>> HI, I'M BRUCE SIMONS-MORTON FROM NICHD IT'S MY PLEASURE TO INTRODUCE TODAY'S SPEAKER DR. ANDREA GIELEN. PROFESSER AT BLOOMBERG SCHOOL OF PUBLIC HEALTH AND THE DIRECTOR FOR INJURY RESEARCH AND POLICY. HER SEARCH THAT SHE'S GOING TO TELL US ABOUT TODAY FOCUSES ON THE EVALUATION OF CHILD INJURY AND DOMESTIC VIOLENCE PREVENTIVE INTERVENTIONS. NOTEABLY THE RESEARCH TEAM CREATE AID NATIONAL MODEL FOR A MOBILE HOSPITAL-BASED CENTER THAT PROVIDES TAILORED EDUCATION AND LOW-COST SAFETY PRODUCTS TO FAMILIES. SHE HAS PUBLISHED OVER 140 SCIENTIFIC PUBLICATIONS AND LEAD AUTHOR OF THE TEXTBOOK "INJURY AND VIOLENCE PREVENTION BEHAVIORAL SCIENCES THEORIES, METHODS AND APPLICATIONS ." AMONG MANY OTHER HONORS, SHE RECEIVED THE AMERICAN PUBLIC HEALTH ASSOCIATION DISTINGUISHED CAREER AWARD AND THE AMERICAN ACADEMY OF HEALTH BEHAVIOR RESEARCH LAUREATE AWARD. PLEASE JOIN ME IN WELCOMING DR. ANDREA GIELEN. [APPLAUSE] >> THANK YOU, BRUCE, FOR THAT VERY LOVELY INTRODUCTION AND THANK YOU ALL FOR THE INVITATION TO BE HERE TODAY. I'M A HUGE FAN OF NIH AND HONORED TO BE HERE. I ACTUALLY STARTED MY CAREER RIGHT OUT OF COLLEGE HERE WORKING FOR THE NEUROLOGY NATIONAL INSTITUTE OF NEUROLOGICAL DISEASES AND STROKE WITH A PERSON BY THE NAME OF DR. THOMAS CHASE. I DON'T KNOW IF ANY OF YOU HAVE ENCOUNTERED HIM OVER THE YEARS HERE. BUT REALLY I'LL BE FOREVER INDEBTED TO HIM. FOR MY FIRST JOB. HE WAS MY INSPIRING BOSS AND HE GOT ME INTO PUBLIC HEALTH MANY YEARS AGO. AND SINCE THEN, BEING AN ACADEMIC RESEARCHER, NIH HAS OBVIOUSLY PLAYED A VERY IMPORTANT ROLE IN MY PROFESSIONAL CAREER. AND AS THE PREMIER BIOMEDICAL RESEARCH INSTITUTION IN THE WORLD, LIKE THE OLD COMMERCIAL WHEN YOU ALL TALK, WE ALL LISTEN. SO IT'S GREAT TO BE HERE TODAY, AND I HOPE THAT YOU WILL FIND SOME OF THESE REMARKS OF INTEREST. SO BASICALLY, WHY INJURY PREVENTION, WHY NOW, AND WHY NIH? WELL, I APPRECIATE THE INVITATION TO TALK ABOUT THE SUCCESSION SUCCESSS AND CHALLENGES IN INJURY PREVENTION, BUT I SUSPECT THAT MANY OF YOU OR MANY AT NIH AT LEAST ARE MUCH MORE FAMILIAR WITH SCENES LIKE THIS, WHERE AFTER AN INJURY, WE HAVE TO HELP ENSURE THAT THE WORLD-CLASS MEDICAL FIELD CAN SAVE A LIFE AND REDUCE THE PAIN AND SUFFERING OF A SERIOUS TRAUMA. AND THIS IS CRITICALLY IMPORTANT WORK AND IT'S MADE AN ENORMOUS DIFFERENCE TO MILLIONS OF PEOPLE AFFECTED BY TRAUMA EVERY YEAR. HOWEVER, TODAY I THINK WE HAVE AN UNPRECEDENTED OPPORTUNITY TO DO EVEN MORE TO SAVE LIVES, REDUCE SUFFERING, AND SAVE HEALTHCARE DOLLARS BY REALLY INVESTING IN PREVENTION RESEARCH. AND ITS APPLICATION TO PRACTICE, WHICH IS THE END OF THAT LOOP. WE HAVE TO DO BOTH. SO I HOPE AT THE END OF MY TALK YOU WILL BE CONVINCED, IF YOU ARE NOT ALREADY, THAT THE TOOLS ARE AT OUR DISPOSAL TO REDUCE THE BURDEN OF INJURY HERE IN AMERICA AND ACTUALLY AROUND THE WORL. THIS CAN ONLY BE ACCOMPLISHED, IN MY OPINION, IF MORE OF US WHO REALLY CARE ABOUT HEALTH AND SAFETY AND DISEASE AND INJURY WORK TOGETHER. SO THE FIRST POINT I WANT TO MAKE IS THAT INJURY IS REALLY A COSTLY EPIDEMIC HIDING IN PLAIN SIGHT. FIVE MILLION INJURY DEATHS EVERY YEAR AROUND THE WORL. IT'S MORE THAN MALARIA, TB, AND H.I.V. COMBINED. AND BY THE YEAR 2020 IF QUESTION DON'T DO ANYTHING DIFFERENTLY,Z CRASHES GOING TO BE THE THIRD LEADING CAUSE OF DISEASE BURDEN IN THE WORLD. SO BIG NUMBERS AFFECT MANY PEOPLE BUT AS WE WERE TALKING BEFORE LUNCH, SAYING THAT PROBABLY EVERYONE IN THIS ROOM CAN ACTUALLY THINK BACK TO BEING IN HIGH SCHOOL AND KNOWING SOMEONE WHO WAS KILLED IN A CAR CRASH AS A TEENAGER, RIGHT? I MEAN, IT'S A PROBLEM THAT AFFECTS EVERYONE, EVEN LESS SERIOUS INJURIES THAT COST TIME AND SUFFERING AND EMERGENCY ROOM CARE ARE ENORMOUSLY IMPORTANT. SO HOW MANY PEOPLE HAVE SEEN THIS SLIDE? OKAY, PREACHING TO THE CHOIR. BUT I'M NOT ALLOWED TO LEAVE THE INJURY CENTER WITHOUT IT SO I TAKE IT EVER WHERE. FOR THOSE OF YOU WHO HAVEN'T SEEN IT, THIS IS THE TEN LEADING CAUSES OF DEATH BY AGE GROUP IN THE UNITED STATES IN 2009. AND YOU'RE NOT SUPPOSED TO BE ABLE TO READ THE BOXES. THE COLORS ARE TELLING THE STORY. AND THE STORY IS IN THE BLUE BOXS ARE UNINTENTIONAL INJURIES, THE LEADING CAUSE OF DEATH FOR AGES ONE TO 44. THE GREEN BOXES ARE SUICIDE AND THE RED BOXES ARE HOMICIDE. WHEN YOU ADD ALL THREE OF THOSE TOGETHER, INJURY IS THE UNINTENTIONAL IS THE FIFTH LEADING CAUSE WHEN YOU ADD THE OTHERS IN, IT BECOMES THE THIRD LEADING CAUSE OF DEATH IN THE UNITED STATES. SO IF YOU LOOK AT SOME OF THE -- FOR AGES 1 TO 44 ALONE, IF YOU LOOK AT JUST THE NUMBER OF DEATHS, THIS CHART SHOWS INJURY RELATIVE TO NON-COMMUNICABLE DISEASES AND INFECTIOUS DISEASE. AND I WANT TO SAY QUICKLY THAT WE'RE NOT TRYING TO SAY THESE OTHER THINGS AREN'T IMPORTANT. WHAT WE'RE TRYING TO SHOW IS WE NEED TO SHED A LIGHT ON THE ACTUAL IMPORTANT MAGNITUDE OF INJURIES IN THE UNITED STATES. IF YOU WANT TO KNOW WHAT'S CAUSING THESE INJURY DEATHS OTHER THAN UNINTENTIONAL, I CAN TELL YOU THE BLUE BOXES ARE MOTOR VEHICLE TRAFFIC, AND THE RED BOXES ARE FALLS. AND THE GREEN BOXES, I WOULD ALSO LIKE TO CALL YOUR ATTENTION TO, ARE UNINTENTIONAL POISONING DEATHS. MANY OF WHICH ARE OPENOID PRESCRIPTION DRUGS. AND YOU CAN SEE THAT THAT IS THE LEADING CAUSE FOR PEOPLE AFTER THE AGE OF 25 NOW. AN IMPORTANT AND UNDERRECOGNIZED PROBLEM. IF WE LOOK AT ANOTHER INDICATOR OF THE PROBLEM AND I PROMISE I WILL GET TO THE PREVENTION PART FIRST. THIS IS THE BAD NEWS SECTION -- IF WE LOOK AT INDICATORS OF POTENTIAL YEARS OF LIFE LOST BEFORE THE AGE OF 65, YOU CAN SEE THAT INJURY ACCOUNTS FOR A MUCH LARGER PERCENTAGE OF THE TOTAL YEARS OF POTENTIAL LIFE LOST THAN ANY OF THE OTHER MAJOR HEALTH PROBLEMS THAT OFTEN WE'RE MORE FAMILIAR WITH. AND NOT TO SAY THOSE ARE NOT IMPORTANT. JUST TO CALL OUT THE FACT THAT INJURY DESERVES ATTENTION AS WELL. BUT DEATHS ARE REALLY JUST THE TIP OF WHAT WE CALL THE INJURY ICEBERG, BECAUSE FOR EVERY INJURY DEATH, THERE ARE TEN HOSPITALIZATIONS AND 178 EMERGENCY ROOM VISITS. AND YOU CAN SEE THE TOTALS HERE AS WELL. SO YOU CAN IMAGINE THEN HOW EXPENSIVE INJURY IS AS A PROBLEM. BUT WHAT ARE THESE NON-FATAL INJURIES? WELL, THIS CHART SHOWS EMERGENCY DEPARTMENT-TREATED INJURIES AGAIN BY AGE GROUP AND RANK ORDER AND ALL THE RED BOXES ARE UNINTENTIONAL FALLS. SO THAT'S WHAT PUTTING PEOPLE IN THE EMERGENCY ROOM AT ALMOST EVERY AGE GROUP