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• Wallack L, Dorfman L. Media advocacy: a strategy for advancing policy and promoting health. Health Education Quarterly 1996; 23(3):293-317. (E.10.22 S)
  
  Abstract: The purpose of media advocacy is to promote public health goals by using the media to strategically apply pressure for policy change. It provides a framework for moving the public health discussion from a primary focus on the health behavior of individuals to the behavior of the policymakers whose decisions structure the environment in which people act. It addresses the power gap rather than just the information gap. Media advocacy focuses on public policy rather than personal behavior. This article uses two case studies to illustrate key aspects of media advocacy. The first is a 5-year statewide violence prevention initiative for young people in California. The second focuses on the activities of a mothers' group working to improve public housing. The "new public health," with its focus on participation, policy development, and political processes, could benefit from incorporating media advocacy.



• Koplan JP, Fleming DW. Current and future public health challenges. Journal of the American Medical Association 2000; 284(13):1696-1698. (E.45.02 S)
  
  Abstract: This article discusses 10 future health challenges outlined by the Centers for Disease Control and Prevention. These challenges encompass changes in health care systems, chronological milestones of childhood and old age, the risks imposed by our lifestyles and the environment, the mysteries of the brain and human behavior, and new scientific frontiers. To position the nation for the century ahead, the authors believe that the medical, scientific, and public health communities must do the following: Institute a rational health care system; Eliminate health disparities; Focus on children's emotional and intellectual development; Achieve a longer "healthspan;" Integrate physical activity and healthy eating into daily lives; Clean up and protect the environment; Prepare to respond to emerging infectious diseases; Recognize and address the contributions of mental health to overall health and well-being; Reduce the toll of violence in society; and Use new scientific knowledge and technological advances wisely. Collectively, these 10 challenges reflect the breadth and complexity of the challenges ahead. They point to the importance of health at the community level, for advances in most of these areas depend on strong community support and activity. However, these concerns are not only local, but also global. In the decades ahead, physicians and public health professionals have both a responsibility and an unprecedented opportunity to apply their current knowledge to improve the health of the nation.

Residential:

• Barillo DJ, Brigham PA, Kayden DA, Heck RT, McManus AT. The fire-safe cigarette: a burn prevention tool. Journal of Burn Care and Rehabilitation 2000; 21(2):162-164. (E.55.08 S)
  
  Abstract: Cigarettes are the most common ignition source for fatal house fires, which cause approximately 29% of the fire deaths in the United States. A common scenario is the delayed ignition of a sofa, chair, or mattress by a lit cigarette that is forgotten or dropped by a smoker whose alertness is impaired by alcohol or medication. Cigarettes are designed to continue burning when left unattended. If they are dropped on mattresses, upholstered furniture, or other combustible material while still burning, their propensity to start fires varies depending on the cigarette design and content. The term "fire-safe" has evolved to describe cigarettes designed to have a reduced propensity for igniting mattresses and upholstered furniture. Legislative interest in the development of fire-safe smoking materials has existed for more than 50 years. Studies that showed the technical and economic feasibility of commercial production of fire-safe cigarettes were completed more than 10 years ago. Despite this, commercial production of fire-safe smoking materials has not been undertaken. The current impasse relates to the lack of consensus on a uniform test method on which to base a standard for fire-safe cigarettes. Although the fire-safe cigarette is a potentially important burn prevention tool, commercial production of such cigarettes will not occur until a standard against which fire- starting performance can be measured has been mandated by law at the state or federal level. The burn care community can play a leadership role in such legislative efforts.

Sports/Recreational:

• Patel DR, Nelson TL. Sports injuries in adolescents. Medical Clinics of North America 2000; 84(4):983-1007, viii. (E.61 S)
  
  Abstract: Musculoskeletal injuries are the most common injuries in youth sports. A number of growth-related factors unique to the adolescent age group play an important role in the epidemiology, types, and management of these injuries. These mainly relate to the physical and psychosocial growth and development during adolescence and are discussed in this article. Overuse injuries are more commonly seen in this age group in the primary care setting. Shoulder impingement, elbow and shoulder injuries related to throwing, stress injuries of the wrist, spondylolysis, and anterior knee pain are some of the overuse injuries reviewed in this article.



