[Senate Hearing 110-899]
[From the U.S. Government Publishing Office]
S. Hrg. 110-899
KEEPING AMERICA'S CHILDREN SAFE: PREVENTING CHILDHOOD INJURY
=======================================================================
HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
ON
EXAMINING PREVENTING CHILDHOOD ACCIDENTAL INJURY
__________
MAY 1, 2008
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
EDWARD M. KENNEDY, Massachusetts, Chairman
CHRISTOPHER J. DODD, Connecticut MICHAEL B. ENZI, Wyoming,
TOM HARKIN, Iowa JUDD GREGG, New Hampshire
BARBARA A. MIKULSKI, Maryland LAMAR ALEXANDER, Tennessee
JEFF BINGAMAN, New Mexico RICHARD BURR, North Carolina
PATTY MURRAY, Washington JOHNNY ISAKSON, Georgia
JACK REED, Rhode Island LISA MURKOWSKI, Alaska
HILLARY RODHAM CLINTON, New York ORRIN G. HATCH, Utah
BARACK OBAMA, Illinois PAT ROBERTS, Kansas
BERNARD SANDERS (I), Vermont WAYNE ALLARD, Colorado
SHERROD BROWN, Ohio TOM COBURN, M.D., Oklahoma
J. Michael Myers, Staff Director and Chief Counsel
Ilyse Schuman, Minority Staff Director
(ii)
C O N T E N T S
__________
STATEMENTS
THURSDAY, MAY 1, 2009
Page
Dodd, Hon. Christopher, a U.S. Senator from the State of
Connecticut, opening statement................................. 1
Isakson, Hon. Johnny, a U.S. Senator from the State of Georgia,
statement...................................................... 2
Kennedy, Hon. Edward M., Chairman, Committee on Health,
Education, Labor, and Pensions, opening statement.............. 3
Prepared statement........................................... 4
Arias, Ileana, Director, National Center for Injury Prevention
and Control, Atlanta, GA....................................... 5
Prepared statement........................................... 7
Korn, Alan, Director of Public Policy, Safe Kids USA
International, Washington, DC.................................. 16
Prepared statement........................................... 17
Bruns, Justin, The Boys Latin School of Maryland, Baltimore, MD.. 26
Prepared statement........................................... 27
Appy, Meri-K, President, Home Safety Council, Washington, DC..... 28
Prepared statement........................................... 30
Williams, Amber, Executive Director, State and Territorial Injury
Prevention Directors, Atlanta, GA.............................. 30
Prepared statement........................................... 31
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Enzi, Hon. Michael B., a U.S. Senator from the State of
Wyoming, prepared statement................................ 42
Kathleen Bruns, mother of Justin Bruns, prepared statement... 28
(iii)
KEEPING AMERICA'S CHILDREN SAFE: PREVENTING CHILDHOOD INJURY
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THURSDAY, MAY 1, 2008
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The committee met, pursuant to notice, at 10:35 a.m. in
Room SD-430, Dirksen Senate Office Building, Hon. Edward M.
Kennedy, chairman of the committee, presiding.
Present: Senators Kennedy, Dodd, and Isakson.
Opening Statement of Senator Dodd
Senator Dodd [presiding]. The committee will come to order,
and we welcome all of you here this morning. We are here today
to celebrate the victories over the past 20 years of an
organization and organizations like Safe Kids USA in protecting
America's children from unintentional childhood injury.
First of all, I want to congratulate Safe Kids on their
20th anniversary. I have been fortunate enough to work with
this organization for the past 20 years on numerous occasions
in various settings, as we have celebrated the work of Safe
Kids and their contributions. They deserve a great deal of
credit for the progress that has been made in protecting our
children from accidental injuries.
On average, the fatality rate from unintentional injuries
has dropped by 45 percent over the past 20 years, and that is
due to the dedication of all of the organizations we have here
today to research the best ways to prevent childhood injury and
to get that information out to parents and to caregivers.
But we are also here today to talk about what still needs
to be done in this area, and a lot needs to be done, of course.
Despite the decrease I mentioned, we still have an average of
430 children dying each month from accidental injuries. It is
still the No. 1 killer of American children under the age of
14, regrettably.
I remember a time, and I am sure my colleague does, when
there were no car seats, we didn't always buckle up, and it was
okay to smoke around your children. We have been able to become
far more sophisticated in how we protect our children, but we
have got a ways to go. So I am pleased to have all of you here
today to discuss that with this committee.
The burden of preventing childhood injury falls on American
families and caregivers, and they have so much to worry about.
Parents have to be concerned about dangers in the home, at
their childcare provider, at the homes of family and friends,
and the potential dangers which arise when children are out of
their sight.
The constant concern can be quite an emotional toll on
parents, but the financial cost associated with keeping a child
safe can be astronomical. Parents and caregivers need to have
car seats, helmets, smoke detectors, carbon monoxide detectors,
temperature-sensing faucets. The list goes on and on. We need
to ensure that families of all income levels have access to the
best technology available to keep their children safe.
I have got to take a moment here to brag a little bit.
Coming from the State of Connecticut, we recently were named
the ``Safest State For Kids'' by Parents magazine. We are
deeply proud of that recognition. It is an honor to be so
designated, and there are a lot of people in my State who
deserve credit for that, helping us--our mayors, our State
legislators, our governors, the State officials, and others who
have worked over the years to earn that reputation.
Today, we have with us representatives from the Centers for
Disease Control and Prevention, Safe Kids USA, the Home Safety
Council, and the State and Territorial Injury Prevention
Directors Association, who have all been crucial in the
decrease in numbers of injuries over the years.
We also have with us a young man, Justin Bruns, who has a
personal story about how he was able to escape permanent injury
because of the safety precautions that he took, and the story
highlights why it is so important for caregivers to take
seriously the issue of injury prevention to protect their
children from harm. We are honored to have Justin with us this
morning, and we thank him in advance for his testimony. It is
very courageous to come forward and talk about a situation that
you have been in.
With that, let me turn to my colleague, Senator Isakson,
and then we will hear from our witnesses. We thank them for
being with us.
Statement of Senator Isakson
Senator Isakson. Well, thank you very much, Chairman Dodd.
It is an honor to be here, and I welcome Safe Kids USA and all
our witnesses, in particular young Justin. We are glad to have
you here to tell your story today.
I am glad to be a part of this. I am the father of three
and the grandfather to eight, six of whom are under 4 years
old. We end up keeping them a lot of weekends when I am home.
So I have become an expert in child safety restraints and all
kinds of things that have been a product of the movement over
the last 20 years really to make our homes safer and our
children safer.
I was particularly pleased to be the co-sponsor of the
Cameron Gulbransen Kids and Cars Safety Act recently, which
came out of a personal tragedy in my district, where a young
lady by the name of Cindy Donald, who was a cheerleader at
Lassiter High School, was sunbathing during the summer between
her junior and senior year. Her father, in a hurry, backed his
SUV out of the garage and rolled over her legs, severing part
of her spine, and she is a quadriplegic today.
I am a part of the Cindy Donald Foundation, where we raise
money to help her rehabilitate and recover. But because of this
new act, now we will have the sounds made by cars backing up in
reverse so that someone who might be in harm's way has a
warning and knows something like that is getting ready to
happen.
I think learning the lessons of life, as Justin is going to
tell us about in his experience, help us to do those things
that make our children safer, and we need to celebrate that.
Today is a celebration of child safety, but it is also an
awareness that we have to continue to be acutely aware of those
challenges that confront us everywhere we can reasonably and
responsibly protect our children and make them safe.
Again, I welcome all of our guests who testify today.
Thank you, Mr. Chairman.
Senator Dodd. Thank you very much.
I mentioned informally at the outset of the hearing that
Senator Kennedy will be here shortly. He has been tied up this
morning and asked me to come on in and be a part of this.
But as I mentioned at the outset, I have enjoyed immensely
over the years, my involvement with Safe Kids USA. As Chairman
of the Subcommittee on Children and Families, we have worked
very closely together over the years developing a lot of
various ideas that I hope have contributed to exactly the
celebration we are enjoying here this morning.
I should also point out, as my friend Johnny, as the father
of--well, here he is now. Look at this. The timing--well, very
good. I was kind of enjoying this right here.
The Chairman [presiding]. That is what I was afraid of.
[Laughter.]
How many years----
Senator Dodd. A lot. I have been waiting a lot.
The Chairman. How many years have you been waiting?
Senator Dodd. I know. I keep on holding his wrist to get a
pulse every now and then.
[Laughter.]
I am sad to report it is very strong. Well, I was just
saying with two young children as well, we are very conscious
in our homes, as all of us are, of safety methods that need to
be taken. I have made an opening statement, as has Senator
Isakson. We have got our first witness here, but do you want to
make some opening comments?
Opening Statement Of Senator Kennedy
The Chairman. Well, I will just put mine in the record.
We want to acknowledge, as we do frequently, that our good
chairman today, Senator Dodd, has been the chairman of the
Children's Caucus before being chairman of a Children's Caucus
was being cool. Years and years, he has chaired that and has
been enormously involved in all of the policy issues relating
to children and has really made a great difference.
Senator Isakson has also been so involved and active in our
committee in terms of the children's issues. So we are very
fortunate to have him as well.
I think the really good news is that progress has been
made. We are not used to good news around here. It seems that
so many of the challenges that we face are so overwhelming and
whether we can really make some progress. But we find out if we
really do what these wonderful organizations have recommended
and the outreach that they have had in terms of families and
parents and urging it in local community levels has really made
a very important difference.
We want them to know that we want to be part of that whole
process because we think they can continue to make progress.
Second, just very quickly, there is always the issue of the
cost of some of these items. Whether they are available,
accessible to parents, and whether they can afford them. We are
going to hear, I know, this incredible story about this young
person's life probably saved because of the use of a helmet,
and can people afford it? Particularly these economic ties are
things we ought to be able to do or think about some of those
issues.
I will put my whole statement in the record, Mr. Chairman.
But I thank you, and I thank our witnesses. We have got a
really extraordinary group of people who have been on this
issue for years and have really been enormously helpful to our
committee and very helpful in terms of helping to shape
national policy. We are very grateful to all of them.
[The prepared statement of Senator Kennedy follows:]
Prepared Statement of Senator Kennedy
Our hearing today is on protecting American children more
effectively from unintentional childhood injury and death. I'd
like to begin by congratulating the organization of Safe Kids
USA on its 20th anniversary and on its 20 years of dedication
and achievement on this important issue.
First, let me say, I've had the privilege of working with
you since the beginning and you deserve great credit for the
progress that has been made in protecting children from
accidental injury. All of our panelists here today represent
organizations that research ways to prevent injury, educate
caregivers in creative ways, and help kids learn to keep
themselves safe. An important challenge that we face in helping
families protect their children is the cost.
As I mentioned, this hearing today focuses on unintentional
childhood injury, but I also want to take this opportunity to
highlight an important related program up for reauthorization
this year--The Child Abuse Prevention and Treatment Act. It was
originally enacted in 1974 to identify and address the issues
of child abuse and neglect, and to support effective methods of
prevention and treatment. It provides grants to States to offer
child protective services, funds for research and demonstration
projects, assistance to States to investigate and prosecute
cases of child maltreatment, and grants for community-based
support service. Furthermore, I look forward to working with my
colleagues to reauthorize this important program.
It's so important that we do all we can to support safety
research and prevention measures. Despite all that we've
accomplished over 20 years, 430 children are still dying each
month from accidental injury. In Massachusetts alone, there are
nearly 43,000 children under the age of 4 who visited the
emergency room each year for nonfatal injuries.
It's amazing how times have changed in not only how we
behave around our children today, but also take extra care in
protecting them. Not long ago, I can remember it was acceptable
to place a baby seat in the front of your car and child bike
helmets were considered optional. It has been proven that these
changes in our behavior, which all of you have been strong
advocates and educators in bringing to our attention, save
lives. Such examples include that since 1987, we have decreased
child motor safety injuries by 49 percent and bike injuries
have fallen 49 percent. These statistics demonstrate the
success in your work and how sophisticated and aware we have
become in protecting our children.
Today unintentional injuries remain the No. 1 killer of
American children under the age of 14. The burden of preventing
childhood injuries can be a tremendous drain on parent's energy
and the worrying can be overwhelming. As a parent, who has
raised three children, I have first-hand knowledge of how
emotionally draining it can be to protect your children and
ensure their safety. It is important for parents to be aware of
dangers in not only their home, but their daycare centers,
relative's houses, and child's friend's houses. It is only
through education and proactive action by parents can we
further reduce childhood injuries.
Today, we have with us representatives from the Centers for
Disease Control, Safe Kids USA, the Home Safety Council, and
the State and Territorial Injury Prevention Director's
Association. Also, we have a tremendous example here with us
today of how safety precautions prevent childhood injury. A
young man, named Justin Bruns, has a personal story of why it's
so important for caregivers to take their responsibility of
childhood safety precautions seriously.
The Chairman. I will ask you if you want to----
Senator Dodd. Thank you very much.
Dr. Ileana Arias is the Director of the CDC's National
Center for Injury Prevention and Control. She is responsible
for the expansion of State programs for injury prevention, the
development of surveillance for circumstances surrounding
violent deaths, and new research in such areas as child
maltreatment.
Dr. Arias is a clinical psychologist with a research
expertise in family violence, and we are truly honored to have
you with us here this morning. I would just say to you, Doctor,
and I guess everyone else, all of your statements and
supporting documents and materials will be made a part of the
record.
So, thank you.
STATEMENT OF ILEANA ARIAS, DIRECTOR, NATIONAL CENTER FOR INJURY
PREVENTION AND CONTROL, ATLANTA, GA
Ms. Arias. Thank you very much, Senator Dodd, Chairman
Kennedy, and Senator Isakson.
I am delighted to be here to talk to you about this
important public health issue and then also join our partners
in this endeavor who have been primarily responsible for the
advances that you alluded to earlier. It is the case that
unintentional injuries is the leading killer of American
children, something that continues to be true in spite of the
advances that we have made.
Motor vehicle-related crashes and traffic incidents are the
primary cause of those deaths, followed very closely by
drownings and fires. Of course, the deaths are just the
beginning of the story as far as the toll and the burden of
injuries among children.
Non-fatal injuries are the leading reason or the main
reason why children are brought to the attention of an
emergency department. Primarily those are the results of falls.
We are talking about kids who are being treated for broken
bones, head concussions, and other injuries associated with
falls, usually in the home or playgrounds.
Not surprisingly, the costs are astronomical. In 2000, we
estimated that the lifetime cost for children between the ages
of 1 and 14 of injuries that included both medical expenses and
productivity losses over the lifetime is in excess of $51
billion, a significant ticket that we have to then pay on a
continuing basis.
That is the bad news. The good news, as you mentioned, is
that these are largely preventable, and they are preventable
because we know what works. We know how to prevent these
injuries, which then accounts for the successes that we have
made over the last couple of decades.
At CDC, we are committed to making sure that children are
safe. That is, we believe that they are entitled to a safe and
healthy life and that every child has the right to live his or
her life to the fullest potential. Our contribution to that is
by supporting the work that needs to be done in order to
decrease that significant challenge to that goal, and that is
injuries.
We essentially support research and then, importantly,
making sure that that research goes out the door and
implemented by communities in order to prevent those injuries.
We want to make sure that all caregivers and parents are fully
aware of what it is that they have to watch out for as far as
their kids are concerned and what kinds of things they can do
in order to maximize their safety.
Over the past couple of decades, we have been primarily
preoccupied with making sure that people understand what the
burden is, that there is a problem, but then very importantly
identifying what it is that they can do to prevent it. Where we
are now is making sure that those tools get into the hands of
individuals who are in a position to actually use them to
accomplish the goal of furthering reducing the burden of injury
among kids in the United States.
As I said, we know what works. The issue now is making sure
that that is widely disseminated and implemented. We recognize
that we can't do that on our own. In fact, we can't do much of
it on our own. We have to be very cognizant of the partnerships
that are crucial to making that happen. Partnering with
organizations such as Safe Kids, Home Safety Council, and then
Government organizations, both at the State and local levels,
as well as to make sure that it happens.
