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Unintentional Injury Deaths Among Persons Aged 0–19 Years — United States, 2000–2009

Monday, April 16, 2012 at Noon E.T.

OPERATOR: Welcome and thank you for standing by.  At this time, all participants are in a listen-only mode until the question-and-answer session of today's conference.  At that time you may press star one to ask a question.  I would like to inform all participants that today's conference is being recorded.  If you have any objections, you may disconnect at this time.  I would now like to turn the conference over to Mr. Tom Skinner.  You may begin. 

TOM SKINNER: Thank you, Jennifer.  And thank you, all, for joining us today for this telebriefing on another Vital Signs report.  This one “Unintentional Injury Deaths among Persons Aged 0 to 19 years- United States, 2000-2009.”  With us today, to provide some opening remarks before we get to your questions, are Dr. Ileana Arias, the deputy director of the CDC.  And Dr. Julie Gilchrist, a medical epidemiologist in the Division of Unintentional Injury Prevention.  Both will provide about three minutes of comments.  And then we'll get to your questions.  So I′d like to turn it over to Dr. Arias. 

ILEANA ARIAS: Thanks, Tom.  Good afternoon and thank you for joining us.  Today I′d like to discuss the findings for the new CDC Vital Signs study on child injury in the U.S.  I'll share information on the trend of child injury deaths over the past decade and especially important, what we can do to help prevent these tragic deaths and help children live lives to their full potential.  This morning, a new CDC Vital Signs report was published on the topic of child injuries.  And when we say child injuries, we referring to unintentional injuries that occur among children and teens from birth through age 19.  The common causes of death for child injuries include motor vehicle crashes, suffocation, drowning, poisoning, fires and burns, and falls.  This report doesn't cover injuries caused by violence or child maltreatment. 

I would like to share a few notable findings from that report.  Unfortunately, more than 9,000 children died from unintentional injuries in the U.S. in 2009.  That means that one child every hour, in other words, between now and the time that you go home to your family at 6:00 tonight, six children will have died from unintentional injuries.  One out of every five children in the U.S. who died in 2009 lost his or her young life due to an injury.  In the U.S., injury death rates for children up to the age of 14 ranks among the worst among all high-income countries.  And as horrible as they numbers are, the facts are even more troubling and difficult to accept when you consider that most of these events are predictable and preventable.  Child injury rates did vary substantially by state in 2009.  Death rates ranged from less than five deaths per 100,000 children in Massachusetts and New Jersey, to more than 23 deaths per 100,000 children in South Dakota and Mississippi.  This variation is important, because it demonstrates what is possible to accomplish.  For example, in 2009, more than 5,700 children's lives would have been saved, if the lowest state death rate had been achieved nationally. 

The numbers are high, and one child's death is one death too many.  But fortunately, we're seeing significant improvement.  Child injury death rates dropped nearly 30 percent from 2000 to 2009.  This decrease in injury death rates has resulted in more than 11,000 children's lives being saved.  A large part of the decline is from a 41 percent drop in motor vehicle crash deaths in children over the past decade.  Several factors have driven this reduction in crash-related deaths including improved use of child safety seats and booster seats.  As well as more widespread adoption and the strengthening of graduated driver's licensing systems or GDL laws for teen drivers. 

Despite the good news there are troubling trends in some causes of injury.  Poisoning deaths rates among young people have increased.  This is driven by a 91 percent increase among teens ages 15-19, largely due to prescription drug overdoses.  Suffocation death rates have also increased.  In the past there was a 54 percent increase in reported suffocation in the past decade.  I'm sorry, this was a 54 percent increase in reported suffocation deaths among infants under one year of age.  While we celebrate a 41 percent drop in motor vehicle crash deaths in children over this past decade, motor vehicle crashes still result in thousands of deaths each year, accounting for half of all child injury deaths.  We've made progress, and because of that progress, our children are safer than ever before. But injury continues to be a leading cause of death among children.  We know more can be done to keep our children safe.  And therefore, more must be done.  To share more about how child injuries can be prevented, I'll now turn to Dr. Julie Gilchrist. 

JULIE GILCHRIST: Thank you, Dr. Arias and thanks to everybody for joining us today.  What more can we do?  At the CDC Injury Center, we're committed to helping young people live full, healthy lives. In order to keep our kids safe from injury, we need two main things. First, we need safer environments, reducing the risk of injury for children where they live, learn and play.  And second we need empowered parents and other caregivers who have the knowledge and skill to make the right choices for safety every time.  There are many ways we can make our environment safer.  Just a few we can choose to create, I'm sorry, we can create or choose to use play areas with soft landing surfaces, we can ensure homes have well-functioning smoke alarms, and we can install fences with self-closing, self-latching gates around swimming pools.  But some things to keep kids safe are not a one-time fix.  They must be safe choices made every time. 

By knowing what to do to keep children as safe as possible and by taking these proven steps for safety, parents and other caregivers can be empowered to prevent child injury.  This includes things like making sure every child is in a seat belt or the right safety seat on every trip, every time.  Putting babies to sleep in safe cribs on their backs with no loose bedding or soft toys.  And keeping medicines, even the ones you use every day, away from children and teens.  Parents and other caregivers can learn how to take actions to ensure safety.  To help with this, we would like to call attention to our newly updated “Protect the Ones you Love” initiative, which offers parents and other caregivers proven injury prevention tips for each of the leading causes of child injury.  But it's more than parents and other caregivers who can make a difference. 

Everyone has a role in keeping our kids safe.  Along with our Vital Signs report today, CDC and more than 60 partner organizations are releasing a national action plan for childhood injury prevention.  The plan provides a framework to guide and coordinate the actions of those responsible for the health and safety of our children, including health care providers, educators and community members.  It′s intended to raise awareness, highlight prevention solutions and mobilize action to reduce childhood injury in our nation.  The plan and all the “Protect the Ones you Love” materials are available online at www.CDC.gov/safechild. We can work together to prevent injuries for the children we love.  Thank you.  Dr. Arias? 

ILEANA ARIAS: As you heard, every hour a child dies as a result of injury and losing even one child to an avoidable injury is one too many, and therefore totally unacceptable.  But, we've made significant progress, because we know what works.  Building on that progress, we now have the national action plan that can guide coordinated efforts to support and do what works in every community across the country.  Thank you. 

TOM SKINNER: Jennifer, I believe we're ready for questions, please. 

OPERATOR: If you would like to ask a question, please press star one and record your name clearly.  To withdraw your request, you may press star two.  Once again, to ask a question, please press star one.  In just one moment for the first question.  Our first question comes from Mike Stobbe of the Associated Press. Sir, you may begin. 

MIKE STOBBE: Hi, thank you for taking my question.  Dr. Arias, you were talking about suffocation death rates, I think you said 54 percent increase in the past decade in children one year and younger.  Do you mind, did I get those numbers right?  And could you say a little more about what was responsible for that increase? 

ILEANA ARIAS: Sure.  The numbers that you quoted are correct.  It's a little complex in terms of the overall picture.  And so I'll have Dr. Gilchrist give you some of those specifics. 

JULIE GILCHRIST: Thanks, yeah, this is a troubling number.  The increase is definitely something we wouldn't like to see.  And part of it may be due to the improved death scene investigations and classifications of infant deaths that might have previously been classified as SIDS.  But when we looked at the SIDS deaths across the decade each year, along with how they might have been reclassified, it didn't explain all of the increase and all of the differences.  But our main point is that regardless of whether this is a new increase or whether it's the way it's been, it's still almost 1,000 infants a year that are suffocating in their beds and in environments that we know aren't safe and that can be prevented with things that we have today.  And so that's our main point, is that these are preventable infant suffocations and we can do more to prevent them. 

TOM SKINNER: Next question, Jennifer? 

OPERATOR: Our next question comes from Deborah Kotz of the Boston Globe. You may begin.

DEBORAH KOTZ: Thank you for taking my question.  Wondering if you could explain some of the differences between the state rates, specifically Massachusetts if possible, you know, why is it that some states really do have lower rates?  Does it have to do a lot with the driving laws?  Or is there something else that's coming into play? 

ILEANA ARIAS: There is, as I mentioned, there's a lot of variability across the states, in terms of the actual rates and there is also variability with regard to the approach that's taken to child safety across the states and some association between those approaches and then the results that you would expect.  A lot of what seems to be driving the variability is variability in policies that are in place that address child safety whether it's in the home, or out in the community, in schools, playgrounds, et cetera.  And then also the extent to which programs, especially comprehensive programs addressing child safety, are being implemented and supported at the state and local levels as well. 

DEBORAH KOTZ: So, do you have anything specific about Massachusetts, what they're doing right? 

ILEANA ARIAS: Other than just the sheer volume and the attention, nothing specific.  So there is any specific thing that they have done, that if others replicated, they would get the same result.  I think Massachusetts has a record of over time being very cognizant of injury of not only as far as children are concerned, but for their general population.  And investing in programs and then policy development to address safety in the prevention of those injuries.  So again, what you see then is a wide range of approaches that they have taken, not just the policy level, addressing things like booster seats and teen driving laws.  But then also looking at the programs that are available, whether it's in schools, or in communities that actually increase or improve the safety factor. 

TOM SKINNER:  Next question, Jennifer? 

OPERATOR:  Our next question comes from Salynn Boyles, of WebMD.

SALYNN BOYLES: Can you talk a little bit more specifically about the poisoning death rate increases among teens?  Specifically what's going on there, any specific drugs, and you know, what can parents do? 

ILEANA ARIAS: The picture with teens is not that different from what's happening with prescription drugs for the entire population.  Even with older Americans and that is, that painkillers are essentially the driver of that prescription drug overdose problem as well.  Specifically, things such as, you know, Vicodin, Percocet, Demerol, et cetera, and it's the abuse of those medications that has been shown over the last ten years to have become a significant, significant problem in the U.S.  for all populations, but then we're seeing it among teens as well.  One of the things that is some of the information that's coming through also that is of concern, is that there seems to be a trend for the prescription drug, prescription drugs or painkillers specifically, almost to replace marijuana as a gate-keeper drug for other, other abuse, such as heroin, etcetera.  So not only are the deaths increasing among that age group, but then it's also increasing the risk for the abuse of other substances that are equally detrimental to those teens. 

TOM SKINNER: Next question?  Do you have a follow up? 

SALYNN BOYLES: Could I follow up?  Are these coming from parents' medicine cabinets?  Is that a significant driver here? 

ILEANA ARIAS: I mean that's one of the things that we're careful to tell people to control.  For example, if you get prescribed medication, painkillers that you don't use, make sure to dispose of them properly and not leave them around the house.  To keep them out of the hands children for sure, and teens and others as well.  There isn't sort of very hard evidence pinpointing exactly where the access is coming from.  What is the primary point of access?  Certainly access in the home or homes, not even the home of that particular teen.  But a friend′s etcetera is one.  And then there's also illegal access as well.  So buying them in the streets.  So it's a combination of methods of accessibility. 

TOM SKINNER: Next question, Jennifer? 

OPERATOR:  Our next question comes from Cheryl Clark of Health Leaders Media.  You may begin. 

CHERYL CLARK: Thank you, I realize this may not be part of the scope of this vital signs report.  But I was wondering if you could address more on the end of what providers might be able to do about this problem to reduce the morbidity and mortality.  And I'm specifically asking about say concerns about funding for poison control centers, lack of transfer agreements among hospitals.  Equipment resources in emergency departments, ambulance time, transfer time.  Use of facilities that specifically are geared to address medical issues in children.  I don't want to go on and on.  But I don't know whether -- can you talk about in the realm of what can we do about this, what might providers do to improve their provider systems? 

JULIE GILCHRIST: This is Julie Gilchrist, I can answer that.  You've brought a lot of them up.  I mean from the preventing it, providers providing education and anticipatory guidance to their patients, and their patients' families is really important.  Anything a provider can do in their community to identify risk and help educate community members and advocate for change in the community is great, because providers are oftentimes well respected and well listened to community members.  So we encourage that.  All the way through to dealing with after an injury, emergency medical services for children, poison control centers, trauma centers you've already named the gamut there of improving all of those for children.  And if you're interested in more about the health care systems and some of the thoughts around that, you might be interested in examining that chapter in the national action plan.  It is laid out, instead of by mechanism of injury; it's laid out across domains.  One of which is the health care domain.  Others are things like research, surveillance, education and training, advocacy, policy, things like that.  And so there's, these organizations got together and thought through some of the strategies and actions that the health care sector could undertake.  And that's included in that chapter.

CHERYL CLARK:  Could you name just a couple? 

ILEANA ARIAS: More significant changes that have taken place over time is essentially adoption of injury prevention, as part and parcel of what public health does and what the medical community, especially the pediatric community does as well.  That has made a big, big difference.  We're continuing to make sure that that continues to increase.  And simply raising the visibility and sensitivity to addressing safety by you know, pediatricians, nurse practitioners, etcetera, with parents and other adults, is significant step that needs to be taken, or that needs to continue to be implemented. 

CHERYL CLARK:  Can you name any one of those things that you think could be done better by provider community? 

ILEANA ARIAS: You mean in terms of an actual mechanism?  Not really.  I mean I think we can, people will focus on some more than others, depending on what is happening at the time.  So there may be more attention paid to you know, access to prescription drugs in the home. As a result of you know, something that may be happening at the time.  But they're all in the same – I think one of the things that's very important, national action plan certainly calls attention to that.  The campaigns for the initiative we have, protect the ones you love also does that, in that end. And that is not to take injury for granted.  In that we usually see injury, especially in childhood, as part and parcel of what happens to kids, almost like a rite of passage. Which is fine and most kids do survive.  You know that rite of passage.  But as we're seeing, there's a significant number of children every year who do not.  And are injured severely enough that they actually will die.  So what we're trying to do is make sure that we don't take that for granted.  And that injuries are dealt with in terms of prevention, very similar to the way we deal with measles, the way we deal with other kinds of disorders and other kinds of conditions that pediatricians and medical professionals handle. 

TOM SKINNER: Next question, Jennifer? 

OPERATOR:  Our next question comes from David Beasley of  Reuters news service, you may begin.

DAVID BEASLEY: Could you elaborate a little bit on how to prevent infant suffocation and SIDS deaths?  Are there other guidelines? 

JULIE GILCHRIST: Yes.  This is Julie Gilchrist.  We support the American Academy of Pediatrics' most recent task force recommendation.  And the vast majority of the infant suffocations involved suffocation in bed.  Well, while they were sleeping, in some sleeping environment.  Whether it was an appropriate one or not.  And that would include things like placing an infant on their back every time, a firm sleep surface, not having any loose bedding or toys in the crib, room sharing and not bed sharing, to avoid you know, layovers and wedging in between the mattress and the wall and all the other tragic things that happen.  I think that gets most of them.  But if you're interested, the American Academy of Pediatrics recommendations came out last summer and they're very well thought out and aimed to prevent both SIDS and infant suffocation. 

DAVID BEASLEY:  Thank You. 

TOM SKINNER:  Next question, Jennifer? 

OPERATOR: Our next question comes from Robert Loves from Medscape Medical News, you may begin. 

