A Healthier Future for West Virginia - Healthy People 2010

15 - Injury and Violence Prevention

Objectives | References

Background

In 1997, over 149,691 Americans died from injuries sustained from a variety of causes such as motor vehicle crashes, falls, fires, drownings, poisonings, homicides, and suicides. This translates into over 390 people who die each day, of whom at least 50 are children. Overall, one death out of every 14 in the United States results from injury. Of these deaths, 65% were classified as unintentional and 35% as intentional in 1997. In that same year, West Virginia had a total of 20,835 deaths. Of these, unintentional injuries accounted for 788, and intentional injuries accounted for 355.

The age-specific death rates for injuries far surpass those for cancer and heart disease for ages 1 through 44. From ages 1 through 4, injuries cause almost half of all deaths and result in more than three times the number of deaths from congenital anomalies. Injury deaths exceed deaths from all other causes combined from ages 5 through 34 and are most prominent at ages 15 through 24, where they cause 78% of all deaths. From ages 35 through 44, they continue to outnumber deaths from any other single cause. After age 45, injuries account for fewer deaths than several other health problems, such as heart disease, cancer, and stroke. Despite the decrease in the proportion of deaths due to injury, the death rate from injuries is actually higher among the elderly than among younger people. In absolute numbers, injuries remain a significant cause of death throughout life.

Injury is a serious public health problem that is both preventable and predictable. However, this widespread human damage too often is taken for granted, in the erroneous belief that injuries happen by chance and are the result of unpreventable "accidents." Working together, the entities participating in the Healthy People 2010 process can effect a positive change in the toll taken annually by injury in West Virginia.

The Objectives

OBJECTIVE 15.1. Reduce intimate partner violence by reducing the rate of domestic violence related homicides to less than 1.3 per 100,000 population. (Baseline: 1.6 per 100,000 West Virginia residents from 1993-97)

Data Source: Uniform Crime Reports (1993-97), West Virginia Department of Public Safety (WVDPS)

Violence is pervasive in our society and has the potential to change the quality of life. Intimate partner violence and sexual assault threaten women in all walks of life. On an average day in America, 70 people die from homicide, 87 people commit suicide, and a minimum of 18,000 people survive interpersonal assault. Intimate partner violence resulting in homicides is at a rate of 1.6 per 100,000 population in West Virginia. In 1995, 5,000 girls and women in the United States were murdered. In those cases for which the FBI has data on the relationship between the offender and the victim, 85% were killed by someone they knew. Nearly half of the women who knew the perpetrators were murdered by a husband, ex-husband, or boyfriend. A minimum of 16% of American couples experience assault during a year, and about 40% of these assaults involve severe violence, such as kicking, biting, punching, choking, and attacking with weapons.

The perpetration of intimate partner violence is most common in adults who, as children or adolescents, witnessed intimate partner violence or became the targets of violence from their caregivers. While West Virginia remains one of the safest states due to a low crime rate, the number of domestic violence related homicides has consistently remained approximately one-third of all homicides over the past five years. However, in 1998 there were 109 homicides; of these 48 (44%) were classified as domestic violence related. This represents only a small fraction of the West Virginia lives and families that are affected by violence in the home each year. Domestic violence not only affects individual lives and families but also the labor force, the cost of medical care, and society as a whole. As a state, community, and individuals, we need to work to protect everyone's right to be safe at home.

OBJECTIVE 15.2. Reduce the rate of forced sexual assault or attempted forced sexual assault to less than 16.1 per 100,000 population. (Baseline: 20.1 per 100,000 West Virginia residents from 1993-97)

Data Sources: Uniform Crime Reports, (1993-97), WVDPS; West Virginia Foundation for Rape Information and Services

Sexual assault is defined as any nonconsensual physical sexual activity including use of force, threats, intimidation, manipulation, coercion, or by taking advantage of physical helplessness or impaired mental and physical health of the victim. In 1994, the National Crime Victimization Survey (NCVS) reported that 407,190 females aged 12 and over were victims of rape, attempted rape, or sexual assault. Other surveys conducted in the past decade indicated that the NCVS underestimated the problem. The National Women's Study, in conjunction with estimates based on the U.S. census, suggests that 12.1 million American women have been victims of forcible rape at some time in their lives. The rate of forcible rape in West Virginia for the years 1993 through 1997 was 20.1 per 100,000 population. The national rate was 11.0 per 100,000 population.

