Introduction

Injuries, whether intentional or unintentional, are a major cause of death and suffering, as well as increased health care costs. They are the leading cause of death among children and young adults aged one through twenty-four. The economic cost is reported to exceed $224 billion nationally. This is particularly disturbing since injuries are largely preventable. Healthy New Jersey 2000 objectives in the area of injury prevention and control focused on the following major causes of injuries: motor vehicles, falls among the elderly, homicide and suicide.

New Jersey has made considerable progress during the past decade in reducing injuries, and it appears that many, but not all, of the year 2000 objectives will be met.

Outlook for Reaching Specific Objectives:
	Achieve target:		Likely	Unlikely	Uncertain
9A.	Reduction in the motor vehicle death rate for:
		the total population
		youths, 15-24 years
		persons 70 and older
9B.	Increase in adults using seat belts
9C.	Reduction in deaths from falls for people:
		aged 65-84
		aged 85 and over
9D.	Reduction in homicide death rates among minority:
		males aged 15-44
		females aged 15-44
9E.	Reduction in suicide rates for:
		youth aged 15-24
		white males 65 and over
9F.	Reduction in hospitalizations due to head/spinal cord injuries

Data Update

9A. Reduce the number of deaths caused by motor vehicle crashes per 100,000 population to:

11.4 for the total population (age-adjusted)
23.0 for youth aged 15-24 years
20.0 for persons aged 70 and over

Achieve target:	Likely	Unlikely	Uncertain
the total population
youths, 15-24 years
persons 70 and older

The year 2000 target for the age-adjusted motor vehicle-related fatality rate for the total population was first met in 1990. The latest rate available, for 1996, reflects further improvement beyond the year 2000 target, although there has been some year-to-year fluctuation. For the two high-risk groups identified in this area - persons aged 15 though 24 and the population aged 70 and over - the experience has been mixed.

For youth the year 2000 objective was actually met in 1989 for the first time, and has been met or exceeded every year since then. For older persons, however, there has been fluctuation in the rate for this group from year to year, with an increased death rate in the most recent years. It is particularly striking that the death rate is now lower for the younger than for the older group, a reversal of the relationship observed at the beginning of this monitoring period. At this point, it is not likely that the objective for the older population will be achieved.

9B. Increase the percentage of persons 18 and over who report the use of seat belts either "always" or "nearly always" when driving or riding in a car to:

75.0 percent

Achieve target:	Likely	Unlikely	Uncertain

No state-specific data on self-reported seat belt use were available at the time the year 2000 target was set. Since then, data have become available through the Behavioral Risk Factor Surveillance System, and the percentage of New Jerseyans 18 and over who report that they use a seat belt "always" or "nearly always" when driving or riding in a car has consistently exceeded the target.

9C. Reduce deaths from falls per 100,000 population to:

12.0 for the population aged 65 through 84 years
105.0 for persons aged 85 years and over

Achieve target:	Likely	Unlikely	Uncertain
aged 65-84
aged 85 and over

Deaths from falls are the second-leading cause of unintentional injury deaths among the elderly, after motor vehicle-related fatalities. The death rate from falls is six to ten times as great among those 85 years of age and older as for those 65 through 84. Over the ten year period 1985 through 1994, the death rates from falls among the latter group of "young elderly" has fluctuated, but it appears possible that the year 2000 target may be achieved. For the oldest group, however, there is no clear trend in the death rate from falls, and it is uncertain that their target rate will be met.

9D. Reduce homicide deaths per 100,000 population to:

39.0 in minority males 15-44 years of age
7.0 in minority females 15-44 years of age

Achieve target:	Likely	Unlikely	Uncertain
males aged 15-44
females aged 15-44

The homicide death rate among minority males who are 15 through 44 years of age is about three to five times the comparable rate in minority females. Among minority males, the rate reached the year 2000 target level once during the 1990s, but increased again in a subsequent year to a level substantially higher than the target. Because of the continuing fluctuation, it is uncertain that the target objective will be met for minority males by the year 2000.

The homicide rate for minority females in this age group declined substantially from 1991 to 1995, but an increase in 1996 makes achieving the target level by the year 2000 uncertain.

9E. Reduce suicides per 100,000 population to:

7.5 for youth aged 15 through 24
16.2 (revised) among white males aged 65 and over

Achieve target:	Likely	Unlikely	Uncertain
youth aged 15-24
white males 65 and over

Although the suicide death rate in 15-through 24-year-olds has fluctuated, the year 2000 objective was met in 1991, 1994, and 1996 and it appears likely that the target level will be met in the year 2000.

A revised, more ambitious target suicide death rate for white males 65 and over was set in 1996, because the experience from 1990 through 1995 was so far below the original target. The trend in the most recent years has generally reflected improvement, making it more likely this new target will be met by 2000.

9F. Reduce hospitalizations for head and spinal cord injuries per 100,000 population to:

113.9 admissions

Achieve target:	Likely	Unlikely	Uncertain

The year 2000 objective for hospitalizations for head and spinal cord injuries was set without benefit of specific surveillance data on such hospitalizations. A traumatic brain injury surveillance system was established in the Department in 1995, and traumatic brain and spinal cord injury (TBI/SCI) data for the years 1993 through 1995 have been developed to assess progress toward the year 2000 objective. The declining trend in admissions for TBI/SCI over these three years may be correlated with some of the improvements in other objectives related to injury death rates, particularly in the areas of motor vehicle-related fatalities and deaths from falls in the 65 through 84 year age group. If current trends continue, it is likely that the TBI/SCI objective will be met by the year 2000.

Discussion

While the trend in motor vehicle death rates for the population as a whole and for youth has been very encouraging, the lack of improvement for the population aged 70 and over is a source of concern. The Department is sharing these findings with the New Jersey Department of Transportation.

As one strategy to lessen fall-related injuries among older New Jerseyans, the Department began an osteoporosis prevention effort in 1991. Osteoporosis is primarily a disease of the elderly, resulting in the loss of bone mass. Because osteoporosis makes bones more brittle, and therefore more prone to break as a result of a fall, this is an important area for intervention. Initial activities included the development of a surveillance system to provide baseline data on statewide osteoporosis prevalence. Other components include provider education and consumer outreach. In addition, an exercise and educational program called "Healthy Bones" was developed for older women at risk for osteoporosis.

Older, low-income minority women are a particular area of concern. The Department is field testing a comprehensive wellness program developed by the National Caucus and Center for the Black Aged. This pilot is focusing on low-income African-American females residing in senior housing in Mercer and Camden counties. The "wellness" components include, in addition to injury prevention, preventive efforts targeted to breast and cervical cancer, nutrition, physical activity, and others.

Despite the progress made in reducing deaths among older New Jerseyans due to falls, there is an ongoing need to educate people on ways to safeproof their homes to reduce the likelihood of falls.

The homicide death rate among minorities, particularly young minority males, is a source of great concern. In 1995, the University of Medicine and Dentistry formed the Violence Institute of New Jersey, to foster research into sources of violence as well as effective interventions, and to provide technical assistance to community programs designed to combat violence. The Attorney General has also convened stakeholders to discuss strategies and professional techniques to better equip communities to address teen violence.

The Violence Institute has recently sponsored conferences on child abuse and a conference on violence against women. The Institute has also developed a questionnaire to survey doctors and nurses to assess their ability to adequately respond to elder abuse. Results from the survey will be used to develop programmatic intervention initiatives to address violence.