Disasters and the public health safety net: Hurricane Floyd hits the North Carolina Medicaid program.
- Domino ME, Fried B, Moon Y, Olinick J, Yoon J. Am J Public Health 2003; 93(7): 1122-1127.
Correspondence: Marisa Elena Domino, University of North Carolina, School of Public Health, Department of Health Policy and Administration, McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411 (e-mail: domino@unc.edu).
OBJECTIVES: We measured the effect of Hurricane Floyd on Medicaid enrollment and health services use in the most severely affected counties of North Carolina.
METHODS: We used differences-in-differences models on balanced panels of Medicaid claims and enrollment data.
FINDINGS: Overall spending per enrollee showed little short-term effect but demonstrated a moderate increase 1 year after the storm. We found very modest short-term increases in Medicaid enrollment, a small long-term decrease in enrollment, and large increases in the long-term use of emergency room and outpatient services.
DISCUSSION: Our findings suggest that hurricane victims experienced substantial changes in patterns of care that endured for much longer than the initial crisis period. These findings can have important implications for the management of disaster relief for this population.
Nonfatal Dog Bite--Related Injuries Treated in Hospital Emergency Departments --- United States, 2001
- Gilchrist J, Gotsch K, Annest JL, G Ryan G. MMWR 2003, 52(26): 605-610.
Full text with all tables, figures, references and editorial note is available online: ( Download Document ).
In 1994, the most recent year for which published data are available, an estimated 4.7 million dog bites occurred in the United States, and approximately 799,700 persons required medical care. Of an estimated 333,700 patients treated for dog bites in emergency departments (EDs) in 1994, approximately 6,000 (1.8%) were hospitalized. To estimate the number of nonfatal dog bite--related injuries treated in U.S. hospital EDs, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of the analysis, which indicate that in 2001, an estimated 368,245 persons were treated in U.S. hospital EDs for nonfatal dog bite--related injuries. Injury rates were highest among children aged 5--9 years. To reduce the number of dog bite--related injuries, adults and children should be educated about bite prevention, and persons with canine pets should practice responsible pet ownership.
NEISS-AIP is operated by the U.S. Consumer Product Safety Commission and collects data about initial visits for all types and causes of injuries treated in U.S. EDs. NEISS-AIP data are drawn from a nationally representative subsample of 66 out of 100 NEISS hospitals, which were selected as a stratified probability sample of hospitals with a minimum of six beds and a 24-hour ED in the United States and its territories. NEISS-AIP provides data on approximately 500,000 injury- and consumer product--related ED cases each year.
The analysis included every nonfatal injury treated in a NEISS-AIP hospital ED in 2001 for which "dog bite" was listed as the external cause of injury. Because deaths are not captured completely by NEISS-AIP, patients who were dead on arrival or died in EDs were excluded. Each case was assigned a sample weight based on the inverse probability of selection; these weights were added to provide national estimates of dog bite--related injuries. Estimates were based on weighted data for 6,106 patients with dog bite--related injuries treated at NEISS-AIP hospital EDs during 2001. Confidence intervals (CIs) were calculated by using a direct variance estimation procedure that accounted for the sample weights and complex sample design. Rates were calculated by using U.S. Census Bureau population estimates for 2001.
In 2001, an estimated 368,245 persons were treated for dog bite--related injuries (rate: 129.3 per 100,000 population). The injury rate was highest for children aged 5--9 years and decreased with increasing age. Approximately 154,625 (42.0%) dog bites occurred among children aged <14 years; the rate was significantly higher for boys (293.2 per 100,000 population) than for girls (216.7) (p = 0.037). For persons aged > 15 years, the difference between the rate for males (102.9) and females (88.0) was not statistically significant. The number of cases increased slightly during April--September, with a peak in July (11.1%). For injured persons of all ages, approximately 16,526 (4.5%) dog bite injuries were work-related (e.g., occurred to persons who were delivering mail, packages, or food; working at an animal clinic or shelter; or doing home repair work or installations). For persons aged > 16 years, approximately 16,476 (7.9%) dog bite injuries were work-related.