I started off by sort of agreeing with you about the bad
news. I agree with you that we do need to concentrate on the
fact that there is some good news, that we have made a
significant impact over the last two decades. More than that,
that we actually do have the tools currently to improve upon
that. So that, fortunately, the good news is that nowadays we
can do more than cross our fingers and hope that when our kids
leave home, when they get up in the morning, that they will be
safe. We actually can ensure that they will be safe.
I thank you for bringing this issue to the attention of the
American public and calling attention to it, and I also thank
you for the support that you have provided over these last
years to make sure that what we are celebrating today actually
is possible to celebrate.
So I thank you very much, and then I am happy to answer any
questions you may have.
[The prepared statement of Dr. Arias follows:]
Prepared Statement of Ileana Arias, Ph.D.
Good morning Chairman Kennedy, Ranking Member Enzi, and
distinguished members of the committee. It is my privilege to appear
before you as Director of the National Center for Injury Prevention and
Control (NCIPC) at the Centers for Disease Control and Prevention
(CDC). At CDC, we work to ensure that all people achieve their optimal
lifespan with the best possible quality of health at every stage of
life. We are equally motivated to ensure that individuals get a healthy
start in life, and nowhere is this more important than in the lives of
children.
Regardless of gender, race, or economic status, injuries remain a
leading cause of death for Americans. Unintentional or accidental
injury and violence are particularly serious threats to the health and
well-being of children and adolescents in the United States. CDC is
leading the Nation's efforts in reducing premature death, disability,
human suffering and the medical costs associated with injuries and
violence. Working with State and local governments, nonprofit
organizations, professional societies, academic institutions, private
entities, other Federal agencies and international organizations, CDC
is documenting the numbers and identifying the causes of injuries,
finding and developing effective prevention strategies, and promoting
widespread adoption of these solutions.
I will begin today by giving an overview of childhood injury and
violence and explaining CDC's unique public health role in their
prevention. For many, we know how to prevent injury and death from
occurring. I will also give an update on CDC's research findings on
specific childhood injuries and give a few examples of CDC efforts that
illustrate how we contribute to a healthier nation.
children and injuries: overview
Infants and young children are at greater risk for many injuries
than adults. This increased risk may be attributed to several factors.
Children are curious and like to explore their environment, which may
lead children to sample pills in the medicine cabinet, play with
matches or venture into a family pool. Young children have immature
physical coordination and cognitive abilities, and are at greater risk
of falls from bicycles and playground equipment. Developing bones and
muscles may make them more susceptible to injury in car crashes if they
are not properly restrained. As pedestrians, children are particularly
vulnerable because developmentally they cannot properly gauge the speed
of traffic, and they lack the perceptual motor skills to avoid the path
of on-coming traffic when they cross the road.
In general, injuries are the leading cause of death for Americans
aged 1 to 44 years. In 2000, injury death and disability cost an
estimated $406 billion in lifetime medical treatment expenses and lost
productivity including lost wages and benefits as well as costs that
are due to inability to perform household activities for an injury
sustained in 2000.\1\ Of that total, injuries among children ages 0-14
account for $51 billion). Unintentional or accidental injuries remain
the leading cause of death among young Americans, with the exception of
Congenital Anomalies for children less than 1 year of age. Overall,
motor vehicles and traffic-related accidents are the leading cause of
injury by which children are killed, followed closely by drowning and
unintentional fires. Additionally, unintentional injuries remain the
leading cause of childhood non-fatal injuries treated in hospital
emergency departments across the Nation.
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\1\ Injury in the U.S.: 2007 Chartbook, National Center for Health
Statistics.
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Below are leading causes of injury deaths by age group:
------------------------------------------------------------------------
Leading Causes of Injury
Age Range Death, 2005
------------------------------------------------------------------------
Less than 1 year.......................... Unintentional suffocation;
unintentional motor vehicle
crashes; unspecified
homicide.
1-3 years................................. Unintentional drowning;
unintentional motor vehicle
crashes; unintentional fire/
burn.
4-11 years................................ Unintentional motor vehicle
crashes; unintentional fire/
burn; unintentional
drowning.
12-19 years............................... Unintentional motor vehicle;
homicide (firearm); suicide
(firearm).
------------------------------------------------------------------------
role of public health in childhood injury prevention
To prevent childhood injuries, CDC uses a systematic public health
approach. This approach has four steps: define the problem, identify
the risk and protective factors, develop and test prevention strategies
and assure widespread adoption of the best interventions. CDC achieves
these primarily through surveillance and data sharing; research on
possible interventions; community implementation and evaluation of
interventions; and widespread adoption of proven interventions.
CDC conducts surveillance to inform efforts in developing effective
public health programs. By knowing the magnitude of the problem and the
affected populations, resources can be directly applied and capacity
adjusted to control or prevent the injury by utilizing and evaluating
proven interventions.
burden of childhood injuries
CDC studies the burden of injury across the lifespan, but today I
will focus on children and the leading causes of childhood injuries.
Child Passenger Safety and Young Drivers
Motor vehicle traffic-related injuries are the leading cause of
death among children in the United States. During 2005, the National
Highway Traffic Safety Administration (NHTSA) reported that 1,451
children ages 14 years and younger died as occupants in motor vehicle
crashes, and approximately 203,000 were injured--an average of 4 deaths
and 556 injuries each day. NHTSA also reported that of children ages 0
to 14 years killed in motor vehicle crashes during 2005, nearly half
were unrestrained. However, many of these deaths can be prevented. We
know that placing children in age- and size-appropriate restraint
systems reduces serious and fatal injuries by more than half. CDC is
currently evaluating State-based programs to increase booster seat use
among children 4 to 8 years of age, in order to inform efforts in other
States to address passenger safety issues among children.
Because motor vehicle crashes are the leading cause of death for
U.S. teens aged 15-19, accounting for 35 percent of all deaths in this
age group, research funded by the AAA Foundation for Traffic Safety
suggests that the most strict and comprehensive graduated drivers
licensing programs are associated with a 38 percent reduction in
fatalities and a 40 percent reduction in injuries of 16-year old
drivers due to crashes. CDC is building partnerships to promote and
strengthen Graduated Driver Licensing (GDL) Systems in States.
Child Maltreatment
The true number of children who are victims of child maltreatment
in the United States is unknown, but in 2006 the Administration on
Children & Families (ACF) reported 905,000 cases of confirmed or
substantiated cases of non-fatal child maltreatment each year in the
United States. Child maltreatment includes physical, sexual, and
emotional abuse and neglect, and is believed to be underreported. In
2006, ACF data further showed that 1,530 child deaths were officially
attributed to maltreatment. Child maltreatment through blunt trauma to
the head or violent shaking (also known as shaken baby syndrome) is the
leading cause of head injury among infants and young children.
In addition to injuries and related health issues during childhood,
child maltreatment can increase the risk factors for many of the
leading causes of death among adults. CDC research shows that children
who are maltreated are at an increased risk for a variety of health
problems, including heart disease, cancer, chronic lung disease, liver
disease, alcoholism, drug abuse and depression; and other forms of
violence, such as intimate partner and family violence. Indeed,
witnessing or experiencing abuse or neglect as a child can increase the
risk factors for becoming a victim or perpetrator of violence. With the
other work CDC is doing in violence and injury prevention, child
maltreatment prevention represents an opportunity for CDC to have an
impact across the lifespan.
CDC has identified programs that teach parenting skills to promote
safe, stable, nurturing relationships as one solution for this problem.
These methods aim to motivate positive parent child interaction and
teach parents to avoid neglectful and physically abusive behavior.
Water Safety
In 2005, of all children 1-14 years old who died, 6.6 percent died
from drowning. Although unintentional drowning rates have slowly
declined, fatal drowning remains the second-leading cause of
unintentional injury-related death for this age group. In addition, for
every child 14 years and younger who died from drowning in 2004, four
received emergency department care for non-fatal submersion injuries.
Research indicates that lack of supervision and proper barriers (such
as pool fencing) are primary risk factors. CDC continues to promote
water safety education to caregivers by providing information to parent
groups, recreation centers and schools.
Residential Fire-Related Injuries
Pre-school children (age 5 and under) and older adults (age 65 and
older) have the highest fire death rates in U.S.-home fires. Deaths
from fires and burns are the sixth most common cause of unintentional
injury deaths in the United States and the third leading cause of fatal
home injury. Residential fires caused nearly $7 billion in property
damage in 2006, with fire departments responding to 412,500 home fires
in the United States. In that same year the lives of 2,580 people were
lost and another 12,925 (not including firefighters) were injured.
Approximately half of home fire deaths occur in homes without smoke
alarms.
Smoke alarms decrease the risk of death in a home fire by up to 50
percent. However, one-quarter of U.S. households lack working smoke
alarms, and those least likely to have an alarm are often at higher
risk of being injured in a fire.
The smoke alarm installation and fire safety education programs--
funded by CDC in 17 States--provide evidence that smoke alarm
installation programs save lives. A review of homes participating in
CDC-funded smoke detector installation and fire safety education
programs found that nearly 1,600 lives have potentially been saved to
date. Program staff have canvassed over 473,000 homes and installed
nearly 350,000 long-lasting or lithium-battery powered smoke alarms in
high-risk homes, including those with children ages 5 years and younger
and adults ages 65 years and older. Technology development,
distribution of smoke alarms, and addressing risky behaviors are key to
reducing the number of fire-related deaths in the United States.
Recreational Injuries (Playground and Sports Safety)
Children spend a lot of time participating in sports and recreation
activities. While participation in sports, recreation, and exercise is
an important part of a healthy, physically active lifestyle, the
associated injuries present a significant public health problem.
Injuries related to playground activities account for many of the
injuries to youth aged 0-9. Although the mortality associated with
these activities is not high (an average of 13 playground deaths per
year from 1999-2001,\2\ more than 200,000 children visit emergency
departments for treatment of a playground injury each year.
---------------------------------------------------------------------------
\2\ Tinsworth, D. and McDonald, J. (April 2001). Special Study:
Injuries and Deaths Associated with Children's Playground Equipment.
Washington, D.C.: U.S. Consumer Product Safety Commission. http://
www.cpsc.gov/LIBRARY/Playgrnd.pdf.
---------------------------------------------------------------------------
According to the CPSC's Public Playground Safety Handbook, 79
percent of playground injuries are due to falls from playground
equipment. Fractures to upper limbs are the most common type of injury.
Half of all playground injuries occur in schools and sporting
facilities.\3\ For sports-related injuries, more than half are
sustained by youth between the ages of 5-18, with boys having higher
rates of injury than girls.\4\ Furthermore, CDC estimates that as many
as 3.8 million sports and recreation-related concussions occur every
year. A concussion is a brain injury caused by a bump or blow to the
head, and can have severe long term consequences for children.
According to the Consumer Product Safety Commission's (CPSC) economic
data, the medical costs of sports and recreational injuries to children
under age 18 years were over $11 billion in 2003. Including parents'
work losses, pain and suffering, and product liability and legal fees,
this societal cost was approximately $121 billion in 2003.\5\
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\3\ Conn JM, Annest JL, Gilchrist J. Sports and recreation-related
injury episodes in the U.S. population, 1997-1999. Inj Prev 2003; 9(2):
117-123.
\4\ Non-fatal Traumatic Brain Injuries from Sports and Recreation
Activities--United States, 2001-2005; MMWR 2007.
\5\ CPSC Directorate for Economic Analysis 2000; CPSC 2003.
---------------------------------------------------------------------------
A CDC-sponsored School Health Taskforce produced recommendations to
schools to develop, teach, implement, and enforce safety rules to
address recreational injuries. Additionally, CDC has been instrumental
in producing appropriate educational materials for parents and youth
sports coaches in the assessment, management and prevention of
traumatic brain injury or concussions. The ``Heads Up: Concussion in
Youth Sports'' initiative offers information to youth sports coaches
and parents to help ensure the health and safety of young athletes.
Furthermore, CDC developed the Acute Concussion Evaluation (ACE), a
tool for physicians to assess and manage patients with concussions.
conclusion
There is now a strong and growing scientific basis for childhood
injury and violence prevention and control. Injuries and violence do
not have to be an accepted risk--lives can be saved and injuries can be
prevented. Public health can promote the use of effective prevention
strategies; yet, where science-based interventions exist, they are too-
often not widely disseminated. This is equivalent to developing a life-
saving medication but not telling physicians or patients that it is
available, not packaging the product for public use, not having skilled
pharmacists to dispense the medication, and not providing guidance
about the management of its effects. To save lives, consumers and
providers need support for adopting and maintaining interventions over
time. To effectively address the issue, CDC is developing national
initiatives and other large-scale approaches to support and expand
current research, improve program evaluation and promote widespread
adoption and use of effective preventative measures. Most injuries are
completely preventable and thus should never happen.
Thank you for the opportunity to discuss these important public
health issues today. Thank you also for your continued interest in and
support of CDC's injury prevention activities.
I will be happy to answer any questions.
The Chairman. Good. Well, thank you very much.
Let me ask you, what do you think would be your estimate if
each of the States were to put in an effective kind of program,
what are we talking about in terms of sort of resources? What
would be just round figures?
Ms. Arias. CDC is currently funding 30 States to implement
a myriad of intervention programs. One of the things that we
are trying to do is focus on those child programs. We would
like to be able to extend that to all 50 States and territories
and would be happy to then get those numbers to you as a
follow-up question.
The Chairman. OK. Yes, would you? So you are in 36?
Ms. Arias. Thirty.
The Chairman. Thirty now, and if they had--do you have a
model? Do you have a model program that you put--
Ms. Arias. There are various--yes, we do. The State
Territory Program Directors Association has come up with models
for how it is that State departments can essentially set up
those programs to be as effective not only in surveying and
monitoring the issue of injury among kids over time, but also
in then disseminating and supporting the implementation of
those programs.
We also have, with their help, gathered a number of success
stories of States that have done a particularly excellent job
and then can be replicated in other States as well.
The Chairman. Let me ask you, how do you go about--do you
get a hold of the States, the States get a hold of you, a mix
of both? Do you look at States that haven't been in touch with
you recently and recommend that they do? Or how do you proceed?
Ms. Arias. That is a great question. We do a combination of
both. We certainly make information available to all States of
the resources that we do have and how those resources can be
employed.
Because we are not able to essentially directly support all
States, what we do with the States we can't support is reach
out to them and find out what are technical assistance or other
kinds of resources that we can make available to them. Also how
is it that in future competitions, for example, they may be
able to then compete more successfully to get that kind of
funding.
The Chairman. Just finally, how are we doing in
Massachusetts? I know you never should ask a question you don't
know an answer to, but let me hear. How are we doing? What
specifically--maybe just specifically, I will ask you for the
record, but do you know offhand how we are doing up there and
what we ought to be doing better?
Ms. Arias. Yes. Massachusetts does quite well, and we can
send you specific information about all the programs that we
do----
The Chairman. OK.
Ms. Arias [continuing]. Fund across the lifespan and in
different settings.
The Chairman. Yes, if you could, just give me what they are
doing and the areas that you think can be strengthened.
Ms. Arias. OK.
The Chairman. I will be glad to get in touch with the
Governor, too, and see if we can't make some progress.
Ms. Arias. Excellent.
The Chairman. Thank you.
Senator Isakson. Thank you very much, Chairman Kennedy.
Did I hear your testimony correctly that the cost annually
is $51 billion?
Ms. Arias. Those are lifetime costs.
Senator Isakson. Those are lifetime costs?
Ms. Arias. Yes. So if we project----
Senator Isakson. The results of those injuries, like the
young lady I talked about who is a quadriplegic. The cost of
her care the rest of her life, that is a part of that number?
Ms. Arias. Yes, sir. Even changes in productivity as a
result of those injuries.
Senator Isakson. Right, and that is incalculable, I guess,
in terms of the productivity loss.
What is the most common accident today?
Ms. Arias. It usually is motor vehicle crashes. So that
really is the leading cause of deaths for sure. For the
unintentional, it depends on the age range. For younger kids,
it tends to be fall. But really, motor vehicle crashes and
traffic-related issues are the primary contributor to those
figures.
