Funded Injury Control Research Centers (ICRCs)
David Hemenway, PhD
Department of Health Policy and Management
Harvard School of Public Health
Kresge Building, 3rd Floor
677 Huntington Ave.
Boston, MA 02115
The Harvard Injury Control Research Center (HICRC) is a multidisciplinary center based at the Harvard School of Public Health (HSPH). The HICRC's theme, "protecting vulnerable populations," is accomplished through applied research projects, training students and practitioners, and communications. The Center's administration and research team demonstrate a long-standing commitment to the field of injury control while welcoming an influx of fresh ideas, personnel, and foci. The Center offers outstanding opportunities for training through its commitment to student research opportunities. Its mentorship program matches experienced researchers with students, provides postdoctoral fellowships, and promotes other research opportunities with local or state agencies. HICRC collaborates with scientists and injury control professionals at the local, national, and international level. To assure the Center's growth and continued development, an independent advisory committee meets annually to evaluate progress and suggest new projects and direction.
The HICRC research resources are devoted to three priority issues: occupational injuries, traffic safety, and violence prevention. For the 1998-2001 period, three major research projects are:
- A survey that will increase our understanding of the risk factors for, and the prevalence and sequelae of, intentional injury among urban youth,
- A firearm survey that will provide policy- relevant information on self-defense gun use, gun storage, and gun carrying,
- The characterization of the effects that residual alcohol intoxication (hangover) has on job-related injury rates.
HICRC is currently leading a national effort to create a nationwide firearms injury surveillance system that will provide accurate, timely, comparable, and comprehensive data on gun-related injuries.
Project Title: Evaluation of State-level Firearms Policies
Project Period: 08/01/98-07/31/06
Description: The project consists of a systematic program for evaluating public policies, technological innovations, and violence prevention strategies involving firearms. Specific aims 1 through 4 pertain to the initial focus on concealed gun carrying laws.
Aim 1: Extend and improve earlier work examining the effect of concealed carry firearm regulations on aggregate categories of violent and property crime, including murder, rape, aggravated assault, robbery, burglary, and motor vehicle theft, using cross-sectional time series data for the 50 United States for 1979 through 1997.
Aim 2: Evaluate the effect of permissive concealed carry regulations on specific subcategories of crime, victims, and perpetrators. For a given outcome, such as homicide, we will identify subgroups of the population for whom concealed carry laws are expected to have an effect and 'control' groups for whom such legislation is unlikely to have a material effect. For example, middle-age white men are more likely than older black women to obtain concealed carry permits and they are also more likely to be victims of homicide outside the home. Homicide rates among middle-age white men should thus be influenced more by changes in carry laws than are homicide rates among older black women. Similarly, outcomes such as homicides by strangers (which generally occur outside the home), might be affected by passage of concealed carry laws, while such laws should have little effect on homicides by family members (which generally occur inside the home).
Aim 3: Explore how well the observed patterns of associations between concealed carry regulations and various crimes conform to various predictive models from the criminology, economic, and public health literatures. According to these predictive models, “shall issue” laws may produce effect via four prime mechanisms: (1) deterring crime, (2) thwarting crime, (3) increasing exposure to firearms, and )4) causing criminals to arm themselves (arms race). For example, if concealed carry regulations deter criminals from attacking victims who might be carrying a gun, homicides committed by strangers (who would not know whether or not a victim was likely to be carrying a gun) should decrease. If, however, concealed carry laws compel criminals to better arm themselves (as in an arms race), homicides committed by strangers and the percentage of such homicides due to handguns should increase.
Aim 4: Examine the relationship between permissive concealed carry regulations and noncriminal outcomes (e.g., the rates of suicide and firearm accidents) using parsing strategies analogous to those described for crime outcomes. To the extent that “shall issue” laws result in changes in firearm carrying, concealed carry regulations change the exposure of individuals (both carriers and those they encounter) to firearms. For example, the proportion of suicides committed with a gun might increase for suicides that occur out of the home but not for suicides that occur inside the homeespecially among men.
Aim 5: Following evaluation of permissive concealed carry regulations, evaluate the effect of child access prevention laws along with at least one other firearm policy (e.g., waiting period regulations, one-gun-a-month laws, design modification requirements, local rights or preemption laws, secondary sales laws). To this end, a legislative history for these laws will be compiled. In addition, using a ranking system like that created by the Open Society Institute, a composite variable measuring the overall permissiveness or restrictiveness of states' firearm-related policies will be created, and this index will be used as an independent variable in analyses. The resultant compendium of legislative histories—drawing from National Rifle Association, Handgun Control, the Bureau of Alcohol, Tobacco, and Firearms, and legal research—will be made publicly available.
Project Title: Low-dose Alcohol, Cold Medications, and Maritime Safety
Project Period: 08/01/98-07/31/06
Description: Low doses of alcohol or therapeutic doses of over-the-counter (OTC) cold medications may be important, but relatively unexplored, sources of injury and error in the workplace. Although impairment from these low-level exposures may pose small risks to individuals, their aggregate effects might be considerable because of the prevalence of exposures. Our research has shown significant decreases in performance in simulated merchant operation when maritime academy cadets were dosed with alcohol at levels between 0.04 and 0.05 g% blood alcohol concentration (BAC). Since 0.04 g% BAC is by federal regulation the level for intoxication for operation of several types of commercial vehicles (trains, merchant ships, and aircraft), and nuclear power plants, our previous findings raise the question of whether decreased performance would occur at lower BACs. Research by others suggests that therapeutic doses of OTC cold medications have impairing effects comparable to low doses of alcohol.
