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One of the privileges of being the editor of Injury Prevention is the opportunity to read 600 or so prepublication reports of the latest research in the injury prevention field—each year, year in year out. After some years of doing this, I have developed a sense that the field of modern injury prevention has matured. Rather than trace our development, what I will do here is use the manuscripts published in this issue to show the extent to which the field is now comfortable in its own skin. There are 14 manuscripts published in this issue. Collectively, they reveal injury prevention to be a profession no longer questioning its identity, just confidently going about important programmes of work in concert with the world of which it is part. The manuscripts in this issue have not been especially selected and collated. They are simply …

My starting point for this discussion is where we left the topic in an editorial 12 months ago; that is, the need for more ‘Public involvement in the production, dissemination and implementation of injury prevention research.’1 In this issue, Jennifer Woody Collins presents an informed critique of the challenges involved, and provides an elegant response.2 I commend her practical advice for researchers and practitioners to you for your consideration. The case for coproduced research is no longer contentious.3 Both for reasons of equity and justice, and for improved translation of research to public benefit, the compelling argument for coproduced research has been made. It is now our responsibility as editors and authors to apply the principle of coproduction in a way that fits our context and achieves the principle’s ethical and practical goals. From January 2020 all authors submitting manuscripts to Injury Prevention will be asked to consider …

Injury remains a leading cause of death and disability for all sectors of the community in all regions of the world.1–3 Since the 1960s when injury was conceptualised as a public health problem, there has been an escalation of knowledge relating to ‘what works’ to prevent injury. However, the rapid development of new injury prevention knowledge is quickly outstripping society’s capacity to implement it.4 This supplement of Injury Prevention brings together examples of empirical-based injury prevention research that demonstrate the state-of-the-art methods of achieving population-level reductions in injury-related harm. The issue also includes contributions that make the case for expanding existing public health paradigms of injury prevention beyond ‘what works’ and towards understanding the contexts and supports necessary for embedding effective injury prevention interventions within sustainable, synergistic systems of safety promotion. Population health science is one orienting frame for understanding and addressing the conditions that shape large-scale distributions of injury outcomes. Galea and Keyes5 describe how population health science can inform public health action in terms of ‘what works’ and ‘when’ and ‘for whom’. They pose a series of considerations injury researchers can use to both uncover the …

One of the defining characteristics of a profession is that its members take responsibility for enabling, educating and training emerging professionals in their field. This education role goes hand-in-hand with a profession’s responsibility to monitor members’ adherence to ethical, technical and professional standards. In the field of injury prevention, there are many who have incorporated this service role into their professional DNA. We can all identify mentors whose passion for educating future injury prevention researchers and practitioners seems to have grown as their experience and opportunity to contribute does too. Yet surprisingly, there are very few opportunities for injury education enthusiasts to share their teaching methodologies and approaches for other educators to learn from. There are …

Editorials throughout 2018 made explicit the journal’s editorial direction. In particular, we drew readers’ attention to the process of manuscript selection1 and the purpose selection was aiming to achieve.2 Rather than being a passive filtering process, editorial selection aims to encourage changes within the research world. At the year’s end, the journal was publishing ‘manuscripts of the highest quality that provided information of high relevance to prevention practice’,3 and hopefully changing the type and quality of research undertaken. Now, 18 months into the current editorial team’s lead-in period, let us take a look at the manuscripts published in this issue. Is the journal publishing the science that supports population-level changes …

Results from randomised controlled trials make an important contribution to improvements in injury-related health. However, publication of findings from randomised controlled trials remains a rarity in the injury prevention literature. Increasing the quantity of randomised controlled trials research need not reduce other types of injury prevention research activity. Highlighting the importance of publishing trials does not devalue the contribution of other designs. The paucity of trial evidence in injury prevention poses a risk to the advancement of the field. We need more randomised controlled trials in injury prevention. In this issue of the journal, we publish five study protocols and the results of one completed study that illustrate how injury prevention researchers are using trial methodology to address important research questions. The first protocol describes a randomised controlled trial designed to quantify the effect of a health education intervention on the safe-sleep knowledge, attitudes and practices of primary care givers of infant children. The second protocol is a cluster randomised controlled trial involving female soccer (football) players 14–18 years of age that aims to quantify the effect of a soccer-specific ankle brace on the incidence of acute lateral sprain of the …

