ICRC Success Stories – Outreach Impact

Since CDC began funding Injury Control Research Centers (ICRCs) in 1987, the ICRCs have advanced the injury and violence prevention field. The following success stories detail the important work ICRC’s do to study injuries and violence and to put their research findings into action to save and protect lives.

Research Impact

Training Impact

Outreach Impact

• Collaborating Injury Center Researchers Launch the Cardiff National Network in the United States
• Injury Free Coalition Hosts Inaugural Injury Prevention Day
• Combatting the Opioid Crisis in Michigan (University of Michigan)
• Johns Hopkins Pioneers Autonomous Vehicle Collaborations in the U.S. (Johns Hopkins School of Public Health)
• University of Rochester and the State of Colorado Developing Innovative Suicide Prevention Collaborative (University of Rochester Center Medical Center)
• University of Pennsylvania Helping to Reduce Concussions Among College Football Players (University of Pennsylvania)
• Johns Hopkins Improving Helmet Use Among Kids (Johns Hopkins School of Public Health)
• Changing Safety Standards for Laundry Detergent Packets (The Research Institute at Nationwide Children’s Hospital)
• Educating Stakeholders about the Opioid Overdose Epidemic and Naloxone Programs (West Virginia University)
• Preventing Motor Vehicle Injuries (Columbia University)

The Cardiff Model Confronts Unreported Violence

More than half of violent crimes in the nation are unreported [PDF – 53 pages] according to the United States Department of Justice. The Cardiff Violence Prevention Model provides a way for communities to gain a clearer picture about where violence is occurring by combining and mapping both hospital and police data on violence. The Cardiff National Network brings together key partners to conduct violence prevention such as:

• Community groups
• Hospitals
• Law enforcement agencies
• Public health agencies and others

Hospital emergency rooms and police share anonymous injury information with partners. Pooling the information provides a more complete picture of where and when violence is occurring. The Injury Control Research Center Injury Prevention Research Center at Emory University (IPRCE) is excited to support the start of the Cardiff National Network across the United States in trauma centers and support organizations that report on violent injury and crime.

The Injury Prevention Research Center at Emory University Assesses Potential Cardiff Model Sites

The extent to which the Cardiff Model intervention can be carried out in the United States is unknown. IPRCE aims to assess the Cardiff Model organizational readiness assessments with potential Cardiff Model sites. The organizational readiness assessments occurred at Phoebe Putney Memorial Hospital in Albany, Georgia and Atrium Health Navicent in Macon, Georgia. IPRCE also assessed two law enforcement agencies in Albany and Macon. Organizational readiness assessments examine whether an organization can carry out the Cardiff Model. IPRCE spoke with partners within each city for the assessment. Partners included hospital staff, police, the mayor, the public safety commissioner, and the city manager. Sites expressing interest or participation in the Cardiff Model become part of the Cardiff Model Network. There are internal conversations about carrying out the Cardiff Model using the organizational readiness assessment findings at the next potential network site, Children’s Healthcare of Atlanta.

The Cardiff National Network Supports Collaborative Violence Prevention Efforts

Researchers at the IPRCE and the Comprehensive Injury Center at the Medical College of Wisconsin brought together a network of 18 cities to support the Cardiff Violence Prevention Model. This network became known as the Cardiff National Network. The network provides each site with individual consultation, technical assistance, sustained support for the Cardiff Model outside of larger network meetings. The Cardiff National Network is available for others to join. The Network also started a newsletter in 2023 to celebrate its first year. The newsletter includes new approaches and best practices for carrying out the Cardiff Model.

Injuries are the leading cause of death and hospitalizations for children in the United States aged 1–18 years. Every day, more than 25 children die from preventable injuries, resulting in more deaths than all other causes combined. The Injury Free Coalition for Kids® coordinated the inaugural National Injury Prevention Day on November 18, 2020 to raise awareness of this important public health issue.

