Practical applications of injury surveillance: a brief 25-year history of the Connecticut Injury Prevention Center.

BACKGROUND: The mission of the Connecticut Injury Prevention Center (CIPC), jointly housed in Connecticut Children's Medical Center and Hartford Hospital, is to reduce unintentional injury and violence among Connecticut residents, with a special focus on translating research into injury prevention programmes and policy. The CIPC engages in four core activities: research, education and training, community outreach programmes and public policy. As surveillance is an essential element of injury prevention, the CIPC has developed a robust statewide fatal and non-fatal injury surveillance system that has guided our prior work and continues to inform our current projects. OBJECTIVE: The purpose of this article is to review the projects, programmes, and collaborative relationships that have made the CIPC successful in reducing unintentional injury and violence in Connecticut throughout the course of its 25 years history. DESIGN, SETTING, PARTICIPANTS: Retrospective review of the application of injury surveillance. RESULTS/CONCLUSIONS: We believe that the application of our surveillance system can serve as a model for others who wish to engage in collaborative, community-based, data-driven injury prevention programmes in their own communities.

Outdoor play: A survey of parent's perceptions of their child's safety.

BACKGROUND: Anecdotal reports suggest that parents may be restricting outdoor play in response to a perceived lack of safety and fear of violence and crime in urban environments. The study objective was to determine whether parents who perceived their neighborhood as unsafe would be most likely to restrict their child's outdoor play and report the greatest worries related to neighborhood characteristics. METHODS: A convenience sample of primary caregivers of children aged 5 years to 7 years were recruited from a pediatric primary care center based at an urban academic children's hospital. Study participants completed a 23-question survey available in English and Spanish. RESULTS: Two hundred fifty-four parents completed the survey. Most were English speakers (69%), female (89%), and aged between 21 years and 35 years (76%). Sixty-two percent let their child play outside often or sometimes; whereas 19% reported never allowing their child to play outside. Parents were less likely to allow outside play as their degree of worry increased about traffic (p < 0.0001), rundown parks (p < 0.003), crime (p < 0.0001), witnessing violence (p < 0.0001), being a victim of violence (p < 0.0009), drugs (p < 0.0001), gangs (p < 0.004), and weapons (p < 0.003). Frequency of outdoor play was not correlated with the sex or age of the child or number of children in the family. Spanish speakers were less likely to allow outside play (p < 0.008) but more likely to allow unsupervised play (p < 0.03). CONCLUSIONS: Decreased frequency of outdoor play correlated with increased parental concerns about safety, however, many parents still report allowing outdoor play at least sometimes.

Intervention improves physician counseling on teen driving safety.

BACKGROUND: As part of a statewide campaign, we surveyed physician attitudes and practice regarding teen driving safety before and after a brief intervention designed to facilitate in office counseling. METHODS: A 31-item self-administered survey was mailed to Connecticut physicians, and this was followed by a mailing of teen driving safety materials to physician practices in the state. A postintervention survey was mailed 8 months after the presurvey. RESULTS: A total of 102 physicians completed both the pre and postsurveys. Thirty-nine percent (39%) reported having had a teen in their practice die in a motor vehicle crash in the presurvey, compared with 49% in the postsurvey. Physician counseling increased significantly for a number of issues: driving while impaired from 86% to 94%; restrictions on teen driving from 53% to 64%; teen driving laws from 53% to 63%; safe vehicle from 32% to 42%; parents model safe driving from 29% to 44%; and teen-parent written contract from 15% to 37%. CONCLUSIONS: At baseline, the majority of physicians who provide care to teenagers in Connecticut report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduate driver licensing laws or related issues. After a brief intervention, there was a significant increase in physician counseling of teens on teen driving laws and on the use of teen-parent contracts. Additional interventions targeting physician practices can improve physician counseling to teens and their parents on issues of teen driving safety.

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety.

PROBLEM: Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety. METHODS: A 31-item self-administered survey was mailed to pediatricians. RESULTS: 160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash. CONCLUSIONS: A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. IMPACT ON INDUSTRY: Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.

Violent death in Connecticut, 2001 to 2004.

We reviewed medical examiner, law enforcement, crime laboratory data, and death certificates on all 1,530 violent deaths (homicide, suicide, undetermined firearm) in Connecticut occurring from 2001-2004. There was an average of 383 deaths (rate = 11.2 deaths per 100,000 persons annually). Overall, males aged 20 to 29 were at the greatest risk of violent death (rate = 30.5/100,000). Of all violent deaths 72% were suicides and 28% were homicides. Firearms were used in 33% of suicides and 58% of homicides. The rate of violent death is lower than most other states in the country. In Connecticut suicide is the leading cause of violent death overall; however, in areas characterized by the highest levels of poverty and lowest levels of education, homicide is the leading cause of violent death.

New teen drivers and their parents: what they know and what they expect.

OBJECTIVES: To assess teens' and parents' knowledge of teen driver safety and to compare teens' and parents' expectations about learning to drive and acquiring a driver's license. METHODS: A convenience sample of 613 Connecticut teens enrolled in commercial driving schools and one of their parents completed self-administered surveys. RESULTS: Significant differences between teens and parent expectations were noted in practice driving with a parent, driving to approved destinations, unlimited vehicle access, curfew, and teen passenger limits. CONCLUSIONS: The discrepancy between teens' and parents' expectations indicates the need to persuade and empower parents to manage their teen's driving experience more rigorously.

A statewide survey of domestic violence screening behaviors among pediatricians and family physicians.

OBJECTIVE: To assess rates of previous domestic violence (DV) training, current screening practices, and barriers to screening among Connecticut pediatric primary care physicians. DESIGN: Self-administered mail survey. SETTING: State of Connecticut. PARTICIPANTS: Pediatricians and pediatric care-providing family practice physicians (N = 903). RESULTS: The response rate was 49% (n = 438). The demographic characteristics of the response sample were as follows: 70% male, 76% older than 40 years, 84% white, 87% in private practice, and 64% in suburban practice. Only 12% of the physicians reported routinely screening for DV at all well-child care visits, 61% reported screening only selective patients, and 30% said they did not screen for DV at all. Sixteen percent of the physicians reported having an office protocol for dealing with victims of DV. Respondents practicing in an urban setting were significantly more likely to screen routinely for DV than those practicing in a suburban setting (odds ratio, 1.77; 95% confidence interval, 1.12-2.79). Prior DV training was the strongest predictor of routine screening (odds ratio, 5.17; 95% confidence interval, 3.13-8.56). In fact, respondents with previous training made up 64% of those who routinely screened for DV. CONCLUSIONS: Only a minority of Connecticut pediatric care physicians routinely screen mothers for DV. Primary care physicians with education and training about DV are screening at higher rates than physicians with no education and training. Pediatric physicians need training, protocols, and best-practice models on how to identify and intervene with families experiencing DV.