Stimulating Research on Prevention

The Economic Stimulus Bill (American Recovery and Reinvestment Act of 2009) provided $1.1 billion for federal agencies to oversee studies on the merits of competing medical treatments. New York Times; Scientific American; Washington Post

"Injury prevention" doesn't readily come to mind as a medical treatment, does it?

But if "healthcare" is the maintenance of good health, what could be more central to maintaining health and well-being than preventing preventable illness?

Prevention education has been likened to a vaccination against shaken baby syndrome. The effectiveness of many medicines varies with individual and social factors, such as gender and race (as noted in this Wall Street Journal article). The effectiveness of education does as well.

So, why shouldn't healthcare dollars evaluate not just the efficiency and effectiveness of treatments for the consequences of disease and injury, but prevention education too?

The Institutes of Medicine will be recommending priorities for that research, and CDC invites suggestions from the public.

You're invited. Visit the IOM website and submit ideas by March 27, 2009.

Link: http://iom.edu/CMS/3809/63608.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=CER+Priorities+Request+for+Input&utm_content=CER+Priorities+Stakeholders&utm_term=

Tiny URL for the link above (preview) - http://preview.tinyurl.com/cy5fzj

ONF Newsletter

Spotlight, the bimonthly newsletter of the Ontario Injury Prevention Resource Centre, is worth a look.  The current issue reports on:

- advice from Andre Picard, public health reporter for the Globe and Mail, about injecting injury prevention into the public policy arena. He noted that it's been "woefully neglected"
- a newsletter from Middlesex that helps parents to prevent early childhood injuries
- an injury prevention program in the Kingston area to increase public awareness of the opportunities for prevention

This summary of Australian research on parenting education prompts three thoughts:

- why did they create a parenting program (the "first"), rather than adapt and evaluate one that has been shown effective, such as the home-visiting program developed by David Olds?;
- as research seems to show that birth is the "teachable moment", why did they wait until 8 months to implement it?; and
- doesn't it seem that a reduction in harsh or abusive parenting behavior is a worthwhile result?

Parenting Program Does Not Prevent Toddler Behavior Problems, Study Shows
ScienceDaily (Feb. 3, 2008) — A study of the first universal parenting programme, designed to prevent early child behaviour problems, shows that it has little impact on toddler behaviour.
Behaviour problems affect up to 20 per cent of children and have major personal, societal and economic ramifications. Left untreated, up to half of behaviour problems in preschool children develop into later mental health problems.
Prevention targeted to high-risk families can be effective, but has limited reach and may stigmatise. Universal programmes offered to all families could address these concerns, but their effectiveness is uncertain.
The study, conducted at the Centre for Community Child Health (CCCH) in Melbourne, Australia, is published by the British Medical Journal.
Researchers from the CCCH and the Parenting Research Centre, with input from maternal and child health nurses, designed a programme suitable for all parents to be delivered by trained health professionals in primary care. The programme aimed to prevent child behaviour problems, such as defiance and aggression, and improve parenting and maternal mental health.
Over 700 mothers of 8 month-old infants participated in the study and were randomised to either the programme (three sessions at age 8-15 months) or usual care from their local Maternal and Child Health centre. Mothers were surveyed throughout the study and their mental health was assessed when their children reached 18 and 24 months.
At 18 months, child behaviour and parenting scores were similar between the two groups. By age 24 months, parents on the programme were less likely to report harsh or abusive parenting and unreasonable expectations of child development, but there was no improvement in maternal distress or toddler behaviour.
This was the first trial to evaluate a universal parenting programme involving families from all social backgrounds, say the authors.
They conclude that the outcomes are insufficient to support widespread introduction of this programme to prevent toddler behaviour problems.

BMJ-British Medical Journal (2008, February 3). Parenting Program Does Not Prevent Toddler Behavior Problems, Study Shows. ScienceDaily. Retrieved September 1, 2008, from http://www.sciencedaily.com/ /releases/2008/01/080131214534.htm

A book review in the New York Times points out some reasons why thinking we're safe can be unsafe....

Some of those "thinks" to keep in mind, whether designing community prevention initiatives or an individual, personalized prevention program for your child:

- we think we're more skilled than experience suggests;
- when routines allow us to think less about safety, we are distracted from anticipating stress events and less prepared to cope; and
- we think we - and other caregivers, like babysitters and child care providers - know what we need to know about the skills required to raise a child.

Assuming you're safe can be fatal. Assuming you "know" what any individual taking care of your child will or won't do can also have tragic consequences.

Nowadays, the cause of collisions, or one of them, is people believing they’re better drivers than they are. We base our judgment on the number of crashes we’ve been in, rather than on the number of accidents we narrowly avoid, which, if we’re being honest (or we’re being me), happen just about every time we drive.

Compounding this vehicular hubris is the fact that most of the driving we do appears to be safer than it is. Driving rarely commands 100 percent of our attention, and so we feel comfortable multitasking: talking on the phone, unfolding a map, taking in the Barca-Lounger on the road’s shoulder. Vanderbilt cites a statistic that nearly 80 percent of crashes involve drivers not paying attention for up to three seconds. Thus the places that seem the most dangerous — narrow roads, hairpin turns — are rarely where people mess up. “Most crashes,” Vanderbilt writes, “happen on dry roads, on clear, sunny days, to sober drivers.” For this reason, roads that could be straight are often constructed with curves — simply to keep drivers on the ball.

This basic truth — feeling safe kills — lies beneath many of the book’s insights. Americans think roundabouts are more dangerous than intersections with traffic lights. Roundabouts require you to adjust your speed, to merge, in short, to pay attention. At an intersection, we simply watch the light. And so we may not notice the red-light runner coming at us or the pedestrian stepping off the curb. A study that followed 24 intersections that had been converted from signals or stop signs to roundabouts showed an almost 90 percent drop in fatal crashes after the change.

For similar reasons, S.U.V.’s are more dangerous than cars. Not just because they’re slower to stop and harder to maneuver, but because — by conferring a sense of safety — they invite careless behavior. “The safer cars get,” Vanderbilt says, “the more risks drivers choose to take.” (S.U.V. drivers are more likely to not bother with their seat belts, to talk on cellphones, and to not wear seat belts while talking on cellphones.) So it goes for much of the driving universe. More people are killed while crossing in crosswalks than while jaywalking. Drivers pass bicyclists more closely on a road with bike lanes than on one without.

Well, it's been a long time...

Since 2003:

- laws requiring SBS prevention education have been passed in several states;

- the hospital education program in Buffalo was joined by a regional program in the lower Hudson Valley, and they are about to go statewide;

- a statewide education support program is operating in Pennsylvania and one is about to start in North Carolina, with funding from the CDC.

- April 20-26 will be recognized by the US Senate for the fourth time, along with New York and several other states, as SBS Awareness Week 2008.

Let's talk more about those things in future posts...