The Injury Free Coalition for Kids® brought together child injury prevention advocates, healthcare professionals, public health professionals, elected officials, and families to shed light on the need to address the burden of child injury in the United States. The coalition operates as an outreach arm of the Columbia Center for Injury Science and Prevention at Columbia University, a CDC-funded Injury Control Research Center (ICRC). The coalition used traditional media, social media, educational opportunities, government proclamations, and green lights to highlight this issue.

Green for Safety

Beacons of green light radiated from over 80 city landmarks and children’s hospitals across the United States to highlight child injury prevention. The Johns Hopkins dome in Baltimore; the Hemsley Building in New York City; the Prudential Building in Boston; Harborview Medical Center in Seattle; Major League Soccer stadiums in Kansas City, Saint Paul, and Philadelphia; and bridges in Houston, Iowa City, and Little Rock are among the many places that lit up in green to raise awareness.

Green was chosen as an inspiration to raise awareness and advocate for child injury prevention because green represents safety, positivity, peace, and growth.

Participation by the Numbers

Injury Free Coalition for Kids® brought together more than 40 Level I trauma centers across the country, including six ICRCs that are also Level I trauma centers. Together they obtained proclamations from 18 mayors, governors, and senators declaring November 18 as National Injury Prevention Day. Media coverage was obtained in 38 venues across the country and a one-hour Twitter chat was hosted by 20 Injury Free sites using the hashtag #BeInjuryFree.

There were 3,286 engagements of the Twitter chat effort demonstrated by likes or retweets of the posts. The Twitter chat reached almost 4 million projected viewers and users saw posts more than 14 million times containing the hashtag #BeInjuryFree.  During the Twitter chat there were 175 posts using the @injuryfree Twitter handle and those posts were engaged 1,902 times demonstrated by liking or replying to those posts. The American Trauma Society, American Academy of Pediatrics, Trauma Centers of America Association, The Society for Advancement of Violence and Injury Research (SAVIR), Everytown’s BeSMART, Moms Against Violence, and the CDC Injury Center all took part.

One Injury Free site in Arkansas created a social media toolkit for its executive leadership. The toolkit included background information, talking points, suggested Tweets, and graphics to facilitate participation.

Participation Inspired New Connections

A post-event evaluation demonstrated that relationships between healthcare providers and child advocate professionals were strengthened by the activities. The following data were reported for 20 Injury Free Coalition for Kids® sites:

• Six sites reported getting to know Coalition members better.
• Five sites reported the experience helped them build better relationships with community organizations.
• Ten sites reported stronger relationships within their institutions.
• Three sites met new healthcare providers through the Twitter chat.
• One site strengthened its relationship with elected officials while another strengthened its relationship with law enforcement.
• Several sites said they formed new relationships with area schools.
• One site said the experience strengthened their relationship with the Department of Transportation.

It’s encouraging to see healthcare professionals, child injury prevention advocates, public health professionals, elected officials, families, and others come together to raise awareness about childhood injury prevention. Plans are being made for 2021 to build on the successful awareness campaign, broaden the reach, and highlight the significance of injuries to children as well as the importance of injury prevention.

Michigan is better prepared to quickly and efficiently respond to the continuing opioid overdose epidemic due in part to Centers for Disease Control and Prevention (CDC) funding. The University of Michigan Injury Prevention Center (U-M IPC) is one of nine universities currently funded by the National Center for Injury Prevention and Control as Injury Control Research Centers (ICRCs).

In Michigan, there are three examples of successful partnerships and collaborations between the U-M IPC, the state health department, and other state agencies:

• the System for Opioid Overdose Surveillance (SOS),
• the Michigan Safer Opioid Prescribing Toolkit, and
• the Opioid Massive Open Online Course (MOOC).

These programs were developed because drug overdose deaths were increasing in the United States. We lose 184 Americans from preventable drug overdoses every day. In 2018 alone, more than 67,000 Americans died from drug overdoses. Drug overdoses are a leading cause of injury-related death in the United States and a leading contributor to the disturbing decline in life expectancy in the U.S. over three consecutive years (2014–2017).