WITH THE EXCEPTION OF 15 TO 24, WHERE IT'S POG STRUCK DEPENDENCE SOMETHING OR BESOMETHING. SO AGAIN, JUST TO GIVE YOU A SENSE OF WHAT THE ACTUAL CAUSES ARE. AND MOST OF THE TIME YOU KNOW, IN TERMS OF THE MEDICAL APPROACHES, WE'RE NOT USED TO SAYING PEOPLE ARE INJURED BY A FALL OR A MOTOR VEHICLE CRASH IF THEY HAVE A FRACTURE. THEY HAVE A TRAUMATIC BRAIN INJURY, IT'S MORE OF THE NATURE OF THE TRAUMA, WHICH IS IMPORTANT, OBVIOUSLY, BUT IF YOU WANT TO TALK ABOUT PREVENTION, WE REALLY NEED GOOD DATA ON WHAT'S CAUSING THOSE FRACTURES AND BRAIN INJURIES, ET CETERA. SO I HAVE SLIDES, AND I AM GOING PRETTY QUICKLY THROUGH THEM. BUT PLEASE FEEL FREE TO JUMP IN IF YOU HAVE QUESTIONS AS WE GO. SO AS I COULD IMAGINE GIVEN THE NUMBERS OF PEOPLE WHO ARE ENCOUNTERING THE MEDICAL CARE SYSTEM, INJURIES ARE VERY EXPENSIVE PROBLEM. THEY GENERATE $406 BILLION IN LIFETIME COSTS EVERY YEAR IN THE UNITED STATES. AND 20% OF THAT IS RELATED TO MEDICAL COSTS. BUT PRODUCTIVITY LOSSES DUE TO DEATH AND TO DISABILITIES WITH EQUALLY IMPORTANT IN DRIVING THESE COSTS TO SOCIETY. AND WE ALL PAY FOR THIS IN ONE WAY OR ANOTHER. IT'S A STAGGERING FIGURE AND IN FACT F YOU JUST LOOK AT THE EXPENSES IN A YEAR, THIS IS FROM 2009 -- FOR ALL OF THE HEALTH PROBLEMS, YOU CAN SEE THAT IN TRAUMA-RELATED DISORDERS JOB, INJURIES ARE THE SECOND MOST EXPENSIVE HEALTH PROBLEM IN THE UNITED STATES. THEY ARE THE SECOND MOST IN TERMS OF TOTAL EXPENSES, HOSPITAL OUTPATIENTS AND OFFICE SPACE PROVIDER VISITS AND IN-HOSPITAL IN-PATIENT STAYS. AND FOR EMERGENCY ROOM VISITS, AS YOU MIGHT EXPECT, THEY ARE THE MOST EXPENSIVE OF THE HEALTH CONDITIONS. >> [INAUDIBLE] >> NO. THAT WOULD BE A TRAUMA. WE WOULD THINK ABOUT INTENTIONAL AND UNINTENTIONAL, RIGHT? SO IN 1985, THE NATIONAL ACADEMY OF SCIENCES ISSUED A REPORT ON INJURY IN AMERICA, AND THIS WAS REALLY A SORT A WATER SHED EVENT. IT DOCUMENTED THE NEED FOR US TO BETTER UNDERSTAND THIS UNRECOGNIZED PUBLIC HEALTH PROBLEM. AND IN RESPONSE TO THAT, CONGRESS UNDER PRESIDENT REAGAN, AUTHORIZED THE ESTABLISHMENT OF A UNIT AT THE C.D.C THAT WAS SUPPOSED TO DREADFUL INJURY PREVENTION. AND AFTER A FEW YEARS, ALL THE VARIOUS PIECES OF C.D.C THAT HAD DIFFERENT PARTS OF THAT CAME TOGETHER. AND THE NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL WAS CREATED. THAT WAS 20 YEARS AGO, WHICH IF YOU THINK ABOUT IT, MAKES OUR FIELD RELATIVELY VERY YOUNG, COMPARED TO SOME OF THE OTHER CHRONIC AND INFECTIOUS DISEASE FIELDS. SO ANOTHER IOM REPORT CAME OUT MANY YEARS LATER, 1999 AND THAT'S THE MOST RECENT ONE THAT WE HAVE CALLED ADVANCING PREVENTION AND TREATMENT TO REDUCE BURDEN OF INJURY. AND IN THIS REPORT, THEY RENEWED THE CALL FOR MORE ATTENTION TO THIS PUBLIC HEALTH PROBLEM. AND THEY REALLY DEFINED OUR FIELD AS HAVING TWO COMPONENTS, BOTH FOCUS ON SPRAFGS FOCUS ON TREATMENT. AND SO IT'S CLEAR IT SHOULD BE CLEAR THEN THAT WE NEED MULTIDISCIPLINARY EXPERTISE IN A FIELD LIKE THIS, WHERE WE NEED PEOPLE TO FOCUS OBPREVENTING THE EVENTS THAT CAUSE AN INJURY, LIKE A CAR CRASH, OR PREVENTING THE INJURY OR MINIMIZING ITS SEVERITY IF THERE IS AN EVENT LIKE ENSURING THAT ALL CARS HAVE AIR BAGS. AND THEN IMPROVING OUTCOMES THROUGH ACUTE CARE AND REHABILITATION. I THINK THIS IS A REALLY LARGE MISSION FOR SUCH A YOUNG FIELD. THE PREVENTION SIDE OF THE FIELD, WHICH IS REALLY THE CENTRAL FOCUS OF THE TALK TODAY, HAS BEEN, I BELIEVE, UNDERREPRESENTED IN THE NUMBERS OF PROFESSIONALS AND IN SUPPORT RELATIVE TO OTHER FIELDS AND RELATIVE TO THE BIOMEDICAL NEEDS THAT WE HAVE TO HAVE IN PLACE TO ADDRESS TRAUMA. BUT WE'VE HAD NOTABLE SUCCESSES, AS I HOPE I WILL NOW TRANSITION TO SHOW YOU. SO THE FIRST ONE IS PICTURED HERE. THIS WAS DECLARED BY THE C.D.C AS ONE OF THE TOP TEN PUBLIC HEALTH ACHIEVEMENTS OF THE 20th CENTURY. SO WHAT IS IT? SEATBELTS? SANITATION? YEAH, I'M FROM THE INJURY CENTER. I'LL GIVE YOU A CLUE. AND I DROVE HERE. YEAH. SO YES, SEATBELTS PLAYED A BIG ROLE IN IT. SO WHAT HAS HAPPENED FROM 1925 TO 1995 IS MANY MORE PEOPLE ARE DRIVING, BUT MOTOR VEHICLE CRASH DEATHS ARE FALLING. SO HERE WE SEE VEHICLE MILES TRAVELED IN THE BILLIONS, QUITE DRAMATIC. AND THEN THE DEATHS PER VEHICLE MILES TRAVELED DECREASING SIGNIFICANTLY. AND I MEAN, FOR ANY PUBLIC HEALTH ISSUE, IT WOULD BE VERY NICE TO HAVE SOMETHING WHERE EXPOSURE GOES UP, BUT DEATHS GO DOWN. SO THIS IS TRULY A PHENOMENAL SUCCESS STORY IN THE FIELD. AND FOR US JUST TO SORT OF THINK ABOUT HOW DID THAT HAPPEN, WHAT IS IT THAT ACCOUNT FOR THESE KINDS OF IMPROVEMENTS TO THIS LEADING CAUSE OF DEATH IN THE UNITED STATES? SO PEOPLE GENERALLY TALK ABOUT TWO DIFFERENT CATEGORIES OF THINGS THAT ARE NEEDED FOR PREVENTION IN OUR CASE, CHANGING THE ENVIRONMENT AND CHANGING INDIVIDUALS. THIS REALLY ISN'T ANY DIFFERENT F YOU THINK ABOUT HOW THEY'RE TALKING ABOUT OBESITY TODAY OR ALMOST ANY OF THE MAJOR DISEASES. WE HAVE TO THINK ABOUT THE PHYSICAL AND SOCIAL ENVIRONMENT AS WELL AS ABOUT THE INDIVIDUALS INTERACTING WITH THOSE ENVIRONMENTS. AND SO FOR MOTOR VEHICLES, WE HAVE INTERSTATE HIGHWAYS AND ROADWAYS DESIGNED, LOTS OF IMPROVEMENTS IN THE VEHICLES AND THE ROADS, AS WELL AS STRONG LAW ENFORCEMENT OF EFFECTIVE POLICIES. AND THAT HAS AFFECTED INDIVIDUALS BY INCREASING SEATBELT USE,=>Ur CAR SEAT USE AND DRINKING AND DRIVING, WHICH HAS BEEN KIND OF THE MOST NOTE WORHTY CONTRIBUTORS TO THIS SUCCESS STORY. SO I WAS ALSO ASKED TO COMMUNICATE THE FACT THAT WE HAVE A SCIENCE BEHIND THIS, AND THERE ARE LOTS OF DIFFERENT APPROACHES.v(jt ONE OF THE SCIENTIFIC UNDERPININGS OF&j) Uf– IS MATRIX, WHICH I'M FIELD SURE LIGHT OF YOU ARE FAMILIAR WITH. I WON'T SPEND BUT A COUPLE MINUTES ON IT. I'LL JUST TELL YOU WHAT WILLIAM HADEN IS ONE OF THE -- BEFORE I GET TO THAT, I'M GOING TO TALK ABOUT PUBLIC HEALTH FRAMEWORK. I AM OUT OF ORDER. SO FROM A PUBLIC HEALTH PERSPECTIVE, HOW WE APPROACH RESEARCH TO DO PREVENTION IS REALLY ILLUSTRATED HERE, WHICH IS AGAIN, WHILE IT'S SCIENTIFIC, I WOULD SAY IT'S NOT ROCKET SCIENCE, PROBABLY NOT AS HARD AS LOOKING FOR A GENE. BUT WE REALLY HAVE TO START WITH DEFINING THE PROBLEM, IDENTIFYING THE RISKS AND PROTECTIVE FACTORS, DEVELOPING AND PREVENTING STRATEGIES AND ASSURING WIDESPREAD ADOPTION OF WHAT WE FOUND IS AN EFFECTIVE INTERVENTION. AND SO IN THE INJURY-CONTROLLED FIELD, ONE OF THE CREATORS OF IT WAS WILLIAM