matic brain injury, the foremost cause of death in cycle-related injuries (Rivara et al., 1997a,b). A population-based, case-control study found the use of bicycle helmets to reduce the risk of head injury by 85 percent and the risk of brain injury by 88 percent (Thompson et al., 1989). Bicycle helmets also reduce the risk of injury to the upper and middle face (Thompson et al., 1996b). As a result of sustaining less severe injuries, helmeted cyclists have shorter lengths of stay in hospitals and intensive care units and lower overall hospital costs (Elliott and Rodriguez, 1996). Research has contributed to the enactment of legislation in many states mandating helmet use and the support by many public and private agencies of helmet education programs.

These examples illustrate the pivotal value of research in many established interventions that avert unintentional injuries (see Table 4.1, Box 4.1). Yet, although there has been much progress in research, more is needed. The 12 percent decline in unintentional injury deaths from 1985–1995 while encouraging, was driven by the decline in motor vehicle fatalities (Fingerhut and Warner, 1997). The overall decline thus obscures the continued need to reduce unintentional injury fatalities related to falls, poisonings, drownings, suffocations, and fires and burns, particularly in special populations such as children and the elderly.

BOX 4.1 Harlem Hospital Injury Prevention Program

A program in New York City is a model injury prevention program whose creation epitomizes many of the aspects of prevention research described in this chapter. The Harlem Hospital Injury Prevention Program was created in 1988 as a result of surveillance revealing that the injury rate to Harlem children was twice the national rate. With the aid of community coalitions and public agencies, a broad-based, surveillance-driven prevention program was established to create a safe community for children (Laraque et al., 1995). The program was geared to reduce injuries from violence, motor vehicles, and recreational activities. A surveillance system was established—the Northern Manhattan Injury Surveillance System—to provide population-based injury data by zip code. This system allowed the program to focus and evaluate interventions by neighborhoods. The Harlem Hospital Pediatric Trauma Registry also provided social data on children admitted to the hospital for injury and carefully evaluated the injury event. The community was surveyed and photographed to document dangers in children's play spaces, propelling a risk-factor analysis of unsafe conditions. Interventions, which served more than 10,000 children, included educational projects, renovation of playgrounds, safe activities, and other social changes. For example, intensive educational programs were established for traffic safety and violence prevention. Twenty safe playgrounds were built at community schools, and parks were refurbished. Bicycle helmets were distributed at reasonable cost. Safe activities were developed by the program or supported in the community to keep children engaged in supervised

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