Injuries occurred most commonly to the arm/hand (45.3%), leg/foot (25.8%), and head/neck (22.8%). The majority (64.9%) of injuries among children aged < 4 years were to the head/neck region; this percentage decreased significantly with age (p < 0.01) (Figure 2). Injuries to the extremities increased with age (p < 0.01) and accounted for 86.2% of injuries treated in EDs for persons aged > 15 years. Injury diagnoses were described frequently as "dog bite" (26.4%); other diagnoses included puncture (40.2%), laceration (24.7%), contusion/abrasion/hematoma (6.0%), cellulitis/infection (1.5%), amputation/avulsion/crush (0.8%), and fracture/dislocation (0.4%). Overall, 98.2% of patients were treated and released from the ED.
Narrative comments in the medical records note common circumstances in which children and adults incurred dog bite--related injuries. Examples among children included a girl aged 18 months who was attacked by the family dog in the backyard and sustained an open depressed skull fracture, mandible fractures, and avulsion of an ear and part of a cheek; a boy aged 4 years who was bitten on the lip by a dog that was guarding her pups; and a girl aged 3 years who was bitten on the face when trying to take food away from the family dog. Examples among adults included a man aged 34 years who sustained an avulsion laceration to his left thumb while trying to break up a fight between his dogs; a woman aged 27 years who sustained multiple puncture wounds to her forearm, thumb, and chest while trying to help her dog, which had been hit by a car; and a woman aged 75 years who was bitten while she was trying to prevent her dog from attacking an Emergency Medical Technician who was attempting to transport her from home by ambulance.
Heat-Related Deaths --- Chicago, Illinois, 1996--2001, and United States, 1979--1999.
- Donoghue ER, Nelson M, Rudis G, Sabogal RI, Watson JT, Huhn G, Luber G.MMWR 2003, 52(26): 610-613.
Full text with all tables, figures, case descriptions, references and editorial note is available online: ( Download Document ).
Heat waves (i.e., greater than or equal to 3 consecutive days of air temperatures above 90 degrees F [> 32.2degrees C]) are meteorologic events that contribute significantly to heat-related deaths. Exposure to excessive heat can cause illness, injury, and death. This report describes four cases of heat-related deaths, as reported by the Office of the Medical Examiner, Cook County, Chicago, that occurred during 1996--2001; summarizes total heat-related deaths in Chicago during 1996--2001; and compares the number of heat-related deaths during the 1995 and 1999 Chicago heat waves. This report also summarizes trends in the United States during 1979--1999, describes risk factors associated with heat-related deaths and symptoms, and outlines preventive measures for heat-related illness, injury, and death. Persons at risk for heat-related death should reduce strenuous outdoor activities, drink water or nonalcoholic beverages frequently, and seek air conditioning.
During the 1990s, Chicago experienced two heat waves. In July 1995, a heat wave resulted in 485 heat-related deaths and 739 excess deaths. An epidemiologic investigation of the heat wave identified advanced age and an inability to care for oneself as major risk factors for heat-related death. During 1999, a heat wave resulted in 103 heat-related deaths; 80 were attributed to extreme heat. Implementation of Chicago's Extreme Weather Operations Plan reduced the death toll by increasing the number of daily contacts for the elderly during the 1999 heat wave. During 1996--2001, annual totals of heat-related deaths across all age groups was highest in 1999.
During 1979--1999, the most recent years for which national data are available, 8,015 deaths in the United States were heat-related. A total of 3,829 (48%) were "due to weather conditions," 377 (5%) were "of man-made origins" (e.g., heat generated in vehicles, kitchens, boiler rooms, furnace rooms, and factories), and 3,809 (48%) were "of unspecified origin". An average of 182 deaths per year (range: 54--651) were associated with excessive heat resulting from weather conditions. Of the 3,764 (98%) weather-related deaths for which age of decedent was reported, 1,891 (49%) occurred among persons aged 15--64 years, 1,709 (45%) occurred among persons aged >65 years, and 164 (4%) occurred among children aged < 15 years. During 1979--1999, rates for heat-related deaths increased with age.
Significant positive correlation was found between f10.7-cm flux and male traffic-accident mortality for the years 1980-1999 in Japan. On the other hand, significant negative correlation was found between annual mean temperature and male traffic-accident mortality on the same period.
Geographic variation of pediatric burn injuries in a metropolitan area.
- Williams KG, Schootman M, Quayle KS, Struthers J, Jaffe DM. Acad Emerg Med 2003; 10(7): 743-752.
Correspondence; Kristine G. Williams, Division of Pediatric Emergency Medicine, Box 8116, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA; (email: griffith_k@kids.wustl.edu).
OBJECTIVES: To use a geographic information system (GIS) and spatial statistics to describe the geographic variation of burn injuries in children 0-14 years of age in a major metropolitan area.