In this project, we will conduct a dose-response, placebo-controlled trial testing the effects of low-dose alcohol exposure (0.02, 0.03, 0.04 g% BAC) on occupational performance. As with our previous research, the occupational model will be merchant ship operation as measured by ship training simulators. We will also conduct trials using the same research design to measure the effects of first generation antihistamines and a non-sedating OTC remedy. This will allow us to assess the risks associated with very low-dose alcohol exposure and OTC cold medications and to compare directly these effects. Secondary hypotheses will explore whether family history mitigates the effects of alcohol on performance and whether a psychomotor vigilance test detects low-level impairment and correlates with simulator performance scores.
Project Title: Outcomes of Elderly Patients Hospitalized with Injuries
Project Period: 08/01/98-07/31/06
Description: Rates of mortality from injury increase with advancing age, and the elderly constitute a disproportionate fraction of patients hospitalized with injuries. Measures to ensure the quality of care for this increasingly large segment of the population have been identified as an important area of research.
Medicare billing data will be used to identify patients over ages 65 who have been hospitalized after injuries and to categorize them by type of injury, severity of injury, and pre-existing health status. For a given injury in a patient with a given state of health, the expected mortality (short- and long-term), acute hospital length of stay, and total institutional length of stay (including rehabilitation and skilled nursing facilities) will be determined. Further variation in these outcomes concerning age, sex, region, hospital volume, and physician experience will be evaluated.
This project will apply methods for using Medicare data in outcome studies that have been previously developed and standardized by the investigators and others. It takes advantage of the nearly complete participation of the elderly population in the Medicare program, a unique beneficiary number enabling linkage of Medicare records across files and over time, and the availability of associated files describing hospitals, physicians, and regional demography. Previously validated methods to estimate co morbidity, classify injuries, and measure injury severity using administrative data will be evaluated in the elderly population. Health Resource Regions previously described in the Dartmouth Atlas of Health Care will be used as the unit of regional analysis.
Having controlled for injury type, injury severity, and co-morbidity, excessive variation in the outcomes dependent upon patient age, sex, region, hospital volume, or physician experience may represent variability in the quality of care. Acquainting providers and policy makers with this variability may improve or standardize hospital care for patients of all ages, and particularly for the elderly.
Project Title: Intentional Injury among Urban Youth
Project Period: 08/01/98-07/31/06
Description: The project will study 5,000 males and females, ages 2, 5, 8, 11, 14, and 17, residing in 80 neighborhoods in Chicago. These children and their caregivers will be assessed twice during home-based sessions to determine the source, frequency, and severity of intentional injury and the consequences of such injury on their physical, psychological, social, and academic functioning. Participants will also be interviewed about gun ownership (self and family), gun carrying, and reasons for gun ownership. Information will be obtained through structured interviews with subjects (ages 7 and older) and one primary caregiver. Data collected in these domains will be embedded in an ongoing study of the neighborhoods, schools, families, and personal risk factors of the study participants. The resulting combined data set will enable an interdisciplinary group of researchers to achieve the following aims.
Aim 1: Determine the prevalence of intentional injury and its variation by age, gender, race/ethnicity, and socioeconomic status in a probability sample of 5,000 children, ages 2 to 17, in the city of Chicago.
Aim 1a: Determine the prevalence of gun ownership by children/adolescents and their family members and its variation by age, gender, race/ethnicity, and socioeconomic status.
Aim 2: Examine cross-sectionally the correlates of intentional injury at community, school, family, and individual levels. Pursuit of this objective will be based on community data obtained from multiple, independent sources, including official records, surveys, and personal interviews.
Aim 2a: Examine cross-sectionally the correlates of gun ownership at community, school, family, and individual levels.
Aim 3: Determine, cross-sectionally, the relative risk for intentional injury associated with the presence of a gun in the home, independent of and in interaction with neighborhood levels of violence and neighborhood levels of gun ownership.
Aim 4: Replicate the findings of Aims 1and 3 in a second round of cross-sectional analyses, using a final wave of data collection.
Aim 5: Examine longitudinally the relationship between intentional injury and psychiatric symptoms and disorders, physical health status, and associated impairments in the areas of academic and social functioning.
Aim 6: Examine longitudinally the antecedents and multiple pathways resulting in intentional injury.
Aim 6a: Examine longitudinally the antecedents and multiple pathways leading to youth gun possession and carrying.
Aim 7: Determine, longitudinally, the relative risk for intentional injury associated with the presence of a gun in the home, independent of and in interaction with neighborhood levels of violence and neighborhood levels of gun ownership.
Project Title: Estimating the Cost of Employing Partner Violence Perpetrators
Project Period: 08/01/03-07/31/06
Description: The purpose of this project is to develop a measurement tool for use in occupational settings that will identify perpetrators of intimate partner violence and assess productivity level. The project involves conducting background research necessary for developing the survey items, creating a pilot survey, administering the survey to workers, and assessing the validity of the measure.
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