In 2018, the state of Michigan experienced 2,599 drug overdose deaths; this included 2,036 deaths that were opioid-specific. While opioid prescriptions have dropped 22% from 2015 to 2018 in Michigan, prescription opioid misuse and related deaths are still major issues.

Real Time Data System Reduces Opioid Overdoses and Deaths

In 2016, the U-M IPC partnered with the Michigan High Intensity Drug Trafficking Areas (HIDTA) with support from the Michigan Department of Health and Human Services  to develop the System for Opioid Overdose Surveillance, or SOS. The system tracks opioid overdoses in near real-time, providing data within one day of overdose incident. Previously, local public health, community groups, and local law enforcement providers found it difficult to access real-time data. The lack of real-time data hindered rapid public health and law enforcement response to the expanding overdose crisis. The SOS filled this gap at the local level.

The U-M IPC used their expertise in collecting motor vehicle crash data to create this state-of-the-art opioid overdose surveillance system.

The SOS collects statewide Emergency Medical System naloxone administration data and medical examiner data from over 80% of the state’s population. The SOS launched as a web-based tool with two levels of access:

• The first level is public and displays county-level summaries.
• The second level of access—which is available to authorized public health and public safety professionals across the state of Michigan—maps non-fatal and fatal opioid overdose incidents in near real-time (within a day of overdose incident) and provides demographic briefs.

This interactive dashboard includes features that allow users to tailor visualizations to meet their specific needs. Users can select a data source, a zoom window, and a time frame to display points and descriptive summaries of suspected overdoses. Qualitative work with community stakeholders suggests the data are being used to inform local planning, implementation, and responses to opioid overdoses. For example, outreach and community organizations report being able to determine where a mobile site could be useful, or where street teams might be effective in reaching those who may need naloxone education or distribution.

As of early May 2020, approximately 250 SOS authorized stakeholders covering 57 (70%) Michigan counties had logged into the system. Before SOS, these data were not widely shared. This new system provides live dashboard information that can be viewed based either on geography or population.

Innovative Educational Resources Provide Guidance and Understanding

The U-M IPC partnered with the Michigan Department of Health and Human Services to develop the new Michigan Safer Opioid Prescribing Toolkit. This is a comprehensive, evidence-based resource created for primary care providers and patients. It aims to provide guidance to make pain management safer, prevent opioid-related harms, and link to substance use treatment. Surgeons, dentists, specialty providers, and allied health professionals, along with patients, can also use this toolkit.

Additionally, the U-M IPC and partners launched a Massive Open Online Course (MOOC) to help providers understand different facets of the opioid crisis. This free, self-paced open learning course is designed primarily for non-prescribing healthcare, behavioral health, dental, and social services professionals, as well as graduate-level students in these fields. Physicians, medical students, and other professionals will also benefit from taking the course. Free continuing education credit is also available.

In November 2019, the Governor of Michigan announced strategies [PDF – 3 pages] for addressing the opioid overdose epidemic in Michigan. The toolkit was an integral part of this announcement. Since launching in November 2019, there have been over 3,100 unique visitors to the toolkit, over 3,900 total page views and over 2,100 learners who have benefited from the MOOC in the first five months of launch.

The CDC funding and structure helps Michigan to better prepare and efficiently respond to the continuing opioid epidemic with both the SOS, the Michigan Safer Opioid Prescribing Toolkit, and the Opioid MOOC. These programs are examples of successful partnerships and collaborations between Injury Control Research Centers, the state health department, and other state agencies.

What’s the problem?
Reducing motor vehicle crash deaths was one of the great public health achievements of the 20th century for the U.S. However, motor vehicle crash deaths are still too high. More than 32,000 people are killed and 2 million are injured each year from motor vehicle crashes. Automated vehicles have the potential to save lives and reduce injuries because human error contributes to 94% of serious crashes. Automated vehicles have the potential to remove human error as a cause of crashes. This will help protect drivers, passengers, bicyclists, and pedestrians. Automation could improve safety, eliminate economic and social costs, improve traffic efficiency, and improve mobility for the millions of Americans that have some form of disability.

