Academic journal article Child Welfare

Effective Primary Prevention Programs in Public Health and Their Applicability to the Prevention of Child Maltreatment

Academic journal article Child Welfare

Effective Primary Prevention Programs in Public Health and Their Applicability to the Prevention of Child Maltreatment

Article excerpt

Principles of public health practice can be applied to problems, such as child maltreatment, that have behavioral antecedents and injury outcomes. Successful campaigns to promote bicycle helmet use to prevent brain injury and to promote supine sleeping to prevent sudden infant death are described. These programs were universally applied, featured simple behavioral goals, were based on the best available evidence, and monitored both behavioral and health-related outcomes.

Public health is concerned with maximizing the health of a population utilizing interventions that are evidence-based, cost-effective and applicable on a large scale. The public health approach (Figure 1) rests on surveillance to determine the burden of a problem in a population and evaluate changes in incidence over time. Associated risk and protective factors are sought, usually in cohort or case-control studies. As risk factors are identified, interventions are developed and evaluated, increasingly in large-scale randomized trials. Interventions found to be effective are disseminated and brought to scale.

Over the last 50 years, important public health achievements have made enormous differences in the health of the population. In this article, we focus on two problems-traumatic brain injuries from bicycle-related crashes and Sudden Infant Death Syndrome (SIDS)-and the public health interventions developed, tested, and implemented to address them. Lessons learned from these successful interventions could be generalized and applied to other issues in child health, including the prevention of child maltreatment.

Traumatic Brain Injuries Due to Bicycle-Related Crashes

The prevention of traumatic brain injury (TBI) though the use of bike helmets illustrates important points for addressing a public health problem. The program was based on scientific evidence behind an intervention (helmets), a careful narrow focus (increasing helmet use), a message that made sense (wear helmets), and a cheap, feasible intervention, supported by marketing and manufacturers.

When the Harborview Injury Prevention and Research Center began work on bicycle injuries in 1986, there were about 500,000 bike-related injuries treated annually in US hospital emergency departments and about 900 deaths per year (Rivara, Thompson, Patterson, & Thompson, 1998). The highest rate of injury (per mile ridden) was among children under the age of 15. TBI accounted for about one-third of ED treated injuries, two-thirds of hospital admissions, and three-fourths of deaths related to bicycling.

Evidence of Helmet Effectiveness

Prior to our studies, there were limited data on the effectiveness of bicycle helmets. To understand the effect of helmet use in bicycling, large cohort studies were not feasible and randomized trials were not an option, for both ethical and practical reasons. Instead, we used casecontrol studies, which had been applied in other injury prevention research (Kellermann, Rivara, Rushforth, et al., 1993; Kellermann et al., 1992; Kellermann, Westphal, Fischer, & Harvard, 1995 ; Haddon, Valien, McCarroll, & Umberger, 1961), but had not been used to examine the protective effect of a device such as helmets.

We undertook two case-control studies. The first, funded by the Group Health Foundation, studied about 700 people and found that helmets reduced the risk of head injuries by 85% and brain injuries by 88% (R. S. Thompson, Rivara, & Thompson, 1989). A second, larger study funded by the Snell Foundation showed that helmets were protective in motor vehicle-bike crashes, were effective at all ages, among all helmet types, and prevented facial as well as brain injuries (Thompson, Nunn, Thompson, & Rivara, 1996; Thompson, Rivara, &c Thompson, 1996).


Public Education Campaign

Helmets were only used by ~2% of children riding bicycles in the mid-1980s. In order to increase helmet use, we sought to change a specific behavior. …

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