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Reducing the Burden of Injury: Advancing Prevention and Treatment
This chapter outlines the challenges ahead for prevention research, which include strengthening the multidisciplinary nature of injury research, developing and evaluating a wide range of prevention interventions, training a highly skilled cadre of injury prevention researchers, and undertaking the research needed to guide the effective prevention of unintentional and intentional injuries. This chapter refers to, but does not concentrate on, treatment research (e.g., acute care and rehabilitation) because treatment research priorities have been addressed by several recent landmark reports, including the NIH Task Force on Trauma Research (NIH, 1994), Disability in America: Toward a National Agenda for Prevention (IOM, 1991), and Enabling America (IOM, 1997). As in other areas of clinical practice, the need to demonstrate the relationship between the quality of acute care and rehabilitation, costs, and outcome has never been more critical (see also Chapter 6).
Prevention research has garnered numerous accomplishments over the past 30 years in terms of understanding risk factors, injury mechanisms, and effective ways to reduce injuries. The greatest research progress has been made with motor vehicle and traffic safety, an area with the longest period of sustained federal support for research and prevention programs (see Chapter 5). The same has not been true for other types of unintentional injuries or for intentional injuries (i.e., suicide and violence). These areas have not received sustained support of sufficient magnitude (Chapter 8).
Unintentional Injury Prevention
Unintentional injuries, as a group, represent the most common cause of injury death. There were a total of 90,402 unintentional injury deaths in 1995 (Fingerhut and Warner, 1997). A strong research base on motor vehicle and highway safety has contributed to the increased crashworthiness of vehicles, and increased use of safety belts, and to decreases in drinking and driving. Certainly, other factors are involved, such as increased public awareness and consumer demand for safe products; federal, state, and local programs; improved medical care; and legislation and enforcement activities. Separating the contribution of research and these other factors is rarely possible in any area of injury prevention, in part because the factors are so interrelated. Research and surveillance, for instance, are used to galvanize public opinion, to justify legislation, and to evaluate legislative impact. Research forms an essential underpinning to a comprehensive approach to tackling the problem of injury.
One of the most impressive research and programmatic accomplishments in the history of injury prevention occurred in the area of childhood poisonings