HADDEN, A PHYSICIAN AND AN ENGINEER WHO WAS THE FIRST HEAD OF THE NATIONAL HIGHWAY TRAFFIC SAFETY INFORMATION, AND HE -- ADMINISTRATION AND HE SAID LET'S LOOK AT THE EPIDEMIOLOGY OF THE SCIENTIFIC UNDERPINNING OF OUR FIELD. AND HE SAID YOU CAN THINK ABOUT AN INJURY OCCURRING WHEN THERE IS A PREEVENT, AN EVENT AND A POST EVENT AND WHAT INFLUENCES THAT IS THESE THINGS ACROSS THE TOP, THE HUMAN BEING, THE VEHICLE, OR THE VECTOR AND THEN THE>gu ENVIRONMENT. SO THE GOOD NEWS ABOUT THIS KIND OF THING IS THAT WE HAVE LOTS OF PREVENTION OPPORTUNITIES. WE CAN ADDRESS THE QUESTION OF WILL AN EVENT WITH A POTENTIAL TO CAUSE INJURY OCCUR? WILL THE TEENAGER CRASH THE CAR? OR IF THE CAR IS CRASHED, WILL AN INJURY EVENT -- WILL AN INJURY ACTUALLY OCCUR? IS THE TEENAGER BUCKLED UP? IS THE AIRBAG GOING TO DEPLOY WHEN NEEDED? AND AFTERWARDS, WHAT WILL THE OUTCOME BE? WILL EMERGENCY MEDICAL SERVICES BE AVAILABLE AND GET THERE ON TIME? SO THIS IS THE UNDERPINNING OF THE WHOLE FIELD OF INJURY PREVENTION AND REALLY HAS CONTRIBUTED TO MANY OF THE SUCCESSES THAT WE'VE HAD TO THINK LIKE THIS. BECAUSE THIS IS FOCUSED ON BEHAVIORAL SCIENCES, I WANTED TO SHOW YOU SORT OF WHAT -- WHAT'S THE THINKING ABOUT THE ROLE OF BEHAVIOR IN ALL OF THIS? SO WE TYPICALLY THINK ABOUT THE INTERVENTION STRATEGIES FOR PREVENTION IN THIS FIELD AS CHANGING THE PRODUCTS OR THE ENVIRONMENTS THROUGH ENGINEERING, CHANGING AGAIN THE PRODUCTS, THE ENVIRONMENTS AND PEOPLE THROUGH ENFORCEMENT, AND MAKING PEOPLE MORE AWARE OF WHAT THE ISSUES ARE THROUGH EDUCATION. AND SO THE NOTION IS THAT ANY THREE OF THESE -- AND THESE THREE IN COMBINATION CAN AFFECT INJURY BY CHANGING INDIVIDUALS' RISKS AND PROTECTIVE BEHAVIORS. SO SOMETIMES IF WE'RE REALLY LUCKY, WE CAN CHANGE INJURY JUST BY MODIFYING THE POLICIES OR LAWS. SOMETIMES WE CAN CHANGE INJURY DIRECTLY BY JUST CHANGING THE ENVIRONMENT OR THE PRODUCT. BUT MOST OF THE TIME, I THINK, THESE THINGS WORK THROUGH CHANGING PEOPLE'S BEHAVIOR. AND THAT'S REALLY THE CHALLENGE FOR US IS HOW TO DO THAT WELL. HOW DO WE UNDERSTAND HOW MODIFYING THE CAR INTERIOR, FOR EXAMPLE, AFFECTS HOW PEOPLE DRIVE AND THEREFORE AFFECTS HOW THEY -- WHETHER OR NOT THEY GET INJURED? IF YOU THINK ABOUT ALL THE ENTERTAINMENT SYSTEMS THAT ARE GOING IN CARS NOW, WE CAN SEE THE INCREASE IN DISTRACTED DRIVING AND WE CAN SEE THE IMPACT ON PEOPLE WHO ARE GETTING NOW KILLED AND INJURED BECAUSE OF DISTRACTED DRIVING. THAT'S JUST ONE EXAMPLE. THERE ARE OTHER EXAMPLES OF CHANGING, OBVIOUSLY, CHANGING POLICY TO MANDATE PEOPLE HAVING TO USE SEATBELTS OR NOT BEING ALLOWED TO TALK ON THEIR CELL PHONES IN THE CAR. SO THAT'S AN ENFORCEMENT ISSUE THAT AFFECTS INJURY BY WAY OF CHANGING HUMAN BEHAVIOR. DID YOU HAVE A QUESTION? >> [INAUDIBLE] >> YEAH, GETTING THAT SECOND QUESTION ANSWERED IS TOUGH. BUT THERE ARE A LOT OF OBSERVATIONAL SURVEYS THAT HAVE BEEN DONE OVER THE YEARS TO MONITOR HOW MANY PEOPLE ARE BUCKLING UP AND SHOWING THAT ROUGHLY I THINK IT'S AROUND IN THE 80%. 80 TO 90% USING SEATBELTS BUT WILL VARY ON THE POPULATION AND THE GEOGRAPHY AND AGES OF THE DRIVERS. MORE THAN THE 0% OF INFANTS ARE IN CAR SEATS BUT BOOSTER SEATS ARE WAY LOWER THAN THAT WHEN THE KIDS GET OLDER. WE DO HAVE DATA ON THAT. WITH REGARD TO DISTRACTED DRIVING, THAT'S PRETTY HARD TO GET BECAUSE THE DATA ARE COLLECTED AT THE TIME OF A CRASH WHEN YOU'RE INTERACTING WITH THE POLICE OFFICER. OR THROUGH SELF-REPORTED SURVEYS. I DON'T REMEMBER REMEMBER, SOME VERY SCARY% OF TEENAGERS SAY THEY TEXT WHILE DRIVING. ANY PERCENT IS SCARY BUT IT WAS IN THE DOUBLE DIGITS. SO, GIVEN THAT, I JUST WANTED TO SHARE THAT WITH YOU AS SORT OF A CONCEPTUAL CONCEPTUALIZATION OF HOW I THINK THE ROLE OF INDIVIDUAL RISK AND PROTECTIVE BEHAVIORS ARE KEY IN ALL OF THE STRATEGIES THAT WE HAVE FOR ADDRESSING INJURY PREVENTION. AND WHETHER OR NOT THAT WORKS IS THE NEXT QUESTION. SO WHAT IS THE EVIDENCE THAT WE CAN ACTUALLY ACHIEVE INJURY PREVENTION AND MODIFYING RISK BEHAVIORS IN PEOPLE? AND I THINK THE EVIDENCE IS REALLY GOOD. I MEAN, THERE IS MANY EXAMPLES. THESE ARE JUST A FEW FROM A STUDY THAT WAS DONE BY TED MILLER, LOOKING AT THE BENEFIT-COST RATIOS FOR INJURY PREVENTION INTERVENTIONS, AND I JUST SLAKTED FEW OF THEM THAT I THOUGHT YOU MIGHT BE INTERESTED IN TO SHOW YOU THAT WE DO HAVE THINGS -- WE DO HAVE TOOLS IF OUR TOOL KIT THAT WE CAN UTILIZE. SO FOR EXAMPLE, MULTIFACETED COMMUNITY PROGRAMS TO REDUCE FALL RISK IN ELDERLY. THE UNIT COST FOR THOSE BASED ON -- THIS IS ALL BASED ON TRIALS THAT HAVE BEEN PUBLISHED WAS $1,000 PER PERSON. THE TOTAL COST AVERTED WERE $8,000 IN TERMS OF THE EFFECTIVENESS OF THIS INTERVENTION, QELED YIELDING A BENEFIT COST RATIO OF 7 TO 1. SO FOR EVERY $1 WE INVEST, WE GET A RETURN OF $7 IN COST AVERTED. AND SIMILARLY, WITH THE COMMUNITY CHILD SAFETY PROGRAMS, THIS IS BASED ON A MODEL OUT OF NEW YORK, THE HARLEM HOSPITAL MODEL, WHICH THEN BECAME THE INJURY-FREE COALITION FOR KIDS, YOU CAN SEE A HUGE BENEFIT-COST RATIO. SAME THING WITH SMOKE ALARMS. 15 TO 1. SOME OF THE INTENTIONAL INJURIES SIDE OF THINGS ALSO HAVE SOME GOOD EVIDENCE. A COUPLE OF EXAMPLES HERE. BIG SISTERS, BIG BROTHERS PROGRAMS ON YOUTH VIOLENCE OUTCOMES HAD A POSITIVE BENEFIT-COST RATIO. SAME THING FOR FAMILY THERAPY, FOR JUVENILE OFFENDERS, AND THEN YOU MAY BE FAMILIAR WITH THE OLD HOME VISITATION PROGRAM FOR HIGH-RISK FAMILIES THAT SHOWED A POSITIVE OUTCOME AS WELL FOR A TWO-YEAR PROGRAM. SO THIS IS SORT OF A SNAP SHOT OF ONE WAY TO JUSTIFY OR EXPLAIN OR CONVINCE PEOPLE THAT WE ACTUALLY HAVE A PREVENTION RESEARCH BASE AND PREVENTION SCIENCE BEHIND US. BUT THERE ARE MANY OTHER EXAMPLES OF HOW PREVENTION RESEARCH PAYS OFF. I WAS THINKING ABOUT JUST LAST WEEKEND I WAS AT THE BEACH, AND I WAS WATCHING THESE KIDS GO BY ON THE BOARDWALK. AND ON THEIR BIKES WITH THEIR HELMETS AND ONE PARTICULARLY REALLY CUTE KID, I DON'T KNOW MAY BE FIVE OR SIX WAS ON A SKATEBOARD AND HE HAD A HELMET AND KNEE PADS AND HE WAS CRUISING ALONG TOTALLY PROTECTED AND I WAS THINKING THAT THIS IS REALLY DIRECT EVIDENCE OF BENEFITS OF THE KIND OF WORK THAT WE DO IN PREVENTION BECAUSE THINK OF WHAT IT TOOK IN TERMS OF RESEARCH AND THE APPLICATION OF RESEARCH TO PROTECT THAT KID. WE HAD TO UNDERSTAND THAT HELMETS WOULD PROTECT THEM, BUILD THE HELMET THAT WOULD PROTECT HEM, GET IT INTO THE