Core 9- Disparities in Injuries and Access to Injury Prevention
Injuries, both unintentional and intentional, contribute significantly to ethnic disparities in morbidity, disability and life expectancy. Unintentional injuries are the third leading cause of death in Hispanics and the fourth in blacks-preceded only by heart disease, cancer, and cerebrovascular disease. In addition to the contribution that unintentional injuries make to disparities in mortality among minority populations, they are also a leading cause of years of potential life lost (YPLL). While far less is known about the effects of the injury burden on active life expectancy in minorities, we hypothesize that the cumulative disadvantage of increased environmental and social hazards coupled with lower access to primary, secondary, and tertiary prevention across the infant, child, and nonelderly adult life span are reflected in more years lived in a disabled state for minorities.
The World Health Organization notes that the "traditional view of injuries as accidents" or random events has resulted in the historical neglect of this important area of public health. In support of this statement, incontrovertible reports document disparities in minority communities, and yet inadequate attention to ethnic disparities left Healthy People 2010 (DHHS 2000) with insufficient information to set targets for reduction of ethnic disparities in many injury areas. Both intentional and unintentional injuries have been shown to have a modifiable component when well-focused interventions are implemented in a minority community.
Therefore, the focus of this grant is to build research infrastructure to study racial and socioeconomic disparities through existing and newly funded programs that are serving large minority populations, but which previous to formation of the Center for the Health of Urban Minorities (CHUM) did not have a specific component to study health disparities. In particular, under CHUM, this project aims to facilitate the study of health disparities through expansion of the age range to cover the life span, increased emphasis on disparities in currently funded programs, identification of new funding streams, and expansion of our professional network to include others who may add expertise to these efforts. We will conduct research on disparities in injury prevention across three major areas which have a modifiable component: prevention of the occurrence of injury (primary prevention); attempts to decrease the severity of injuries that do occur (secondary prevention); and attempts to decrease injury-related disability through increased access to effective medical treatment and rehabilitation. The specific aims of this project are to:
Aim 1: Use existing state and locally collected/extracted data to identify factors associated with disparities in mortality, disability, and access to potentially disability-reducing treatments (tertiary prevention) in New York City through:
a.) Expansion of existing infrastructures for injury surveillance in children to include injury surveillance for adult and elderly populations.
b.) Characterization of injury rates from NYC communities with and without implemented injury interventions.
c.) Examination of ethnic and socioeconomic differences in injury-related health outcomes, health care utilization, and expenditures.
d.) Comparative analysis of the intensity of rehabilitation post injury for minorities.
e.) Expansion of our funding base to include the design and implementation of community interventions to address injury-related ethnic disparities across the life span.
Aim 2: Stimulate interest nationally for research on ethnic disparities in injuries, access to care, and injury outcomes by:
a.) Expanding the agenda of the Annual Meeting of the Injury Free Coalition for Kids (Injury Free Coalition) members to include a presentation on research and evaluation of ethnic disparities in injuries and access to injury-related health care.
b.) Expanding currently offered technical assistance to member Injury Free Coalition sites to include issues related to injury disparities.
c.) Developing a national level committee within the existing Injury Free Coalition structure specifically to address scientific issues related to measuring and narrowing injury disparity gaps.
d.) Publishing findings in peer review journals and presenting at national professional meetings.
Aim 3: Expand analyses in our currently funded programs for infants, children, adolescents, and elderly to characterize health disparities in safety, injury, and/or injury outcomes by:
a) Analyzing data from the ongoing multi-site randomized controlled trial on child and infant home safety for factors associated with ethnic disparities.
b) Examining factors associated with ethnic differences in injury rates, mechanisms of injury, disparities in access to potentially disability-reducing treatment and rehabilitation care, and related health outcomes in the elderly.
Key Personnel
Joyce Pressley, Ph.D, M.P.H.
has a broad array of experience in the investigation of health disparities, injury prevention, and program administration. As a former Director of Emergency Medical Services, she worked to set up and evaluate regional medical services at the pre-hospital, hospital, and critical care center levels. She is principal investigator of an NIH-funded study to examine mechanisms that contribute to population-level differentials in life expectancy and disability, specifically in physically vs. cognitively active life expectancy and the costs associated with these health states. She developed a socioeconomic model of functional decline (Pressley 1999) that she used to investigate pathways between functional outcomes and access to potentially disability-reducing medical treatment, surgical interventions, and rehabilitative therapies. Dr. Pressley recently extended this model for use in the investigation of injuries and injury-related disabilities at the primary, secondary, and tertiary phases of injury prevention. She is currently the National Program Evaluator for the Injury Free Coalition for Kids and an Assistant Professor in the Mailman School of Public Health at Columbia University.
Barbara Barlow, M.D.,
Co-Principal Investigator, as Director of the Injury Free Coalition for Kids (IFCK) and the Director of Surgery at Harlem Hospital Center, is heavily involved in community efforts to reduce disparities in injuries. A major goal in her current activities is assisting residents, community leaders, and health care professionals in designing effective interventions to address minority disparities in injuries. In her former role as Director of Pediatric Surgery, her research focused on injury prevention in children and adolescents. In her current role as Director of Surgery, she is observing patterns of preventable injuries across the age span. She has been notably successful in building community coalitions to prevent injuries in younger community residents and to address those occurring in adults and elderly minorities.
Dr. Maureen Durkin
is an Associate Professor of Clinical Epidemiology and has doctoral degrees in anthropology and epidemiology. One of major interest areas is on the epidemiology of pediatric injuries. Her research has also examined brain injuries associated with premature birth and developmental disabilities. She has been a scientific consultant to the Institute of Medicine' Committee on Nervous System Disorders in Developing Countries, the United Nations Office of Disability Statistics and the New York State Department of Health's Bureau of Injury Control. As Director of Research and Evaluation for the Injury Prevention Center at the School of Public Health, Dr. Durkin has ongoing collaborations with Dr. Barlow's Harlem Hospital Injury Prevention Program.
Contact Information:
Joyce Pressley, Ph.D, M.P.H.
e-mail: jp376@columbia.edu
Barbara Barlow, M.D
e-mail: bab1@columbia.edu
