Category Archives: Injury
As school winds down and camps and sports prepare for the summer season, a new study funded by the Robert Wood Johnson Foundation and published in the American Journal of Public Health on sports-related traumatic brain injuries in youth sports, is generating deserved attention.
The study, by Hosea Harvey, JD, PhD, Assistant Professor of Law at the Temple University Beasley School of Law, found that while forty four states and Washington, D.C., passed youth sport TBI laws between 2009 and 2012, none of the laws focus on preventing the injuries in the first place. The laws on the books deal primarily with increasing coaches’ and parents’ ability to identify and respond to traumatic brain injuries and reducing the immediate risk of multiple brain injuries.
Harvey’s conclusion is that continued research and evaluation is needed to develop a more comprehensive reduction in youth sport traumatic brain injuries.
NewPublicHealth: What did your study address?
Hosea Harvey: I looked at traumatic brain injury (TBI) laws that were passed at the state level that purported to deal with the problem of youth TBIs in sports statewide. I looked at every related state law passed between 2009 through the end of 2012, though most states only had one law that they passed that dealt with youth sports TBIs during that period.
NPH: And your study found that no state that right now has a law that says this is what you have to do in order to prevent these concussions in the first place?
While a growing number of major league sports teams have policies on concussion assessment and return to play, many youth and school sports leagues and teams do not have similar rules, despite thousands of sports-related traumatic brain injuries (TBIs) reported in children and adolescents every year.
Hosea H. Harvey, PhD, JD, Assistant Professor of Law in Temple University’s Beasley School of Law, has just published an article in the American Journal of Public Health analyzing how this health issue is being addressed across the country. He found that there are laws dealing with concussions in youth sports in 44 states and D.C.—but none are focused on preventing the injuries. The laws only address detecting the injuries or preventing an additional injury after one has already occurred.
The study also revealed that many laws don’t draw on evidence around what works. For example, most state laws establish a minimum 24-hour period of youth athlete removal, but there is no scientific agreement about the optimal minimal time someone who has suffered a sports-related TBI should be removed from play. The study utilized an open source dataset from Robert Wood Johnson Foundation grantee Public Health Law Research called LawAtlas.
>>Read the full study.
NewPublicHealth previously spoke with Harvey and Kerri McGowan Lowrey, JD, MPH, Senior Staff Attorney with the Network for Public Health Law — Eastern Region, about legal and legislative approaches to addressing concussions in youth sports. The previous interview is included below:
Did you know that consumers are supposed to call a three-digit number, 811, before starting any digging on residential property? Many would-be diggers don’t, which is why the U.S. Department of Transportation’s Pipeline and Hazardous Materials Safety Administration (PHMSA) began an 811 public education campaign last month.
PHMSA has good reason for getting the word out. Striking buried lines is a leading cause of pipeline-related death and injury and can lead to service outages in whole neighborhoods. Over the last 20 years, property damage costs were over $500 million nationwide from such strikes.
PHMSA estimated that three out of ten households will begin residential construction or renovation projects this spring. A call to 811, which connects would-be diggers to a local utility’s call center, a few days before planned digging generates a visit from a local representative who will mark the approximate location of nearby underground lines, pipes and cables, so workers can dig safely.
“We want 811 to become as well-known as 911, because digging without getting your utilities marked is not only dangerous, it can also cut off services to an entire neighborhood and cost you money[in fines],” said PHMSA Administrator Cynthia Quarterman.
Since 811 debuted six years ago, serious pipeline incidents from unsafe digging have decreased by more than 45 percent, according to PHMSA.
It has been a busy month for the Department of Transportation’s National Highway Traffic Safety Administration (NHTSA). Car safety innovations released by the organization in just the last few weeks include:
- A free app to help consumers find the safest cars when buying or renting, as well as nearby sites for car seat installation services and checks.
- New guidelines for auto-makers to help reduce the use of electronic devices while driving, and with that reduce the number of people killed and injured by distracted driving every day. A recent NHTSA survey found that 600,000 drivers talk on their cell phones or use electronic devices at any given daylight moment. More than 3,300 people were killed in 2011 and 387,000 were injured in crashes involving a distracted driver, according to NHTSA data.
- A reminder that during the spring and summer highway construction kicks into high gear and drivers need to pay attention to road changes and warnings. In 2011, the most recent year for which data are available, 587 people died in highway work-zone fatalities—an increase of 11 fatalities over 2010.
There’s good reason for NHTSA’s steady supply of information and action. Recent statistics from the Centers for Disease Control and Prevention (CDC), which has designated the high motor vehicle injury rate as a winnable battle, shows that in the United States, motor vehicle-related injuries are the leading cause of death for people age 5 through 34.
Public Health Law Research (PHLR), a program of the Robert Wood Johnson Foundation, will hold its annual meeting in New Orleans this week. NewPublicHealth will be on the ground covering sessions on research in public health law as well as posting interviews with conference speakers including Thomas Farley, MD, MPH, Health Commissioner of New York City and Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.