MARKETPLACE, CONVINCE PARENTS THAT THEY NEEDED THESE THINGS, AND THEN GET PARENTS PERSUADED TO PERSUADE THEIR KIDS TO USE THEM. SO THERE IS MANY STEPS ALONG THE PREVENTION CHAIN, AND THAT'S JUST A REALLY SMALL EXAMPLE BUT IT'S A REAL-WORLD EXAMPLE THAT SHOULD MAKE US FEEL REALLY GOOD ABOUT THE KIND OF WORK THAT WE DO IN GETTING PREVENTION RESEARCH DONE AND TRANSLATED INTO ACTION. SOME OF THE OTHER ONES THAT I THINK ARE WORTH TALKING ABOUT ARE THINGS RELATED -- WELL, THERE ARE MANY BUT I DON'T HAVE ALL DAY. THE ALCOHOL-RELATED INJURY AREA HAS A LOT OF PROMISE. COMMUNITY MOBILIZATION PROGRAMS IN ALCOHOL REDUCTION HAVE DEMONSTRATED IMPACTS ON REDUCING NOT JUST MOTOR VEHICLE CRASHES BUT ALSO ON VIOLENCE INJURIES, ALCOHOL-RELATED ASSAULT INJURIES THROUGH COMMUNITY MOBILIZATION -- MOBILIZING. THEN EXPERT IS THE SCREENING BRIEF INTERVENTION REFERRAL AND TREATMENT PROGRAM, WHICH WAS I THINK EASIER TO SAY. BUT NOW THEY ARE CALLED S PERT PROGRAMS AND THESE ARE THINGS IN TRAUMA CENTERS THAT HAVE BEEN DEMONSTRATED TO REDUCE RESCIDIVISM WHEN SOMEONE COMES IN WITH AN ALCOHOL-RELATED TRAUMA. AND THEY ARE NOW OFFERED WIDELY THROUGHOUT TRAUMA CENTERS. YOUNG DRIVERS. I AM THE MECCA FOR YOUNG DRIVER RESEARCH. BRUCE HAS BEEN LEADING THE WAY IN HELPING TO MAKE GRADUATED DRIVER LICENSING PROGRAMS WORK BY FINDING INNOVATIVE WAYS TO GET PARENTS ENGAGED TO MAKE THOSE GRADUATED DRIVER LICENSING PROGRAMS MORE EFFECTIVE. AND A GREAT EXAMPLE OF THE NEED TO BRING POLICY AND EDUCATION AND BEHAVIOR CHANGE TOGETHER TO ADDRESS A PROBLEM. AND THEN BRUCE ALLUDED TO THIS AND I'LL JUST TELL YOU BRIEFLY ABOUT OUR CHILDREN SAFETY RESOURCE CENTERS. THIS IS SOMETHING THAT WAS RESEARCH-DRIVEN WHEN WE TRIED TO UNDERSTAND WHY LOW-INCOME URBAN FAMILIES WERE NOT FOLLOWING THEIR PEDIATRICIANS' ADVICE ABOUT NOT CHILD-PROOFING THEIR HOME AND USING ALL THE THINGS WE SHOULD DO TO PROTECT OUR KIDS FROM HOME INJURIES. AND WHAT WE LEARNED WAS THAT PARTICULARLY IN LOW-INCOME URBAN COMMUNITIES, ACCESS TO SAFETY PRODUCTS IS REALLY IMPORTANT AND A HUGE BARRIER. FAMILIES WOULD SAY WELL, I HAVE TO TAKE TWO BUSS AND TESTIFY SPEND ALL MY GROCERY MONEY TO GET A STAIR GATE SO PLEASE DON'T TELL ME ANY MORE ABOUT HOW I NEED A STAIR GATE. WHAT WE DID WAS WORKED VERY CLOSELY -- AGAIN THE THEME OF PARTNER SHOIRP I HOPE WILL COME THROUGH. WE WORKED VERY CLOSELY WITH PEDIATRICIANS WHO DON'T WANT TO TALK ABOUT SOMETHING THAT THEIR PATIENTS CAN'T DO, RIGHT? SO WE WORKED WITH THE PEDIATRICIANS TO SAY LOOK, IF WE CAN HELP YOU TALK ABOUT THIS AND WE CAN HELP PARENTS ACT ON YOUR ADVICE, HOW ABOUT WE DO THAT? AND THEY WERE VERY HAPPY TO WORK WITH US. SO WE COUPLED THE PEDIATRICIAN COUNSELING, WHICH IS PART OF WHAT THEY DO, THE ANTICIPATORY GUIDANCE THEY ARE REQUIRED TO DO, WITH ACCESS TO CHILDREN SAFETY RESOURCE CENTER RIGHT NEXT TO THE CLINIC. SO THE PHYSICIANS COULD WRITE A PRESCRIPTION AND SEND A PARENT OVER, WHERE IT'S INTERACTIVE. IT LOOKS LIKE A HOME ENVIRONMENT, PARENTS. CAN TRY BEFORE THEY BUY, FIGURE OUT WHAT THEY NEED, AND THEN THEY CAN ALSO GET THE PRODUCT RIGHT THERE BEFORE THEY LEAVE AT A REDUCED COST. SO CALL IT OUR PHARMACY FOR SAFETY BECAUSE GETTING THESE THINGS ARE JUST AS POTENTIALLY LIFE-SAVING AS GETTING THEIR ANTIBIOTICS. SO THIS HAS BEEN I THINK A REALLY GOOD EXAMPLE FOR US ANYWAY, OF PARTNERING WITH THE MEDICAL CARE COMMUNITY TO ENHANCE PREVENTION AND PREVENTION SERVICES. A NUMBER OF CHILDREN'S HOSPITALS NOW HAVE THESE KINDS OF PROGRAMS. BUT IT'S GREAT THAT WE BELIEVE THAT PREVENTION RESEARCH MATTERS FIRM PROVING PUBLIC HEALTH. BUT I THINK TO REALLY ADVANCE THE FIELD, WE NEED TO IMPRESS UPON THE PUBLIC THE IMPORTANCE OF OUR WORK. SO THIS IS FROM SOME WORK THAT I WAS PART OF WHEN THERE WAS AN ORGANIZATION CALLED SAFE U.S.A., AND WE PARTNERED WITH RESEARCH AMERICA, WHICH MAY BE FAMILIAR TO YOU ALL. RESEARCH AMERICA ARE VERY ACTIVE IN ADVOCATING FOR RESOURCES FOR MEDICAL AND HEALTH RESEARCH. AND WE DID A PUBLIC OPINION POLL WITH THEM. THE FIRST TIME EVER THEY HAD DONE ANYTHING, I THINK, ON INJURIES. AND WHAT WE FOUND WITH THE NATIONAL SURVEY WAS THAT 35% OF PEOPLE KNEW INJURIES WERE THE LEADING CAUSE OF DEATH. SO A LOT MORE PEOPLE WHO NEED TO KNOW THAT MESSAGE. AND MORE THAN HALF OF THESE PEOPLE WHO RESPONDED REPORTED HAVING EXPERIENCED A MEDICALICALLY ATTENDED INJURY, WHICH SPEAKS TO THE UBIQUITOUS CHBS THIS PARTICULAR PROBLEM. AND IMPORTANTLY FROM AN ADVOCACY PERSPECTIVE, WHEN WE ASKED HOW IMPORTANT DO YOU THINK IT IS FOR THE UNITED STATES TO INVEST IN NEW WAYS TO PREVENT INJURY, WE CAN SEE THAT THE MAJORITY SAID IT WAS VERY IMPORTANT OR SOMEWHAT IMPORTANT. SO CLEARLY, WE CAN CAPITALIZE ON THE FACT THAT THE PUBLIC IS ON OUR SIDE. IF ONLY WE SPEAK TO THEM MORE OFTEN. AND MORE EFFECTIVELY. ANOTHER WAY THAT WE CAN COMMUNICATE THE IMPORTANCE OF PREVENTION, RESEARCH AND PRACTICE, I THINK IS BY INTEGRATING THE INJURY ISSUE MORE INTO THE MAINSTREAM OF THE PUBLIC NARRATIVE ABOUT HEALTH IN GENERAL. FOR INSTANCE, WE SHOULD BE USING THE TERMS -- AND I DID THIS AT THE BEGINNING -- I DON'T KNOW IF YOU CAUGHT IT BUT I WILL TRY TO DO IT AGAIN -- WE SHOULD BE USING THE TERMS HEALTH AND SAFETY, DISEASE AND INJURY WHEN WE TALK ABOUT THE PUBLIC'S HEALTH. AND HERE IS AN EXAMPLE OF ONE APPROACH THAT A COALITION OF ORGANIZATIONS TOOK. THERE WERE ABOUT 20 OF US FROM THE AMERICAN ACADEMY OF PEDIATRICS TO SEVERAL OF OUR INJURY-CONTROLLED RESEARCH CENTER COLLEAGUES, AND A NUMBER OF OTHER ORGANIZATIONS THAT CAME TOGETHER TO TAKE OUT AN AD IN THE CONGRESSIONAL NEWSPAPER THAT GOES TO EVERY CONGRESS PERSON ON CAPITOL HILL RIGHT WHEN THEY CAME BACK FROM AUGUST RECESS, WHEN THEY WERE DEBATING THE HEALTHCARE REFORM BILL. AND YOU CAN SEE THE MESSAGE HERE. WHILE YOU WERE ON RECESS, NEARLY FOUR MILLION AMERICANS RECEIVED MEDICAL TREATMENT FOR INJURIES, GENERATING $9 BILLION IN LIFETIME MEDICAL COSTS. INJURY IS ONE OF THE MOST SERIOUS COSTLY AND PREVENTABLE HEALTH PROBLEMS IN THE U.S., ET CETERA, ET CETERA. MANY INJURIES CAN BE PREVENTED, INCLUDING INJURY PREVENTION AND HEALTHCARE REFORM TO SAVE LIVES AND MONEY ." I DON'T THINK INJURY PREVENTION NECESSARILY IS FRONT AND CENTER OF THE HEALTHCARE REFORM BUT THERE ARE ELEMENTS OF IT THAT ARE INCLUDED AND IT'S OPPORTUNITIES LIKE THIS WHERE I THINK WE CAN BE STRATEGIC IN PARTNERING WITH