OBJECTIVE 15.3. (Developmental)
Reduce the incidence of maltreatment of children younger than 18 to fewer than 6,438 cases annually. (Baseline: September 1997-1998/99 6,782 maltreated children per year)

Data Source: West Virginia Department of Health and Human Resources (WVDHHR)

Each year in the United States an estimated three million cases of suspected child abuse and neglect are reported by Child Protective Services (CPS) agencies, and almost three children a day die from child abuse and neglect. More than half of child abuse fatalities are typically unknown to CPS. In West Virginia, there were 16,349 reports of child abuse or neglect in 1998, which included reports of physical abuse, sexual abuse, emotional maltreatment, and neglect. Of those reported, 7,793 children were found to have already been maltreated or were at serious risk of maltreatment.

Child abuse and neglect can result in permanent and serious damage to the physical, emotional, and mental development of the child. The physical effects may include damage to the brain, vital organs, eyes, ears, arms, or legs. These injuries can result in mental retardation, blindness, deafness, or loss of a limb. Child abuse or neglect may also cause delays in development. The language, perceptual, and motor skills of maltreated children are often underdeveloped. At its most serious consequence, it may result in death.

Child maltreatment is often as damaging emotionally as it is physically. Maltreated children may be impaired in self-concept, ego competency, reality testing, defensive functioning, and overall thought processes. They also have higher levels of aggression, anxiety, and self-destructiveness and low impulse control. These characteristics can cause maltreated children to display high levels of antisocial behavior as they get older. Histories of abuse or neglect are strongly associated with teenage pregnancy, runaways, crimes, juvenile delinquency, mental retardation and other permanent disabilities, sexual offenses, prostitution, and domestic violence.

OBJECTIVE 15.4. Reduce to less than 9.2% the percentage of students aged 14-18 who carry a weapon on school property. (Baseline: 10.8% in 1997)

Data Source: West Virginia Department of Education, Office of Healthy Schools, Youth Risk Behavior Survey (YRBS)

Adolescents and young adults face an extraordinarily high risk of death and injury from violence. Arrest rates for homicide, rape, robbery, and aggravated assault are consistently and substantially higher for young people aged 15 to 34 than all other age groups. Nationally 8.5% of students reported carrying a weapon on school property in 1997, compared to 10.8% in West Virginia. The rural nature of West Virginia and its culture may nurture this factor.

FLAGSHIP OBJECTIVE
OBJECTIVE 15.5. Reduce overall motor vehicle crash deaths to no more than 17.7 per 100,000 population. (Baseline: 20.8 per 100,000 population in 1993-97)
15.5a. Ages 0-14 4.8 (Baseline: 5.7 in 1993-97) 15.5b. Ages 15-24 27.7 (Baseline: 32.6 in 1993-97)
15.5c. Ages 25-44 20.0 (Baseline: 23.5 in 1993-97)
15.5d. Ages 45+ 18.0 (Baseline: 21.2 in 1993-97)

Data Sources: WVDHHR, West Virginia Bureau for Public Health (WVBPH), Office of Epidemiology and Health Promotion (OEHP); Division of Highways (DOH), National Highways Traffic Safety Administration (NHTSA)

OBJECTIVE 15.6. Reduce the overall number of motor vehicle crash deaths to no more than 2.0 per 100,000,000 miles traveled. (Baseline: 2.08 per 100,000,000 miles traveled from 1996-98)

Data Source: West Virginia Department of Transportation, Highways Division, Crash Data Report

Motor vehicle crashes (MVC) remain a major public health problem. MVCs are the leading cause of death for all Americans aged 1-24, as well as the leading cause of death for the same age group in West Virginia. According to the Department of Transportation, the societal cost of crashes exceeds $150 billion annually. There were 47,460 motor vehicle crashes in WV in 1998. Among these, there were 372 deaths, 24,173 persons were injured, and the economic loss to our state was estimated at $2,851,383,000. There are 1,280,555 licensed drivers in West Virginia, 1,529,285 licensed motor vehicles, and 17,867,924,000 annual vehicle miles traveled. The motor vehicle death rate per 100,000 population is especially high among those aged 16-24 and 75 and older. At all ages, males have higher motor vehicle death rates per 100,000 population compared to females. Teenagers experience a disproportionately high incidence of crashes and crash deaths. Among children aged 1-14, crash injuries are the leading cause of death.

OBJECTIVE 15.7. Initiate and pass into law legislation that requires the use of helmets by ATV operators. (Baseline: N/A )

Data Source: West Virginia University (WVU) Center for Rural Emergency Medicine

OBJECTIVE 15.8. Maintain current laws and support the enforcement of these laws for operators of (a) motorcycles and (b) bicycles. (Baseline: Helmet laws are already in place for all motorcycle operators in West Virginia and bicycle operators aged 14 and younger.)