In advance of the conference, NewPublicHealth spoke with Diana Silver, PhD, MPH, assistant professor of public health at the Steinhardt School of Culture, Education and Human Development at New York University. Silver’s research looks at the impact of public and private services on health and well-being for children and families, especially in urban America. Her presentation at the PHLR annual meeting is called “Are More Laws Better?” with a specific look at what has happened to traffic fatalities between 1980 and 2009 as new laws have been implemented in some parts of the country.
NewPublicHealth: Tell us about your research on laws and traffic fatalities.
Diana Silver: The motivating idea here was that there are multiple laws at the state level that govern traffic safety. Some deal with alcohol, some deal with restraining children one way or another in the car, some are about the vehicle itself such as seatbelts or speed limits. The laws vary at the state level, and they create, in some sense, really different environments that people are exposed to. We have now categorized across 30 years 25 different laws in all 50 states.
What we found is that there are some laws that virtually all states have adopted, mostly because there’s been a federal mandate to do so, like a minimum legal drinking age. But many laws vary across states, and so we were interested to find out what factors predicted whether a state would pick up new laws and how quickly they would do that. Then, how do these different packages predict, or are they associated with reductions in motor vehicle fatalities?
NPH: How was your research different than other research that looks at this data?
Concerned by reports that volunteers and New Jersey residents are frequently unaware of environmental dangers when cleaning up homes and communities, the New Jersey Department of Health released an advisory earlier this week with advice on staying safe while scrubbing and rehabbing. Mold and materials containing asbestos and lead-based paint are examples of potential hazards in storm-damaged buildings and the advisory urged those tackling the heavy jobs to wear protective equipment appropriate for the work they are doing such as waterproof boots, gloves, goggles, and face masks.
"Homeowners doing cleanup work and the volunteers assisting them are critical assets in New Jersey's recovery efforts, but making sure they protect themselves is equally important," said New Jersey Health Commissioner Mary O'Dowd.
NewPublicHeatlh recently spoke about Hurricane Sandy clean-up safety with Donna Leusner, director of communications for the New Jersey Department of Health; Tina Tan, MD, state epidemiologist and assistant commissioner for epidemiology, environmental and occupational health and Joe Eldridge, director of New Jersey’s Consumer, Environmental and Occupational Health Service.
NewPublicHealth: What kind of environmental concerns specifically are there for those cleaning up the community after the storm?
Dr. Tan: There are concerns about individuals coming into contact with contaminated materials, whether contaminated with chemicals or infectious agents—residuals from flood waters as well as the general debris that might be around. We encourage individuals to take the appropriate precautions to try to avoid any sort of injuries or potential illnesses that could result from contact with these contaminated materials.
NPH: Are people aware of the critical basic information for safe cleanup, such as getting a tetanus shot if they’re injured during the cleanup in such terrible conditions?
Substandard housing has been linked to a variety of health problems including higher blood lead levels in children and an increased asthma risk. Now a new study by researchers at the Johns Hopkins Center for Injury Research and Policy finds kids living in poor housing may also be at an increased risk for fire and scald burns. The research was published in the journal Pediatrics.
The researchers surveyed the homes of 246 low-income families in Baltimore with at least one young child, and found homes with more housing quality code violations were less likely to have a working smoke alarm and safe hot water temperatures. "The effect of substandard housing on children’s risk of diseases such as asthma is well-known, however little was known about how it affects injury risk,” says Andrea Gielen, ScD, ScM, the study’s lead author and director of the Johns Hopkins Center for Injury Research and Policy. “The results of this study clearly demonstrate that substandard housing is also related to home injury risks, Gielen adds. "Even more disturbing is the finding that virtually all of the children in our urban sample were living in substandard housing."
Injury is the leading cause of death for young people in the U.S., and is responsible for more than180, 000 deaths annually, according to data from the Centers for Disease Control and Prevention. Deaths from fires and burns are the third leading cause of fatal home injury. Smoke alarms and lower water temperatures reduce the risk of burns, says Gielen, but living in substandard housing appears to be a barrier to having these protective measures in place.
- Read a NewPublicHealth post on how low income families can get free smoke alarms
- Read a NewPublicHealth National Prevention Strategy series interview with Estelle Richman, Senior Advisor to the Secretary of the Department of Housing and Urban Development on the intersection of housing and health.
- Read a NewPublicHealth interview with Andrea Gielen on injury prevention.
A new study out this week finds New Jersey’s law requiring novice drivers to display a red decal on their license plates was effective in helping police officers enforce regulations unique to new drivers, and in preventing crashes. New Jersey is the first state in the nation to enact a decal law, which went into effect in May 2010 as part of N.J.’s Graduated Driver Licensing (GDL) law. Nearly every state has a GDL law on the books, but “Kyleigh’s Law,” named for a teen driver killed in a 2006 N.J. crash, is the first one that helps support enforcement of GDL restrictions using a visible decal.