PEOPLE OUTSIDE OF OUR ORGANIZATIONS WHO CAN CARRY THE MESSAGE. SO I HOPE THAT THIS BACKGROUND AND THESE EXAMPLES HAVE AMPLELY DEMONSTRATED THE BRETT OF THE INJURY PREVENTION FIELD AND THE FACT THAT MULTIPLE DISCIPLINES AND PARTNERSHIPS ARE INVOLVED IN MAKING THE WORLD A SAFER PLACE AND THE PEOPLE IN IT THAT ARE PROTECTED. THE OBVIOUS ACTORS INCLUDE THE MEDICAL AND EMERGENCY MEDICAL SERVICES CARE PROVIDERS, LAW ENFORCEMENT IS ANOTHER OBVIOUS CRITICAL PLAYERS AND MANY INTERVENTIONS REQUIRE ENFORCEMENT LEGISLATION. BUT THE ONE THAT STANDS OUT HERE PERHAPS TO YOU YOU MIGHT WONDER ABOUT IS WHY THE ARCHITECT OR ENGINEER IS IN THE PICTURE? THESE FOLKS DESIGN OUR ENVIRONMENT. THEY ARE CRITICALLY IMPORTANT IT OUR MISSION TO PREVENT INJURIES, AND I WANTED TO JUST USE THIS AS AN OPPORTUNITY TO MENTION A NEW PROJECT THAT'S COMING OUT OF NEW YORK CITY THAT I THINK WILL ILLUSTRATE THE BENEFIT OF THIS KIND OF COLLABORATIVE INTERDISCIPLINARY WORK THAT I THINK WE NEED TO MOVE FORWARD. SO NEW YORK CITY -- ANYBODY FROM NEW YORK, SPEND TIME IN NEW YORK? OKAY. SO IF YOU'VE BEEN THERE RECENTLY, YOU MIGHT HAVE NOTICED THAT THE ENVIRONMENT -- THERE IS LOTS OF PLACE THERE'S TO WALK SAFELY, TO PLAY SAFELY, TO RIDE BIKES SAFELY. THEY REALLY HAVE DONE A PHENOMENAL JOB IN TERMS OF MODIFYING LOTS OF AREAS OF THE BUILT ENVIRONMENT FOR HEALTH. THEY DIDN'T DO IT FOR SAFETY. THEY DID IT BECAUSE THEY WANT TO REDUCE OBESITY AND INCREASE PHYSICAL ACTIVITY. SO THEY ARE REALLY PUSHING WALKING, BIKING, WALKING, BIKING. THAT KIND OF TRANSIT. SO IT'S GREAT. THEY PRODUCED THIS DOCUMENT, THESE GUIDELINES FOR ARCHITECTS, URBAN PLANNERS, URBAN DESIGNERS AND BUILDING DESIGNERS, AND THEY SENT IT OUT -- IT'S A PHENOMENAL DOCUMENT THAT THE ARCHITECTURAL COMMUNITY IS SAYING GOOD THINGS ABOUT, ET CETERA. BUT IT HAD NO MENTION OF INJURY PREVENTION IN IT. SO THROUGH A SERIES OF THINGS, WE WERE LUCKY ENOUGH TO GET -- TO PARTNER WITH THEM TO ACTUALLY CREATE A SUPPLEMENT THAT IS ACTIVE LEG OF BY DESIGN A SAFETY SUPPLEMENTS NOW IT REALLY, I THINK, PUTS THIS NOTION OF ACTIVE LIVING BY DESIGN, WHICH EVERYONE IS TRYING TO DO TO REDUCE CHRONIC DISEASES, AND MARRY IT WITH INJURY AND INJURY PREVENTION. AND SPEAKS TO THE PEOPLE WHO CAN BUILD THE ENVIRONMENT THAT WAY. SO WE'RE GOING TO BE COMING OUT NEXT WEEK WITH THE DOCUMENT THAT HAS ENDORSEMENTS FROM THE ARCHITECTURAL PROFESSIONAL ASSOCIATION AND REALLY SAYS IT'S GREAT TO GET PEOPLE TO RIDE THEIR BIKES MORE OFTEN BUT YOU HAVE TO THINK ABOUT WHERE ARE THEY GOING TO GET THEIR BIKE HELMETS AND STORE THEIR BIKE HELMETS? WE NEED TO MAKE THOSE THINGS MORE VISIBLE. THERE IS A CONFLICT THERE, AS YOU CAN IMAGINE BECAUSE IF YOU WANT PEOPLE TO BE MORE PHYSICALLY VAEFK, YOU DON'T WANT TO TELL THEM BUT YOU MIGHT GET HURT. ACTIVE. SO THAT'S BEEN KIND OF THE PUSH WITH IT AND I THINK THERE IS A BIG OPPORTUNITY GOING FORWARD TO REALLY TRY TO ADDRESS THAT AND BRING THOSE TWO GROUPS TOGETHER. SO IF THAT'S SOMETHING THAT YOU'RE INTERESTED IN, I'D BE GLAD TO MAKE SURE YOU GET A COPY OF THIS WHEN IT COMES OUT. IT'S GOING TO BE POSTED SO IT WILL BE EASY TO DOWNLOAD. SO THAT'S AN EXAMPLE OF INTERDISCIPLINARY WORK THAT I THINK IS EXCITING AND PROMISING. ANOTHER EXCITING COLLABORATIVE DISCIPLINARY POTENTIAL FOR RESEARCH COMES FROM WORK OF THE SOCIETY FOR ADVANCEMENT OF VIOLENCE AND INJURY RESEARCH. HAS ANYBODY HERE HEARD OF IT? SQLECHBLET THAT'S WONDERFUL. SAVOR IS A PROFESSIONAL DAYCARE NEW RELATIVELY PROFESSIONAL ASSOCIATION FOR PEOPLE IN OUR FIELD, AND WE WERE LUCKY ENOUGH TO MEET WITH DR. GUTTMACHER AND BE INVITED TO PREPARE A REPORT FOR NICHD ON WHAT WOULD BE A CALL FOR ACTION TO INJURY RESEARCH WITHIN THE SCOPE OF PEOPLE WHO CARE ABOUT CHILDREN, ADOLESCENTS AND FAMILIES. SO THIS REPORT INCLUDED THESE TOPICS AND THESE TYPES OF RESEARCH JUST TO GIVE YOU A LITTLE BIT OF A HEADSUP OF THE KINDS OF THINGS THAT WE WERE DISCUSSING. IT INCLUDES, AS YOU MIGHT EXPECT, YOUNG DRIVERS AND MOTOR VEHICLES, SINCE IT'S STILL THE LEADING CAUSE OF THEIR DEATH. POISONING AND INCREASING PROBLEM, CHILD ABUSE AND NEGLECT, ET CETERA, AND CONCUSSIONS AND INTIMATE PARTNER VIOLENCE AS WELL. OFTEN WE FIND THAT PEOPLE THINK OF INJURIES AND THEY THINK ONLY UNINTENTIONAL. BUT THE SCIENTIFIC UNDERPINNING WORKS JUST AS WELL WHETHER YOU ARE TALKING ABOUT VIOLENT OR UNINTENTIONAL INJURIES SO WE PUT THEM TOGETHER. AND THEN THE TYPES OF RESEARCH THAT WE TALKED ABOUT ARE THE BASIC RISK FACTOR RESEARCH, DEVELOPMENT OF NEW METHODS AND MEASUREMENTS, CLINICAL RESEARCH FOCUS ON INDIVIDUALS, AND IMPORTANTLY, INTERVENGS THAT'S WOULD BE FOCUSED AS A POPULATION LEVEL. AND THIS IS GREAT AND WE ARE VERY EXCITED TO HAVE THIS OUT THERE AS SOMETHING THAT WE CAN TURN TO TO GUIDE DISCUSSIONS ABOUT WHERE PREVENTION RESEARCH SHOULD BE GOING IN THE FUTURE. BUT REALLY THERE ARE MANY OTHER OPPORTUNITIES, AND I AM SURE THAT YOU ALL, KNOWING NIH WAY BETTER THAN I DO, CAN THINK ABOUT SOME OF THESE OTHER OPPORTUNITIES. I KNOW OTHER EXISTING PRIORITIES IN OBESITY AND PHYSICAL ACTIVITY. WE JUST TALKED ABOUT ONE APPROACH TO ADDRESSING THAT, WHICH IS PARTNERING WITH THOSE PEOPLE TO MAKE SURE A, THAT INJURIES ARE COUNTED AND THOUGHT ABOUT AND PREVENTION IS BUILT IN TO THE STRATEGIES. AGING OBVIOUSLY IS ANOTHER HUGE AREA WITH THE AGING POPULATION AND THE HIGH RISK OF DEATH FROM FALLS. REALLY COULD BE A LOT MORE DONE IN THAT AREA. THERE ARE INNOVATIVE MODELS NOW. A WOMAN OF THE SCHOOL OF NURSING ACTUALLY FUND BY NIH. SHE DEVELOPED A REALLY GOOD MODEL PROGRAM FOR IMPROVING THE SAFETY OF OLDER ADULTS HOME ENVIRONMENTS TO REDUCE INJURY RISKS. AND THEN THE WHOLE AREA OF HEALTH DISPARITIES. ALTHOUGH WE'VE HAD SO MANY GREAT SUCCESSES AND INJURIES, IT'S NOT EQUALLY SPREAD OUT ACROSS THE POPULATION, AS YOU MIGHT EXPECT. NATIVE AMERICANS ARE STAGGERINGLY HIGHER RATES OF MOST INJURIES. IN PARTICULAR MOTOR VEHICLE CRASHES AND ALCOHOL-RELATED INJURIES. WE HAVE SO MANY MORE NON-ENGLISH-SPEAKING CITIZENS. WE HAVE A HUGE PROBLEM WITH LITERACY. THOSE POPULATIONS ARE NOT REACHED BY A LOT OF OUR EFFORTS. CLEARLY, POVERTY, AS I ALOUED TO IN MY EXPLANATION IN PEDIATRICS IN BALTIMORE, AGAIN, OLDER ADULTS, CHILDREN AND ADOLESCENTS ARE POPULATIONS THAT ARE AFFECTED BY INJURIES. THE LAST AREA OF OPPORTUNITY THAT I REALLY WANTED TO TALK ABOUT IS THE WHOLE AREA OF