Data Source: Legislative bills and repeals

As of 1999, West Virginia had a mandatory motorcycle helmet law for all operators of all ages. A bicycle helmet law was also in place for those 14 years of age and younger. Each year there is constant pressure on the legislature to repeal the motorcycle helmet law.

OBJECTIVE 15.9. Reduce overall deaths resulting from ATV crashes to no more than 0.5 per 100,000 population. (Baseline: 1.1 per 100,000 during 1996-98)
15.9a. Ages 1-14 0.5 (Baseline: 1.1 during 1996-98)
15.9b. Ages 15-64 0.5 (Baseline: 1.1 during 1996-98)
15.9c. Males aged 65+ 1.0 (Baseline: 2.0 during 1996-98)

Data Sources: WVU Center for Rural Emergency Medicine; U.S. Consumer Product Safety Commission

From 1990-98, 101 men, women, and children died as a result of ATV-related injuries in the state. During this period, West Virginia had the seventh highest number of fatalities and the second highest per capita rate of death (second only to Alaska) among all states. The average number of deaths from ATV incidents has risen over 150%, from 7 during 1993-1995 to 18 during 1996-98. Twenty-five percent (25%) of the deaths were among children 16 years of age or younger; 7 were under the age of 10, with the youngest an 18-month-old girl. Nine men aged 65 years or older have also died as a result of ATV crashes. Approximately 85% of the victims were male. Fewer than 5% of the victims wore helmets at the time of their ATV crashes, and two-thirds of the deaths were due to neck and head injuries. Forty-two percent (42%) of the incidents involved collisions with other vehicles or with fixed objects, and 33% involved ATVs flipping or overturning. One-fifth of the fatal incidents involved the use of alcohol and drugs. Twelve percent (12%) of the deaths were among persons who were riding as passengers. The precipitous rise in the number of deaths resulting from the recreational use of ATVs is a serious public health issue within the state.

OBJECTIVE 15.10. Reduce the number of deaths resulting from falls among the elderly (aged 65+) to no more than 34.6 per 100,000 population. (Baseline: 38.4 per 100,000 during 1993-97)

Data Source: WVBPH, OEHP, Health Statistics Center

Within West Virginia, for the period 1995-97, falls were the second leading cause of injury death among people aged 65 to 74 (25% of all unintentional injury deaths) and the leading cause for people 75 years of age or older (49% of all unintentional injury deaths). Falls are the most common cause of injuries and hospital admissions for trauma among the elderly. Falls account for over 80% of all fractures among the elderly and are the second leading cause of spinal cord and brain injury. Since most fractures are the result of falls, understanding factors that contribute to falling is essential in order to design effective intervention strategies. Factors that contribute to falls include dementia, visual impairment, neurologic and musculoskeletal disabilities, psychoactive medications, and difficulties in gait and balance. Environmental hazards such as slippery surfaces, uneven floors, poor lighting, loose rugs, unstable furniture, and objects on floors also may play a role.

OBJECTIVE 15.11. Increase the use of safety belts among adults and children older than eight to at least 74% of motor vehicle occupants. (Baseline: 68% in 1998)

Data Sources: NHTSA; U.S. Centers for Disease Prevention and Control (CDC)

Safety belts, when used, are the single most effective means for occupants to reduce the risk of death and serious injury in a motor vehicle crash. Lap and shoulder belts are 45% effective in reducing deaths and 50% effective in preventing moderate to critical injuries to passengers. Eleven states have primary enforcement laws, while West Virginia has a secondary enforcement law. States with primary enforcement and publicized enforcement of these belt laws can produce use rates at 80% and above.

OBJECTIVE 15.12. Increase the use of child restraints in motor vehicles to at least 98%. (Baseline: 96.5% in 1997)

Data Source: WVBPH, OEHP, Behavioral Risk Factor Surveillance System (BRFSS)

OBJECTIVE 15.13. (Developmental) Reduce Traumatic Brain Injury (TBI) as a result of intentional or unintentional injury. (Baseline data available in 2000)

Data Sources: West Virginia Trauma Registry/West Virginia Traumatic Brain Injury Registry

Traumatic brain injury may be caused by an unintentional event (such as motor vehicle or ATV crash injuries, pedestrian injuries, bicycle injuries, etc.) or intentionally through violence (e.g., gunshot wounds, domestic violence injuries, sexual assault, etc.). Estimates of injuries reported in West Virginia indicate that approximately 3, 600 individuals per year experience some type of head injury. Over two million Americans sustain traumatic brain injuries each year. These injuries are the leading cause of death and disability of children and young adults in the United States. Conservative estimates indicate that each year in West Virginia brain injuries are responsible for 3,600 hospitalizations, 700 deaths, and 600 long-term disabilities.

Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

• Worksites
• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

The West Virginia Injury Prevention Coalition will use as its guidelines for setting its goals and objectives the objectives stated in Healthy People 2010. Members of the Coalition include:

West Virginia Bureau for Public Health
West Virginia Office of Emergency Medical Services
West Virginia University Center for Rural Emergency Medicine
West Virginia Foundation for Rape Information and Services
West Virginia Coalition Against Domestic Violence
West Virginia Department of Health and Human Resources, Child Support Services
West Virginia State Fire Marshal's Office
West Virginia Bureau for Public Health, Office of Epidemiology and Health Promotion, Osteoporosis Program
West Virginia Department of Education, Office of Healthy Schools
West Virginia Emergency Medical Services for Children
West Virginia Safe Kids Coalition
Brain Injury Association of West Virginia
West Virginia Traumatic and Spinal Cord Injury Rehabilitation Fund Board

Work Group Members

Penny Byrnside, MS, RN, Work Group Leader, Injury Prevention Coordinator, Office of Emergency Medical Services, WVBPH
Janet M. Williams, MD, FACEP, Director, Center for Rural Emergency Medicine, WVU; Assoc. Professor, Department of Emergency Medicine, WVU
Susan J. Derk, MA, Research Program Manager, Center for Rural Emergency Medicine, WVU
Jim Helmkamp, PhD, Epidemiologist, Center for Rural Emergency Medicine, WVU
Patty Hawkins, Program Administrator, Emergency Medical Services for Children, WVBPH
Pete Shaffon, EdD, Community Health
Program, WVU
Sharon Sanders, MS, Health Promotion Specialist
Diane Reese, West Virginia Coalition Against Domestic Violence
Jim Cook, Special Assistant to the Commissioner for Healthy Schools, WVBPH
Shawna Phares, Assistant to the Director, WVDHHR
Carol Nolte, MS, Assistant Fire Marshal, West Virginia State Fire Marshal's Office
Renee Hager RN, BA, Executive Director, Clinical Services, Boone Memorial Hospital
Pastor Matthew Watts, Grace Bible Church
Monica Rozzell, RN, BS, Education Coordinator, Center for Rural Emergency Medicine, WVU
Beth Morrison, Cabinet to Family Violence Coordinating Council
Marla Eddy, LSW, Family Service of Kanawha Valley
Frank O'Hara, MS, CHES, Member, Mineral County Child Injury Council
Patricia J. Nutter, RN, BSN, Ritchie County School Nurse
Jim Grate, Manager, West Virginia Governor's Highway Safety Program
Archie Hubbard, Director, Boone County Ambulance Authority
Nancy Hoffman, MA, Director, West Virginia, Foundation for Rape Information and Services
Kathie King, MSW, Program Specialist, Office of Social Services, WVDHHR
Rina Foy, MS, Community Outreach Coordinator, West Virginia Poison Center

References/Resources

CDC. Injury and Fatality Data, 1997-1998. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, 2000.

Helmkamp, Jim. ATV Statistics, 1997-1998.
Morgantown, WV: Center for Rural Emergency Medicine, WVU, 1999.

National Highway Traffic Safety Administration. State Statistics. 1998.

West Virginia Brain Injury Registry, 1997-1998.

West Virginia Bureau for Public Health. Behavioral Risk Factor Survey 1997. Charleston, WV: West Virginia Department of Health and Human Resources, 1998.

West Virginia Department of Health and Human Resources, Child Protective Services. 1997-1999 data.

West Virginia Department of Public Safety. Uniform Crime Reports. 1993-1997. Charleston, WV: West Virginia Department of Public Safety.

West Virginia Division of Highways. Crash Data Report. Charleston, WV: West Virginia Department of Transportation, 1998.

West Virginia Foundation for Rape Information and Services.

West Virginia Office of Healthy Schools. West Virginia Youth Risk Behavior Survey. Charleston, WV: West Virginia Department of Education, 1997.

West Virginia Trauma Registry, 1997.
For More Information

Injury Prevention Program
Office of Epidemiology and Health Promotion
Room 319
350 Capitol Street
Charleston, WV 25301-3715
Phone: (304) 558-0644; Fax: (304) 558-1553

This page was last updated June 13, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov