resentative sample of hospitals, through its National Hospital Ambulatory Medical Care Survey (NHAMCS). The survey collects information on patients' symptoms and demographic characteristics, diagnoses, services provided, drugs prescribed, referral status, and expected payment source. Although not limited to visits for injuries, NHAMCS data includes information on work-related injuries. The injuries are coded using the standard E-codes, allowing this data to be compared to those from other sources.

Weiss et al. (1997) used NHAMCS data to study the incidence, characteristics, and payments of child and adolescent emergency department visits by narrow age groupings. No work-related injuries were recorded for youngsters under the age of 15 in the 1993–1994 survey. For adolescents aged 15 to 17 years, 103,000 visits were for injuries identified as work-related, more injuries than found by either SOII or NEISS data. Work-related injuries represented 5 percent of the emergency department visits for injuries by this age group. This may be a conservative estimate as place of injury was unspecified for 19 percent of the injuries.

State-Based Surveillance Systems

State-based surveillance activities provide important opportunities to link data collection efforts with active intervention in the workplace and community and to identify local concerns that may be obscured in national efforts. The Massachusetts Department of Public Health, for example, has been working since 1992, with funding provided by NIOSH, to establish a model state-based surveillance system for work-related injuries to youth. Recognizing that no single data source captures the full extent of the problem, the department uses several data sources to identify cases. New state regulations require physicians and hospitals to report to the department all cases of young people being injured at work. These reports, together with data from the workers' compensation system, the Census of Fatal Occupational Injuries, and the Fatality Assessment and Control Evaluation program, are used to identify cases. Some of the injured youngsters are interviewed to obtain additional information, and their cases may be referred to other agencies for workplace follow-up. Summary data are used to target a variety of broad-based intervention efforts, ranging from a community-based educa-

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