It is 70 years since John Gordon wrote ‘The epidemiology of accidents’ in the American Journal of Public Health 1 and 55 years since Haddon W Jr and colleagues edited the text book ‘ Accident Research: Methods and Approaches ’ published by Harper and Row.2 Thirty years ago, the First World Conference on Accident and Injury Prevention was held in Stockholm. Twenty-five years ago, Injury Prevention published our first issue. In the modern form, injury prevention is no longer new. Does the field of injury prevention yet have the level of self-confidence required to step forward with purpose into the future? I was at an international meeting recently where there was much reference to ‘the injury prevention community’. At this same meeting, there was also much discussion about how the injury prevention community needs to be more effective in influencing governments, institutions, industry, funders and members of the public to better support our community’s activities and goals. “If other people listened to us more and took our …

Objectives Exploring the characteristics of recommendations generated from medicolegal death investigations is an important step towards improving their contribution to injury prevention. This study aimed to: (1) quantify coroners9 recommendations; and (2) examine the nature of these recommendations according to public health principles of injury causation and prevention. Methods Deaths where coroners9 recommendations were and were not made in the State of Victoria, Australia during the period 1 July 2000 to 30 June 2005 were compared by sex, age group and underlying cause of death. The nature of recommendations made was examined retrospectively using a derived model based on principles of injury causation and prevention, comprising seven elements: (1) priority population; (2) risk/contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6) organisation; (7) time frame for implementation. Results Coroners9 recommendations were relatively rare, made in only ∼6% of external-cause deaths. When coroners did make recommendations, they were statistically significantly more likely for persons aged 0–14 years and deaths resulting from transport crashes, complications of medical and surgical care, drowning and inanimate mechanical forces. Of the coroners9 recommendations, ∼70% included at least four of the model9s seven elements. The elements ‘countermeasure’ and ‘level of intervention’ were most commonly specified by coroners (∼95%) in their recommendations. Conclusions This study shows that highly evolved medicolegal death investigation systems may not draw systematically from the scientific research evidence base to inform the formulation of coroners9 public health and safety recommendations. To maximise its contribution to fatal injury prevention, the medicolegal death investigation may benefit from incorporation of a public health perspective.

There is considerable confusion about the nature of indicators, their use in the injury field and surprisingly little discussion about these important tools. To date discussions of injury indicators have focused on the content and presentation of health outcome measures and on the dearth of data on exposure measures. Whereas these are valuable measures and assessing the optimal use of available routinely collected data in forming indicators is important, they do not provide sufficient information to support comprehensive prevention efforts, nor do they harness the full potential of indicators as tools to support prevention efforts. This paper provides an overview of the characteristics and uses of indicators for the field of injury prevention in order to make the case for action indicators and provide a framework for their appropriate use.

I ask this, not as a rhetorical question, but a sincere one.1 There is a distinguished history of the self-conscious search for an identity statement for ‘injury’. A codified set of descriptors from WHO’s International Statistical Classification of Disease and Related Health Problems (ICD) is generally used as injury’s manifestational definition.2 3 Several common, but not universal, definitions are available to categorise the necessary additional dimension of severity.4 5 Haddon’s seminal work explaining the role of energy as agent in an epidemiological model of injury causation is now concreted into injury’s conceptual, aetiological definition.6 7 Has there been a similar search for the identity of ‘injury prevention’? Using language that is essentially manifestational, injury prevention is frequently described as the process of intervening in the causation of injury in a …

Objective: To assess extent of coder agreement for external causes of injury using ICD-10-AM for injuryrelated hospitalisations in Australian public hospitals. Methods: A random sample of 4850 discharges from 2002 to 2004 was obtained from a stratified random sample of 50 hospitals across four states in Australia. On-site medical record reviews were conducted and external cause codes were assigned blinded to the original coded data. Code agreement levels were grouped into the following agreement categories: block level, 3-character level, 4-character level, 5th-character level, and complete code level. Results: At a broad block level, code agreement was found in over 90% of cases for most mechanisms (eg, transport, fall). Percentage disagreement was 26.0% at the 3-character level; agreement for the complete external cause code was 67.6%. For activity codes, the percentage of disagreement at the 3-character level was 7.3% and agreement for the complete activity code was 68.0%. For place of occurrence codes, the percentage of disagreement at the 4-character level was 22.0%; agreement for the complete place code was 75.4%. Conclusions: With 68% agreement for complete codes and 74% agreement for 3-character codes, as well as variability in agreement levels across different code blocks, place and activity codes, researchers need to be aware of the reliability of their specific data of interest when they wish to undertake trend analyses or case selection for specific causes of interest.