• Grimmer KA, Jones D, Williams J. Prevalence of adolescent injury from recreational exercise: an Australian perspective . Journal of Adolescent Health 2000; 27(4):266-272. (E.61 S)
  
  Abstract: The purpose of this study was to report the prevalence of recent adolescent recreational and sporting activities and associated injury. Data were collected during three school terms in 1997 using a validated questionnaire administered once only to 3538 girls and boys aged 11-12 years and 15- 16 years. These students comprised 97.5% of the students in these age ranges in randomly selected state and private schools in the Adelaide metropolitan area (South Australia). Participants identified up to three recreational and/or sporting activities in which they had participated in the previous week. Data were collected on the nature and extent of participation, and on associated injuries. Participation and injury reports were summarized descriptively in gender strata in the two adolescent age groups and stratum specific odds ratios were used to explore injury risk. Subjects reported participating in 8997 sporting and/or recreational activities in the preceding week (an average of 2.5 participations per student). Over 140 sports and recreational pursuits were represented, incorporating organized and nonorganized activities undertaken in teams, social groups, or alone. Approximately 25% of adolescents reported at least one recreational injury. Injuries were mostly minor, reflecting soft tissue trauma and skin abrasions. Organized group sport incurred the highest risk of injury. There were marked gender and year level differences in injury risk in a number of common activities. These findings support the need for ongoing education regarding injury prevention and management.

Transportation:

• American Academy of Pediatrics Committee on Injury and Poison Prevention. Children in pickup trucks. Pediatrics 2000; 106(4):857-859. (E.52.08 S)
  
  Abstract: Pickup trucks have become increasingly popular in the United States. A recent study found that in crashes involving fatalities, cargo area passengers were 3 times more likely to die than were occupants in the cab. Compared with restrained cab occupants, the risk of death for those in the cargo area was 8 times higher. Furthermore, the increased use of extended cab pickup trucks and air bag equipped front passenger compartments creates concerns about the safe transport of children. The most effective preventive strategies are the legislative prohibition of travel in the cargo area and requirements for age appropriate restraint use and seat selection in the cab. Parents should select vehicles that are appropriate for the safe transportation needs of the family. Physicians have an important role in counseling families and advocating public policy measures to reduce the number of deaths and injuries to occupants of pickup trucks.

Violence/Weapons:

• Damore DT, Ramundo ML, Hanna JP, Dayan PS. Parental attitudes toward BB and pellet guns. Clinical Pediatrics 2000; 39(5):281-284. (E.96 S)
  
  Abstract: As well as describing pediatric BB and pellet gun injuries and the circumstances surrounding these injuries, the authors evaluated parental perceptions of the dangers of BB and pellet guns. A convenience sample of three groups of parents and their children presenting to a Midwest, urban, children's hospital emergency department was prospectively enrolled. The three groups of parents included the injured group, which consisted of the parents whose children had been injured by BB or pellet guns; the gun group, which consisted of the parents who allowed their children to possess BB or pellet guns but had not sustained injury from these guns; and the no gun group, which consisted of the parents who did not allow their children to have these guns. All parents completed a survey concerning their attitudes toward BB and pellet guns. Twenty-eight parents completed questionnaires in each of the three groups. Most BB and pellet gun injuries occurred in adolescent males at home without adult supervision and were inflicted by a friend or by themselves. The injured group and the no gun group viewed BB and pellet guns as significantly more dangerous than the gun group. Parents who allow their children to have BB or pellet guns appear to misperceive their potential for injury by allowing their children to use these guns in an unsafe manner. Clinicians must educate parents about the significant potential for injury of nonpowdered guns