METHODS: The authors reviewed patient records for burn injuries treated during 1995 at the two children's hospitals in St. Louis. Patient addresses were matched to block groups using a GIS, and block group burn injury rates were calculated. Mapping software and Bayesian analysis were used to create maps of burn injury rates and risks in the city of St. Louis.
FINDINGS: Three hundred eleven children from the city of St. Louis were treated for burn injuries in 1995. The authors identified an area of high incidence for burn injuries in North St. Louis. The filtered rate contour was 6 per 1,000 children at risk, with block group rates within the area of 0 to 58.8 per 1,000 children at risk. Hierarchical Bayesian analysis of North St. Louis burn data revealed a relative risk range of 0.8771 to 1.182 for census tracts within North St. Louis, suggesting that there may be pockets of high risk within an already identified high-risk area.
DISCUSSION: This study shows the utility of geographic mapping in providing information about injury patterns within a defined area. The combination of mapping injury rates and spatial statistical analysis provides a detailed level of injury surveillance, allowing for identification of small geographic areas with elevated rates of specific injuries.
The effect of wearing a restrictive neck brace on driver performance.
- Barry CJ, Smith D, Lennarson P, Jermeland J, Darling W, Stierman L, Rizzo M, Traynelis VC. Neurosurgery 2003; 53(1): 98-102.
Correspondence: Christopher J. Barry, Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; (email: christopher-barry@uiowa.edu).
OBJECTIVE: Thousands of Americans are prescribed cervical orthoses each year. These orthoses restrict motion, which may influence the patient's driving performance. No legal restrictions exist that prohibit patients from wearing cervical orthoses while driving. No study addressing this issue has been published to date. Thus, we sought to assess the effects of wearing a restrictive neck brace on driver performance on the open road.
METHODS: We conducted a prospective, randomized block design study in 23 volunteers. Twenty-three adult licensed drivers from the state of Iowa were recruited. Evaluation of neck motion was performed with and without the rigid cervical orthosis. On-road performance testing was conducted with the use of a state-of-the-art mobile laboratory. Drivers were randomly assigned to one of two testing groups. Each driver was evaluated during two separate drives. Volunteers in Group A (n = 11) wore a neck brace for the first drive but not during the second. Participants in Group B (n = 12) did not wear a neck brace in the first drive but did for the second. The assessment included velocity, acceleration, cervical axial rotation, and evaluation of the driver's blind spot.
FINDINGS: Driving performance measures were collected and analyzed for both drives. Wearing a cervical orthosis resulted in decreased velocity (P < 0.05), decreased lateral acceleration (P < 0.05), decreased axial rotation (P <0.05), inadequate evaluation of intersection traffic, and an increase in the blind spot.
DISCUSSION: A rigid cervical orthosis alters driver performance.
Judgments about collision in younger and older drivers.
To travel safely, drivers must detect imminent collisions. Older drivers have more accidents per miles driven than younger drivers, potentially reflecting age differences in judgments about collision. Prior studies measured age differences in judgments about when a collision would occur (time to contact). Older adults made greater underestimations, but this would lower their risk for accidents. Judgments about when a collision would occur must be preceded by judgments about whether a collision would occur (Presented at the Annual Meeting of the Human Factors and Ergonomics Society (2001) Minneapolis). Results of the present study indicated that judgments about potential collision were less accurate for older drivers compared with younger drivers. This would increase their risk for accidents. Age differences in driver performance may be associated more with age differences in judgments about whether a collision would occur than with age differences in judgments about when a collision would occur. Age differences in judgments about potential collision suggest a new avenue to pursue in an account of differential accident rates in older and younger drivers.
Peripheral detection as a measure of driver distraction. A study of memory-based versus system-based navigation in a built-up area.
Correspondence: Lisbeth Harms, Department of Psychology, University of Copenhagen, Njalsgade 88, DK-2300, Copenhagen, DENMARK; (email: harms@psy.ku.dk).
The effect of in-vehicle information systems (IVIS) on traffic safety is currently under debate and suitable methods for measuring and comparing the impact of such devices on driver behaviour are urgently required. The secondary-task technique may be a good tool for objective measurement of driver distraction caused by IVIS.