TRANSLATIONAL RESEARCH. AND AGAIN, IF WE GO BACK TO THE PUBLIC HEALTH MODEL, WHERE WE HAVE IDENTIFIED THE PROTECTIVE AND RISK FACTORS WE'VE DEVELOPED AND TESTED IN INTERVENTION, WE THEN THINK MAGIC HAMS -- HAPPENS AND THOSE INTERVENTIONS ARE WIDELY ADOPT BID EVERYONE WHO NEEDS THEM. BUT AS WE ALL KNOW, THAT'S NOT WHAT HAPPENS AND WE HAVE TO SPEND AS MUCH EFFORT AND TIME FOCUS ON MAKING THAT LINK FROM PROVEN AND EFFECTIVE INTERVENTION TO GETTING IT TO THE PEOPLE WHO NEED IT. AND HOW DO WE GO ABOUT DOING THAT? WELL, HERE, IT SEEMS LIKE WE TACK A LOT ABOUT THE T 1 FROM BENCH TO BEDSIDE, FROM BEDSIDE TO CLINICAL PRACTICE, AND FROM PRACTICE TO THE PUBLIC. SO THAT APPLIES HOW DOES THAT TRANSLATE WHEN YOU ARE TALKING ABOUT INTERVENTIONS TO REDUCE INJURIES? WELL, WE THINK THAT IT DOES APPLY, AND SHOULD APPLY VERY CLEARLY. WHEN WE THINK ABOUT THAT -- THESE ARE JUST THE DEFINITIONS WHICH I ACTUALLY GOT FROM YOU ALL SO YOU PROBABLY KNOW THEM. WHEN WE THINK ABOUT TRANSLATIONAL RESEARCH IN INJURY PREVENTION, IT'S A LITTLE BIT DIFFERENT. SO THESE ARE THREE DIFFERENT EXAMPLES OF A TRANSLATIONAL RESEARCH QUESTION, WHICH IS HOW BEST TO DISSEMINATE SMOKE ALARMS TO LOW-INCOME URBAN COMMUNITIES, FOR EXAMPLE? SO HERE THE INTERVENTION IS A PRODUCT. WE KNOW THAT SMOKE ALARMS SAVE LIVES. THAT'S OUR PROVEN EFFECTIVE INTERVENTION. THE NEXT ONE IS HOW TO INCREASE COMMUNITIES WITH RESIDENTIAL SPINK LER ORDNANCES? WE KNOW THAT THEY DO A BETTER JOB EVEN THAN SMOKE ALARMS BUT THOSE REQUIRE POLICIES TO BE ADOPTED. SO HERE THE INTERVENTION IS CHANGING POLICY. HOW DO WE DO THAT? AND THEN WHAT ARE THE BARRIERS AND FACILITATORS TO WIDESPREAD IMPLEMENTATION OF THESE SCREENING BRIEF INTERVENTION PROGRAMS AND TRAUMA CENTERS? HERE THE INTERVENTION IS A PROGRAM. SO WE HAVE LOTS OF OPPORTUNITIES TO THINK ABOUT ALL THE THINGS WE KNOW WILL PREVENT INJURIES AND HOW TO GET THEM OUT THERE. WE TRIED TO WORK THROUGH AN EXAMPLE OF˝; THAT WE WROTE RECENTLY IN THE AMERICAN PUBLIC HEALTH ASSOCIATION'S BOOK ON PREVENTING INJURIES IN CHILDREN. WE HAVE OTHER EXAMPLES, BUT I THOUGHT I WOULD JUST SHARE THIS ONE WITH YOU TO TRY TO MAKE IT MORE CONCRETE. SO IF WE TAKE T 1, WE CALL IT MOVING EPIDEMIO LOGICAL AND BIOMEDICAL DISCOVERIES FROM DATA TO INTERVENTION. SO IN THE EXAMPLE OF CAR SEATS, WE HAD RESEARCHED THE DEMONSTRATED RISKS OF UNRESTRAINED CHILDREN AND THE BENEFITS OF CAR SEATS. CAR SEATS GOT MANUFACTURED AND WE HAD TO BE EFFECTIVE STRATEGIES TO INCREASE THEIR USE. SO WE HAD TO RESEARCH HOW DO WE DO THAT. SO MOVING FROM THE DISCOVERY OF CAR SEATS TO HOW DO WE GET THAT CAR SEAT INTERVENTION INTO ORGANIZATIONAL AND COMMUNITY SETTINGS OR T 2 RESEARCH? AND HERE IN THE HISTORY OF CAR SEATS, WE USED EDUCATION AND LEGISLATION AND HAD SIGNIFICANT SUCCESS WITH THAT. SO WHAT WOULD BE T 3? T 3 WOULD BE OKAY, WELL, WE KNOW THAT IN TENNESSEE, WHICH IS WHERE THIS STARTED, CAR SEAT LEGISLATION INCREASED IN EDUCATION INCREASED THE USE OF CAR SEATS IN TENNESSEE, BUT HOW DO WE SCALE IT UP? HOW DO WE DO THE T 3 RESEARCH OF SCALING IT UP TO A LARGER POPULATION? WELL, IN THE CAR SEAT EXPERIENCE, WE HAD 23 STATES BY 1980 HAD PASSED CAR SEAT LAWS AND BY THE 1985 ALL 50 STATES HAD THEM AND STATE HEALTH DEPARTMENTS WERE ENGAGED IN PROVIDING SUPPORTS, ACCESS TO SEATS AND SO FORTH. SO WHAT'S LEFT? THE LAST STAGE OF A TRANSLATION PROCESS THEN WE THINK ABOUT HOW DO WE REFINE THE INTERVENTION AND THE INTERVENTION DELIVERY BASED ON OUR ONGOING SORT OF FIDELITY MONITORING TO MAKE SURE THESE PROGRAMS AND THESE LAWS ARE BEING IMPLEMENTED AND DELIVERED IN EFFECTIVE WAYS? AND WE WILL CONTINUE TO MONITOR THAT AND WHAT WE NOW KNOW IS THAT YES, WHILE 90% OF INFANTS ARE IN CAR SEATS, WE HAVE A PROBLEM WITH A HUGE PERCENTAGE OF CAR SEATS BEING USED IMPROPERLY. SO WE'RE BACK INTO THE CYCLE OF HOW DO WE ADDRESS THAT NEW PROBLEM? SO IN TERMS OF AN EXAMPLE OF TRANSLATIONAL RESEARCH, I THINK THAT THIS IS A GOOD ONE. AT LUNCH WE WERE TALKING ABOUT HOW WE GOT INTO THIS BUSINESS AND THAT'S MY SON IT A CAR SEAT AT MY VERY FIRST JOB. SO WE'VE COME A LONG WAY, BABY, IS WHAT THEY SAY AND NOW WE CAN SAY THAT EVERY YEAR MORE THAN 400 CHILDREN FROM AGES 0 TO 5 ARE SAVED DUE TO THESE CAR SEATS. IN MY OPINION, ANOTHER GREAT SUCCESS STORY IN INJURY PREVENTION. SO LET ME JUST WRAP UP AND WE'LL HAVE PLENTY OF TIME FOR CONVERSATION, I THINK. SO I HOPE WHAT I'VE BEEN ABLE TO SHARE WITH YOU IS THE IDEA THAT INJURY IS A COSTLY EPIDEMIC HIDING IN PLAIN SIGHT. WE NEED, DESPITE OUR GREAT PROGRESS, INJURY REMAINS THE NUMBER ONE CAUSE OF DEATH FOR FAR TOO MANY OUR POPULATION, CHILDREN AND YOUNG PEOPLE IN THE U.S.. AND IT'S INCREASINGLY IMPORTANT IN TERMS OF ITS GLOBAL BURDEN. WE DO KNOW THAT PREVENTION RESEARCH HAS YIELDED BENEFITS TO SOCIETY, BUT THE CHALLENGES THAT REMAIN ARE WITH THE AREA OF THE TRANSLATIONAL PROCESS TO WIDELY DISSEMINATE THESE PROVEN EFFECTIVE INJURY PREVENTION STRATEGIES, ESPECIALLY TO CLOSE THE DISPARITY GAP IN INJURIES. AND THEN FINALLY, THE WAY TO DO THAT, I THINK, IS THROUGH USING MULTIDISCIPLINARY EXPERTISE, PARTNERSHIPS, AND TRANSLATIONAL SCIENCE. CAUSE NONE OF US CAN DO IT ALONE. SO IF YOU ARE INTERESTED IN MORE INFORMATION, WE'RE GOING TO BE HAVING A NATIONAL INJURY PREVENTION CONFERENCE IN BALTIMORE IN JUNE OF NEXT YEAR. THERE WILL BE MORE INFORMATION AVAILABLE ON THAT. AND WE WOULD LOVE TO SEE YOU COME UP THE ROAD. IT'S NOT THAT FAR. AND THAT IS IT. THANK YOU VERY MUCH FOR INVITING ME TO TALK ABOUT THIS. [APPLAUSE] >> YES. >> [INAUDIBLE] >> MANY, MANY,. . THE AREA THAT I KNOW A LITTLE BIT ABOUT MORE THAN OTHER AREAS, I GUESS IS WHERE I SHOULD DRAW FROM. AND YOU KNOW, THE FIRST THING THAT COMES TO MIND IS THE SIGNIFICANT IMPACT ON WOMEN'S HEALTH OF INTIMATE PARTNER VIOLENCE AND VIOLENCE IN GENERAL. FROM THE SPECTRUM OF EARLY CHILDHOOD ABUSE, SEXUAL ABUSE ALL THE WAY THROUGH ADULT TO INTIMATE PARTNER VIOLENCE AND HOW THAT CYCLE OF VIOLENCE WITHIN FAMILIES PERPETUATES ITSELF AND WHAT ARE THE BEST INTERVENTION POINTS FROM MULTIPLE PERSPECTIVES FROM THE HEALTHCARE DELIVERY SYSTEM TO THE COMMUNITY TO FAMILY INTERVENTIONS? THE IDEA, I THINK THE EVIDENCE IS PRETTY DARN SOLID THAT WE KNOW THAT'S BAD FOR WOMEN'S HEALTH. WE HAVE LOTS OF DOCUMENTATION OF ITS IMPACT ON MENTAL HEALTH, PHYSICAL HEALTH, REPRODUCTIVE HEALTH. SO WHAT WE NEED TO DO