• Feigelman S, Howard DE, Li X, Cross SI. Psychosocial and environmental correlates of violence perpetration among African-American urban youth. Journal of Adolescent Health 2000; 27(3):202-209. (E.80.06 S)
  
  Abstract: The purpose of this study was to ascertain the proportion of youths involved in acts of violence; to examine individual, social, and environmental factors associated with perpetration; and to determine the relationship among victimization, witnessing, and perpetration of violence. A cross-sectional survey was completed by 349 volunteer males and females, aged 9-15 years, 96% of whom were African-American. The youths were recruited from recreation centers associated with 10 public-housing communities in an eastern city. Survey instruments included the Child Health and Illness Profile, Survey of Children's Exposure to Community Violence, and other standardized questionnaires. Statistical analyses included Chi-square, correlation, regression, and test for linear trends. Half of the youths self-reported at least one act of violence perpetration, with similar distributions among males and females. One-third of the youths reported both personal victimization and the witnessing of violent events. Victim and witness status were moderately correlated. Individual risk behaviors and victimization made significant contributions to perpetration status. Further analysis demonstrated a linear relationship between acts of perpetration and number of victimization events. Participation in problem behaviors may place youths in circumstances in which they may be victim, witness, or aggressor. The chronic and high levels of community violence to which many youths are exposed are likely to contribute to an individual's participation in acts of violence



• McLaughlin CR, Daniel J, Reiner SM, Waite DE, Reams PN, Joost TF et al. Factors associated with assault-related firearm injuries in male adolescents. Journal of Adolescent Health 2000; 27(3):195-201. (E.96.10 S)
  
  Abstract: The purpose of this study was to identify factors associated with an increased prevalence of assault-related firearm injuries in male adolescents. This study is a retrospective comparison of two samples of adolescent males from the same geographic localities regarding their involvement in the juvenile justice system (court involvement) and injury status (current or prior firearm injury at the time of the study). The subjects included adolescent male patients admitted to an urban, Level I trauma center for assault-related firearm injuries (court-involved and noncourt-involved), and incarcerated juvenile offenders (prior firearm injury and no known firearm injury) Two-thirds of the male assault-related pediatric firearm injury victims treated over a 2 year period were involved in the juvenile justice system. Court-involved adolescents were almost 22 times more likely to have sustained an assault-related firearm injury, when compared to noncourt-involved patients with firearm injuries. Additional analysis documented recent substance use and/or involvement in criminal offenses in 82% of the victims. For most of the juvenile offenders (88%), court involvement preceded their injuries. Analysis of the injury patterns revealed an increased prevalence of truncal injuries (injuries to the thorax or abdomen) in the court-involved victims, when compared to their noncourt-involved peers (40% vs. 14%). Incarceration was associated with a 17-fold increase in the firearm injury prevalence over the court-involved, but not incarcerated, sample. These results suggest that involvement in substance use and/or the criminal justice system is associated with an increased risk of firearm injuries in male adolescents, and that an increased level of involvement in the juvenile justice system is associated with a concomitant increase in firearm injuries.



• Anderson CR. Television commercial violence during nonviolent programming: the 1998 major league baseball playoffs. Pediatrics 2000; 106(4):e46. (E.78.06 S)
  
