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From the Front Row: Injury and violence prevention trends, initiatives, and effects of COVID-19

Published on November 18, 2021

This episode highlights National Injury Prevention Day (November 18) with guests Maggie Ferguson, Brain Injury & Disability Manager for the Iowa Department of Public Health; Lisa Roth, Deputy Director for the University of Iowa’s Injury Prevention Research Center; and Clare Willey, second-year graduate student in occupational and environmental health at the University of Iowa.

Read more about injury and violence prevention efforts and research at iprc.public-health.uiowa.edu/

Find our previous episodes on SpotifyApple Podcasts, and SoundCloud.

Alexis Clark:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Alexis Clark, and if this is your first time with us, welcome. We’re a student run podcast that talks about major issues in public health and how they are relevant to anyone both in and out of the field of public health. Today, we are celebrating National Injury Prevention Day, and I’m excited to welcome Maggie Ferguson, Lisa Roth and Clare Willey onto the podcast. Maggie has had over 17 years of experience working in disability services and is currently the Brain Injury and Disability Program Manager for the Iowa Department of Public Health, and is the President Elect for the National Association for State Head Injury Administrators.

Lisa has a background in community health education and more than 15 years of experience in the field of public health and injury prevention. She currently serves as the Deputy Director for the University of Iowa’s Injury Prevention Research Center, and is the Vice President of the Safe States Alliance. Clare is in her final year of the Master of Public Health Program in the Department of Occupational and Environmental Health, and she is currently completing a practicum with the Iowa Department of Public Health in the Office of Disability, Injury and Violence Prevention. Thank you all for being here and welcome to the show. So before we begin, can you each tell us a little bit about out yourself and how you got into the field of public health? Maggie, why don’t you start us off?

Maggie Ferguson:

Okay. I took a little bit of an indirect route probably. My education is in biology as an undergrad, and then I had my master’s degree in counseling. So I’ve worked, as you mentioned earlier, pretty extensively in the disability services field. I wanted to be able to specialize a little bit more in disability. And so I worked for the Brain Injury Alliance for four and a half years. And while I was there, an opening came up at the Department of Public Health in the role that I am now. And so I wanted to just stretch myself a little bit and learn something new. And so came to the Department of Public Health about eight years ago and have really enjoyed the field and learning more about injury prevention and the services that public health provide.

Alexis Clark:

Lisa, what about you? What’s your background into public health?

Lisa Roth:

Yeah. So I have a background in community health education, and it’s not something I discovered until I was an undergrad. And I thought I was going to be a physical therapist. And then I took a class as part of my undergraduate education. And I had a professor who just lit a fire under me about injury prevention. As part of his class, we had to go out and identify a problem that we saw on campus. And it was just one of those things that it took me a long time. So I just basically sat one day on a bench in the middle of Iowa State Campus and just was like, “What’s an injury problem?” I really was having a hard time identifying it. And I saw many people roll past me on their bikes with no helmets. And I was just like, “Ugh, that’s it. That’s the problem that we have here,” because background, he gave us some information about the types of injuries that he was seeing, those types of things.

And so I really, I don’t know, got passionate about being able to identify a problem, being able to develop some program or intervention around that, and then building some awareness within the student population there. And so really, that just continued to grow. And then I took more classes as it related to community health education and injury prevention just became a focus of mine.

Alexis Clark:

Clare, what about you? Last but not least.

Clare Willey:

Yeah. My journey is, of course, a little shorter, but I really just got into it in my undergraduate. I came in as [inaudible 00:03:59]. I had no clue what I wanted to do really. And luckily, a friend and roommate of mine was taking a class in public health and she recommended it to me. So I started taking it my second semester and I really loved it from the get go. It just made a lot of sense to me and it felt like it was really just a logical thing I could really focus on and really I just got it. So then it just progressed from there. I did my undergrad in it and really enjoyed a bunch of areas. And then I went to get my graduate degree because COVID happened and it made more sense to just go right into it. I’d always been thinking about it. And I just was really passionate about occupational and environmental health as well. So it seemed like a good fit.

Alexis Clark:

So when we think about injuries in general, I think that can be a broad term used. So Clare, when you think of injuries in the form of study that you are doing, or that you are looking to prevent, what exactly are you talking about?

Clare Willey:

Yes. Injuries are a very broad category. But when we think about specifically unintentional injuries, that’s injuries that are occurring without intention, of course, they’re not purposely done, the main three that we see in Iowa and the top one is falls, the number two is motor vehicle crashes and then the final is poisonings.

Alexis Clark:

We have seen COVID’s changed a lot in terms of people’s day to day activities. So Lisa, do you have any insight on how COVID has impacted the prevalence of injuries in general?

Lisa Roth:

Yeah. I think COVID certainly has had an impact in specific types of injuries. So I don’t know that we can say with any certainty the impact that it’s had in the unintentional realm, specifically when Clare was talking about falls, motor vehicle crashes, those types of things, because we haven’t taken a deep enough dive into the data yet to be able to say, again, with any certainty that COVID had an impact. Now, I mean motor vehicle crashes, we can take a look and say, “Well during the pandemic when everybody was at home, there were less cars on the road. So we know our crash rates were lower at that point.” As people started to come out of, I’ll say lockdown, but being able to return to work and some of their normal activities, more cars are back out on the road. So we’re naturally going to see an increase in crashes. What we can look at and say, and there’s some new information out from CDC, that overdose deaths, unfortunately, saw a huge acceleration over the past two years.