ROBERT LOVES:  Thanks for taking my question.  I would like to go a little more into detail about the accidental poisoning deaths by prescription drugs.  Can you describe any role played by psychiatric drugs?  Are they, how do they compare to the opiates in terms of being a cause of this upswing?  Also, in terms of the increase among older teens, are you saying that the overdoses with the painkillers, is that the main reason why it's gone up so dramatically?  Or how would you describe you know, the level of contribution there? 

JULIE GILCHRIST: This is Julie Gilchrist.  So among those 15 to 19 years of age, we saw you know, dramatic increase, almost doubling of the poisoning rate from that, the vast majority were from prescription medication.  And among those, the largest group was the opioids and other prescription painkillers.  Now certainly the neuropsychiatric and other medications can play a role in that; and there were certainly some.  But you know, our concern is specifically, you know, our main concern, I would say is the prescription painkiller; because that's what we're seeing in the older populations as well; adult population.  And so it's just tragic to see this epidemic beginning in our young people. 

ROBERT LOVIS: Okay. 

TOM SKINNER:  Next question, Jennifer? 

OPERATOR: As a reminder, if you would like to ask a question, please press star one.  And record your name.  Our next question comes from Naseem Miller of Pediatric News.  You may begin. 

NASEEM MILLER:  Thanks for taking my question.  I was wondering if and when you're planning to repeat this report.  And if it, lets say, a decade long period, are there areas of concern that you're turning your focus on right now?  Because I can think of poisoning, I know synthetic drugs are gaining momentum. 

JULIE GILCHRIST: This is Julie Gilchrist.  So I don't have a schedule on which we'll do a large-scale report like this.  However, we are definitely focused on these areas that have been identified here.  So poisoning, we've been working in at the injury center for quite a long time, to identify and define this epidemic.  And try and focus some preventive work in the area.  We've moved forward, a lot of things have been, we're hopeful will be successful, prescription drug monitoring programs and improved prescriber practices.  We collaborated with the American College of Emergency Physicians to improve prescriber practices, to create guidelines to improve provider practices in the emergency department.  Where a large number of prescription painkillers go out.  And things like that. So as far as the specific mechanisms, we will continue to stay on top of what's going on and try and report them when it's appropriate and look into preventive causes. I would hope that we would be able to do you know, another summary report like this in the future.  But i can't tell you when that might be.  

TOM SKINNER: Jennifer, we've got time for one more question. 

OPERATOR:  Our last question comes from David Brown of the Washington Post. You may begin. 

DAVID BROWN:  Hi, Yes, Thanks a lot.  I'm a late arrival. So -- the poisoning with opioids and the teenagers, is most of, what's the route of delivery of this? 

ILEANA ARIAS: That has not been pinpointed. There are several that have been looked at.  As you can well imagine, one is access in the home; in the home of that particular child.  But not all the deaths are the result of overdoses from medications that were available in the home per say.  So that there's also a lot of sharing that's going on and a lot of sale that's going on in the streets of medications that are either obtained in the home by teens or adults and sold on the street, or obtained in other ways. 

DAVID BROWN: That's not my question. Are these things taken orally or are they being taken IV? 

ILEANA ARIAS: It is oral. But you know sometimes and there's some snorting, but it is mostly oral. 

DAVID BROWN: Okay, Thanks.

ILEANA ARIAS: Thank you very much for joining us. The report that we released today finds that injuries are the number one killer of children in the U.S.  We are fortunate that child deaths from injuries have dropped 30 percent in the past decade, the result of the support of effective interventions and strategies for preventing those injuries.  We all know what needs to be done. We certainly can improve upon the success that we have accomplished. And we're looking forward to using the tools that we have made available in implementing those, so that we can significantly improve upon that 30 percent. 

TOM SKINNER: Jennifer, this concludes our briefing.  Thank you all for joining us.  If you have any follow-up questions or need copies of the information, that has been provided today, please call the CDC press office at 404-639-3286.  Thanks again. 

OPERATOR: Thank you for your participation in today's conference, you may disconnect at this time. 

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