What did the ICRC do?
The Johns Hopkins School of Public Health sponsored two high visibility symposia to launch a new initiative focused on the safe and equitable deployment of autonomous vehicle technology. These symposia are archived online: The Road to Zero: Research, Policy, and Practice, and The Future of Personal Transportation. The Future of Personal Transportation seminar was conducted in partnership with Sweden’s KTH Royal Institute of Technology and was the first-of-its-kind gathering in the United States.

The Future of Personal Transportation event brought together key thought leaders to discuss vehicle technology and Vision Zero – zero accidents and emissions – as public health interventions. A former U.S. Secretary of Transportation and former Administrator of the National Highway Traffic Safety Administration spoke along with numerous national and international experts. They discussed ethical and legal issues and implementation considerations that can help realize the desired social benefits of autonomous vehicles. The symposium was attended by more than 100 people and was web cast to a remote audience. The audience included diverse representatives from public health, academia, government, and law enforcement.

What was the outcome/impact?
Since the symposium, preliminary findings from the new research projects on autonomous vehicles have been presented to policy makers, industry groups, and safety regulators. These presentations have reached such stakeholders as Advocates for Highway and Auto Safety, the Insurance Institute for Highway Safety, the National Highway Traffic Safety Administration, Safekids Worldwide, and the Royal Swedish Institute of Technology. Johns Hopkins staff also recently met with Lyft’s director of autonomous vehicle strategy to discuss safety in transportation and opportunities for research.

Johns Hopkins is pursuing further research studies an innovative partnerships in this area. Pilot research projects focused on safe and equitable testing and deployment of autonomous vehicles are in development. These projects include collaborations with city planners and the automotive industry. Partnerships are underway with the Swedish Royal Institute of Technology and with localities implementing Vision Zero and Safe Systems approaches to improving transportation safety. Johns Hopkins is also exploring the unique needs of child passengers in driverless cars through a collaboration with Safekids Worldwide.

To learn more:

Johns Hopkins School of Public Health

What’s the problem?
Suicide is a leading cause of death in the United States. Suicide rates increased in nearly every state from 1999 through 2016. Mental health conditions are often seen as the cause of suicide, but suicide is rarely caused by any single factor. Many people who die by suicide are not known to have a diagnosed mental health condition at the time of death. Other problems often contribute to suicide, such as those related to relationships, substance use, physical health, and job, money, legal, or housing stress. It is important for government, public health, healthcare, employers, education, the media, and community organizations to work together to prevent suicide. Public health departments can bring together these partners to focus on comprehensive state and community efforts with the greatest likelihood of preventing suicide.

What did the ICRC do?
The Colorado National Collaborative (CNC) is a major initiative led by the University of Rochester and the Colorado Department of Public Health and Environment (CDPHE). Through this initiative, state and local public health, policy and operational leaders, and other partners are building and testing a comprehensive set of coordinated suicide prevention efforts statewide. The collaborative includes an impressive array of local, state, and national partners to assure diverse input and broad expertise. Other states are watching this unique collaborative to see if it can be a new model for comprehensive state-based suicide prevention efforts.

The CNC used their resources to investigate areas in Colorado experiencing high rates of suicide and factors that contribute to suicide. Based on data CDPHE shared from the National Violent Death Reporting System (NVDRS), partners were able to document suicide patterns and how they changed over time. This information complements an inventory of prevention efforts that the CNC gathered through an environmental scan of state and local agencies, non-governmental organizations, and health systems. The CNC used these data to identify communities that have access to preventive interventions and those that do not and which ones are experiencing high rates of suicide or suicide risk factors.

The University of Rochester also secured additional funding to support in-person meetings to expand visibility of the project and engage national partners. These partners include the National Institute of Mental Health (NIMH), Substance Abuse and Mental Health Services Administration (SAMHSA), the American Foundation for Suicide Prevention, and violence and suicide prevention coordinators of HHS Regions 1 and 2.

