ICRC Success Stories - Research Impact

New York State Implements Rear Seat Belt Law (Columbia University)
Cyclist couple riding together in a park

A new law in New York State (NYS) requires all people in a vehicle to wear a seat belt, no matter where they are sitting. This law includes vehicles for hire, such as taxis and ride share services. NYS teens and adults could previously legally travel unrestrained in the rear seat of four-wheeled passenger vehicles.

The Columbia Center for Injury Science and Prevention (CCISP), a CDC-funded Injury Control Research Center, collaborated extensively with multiple partners and worked for over a decade to help make the case for this new law that will save lives.

Collaborative Research & Analysis Move Science Forward

More research has been conducted about what happens to teens and adults in the front seat during a motor vehicle crash than about what happens to those in the back seat. This contributed to a gap in available science that could explain the full social, financial, and injury impacts for teen and adult passengers seated in the back of a vehicle who were not wearing a seat belt. CCISP used data specific to NYS to analyze the practice of rear seat safety among different age groups. They collaborated with the NYS Department of Health (NYSDOH) Bureau of Occupational Health and Injury Prevention (BOHIPexternal icon) and their CDC-funded Core State Violence and Injury Prevention Program (SVIPP) on this research.

They found that unbuckled teens and adults sitting in the back seat of a motor vehicle in NYS are three times more likely to experience moderate-to-severe injury or death than those properly buckled. Nine of 10 people who die in car crashes in this age group were not wearing seatbelts. More than 95% of people who were ejected from rear seats in car crashes were not wearing seatbelts, and they had 7-fold higher medical charges than those who were. Hospital stays were longer; hospital charges and societal financial costs were also higher as the unrestrained were more frequently uninsured, self-insured, or government-insured than those who were restrained.

CCISP, the American Automobile Association (AAA) Northeast, and many other partners educated lawmakers and the public on the additional injury, death, and healthcare costs associated with a New Yorker traveling in the rear seat without a seat belt.

The collaborative work with NYS BOHIP on rear seat safety research, training, and outreach spanned many years. The research and activities covered infants, children, teens, and adults in both private and for-hire vehicles and taxis. CCISP reviewed and shared input on BOHIP-produced fact sheets for use with partners and legislators. They co-produced analytic information and graphics for use in publications and educational materials, sharing science and fact sheets with a wide array of partners.

CCISP presented the findings widely at more than a dozen professional association meetings. They presented at the state-wide NYS DOH BOHIP-organized Injury Community Planning Group and later to the Injury Community Implementation Group meetings. They met and presented findings to key professionals, including the National Transportation Research Board (NTSB), prior to offering a full day symposium with partners for rear seat safety.

Rear seat belt legislation was introduced every year for a decade. It would often pass the NYS Senate but not the NYS Assembly. In the winter of 2019/2020, CCISP presented evidence supporting reclassification of the bill from revenue neutral (showing no impact on the budget) to cost saving. The reclassification was based on the collaborative rear seat research findings that were specific to NYS and clearly showed how fewer injuries happen and costs are lower when passengers in the rear seats wear seatbelts.

CCISP provided testimony and met with assembly representatives and other partners. CCISP educated lawmakers and answered questions on rear seat safety science. The bill closed a legislative gap and now requires all occupants of a motor vehicle to wear seat belts – in both front and rear seats, whether private vehicles or for hire. The bill was passed in the 2019/2020 winter NYS legislative session and signed into law by Governor Andrew Cuomo. The law took effect on November 1, 2020.

Using County-level Data to Better Promote the New Law

CCISP continues to collaborate with NYS DOH and a group of stakeholders who participated in a May 2020 motor vehicle roundtable as part of CCISP’s Annual Translating Injury Science to Prevention Symposium. These partners are strategizing on approaches to increase the law’s effectiveness. They have analyzed NYS county-level data on motor vehicle crashes, ranking the proportion of unbelted drivers and passengers involved in fatal and serious crashes.

