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Reducing the Burden of Injury: Advancing Prevention and Treatment
from consumer products. In 1970, 226 poisoning deaths among children under age 5 occurred in the United States, whereas in 1985, only 55 such deaths occurred (CDC, 1985). Aspirin poisoning—the single leading cause of childhood poisoning death in the 1960s and early 1970s—had virtually disappeared by 1985. This accomplishment was due, in large measure, to a body of research on the epidemiology of childhood poisoning; ongoing surveillance of childhood poisoning through the nation's poison control centers; and innovative work on the development of environmental and legislative approaches to keep hazardous substances, particularly baby aspirin, out of the hands and mouths of young children. The final vehicle for this success was passage of the Poison Prevention Packaging Act of 1970 that required the use of special childproof containers and limited the number of pills of baby aspirin to 30 per bottle. Subsequent research investigated compliance with the legislation (Dole et al., 1986). A recent study by Rodgers (1996) found that child-resistant packaging of prescription drugs was associated with a 45 percent reduction in mortality rates involving children younger than 5 from 1974–1992, resulting in 460 fewer child deaths over this period than otherwise projected. This study controlled for long-term safety trends and changes in consumption of prescription drugs. The overall strategy of combining regulation and community-based intervention through poison control centers has been used as a case study of effective injury prevention (National Committee, 1989).
Falls are the most common cause of nonfatal injuries and among the most common causes of injury deaths. They are an especially serious problem for the elderly and for children (Chapter 2). Falls occur annually in about 30 percent of elderly persons living in the community (NCIPC, 1996). Research has provided the scientific foundation for interventions (e.g., hormone replacement therapy, vitamin supplements, exercise, protective hip pads) that can prevent or protect the elderly from hip fractures, the most serious consequence of falls in this group (Paganini-Hill et al., 1991; Grady et al., 1992; Lauritzen et al., 1993; Tinetti et al., 1993, 1994; Meunier et al., 1994; Province et al., 1995).
Research has established that many population-based injury prevention strategies are inexpensive and easily integrated into existing systems or practice. For example, counseling by physicians has been found to prevent or alleviate many types of unintentional injuries, including certain traffic-related injuries and injuries related to falls and burns (Christophersen and Sullivan, 1982; Berger et al., 1984; Katcher et al., 1989; Persson and Magnusson, 1989; Bien et al., 1993; Miller and Galbraith, 1995). The installation of smoke alarms in high-risk homes in a community-wide program in Oklahoma City was found to achieve a 74 percent decrease in fatal and nonfatal injuries from residential fires (Mallonee et al., 1996). In a randomized controlled trial of low-income women and children, home visits by nurses during the pregnancy of the women and for two years after the birth were found to significantly reduce childhood injuries (Kitzman et al., 1997).
One of the most effective prevention strategies is the use of helmets by bicyclists and motorcyclists (Elliott and Rodriguez, 1996). Helmets prevent trau-