What was the outcome/impact?
The community-level data gathered by the University of Rochester and CDPHE identified six priority counties across Colorado. The CNC will focus their suicide prevention efforts in those counties. Local-level data have provided critical information for these six counties to inform their comprehensive, data driven suicide prevention efforts. This includes data on populations within counties affected by suicide, key risk and protective factors in each county, and existing suicide prevention resources and services to identify priorities for strengthening comprehensive suicide prevention in each county. The University of Rochester and CDPHE are planning a CNC meeting to bring together all six counties with state and national partners. At this event, counties will begin using the local-level data to develop their comprehensive suicide prevention plans, which target the unique needs and strengths of their county.

To learn more:
University of Rochester Medical Center

What’s the problem?
A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.

The severity of a TBI may range from mild to severe. A TBI can cause a wide range of functional short- or long-term changes that affect thinking, sensation, language, and emotion. About 75% of TBIs that occur each year are concussions or other forms of mild TBI. Repeated mild TBIs occurring over an extended period of time may increase the risk for neurological and cognitive deficits. While rare, repeated mild TBIs occurring within a short period of time, such as hours, days, or weeks, can cause severe damage to your health and may even cause death.

What did the ICRC do?
Since 2012, the University of Pennsylvania has collaborated with multiple institutions in the Big Ten and Ivy League sports conferences to collect concussion data on varsity athletes in a surveillance system. The study collects information in real-time from students playing all types of sports. Each athlete is monitored to determine how long it takes for symptoms to resolve and how long it takes to return to academic and physical activities. Since 2012, more than 2,000 concussion cases have been entered into the surveillance system. In 2017, the University of Pennsylvania ICRC partnered with the Big Ten – Ivy League Traumatic Brain Injury Research Collaboration to take over operations of the surveillance system and to conduct analyses with the data.

Data analysis showed that football kickoffs accounted for 6% of all plays but 21% of concussions in 2015 in the Ivy League. After sharing this information with Ivy League football coaches, the coaches recommended new kickoff return rules to decrease the potential for collisions or falls that that could result in concussions. Several new rules were put in place for the 2016 and 2017 seasons.

What was the outcome/impact?
The new kickoff rule changes are making a difference in the lives of college athletes. Further data analysis showed that the average annual concussion rate fell from 11 to 2 per 1000 kickoff plays after the new rules were put in place. The authors explain these results and others in a JAMA Network Research Letter. The NCAA has already used the study results to change one rule for the 2018 season.

To learn more:
University of Pennsylvania

What’s the problem?
A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.

The severity of a TBI may range from mild to severe. A TBI can cause a wide range of functional short- or long-term changes that affect thinking, sensation, language, and emotion. About 75% of TBIs that occur each year are concussions or other forms of mild TBI. Repeated mild TBIs occurring over an extended period of time may increase the risk for neurological and cognitive deficits. While rare, repeated mild TBIs occurring within a short period of time, such as hours, days, or weeks, can cause severe damage to your health and may even cause death.

What did the ICRC do?
Johns Hopkins School of Public Health developed a 4-minute video to reach urban, minority youth who attend a pediatric primary care clinic. The video was part of a larger program that also provided a free bicycle helmet, a fitting, and instructions by a health educator. The intervention’s pilot test was completed with 20 pairs of parents and children between Oct-Dec 2017. Children who participated were about 10 years old and included equal numbers of boys and girls. The majority of these children reported daily or weekly bike-riding (65%); 80% of the children did not own a helmet and 80% reported “never” wearing a helmet.

What was the outcome/impact?
At the one-month follow up, helmet use was significantly higher in youth reporting bike-riding after the intervention. Five out of five kids (100%) reported “always” using helmets compared to 0/20 (0%) pre-intervention. There was also an increase from 35% to 66% in youth reporting that parents required helmet use. The project received a Gold Winner and Best in Show awards from the National Health Information Awards program. Johns Hopkins is sharing this important work through national and international conference presentations and academic papers.