From county-level analyses, they observed:

  • injuries and deaths of unbelted motor vehicle occupants vary widely by county;
  • enforcement of seat belt laws varies widely by county;
  • rural, resource-limited counties have higher rates of injury and serious injury and are therefore a high priority for improved restraint use to lower injury;
  • gathering information from counties, assessing it, and sharing it with injury prevention professionals, the public, and law enforcement, and allowing them to respond to it is necessary;

Getting and keeping all partners engaged in promoting the law at the county, regional, and state level is key to success. This information demonstrating seat belt laws are most effective when they cover occupants in all seating positions will be distributed widely to help focus resources in areas of greatest need and ensure effective restraint use.

Bicycle Safety Enhanced by University of Iowa Injury Prevention Research Center (UI IPRC)
Cyclist couple riding together in a park

Bicycling and E-Bike Use on the Rise

The University of Iowa Injury Prevention Research Center (UI IPRC)external icon has enhanced bicycle safety in Iowa through research, training, and outreach in recent years.

Across the United States the popularity of cycling is trending upward, especially with the advance of electric bikes and bike share programs in many cities and towns. From 2006 to 2018, the number of cyclists nationwide grew from an estimatedexternal icon 40 million cyclists to nearly 48 million. As the number of cyclists increased, so did the risk of bicycle-motor vehicle crashes. In the past five years there have been 1,816 crashes involving bicycles and motor vehicles in Iowa that resulted in 183 serious injuries and 35 deaths (Iowa DOT: https://icat.iowadot.gov/#external icon). These deaths make up 2% of all traffic-related deaths in Iowa, even though bicyclists represent only 1% of road users (National Household Travel Survey, 2017).

Bicycle safety is critical for riders and others on the road. Best practices and evidence-based recommendations are important to inform local, state, and federal programs and policies for bicycle safety.

Improving Safety Through Programs, Technology, and Partnership

Programs

Increasing bicycle safety education for children is crucial to increasing overall bicycle safety. Numerous child bicycle education programs are taught throughout the United States, but no program has emerged as the gold standard. Program content and duration vary widely. Researchers at UI IPRC created an inventorypdf iconexternal icon of 96 child bicycle education programs based on age and child developmental considerations. This inventory provides a foundation for child bicycle education standards, with a goal of increasing overall childhood safety.

Technology

UI IPRC also developed Pedal Portal, an innovative portable GPS/video system to objectively observe the dangers of bicycling (known as risk exposure) and the cycling behaviors of adults and children. Several cycling studiesexternal icon have been conducted using Pedal Portal. The studiesexternal icon captured real-life riding data for adults and children on near-crashes, errors, and common riding behaviors, such as route choice. The dataexternal icon will help bring a better understanding of the risk factors for bicycling crashes and will help inform the development of effective interventions. For example, these study results were applied to the implementation of a pilot bicycle safety program for elementary school children in Iowa. The studies also informed an adolescent bicycle safety education program that UI IPRC would like to look at further through a proposed research project grant to study any behavioral change after the safety education.

Partnership

Additionally, UI IPRC collaborated with the Iowa Department of Transportation, the Iowa Bicycle Coalition, and the mother of a young woman who was killed in a bicycle-motor vehicle crash to hold a webinar on strategies to end fatal bicycle crashes in Iowa. Topics included evidence-based policy and infrastructure solutions to reduce bicycle crashes and injuries.

Years of planning and collaboration preceded these efforts in Iowa. A 2016 meeting coordinated by the Iowa Bicycle Coalition, Iowa Institute of Public Health Research and Policy, and UI IPRC provided the impetus for effective change. The meeting brought together 40 stakeholders to discuss key issues and recommend solutions to address bicycle safety in Iowa. The proceedings from this meeting provided a framework for action that led to policy change.

Policy Changes Support Bicycle Safety

UI IPRC outreach and training efforts in bicycle safety contributed to several policy successes during the 2018 Iowa legislative session. Laws enacted improved overall road safety, including bicycle safety. Penalties to drivers in crashes involving electronic devices increased. The use of a hand-held electronic device while driving changed from a secondary to a primary offense. These changes demonstrated that research and identification of evidence-based policy options can have a wider impact on all road users. UI IPRC’s social media campaign, “#12MonthsofInjuryPrevention,” helped raise awareness of these efforts.

