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Reducing the Burden of Injury: Advancing Prevention and Treatment
The NRC report Violence in Families (NRC, 1998) examined the research literature on evaluations of interventions for child maltreatment, domestic violence, and elder abuse. Although it identified 114 evaluation studies in these areas, it found most to be "not yet mature enough to guide policy and program development." Only one area, home visitation programs for child maltreatment (see Olds et al. ), was recommended as policy for first-time parents living in social settings with high reported rates of child maltreatment.
Evaluation research is needed for a number of prevention interventions, including peer mediation, social skills training, comprehensive community initiatives, shelter programs and other services for victims of domestic violence, child fatality review panels, mental health and counseling services for child maltreatment and domestic violence, child witness to violence prevention and treatment programs, and elder abuse services (NRC, 1998). Finally, the committee believes that, from the perspective of violence research, a high priority is to strengthen the health system databases for monitoring nonfatal injuries. Accurate measures of violence can be achieved only by establishing reliable health-based surveillance systems. Strengthening these databases will advance the field of violence research whether it is conducted by criminologists or public health specialists, and whatever the source of funding.
Violence prevention research is the purview of multiple federal agencies, including the Office of Justice Programs of the Department of Justice and the following agencies of the Department of Health and Human Services: the National Center for Injury Prevention and Control (NCIPC), the National Institute of Mental Health, the Maternal and Child Health Bureau, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. Many of these federal programs are discussed at greater length in Chapter 8, where the committee makes several recommendations. In addition, the committee urges that the research recommendations of previous NRC reports be implemented to promote effective violence interventions.
Injury prevention encompasses a vast array of programs and policies aimed at reducing the frequency or severity of injuries. Although these interventions can be categorized in a variety of ways, the committee elected to group them as follows: (1) interventions for changing individual behavior; (2) interventions for modifying products or agents of injury; (3) interventions for modifying the physical environment; and (4) interventions for modifying the sociocultural and economic environment. These categories are adapted from those originally proposed by William Haddon more than three decades ago (Haddon et al., 1964).
Research on injury interventions often begins with estimating their efficacy, effectiveness, and cost-effectiveness. Factors that are considered include feasibility; potential mortality and morbidity reduction; economic impact; ethical,