  Abstract: The purpose of this study was to identify the frequency of violent commercials during the major league baseball playoffs in 1998 and to compare it with the 1996 playoffs. All 4 World Series games televised on the Fox Television Network (Fox), all 6 National League Championship Series (NLCS) televised by Fox, and 5 of 6 American League Championship Series (ALCS) playoff games televised by the National Broadcasting Company (NBC) were videotaped in October 1998. The results were compared with a similar study that analyzed the 1996 playoffs. Forty-four commercials (11.0 per game) that included violent interactions were noted during the World Series, 53 violent commercials (8.8 per game) during the NLCS, and 40 (8.0 per game) during the ALCS for a total of 137. Of these 137 violent commercials, 78 contained at least 1 violent act, 126 contained at least 1 violent threat, and 12 contained evidence of at least 1 violent consequence. One hundred five of the 137 violent commercials (76.6%) were television promotions and 23 (16.8%) were for big-screen movie promotions. Twenty-three of 35 big-screen movie promotions (65.7%) were violent. Ten of the 137 violent commercials (7.3%) contained obvious blood, of which 9 were televised by NBC. There were, however, an additional 20 commercials televised by Fox that contained visible blood if the videotape was slowed or paused. Sixty- three of the 137 violent commercials (46.0%) used fire and explosions, of which 53 were televised by Fox and 10 by NBC. Guns were involved in 86 of 137 violent commercials (62.8%), with Fox accounting for 64 (6.4 per game) and NBC accounting for 22 (4.4 per game). Knives were used in 1 violent commercial on both Fox and NBC. Comparisons that can be made to 1996 include the following: 1) violent commercials during the World Series (both televised by Fox) increased from 10.1 to 11.0 per game; and 2) violent commercials during the ALCS (both televised by NBC) increased from 6.0 to 8.0 per game. Commercials during the 1998 major league playoffs were similar in violent content, compared with 1996. The violent commercials continue to consist primarily of promotions for television programs and big-screen movies. It continues to be counterintuitive to find such commercials in family-oriented programming and makes it difficult for parents to avoid exposing their children to this form of violence.



• Brener ND, Simon TR, Krug EG, Lowry R. Recent trends in violence-related behaviors among high school students in the United States. Journal of the American Medical Association 1999; 282(5):440-446. (E.80.06 S)
  
  Abstract: Violence-related behaviors such as fighting and weapon carrying are associated with serious physical and psychosocial consequences for adolescents. The objective of this study was to measure trends in nonfatal violent behaviors among adolescents in the United States between 1991 and 1997. Nationally representative data from the 1991, 1993, 1995, and 1997 Youth Risk Behavior Surveys were analyzed to describe the percentage of students in grades 9 through 12 who engaged in behaviors related to violence. Overall response rates for each of these years were 68%, 70%, 60%, and 69%, respectively. To assess the statistical significance of time trends for these variables, logistic regression analyses were conducted that controlled for sex, grade, and race or ethnicity and simultaneously assessed linear and higher-order effects. Self- reported weapon carrying, physical fighting, fighting-related injuries, feeling unsafe, and damaged or stolen property were the main outcome measures. Between 1991 and 1997, the percentage of students in a physical fight decreased 14%, from 42.5% to 36.6%; the percentage of students injured in a physical fight decreased 20%, from 4.4% to 3.5%; and the percentage of students who carried a weapon decreased 30%, from 26.1% to 18.3%. Between 1993 and 1997, the percentage of students who carried a gun decreased 25%, from 7.9% to 5.9%; the percentage of students in a physical fight on school property decreased 9%, from 16.2% to 14.8%; and the percentage of students who carried a weapon on school property decreased 28%, from 11.8% to 8.5%. All of these changes represent significant linear decreases. Declines in fighting and weapon carrying among US adolescents between 1991 and 1997 are encouraging and consistent with declines in homicide, nonfatal victimization, and school crime rates. Further research should explore why behaviors related to interpersonal violence are decreasing and what types of interventions are most effective.



• Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science 1997; 277(5328):918-924. (E.75 S)
  
  Abstract: It is hypothesized that collective efficacy, defined as social cohesion among neighbors combined with their willingness to intervene on behalf of the common good, is linked to reduced violence. This hypothesis was tested on a 1995 survey of 8782 residents of 343 neighborhoods in Chicago, Illinois. Multilevel analyses showed that a measure of collective efficacy yields high between-neighborhood reliability and is negatively associated with variations in violence, when individual- level characteristics, measurement error, and prior violence are controlled. Associations of concentrated disadvantage and residential instability with violence are largely mediated by collective efficacy

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