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Injury Control: A Guide to Research and Program Evaluation

Hemenway, David


Professor of Health Policy

Director, Harvard Injury Control Research Center

Harvard School of Public Health

677 Huntington Avenue

Boston, MA 02115

(address for correspondence)

Injury Control: A Guide to Research and Program Evaluation Frederick P. Rivara, Peter Cummings, Thomas D. Koepsell, David C. Grossman, and Ronald V. Maier, editors. New York: Cambridge University Press, 2001. ISBN: 0-521-66152-8

Injury Control is a basic guide to research methods in the field of injury prevention. The book contains 20 chapters, written by 30 authors, and compiled by 5 editors. The editors have done an outstanding job of ensuring consistency across the chapters. Each chapter is on a different research topic; all are succinct, contain a history of the approach, important definitions, examples of findings from injury-related research, and sources for the reader to turn to for further treatment of the subject. Anyone reading this book must come away convinced that injury prevention is indeed a scientific discipline.

The book is an incredibly useful guide for doing research on injury prevention. It contains many chapters on topics thoroughly familiar to epidemiologists—randomized trials, cohort studies, case-control studies, ecologic studies and case series. Each chapter highlights the advantages and drawbacks of that type of research approach, and includes interesting examples from the growing literature on injury control. For example, the draft lottery during the Vietnam War provided the opportunity for an unusual randomized trial. Although investigators had no control over the lottery, it randomized men into two groups that would be expected to have similar injury mortality in the absence of an effect of military service. Men whose draft lottery number made them eligible for the draft proved to have higher mortality from suicide and vehicular trauma, suggesting long-term effects of military service on the risk of traumatic death.

Injury Control also contains many chapters on issues in the mainstream of public health, which are often outside the realm of epidemiologic courses or texts—qualitative methods, evaluation of interventions, economic evaluations, measurement of disabilities, trauma performance improvement, and ethical issues. The chapter on qualitative methods describes three major research traditions—ethnography, participant observation and focus groups. A great strength of qualitative research is its potential to develop explanatory models and theories; qualitative research relies on inductive reasoning and is not used primarily for hypothesis testing but for hypothesis generation. Qualitative studies in the injury field include a year-long ethnographic investigation of observed parental actions following injuries to children, and focus groups to determine adolescent opinions about suicide prevention interventions and patient views of firearm counseling by primary care providers.

The chapter on measuring disability and the quality of life carefully explains the differences between functional limitations (which are independent of the physical and social environment) and disability (which is defined as difficulty performing activities or roles expected of the individual). Functional limitations are often viewed from the clinician’s perspective (eg, hand function tests or intelligence tests which measure the capacity of an individual to perform specific tasks within a controlled environment) while disability is typically measured from the patient’s perspective, using standardized questionnaires. The chapter contains a description and review of the advantages and limitations of various quality of life measures used in injury outcomes research, including the health-related quality of life (HRQOL), the sickness impact profile (SIP), the medical outcome 36-item short form health survey (SF-36) and the child health questionnaire (CHQ).

Trauma performance improvement traces its roots to the surgical audit of the 19th century, which began as a system of counting procedures, complications and deaths. In the 1960s and 1970s the concept of preventable mortality was used to examine multi-institutional or system levels of performance. Judgments came from panels of experts utilizing empiric assessments. Evidence-based guidelines are slowly beginning to replace expert-opinion based audit filters. About twenty-five years ago, an industry-wide initiative in medical care known as quality assurance emerged from the Deming model of quality control in industry. That approach has shown that most practice errors are due to system-level rather individual-level problems, and that assigning individual blame for poor outcomes is counterproductive and destructive to the performance improvement process.

The chapter on ethical issues describes the three key principles of respect, beneficence and justice. Respect (or autonomy) states that individuals have the right to decide whether to become research subjects and individuals with limited capacity (eg, children) are entitled to special protection. Beneficence means that researchers must try to minimize the harm to subjects and maximize the benefits to subjects and to society. Justice requires that no one group of subjects should be inappropriately or exclusively burdened with the research risks. Informed consent, a continuous process, must ensure these principles are met.

Injury Control is an ideal text for a course on research approaches to injury prevention. It is also an excellent reference book. Need a quick review of rates and proportions, economic evaluation, or measures of injury severity and co-morbidity? Injury Control is the place to look. Anyone interested in injury prevention research should have this volume readily available on her bookshelf.

David Hemenway, PhD

Professor of Health Policy,

Director, Harvard Injury Control Research Center

Harvard School of Public Health

677 Huntington Avenue

Boston, MA 02115 , (address for correspondence)

© 2001 Lippincott Williams & Wilkins, Inc.