Senator Isakson. Are you in CDC in Atlanta?
Ms. Arias. Yes, we are.
Senator Isakson. Good, well, welcome. We are neighbors.
On reaching our kids and reaching, in many cases, our
adults, when I chaired the State Board of Education in Georgia,
we found out the best way to communicate was through the kids,
and particularly starting at the elementary school, in terms of
good diet, safety practices, even in the enrollment of kids in
SCHIP.
When that first started back in 1996, and I chaired the
Board of Education, we had a very low enrollment rate until we
used the schools to educate the kids to go home and tell mom
and dad, ``hey, this insurance is available if you will go down
and sign up''.
So an answer in response to Senator Kennedy's question, I
think the single-best conduit to get reinforced safety and good
health practices and everything else is through the public
schools and through public education. I know in Georgia, we
have got Superintendent Kathy Cox, who has done a good job in a
number of areas like that. I would recommend any time CDC can
or your part of CDC can get that information and use the State
centers of education, the better that information will get
disseminated.
Ms. Arias. Yes. No, that is an excellent point. Both on the
unintentional side and even on violence issues related to
safety in schools, we have traditionally focused significantly
on school programs and how it is that those messages and what
kind of tools teachers and other school personnel need in order
to deliver those messages.
The other is, of course, trying to deliver them as early as
possible. So, if possible, working with elementary school-age
kids so that they can then develop those behaviors very early
so that by the time they reach high school, where they are a
little more autonomous, are engaging in the kinds of behaviors
that are going to safeguard them.
Senator Isakson. I remember when my youngest son, Kevin,
was in some elementary school grade, and he came home with a
clay thing that he had made. It was an ashtray, and he gave it
to me. At the bottom, he had written on it ``don't smoke.'' You
know, one of the great things for kids to do. But this is a
very impressionable time in their lives, but also it helps us
to make impressions on them that will save them from many
dangers in the future.
So we appreciate what you are doing, and thank you for
being here.
Ms. Arias. Thank you.
Senator Dodd. Doctor, just a couple of things. One is to
what extent do you work at all with the entertainment industry?
We talk about influences on children, and obviously there's
programming, cartoons, all sorts of things. To what extent, I
mean, is there an awareness that a lot of repetition or
imitation of important messages occurs? Obviously, parents have
a responsibility to warn their children about what they can and
cannot do.
But do you get any cooperation? Are they helpful at all in
this?
Ms. Arias. They are very helpful, both in terms of working
with us directly and then working through our partners as well,
whether it is print media or television or others, trying to
look for opportunities to deliver those safety messages. For
example, a partnership with Parents magazine potentially this
coming year on safety issues across the lifespan.
We are now in the process of also reaching out to Sesame
Street Workshop. Walt Disney, who has done an excellent job of
addressing the issue, for example, of residential fires and the
prevention of fires in the home. So that the entertainment
industry has a significant and strong interest in being helpful
in that way.
Senator Dodd. It is an average of 430 deaths a month from
accidental injury. Tell me about how those numbers have changed
in the last few years. And do me a favor as well, break down
that number. It seems like there is an inordinate amount of
reporting lately on violence, gun violence and the like. Please
share with us your thoughts on that and what CDC is doing about
it and how cooperative are States being in some of the issues
where you are trying to reduce the level of gun violence in our
schools.
Ms. Arias. The focus today was on unintentional injuries
primarily because it is by far the most significant contributor
to injuries and deaths among kids. However, violence is a
significant issue for children and adolescents and young
adults. For example, we know that homicide is the fourth-
leading cause of death for kids between ages----
Senator Dodd. Is what? I am sorry?
Ms. Arias. Homicide is the fourth-leading cause of death--
--
Senator Dodd. Fourth leading.
Ms. Arias [continuing]. For children between the ages of 1
and 9. So that is a pretty startling statistic. Most of that,
of course, is the result of child maltreatment, which includes
anything from physical abuse, sexual abuse, and then neglect.
What we are doing, very similar to what we do with
injuries, is trying to identify who are the kids who are at
high risk for that or who are the families that are at high
risks for those kinds of issues, and then what are the most
effective ways of preventing those issues from happening?
We know from the research and the science that we have
supported at CDC and that others have conducted that parenting
programs are significant in order to prevent child maltreatment
and also to prevent a number of negative health outcomes for
kids. That is, programs that essentially teach parents not only
how to discipline their children, but also how to interact in a
positive way with their children and sort of help them develop
in the way that they want.
In addition to those parenting programs, early home
visitation programs have also been shown to be incredibly
successful, looking at a reduction of about 40 percent in child
maltreatment among families who have been enrolled in those
programs. So that very similar to unintentional injuries, it is
a big problem, but fortunately, we know what can be done.
Currently, it is then a matter of making sure that communities
are equipped to be able to address the issue by having those
things available to them.
Senator Dodd. Yes. I wonder if you might address as well
the current state of collaboration between the Federal agencies
on coordinated injury prevention approaches, particularly
between the CDC and HRSA. How is that working?
Ms. Arias. It is working quite well. Usually, it winds up
being topic specific, so that if we have an issue that we are
pursuing--for example, whether it is shaken baby syndrome or
car seats--finding other Federal agencies, either within the
Department of Health or other Federal agencies who have a role
in making sure that that happens.
One of the things we do in public health is recognize that
everything we do is multisectorial. It is not just about public
health. Usually there are a number of other sectors that have
to essentially coordinate with what we are doing in order to be
effective. From the very beginning, we reach out to them, make
sure that we do coordinate. Otherwise, we are going to
essentially hamper our chances of success in addition to then
maybe getting in their way.
Senator Dodd. Is your general conclusion that they are
receptive, the various Federal agencies?
Ms. Arias. Yes, they are. What we try to do is be very
clear about what is the value added that each of us brings to
the table. In the case of CDC, we know that there are certain
things that we do that usually are not replicated in other
agencies and that we have particular expertise.
Primarily, that has to do with the surveillance issues,
making sure that we support the systems to collect the
information to find out what the problem is, where the problem
exists and, therefore, where we should be investing our
resources. The other is in the evaluation of those programs. So
that other agencies are ideally equipped and suited to be able
to disseminate programs, but not necessarily support the
evaluation of those programs once they are implemented in a
community.
Of course, we are very interested in making sure that we
document the effect of those programs when they are implemented
to make sure that we want to continue with that investment and
not have to change it in order to improve success.
Senator Dodd. Yes. And last, let me just mention that
Senator Kennedy raised this and I think Senator Isakson did as
well, touched on it, and that is cost. We are looking--as a
parent of these young children, just going out and buying car
seats and other safety equipment, it is expensive. And if you
are a family that is struggling, those costs can be
astronomical and can become prohibitive in some cases.
I know there are places you can go to get secondhand and
used equipment, good equipment, by the way. It doesn't mean it
is faulty in any way. What recommendations and thoughts do you
have? Because so many people today are struggling to make these
ends meet. They want to keep their children safe, and yet these
objects are----
Ms. Arias. Yes. We have explored various options for
reducing those costs, again to make sure that everybody does
have the benefit of the tools that are available to protect
their children. Most of what we have looked at and actually
have done is building those partnerships.
So whatever resources we can bring to the table and then
really focusing on the private sector as well so that we have
supported programs, for example, where a Wal-Mart or a Target
may actually donate the equipment. Health departments then
basically take charge of distributing those and educating
individuals about how to use that equipment.
The other is to the extent to which medical services can
actually cover the cost of that equipment. So we are looking at
those models as a way of then making sure that these things are
accessible to all families.
Senator Dodd. Thank you very much.
Senator Isakson. Mr. Chairman, can I add something?
The Chairman. Please.
Senator Isakson. Senator Dodd asked a question, I know, Dr.
Arias, I believe you would be aware of this. But last year,
there was an attempt by a member of the Senate to delete in the
appropriations act for CDC a line item for what I call the
Hollywood Help Desk at CDC.
But CDC has, under Dr. Gerberding, established a working
group that works with television writers and screenwriters to
make sure that when they put health-related, safety-related,
any type incident like that that is depicted in a film, to try
and get them to depict it in the proper way, both negatively,
if it is a bad thing for someone to do, as well as positively,
if it is the right way to handle it.
So CDC has been a leader in trying to communicate with
Hollywood and television to make sure that what people are
seeing and influenced by so much at least has credible
information in it and that hopefully depict the type of outcome
we would all want to have.
The Chairman. That is good. That is useful.
Let me just ask a final question, do you look at the
Advertising Council, too? Have you tried the Advertising
Council to get them sort of involved? They take on various
projects, and they are--when they get behind it, they have got
enormous resources and interests. But it seems to me there may
very well be interest in the Ad Council. See if they would take
on something like this, you might take a look.
And we might inquire. Maybe that is a job for us to inquire
of the Ad Council, and we might be back in touch with you about
how that might be suggested, recommended. But if we could get
them involved in it, too, it might be of value and use to all
of the different groups that are doing a lot of good work.
So I guess we will follow up. I am just rambling along
here. But we will follow up with you and see if there is
something that makes some sense.
Ms. Arias. Most definitely.
The Chairman. OK. Thank you very much.
Senator Dodd. Thank you, Doctor.
The Chairman. Go ahead. You have got the second panel
there.
Senator Dodd. Alan Korn, I want to welcome you. Alan, thank
you for being here. He is the Director of Public Policy for
Safe Kids Worldwide.
We invite Justin to come on up and join us as well. Justin,
come on up here. Justin is a student from The Boys Latin School
in Baltimore, MD, and we thank Justin for joining us.
Meri-K Appy, did I pronounce that correctly? Meri-K is
President of Home Safety Council, and we thank you for being
with us.
Amber Williams is the Executive Director of State and
Territorial Injury Prevention Directors Association in Atlanta,
GA. You have got a lot of constituents here.
Senator Isakson. Absolutely. We are on top of this.
Senator Dodd. I know. Justin, how are you? You doing okay?
Good man. Good to have you with us. Got off school today. So we
can keep you talking all day. You don't have to go to school
today.
[Laughter.]
The Chairman. We have got some young observers here, back
here. Do they want to stand up? Some young children, I see them
in the second row. Are they your sisters? You are going to
introduce them for us? Good morning.
Senator Dodd. Good morning.
The Chairman. Thank you for being here.
Senator Dodd. Well, we will begin, Alan, with you. Thank
you for being with us this morning.
STATEMENT OF ALAN KORN, DIRECTOR OF PUBLIC POLICY, SAFE KIDS
USA INTERNATIONAL, WASHINGTON, DC
Mr. Korn. Sure. Thank you very much.
There we go. Safe Kids appreciates the attention this
committee has thrown toward this issue over the past 20 years.
I would be remiss if I did not point out that this committee
helped us at our launch 20 years ago--Senator Dodd, you were
chair of that subcommittee when we did it--at our 10th, 15th,
and now 20th anniversary.
This committee has played a tremendous role in helping us
with the good news that we reported earlier this week, with the
help of a lot of groups and the Federal Government. It has been
quite remarkable.
Let me just say one other thing, if I didn't point out--
with your permission, Chairman Kennedy and Senator Isakson--
point out Senator Dodd individually. Senator Dodd, you have
been thinking about and acting on these issues for 20-plus
years. It is, if I were to spend the time drawing down the list
of things that you have done on behalf of injury prevention, we
would eat up our entire time of the hearing.
This committee in particular and Senator Dodd specifically,
so we really do appreciate--
The Chairman. Is this your witness, Senator Dodd?
[Laughter.]
Senator Dodd. But he is going to be at every hearing that
I----
Mr. Korn. You always risk pointing out one particular
Senator, but it is well deserved.
The Chairman. It is well deserved.
Mr. Korn. I should say now to rebuild my reputation here a
little bit, Senator Kennedy, no one has done more, too, for
public health also. I mean, really.
The Chairman. There you go. Something nice about Johnny
Isakson over here, and he will----
[Laughter.]
We can say the same about you, Mr. Korn.
Mr. Korn. Thank you very much.
The Chairman. Well known. So thank you.
Mr. Korn. We are smack-dab in the middle of Safe Kids Week,
which Congress has helped us celebrate for many, many years,
and I will be very brief. I am not going to read my statement.
I am just going to make a few points and try to make it as
informal as possible.
We released this report earlier this week on Monday here in
Washington, DC. It has got absolutely, we believe, tremendous
news in it. It is success that all of us here and all of our
partners can be very proud of, including the CDC, the CPSC,
NHTSA, the U.S. Fire Administration, and this committee--and we
can talk about some of the things that this committee has done
under your leadership, Chairman Kennedy.
Over the past 20 years, in two decades, we have seen a
decrease of 45 percent in the death rate to children. We think
that is remarkable. In fact, I can't think of--there might be,
but there is very few of a public health issue that has had
that kind of success over that really short period of time. I
mean, it seems like a long time, but two decades, and it is
remarkable.
It says to us that we know how to prevent these injuries. I
brought a lot of visuals. If we get to them, I will be happy to
talk about them. But we know how to prevent these injuries, and
every single one of them is preventable, in our view. Always
with the glass half full, there is a little space yet to go and
it is half empty. For some reason, it is still the leading
cause of death in this country. Unintentional injury is 5,200
deaths a year.
In fact, is today May 1st? I think it is. We are starting
trauma season in this country, which is May 1st to the end of
August. Seventeen children a day will die in this country
because of an accidental injury during that time period. The
CDC and public health groups call it the trauma season, and it
is for a reason. They are all preventable.
We are celebrating Safe Kids Week this week with activities
around the country, with our support of our founding sponsor,
Johnson & Johnson, who, as you know, Senator Kennedy and Dodd,
have been with us for so long in our efforts. Doing events in
Massachusetts, in Connecticut, and Georgia--and here is my
shout-out to Georgia.
We have State and local offices all around the country. I
think a lot of our staff here is in the audience, our very best
ones are in Georgia. They really know how to do the job there.
They are doing child safety seat----
The Chairman. Have you ever thought of running for office?
[Laughter.]
Senator Dodd. As a Democrat.
Mr. Korn. I see what happens, and I am not so sure I want
to expose myself to that. But they are doing child safety seat
checkup events. They are doing bicycle helmet checks this week
and giveaways, personal flotation device giveaways, and they
are very good.
That is the type of thing that Dr. Arias was mentioning,
about that collaboration, that partnership to get the job done.
I will defer to my other colleagues here.
[The prepared statement of Mr. Korn follows:]
Prepared Statement of Alan Korn
My name is Alan Korn, and I am the Director of Public Policy and
General Counsel for Safe Kids USA, a member country of Safe Kids
Worldwide. Safe Kids thanks the Senate Health, Education, Labor, and
Pensions Committee, and in particular Chairman Kennedy and Ranking
Member Enzi for holding a hearing on childhood injury prevention. We
have all come a long way over the past 20 years in protecting children
from unintentional injuries and deaths. Despite the many successes,
``accidents'' are still the No. 1 killer of children ages 1-14 in the
United States. Clearly there is so much more to do. Safe Kids hopes
that the attention fostered by both the roundtable and the activities
surrounding Safe Kids Week 2008 will prove to be the catalyst we all
need to redouble those efforts that we know work, improve upon others
that missed the mark and try new initiatives, both government-based and
otherwise, that hold the promise of saving children's lives.
i. history of safe kids worldwide
Safe Kids Worldwide is the first and only international
organization dedicated solely to addressing an often under recognized
problem: More children ages 1-14 in the United States are being killed
by what people call ``accidents'' (motor vehicle crashes, fires,
drownings and other injuries) than by any other cause. Formerly known
as the National SAFE KIDS Campaign, Safe Kids Worldwide unites more
than 450 coalitions in 16 countries, bringing together health and
safety experts, educators, corporations, foundations, policymakers and
volunteers to educate and protect families against the dangers of
accidental injuries. Our USA network includes coalitions in all 50
States and the District of Columbia, including outstanding programs in
both Massachusetts and Wyoming.
Founded in 1987 by the Children's National Medical Center and with
support from Johnson & Johnson, Safe Kids Worldwide and its member
country, Safe Kids USA, relies on developing injury prevention
strategies that work in the real world--conducting public outreach and
awareness campaigns, organizing and implementing hands-on grassroots
events, and working to make injury prevention a public policy priority.