Future bicycle safety activities at UI IPRC include:

  • a study examining traffic charges and convictions in bicycle- and pedestrian-involved crashes and driver charges and convictions histories;
  • a “naturalistic” or real-life bicycling study examining the impact of daytime running bicycle lights on bicyclist traffic stress and motor vehicle lateral passing distance;
  • plans for a large-scale randomized trial to evaluate bicycle safety education programming (Iowa Bicycle Library and Neighborhood Centers of Johnson county helped to collect pilot child bicycle safety education evaluation data); and,
  • collaboration with UI School of Urban Planning on developing a statewide bicycle and pedestrian traffic monitoring program, which will provide the basis or “denominator data” for the calculation of crash, injury, and fatality rates by miles ridden or miles walked.

These examples illuminate UI IPRC’s continued efforts to increase bicycling safety by building upon their past successes and existing collaborations.

Are Concussion Laws Effective? (Nationwide Children’s Hospital)

 

Footballer wearing a blue shirt, black pants injured in the…

The percentage of young athletes who visited clinics within 7 days after sustaining a concussion increased after Ohio’s concussion lawexternal icon was enacted in 2013. Athletes who visited clinics soon after their concussions recovered significantly more quickly than those who waited longer, according to a 2018 research study.

Nationwide Children’s Hospital’s Center for Injury Research and Policy (CIRPexternal icon), funded by CDC’s National Center for Injury Prevention and Control, Division of Injury Prevention (NCIPC DIP), published these results in Research in Sports Medicineexternal icon. The study also showed an overall increase in concussion clinic visits after the Ohio law was enacted, likely due to increased awareness of potential injuries after implementation of the law.

All 50 States Develop Concussion Legislation

Concussions, which are considered mild traumatic brain injuries, are the only injury that by law require a medical clearance before returning to sport or play. It’s critical to understand the influence of concussion legislation – and potentially the differences between state concussion laws – on how concussions are managed.

Washington was the first state to pass concussion legislation in 2009. By 2014, all 50 states and the District of Columbia had passed laws on concussion to help protect young athletes involved in youth, middle school, and high school sports. Most laws contain language about the education of coaches, parents, and athletes; removing athletes from play following concussion; and return-to-play criteria.

Research Informs Better Concussion Management

Traumatic brain injuries (TBIs), including concussions, are common among young athletes. A TBI can affect the way you think, act, move, and feel – either for the short-term or long-term. An estimated 283,000 children visit U.S. emergency departments each year due to sports- and recreation-related concussions (mild TBIs). That’s an average of 775 children per day. About 45% of those injuries are due to contact sports.

Studies like those conducted by CIRP can help healthcare providers be better prepared to manage concussions. For example, after the concussion law was enacted in Ohio, the initial influx of emergency department visits revealed a need for more information, such as handouts, to be available to parents, coaches, and athletes after a concussion. As a result, CIRP developed an abundance of guidance and resourcesexternal icon on sports-related concussion.

These studies can also significantly inform policy interventions that can help optimize the use of medical care and reduce severe consequences of concussions in youth. As researchers publish studies of the effectiveness of concussion laws, appropriate prevention efforts can be crafted to address changing needs over time.

Suicide Rates in Rural Areas Are Higher than in Urban Areas (University of Iowa)
girl laying head on another woman's shoulder

The rural United States has a suicide rate 45% higher than urban U.S. areas, according to recent data from CDC’s WISQARSTM. Farmers and agricultural workers have a higher combined rate of suicide at work compared to the overall rate among all occupations according to a studyexternal icon by the University of Iowa Injury Prevention Research Centerexternal icon (UI IPRC).

Many of the risk factors for suicide are common in the daily lives of farmers. These risk factors include:

  • poor access to quality healthcare — including mental healthcare;
  • social isolation;
  • physical injury and chronic pain from the hard work of farming;
  • financial worries; and
  • crisis situations and conditions that they have no control over, including
    • unpredictable and extreme weather,
    • market fluctuations, and
    • tariffs.