The study showed that in its first year of implementation, the New Jersey decal law prevented an estimated 1,624 crashes by probationary drivers. Allison E. Curry, PhD, MPH, director of Epidemiology and Biostatistics at the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia, was a lead author on the study, published in the American Journal of Preventive Medicine. The study was funded by a grant from Public Health Law Research, a national program of the Robert Wood Johnson Foundation.
NewPublicHealth caught up with Allison Curry to get her take on why decals work as a law to help protect the public’s health.
NewPublicHealth: Can you summarize the new study?
Allison Curry: Graduated driver licensing (GDL) was first introduced in the U.S. around the mid-1990s and since then it’s been really effective in reducing the burden of crashes on teens. New Jersey in particular has a really progressive GDL program, and it’s served as one of the models in the U.S. But even so it still has what we would still consider an unacceptable number of crashes each year. So by introducing decals, New Jersey was trying to take their law a step further in improving the effectiveness of their GDL program.
What we wanted to understand was if the decals really did have an additional safety benefit for both adolescents and other road users. The aims were to examine the effect of the decals on both the police’s ability to enforce graduated driver licensing restrictions among probationary or intermediate drivers, as well as the crash rate among intermediate drivers (those who are in the stage between licensed permit holder and full unrestricted driver). We did this by linking New Jersey’s crash and licensing database in order to compare the rate of crashes and citations in the two years before the decal requirement was implemented, compared to the year after it was implemented.
NPH: And what were the findings?
Alan Schwarz spent the majority of his career as a baseball reporter before authoring dozens of stories for The New York Times unearthing the dangers of concussions in football at all levels—from the professional leagues down to kids’ leagues. He was working as a freelancer when first approached about the public health issue. The end result was a series that made him a Pulitzer Prize-finalist and helped change the face of football.
NewPublicHealth sat down with Schwarz before he delivered a keynote address at the 2012 Public Health Law Conference to discuss how his interest in sports-related concussions began and what he thinks about the impact he made on public health.
NewPublicHealth: How did you come to report on this issue?
Alan Schwarz: Most regularly I was, along with David Leonhardt, the Keeping Score columnist for the Times sports section on Sundays, where every week we looked at some phenomenon through a statistical lens. But my beat was exclusively baseball. However, I came to know a fellow named Chris Nowinski, former Harvard football player turned professional wrestler, who had written a book about concussions and how serious they were. This was the summer of 2005.
Chris called me up. I got lots of calls from lots of young writers at that time and tried to be nice to them and Chris sent me the manuscript and it was incredible. It was really, really well done, and I thought “this is a very important book.” So I introduced him to a few people I knew here in New York in publishing, because I thought this was really good stuff. Well, no one really gave him the time of day, frankly. No one thought it was commercial enough to succeed as a book. And that was that. I didn't hear from him again, nor did I expect to.
NPH: Then what happened?
Faces of Public Health is a recurring editorial series on NewPublicHealth featuring individuals working on the front lines of public health and helping keep people healthy and safe.
According to the U.S. Centers for Disease Control and Prevention (CDC), each year 1.3 million people are killed and 20 to 50 million are injured in car crashes around the world. Most of the crashes happen in low- or middle-income countries, and 25,000 of the deaths are among tourists. In fact, nearly half of medical evacuations back to the United States, which can cost $100,000 or more, are the result of a car crash.
According to the CDC, reasons for an increase in crashes in foreign countries include:
- More people driving cars and other motorized vehicles
- Poorly maintained roads
- Insufficient traffic laws and poor enforcement in some countries
- Insufficient emergency response capabilities in some countries
Rochelle Sobel knows the worst possible outcome of these crashes first hand. She founded the Association for Safe International Road Travel (ASIRT) in 1995, after her son, Aron, was killed in a bus crash in Turkey along with 22 other passengers from many countries, just two weeks before his graduation from the University of Maryland Medical School. The bus Aron was traveling on was speeding down the wrong lane of a narrow, poorly maintained road with no guard rail. The bus hit oncoming traffic and plunged down an embankment, landing on its side. Emergency medical crews were slow to respond, likely a factor in at least some of the deaths. After the crash the U.S. Ambassador to Turkey recommended the creation of a road safety organization to protect both American citizens abroad and residents of countries around the world.
NewPublicHealth spoke with Rochelle Sobel about ASIRT.
NewPublicHealth: ASIRT was started out of personal tragedy, the loss of your son Aron, in a bus crash in Turkey. How did you get started?
Rochelle Sobel: The first thing I did was talk to the U.S. embassy in Ankara, and I asked them if they could please tell me when such crashes occur again, and they said, “Mrs. Sobel, we’d be calling you constantly.” That led me to understand that this is indeed a health issue that was not getting the kind of public attention that it deserved. So I started to call different organizations, and unfortunately, it was not yet recognized as a health issue. So we decided to become the organization that would bring attention to the issue. We got help from the embassy; we got a lot of help from the State Department. We asked the State Department to start collecting data on the numbers of Americans who die abroad in road crashes by country, and they discovered that it was the single greatest cause of death for healthy Americans traveling abroad.
NPH: Is that still the case?