This year marks our 20th anniversary of our efforts, which has
resulted in the significant reduction of accidental childhood injury-
related deaths in the United States. We have, over the years,
reinforced the ways that parents, caregivers, State and Federal
policymakers, and communities can continue to promote children's
safety. We have released a comprehensive report to the Nation
demonstrating how far we have come in 20 years, and how far we still
have to go. In addition, the week of April 26-May 4, is Safe Kids Week
and Safe Kids coalitions across the country will be holding local
community outreach events to spread awareness about child safety, such
as bike helmet rodeos, health fairs and car seat check up events.
The ongoing work of Safe Kids coalitions reaching out to local
communities with injury prevention messages has contributed to a
decline in the childhood unintentional injury death rate since 1987.
However, with more children dying from accidental injury than from
cancer, heart disease and birth defects, Safe Kids Worldwide and its
member countries remain committed to reducing unintentional injury by
implementing prevention strategies and increasing public awareness of
the problem and its solutions.
Safe Kids has been proud to work with the Senate Health, Education,
Labor, and Pensions Committee over the years to increase the knowledge
and understanding of proper child safety practices. This committee has
addressed childhood accidental injury through hearings and media
outreach events for Safe Kids' other milestones, such as our launch in
1988 and our 10th and 15th anniversary celebrations. We thank the
committee once again for being a part of Safe Kids' history and most
importantly, for helping us to promote programmatic, educational and
legislative interventions to ensure that every child in this country is
protected from their most serious public health problem--accidental
injury.
ii. findings from safe kids' report to the nation: trends in
unintentional childhood injury mortality and parental views on child
safety
A. Safe Kids USA's 2008 Report
Safe Kids marked our anniversary by releasing a comprehensive
report to the Nation demonstrating how far we have come in 20 years,
and how far we still have to go. Entitled, Report to the Nation: Trends
in Unintentional Childhood Injury Mortality and Parental Views on Child
Safety, the report examines accidental injury in the United States and
its impact on children by age, gender and race, and reviews the changes
in unintentional injury fatality rates for children ages 14 and under
in areas such as motor vehicle occupant injuries, drownings and
suffocation (which includes strangulation and choking).
B. Major Findings
Major findings from the report include:
1. The unintentional childhood injury fatality rate among children
ages 14 and under has decreased in the United States by 45 percent
since 1987.
2. Despite this decline, unintentional injury remains the leading
cause of death among children ages 1 to 14 in the United States. In
2005, 5,162 children ages 14 and under died from an unintentional
injury, and 6,253,661 emergency room visits for unintentional injuries
in this age group occurred in 2006.
3. The unintentional injury fatality rate has declined in most risk
areas. Some of the greatest improvements have been made in prevention
of bicycle injuries (down 73 percent), fire/burn injuries (down 68
percent) and pedestrian injuries (down 62 percent). The four leading
causes of death from accidental injuries to children 14 and under are
suffocation (19 percent), motor vehicle occupant injuries (16 percent),
drownings (16 percent) and pedestrian incidents (11 percent).
4. Unfortunately, the suffocation rate has a documented increase of
21 percent. This is largely the result of a re-categorization of the
cause of death driven by an improvement in the quality of death scene
investigations that is occurring at various levels across the country.
Previously, many of these deaths were categorized as Sudden Infant
Death Syndrome (SIDS). With the improved investigations, more cases are
being seen where a child suffocates from soft pillows, mattresses, or
mattress coverings in his/her crib or from bed-sharing with a parent.
5. Children ages 4 and under have the highest fatality rate as well
as the highest number of deaths (2,747 in 2005). Between 1987 and 2005
there has been a 35 percent decrease in fatal unintentional injuries in
this group.
6. The fatality rate from unintentional injury is higher among
males than females, as is the actual number of deaths. In 2005,
approximately 3,000 boys and 2,000 girls ages 14 and under died from
unintentional injury.
7. There are large disparities between the fatality rates among
children of different races and ethnicities. American Indian/Alaskan
Native children have the highest fatality rate from unintentional
injury at 15.3 per 100,000, and Asian/Pacific Islander children have
the lowest fatality rate at 4.24 per 100,000. These disparities have
been consistent since 1987.
8. Fatality rates from unintentional injury declined in each of the
four regions of the United States between 1987 and 2005. The largest
decrease, almost 60 percent, was in the Northeast, while the Midwest
had the smallest decrease, 40 percent. Since 1987, the South has
consistently had the highest rate of fatality, 10 per 100,000 in 2005,
and the Northeast has had the lowest, 4.56 per 100,000.
iii. advancements in child safety over the years
While the fatality rate in the United States from unintentional
injury in children ages 14 and under has declined by 45 percent since
1987, and significant progress has been made in most risk areas, there
is still a long way to go. Every year, more than 5,000 American
children ages 14 and under die from unintentional injury. Deaths from
suffocation, motor vehicle crashes and drowning still represent a
majority of these deaths--and the vast majority of these deaths could
have been prevented.
A. Motor Vehicle Occupant Safety
1. Problem: Car crashes pose a significant risk for injuries and
death to children. Although the motor vehicle occupant death rate among
children ages 14 and under declined 49 percent from 1987 to 2005, motor
vehicle crashes remain the leading cause of death among children ages 3
to 14 in the United States. In 2005, an estimated 842 children ages 14
and under died unintentionally as motor vehicle traffic occupants.
Additionally, in 2006 an estimated 190,346 emergency room visits were
for motor vehicle traffic occupant injuries to children ages 14 and
under.
In addition to motor vehicle crashes, children are also at risk of
injury or death from being left unattended in closed vehicles. Each
year from 1998 to 2004, an estimated 33 children died from heat stroke
after being left unattended in a vehicle. Between 1987 and 1998 there
were 19 reported deaths to children under age 7 due to car trunk
entrapments, where children were playing in the trunk and closed the
door. Children can also be backed over by unknowing drivers; from 2001
to 2003 approximately 7,475 children (2,492 per year) aged 1 to 14
years were treated for non-fatal motor vehicle backover injuries in
emergency departments. Most backovers occurred at either home or in
driveways or parking lots; 47 percent occurred at home, and 40 percent
occurred in driveways or parking lots.
2. Solution: The increased use of car seats has contributed to the
reduction in injury and death rates from motor vehicle accidents. Adult
seat belts do not adequately protect children under age 8 from a crash
injury so car seats, when used appropriately, are the most effective
safety devices to protect children. Research demonstrates that
correctly installed car seats can reduce fatal injury by 71 percent for
infants less than 1 year of age and by 54 percent for toddlers ages 1
to 4. Booster seats for older children reduce the risk of injury by 59
percent. It is recommended that children ride on booster seats, in the
rear seats of a vehicle, until they reach 49" in height and weigh
between 80-100 pounds. Many children are moved prematurely to seat
belts when they should still ride on booster seats.
a. Education: The nationwide proliferation of car seat education
and distribution programs--and in particular, increased availability of
child restraint inspection/
installation opportunities utilizing certified technicians--has
increased the prevalence and proper usage of these vital safety
devices.
Safe Kids has a national program sponsored by General Motors to
educate parents and caregivers about the importance of properly
restraining children on every ride. Since 1996, the General Motors
Corporation has served as Safe Kids Buckle Up's exclusive funding
source and helped build Safe Kids Buckle Up into a multifaceted
national initiative, bringing motor vehicle safety messages to children
and families through community and dealer partnerships. In October
2004, Chevrolet became the lead partner of Safe Kids Buckle Up,
bringing an added dimension to the promotion of Safe Kids Buckle Up
activities.
Since the program's inception, more than 13 million people have
been exposed to Safe Kids Buckle Up events and community outreach
efforts, and child passenger safety specialists have examined more than
915,250 seats and donated 365,000 seats to families in need. The
program includes car seat check up events, mobile car seat check up
vans, child safety seat inspection stations, child safety seat
distribution programs, technical child passenger safety trainings,
educational workshops, legislative and enforcement efforts to enact or
publicize child restraint laws and a toll-free hotline for parents and
caregivers to access child safety information.
b. Enactment and Enforcement: Over the years improvements in child
occupant protection and safety belt laws have proven effective at
increasing restraint use and protecting children. The first child
occupant protection law was passed in Tennessee in 1978. Since then,
all States have passed laws requiring young children be restrained in
car seats in motor vehicles. The first booster seat law to protect
older children went into effect in California on January 1, 2002. Since
then, 43 States, including Washington, DC, have improved upon their
restraint law to require some older child passengers to ride properly
restrained in a booster seat. Significantly, Massachusetts became the
last State in the Northeast to pass a booster seat law. Governor Deval
Patrick signed the bill into law on April 11, 2008. Wyoming passed
their law in 2003 and has one of the strongest child passenger safety
laws in the Nation.
Primary enforcement of seat belt laws is also important. Currently,
seat belt use laws in only 26 States and the District of Columbia are
subject to primary enforcement. These laws allow a citation to be
issued if a police officer simply observes an adult or child riding
improperly without a safety belt. Primary enforcement has proven
effective in increasing restraint use for both adults and children. In
2007, seat belt use was 87 percent in primary law States versus 73
percent in secondary law States.
In addition, several States have enacted safety laws that protect
children in and around cars, including 14 States that prohibit leaving
children unattended in a motor vehicle.
The National Highway Traffic Safety Administration has also
contributed greatly to the success. Improvements to the Federal Motor
Vehicle Safety Standard Number 213, the LATCH system of car seat
installation, ease of use ratings for child safety seats--along with
their many government-funded public education campaigns supported by
the 2005 Federal SAFETEA-LU (Safe, Accountable, Flexible, Efficient
Transportation Equity Act: A Legacy for Users) law--have made child
safety seats more effective, user-friendly and has helped Safe Kids
spread the important message of consistent and correct car seat usage.
In addition, the National Transportation Safety Board has helped
promote this vital message. Their Most Wanted List of Traffic Safety
Improvements has consistently included the recommendation for State
governments to upgrade their child passenger safety laws. The Board has
taken a strong role in encouraging these changes through their Advocacy
Center.
B. Bicycle and Wheeled Sports Safety
1. Problem: Although the bicycle unintentional injury death rate
among children ages 14 and under declined by 73 percent from 1987 to
2005, bicycle injury remains a major cause of child mortality and
morbidity. In 2005, an estimated 121 children ages 14 and under died
from unintentional bicycle injuries. Additionally, in 2006 an estimated
226,409 emergency room visits by children 14 and under were for
unintentional bicycle-related injuries.
Other wheeled sports such as skateboarding and skating continue to
grow in popularity, and a significant rate of child injury is
associated with these activities. According to the U.S. Consumer
Product Safety Commission (CPSC), in 2004, more than 46,200 emergency
room visits by children 5 to 14 years old were for injuries from inline
skating and roller skating. In the same year, more than 43,100
emergency room visits by children 14 and under were for injuries
involving non-powered scooters. Nearly 60,300 emergency room visits by
children 5 to 14 years old were for skateboarding injuries. The most
serious injuries and many of the deaths are due to head injuries.
Quite simply, not enough children are wearing helmets and other
protective gear when using bikes, scooters, in-line skates or
skateboards.
2. Solution: Public health interventions such as education about
the proper use of a bicycle helmet, safety campaigns, and environmental
changes, have likely helped reduce the child injury death rate from
bicycle and other wheeled sports. Bicycle helmets can help protect
children from head injuries while participating in bicycle and wheeled
sports. In fact, bicycle helmets are 88 percent effective in preventing
serious brain injury, yet fewer than half of bicycle riders wear one.
a. Education: In addition to promoting helmet use, advocates and
researchers recommend creating a comprehensive bicycle safety campaign
that includes education about safe riding practices and provides
helmets at a discounted cost to those in need. Community-based
interventions that include making environmental changes, educating
children about helmets and safe riding practices, and enforcing bicycle
helmet laws, have proven to increase helmet use and decrease bicycle
injuries.
Environmental changes that make streets safer also protect children
when they are biking, skateboarding, or skating. A nationwide coalition
of diverse members and organizations is currently pushing for States,
cities and towns to build road networks that include safety
improvements. This coalition stated that a recent survey found 71
percent of adults walked or rode their bicycles to school as a child,
but only 17 percent of their own children currently do so. Although
decreased biking also decreases a child's risk of injury, the goal is
to increase participation in these activities among children in a safe
way. More children are likely to bike to school when there are
sidewalks or footpaths, safe street crossings, and when there are
enforced school zones of vehicle speed.
b. Enactment and Enforcement: Legislation requiring helmet use and
strict enforcement has positively impacted bicycle helmet use among
children. California had the first State helmet law, which became
effective in 1987. The enactment and enforcement of mandatory helmet
legislation for children (in 21 States, the District of Columbia and
over 150 localities across the United States) has likely contributed to
the decline in bicycle-related injuries and deaths from 1987 to 2000.
Various studies have shown bicycle helmet legislation to be
effective at increasing bicycle helmet use and reducing bicycle-related
death and injury among children covered under the law. One study showed
that in the 5 years following the passage of a State-mandatory bicycle
helmet law for children ages 13 and under, bicycle-related fatalities
decreased by 60 percent. Police enforcement increases the effectiveness
of these laws. In addition, eight States and Washington, DC now require
children to wear a helmet while participating in a wheeled sport (e.g.,
scooters, inline skates, skateboards). Other States should follow suit.
Over the years, helmets used by children and required by State and
local laws have become much more effective. In 1994, Congress required
the CPSC to establish performance standards for bike helmets. These
better engineered helmets have contributed to our success in lowering
the injury death rate.
In addition, the enactment of SAFETEA-LU included the establishment
of Safe Routes to Schools, a federally funded program designed to make
it safer for children to walk or bike to school. Through this program
and with grant monies, States can fix sidewalks, execute traffic-
calming and speed-reduction measures, improve pedestrian and bicycle
crossings, and conduct public education campaigns to encourage children
to walk or bike to school.
C. Poisoning Prevention
1. Problem: The childhood unintentional poisoning death rate among
children ages 14 and under declined 42 percent from 1981 to 1987 and
has continued to decline by 21 percent since 1987. However,
unintentional poisoning is still a serious threat to young children. In
2005, an estimated 92 children ages 14 and under died from
unintentional poisonings. Additionally, in 2006 an estimated--71,649
emergency room visits were for unintentional poisoning injuries to
children 14 and under. In 2005 nearly 63,000 children under age 5 were
treated for unintentional medication poisoning. More than 1.2 million
unintentional poisonings among children ages 5 and under are reported
to U.S. poison control centers. In addition, according to the Centers
for Disease Control and Prevention, from 1999-2004, 135 children ages
14 and under died from unintentional, non-fire related CO poisoning.
Carbon monoxide is a hidden hazard for children and families. CO is
produced when any fuel is incompletely burned--potentially resulting in
flu-like illnesses, such as dizziness, fatigue, headaches, nausea, and
irregular breathing. Common fuel-burning appliances, like furnaces,
stoves, fireplaces, clothes dryers, water heaters, and space heaters
can produce lethal amounts of CO under certain conditions. Carbon
monoxide poisoning mimics other illnesses so it can sometimes be
difficult to diagnose. CO poisoning symptoms include headache,
dizziness, weakness, nausea, vomiting, chest pain, confusion, loss of
consciousness and death to unborn babies. Infants are more susceptible
to the effects of CO. Carbon monoxide detectors are essential to have
in homes and are effective in preventing deaths from carbon monoxide
exposure.
Lead paint poisoning is an additional danger to children. In
children, lead poisoning can cause brain damage, impair mental
functioning, retard mental and physical development and reduce
attention span. Because the early symptoms of lead poisoning are easy
to confuse with other illnesses, it is difficult to diagnose lead
poisoning without medical testing. Early symptoms may include
persistent tiredness, irritability, loss of appetite, stomach
discomfort, reduced attention span, insomnia, and constipation. Failure
to treat children in the early stages can cause long-term or permanent
health damage.