IS FIND WAYS TO ADDRESS THAT THROUGH PREVENTIVE INTERVENTIONS, SO I THINK THAT'S A BIG GAP. IN TERMS OF THE WORK THAT I AM DOING NOW WITH CHILD INJURY, UNINTENTIONAL INJURIES, I'M EXCITED BY THE FACT THAT WE HAVE ALL OF THESE NEW COMMUNICATION TECHNOLOGIES, AND I REALLY DON'T KNOW WHAT NIH IS FUNDING IN THE WAY OF USING INNOVATIVE COMMUNICATION TECHNOLOGIES THAT ARE EVERYWHERE. I ONLY KNOW WHAT THEY'RE CALLED, TWITTER, TWEET AND FACEBOOK. AND INTERACTING WITH THE WEB MORE AS A WAY TO BE EFFECTIVE COMMUNICATION THAT REALLY CHANGES BEHAVIOR. >> [INAUDIBLE] >> IT'S VERY EXCITING. BUT BRUCE IS REALLY THE EXPERT IN THE TECHNOLOGIES AND HOW THEY WORK. DO YOU WANT TO OFFER AN OPINION? >> [INAUDIBLE] >> WHAT I WOULD SAY IS -- [INAUDIBLE] I THINK DIFFERENCE -- BASICALLY AT THE -- MOST OF THEM INCLUDE A DRIVING SIMULATEOR BUT THEY ALSO HAVE THINGS LIKE SMART ROADS. SO TOGETHER THESE ARE THE VARIOUS COMPONENTS OR RESOURCES THAT ARE REQUIRED. >> THAT REMINDED ME OF ONE THING IT WE ARE DOING THAT I THINK IS MAYBE A GAP IS WITH OLDER ADULTS. AS WE GET MORE AND MORE OLDER ADULTS THE WHOLE ISSUE OF WHEN TO STOP DRIVING IS AN ENORMOUS ISSUE THAT WE DON'T HAVE THE ANSWERS TO. WE HAVE IDEAS AND WE HAVE PROGRAMS THAT ADDRESS SELF-REGULATION, LIKE TO THE EXTENT THAT THE OLDER DRIVER ONLY DRIVES ON GOOD WEATHER IN DAYLIGHT, AND NOT FAR FROM HOME. BUT WE REALLY DON'T KNOW WHAT TO DO IN TERMS OF TAPERING OFF THEIR DRIVING PRIVILEGES. AND THE GENERATION -- THEIR CHILDREN DON'T KNOW HOW TO TALK TO THEIR PARENTS ABOUT IT. DOCTORS DON'T KNOW HOW TO TALK TO OLDER ADULTS ABOUT IT. I THINK THAT'S A HUGE GAP IN GENERAL, AND I WAS THINKING. SIMULATORS MIGHT BE ONE THING BUT ONE ADVANTAGE MAY BE IS THAT YOU AT NIH HAS SUCH CREDIBILITY WITH THE MEDICAL COMMUNITY SO HOW CAN WE ENGAGE MORE THE MEDICAL COMMUNITY WITH INJURY PREVENTION GOALS? THAT MIGHT BE -- WHEN WE THINK ABOUT WHAT TO INVEST IN, THINKING ABOUT IT THAT WAY MIGHT HELP, TOO, BECAUSE LOOK SAID, WHEN I STARTED WHEN YOU ALL TALK, WE ALL LISTEN. >> [INAUDIBLE] >> SO YES, ADDRESSING HEALTH DISPARITIES OF INTINCTIONAL INJURY TYPES AND WHAT'S MORE COST EFFECTIVE? THOSE ARE REALLY BIG QUESTIONS, AND I GUESS IT WOULD DEPEND ON WHAT PARTICULAR POPULATION YOU WERE THINKING ABOUT. BUT IF YOU THINK ABOUT, FOR EXAMPLE, CERTAIN ENVIRONMENTS ARE NOT GOING TO BE AS SEVEN AS OTHER ENVIRONMENTS. SO IF YOU LIVE IN LOW-INCOME URBAN COMMUNITIES WITH LOTS OF BORROWED UP HOUSING, FOR EXAMPLE, SO POVERTY WOULD BE SORT OF UNDERLYING PROBLEM. IF WE TAKE THE SCIENCE OF INJURY PREVENTION TO THAT COMMUNITY, IT'S NOT SO MUCH THAT WE'RE NOT TEACHING PEOPLE IN THAT ENVIRONMENT, BUT WE'RE NOT ADDRESSING THE ENVIRONMENTAL DETERMINANTS OF THE INJURY CAUSES AND THE SAME THING IS TRUE FOR NATIVE AMERICAN RESERVATIONS WHERE IF YOU LOOK AT THE ROADWAYS, IT'S PRETTY CLEAR HOW WE COULD ADDRESS THAT PARTICULAR KIND OF DISPARITY. LET'S SEE. WHAT ELSE? SOME OTHER EXAMPLES. SO REALLY SWIGSALLY SPECIFIC. BUT I THINK IF YOU LOOK -- JUST SIMPLY LOOKING AT THE NON-ENGLISH-SPEAKING POPULATION AND THE LOW LITERACY POPULATION, YOU CAN PICK ANY UNINTENTIONAL INJURY TOPIC, LOOK AT THE EDUCATIONAL MATERIALS THAT YOU HAVE, AND AGAIN, YOU WILL BE ABLE TO FIX THAT PROBLEM REALLY QUICK BECAUSE THEY ARE WRITTEN AT HIGH READING LEVEL. THEY'RE NOT WRITTEN IN THEIR RIGHT LANGUAGE. THEY'RE NOT CULTURALLY APPROPRIATE. SO SOME OF THIS IS PRETTY SIMPLE-SOUNDING UNTIL YOU TRY TO IMPLEMENT IT. BUT THERE ARE OTHER PEOPLE WITH DISPARITIES, BACKGROUND AND INTERESTS AND EXPERTISE IF ANYBODY WANTS TO COMMENT ON THAT BIG QUESTION. >> SO A LOT OF INJURY IS LINKED TO DEVELOPMENTAL -- [INAUDIBLE] WHEN YOU HAVE A SMALL CHILD -- [INAUDIBLE] THERE IS A TRANSITION TO TODDLER SEATS AND SAFETY BELT ISSUES. SO BY THE TIME -- MY POINT -- I GUESS THE QUESTION IS YOU'RE NOW FOCUSING ON THIS ONE AREA, WHICH IS THE TRANSITION TO THE TODDLER SEAT. TELL US A LITTLE BIT ABOUT WHAT YOU NEED TO TLAP TO GET SOME REAL IMPROVEMENT? >> SO THE STUDY THAT BRUCE WAS REFERRING TO IS WE'RE EXCITED TO GET THIS UP AND RUNNING. IT BUILDS ON SOME WORK WE DID BEFORE TO USE COMPUTER TAILORING. SO YOU CAN USE A COMPUTER, INTERACT WAY COMPUTER FOR TEN MINUTES AND IT ASKS YOU A WHOLE BUNCH OF SPECIFIC QUESTIONS AND THEN YOU HAVE A MESSAGE LIBRARY THAT BASED ON THE ANSWERS YOU GOT A PERSONALIZED TAILORED REPORT THAT SPEAKS JUST TO YOU AND YOUR CHILD. SO WE ARE USING THAT TECHNOLOGY TO BUILD A WEB-BASED PORTAL WHERE FAMILIES CAN PUT IN INFORMATION ABOUT THEIR CHILD AND THEIR CAR AND THEIR NEEDS AND THEN GET THIS PARTICULAR TAILORED REPORT BACK. AND THEY WILL BE ABLE TO INTERACT WITH THE PORTAL OVER TIME SO YOU ADOPT HAVE TO -VTHIS ONE-SHOT MESSAGE PROBLEM THAT WE HAD IN OUR PREVIOUS STUDY. SO THE THING WE WANT TO DO WITH THAT IS ADDRESS THE MISUSE PROBLEM FOR THE LITTLE ONES, BUT THE REAL ISSUE RIGHT NOW IS THAT PEOPLE ARE USING CAR SEATS BUT THEN THEY DON'T KNOW WHEN THEIR CHILD SHOULD GO TO AN ADULT SEATBELT. WHEN THEIR CHILD SHOULD GO TO A BOOSTER SEAT. AND SO YOU SEE A BIG DROPOFF IN CAR SEAT RESTRAINT USE FROM THE TODDLERS TO THE ADULT SEATBELT WITHOUT THE PROPER TRANSITION THROUGH BOOSTER SEATS. SO WE'RE EXPLORING THAT. THAT'S THE QUESTION THIS WE WANT TO LOOK AT IS WHETHER OR NOT WE CAN GET PERSUASIVE MESSAGES BUILT INTO THIS PORTAL THAT WILL REDUCE THE PROBLEM OF DROPOFF AFTER THE KID OUTGROWS THE CAR SEAT AND NEEDS TOB A IN A BOOSTER SEAT OR PREMATURELY LEAVING THE BOOSTER SEAT TO AN ADULT SEATBELT AND THAT IS A IS IT FAIRIO THAT HASN'T BEEN VERY WELL-ADDRESSED. WHAT MOST PEOPLE HAVE BEEN DOING IS JUST DEMONSTRATING THE PRECIVE VALUE OF BOOSTER SEATS, LOOKING AT EXACTLY HOW MUCH PROTECTION SMALL BODIES NEED AND FOR HOW LONG. BUT THAT MADE ME THINK OF ANOTHER GAP. CAN I TELL YOU? I DON'T KNOW IF YOU CAN DO ANYTHING ABOUT THIS GAP, BUT THERE WAS A STUDY THAT RECENTLY CAME OUT OF PHILADELPHIA THAT SHOWED THE COST SAVINGS IF MEDICAID PAID FOR CHILD CAR SEATS. SO IF THERE WAS ANY WAY THAT WE COULD FACILITATE GETTING THESE LIFE-SAVING PRODUCTS COVERED, JUST LIKE WE COVER ALL THE OTHER MEDICAL DEVICES AND PRESCRIPTIONS, THAT WOULD BE A DREAM COME TRUE. THAT'S A REALLY GOOD QUESTION AND NOT THAT I'M AWARE OF. I THINK THE ISSUE AT LEAST WITH SCHOOL BUSES HAS ALWAYS BEEN THAT THE RISKS RELATIVE TO EXPOSURE THE RISK IS SMALL AND