Background: Children engage in various physical activities that pose different injury risks. However, the lack of adequate data on exposure has meant that these risks have not been quantified or compared in young children aged 5-12 years. Objectives: To measure exposure to popular activities among Australian primary school children and to quantify the associated injury risks. Method: The Childhood Injury Prevention Study prospectively followed up a cohort of randomly selected Australian primary and preschool children aged 5-12 years. Time (min) engaged in various physical activities was measured using a parent-completed 7-day diary. All injuries over 12 months were reported to the study. All data on exposure and injuries were coded using the International classification of external causes of injury. Injury rates per 1000 h of exposure were calculated for the most popular activities. Results: Complete diaries and data on injuries were available for 744 children. Over 12 months, 314 injuries relating to physical activity outside of school were reported. The highest injury risks per exposure time occurred for tackle-style football (2.18/1000 h), wheeled activities (1.72/1000 h) and tennis (1.19/1000 h). Overall, boys were injured more often than girls; however, the differences were non-significant or reversed for some activities including soccer, trampolining and team ball sports. Conclusion: Although the overall injury rate was low in this prospective cohort, the safety of some popular childhood activities can be improved so that the benefits may be enjoyed with fewer negative consequences.

Objective: To demonstrate properties of the International Classification of the External Cause of Injury (ICECI) as a tool for use in injury prevention research. Methods: The Childhood Injury Prevention Study (CHIPS) is a prospective longitudinal follow up study of a cohort of 871 children 5 - 12 years of age, with a nested case crossover component. The ICECI is the latest tool in the International Classification of Diseases (ICD) family and has been designed to improve the precision of coding injury events. The details of all injury events recorded in the study, as well as all measured injury related exposures, were coded using the ICECI. This paper reports a substudy on the utility and practicability of using the ICECI in the CHIPS to record exposures. Interrater reliability was quantified for a sample of injured participants using the Kappa statistic to measure concordance between codes independently coded by two research staff. Results: There were 767 diaries collected at baseline and event details from 563 injuries and exposure details from injury crossover periods. There were no event, location, or activity details which could not be coded using the ICECI. Kappa statistics for concordance between raters within each of the dimensions ranged from 0.31 to 0.93 for the injury events and 0.94 and 0.97 for activity and location in the control periods. Discussion: This study represents the first detailed account of the properties of the ICECI revealed by its use in a primary analytic epidemiological study of injury prevention. The results of this study provide considerable support for the ICECI and its further use.

Objective: Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in preventing poisoning in children 0–15 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; target population was children under 15 years; outcome measure was poisoning rates; and either a community control or an historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: The review found only four studies, which met all the inclusion criteria. Only two studies used a trial design with a contemporary control and only one study provided convincing evidence of an effective community program for reducing poisoning in children. Conclusion: There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community based childhood poisoning prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

Injury Prevention publishes the science that defines our field. It is the signature publication supporting the primary, secondary and tertiary prevention of injury, for all people, from any cause. Accumulating in the pages of the Journal is a body of knowledge used across the world to improve the health of individuals and populations. The Journal’s emphasis on primary prevention addresses the point in the prevention continuum with the greatest scope for minimising harm. More than being simply an archive of information, the Journal is the intellectual charter that supports our field’s currency and validity. Each issue contains the latest research findings judged by peers to be important contributions to knowledge. In editorials, commentaries and letters, contributors discuss approaches most likely to produce the best results. Established positions are revisited as we challenge and rejuvenate our beliefs. Injury Prevention is the …

This paper provides an overview of the ecological study design and its application to injury prevention. The advantages and disadvantages of ecological designs are described and the principle characteristics of the ecological design are highlighted. The paper concludes by highlighting the pivotal role that ecological studies can have in our understanding of the complex interaction between the environment and injury, and the application of this design in elucidating key population based strategies for injury prevention.

> And when all the tigers are caged, what then the need to hide, the world all being safe?1 2 There is substantial need indeed if the results of the study by Pickett et al 3 reported in their article published in this issue of Injury Prevention ( see page 376 ) are an indication. While the reported study is one of the most important recently undertaken, it is not only in the analytical results that the importance of this paper lies, but also in the questions the authors raise. The study was grounded in the ecological understanding of the causation and prevention of injury introduced by Haddon in his seminal paper published 40 years ago.2 Pickett et al have worked towards actualising that theory (using multi-level models of causation), describing the concept of ‘exposure’ within an ecological framework, and accurately measuring the relevant contextual and individual level component causes. The issues addressed by the authors are critical (both in content and timing) for the future of injury prevention practice, and, in exploring these issues through empirical study rather than conceptual discussion, the authors have made an important contribution to the field. The conventional position on injury prevention recommends that efforts should be restricted to a consideration of ‘the necessary conditions for harmful results’ and not of the ‘complex mix of factors’ that lead to serious injury events.4 5 Pickett et al have based their study on the alternative position; that …

