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Journal Issue: Unintentional Injuries in Childhood Volume 10 Number 1 Spring/Summer 2000

Unintentional Injuries in Childhood: Analysis and Recommendations
Lisa W. Deal Deanna S. Gomby Lorraine Zippiroli Richard E. Behrman


The twentieth century saw huge successes in health care in the United States. Immunizations, antibiotics, and public health initiatives have combined to lower the infant mortality rate and lengthen life span. Unlocking the secrets of the human genome promises more advances. Despite these advances, we remain stymied by the steady drumbeat of death and disfigurement attributable to childhood injuries. Injuries, both violent and unintentional, are one of the most significant public health issues facing children today, but public outrage is absent. As a result, proven solutions go unused, and thousands of children die each year.

Injuries are the leading cause of death among children between the ages of 1 and 19, and most of these injury deaths can be prevented. In 1996, more than 13,000 children and adolescents in the United States died from unintentional (“accidental”) injuries, predominantly resulting from motor vehicle crashes, drownings, and residential fires.1 This translates, on average, to more than 250 child deaths each week, or approximately 37 child deaths each day. As illustrated in the article by Grossman in this journal issue, although the greatest number of injuries occur among middle- or upper-middle-class white children, poor and minority children experience higher rates of unintentional injuries. This increased risk occurs primarily because they live in environments where heavy neighborhood traffic makes outdoor play areas unsafe, or where safety devices, such as bicycle helmets, car seats, or smoke detectors, are unaffordable or may seem less important than other necessities.

In recent years, scientists have applied the tools of public health and medicine to better understand the incidence of injuries, the risk factors, and the preventive measures needed to successfully reduce the occurrence. This issue of The Future of Children outlines the scope of the childhood unintentional injury problem and reviews the evidence for the effectiveness of injury prevention strategies in physician offices and other clinical settings, in communities, and at state and national levels. This review concludes that the most important task today is not to conduct more research on risk factors for, and the epidemiology of, injury, but rather to conduct rigorous trials of intervention strategies and to translate new and existing research findings into effective prevention programs. This requires adequate funding to design, implement, and evaluate injury prevention programs in addition to training to prepare a cadre of individuals skilled at promoting injury prevention interventions.

Taking these steps and implementing proven interventions, such as child car seats, environmental measures to lessen traffic speed and volume in neighborhoods, bicycle helmets, and smoke detectors, could reduce injury deaths among children by nearly one-third.2 More than 4,000 childhood injury deaths and nearly 20 times that number of serious nonfatal injuries could have been prevented in 1996 alone.3 But what approaches should be used to encourage the adoption of these proven interventions? Three distinct approaches to injury prevention—education, environmental/ product modification, and enforcement of legislation or regulation—provide pathways for translating knowledge about prevention into effective policy and practice.

Following a brief discussion of the magnitude, trends, and costs associated with childhood injuries and models for injury prevention, the remainder of this article reviews what is known about the effectiveness of these injury prevention approaches. Within each section, the following questions are addressed:

  • What are the childhood injury prevention strategies that fit within each approach?
  • What is the evidence about the effectiveness of these strategies?
  • What are the limitations in knowledge about these strategies?

The promise of the human genome project is enormous, but is not likely to significantly improve child health for some years to come. In contrast, the means are available now to prevent death and disability from injuries to thousands of children in communities across the country.