2. Solution: A multitude of factors have contributed to the reduced
number of deaths from poisonings, including child-resistant packaging
for medications and household cleaning products, educational programs,
increased accessibility of poisoning prevention information, and
treatment/care advances. For unintentional medication exposures,
manufacturers are being encouraged to further improve container
designs, allowing more convenient access for the user, especially
seniors, while also serving as a barrier to children gaining entry.
Intensive efforts to reduce lead in consumer products such as
gasoline and paint have helped to protect children from lead poisoning.
However, lead paint continues to be an issue in older homes, especially
in low-income apartment buildings, where children can ingest paint
chips or inhale paint dust. Children also can be poisoned by lead if
they lick their fingers after they interact with products that are
coated with lead paint. Recently, lead paint in toys has posed a risk
to children. Significant news coverage and outreach by nonprofits about
lead in toys has likely increased awareness of this issue.
a. Education: The Nation's 70 poison control centers historically
operated with distinct phone numbers for each center. A big advancement
has been the creation of a new nationwide toll-free number for poison
control centers. The hotline (1-800-222-1222) was established through
the passage of the Poison Control Center Enhancement and Awareness Act
of 2000, a law which originated in the Senate HELP Committee with the
leadership of Senators Kennedy and DeWine, among others. The hotline is
available 24 hours a day and 7 days a week to provide assistance with
poisoning emergencies, questions about a specific poison, or
information about poison prevention, no matter where the caller is
from.
In addition to emergency response, these centers perform public
education, professional education, data collection and referral
resources--services which are all supported by the Federal Act.
b. Enactment and Enforcement: The enactment of laws has protected
children from unintentional poisoning. The Poison Control Center
Enhancement and Awareness Act of 2000 also provided much needed funding
to the centers which were on the verge of having their doors shut due
to budget shortfalls. In addition, the issuance of the U.S. Food and
Drug Administration regulation requiring iron-containing products to
carry a warning about the acute poisoning risk to children has been
important in protecting kids from poisoning.
The Federal Government has also banned paint that contains a
certain amount of lead. The ban protects children from lead poisoning
that can occur by ingesting paint chips or inhaling paint dust. The
regulation also includes toys or other children's products as well as
furniture with lead paint.
The Poison Prevention Packaging Act of 1970, administered by the
CPSC, mandated child resistant packaging for hazardous products such as
drugs, certain household cleaners, and some residential use portable
fuels. The purpose of the act is to protect children under age 5 from
poisonings and deaths that occur when they open containers of hazardous
products, and eat or drink the contents. The act has been credited with
reducing prescription medication deaths in children less than 4 years
of age by 45 percent from 1974 to 1992.
In addition, 14 States and some local jurisdictions have passed
legislation requiring the use of carbon monoxide detectors in some
homes. However, most State carbon monoxide detector laws only apply to
newly constructed residences, reinforcing the need for legislation that
applies to all homes.
D. Fire and Burn Safety
1. Problem: The unintentional fire/burn death rate among children
ages 14 and under declined by 68 percent from 1987 to 2005, yet fire
and burn injury remains the fifth leading cause of child unintentional
injury-related death. In 2005, an estimated 467 children ages 14 and
under died from unintentional fire/burn injuries. Fire and flames
accounted for 460, or 99 percent, of these deaths. Additionally, in
2006 an estimated 98,760 emergency room visits were for unintentional
fire/burn injuries to children ages 14 and under including scald,
thermal, chemical and electrical burns. Scald burns, caused by hot
liquids or steam, are more common types of burn-related injuries among
young children, compared to contact burns, caused by direct contact
with fire, which is more prevalent among older children.
The majority of scald burns children experience, especially in ages
6 months to 2 years, are from hot foods and liquids spilled in the
kitchen or wherever food is prepared and served. Hot tap water accounts
for nearly 1 in 4 of all scald burns among children and is associated
with more deaths and hospitalizations than any other hot liquid burns.
Because younger children have thinner skin, their skin burns at lower
temperatures and more quickly than adult skin does.
2. Solution: There are many factors likely involved in the downward
trend of the child death rate from fire and burn injuries. Most home
fires started by children begin with playing with lighters or matches
and the most common items ignited are mattresses, bedding, clothing,
upholstered furniture, trash or papers. Fortunately, there has been a
decline in the number of fires set by children playing with lighters
and matches, most likely as a result of lighters being subject to a
consumer product safety standard that requires them to be child
resistant. However, parents still need to be educated to store matches
and lighters out of children's reach, preferably in a locked cabinet.
a. Education: In addition, smoke alarms, which cut the chances of
dying in a residential fire nearly in half, have been promoted as an
invaluable tool for preventing fire and burn injury. According to data
from the National Fire Incident Reporting System (NFIRS) and the
National Fire Protection Association's (NFPA) annual fire department
experience survey, 96 percent of U.S. homes report having at least one
smoke alarm. However, 47 percent of fire deaths in one- and two-family
dwellings and 15 percent of apartment fire deaths resulted from fires
with no smoke alarms present, reinforcing the need for continued
promotion of smoke alarms in homes.
Another factor involved in the downward trend of reduced fire and
burn-related deaths include intensive public education campaigns by
Federal agencies such as the CPSC and U.S. Fire Administration, non-
profit advocacy groups like Safe Kids, the National Fire Protection
Association, the Home Safety Council and the thousands of committed
fire departments that promote residential fire safety and burn
prevention. Efforts to educate parents about the importance of checking
smoke alarm batteries monthly as well as grassroots activities that
distribute smoke alarms have made a difference. These efforts must be
continued, with the help of the Federal Government, since most of the
deaths and injuries to children happen in residential fires in homes
with no smoke alarms.
Methods to reduce scald burns include lowering hot water
temperatures to 120 degrees and keeping hot fluids and liquids away
from children, especially when cooking. Educational efforts around
these messages to parents may have contributed to a decline in burn-
related deaths.
b. Enactment and Enforcement: The 1994 child-resistant lighter
standard established by the CPSC and the agency's regulations requiring
that children's sleepwear be flame resistant and self-extinguish if a
flame causes it to catch fire have reduced fire-related deaths. Since
the lighter standard has been in effect, the number of child-play
lighter fires has declined 58 percent and the number of deaths and
injuries associated with these fires has declined by 31 percent and 26
percent, respectively.
For smoke alarms, all States and the District of Columbia have laws
that require smoke alarms to be used in both new and existing
dwellings.
E. Drowning Prevention
1. Problem: Although the childhood drowning death rate declined by
49 percent from 1987 to 2005, fatal drowning remains the second-leading
cause of unintentional injury-related death for children ages 1 to 14
years. In 2005, 810 children ages 14 and under died from unintentional
drowning, and in 2006, an estimated 3,771 emergency room visits were
for unintentional drowning injuries to children ages 14 and under. As
many as 20 percent of near-drowning survivors suffer severe, permanent
neurological disability. Infants less than 1-year-old drown in
bathtubs, buckets, or toilets most often, while the majority of child
drownings between ages 1 to 4 occur in residential swimming pools.
Older children drown more often in open bodies of water.
In swimming pools and spas, the suction from drain outlets is
strong enough to cause entrapment of hair or body parts, and children
cannot free themselves. From 1985 to 2004, at least 33 children ages 14
and under died as a result of entrapment in a pool or spa drain, and
nearly 100 children ages 14 and under were injured. However, because
entrapment is generally a little-known risk for drowning, it is
possible that many drowning deaths have not been classified as
entrapment and as a result, the number of fatalities could be much
higher than reported.
2. Solution: Many factors have contributed to the decrease in the
childhood drowning rate, including water safety public education
efforts, the passage of critical pool/spa and boating safety laws and
the decreased use of alcohol in and around water. Advances in emergency
medical services and increased training of the public in
cardiopulmonary resuscitation (CPR) for drowning incidents also have
likely contributed to the downward trend.
a. Education: Despite successes in reducing the death rate from
drowning, there is still much that can be done to protect children.
Nearly 9 out of 10 fatal drowning events occur during a brief lapse in
supervision. Most children who drown in swimming pools were last seen
in the home, had been missing from sight for less than 5 minutes and
were in the care of one or both parents at the time of the drowning.
Very young children can drown when they wander outside and fall into
their own or other's backyard pools. These research results emphasize
the need for pool fencing, swimming lessons for children, and active
supervision by parents and caregivers. The installation and proper use
of four-sided fencing could prevent 50 to 90 percent of residential
swimming pool drownings and near drownings of children.
A specific type of pool/spa drowning known as entrapment cannot be
prevented with supervision as the force of the drain's suction is too
strong for many adults to remove a child. Entrapments can be prevented
by using proper devices, such as anti-entrapment drain covers, a safety
vacuum release system, and a multiple drain or no-drain system.
For children ages 10 to 14, recreational or open water settings
(such as lakes, rivers, or the ocean) pose a higher risk representing
the majority of drownings for this age group. From 1999 to 2003, it is
estimated that 85 percent of boating-related drownings could have been
prevented if the victim had been wearing a life jacket, however a Safe
Kids 2007 Parent Survey showed that only 76 percent of parents
consistently have their child wear a life jacket when they are in or
near a lake, river or ocean. These statistics emphasize the need for
educating parents and caregivers on the importance of consistent use of
life jackets when children are boating or playing in or near open
bodies of water.
Life jacket loaner stations are an effective way for communities to
provide education and safety devices to parents and children. The
stations consist of life-jacket loaner boards from which families can
borrow a life jacket for their child before heading out on the open
water. In Alaska, 75 percent of children under 18 used life jackets at
loaner sites compared to 50 percent at non-loaner sites and have
reported 12 lives saved.
b. Enactment and Enforcement: There have been laws passed in many
States to protect children from unintentional drowning. Ten States have
safety laws requiring fencing around residential swimming pools and
many local jurisdictions also have fencing or barrier ordinances. Five
States have laws designed to prevent entrapment-related incidents for
residential swimming pools. These generally consist of requiring anti-
entrapment safeguards, such as the installation of drain covers or
multiple drains. The Virginia Graeme Baker Pool and Spa Safety Act, a
Federal law passed in December 2007, provides an incentive for States
to pass comprehensive laws requiring safeguards for pools and spas,
such as barriers/fences and anti-
entrapment devices. The law also requires the establishment of a safety
standard for anti-entrapment drain covers; public pools and spas to be
equipped with anti-entrapment drain covers and other layers of
protection, such as safety vacuum release systems; and a Federal
Government-implemented national drowning prevention education program.
Forty-seven States and the District of Columbia have enacted
boating safety laws that require children to wear life jackets while
participating in recreational boating and in 2002, the U.S. Coast Guard
issued a rule requiring children under 13 wear life jackets while
aboard recreational vessels in Coast Guard waters.
iv. safe kids usa's call to action
Despite the reduction in the child injury death rate, more work
still needs to be done in order to address the leading killer of
children ages 1-14 in this country. Safe Kids USA is calling on
national and State governmental leaders to recognize that accidental
injury is the #1 threat to the Nation's children, and in response, to
marshal a multi-faceted effort (similar to what the Nation has done to
address drunk driving and smoking cessation) to eliminate this serious
public health threat.
A. Federal Efforts Needed
Specifically, Safe Kids is urging the Federal Government to
implement a number of steps to keep kids safe:
1. Congress and the President should continue and increase efforts
to modernize the operations and facilities of the U.S. Consumer Product
Safety Commission (CPSC) so that it can better fulfill its critical
mission of protecting consumers, especially children, from dangerous
products. This includes swift passage and enactment of the CPSC's
pending reauthorization legislation (H.R. 4040/S. 2663).
2. Congress and the President should target increased funding to
the several Federal agency programs charged with promoting and
improving child safety. These include programs housed at agencies, such
as the National Highway Traffic Safety Administration (NHTSA), the
United States Fire Administration (USFA) and the National Center for
Injury Prevention and Control (NCIPC) at the Centers for Disease
Control (CDC).
3. Congress should continue its aggressive oversight of the Federal
agencies charged with protecting children from unintentional injury to
ensure each agency is properly meeting its mission.
4. Congress and the President should support full funding to the
programs recently authorized by the Virginia Graeme Baker Pool and Spa
Safety Act (P.L. 110-140). This would allow the CPSC to properly and
fully implement the State law advocacy grant program that is designed
to motivate States to pass or improve pool and spa safety laws by
requiring ``layers of protection'' that prevent drowning and
entrapments (i.e., four-sided isolation fencing, anti-entrapment drain
covers, safety vacuum release systems, among other safety devices).
Congress and the President should also provide the necessary funds to
implement the critical pool and spa safety education program required
by the law.
5. Congress and the President should fully fund, and Federal
agencies should continue to support, incentive grants programs that are
designed to encourage States to pass child safety laws, such as primary
safety belt enforcement, booster seat and pool/spa safety legislation.
6. Congress and the President should, through existing programs and
the creation of new authorities, ensure that life-saving child safety
devices (car seats, carbon monoxide detectors, smoke alarms, pool/spa
anti-entrapment drain covers, for example) are available at no cost (or
low cost) to disadvantaged families that could not otherwise afford
them.
7. Congress, Federal agencies and injury prevention stakeholders
should work together to improve consumer product recall effectiveness
so that dangerous products are quickly removed from retail store
shelves, homes, day care centers and re-sale shops.
8. The U.S. Surgeon General, America's chief health educator,
should focus the Nation's attention on childhood accidental injury by
issuing an official public health report on unintentional injuries and
deaths and how, collectively, we can prevent them. This report should
be a catalyst to generate a major public health initiative in the
Office of the U.S. Surgeon General.
B. State Efforts Needed
Safe Kids also believes that there is a role for State government
officials to promote proper child safety practices:
1. Safe Kids calls on State legislatures and governors to enact:
a. Laws that require all children to be appropriately buckled in a
child safety seat (infant seat, forward facing child safety seat or
booster seat) or seat belt in the back seat of motor vehicles; and
b. Laws that make it unlawful to leave a child unattended in a
motor vehicle even for a short period of time.
2. State legislatures should address bike crashes by passing or
improving child helmet use laws in all 50 States for all wheeled
activities (i.e., bicycles, scooters, skateboards and in-line skates).
3. State legislatures should address carbon monoxide poisoning by
passing carbon monoxide detector use laws in all 50 States that require
detectors in all residences, day care centers, hotels/motels and
schools.
*Please note that the penalties for violations of these safety
device use laws (items 1-3) should be high enough to provide an
economic disincentive for non-compliance.
4. State governors and legislatures should ensure that their
respective State public health agencies have adequate funding streams
to support the country's injury prevention departments. For the last
several years, funding has been reduced for State agencies to address
unintentional injury prevention. An adequately funded State public
health agency is the cornerstone of a State government's commitment to
preventing accidental childhood injury.
v. conclusion
As childhood unintentional injuries and deaths still exist and can
be prevented, parents, caregivers, State and Federal policymakers, and
communities must make children's safety a priority. Safe Kids commends
Chairman Kennedy and Ranking Member Enzi, along with the other members
of this committee, for their support of child safety and safer
environments for children. We look forward to working with this
committee on any efforts designed to protect children from accidental
injury and death.
Senator Dodd. Terrific. Great work. Good.
Justin, welcome.
STATEMENT OF JUSTIN BRUNS, STUDENT, THE BOYS LATIN SCHOOL OF
MARYLAND, BALTIMORE, MD
Mr. Bruns. Good morning. My story starts, I was in
Breckenridge with our friends the Mulroys. Shawn and I woke up
early one morning, and we went to go get our lift tickets for
the day. It was a beautiful day, and everything was going
great. We were doing the terrain park all day, no problem.
So our last run of the day, we decided that we wanted my
dad to film us so we could put it on YouTube or something. So
we were all tired, and it probably wasn't a good idea to do one
more run.
We did the first two rails fine, and the last rail was the
kinked rail, which is one of the toughest rails there. When
you're going up to a kinked rail, you have to be leaning
forward, and I was leaning back, and the board slipped out from
under me, and I nailed my head on the packed snow.
I got knocked unconscious and woke up a few minutes later
with all of the people around me, not really sure what was
going on. They took me to the hospital, and they found trace
blood in the left side of my brain. I was in the hospital for 3
days, not really feeling any pain because I was on morphine and
all of these painkillers, luckily.