To learn more:
Johns Hopkins School of Public Health

Laundry detergent packets, first sold in the United States in 2012, have become widely used in homes across the country. Packets tend to be round, colorful, and closely resemble candy—particularly to young children. As packet popularity increased, so have child poisonings associated with this product. Concern over this issue led the Center for Injury Research and Policy (CIRP) and the Central Ohio Poison Center—both based at Nationwide Children’s Hospital—to conduct a study in 2014 to quantify the risks. The research showed that from 2012 through 2013, U.S. poison control centers received reports of more than 17,000 children under age 6 who swallowed, inhaled, or were exposed to the chemicals in laundry detergent packets—an average of one child every hour. Seven hundred and sixty nine children were hospitalized during that period and two children died. Other clinical effects included vomiting, coughing or choking, eye pain or irritation, and drowsiness.

CIRP conducted a follow-up study that compared the medical risks and outcomes of exposure to laundry detergent packets with other types of laundry and dish detergents. They found that the harmful effects of laundry packets were significantly higher.

Leadership from Nationwide Children’s Hospital’s ICRC and their partners shared these results with key legislative and policy audiences, and with parents and industry. Based on the data, legislation was introduced in February 2015 by members of the U.S. Congress to require the U.S. Consumer Product Safety Commission (CPSC) to set mandatory safety standards for liquid laundry detergent packets.

The bill, called the Detergent PACS (Poisoning and Child Safety) Act of 2015, also allows CPSC to adopt a voluntary safety standard by ASTM International, a standards development organization, or to create its own standard. Dr. Gary Smith, director of CIRP and senior author of the studies, provided input on the legislative language to “make sure that all packet- makers adopt safer packaging and labeling.” In 2015, ASTM International published a voluntary Standard Safety Specification for Liquid Laundry Packets to help reduce unintentional exposures to the contents of the packets, especially by children. After the first study, the Consumers Union recommended that laundry detergent packets not be used, which is only the second time in its history it has made such a strong statement.

As a result of this work, some manufacturers have changed the container of their laundry detergent packets from clear to opaque and have made them less easy to open for children. Other manufacturers began including safety warnings in their ads and on their packaging, advising that laundry detergent packets are a danger to children under 3 years old and need to be stored safely.

Representatives working on laundry detergent packet safety from Canada, Sweden, and New Zealand have requested data from CIRP regarding its studies for use in developing safety policy in their countries.

To learn more:
The Research Institute at Nationwide Children’s Hospital
News article on CIRP’s laundry detergent packet study

The West Virginia University Injury Control Research Center (WVU ICRC) is supporting the implementation of take-home naloxone programs in substance abuse treatment centers, among law enforcement agencies, and substance abuse treatment programs around the state. The WVU ICRC first conducted research that demonstrated the effectiveness of naloxone programs in rural areas. They used the findings to educate key stakeholders about the opioid overdose epidemic in WV and the effectiveness of take-home naloxone programs. WVU ICRC was instrumental in informing stakeholders who then use the information to reduce liability concerns that were central to the successful implementation of these programs. In collaboration with key partners, the WVU ICRC is training and equipping law enforcement agencies around the state to carry and administer take-home naloxone. There were at least 25 overdose reversals in the first 9 months after the program was implemented in 16 counties.

To learn more:
West Virginia University

Ensuring the safety of children as they walk to and from school was formally recognized as a national priority in 2005, with federal funding of the Safe Routes to School (SRTS) program. Eight years earlier, New York City (NYC) implemented the first program in the United States, followed shortly by many other cities. Until recently, however, little was known about SRTS’s impact on pedestrian injuries. The Center for Injury Epidemiology and Prevention at Columbia University (CIEPAC) developed a well-designed evaluation that documented a 44 percent reduction in injuries among children walking to school. CIEPAC used these findings to generate media attention and to spark support among NYC officials for a citywide campaign on pedestrian and traffic safety. This research, training, and outreach has supported policy changes, including the enactment of a city-wide 25 mile-per-hour speed limit and adoption of NYC regulations for better pedestrian safety. Word of CIEPAC’s success has spread rapidly to cities throughout the nation, stimulating numerous efforts to make our roadways safe for pedestrians of all ages.

To learn more:
Columbia University