The present study summarises previous results of secondary-task studies in traffic contexts and investigates the suitability of one secondary-task method, the peripheral detection task (PDT)-method, as a standard procedure for safety testing and evaluation of IVIS. The study was concerned with the effect of navigation messages on PDT-performance (reaction time and hit rate) taking into account also behavioural variables. Professional drivers served as subjects. They had extensive prior local-knowledge and experience of driving in the built-up area in which the experiment took place. They were required to drive two different routes, one after memory and the other in accordance with navigation messages a standard navigation system installed in the car. In the navigation system condition subjects were subdivided into three groups, receiving either verbal, visual or both visual and verbal (full) navigation messages.
Driving behaviour was virtually uninfluenced by navigation condition (memory versus navigation system) and message modality (full, visual or verbal) whereas PDT-performance, showed some effects of navigation condition on subjects' reaction times and hit rates. Pairwise comparison of message modality within each three groups showed a prolongation in reaction time and a marginally significant decrease in hit rate with full navigation messages (combined visual and verbal ones). Visual navigation messages affected only hit rate and no significant differences between navigation conditions were observed for the group presented with verbal messages. The pattern of results suggests that the PDT-method is biased toward visual sources of information from IVIS. As visual information processing is an important component in safe driving, the PDT-method is suitable as a predominant method in a test battery, but for unbiased measurement of distraction, methods less dependent on mode of presentation would be more appropriate.
Violence and Substance Use among an Injured Emergency Department Population.
- Cunningham R, Walton MA, Maio RF, Blow FC, Weber JE, Mirel L. Acad Emerg Med 2003; 10(7): 764-775.
Correspondence: Rebecca Cunningham, MD, Department of Emergency Medicine, The University of Michigan, TCB1380 1500 East Medical Center Drive, Ann Arbor, MI 4819-0305, USA; (email: stroh@umich.edu).
OBJECTIVES: This study evaluated a sample of emergency department (ED) patients for history of violence and substance abuse.
METHODS: Injured patients (n = 320) completed questionnaires (14% refusal rate) during a visit to a Level 1 urban ED after an acute injury. Specific questions were asked regarding whether the injury was related to acute violence (AV), whether there was past-year violence history (VH), including violence victimization and perpetration in both partner and nonpartner relationships, as well as any substance use in the past month and any substance-related consequences in the past year.
FINDINGS: Fourteen percent of the participants presented with an AV-related injury, and 53% reported VH. Most AV patients (89%) reported VH. No significant differences were found between the participants with AV and VH in demographic, substance use, or substance-related consequences. The AV and VH groups were combined (V), with analyses comparing these participants with those without AV and VH. Men were significantly more likely than women to report V (odds ratio = 2.0). V was significantly related to substance use and substance-related consequences. For example, in comparison with the participants reporting no alcohol or drug use, those reporting illicit drug use were 6.2 times as likely to report V, and those drinking any alcohol only were 2.0 times as likely to report V.
DISCUSSION: A large percentage of injured patients in this urban ED experienced violence in the past year. Alcohol and illicit drugs appear to be concomitant with violence.
Personal and social contextual correlates of adolescent dating violence.
- Howard D, Qiu Y, Boekeloo B. J Adolesc Health 2003; 33(1): 9-17.
Correspondence: Donna E. Howard, University of Maryland, Department of Public and Community Health, , College Park MD 20742, , USA; (email: dh192@umail.umd.edu).
OBJECTIVES: To examine the association of dating violence with personal and social contextual factors among a sample of 12- to 17-year-olds enrolled in managed care health plans.
METHODS: A sample of 444 youth (45% male; 80% African-American; 38% aged 12-13 years) agreed to participate in an alcohol risk-prevention randomized controlled trial, and completed a survey. Cross-tabulations and calculation of odds ratios were performed to assess associations between dating violence and sociodemographics, religious service attendance, personal alcohol use, peer-drinking exposures and parental monitoring. Logistic regression modeling was used to identify the significant predictors of dating violence.
FINDINGS: Seven percent of youth reported recent dating violence. In a logistic regression model, peer-drinking exposures was associated with dating victimization (OR = 3.24; CI = 1.04-10.15). Religious service attendance (OR =0.40; CI = 0.17-0.91) and parental monitoring (OR = 0.41; CI = 0.17-0.99) were protective against dating violence.
DISCUSSION: Religious service attendance and frequent parental monitoring were associated with a lower prevalence of recent dating violence. Conversely, being in places where one's friends are drinking alcohol was associated with an increased risk of victimization. It may be that dating violence is, in part, mediated by adolescents' important social contacts.
Risk Factors for Femicide in Abusive Relationships: Results From a Multisite Case Control Study.