Deep-rooted cultural norms and values may also play into the complexity of suicide risk in rural communities. Hard work, strong morality, family centeredness, and purposeful living are valued aspects of rural life. Farmers often see their work as a significant part of their identity and not just a job. Therefore, difficulties in their farming businesses may be seen as personal failures and can lead to depressed moods and suicide risk.

UI IPRC Experts Identify Suicide Burden in Iowa

With funding from CDC’s National Center for Injury Prevention and Control, the UI IPRC partners with the Iowa Department of Public Health to collect and analyze state-level data for the National Violent Death Reporting System (NVDRS). The Iowa Department of Public Health relies on the UI IPRC’s data analyses and interpretation to identify suicide burden in their state. NVDRS is a state-based surveillance system that pools data on violent deaths and their circumstances from multiple sources into one anonymous database. Participating in this CDC-funded program allowed the state to learn the contexts around violent deaths in Iowa. They found that 76% of violent deaths were suicides.

The UI Injury Prevention and Research Center (IPRC) and Iowa Department of Public Health are using these data to produce an annual Suicide in Iowa pdf icon[PDF – 525 KB]external icon report. This report summarizes the suicide data in their state and provides comparisons to national data. The UI IPRC uses this report to educate Iowa legislators and stakeholders on the problem of suicide in their state, a primarily rural state of around 3 million people. The UI IPRC elevated the issue of rural suicide in Iowa and beyond.

Increased Awareness and Proposed Legislation

The University of Iowa IPRC Director, Corinne Peek-Asa, is recognized publicly as a subject matter expert on rural suicide, in part because of the research conducted by the UI IPRC. She and other CDC-funded researchers were interviewed by multiple local, regional, and national news outlets about suicide in Iowa. These interviews helped raise the awareness of this serious public health issue.

As a result of this work, lawmakers engaged with UI IPRC to discuss suicide among farmers in Iowa, as well as other traumatic injury issues relevant to rural states. Currently, a new federal bill with bipartisan support aims to curb the rising rate of farmer suicides in America. If passed, this act would implement a voluntary stress management training program, create a public service announcement (PSA) campaign to raise awareness of the issue, and determine best practices for addressing stressors farmers face.

To learn more:
The University of Iowaexternal icon

Preventing Violence through Blight Remediation (University of Pennsylvania)
Before-after examples of abandoned building (a and b) and vacant lot (c and d) remediations.

The recent economic downturn and job losses have left many U.S. cities with blighted neighborhoods full of abandoned lots and buildings. The University of Pennsylvania Injury Science Center (Penn Injury Science Center) conducted groundbreaking experimental research based on principles from Crime Prevention through Environmental Design. Penn Injury Science Center studied the impact of low-cost repairs to abandoned buildings and vacant lot greening on residents’ health, safety, and quality of life. For the past decade, they partnered with Philadelphia and a half dozen other cities around the United States to study what happened when these cities used inexpensive, readily implemented interventions to clean, repair, and green nearly 10,000 abandoned buildings and vacant lots. These blight remediation programs are straightforward and quickly implemented—graffiti and trash removal, simple installation of new windows and doors, planting grass and trees, and installing basic wooden fences—yet immediately evident to grateful city residents. These interventions are easy to scale and adapt to many different urban environments. Penn Injury Science Center completed large, randomized controlled trials of these same abandoned building and vacant lot remediation strategies in other communities, even beyond Philadelphia, with additional federal and private funds.

The impact of these simple improvements is remarkable. City-wide, areas around remediated abandoned buildings had a 39 percent drop in gun assaults, 19 percent drop in other assaults, and a 16 percent drop in nuisance crimes. Vacant lot greening also led to significant, long-term reductions in gun violence (8 percent drop) and vandalism, and residents’ reporting less stress and more exercise. Every dollar invested in these remediation programs returned anywhere from $5–$333 in violence related-costs that were averted. Word of the projects’ successes has also spread, leading the Penn Injury Science Center to now link with partners in Louisiana, Michigan, New Jersey, Ohio, Virginia, and other states in remediating hundreds of additional blighted spaces in new cities and evaluating the impact.