But when I got out, all I could have was Tylenol, and I had
headaches for at least 2\1/2\ weeks after, and it was probably
the worst couple weeks of my life. The pain was crazy, and in
school, I only could go 2 to 4 hours a day because the doctor
said the more you concentrate, the worse you can make the
injury.
So that was hard catching up. But the teachers, luckily, I
have a good relationship with them, and they made it really
easy for me to get back. My grades didn't drop too much. So
that was good.
Excuse me, I was out of sports for 8 weeks and anything
active. I am an athlete, and I like to go full all the time. So
it was hard to stop doing that for 8 weeks.
Luckily, I am back now, and I haven't had a headache or
anything in at least 5 weeks, or any symptoms. So I am happy I
was wearing a helmet because it saved my life.
[The prepared statement of Mr. Bruns follows:]
Prepared Statement of Justin Bruns
Good Morning, my name is Justin Bruns. I am an eighth grader from
Baltimore, MD. I want to thank Chairman Kennedy, Senator Enzi and other
distinguished members of the HELP Committee for inviting me to testify
about this important topic and tell my story of how a helmet saved my
life in a snowboarding accident.
This past winter my family and I went to Colorado for President's
Day weekend. We went to visit friends and family and go skiing/
snowboarding. On Saturday, February 16, I got up early to go
snowboarding with my friend Shawn. We were having a great day and the
runs were amazing. As the end of the day neared we decided to film
ourselves while boarding in the terrain park. My dad came along and
offered to film the two of us. It was to be the last run of the day on
probably the toughest rail of the day. It was a kinked downhill rail
and it was very long. It was a little intimidating and I was a little
freaked out. I guess I wasn't leaning forward enough and the board
slipped out from under me and I nailed my head on the snow.
I don't remember the fall or going up the rail for that matter. A
few minutes later I came to and I was on a backboard with a neckbrace
on being taken down the mountain by ski patrol. They took me to the
local Medic Center. They did a CT scan and found traces of blood. The
doctors decided I needed to go to the hospital in Denver--St.
Anthony's. I was admitted to the Trauma unit. I had to stay in the unit
for 3 days and 2 nights. I was happy when I finally got released Monday
afternoon.
I went back to Baltimore the next day--Tuesday. My parents were
really worried about how I was doing/feeling. I had headaches and was
tired for the next couple of weeks. I was only allowed to take Tylenol
to relieve the pain. My parents told my teachers about my accident.
School was helpful and accommodating about how I was feeling. I had
trouble with reading and taking notes. Doing both of these almost
always gave me a headache in the first couple of weeks after the
concussion.
I had to see a couple of doctors over the next 4-5 weeks. I had to
stay out of all sports until my doctor in Baltimore said it was okay to
play sports. After 7\1/2\ weeks I was finally told it was okay to play
lacrosse. This was the worst time of my life but I am sure glad I had
my helmet on. I can't imagine what things would be like for me if I
hadn't.
Senator Dodd. Terrific. Well, that is great. Thank you very
much.
The Chairman. What do you think would have happened to you
if you weren't wearing your helmet?
Mr. Bruns. I probably wouldn't be the same person, or the
doctor said I could have died.
The Chairman. Have you always worn your helmet?
Mr. Bruns. I have. My parents are ``helmet Nazis.''
[Laughter.]
Senator Dodd. Clean up that record here.
[Laughter.]
The Chairman. Good for them, I guess. OK, thanks.
Do most of your friends wear helmets?
Mr. Bruns. No. Only one of them, who I just met like this
school year. But besides that, none of my other friends wear
them.
The Chairman. What do they say? It is not cool, or what do
they----
Mr. Bruns. They don't really say anything to me, but I just
don't like wearing one, I guess. I feel kind of weird wearing
one. But now I do because I know what can happen.
The Chairman. Do you feel now, do you ever suggest to any
of these other kids that they might think about it, too?
Mr. Bruns. I don't want to nag them about it, but I told
them what happened, and I think they are a little more afraid.
The Chairman. There you go. That is a nice way of doing it,
too. You get the example that you set, and they see that you
are having a good time and a safe time. It may make a
difference to them. It certainly does.
We have your mom here.
Mr. Bruns. Yes.
The Chairman. We want to thank you. You wrote a statement
as well, and we are going to put that in the record. It is a
wonderful, wonderful statement. Very, very appreciative of
spelling this out. It was very powerful and very moving, and we
are very, very grateful. It will be very helpful to the people.
[The prepared statement of Ms. Bruns follows:]
Statement of Kathleen Bruns, Mother of Justin Bruns
On February 16 of this year my husband and I experienced a
situation I hope very few parents ever go through. Our 14-year-old son,
Justin, had a snowboarding accident while boarding with his father and
his friend Shawn. Justin took a hard spill off of a rail in a terrain
park while boarding in Breckenridge, CO. Bob and I are adamant about
helmet use and thankfully for Justin, he had his on.
Justin suffered a stage 3 concussion. This means he was knocked
unconscious and had some memory loss. In Justin's case it was about 3-5
minutes. This stage is the highest degree of severity. As a result of
this injury Justin had to spend 2 nights in the hospital, the first
being spent in the trauma unit. The hospital performed CT scans that
showed blood, which is one of the reasons they wanted to keep him for 2
nights. The speech pathologist also gave Justin a cognitive test to
test his brain function. The first time he took this test he missed
passing by just a few points. The hospital decided to follow up with a
second test Monday morning, which Justin passed. An MRI was also done
Monday. Dr. Nichols, the Neurological Surgeon informed us it was clear
and Justin was discharged in the early afternoon.
Justin was told he would have headaches for some time and that he
should take it easy. He had to be honest with how he was feeling since
there were no clear outward signs of injury. Doctors had told him, if
you had broken a bone everyone would immediately know because you would
have a cast. In his case there was no outward sign to let others know
what had happened.
We contacted Justin's teachers at school to let them know what had
happened. We made it clear to them the symptoms that would be troubling
Justin. The biggest indicator in his recovery was going to be how he
was doing cognitively. Was he able to read, study, complete homework
and class assignments and take tests. The first couple of weeks after
the concussion Justin only went to school for about 4\1/2\ hrs because
he tired very easily and developed regular headaches. He was given some
leeway by teachers, who allowed him to skip on some of the class work.
Within about 3 weeks after the concussion Justin was reporting that he
was headache free. By the end of the third week Justin was able to
start exerting some energy on the elliptical at home for 15-20 minutes.
Dr. Andy Tucker, our doctor in Baltimore, allowed Justin to slowly
increase his workouts over the next 3 weeks. On the school/cognitive
front, by the 6th week after the accident Justin was finally caught up
on all assignments and tests.
During the time, immediately after the head trauma, Justin was not
allowed to participate in any physical activities. He was not even
allowed to be in the same vicinity as kids who were playing catch with
a football, playing basketball, or roughhousing in any way. He was not
allowed to risk having any kind of trauma to his head, so soon after
the accident, or it could have very disastrous repercussions to the
level of his brain function. As a member of 2 lacrosse teams he was not
even to be near the field to watch his teams practice for fear of an
errant ball coming his way and hitting him in the head.
It took 7\1/2\ weeks for Justin to be cleared for full contact
physical activity. This seemed like much longer to all of us and was
very difficult to get through. Justin will continue with the activities
he has always done, but with a greater understanding of how a $70
helmet kept him ``the Justin we know and love.'' His helmet truly saved
his life!
The Chairman. OK. Meri-K, please.
STATEMENT OF MERI-K APPY, PRESIDENT, HOME SAFETY COUNCIL,
WASHINGTON, DC
Ms. Appy. Good morning. I feel very fortunate. I grew up in
Connecticut. My children were born and raised in Massachusetts.
The Chairman. There you go.
Ms. Appy. Henry will graduate from U-Mass next month. My
dear oldest brother lives in Georgia. So, I feel--How do you
like that, Alan?
[Laughter.]
Thank you so much for letting me be here today, and
congratulations to Safe Kids for their 20 years of service to
our shared purpose.
I am Meri-K Appy, President of the nonprofit Home Safety
Council. HSC's mission is to prevent accidental injuries in and
around the home. This is a serious public health problem,
resulting in nearly 20,000 deaths and more than 21 million
medical visits in America every year.
Far too many of these tragic events involve children, and
we believe, as does Safe Kids, almost all of them could be
prevented. Our dream is to help kids learn safety lessons today
so they grow up being safer parents and caregivers in the
future.
We make safety fun, hands on, and high impact. For example,
our Great Safety Adventure, or GSA, is an incredible field trip
on wheels. We have two 1,000-square foot vehicles that travel
across America, visiting schools and communities free of charge
at events throughout the year. More than 1 million kids, family
members, and teachers have experienced GSA with proven results.
Our Safety Ranger Classroom program--Senator Isakson, I
loved what you said earlier--developed through a partnership
with Weekly Reader, have reached more than 75 million teachers,
students, and family members. Our method is to engage teachers,
local safety experts, and parents to help children develop
positive safety habits.
CodeRedRover.org is the Home Safety Council's educational
Web site for kids, and it was recognized by USA Today as an
Education Best Bet Award winner.
The Home Safety Council loves teaching children about
safety. But when you think about it, family safety is really an
adult responsibility. Unfortunately, many parents and
caregivers are missing this message. HSC is convinced that part
of the problem lies in how we have all been communicating that
message.
Here is a shocking statistic I would like to share with
you. More than 93 million adults in America read at or below
basic levels. This has huge implications when we think about
educating the caregivers about how to take care of their
children.
The Home Safety Council and our partner, Pro Literacy
Worldwide, has launched an award-winning home safety literacy
project in 2005. It teams up local literacy tutors and teachers
with firefighters and other safety experts. They use our
specially designed materials to teach basic safety lessons and
even install devices such as smoke alarms as the adults are
learning to read in English. So it is taking care of two huge
societal issues at the same time.
I would like to thank you so much. We were thrilled to be
included in this August lineup this morning. We are thrilled to
be contributing to the safety of our children, particularly in
the place we all would like them to be safest--their homes.
[The prepared statement of Ms. Appy follows:]
Prepared Statement of Meri-K Appy
Chairman Kennedy, Ranking Member Enzi, and members of the
committee, I very much appreciate the opportunity to share my comments
on keeping children safe by preventing childhood injuries. I am Meri-K
Appy, president of the Home Safety Council.
Good morning and congratulations to SAFE KIDS for their 20 years of
service to the safety of our Nation's children.
The Home Safety Council's mission is to prevent accidents in and
around the home. This is a serious problem, resulting in nearly 20,000
deaths and 21 million medical visits on average each year in America.
Far too many of these tragic events involve children, and most can be
prevented.
Our dream is to help kids learn injury prevention lessons early in
life so they can grow into a future generation of safer adults and
caregivers. We make safety fun, hands-on, and high-impact. For example:
Our Great Safety Adventure (GSA) is an incredible ``safety field
trip on wheels.'' Two 1,000-square foot traveling exhibits visit
schools and community events across America. More than 1 million kids
and family members have toured GSA since the tour began in 1999, with
proven success.
HSC's ``Safety Ranger'' classroom programs, developed through a
partnership with Weekly Reader, have reached more than 75 million
teachers, students, and family members with documented results. We
engage teachers, local safety partners, and parents to help children
develop positive safety habits that will last a lifetime.
CodeRedRover.org, the Home Safety Council's Web site for children,
is an interactive, educational site offering games, activities, home
safety checklists, and tips for children and the adults who care for
them. The site was recognized by USA Today as an ``Education Best Bet''
award winner.
The Home Safety Council loves teaching children about safety. But
it's really the responsibility of adults to create a safe environment
for our kids. HSC learned something that frankly shocked us: more than
93 million adults in America read at or below basic levels.
So HSC and our partner, ProLiteracy Worldwide, launched the Home
Safety Literacy Project. This program teams local literacy tutors and
teachers with firefighters and emergency managers who use our
specially-designed educational materials to teach basic safety lessons
and even install free smoke alarms.
These are just a few of the programs of the Home Safety Council
we've implemented to help prevent injuries to our children.
Thank you for inviting me to be here today. On behalf of the Home
Safety Council, here's to another 20 years of progress for SAFE KIDS
and all of us in the injury prevention world. &
The Chairman. Great.
Ms. Williams.
STATEMENT OF AMBER N. WILLIAMS, EXECUTIVE DIRECTOR, STATE AND
TERRITORIAL INJURY PREVENTION DIRECTORS, ATLANTA, GA
Ms. Williams. Thank you, Mr. Chairman, for the opportunity
to be here today.
My name is Amber Williams, and I am the Executive Director
of the State and Territorial Injury Prevention Directors
Association, which is also known as STIPDA. We are based out of
Atlanta, but we represent State public health injury and
violence prevention programs across the United States.
We are also pleased to celebrate with our colleagues and
partners the tremendous advances that have been made in
preventing unintentional injuries to children, or what are
commonly referred to as accidents. And I am pleased to tell you
about the role that State health departments have played in
those reductions.
They have, first, helped us to truly understand what has
been going on, how children have been injured, who is at risk
for certain injury types, and have been involved in developing
effective interventions and disseminating those widely to those
at the local level.
One example of State leadership in this area has been in
preventing residential fire-related injuries and deaths. In the
State of Oklahoma, the injury prevention program identified an
area that had a much higher than average rate of fire-related
injury death. They went in, did a smoke alarm distribution
program and educated the residents and, following that, saw an
81 percent decrease in the rate of residential injury and fire-
related death.
That is incredible. At the same time in Oklahoma, there was
only a 7 percent decline.
The Chairman. Can you give that to me again? I missed the
significance.
Ms. Williams. They saw an 81 percent decline in residential
injury/fire-related deaths, while in the rest of Oklahoma there
was only a 7 percent decline.
The Chairman. What is that, why--what is that attributed
to?
Ms. Williams. They distributed and installed smoke alarms.
The Chairman. Smoke alarms, good.
Ms. Williams. This program has since been replicated across
the United States with support from the Centers for Disease
Control, and we have had similar successes, and the program has
been credited with saving 1,500 lives. We have seen similar
progress, obviously, in the areas of child passenger safety and
bicycle safety.
Today, our economy is uncertain. We are facing growing
healthcare rates--healthcare crisis, and the cost of injuries
are one of the top 10 most expensive medical conditions, along
with cancer and heart disease. But injuries are predictable,
they are preventable, and our prevention efforts are cost-
effective. Most of all, children deserve our help in keeping
them safe.
So I thank you again for the opportunity to be here, and I
look forward to any questions you may have.
[The prepared statement of Ms. Williams follows:]
Prepared Statement of Amber N. Williams
summary
Thank you, Mr. Chairman, for the opportunity to participate in this
hearing on childhood injury prevention along with our colleagues and
partners at the National Center for Injury Prevention and Control at
the Centers for Disease Control and Prevention, Safe Kids Worldwide,
and the Home Safety Council. My name is Amber Williams and I am the
Executive Director of the State and Territorial Injury Prevention
Directors Association, also known as STIPDA. STIPDA is the only
membership association representing State public health injury and
violence prevention programs and has more than 300 members who are
professionals working at the State, territorial and local levels to
prevent injuries and violence. During this hearing, I will share
examples of how State public health departments have contributed to the
declines we have seen in deaths due to unintentional injuries among
America's children, as well as offer our perspective on future
opportunities to keep our children safe.
If those of us working in the field of injury and violence
prevention had been asked to share our progress regarding childhood
injury prevention 20 years ago, we would have only been able to tell
you that we know children were dying unnecessarily in car crashes,
falling off bikes, in residential fires and other unintentional or
``accidental'' ways. At the time, however, we didn't understand enough
about the problem. Fortunately, today my colleagues and I can sit
before you and share the tremendous progress we have made collectively
in reducing deaths related to unintentional childhood injuries. This
progress is partly through the efforts of State health departments
which have helped us better understand how children are being injured,
what children are at greatest risk for injuries, what interventions are
best to prevent these injuries, and ensure the widespread adoption of
these interventions. State health departments have also been strong
allies of Safe Kids coalitions, and often serve as the lead agency for
State coalitions. Through these relationships, State health departments
provide data, technical assistance, training, and often financial and
in-kind support.