- Campbell JC, Webster D, Koziol-McLain J, Block C, Campbell D, Curry MA, Gary F, Glass N, McFarlane J, Sachs C, Sharps P, Ulrich Y, Wilt SA, Manganello J, Xu X, Schollenberger J, Frye V, Laughon K. Am J Public Health 2003; 93(7): 1089-1097.
Correspondence: Jacquelyn C. Campbell, PhD, RN, Johns Hopkins University, School of Nursing, 525 N Wolfe St, #436, Baltimore, MD 21205-2110 (email: jcampbell@son.jhmi.edu).
OBJECTIVES: This 11-city study sought to identify risk factors for femicide in abusive relationships.
METHODS: Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women.
FINDINGS: Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrator's access to a gun and previous threat with a weapon, perpetrator's stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrator's use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy.
DISCUSSION: There are identifiable risk factors for intimate partner femicides.
A Case-Control Study of Female-to-Female Nonintimate Violence in an Urban Area.
- Hirschinger NB, Grisso JA, Wallace DB, McCollum KF, Schwarz DF, Sammel MD, Brensinger C, Anderson E. Am J Public Health 2003; 93(7): 1098-1103.
Correspondence: Nancy B. Hirschinger, Widener University, Social Science Division, One University Place, Chester, PA 19013-5792 (email: nbh0300@mail.widener.edu).
OBJECTIVES: The aims of this study were to describe the characteristics surrounding female-to-female nonpartner violence and to identify independent factors associated with risk of female-to-female intentional injuries.
METHODS: A case-control investigation was conducted among women who resided in an urban, low-income community and presented for emergency department care for injuries inflicted by female nonpartners.
FINDINGS: Women were typically victimized by women they knew (88%), in outdoor locations (60%), and in the presence of others (91%). Those found to be at risk for injury typically were young and socially active, used marijuana, and had experienced other kinds of violence.
DISCUSSION: The present results showed that women injured by female nonpartners had limited resources, experienced disorder in their lives, and were the victims of violence within multiple relationships.
Violence against women in Mexico: a study of abuse before and during pregnancy.
- Castro R, Peek-Asa C, Ruiz A. Am J Public Health 2003; 93(7): 1110-1116.
Correspondence: Roberto Castro, Centro Regional de Investigaciones Multidisciplinarias, Apartado Postal 4-106, 62431, Cuernavaca, Morelos, MEXICO; (email: rcastro@servidor.unam.mx).
OBJECTIVE: We identified the prevalence and types of violence experienced by pregnant women, the ways victimization changed during pregnancy from the year prior to pregnancy, and factors associated with violence during pregnancy.
METHODS: We interviewed 914 pregnant women treated in health clinics in Mexico about violence during and prior to pregnancy, violence during childhood and against their own children, and other socioeconomic indicators.
FINDINGS: Approximately one quarter of the women experienced violence during pregnancy. The severity of emotional violence increased during pregnancy, whereas physical and sexual violence decreased. The strongest predictors of abuse were violence prior to pregnancy, low socioeconomic status, parental violence witnessed by women in childhood, and violence in the abusive partner's childhood. The probability of violence during pregnancy for women experiencing all of these factors was 61%.
DISCUSSION: Violence is common among pregnant women, but pregnancy does not appear to be an initiating factor. Intergenerational violence is highly predictive of violence during pregnancy.
A Longitudinal Perspective on Dating Violence Among Adolescent and College-Age Women.
- Smith PH, White JW, Holland LJ. Am J Public Health 2003; 93(7): 1104-1109.
Correspondence: Paige Hall Smith, Department of Public Health Education, University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402-6170, USA; (email: phsmith@uncg.edu).
OBJECTIVES: We investigated physical assault in dating relationships and its co-occurrence with sexual assault from high school through college.
METHODS: Two classes of university women (n = 1569) completed 5 surveys during their 4 years in college.
FINDINGS: Women who were physically assaulted as adolescents were at greater risk for revictimization during their freshman year (relative risk = 2.96); each subsequent year, women who have experienced violence remained at greater risk for revictimization than those who have not. Across all years, women who were physically assaulted in any year were significantly more likely to be sexually assaulted that same year. Adolescent victimization was a better predictor of college victimization than was childhood victimization.
DISCUSSION: There is a need for dating violence prevention/intervention programs in high school and college and for research on factors that reduce revictimization.