To learn more:
Penn Urban Health Labexternal icon
University of Pennsylvaniaexternal icon

Addressing Teen Dating Violence Before It Begins (University of North Carolina at Chapel Hill)

In 2015, one of every 10 U.S. high school students reported being sexually or physically victimized during a date in the last year. To address this issue, researchers at the University of North Carolina Injury Prevention Research Center (UNC IPRC) designed Safe Dates, a teen dating violence prevention program for middle and high school students. Safe Dates is highly engaging and interactive and helps teens recognize the difference between caring, supportive relationships and controlling, manipulative, or abusive dating relationships.

Teenage girl and boy sitting together.

UNC IPRC researchers tested the program in 14 public schools. The results showed a significant reduction in both perpetration of dating violence and victimization. Adolescents participating in the program also reported less acceptance of dating violence, stronger communication and anger management skills, less gender stereotyping, and greater awareness of community services for dating abuse. Four years after the program, adolescent participants reported far less dating violence victimization and perpetration (56 percent to 92 percent less) than other students.

Additional research showed that Safe Dates also reduced peer victimization and weapon carrying behavior among youth who participated one year after receiving the intervention.

As a result of the program’s proven success, Safe Dates has become one of the most extensively used and endorsed teen dating violence programs. It is designated as a Model Program by the Substance Abuse and Mental Health Services Administration and was selected for the National Registry of Evidence-based Programs and Practices (NREPP)external icon, a prestigious national registry that promotes the adoption of scientifically proven behavioral health interventions. This highly rated model has been adopted in more than 20,000 locations and has reached more than 1.68 million youth in the United States, Canada, Chile, Greece, Iceland, Ireland, Japan, the Netherlands, Switzerland, Taiwan, Thailand, and the United Kingdom. In addition, Safe Dates has been added to CDC’s 2016 STOP SV: Technical Package to Prevent Sexual Violence pdf icon[PDF – 3 MB],  which helps communities and states design effective prevention activities and represents a select group of strategies with the greatest potential to reduce sexual violence and its consequences.

To learn more:
University of North Carolina at Chapel Hill external icon

Strengthening Interdisciplinary Collaboration with Expert Research Teams (University of Iowa)
Teenager driving a car with a passenger.

The University of Iowa Injury Prevention Research Center (UI IPRC) brings together experts in many different fields to discover ways to prevent injuries and violence in rural communities. UI IPRC partnered with Blank Children’s Hospital and the Public Policy Center to evaluate an intervention for parents to improve communication with and supervision of their teens who were learning to drive—particularly in rural settings. Participating teens reported a 21 percent decrease in risky driving. The program is now being translated into workplace wellness programs of three Iowa companies and has garnered $3.5 million in additional funding.

In addition, road traffic safety team efforts have led to safer roadways locally, nationally, and internationally. The UI IPRC conducts the Iowa Child Passenger Safety Seat Survey, funded through the Governor’s Highway Traffic Safety Bureau, and has leveraged this design to conduct child passenger occupant surveys in other communities internationally, some of which have led to hospital-based programs to increase child restraint use. This example highlights how the wide-reaching impact that ICRC research conducted in local settings can have an impact nationally and internationally.

To learn more:
University of Iowa external icon

Implementing a Violence Prevention Program for Juvenile Offenders (Icahn School of Medicine at Mount Sinai)

The Mount Sinai Injury Control Research Center at the Icahn School of Medicine is working with the Texas Juvenile Justice Department to reduce criminal offenses and violent crimes among youth offenders with and without traumatic brain injury (TBI). They adapted their evidence-based cognitive rehabilitation intervention originally developed for adults with TBI to a youth population. The Youth Short-term Executive Plus (Y-STEP) intervention, which focuses on improving cognitive processing and emotional self-regulation, is being implemented and evaluated in the El Paso Juvenile Justice Center. To date, interim analysis indicates that youth participating in Y-STEP had a 44% reduction in recidivism (person’s relapse into criminal behavior). Recidivism is measured by criminal acts that resulted in re-arrest, reconviction or return to prison with or without a new sentence during a three-year period following the prisoner’s release.

To learn more:
Icahn School of Medicine at Mount Sinaiexternal icon