Background Many mothers of young children experience significant psychological distress which is associated with poor child health outcomes, including increased risk of injury. This research explores possible pathways through which maternal distress may influence injury occurrence in the first year of life. Method The Environments for Healthy Living Study enrols pregnant mothers in a peri-urban area of Australia. Enrolled mothers complete surveys at recruitment (approximately 36 weeks gestation) and at 12 months postbirth to elicit information related to social, behavioural and health outcomes. Results 1112 pregnant mothers were enrolled in the first 2 years of the study, and 857 (77%) returned a follow-up survey after 1 year. Responses indicated that 148 (17%) infants suffered an injury requiring medical attention in the first year. Mothers categorised with moderate to high psychological distress according to the Kessler 6 rating scale were more likely to report an injury than non-distressed mothers (p=0.028). Infant injury risk was also elevated among younger mothers and those who reported their child was difficult to care for, lower baseline ratings of community satisfaction or changes in parenting burden since the birth. Maternal psychological distress levels were influenced by a large number of social and demographic variables including relationship status, paternal education level, neighbourhood satisfaction, perceived financial difficulties and parenting burden. Conclusion A number of personal, social and neighbourhood variables exist that may explain the demonstrated link between maternal psychological distress and injury in the first year of life.

Background Unintentional injuries are one of the leading causes of hospitalisation among preschool children in Sri Lanka resulting disability and death. Though majority of unintentional injuries among this age group occur when the children are at home with their parents, there is dearth of information on parent related contributory factors. Objectives To ascertain parent related contributory factors for unintentional injuries among preschool children. Methods A community based sample of 1117 preschool children was recruited using a two tier randomisation process. Parents of participating children completed an interviewer administered questionnaire that recorded the parent9s recollection of their child having an unintentional injury needed medical attention, within 6 months prior to the interview. In addition parents completed measures assessing type and quality of parenting, quality of marital life, exposure to family stressors and Beck Depression Inventory. Psychosocial stimulation potential of child9s home environment was assessed by the Home Observation for Measurement of the Environment inventory. Results Logistic regression analysis demonstrated poor quality of parenting (OR 4.9, CI 2.4 to 9.9) and depressive mental health status (OR 4.5, CI 2.5 to 7.9) of the mother, poor quality of parent9s marital life (3.08, CI 1.8 to 5.2) and inadequacy of psychosocial stimulation at home (OR 2.4, CI 1.2 to 4.8) as the variables that predict the occurrence of unintentional injuries among the study group. Contribution to the Field Identification of parent related risk factors for unintentional injuries among preschool children will enable policy makers to plan and implement injury prevention programmes addressing these factors.

Background The introduction of the National Strategy for Disaster Resilience (NSDR) represents a new, proactive, all-hazards approach to disaster management in Australia. This represents is a timely opportunity to revisit the recommendations and key themes from recent disaster inquiries. Aims/Objectives/Purpose To identify the common strategic themes across recent disaster inquiries and determine whether the NSDR is aligned with findings from the recent inquiries. Methods A thematic analysis of seven prominent Australian inquiries into natural disasters was undertaken. The NSDR was used as a thematic framework to analyse the inquiry reports. When an additional theme was identified that was not in the NSDR, this became a new category in the thematic analysis. Results/Outcome All of the themes from the NSDR were evident in the inquiry reports; however, a number of additional themes were identified from the inquiries. Six key themes were identified as particularly critical: State emergency management arrangements, understanding, awareness and assessment of risk, critical infrastructure, community communication and empowerment, research, and what does a disaster resilient community look like? Significance/Contribution to the Field The common themes from recent disaster inquiries provide key pointers toward strategies for enhancing Australia9s disaster resilience in particular, and more generally, represent critical areas that require further research.