RETROFITTING IS SO EXPENSIVE AND THEN YOU MIGHT INTRODUCE SOME UNINTENDED CONSEQUENCES OF SEATBELTS BEING -- FIT ON OTHER KIDS. BUT THERE ARE PARENTS IN NEW COMMUNITIES WHO WANT NEW SCHOOL BUS THAT'S DO HAVE THEM BUT ON PUBLIC TRANSPORTATION, I DON'T KNOW. >> [INAUDIBLE] >> WELL, WE'VE HAD A COUPLE OF EXAMPLES OF PARTNERSHIPS WITH INSURANCE CARRIERS. FOR THE HOSPITAL QUESTION I CAN SAY THAT THE CHILDREN SAFETY CENTER WAS A DEMONSTRATION RESEARCH PROJECT THAT NOW IS A SERVICE PROGRAM OF THE HOSPITAL. SO THE HOSPITAL LIKED THE BENEFITS OF HAVING IT THERE. SO THEY HELPED PAY FOR IT NOW. SO AND CHILDREN'S HOSPITALS AROUND THE COUNTRY, A LOT OF THEM ARE DOING SIMILAR THINGS. SO I THINK HOSPITALS SEE AT LEAST THE PR VALUE. IN TERMS OF THE COST, WE'VE HAD A COUPLE OF LITTLE SUCCESSES, I WOULD SAY, WELL, NOT REALLY. I SHOULDN'T SAY THAT. WE'RE VERY GRATEFUL. SO CARE FIRST, BLUE CROSS, BLUE SHIELD IN MARYLAND GAVE US MONEY TO TAKE THE CHILDREN SAFETY CENTER MODEL AND SCALE IT UP INTO A MOBILE 40-FOOT TRUCK VERSION THAT GOES AROUND THROUGH COMMUNITIES TO PROVIDE LOW-COST PRODUCTS AND EDUCATION AND EDUCATION. AND SO THEY SEE THE BENEFIT OF THAT IN TERMS OF IF WE CAN TAKE IT TO PLACES WHERE THEIR CLIENTS ARE WHERE THEIR HEALTH CLINICS ARE AND OF COURSE, IT'S GOOD P.R. FOR THEM AS WELL. AND THEN IF OUR MEDICAID CLINIC IN THE HOSPITAL, THE HEALTH INSURER OF THOSE MEDICAID KIDS IS PRIORITY PARTNERS AND THEY'VE ACTUALLY INVESTED IN PAYING FOR THE HEALTH EDUCATOR WHO RUNS THE SAFETY CENTER SPECIFICALLY FOR THEIR FAMILIES. AND SO WHAT THEY WANT US TO DO NOW AND MAYBE YOU CAN HELP US WITH THIS -- THEY WANT TO US DEMONSTRATE THAT IT'S REDUCED THEIR CLAIMS, THAT IT'S COST-SAVING. AND WE REALLY WANT TO DO THAT. SO BUT I THINK IT'S CHALLENGING. IT'S REALLY CHALLENGING, BECAUSE OF HOW SERIOUS -- I GUESS HOW SERIOUS DEATHS DUE TO INJURIES ARE SO RARE AND WE NEED TO FIGURE OUT HOW TO GET AT THOSE EXPENSIVE MULTIPLE EMERGENCY ROOMS AND THOSE KINDS OF THINGS. YEAH, WE SHOULD TALK. >> [INAUDIBLE] THAT'S A GREAT QUESTION. I THINK MOTIVATIONAL INTERVIEWING IS BEHIND THE SCREENING BRIEF INTERVENTION FOR TREAT. THE BRIEF ALCOHOL INTERVENTION I THINK GREW OUT OF THAT WHOLE INTERVIEWING LITERATURE SO I THINK IT HAS GREAT POTENTIAL AND ACTUALLY IT MADE ME THINK THE OTHER GAP -- THERE ARE A LOT OF GAPS. HERE IS ANOTHER REALLY GOOD GAP IS THE WHOLE TIPPING ABOUT OPOID POISONING AND SO PERHAPS USING THAT KIND OF MOTIVATIONAL INTERVIEWING IN THE CONTEXT OF PRESCRIBING PAIN MEDICINE FOR PEOPLE WHO REALLY NEED IT OR FOR PEOPLE WHO THEN GET ADDICTED TO IT MIGHT BE -- I DON'T KNOW IF ANYBODY'S DOING THAT KIND OF WORK BUT THAT MIGHT BE REALLY INTERESTING TO DO. >> [INAUDIBLE] >> RIGHT. CORRECT. YEAH. NIH IS FUNDING SAFE RESEARCH, WHICH IS GREAT. THEY ARE REVIEWING APPLICATIONS NOW. I JUST HAPPEN TO KNOW. >> [INAUDIBLE] THAT'S A GREAT QUESTION. ONE OF OUR -- ONE OF THE GRANTS THAT WE RECEIVED WAS COMMUNITY-BASED PAR ADVERTISE PATRY RESEARCH. IT WAS UNDER THAT KIND OF HEADING OR WORDS TO THAT EFFECT. AND SO WE WERE SUCCESSFUL IN GETTING FUNDING TO APPROACH THE FIRE AND BURN PROBLEM IN BALTIMORE CITY USING A COMMUNITY-ORIENTED APPROACH FROM NICHD. AND I THINK THAT AREA IS A WHOLE OTHER AREA THAT WE COULD TACK A LOT MORE ABOUT IN TERMS OF THE IMPORTANCE OF PARTNERSHIPS NOT JUST BECAUSE WE'RE A MULTIDISCIPLINARY FIELD AND WE NEED OTHER DISCIPLINES, BUT BECAUSE IN MY EXPERIENCE, WHILE IT TAKES WAY LONGER TO HAVE A GOOD COMMUNITY PARTNER PROJECT, YOU GET MUCH BETTER, MORE SUSTAINABLE RESULTS. AND I THINK THE CHALLENGE OF IT HAS BEEN TO MAINTAIN EFFECTIVE PARTNERSHIPS BECAUSE EVERYBODY IS SO BUSY AND HAS DIFFERENT GOALS AND YOUR GOALS OVERLAP. LIKE OUR BIGGEST PARTNER IN THAT WAS THE BALTIMORE CITY FIRE DEPARTMENT. THEIR NUMBER ONE PRIORITY IS NOT HOME SAFETY. IT IS A PRIORITY AND THAT'S WHAT THEY LIKE TO WORK ON BUT THEY NEED TO KEEP FIRE DEPARTMENTS OPEN AND PUT THE RED STUFF ON THE RED STUFF. SO IT IS A BIT CHALLENGE -- AND THE OTHER CHALLENGE FOR RESEARCHERS SOMETIMES IS TO BE WILLING TO COMPROMISE. SO I AM NOT SAYING COMPROMISE ON YOUR SCIENTIFIC INTEGRITY OR COMPROMISE ON YOUR SCIENTIFIC RIGOR IN A MAJOR WAY. I AM JUST SAYING BE OPEN TO FIGURING OUT WHAT'S THE BEST WAY TO ANSWER THE QUESTIONS THAT YOU BOTH YOU AND YOUR PARTNER HAVE. SO THERE WAS ANOTHER ONE -- ACTUALLY I THINK NIH IS DOING MORE BECAUSE THERE WAS JUST ANOTHER GRANT THAT WAS -- AND I DON'T KNOW IF IT WAS FROM THE DISPARITIES GROUP OR NOT. BUT IT WAS A PDPR REQUEST FOR PROJECTS WHERE YOU HAD TO HAVE AN ESTABLISHED PARTNERSHIP AND WE'RE WOULD GO WITH THE HEALTH OF MARYLAND TO DO COLLABORATEIB RESEARCH PROJECTS UNDER THE BIG UMBRELLA OF HOW DO WE IMPROVE SERVICES TO DOMESTIC VIOLENCE SURVIVORS IN THE MARYLAND AREA. AND I THINK IT WAS THE DISPARITIES GROUP AND IT'S LIKE THE BEGINNING OF A FOUR FOUR-YEAR PROCESS. IF YOU GET THE FIRST PLANNING GRANT AND YOU DO WELL, THEN YOU CAN COMPETE FOR MORE FUNDING. SO I THINK BOTH OF THOSE KINDS OF THINGS ARE JUST SUPER EXCITING. 11 YEARS? OH, WOW. YEAH, SO YOU APPRECIATE HOW LONG IT TAKES TO DO THESE THINGS. DEBRA, HI. >> [INAUDIBLE] EXACTLY. >> [INAUDIBLE] >> WELL, I MEAN, I THINK THAT IT WOULD BE IDEAL IF THERE WERE MORE FEDERAL AGENCIES AND DOLLARS GOING TO TRANSLATION, NOT AT THE EXPENSE OF DOING BASIC SCIENCE. AND THAT'S CONSTANTLY WHAT -- ALL OF OUR FUNDING -- THE INJURY CENTER FUNDING IS FROM THE C.D.C AND THAT'S AN INJURY-CONTROLLED RESEARCH PROGRAM THAT THEY HAVE. AND SO THE ISSUE FOR US IS ALWAYS LET'S MAKE THE POT BIGGER. THERE ARE ONLY 11 CENTERS FOR EXCELLENCE IN INJURY RESEARCH IN THE COUNTRY. THAT'S NOT ENOUGH. SO IT'S NOT THE QUESTION THAT WELL, WE SHOULDN'T DO -- WE SHOULDN'T DO THIS AND INSTEAD DO THAT. MAYBE I'M PROBABLY -- BUT I THINK WE SHOULD BE DOING MORE ALL OF IT AND -- I THINK YOUR POINT IS LET THE DATA DRIVE THE DECISIONS AND WHEN WE KNOW WE HAVE EFFECTIVE INTERVENTIONS THAT COULD SAVE LIVES AND SAVE DOLLARS, BUT FOR MONEY TO IMPLEMENT THOSE, CERN YEAH, THERE IS A GOOD ARGUMENT FOR PUTTING MORE MONEY THERE, IT SEEMS TO ME. OKAY. ALL RIGHT. WELL, THIS WAS GREAT FUN. THANK YOU SO MUCH FOR INVITING ME AND I HOPE TO SEE YOU ALL AGAIN. [APPLAUSE] >> HI. HOW ARE YOU? >> GOOD. I DON'T KNOW IF YOU REMEMBER ME. >> IT HAS BEEN. YES. I'M GOOD. HOW ARE YOU? >> I'M VERY GOOD.