Public beliefs about the preventability of unintentional injury deaths
Introduction
Injuries kill more Americans between the ages of 1 and 45 than any other cause (Centers for Disease Control, 1998). Injury control professionals are often perplexed as to why more attention is not paid to this important problem. No major voluntary organization, such as an American Cancer Society or American Heart Association, exists to coordinate efforts to support injury research and education. The Federal government devotes five times as many research dollars to cardiovascular disease as it does to injury, which garners one-tenth of what we invest in cancer research (National Research Council, 1985). This despite the fact that injuries claim more years of productive life than heart disease and cancer combined.
One explanation for this state of affairs that is widely circulated among the injury control community is that people believe that injuries cannot be prevented. In 1989, the National Committee for Injury Prevention and Control issued a report which pronounced that, “… the vast majority of legislators, governors, commissioners, physicians, nurses, lawyers, and the general public continue to view injuries as acts of fate” (National Committee for Injury Prevention and Control, 1989). Similarly, in its 1999 follow-up report, the Institute of Medicine named as a priority the need to “broaden public understanding of the feasibility … of efforts to prevent … injuries” (Bonnie et al., 1999). Such statements have typically been made, however, without reference to empirical research. The present study was designed to shed light on whether professional concerns about public preventability beliefs are well founded.
Specifically, it will assess whether members of the lay public believe that deaths due to motor vehicle crashes, falls, drownings, fires/burns and poisonings are preventable. Homicides and suicides were not addressed in this investigation. Our background summary will also be limited to unintentional injury, although it will include non-fatal events since no national studies of exclusively fatal injuries were identified. Finally, studies which explored the preventability of one particular injury, after it occurred, were not included.
There is clearly support in the literature for studying beliefs in relation to health behaviors. The Health Belief Model posits that the likelihood of taking a preventive action is a function of — among other constructs — the perceived benefits of taking the action (Janz and Becker, 1984). Foss (1985) found that parents who believed child safety seats were very effective were significantly more likely to use them. Peterson and colleagues (1990) found that parents who believed that childhood injuries can be prevented were more likely to teach their children about safety. In another study by this research group, it was found that parents were more likely to ‘interact preventively’ with their child after a minor injury if they attributed the injury to the child rather than fate (Peterson et al., 1995). Investigators in New Zealand found that boys who disagreed with a statement attributing bicycle crashes to chance were significantly less likely to ride their bikes at night (Langley and Williams, 1992). Gielen et al. (1994) found that children living in suburban Maryland who endorsed statements indicating that they believed there was a need to wear a bicycle helmet were significantly more likely to have worn a helmet on their most recent bicycle ride. Included among items designed to assess such beliefs was the statement, ‘Whether or not I get hurt in a bike accident is just a matter of luck.’ Wilde et al. (as cited in Wilde and Ackersviller, 1981) reported that people ‘drive [more] carefully’ if they believe that car accidents are caused by human behavior rather than fate, luck or chance. Colón (1992) found that belief in an immutable destiny was a significant predictor of low (self-reported) seat belt use.
Another reason for studying injury-related preventability beliefs is because they have been linked to support for safety legislation (Hingson et al., 1988, Schenck et al., 1985, Hu et al., 1993). And a legislator's likelihood of voting for such legislation has been shown to be directly related to their perceptions of how much their constituents support it (Jason and Rose, 1984, Lowenstein et al., 1993).
Although rarely cited by proponents calling for changes in public beliefs, studies which measure preventability beliefs related to unintentional injuries have been published. Only one was national, however, and it focused on the prevention of childhood injuries. That survey of parents, sponsored by the National SAFEKIDS Campaign, found that 87% of respondents agreed with the statement ‘most accidents are avoidable’ (Eichelberger et al., 1990).
A Canadian study which also dealt with childhood injuries reported that 82% of urban, and 91% of rural, parents agreed with the statement, ‘Most accidents are avoidable, parents can prevent most accidental injuries involving children’ (Hu et al., 1996). In Sweden, when 1843 heads of households were asked which of four categories of preschool injury causes was most important, only 14% said ‘fate or bad luck’ (Sundelin et al., 1996). In a Scottish study of low-income parents, 61% of respondents disagreed with the statement, ‘There's nothing you can do to stop accidents. They just happen..’ (Roberts et al., 1995). When parents were queried while visiting an emergency department in Florida — predominantly for causes that were unrelated to trauma — only 15% agreed with the statement, ‘Injuries just happen’ (Mulligan-Smith et al., 1998). The largest proportion of respondents (46%) instead endorsed, ‘Most injuries can be prevented.’ In another investigation from the UK, when mothers were asked, ‘Do you think that children's accidents are mostly just bad luck or mostly could be prevented,’ 89% of respondents replied, ‘Mostly could be prevented’ (Colver et al., 1982).
When looking at the perceived preventability of specific types of injuries, Peterson et al. 1990 found that respondents felt a majority of childhood injuries could be prevented, with poisonings and near-drownings being perceived as the most preventable. A large (n=1659) Australian study found that ‘child drowning’ was perceived as relatively more preventable, and ‘road injuries’ less preventable, when compared to burns and scalds (Smith et al., 1999). Interpretation of this finding is complicated, however, by the mixed age referents used by investigators. Still, a number of other studies (Colón, 1992, Kulik and Mahler, 1987, Moore and Rosenthal, 1992, Peterson et al., 1990) have found that motor vehicle crash deaths are perceived as relatively less preventable.
The present study was designed to provide national data on lay beliefs related to a broad spectrum of fatal, unintentional injuries.
Section snippets
Sampling
The sampling frame for this study consisted of blocks of United States telephone numbers which were purchased from a commercial sample supplies (GENESYS Sampling Systems). At the investigator's direction, GENESYS used list-assisted sampling to generate an equal probability sample of telephone numbers designed to be representative of households in the United States. This means they worked from banks of 100 randomly generated telephone numbers, which were known to include at least one published
Sample
A total of 943 subjects completed our survey instrument. Of the original 6761 telephone numbers transferred from GENESYS, 22% were non-working, 19% were not answered despite six or more attempts, and 59% were confirmed working. Of the working numbers, 29% were deemed ineligible, primarily because they represented businesses rather than residences. Of confirmed eligible households, 5% remained unresolved at the close of data collection. Of the 2695 people who were offered study participation,
Discussion
Most of our respondents apparently believe that most fatal injuries could be prevented. Another report from this survey indicated that 83% of lay subjects associated preventability with the word ‘accident’ (Girasek, 1999). These findings may be welcomed by injury control professionals who feared that fatalistic perceptions on the part of the public were impeding the field's progress. Of course, such developments leave open the question of why injury control has not garnered more support.
Among
Acknowledgements
Deborah C. Girasek was a doctoral candidate at the Johns Hopkins School of Hygiene and Public Health when this work was carried out. She is now the Director of Social and Behavioral Sciences in the Department of Preventive Medicine at the Uniformed Services University of the Health Sciences. Dr Girasek wishes to acknowledge the valuable guidance she received from Dr Andrea Gielen, who was her thesis adviser at Johns Hopkins. This research was supported by the Lowe's Home Safety Council, the
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