Underreporting of Justifiable Homicides Committed by Police Officers in the United States, 1976-1998.
- Loftin C, Wiersema B, McDowall D, Dobrin A. Am J Public Health 2003; 93(7): 1117-1121.
Correspondence: Colin Loftin, PhD, Violence Research Group, School of Criminal Justice, University at Albany, SUNY, 135 Western Ave, Albany, NY 12222 (e-mail: cloftin@albany.edu).
OBJECTIVES: This study assessed the consistency of estimates of the number of justifiable homicides committed by US police officers and identified sources of underreporting.
METHODS: The number of justifiable homicides committed by police officers between 1976 and 1998 was estimated from supplementary homicide report (SHR) and National Vital Statistics System (NVSS) mortality data.
FINDINGS: Nationally, the SHR estimate was 29% larger than the NVSS estimate. However, in most states this pattern was reversed, with more deaths reported in the NVSS.
DISCUSSION: Both systems underreport, but for different reasons. The NVSS misclassifies cases as homicides, rather than justifiable homicides committed by police officers, because certifiers fail to mention police involvement. The SHR misses cases because some jurisdictions fail to file reports or omit justifiable homicides committed by police officers.
Rape-Law Reform circa June 2002: Has the Pendulum Swung Too Far?
Stephen Schulhofer, Robert B. McKay, Professor of Law, New York University Law School, 40 Washington Square South, New York, NY 10012, USA; (email: schulhos@juris.law.nyu.edu).
This paper reviews court decisions determining the scope of liability for rape over the period 1998-2002. It finds many troubling signs that some courts, under some circumstances, are still wedded to the traditional (very strict) view of the kind of force necessary to support a charge of rape. There are, however, signs of encouraging progress: convictions in circumstances where even a decision to prosecute would have been unthinkable 20 years ago, and holdings that accept power, authority, or indirect intimidation as sufficient "force." Is it possible to go too far in this direction? And is there any reason to worry that this could actually happen in reality? The research identifies several areas in which this surprising possibility may be about to materialize, for example on the normatively and practically difficult question of the degree of intoxication or alcohol-induced willingness sufficient to invalidate consent.
Sex Offender Registration and Community Notification: Emerging Legal and Research Issues.
Sex offender registration and community notification laws, now in effect nationwide, have inspired considerable controversy. This article examines the variety of legal challenges brought against the laws since the mid-1990s and surveys issues likely to receive judicial attention in the immediate future. The article also provides an overview of the limited empirical work done to date on registration and notification, and the major areas that warrant additional research, including, most notably, inquiry into efficacy, costs, and consequences.
Implications of Public Health for Policy on Sexual Violence.
Correspondence: Kathleen C. Basile, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Mailstop K60, 4770 Buford Highway NE, Atlanta, Georgia 30341-3724, USA; (email:
kbasile@cdc.gov).
In the last ten years, researchers and practitioners have written about why sexual violence in particular should be viewed as a public health issue, and the importance of prevention of sexual violence. However, little has been written about how to accomplish this. In this paper I describe steps that could be taken using the public health approach to better achieve prevention of sexual violence. Most research and prevention related to sexual violence have focused on the individual and relationship levels. I discuss the importance of addressing all levels using an ecological approach (macrosystem, exosystem, microsystem, and personal history) and focusing more on prevention that addresses the societal and social roots of sexual violence. The paper concludes with some examples of potential preventive measures and policies consistent with a public health model.
Sex Offender Management: The Public Policy Challenges.
Correspondence: Laurie O. Robinson, President, CSR, Inc., 2107 Wilson Blvd., Suite 1000, Arlington, VA 22201, USA; (email: lrobinson@csrincorporated.com).
Few issues within the crime policy arena are as volatile as those involving sex offending, yet there is an enormous "knowledge gap" between research, science, and clinical practice, on the one hand, and the policy and criminal justice practitioner communities, on the other. Recent highly publicized cases involving sex offending, which have elevated the issue in the public eye, provide an opportunity for experts in this field to play an aggressive role in informing this debate. In particular, high priority should be given to developing more effective means of communicating to policymakers, practitioners, the media, elected officials, and the public what is known from science and clinical practice about sex offending and about what works in addressing it. A strong commitment to greater cross-disciplinary collaboration is also needed, as is federal leadership, particularly in supporting a cross-department research agenda. Researchers and other experts in this field can play a valuable role in helping ensure rational and effective public policy relating to sex offending that can achieve public safety and help reduce future victimization.