Introduction A purported strength of the medico legal death investigation system (coroner or medical examiner) is the provision for formal recommendations to be made about the prevention of fatal injury. Recent changes in the United Kingdom and Australia are requiring organisations to respond to coroners recommendations. Aim To describe the nature of coroners recommendations for injury fatalities in Victoria, Australia using a novel model. Methods Injury fatalities investigated by the coroner were extracted for the State of Victoria from the Australian National Coroners Information System (1 July 2000 – 30 June 2005). Unique coroners recommendations were examined by incident using a derived model comprising seven elements important for injury prevention: (1) population at risk; (2) risk/contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6) organisation; and (7) timeframe for implementation. Results Of the 7655 injury deaths (from 7394 incidents) investigated by the coroner, only 456 (6%) deaths (407 incidents) had recommendations, 338 of which were unique. Overall, most unique coroners recommendations described the elements (5) strategy for implementation (n=320, 94.7%) and (3) countermeasure (n=318, 94.1%). Few recommendations described elements (1) population at risk (n=185, 54.7%) or (2) risk/contributing factors (n=175, 51.8%). Recommendations About transport-related deaths had the most comprehensive coverage of the seven elements. Discussion and conclusion Coroners make few recommendations for the prevention of injury fatalities. There are significant gaps in their formulation with incomplete adherence to the principles of injury prevention. This information is an essential step to improving the formulation of coroners recommendations and optimising their capacity for prevention.

Background Despite widespread application of the public health approach to injury prevention there is an acknowledged limitation in the extent to which it facilitates translation of research evidence to injury prevention practice. Aims This paper critically examines the contemporary public health approach using the academic framework of public policy with view to amending the approach to improve the translation of research to practice. Methods A fatal injury case study drawn the Australian experience is used to illustrate the limitations of public policy model underlying the contemporary public health approach to injury prevention and the better performance of a preferred public policy model in terms of the extent to which each facilitates translation of research to practice. Results In this case study, careful accumulation of evidence relating to policy definition, causation and intervention efficacy within the research domain did not lead to policy action once this evidence was placed on the public agenda. Policy action was only achieved as a result of a window of opportunity that arose when the spate of drowning in 2004, generated public recognition of the problem and generated political will to recognise and hence implement existing policy solutions. Discussion and Conclusions The rational model that underlies the contemporary approach to injury prevention is consistent with the stages of empirical scientific method but not consistent with the mechanisms that drive policy implementation. The implications for these findings for the public health approach to injury prevention are that it needs to be adapted so that its foundation model from the rational to the incremental approach.

Objectives To determine the baseline frequency and distribution of transport injury and prevalence of road safety behaviours in an ongoing cohort study of Thai adults. Methods The Thai Health-Risk Transition Study includes an ongoing cohort study of 87 134 adult Open University students residing across Thailand. The baseline survey data collected in 2005 includes information on self-reported transport injury within the previous 12 months and demographic, behavioural and transportation factors that could be linked to Thailand9s transport risks. Findings Overall, 7279 (8.4%) of respondents reported experiencing a transport related injury in the previous 12 months, with risk being higher for males and those aged 15–19 years. Most of the injuries occurred while using motorcycles. Approximately half of the male drivers reported driving after three or more glasses of alcohol at least once in the previous year, compared to 10% of female drivers. The prevalence of motorcycle helmet wearing and seat belt wearing were higher than previously reported for Thailand, however there is still much room for improvement. Conclusions We found much higher rates of transport injury than previously estimated and revealed valuable information about the prevalence of various road safety behaviours. Our ongoing study provides an opportunity to monitor these risks and behaviours in the context of future road safety programs. These data make a valuable contribution to the available evidence from which Thai authorities can draw on to address transport injury, one of the major causes of individual and social burden of health.

Introduction Burden of disease estimates have been used to inform prioritisation of research needs. In Australia, National Health Priority Areas (NHPAs), of which injury prevention is one, have been identified as priorities for prevention and research. The National Health and Medical Research Council (NHMRC) is the principal source of medical research funding in Australia. This research aims to examine NHMRC funding for each NHPA to quantify the relationship between grants awarded and burden of disease measures. Method A retrospective analysis of NHMRC funding from 2000 to 2008 to assess the strength of correlation between level of funding and the contribution of each NHPA to burden of disease measures (YLD, YLL, DALY) and health system expenditure was conducted. Also examined were observed versus expected research grants by grant type relative to the proportional contribution of each NHPA to DALYs. Results There were 6099 new and continuing grants awarded, ranging from a total of $A94.6 to $A423.3 million during 2000–2008. Both YLL and DALYs were strongly correlated with NHMRC funding. Injury received a lesser number of scholarships, overseas training fellowships, career awards, research project and programme grants than what would be expected based on its proportional contribution to total NHPA DALYs. Conclusion Injury research and investigator training appears to be underfunded by the NHMRC in Australia based on burden of disease measures. Investigator training dollars should be allocated to ensure an optimum workforce distribution that is capable of undertaking research in areas deemed to be of national importance.