Today I would like to share with you some of the specific ways
State injury and violence prevention programs are preventing
unintentional childhood injuries. The Georgia State Injury and Violence
Prevention Program has been able to document at least 56 lives
potentially saved since 2006 through a child safety seat distribution
program and unique partnership with the Emergency Medical Services
(EMS). The New York Injury and Violence Prevention Program was able to
document reductions in bicycle-related injuries and traumatic brain
injuries following the implementation of a statewide comprehensive
bicycle helmet program that culminated in a bicycle helmet law passing
easily through the State legislature. Finally, the Oklahoma Injury
Prevention Service was able to identify a high-risk area in Oklahoma
City for house-related fire injuries. In response, they conducted a
smoke alarm distribution program. After the program, Oklahoma saw an 81
percent decline in residential fire injury-related deaths in the target
population while rates declined only 7 percent in the rest of Oklahoma
during the same time period.
As we look to the future, we see that so many childhood health
issues are interrelated and that really what truly is needed is an
investment in healthy communities. In healthy communities, children can
walk to school without fear of being hit by a car, or becoming the
target of bullies or other violence; they have access to safe equipment
that will allow them to participate in sports and other recreational
activities while being protected from a variety of injuries, including
head and brain injuries. We need to expand our focus to building
communities where American families can live active, safe and healthy
lives.
about stipda
Good morning Mr. Chairman, Senator Enzi, and other distinguished
members of the committee. It is my pleasure to appear before you as the
Executive Director of the State and Territorial Injury Prevention
Directors Association (STIPDA). We appreciate the opportunity to
participate in this hearing and to share the stories of the success
we've seen in preventing unintentional injuries and deaths among
America's children from the perspective of State public health injury
and violence prevention programs. Formed in 1992, STIPDA is the only
organization that represents public health injury prevention
professionals in the United States and has a membership of more than
300 professionals committed to strengthening the ability of State,
territorial and local health departments to reduce death and disability
associated with injuries and violence. To accomplish this, STIPDA
engages in activities to increase awareness of injury, including
violence, as a public health problem; provides training and technical
assistance; supports policies designed to advance injury and violence
prevention; and works to enhance the capacity of public health agencies
to conduct injuries and violence.
the role of state public health injury and violence prevention programs
in reducing childhood unintentional injuries and deaths
State governments have a responsibility to protect the public's
health and safety. A comprehensive injury and violence prevention
program at the State health department provides focus and direction,
coordinates and finds common ground among the many prevention partners,
and makes the best use of limited injury and violence prevention
resources. State public health injury and violence prevention programs
apply the public health approach to help understand, predict and
prevent injuries and use a population-based approach to extend the
benefits of prevention beyond individuals.
State injury and violence prevention programs use surveillance data
to determine how injuries occur, who is most at risk, and what other
factors contribute to whether or not an individual will be injured and
to what degree. We have also come a long way in our understanding of
how to prevent injuries and look beyond just the personal behaviors
that lead to an injury to also investigate to the products that people
use, the physical and social environment, and the organizational and
governmental policies that affect the safety of our environments.
State programs have also contributed to the dissemination of
effective practices through partnerships with injury control research
centers, local health departments, local coalitions and other
organizations. State programs provide training and technical assistance
to local injury prevention efforts every day.
Although we have seen successes in many areas of childhood
unintentional injury prevention, three areas that stand out include
improvements in child passenger safety, bike and wheeled sports injury
prevention, and residential fire-related injury prevention.
child passenger safety
When you get into your car, do you automatically secure your
children (or grandchildren) in car seats before buckling up yourself ?
Chances are, like most Americans, you do. However, just a few short
decades ago this wasn't the case. Today it is more the exception than
the rule for Americans not to buckle up--or to not use car seats for
their children. In fact, when a celebrity recently drove with her
infant in her lap, the public was outraged. Motor vehicle crashes are
the leading cause of death for children and by putting a child in an
appropriate restraint--whether it's a car seat turned to the rear of
the vehicle for an infant or a belt-positioning booster seat for a
young child--you can reduce serious and fatal injuries by more than
half. However, there is still work that must be done to ensure everyone
is restrained properly for every ride in the car and that car seats and
boosters seats are used correctly.
It's evident that collectively, we have made incredible strides in
reducing the number of children who die or are injured in car crashes
by increasing the number of children who are restrained properly in car
seats until they are able to properly fit in a car's seat belt. In fact
deaths have decreased 32 percent during the last two decades. This
success have been achieved using a number of strategies including: by
strengthening laws that require children to be properly restrained and
enforcing those laws, training child passenger safety technicians to
work with parents and help them to use car seats properly, distributing
car seats to low-income families, and increasing awareness of the need
for car seats. We have changed the ``norm'' for riding in cars so that
today there is an outcry when anyone is found driving with infants in
their laps or turning their child's car seat to face the front of the
car before the child's first birthday.
State injury and violence prevention programs are often involved in
efforts to raise awareness, distribute car seats, conduct car seat
checkpoints, and strengthen organizational policies:
Over the last several years, the Georgia Injury and
Violence Prevention Program has conducted a car seat distribution
program to low-income families in 109 of the 159 counties in Georgia in
partnership with local health departments, Safe Kids coalitions, and
other organizations. Each seat distributed through the program has a
teddy bear sticker that EMS personnel look for on the scene of car
crashes. The State health department has documented at least 56
potential lives saved through this program so far between 2006 and
March 2008.
In New York State, the Bureau of Injury Prevention
conducted a program called ``Gimme a Boost'' in three counties to
determine the barriers to booster seat use and how to best increase use
among 4-8 year olds. Through interviews with parents and guardians of
4-8 year olds, the Bureau was able to determine that reasons for non-
use included: New York State law does not require use by 4-8 year olds,
the belief that their child was too big or old for a booster seat, lack
of knowledge about the need for booster seats and the injury risks
associated with only using safety belts, and child resistance to using
a booster seat. Booster seat distribution, public awareness campaigns,
and school-based programs were implemented in the three counties to
determine which combination(s) might be associated with increase
booster seat use. Comparison to a control county that received none of
the interventions found that the combination of all three interventions
led to the largest increase in booster seat use from 21 percent to 53
percent. Using this information, as well as injury hospitalization and
death data, communities educated their policymakers in support of
legislation requiring the use of booster seats for children 4-6 years
of age. The booster seat law was enacted in 2005.
The Michigan Injury Prevention Program was able to
identify that because the child passenger safety law did not include
older children, parents were not using booster seats. Through a
targeted educational effort, the Michigan Injury Prevention Program was
able to demonstrate an increase in booster seat usage by 300 percent.
These efforts and many others have translated into the support needed
to strengthen the child passenger safety law to include older children
and was signed by the Governor just this year. In fact, there are four
new booster seat laws this year--bringing the total to 43 States--which
now protect older children in some form through child passenger safety
laws.
The Utah Department of Health conducted a statewide
program to increase booster seat usage among children ages 4-8 years
from 2002-2005. Through partnerships with local health districts, the
Utah Department of Health conducted awareness and media activities,
distributed more than 2,000 child safety seats, conducted more than 120
car seat checkpoints to ensure families were using car seats correctly,
and implemented booster seat policies in pre-schools and daycare
centers. As a result, an estimated 44 Utahans are alive today and the
death rate decreased 6 percent from 2002 to 2004 while booster seat
usage increased by 10 percent from 2002-2005. Every $1 spent on child
safety seats saves $41. In 2005, distributing 2,000 child safety seats
in Utah saved approximately $3.3 million.
In Colorado, the Injury and Violence Prevention Program
conducted a booster seat program between 2001 and 2004. During this
program, booster seat use by children ages 4-8 increased significantly
in Colorado from 2001-2004. In 2001, adults reported that 86 percent of
the 4- to 8-year-olds in their household always used a restraint while
riding in a vehicle. Of those who always used a restraint, 15 percent
used a booster seat. In 2004, the percentage of children who always
used a restraint remained high at 89 percent, but booster seat use
increased to 45 percent.
Today, motor vehicle crashes remain the leading cause of injury
death for children, but the collective efforts of those working has
lead to a 32 percent decrease in this rate over the last two decades.
Future efforts should continue to focus on older children ages 4-8 who
are still not ready for a vehicle's lap and shoulder belt as well as
effort to ensure all States have laws that appropriately protect our
youngest riders.
bicycle and other wheeled sports
Bicycling and participating in other wheeled sports, such as
skateboarding, riding scooters and in-line skating, are excellent ways
to increase physical activity and combat obesity and other chronic
health conditions. Although these activities provide healthy exercise,
they are not without risk of injury, with head injuries accounting for
60 percent of bicycle-related deaths and more than two-thirds of
bicycle-related hospital admissions. Extensive research has shown that
use of helmets can reduce the risk of head and brain injury by 70
percent to 88 percent. Survivors of head injuries can have severe
physical, emotional or cognitive problems that result in a long-term
disabilities including difficulties with learning and activities of
daily living.
Universal use of bicycle helmets by children ages 4 to 15 could
prevent between 135 and 155 deaths, between 39,000 and 45,000 head
injuries, and between 18,000 and 55,000 scalp and face injuries
annually. If 85 percent of all child cyclists wore helmets every time
they rode bikes for 1 year, the lifetime medical cost savings could
total between $134 million and $174 million.
Over the last two decades, deaths have declined from 389 deaths to
132 deaths in 2004. State injury and violence prevention programs have
contributed to the reduction in these injuries and deaths by providing
data to partners, raising awareness, distributing bicycle helmets and
supporting efforts to require the use of bicycle helmets by law. Today
21 States, the District of Columbia and over 140 localities have
enacted some form of mandatory child bicycle helmet legislation.
Efforts of State injury and violence prevention programs have included:
From 1991-1995, the New York State Injury Prevention
Program conducted a statewide multifaceted bicycle helmet safety
program featuring a Teenage Mutant Ninja Turtle character. The program
included a public service campaign, prescription pads for New York
State pediatricians and family practice physicians to prescribe helmet
use for children seen in the practice, and the development of 77
community-based programs. Community coalitions distributed more than
30,000 bicycle helmets to children from families and need. With so much
public attention and support, in 1994, State legislation was enacted
requiring all bicyclists under the age of 14 to wear a bicycle helmet.
School-based and observational surveys documented an increase in helmet
ownership and usage between 1989 and 1993, and the New York State
injury and violence prevention program has found a steady decline in
bicycle-related deaths since the implementation of the program.
The Louisiana Injury Prevention Program has provided
information to advocates such as Safe Kids, Think First, the Governor's
Highway Safety Commission, and other public and professional groups.
These advocates have used the information to educate State legislators,
inform their constituencies, and promote appropriate injury prevention
behaviors. These activities led to establishment of a law requiring the
use of bicycle helmets, and re-establishing a law requiring the use of
motorcycle helmets.
After learning that children ages 5-14 have the highest
rate of bicycle-related hospitalization and 32 percent of these
hospitalized children sustain a brain injury, the Colorado Injury and
Violence Prevention Program implemented a bicycle helmet program.
Survey results indicate that the percent of Colorado children ages 5-14
who were reported as always wearing a helmet when bicycling increased
slightly, from 40 percent in 1999 to 49 percent in 2005.
In California, bicycle helmet legislation, which led to an
increase in helmet use, resulted in an 18 percent reduction in the
proportion of traumatic brain injuries among young bicyclists.
The Florida Injury and Violence Prevention Program
provided data on bicycle-related injuries comparing one county with the
rest of the State of Florida upon request in January 2006 to the
administrator of local health department. The administrator used the
data to present to county commissioners, who finally opted to enforce
the State's bike helmet law for riders under age 16--the last county in
the State to do so.
From 1993-2000, the Oklahoma Injury Prevention Service
collaborated with numerous national, State, and community partners and
with funding provided by the National Center for Injury Prevention and
Control, implemented bicycle helmet programs in several Oklahoma
communities. These comprehensive, community-based efforts targeted
children at greatest risk of bicycle-related TBIs, those 5-12 years of
age. Mini-grants were awarded to county health departments, schools,
police departments, civic organizations, and injury prevention
coalitions to implement bicycle helmet distribution and education
programs throughout the State. These bicycle helmet programs have been
conducted in more than 90 communities and more than 100,000 bicycle
helmets have been distributed. According to the OSDH Behavioral Risk
Factor Surveillance System (BRFSS), from 1992 to 1998, reported bicycle
helmet use among children increased from 6 percent to 25 percent.
residential fire
Finally, we have seen a lot of progress in preventing injuries and
deaths due to residential fires through smoke alarm distribution
programs. Children, especially those in rural areas, are at high risk
for injuries and deaths due to residential fires--partly due to their
greater likelihood of starting fires as well as their greater need for
assistance in escaping fires. It is well established that smoke alarms
are extremely effective at preventing fire-related injuries and deaths.
An individual's chance of dying in a residential fire is reduced by
half when a smoke alarm is present.
In the late eighties and early nineties, the Oklahoma Injury
Prevention Service led the way in establishing the best practices for
preventing fire-related injuries and deaths through an innovative smoke
alarm distribution program that involved developing a strong
partnership with local firefighters, identifying areas at highest risk
for fires, canvassing these areas and installing smoke alarms outside
sleeping areas and on each floor of high-risk homes.
The work in Oklahoma led to the development of a residential fire
injury prevention program through the National Center for Injury
Prevention and Control to provide funding to State health department
injury and violence prevention programs to conduct smoke alarm
distribution and installation programs. Through this funding, State
health departments, in partnership with local firefighters, have been
able to reach 185,000 high risk families, install more than 348,000
smoke alarms and potentially save more than 1,500 lives. Overall,
deaths related to fires and burns have decreased nearly 60 percent over
the last 20 years.
State successes have included:
In Washington State, firefighters installed a smoke alarm
in the mobile home of a Shoreline mother and her 3-year-old son. Weeks
later the alarm woke the mother, who found a portion of her home
ablaze. She woke her sleeping child and escaped before the home became
fully engulfed. She was treated for smoke inhalation and released; her
son was unharmed.
In Georgia, firefighters visited a home in Moultrie,
installed smoke alarms in the proper places, and educated the family
about a fire escape plan. When wires shorted and ignited the old wood
home, a teenage boy awoke in the night to the alarm, alerted his mother
and two younger siblings, and followed the fire escape plan. Although
the fire damage was extensive, no injuries occurred.
Between 1998 and 2006 in New York, the Bureau of Injury
Prevention canvassed approximately 39,732 homes in communities across
New York State, installed more than 21,000 smoke alarms, and documented
379 lives saved in 165 fire and severe smoke incidents.
opportunities for the future
We must continue to invest in the prevention efforts that have
demonstrated so much success over the last 20 years, such as child
passenger safety, residential fire injury prevention, and bicycling and
other wheeled sports. Additionally, State injury and violence
prevention programs must continue to study the patterns of injuries to
identify new injury concerns--such as the recent rise in unintentional
poisonings/drug overdoses, as well as translate new research into
community-based practices.
As we learn more about what puts children at risk for injury, we
must also consider the reality that children today are less active,
more likely to be overweight or obese, and at increased risk for
chronic diseases in adulthood. Yet parents are fearful of allowing
their children to walk to and from school or to play outside due to the
dangers of traffic and crime. America's children deserve to live in
communities where they can be healthy and active without the fear of
violence or ``accidental'' injury. Investments in healthy communities
and smart growth initiatives are one of the strongest ways we can work
together to improve the overall health and safety of America's
children.
We believe that with appropriate investments for continued and new
injury prevention efforts, we will be able to see even more dramatic
declines when we meet again to celebrate 25, 30 and 40 years of
preventing unintentional injuries to children.
The Chairman. Very good.
Let me, if I could, just a few--do you have to go, Chris?
Do you have questions?
Senator Dodd. No, just this, and I thank all of you--I
apologize slipping out a little early. I just can't thank you
enough, and we will just keep working. Give us more ideas on
how we can deal with these issues.
Just one question, you mentioned how you--that last run,
you wanted your father to film you on that run. Did he film you
on that run?
Mr. Bruns. He did, yes.
Senator Dodd. Well, that is not a bad idea. Have you shown
that to your pals?
Mr. Bruns. Ah, yes. They all laughed.
Senator Dodd. That is not a bad way maybe of convincing
them of what can go wrong. Maybe put it on YouTube.
Mr. Bruns. I already put a song with it. So----
Senator Dodd. Did you? Put a song to it, too.
This is the father here, too. I am getting him in a lot
more trouble. You are not from Connecticut, are you?
[Laughter.]
Well, thank you very, very much, and I apologize again for
leaving early. Appreciate your testimony. Thanks.
The Chairman. Mr. Korn, let me ask you, Safe Kids attribute
45 percent decline in the unintentional death rate for children
over the last 20 years. Do you want to tell us, what do you
attribute that to?
Mr. Korn. Well, 20 years ago--I am 43 years old and rode a
bike and never wore a bike helmet. When I used to ride in my
father's car, I used to stand up. He had a convertible. I used
to stand up in the center between my mother and father. There
was no car seats.
So the devices that you hear about today, that I brought
with me today, have made a real difference. Twenty years ago,
these type of things didn't exist. Or if they did, they weren't
nearly as good as they are today. So we have seen the
consciousness of parents raised quite remarkably. Second, they
have had the devices that they need--smoke alarms, carbon
monoxide detectors, personal flotation devices--to use when out
doing their winter or summer activities.
The other thing I will mention just real quickly. Twenty
years ago, there was no such thing as a bicycle helmet law.
Georgia has a bicycle helmet law now. So does Massachusetts.
Twenty years ago, there was no such thing as a State child
safety seat law. Massachusetts, I think it was April 11th, just
improved their child restraint law to include booster seats.
Georgia has had one for a while.
Twenty years ago, those didn't exist, which is a good
motivation to get parents to not only use the devices, but use
them as a custom pattern and practice over time.
The Chairman. Well, what is your answer to those that would
say we are just coddling our children on these?
Mr. Korn. Yes. You know, Safe Kids--and I know STIPDA and
the Home Safety Council are the same way on this. We are not
suggesting that you need to wrap kids in bubble paper every
time they go out. You want them out there enjoying the summer,
swimming, biking. You are even going to fall off your bike and
scrape your knee, a little stitch in your elbow. Those are
badges of honor. Maybe his small concussion is a badge of
honor, maybe.
But we are talking about serious traumatic injuries here.
We want the kids out there enjoying summer. So my response to
those people is, these are the things that are preventable.
These are the things that we know how to take charge of and
prevent from happening in the first place. It is not preventing
the little scratch. It is preventing the concussion that will
kill you or the drowning that will happen when 100 parents are
standing around a pool. A kid goes under, that is the end of
it.
Or a smoke alarm. When there is smoke, it rings, and you
are out of the house. These are serious injuries, not those
smaller injuries.
The Chairman. Your report points out that accidental
injuries disproportionately affect minority children. Can you
tell us why that is the case and what suggestions you have to
do something about it?
Mr. Korn. I think Senator Isakson and Dodd both referenced
to it. One of the reasons is the cost associated with these
items. A bike helmet is now $15, down a lot over the past 10
years. But still, when you are choosing between a gallon of
milk, which is increasing now, and a bicycle helmet, a family--
and I, quite frankly, don't blame them--choose the gallon of
milk.
So it is incumbent upon groups like ours and the Federal
Government to make sure that we are giving away free bicycle
helmets, which we do each year, or that we are giving away free
smoke alarms, which I know the Home Safety Council does each
year. So these are the types of things that we need to do to
reach those underserved populations.
The other thing is maybe getting additional funding through
the CDC, the U.S. Fire Administration, the National Highway
Traffic Safety Administration, to buy these devices, to make
sure we can give them away without charge to those families.
The Chairman. Amber, what are the biggest barriers at the
State and local level to implementing programs to address
childhood injury?
Ms. Williams. I think, first of all, it is a resource
issue. As Ileana said at the beginning, CDC funds 30 States to
do basic injury prevention for the entire State, and that
figure is about--just over $100,000 for a State to do
coordinated injury prevention.
So when you take that and you are trying to do
surveillance, you are trying to do interventions, you are
trying to distribute safety products to folks, it doesn't go
very far. So, we really have to do a lot to engage States and
private industries to help us in getting those devices into the
hands of the public.
I think the other part of it is that from a State
perspective, they are really charged with truly understanding
what is going on because it does vary from State to State and
from community to community. Our ability to do the surveillance
that we need to is limited by the quality of the external cost
coding and hospital discharge data.
So that is another challenge, and just one further
challenge is overall the public health workforce. There is a
shortage of workers in the public health workforce, and I am
sure you are familiar with that issue as well.
So there are a number of challenges from the workforce to
resource issues to be able to take what is known about
preventing injuries and doing that at the State and community
levels.
The Chairman. OK. Senator Isakson.
Senator Isakson. Thank you, Mr. Chairman.
Mr. Korn, I remember in the 1970s or 1980s, when I was in
the State legislature, we passed a mandatory helmet law for
motorcycle operation in Georgia. There was a tremendous lobby
against mandatory helmet law. Do those lobbies still exist
today?
Mr. Korn. They sure do. In fact, there has been a
retraction in the helmet use laws in some States around the
country. The childhood injury prevention movement doesn't quite
have the organized opposition that the motorcycle helmet law
has, but we do run into that same issue like kind of
Government's role is overstepping its bounds a little bit.
My response to that, when it comes to the children, we
always have to keep the best interest of children in mind, and
there are so many examples of that, adoption and child abuse.
You always keep the best interest of the children in mind.
When it comes to these types of State laws that happen, the
bicycle helmet laws, the personal flotation device laws, the
smoke alarm laws, we are talking about children. That helps us
cross that hurdle that the motorcycle helmet efforts and
advocates run across from that very organized lobby that does
still exist today.
Senator Isakson. I remember my predecessor, Senator
Coverdell from Georgia, who was in the Senate before Zell
Miller was here in the seat I hold, he actually was the driving
force behind the mandatory seatbelt law in Georgia, which also
was taking place in that same time period. The compelling
argument that finally broke the opposition in terms of
intervention versus freedom was the impact, cost impact to
society on the lost productivity, which was testified to
earlier, as well as the medical cost and the treatment cost and
the rehabilitation cost.
That was the argument that finally broke the opposition on
those two pieces of legislation.
Mr. Korn. Thankfully, Justin is with us here today. I mean,
if he had been seriously injured, the medical costs would have
been astronomical, and we all would have paid that. The family
couldn't have afforded that. Instead, it was a $15 helmet that
saved his life.
So those costs, as if protecting and saving the child's
life isn't enough--I think it is--but now we can also make the
cost effectiveness argument in addition to that, and that helps
us combat what little opposition there is. We do have
opposition, but it helps us get over that hurdle.
Senator Isakson. Justin, I am not a snowboarder. So you are
going to have to--you were snowboarding, right?
Mr. Bruns. Yes.
Senator Isakson. What is a rail?
Mr. Bruns. A rail, it is like something that you grind on
with your board.
Senator Isakson. That you grind?
[Laughter.]
Mr. Bruns. Yes. I can't really explain it. But go to
YouTube.
Senator Isakson. Well, I know the Summer Olympics are
coming up, and this is a Winter Olympic example. But
snowboarding has become a huge part of Olympic sports. The
Olympics do a good job of mandatory helmet requirements of all
participants, don't they?
Mr. Bruns. Yes, everyone has to wear a helmet.
Senator Isakson. Snowboarding looks particularly--to
somebody my age, snowboarding looks particularly dangerous to
start with. So I want all the protection that I could get. But
your testimony is outstanding. I want to encourage you to be an
advocate and use your personal story because kids influence
kids more than anybody else.
When you can tell your story and tell them that you got to
come to the U.S. Senate and advocate on behalf of what a helmet
did for you, you can save somebody else's life. So what you are
doing today is very important, and we commend you for being
here and what you are doing.
I commend all of you for your advocacy on behalf of safety
for kids.
The Chairman. Good. Thank you.
Just a final couple of questions, and I join--thanking
Senator Isakson for making that point and just underline it.
Your example is key in terms of the future. It will make a real
difference to other children's safety. So good for you.
Let me ask Meri-K about hidden hazards in the home that
parents should know about. Do you want to just talk about that
for a minute?
Ms. Appy. I would love to. The Home Safety Council has done
a number of studies, including the most definitive one, the
State of Home Safety in America, followed up by a series of
smaller studies to get an idea about what parents are thinking
about out there.
About 90-plus of the caregivers we surveyed indicated that
they do think about safety quite a bit, but they are not acting
really. We wanted to know why. Many of them said they don't
know what actions to take, or they don't have enough time to do
it, or home improvements are too expensive.
I think our challenge here is to really help make it very
clear what the hazards are that you may not know about. I will
give you one specific example. Hot water tap burns, scalding
burns. When we surveyed parents, we found that hardly any of
them knew what the temperature of the water coming out of the
tap really is. Yet at temperatures of 140, 150 degrees, a child
can be devastatingly scalded in just seconds.
We worked with a mother actually from Georgia, come to
think of it, Shelly McCammon, who has been helping us raise
awareness of the dangers of hot water tap burns. Her story
actually inspired the private sector to create a tool that can
prevent that. It is called Hot Stop. It has got sensing devices
in the tub spout and shower head so that if the water reaches a
dangerously high level, it shuts it off to just a trickle. It
only costs $25 to replace this tub spout.
When I talked with Shelly, this mother, she looked me right
in the eye and said, ``Meri-K, I am a conscientious mom. David
and I baby-proofed everything. Nobody ever told us that hot
water could do this to Leah.'' Her baby died of third-degree
burns.
So I think part of what we have to do without scaring the
parents too much, we have to kind of point out these are the
things that can happen, these are the things you can do to
prevent it from happening, and if you do these things, you know
what, it will work.
Once we complete that circle, thinking always about the
ones who may not be able to read that brochure. They may not
see the notice that there is a free smoke alarm distribution.
They may be falling through the cracks. So working harder to
get into those homes, I really believe we can make a tremendous
difference.
The Chairman. That is an enormously interesting. I think
all of us have had over our life experience that same sort of
situation where that just scalding hot water comes out of the
taps.
Ms. Appy. Exactly.
The Chairman. Could I ask you just about the key elements
of the Home Safety Council, home safety, the literacy project?
Do you want to just tell us, could you speak to that for a
minute?
Ms. Appy. Yes, you see me smiling. I have been a safety
educator for more than 25 years. I don't know if you know,
Senator, I spent 13 years at the National Fire Protection
Association in Massachusetts, in fact. So I have really devoted
my life to safety education programs, particularly school-based
programs for children, which I love.
However, in thinking about who makes safety changes at
home, it became clear it is really the adults. When we did some
research on most of the information going home to families, we
learned that much of it, if not most of it, is written at a
level the parents can't--many parents cannot read.
So the idea behind the Home Safety Literacy Project is to
identify adults in the community who come forward to learn to
read as they are adults. As they are learning to read in
English, we integrate basic safety lessons into that process.
So you join forces with literacy experts and safety experts to
really get into some of the homes where families are of lower
income levels and education levels. Those tend to be families
at highest risk.
So it is very efficient. Thread the needle into some of
those homes we really can't reach any other way.
The Chairman. Good. Alan, finally, just on those props that
you have there, do you want to give us one, a little visual
there?
Mr. Korn. Sure. Your question of hidden hazards, one of
which we are concerned with is carbon monoxide. This is a
carbon monoxide detector that you put up in your home. The
sources of carbon monoxide are your car, gas heaters,
anything--a combustible natural source of fuel in the home, a
fireplace.
If you don't have a carbon monoxide detector in your home,
there is no way you can detect that it exists. It is odorless.
It is tasteless. It doesn't have any smell, unlike fire.
So this is a newer, relatively newer device out there, and
we could use the help, maybe through your Poison Control
Enhancement Act, which I know you have passed out of this
committee and I think is up for some reauthorization. This is a
hidden hazard in the home that we are actually taking an extra
look at and making some more efforts at.
We are starting the summer season and drownings are of
particular concern to me. Notwithstanding what I do for a
living, I am not that tightly wound as a parent. I want my
child out there playing. But when it comes to pools, when it
comes to hot tubs, watching your children every step of the way
when they are in the water makes such a big difference because
drowning does not happen like it does in the movies.
There isn't a ``help, help, I'm drowning'' and plenty of
time to react. A 2-year-old or 4-year-old goes under, that is
the last you see of them. So we kind of work with a water
watcher program, where you assign a parent to a pool to watch.
You want to avoid the situation where everybody is watching the
pool, but nobody is watching the pool. It is this type of
device and those types of hidden hazards that we are going to
work toward preventing.
The Chairman. OK. I want to thank--Senator Isakson,
anything further?
Senator Isakson. I would just thank the panelists for being
here.
The Chairman. Panelists, very helpful. We will want to hear
from you another time, another year or so, find out the
progress that is being made. We are always interested in any
suggestions you have for us about what we can do to help.
Where we stand ready, we can do both sort of legislatively
or if you have some suggestions about things that we ought to
know about and that we ought to be involved in, I hope you will
feel free to let us know. We congratulate all of you for the
difference that you make.
The committee will stand in recess.
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of Senator Enzi
Good morning and thank you for joining us today to discuss
preventing childhood injuries. Our Nation has come a long way
in reducing childhood injuries and making parents and others
aware of ways they can help keep their kids safe. Today, we
will take a look at where our Nation has been, where we are
today, and where we need to be in the future for child injury
prevention.
Unintentional injuries are the leading cause of death among
children in the United States with nearly 100,000 deaths a
year. Those injuries include motor vehicle accidents, bicycle
accidents, fires, poisonings, burns, falls, and playground
injuries, among many others. While the number of deaths is
startling, we also need to put that into perspective.
Twenty years ago, parents generally didn't secure an infant
or young child in a safety seat when driving. Today, all 50
States and the District of Columbia require infants and
toddlers to be in a child safety seat, and 43 States have child
booster laws. The child-safety seat campaign has proven to be
one of the most successful campaigns in child injury
prevention. We also have requirements that motor vehicles are
designed to make child-safety seats more effective and to allow
for installation to be much easier. These efforts, accomplished
by a partnership with State governments and the Federal
Government, have significantly decreased the number of
unintentional deaths caused by car accidents. Since 1975,
deaths among children aged less than 5 years have decreased 30
percent to 3.1 per 100,000 population.
We've not only taken action in our cars but also in our
homes. Through city ordinances requiring fire and carbon
monoxide detectors to additional Federal standards for safer
pools to increased use of bicycle helmets, we have
significantly reduced the number of childhood injuries. As each
of these cases demonstrates, the public health actions are not
simply those made by the Federal Government. In fact, States
and localities have traditionally had the most successful
efforts.
Sometimes, what the Federal Government can do is simply
ensure that we have the right information to parents. Last
year, as part of the FDA Amendments Act, we reauthorized the
Best Pharmaceuticals for Children Act (BPCA) and the Pediatric
Research Improvement Act (PRIA). BPCA and PRIA act as a
``carrot and stick'' to ensure that parents have the right
information about the drugs kids take. Kids aren't little
adults. They metabolize drugs differently than adults. Because
of BPCA, over 300 studies have been performed to see how drugs
affect kids.
The local police and fire fighters play a large role in
preventing and responding to unintentional child injuries and
are much more effective because of their relationship with the
community and ability to react more quickly than any program
the Federal Government could create. Child injury prevention
must continue to be the responsibility of the State first and,
when needed, the Federal Government may support their efforts.
Between 1987 and 2000 we have seen a 40 percent decline in
the injury death rate. The decline is a result of successful
prevention campaigns with child-safety seats, a reduction in
alcohol-related motor vehicle deaths and many other child
injury prevention efforts. All 50 States have come a long way
in injury prevention yet we still see over 100,000 deaths per
year caused by unintentional injuries. We must continue to
reduce these numbers through public education and messaging,
new devices to eliminate risk and continued support for
prevention programs across the country.
I look forward to hearing from our witnesses today to
better understand how far we have come to reduce the number of
deaths, where we need to be in the future and how to address
the challenges we see ahead.
[Whereupon, at 11:37 a.m., the hearing was adjourned.]