalization occurred among children less than 1 year of age.

Data

Goals

  • Increase the reach and effectiveness of existing policies aimed at reducing youth sports concussion.
  • Enhance use of pediatric guidelines by Oregon health care systems.

Strategies

  • Partner with Oregon Concussion Awareness and Management Program (OCAMP) to form an ICIG TBI workgroup to identify and prioritize evaluation activities for Oregon’s youth sports concussion laws.
  • Identify resources and/or partnerships to implement a plan to evaluate gaps in state youth concussion return to play laws.
  • Engage OCAMP and project policy team to identify data-informed policy approaches to enhancing youth sports concussion laws.
  • Disseminate pediatric mild TBI guidelines through large health systems and CCOs in Oregon.

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