And again, there’s a couple of studies out there saying that probably can be attributed to the COVID-19 pandemic simply because many drug users were probably left without treatment services or being able to access those types of treatments. They were socially isolated and they didn’t have the support that they needed during that time. So that likely has had an impact in overdose deaths. There’s other things that we can look at too. Going back to unintentional injuries with falls, you’re in your home more so if you don’t have the appropriate plans in place for fall prevention in your home, we may have seen an uptick in the elderly population having falls within the home. So some of its anecdotal, some of it can actually be found in the data. I think in the next couple of years, you’re going to see many, many studies coming out looking very specifically at the impact that COVID-19 has had on our injury rates.

Alexis Clark:

So just a follow up question to that, are there any other socioeconomic factors that play a role into the prevalence of injuries? Or are there specific populations that are more likely to be in these research studies?

Lisa Roth:

I mean one of the things I can speak to is the fact that access to, when we’re looking at unintentional injuries, again, I’m going to speak more specifically to probably bike helmets, car seats, those types of devices, there are many, many programs across our state and across our country that provide access to those safety devices to people who might have low income, or there might be a language barrier, things like that. So I think we’ve overcome some of those barriers. Are there still those that exist? Absolutely. But I think many programs are working very hard to overcome and be more equitable in the types of injury prevention programs that are occurring.

Alexis Clark:

Yeah, thank you for that. So injuries are the leading cause of death in Iowa. Unintentional injuries are the leading cause of death for Iowans aged one to 44. And it is the fourth leading cause of death for all Iowans. What efforts does the Iowa Department of Public Health make to address these concerns? Maggie, do you have any insight on that?

Maggie Ferguson:

Sure. So a major role that the department has is looking at the data, doing some data surveillance and putting out reports, taking a deeper dive into what are those leading causes of injury, looking at falls, what are the mechanisms of injury? Or what contributes to people falling? So that we can then go on and implement some prevention programs. We do have folks at the department who specialize in certain areas. For example, we have Bureau of Substance Use and they’re working on substance use prevention, overdose prevention. The Naloxone Program is a great example of work that they’ve done to reduce unintentional injuries related to overdose death. We have other programs, like myself specifically, I work in the brain injury area. And so I’m working on concussion prevention and also falls related brain injury prevention.

Alexis Clark:

Lisa, what about you? What is the University of Iowa Research Prevention Center looking at and doing in terms of outreach for this topic?

Lisa Roth:

Yeah, absolutely. So we are one of nine CDC funded injury control research centers across the country. So we happen to be in the Midwestern region obviously. And so our primary function is to do research to prevent injuries and violence. And then we like to work with our community partners to be able to put that research into practice. So we’re looking at evidence-based types of programming that works, and then helping our community partners to be able to implement that to prevent the injuries and violence that are occurring in their communities. One of the unique things about our center is because of our location in the country, we focus in a lot on rural injuries and have a lot of great resources for those rural communities. And it’s just been really interesting to see the differences in how some of these rural communities address injury problems, because they may have less resources and less access to some of the programming and services that other more metropolitan or urban areas might have.

Alexis Clark:

You mentioned briefly the partnerships, what type of injury prevention collaborations or partnerships are around the state of Iowa?

Lisa Roth:

That is one of the most exciting parts of my job is the outreach that I get to do with our partners. We have some really fantastic longstanding relationships that have helped us be able to approach this problem in a more comprehensive way. So one of our strong partners, specifically for National Injury Prevention Day, but all sorts of other pediatric injury issues is the University of Iowa’s Stead Family Children’s Hospital Injury Prevention Program. Pam Hoogerwerf is the program manager there, and she has done a phenomenal job of being able to do a lot of outreach to local communities across the state when it relates to anything about keeping kids safe. So that’s one really strong partnership. And I mean I can name a lot of other ones and I’ll have Maggie chime in here about some of the work we’re doing with strategic planning around injury and violence prevention in the state.

But I think we like to partner with anybody from a local police department, to a local fire department, to a trauma center, to a local public health department. It just really takes that comprehensive united effort to be able to prevent these type of injuries. But I’ll let Maggie chime in about some strategic planning work we’re doing here in the state.

Maggie Ferguson:

Thank you. So the past year, Iowa was lucky enough to receive some technical assistance from the Safe States Alliance really to look at what we’re doing for injury and violence prevention. And we’ve been partnering with the UI Injury Prevention Research Center for many years, but they’ve been a really key partner through this process as well. And so one of the recommendations from that technical assistance was the need to pull together our statewide partners and stakeholders to serve as an advisory group to us. And we’ve been using that group also to develop the state plan or strategic plan that Lisa mentioned. So when we pulled those groups together, we really shared with them a lot of the information that we had already had on the data and then developed various focus areas that we wanted to take a closer look at.

So what additional partnerships do we need? What additional infrastructure needs to be developed, data reporting and policy recommendations that maybe are needed to further our work in those area? So as Lisa mentioned, we have a lot of longstanding partners. This was a great opportunity to bring those partners together, to just help them get to know each other a little bit more, get some synergy going as well as help us further the work that we want to do at a statewide level.

Alexis Clark:

Yeah, that’s really great to hear that there’s a lot of people looking at this crucial issue around the state. So it’s really enlightening to hear about that because I think oftentimes, we don’t think about what’s going on behind the scenes in terms of injury prevention. Just a question for the table, anyone can chime in here, but in cases where we can’t necessarily prevent injuries, whether they’re intentional or unintentional, what tools do we have to identify and respond to those cases?

Lisa Roth:

Well one of the first things that comes to my mind is if an injury does occur, we want to make sure that the person who’s injured can get to the type of emergency care that they need in a quick fashion. And so one of the things that occurs here in the state of Iowa, or has been implemented, is a trauma system that’s really allowing people to be able to get to the level of care that they need to hopefully survive the injury and then recover fully. And that’s been something that’s been implemented over 20 years ago and has definitely improved our injury outcomes. So that can be a challenge in a rural state though, because if you are injured in a more remote part of the state where access to care might take a little bit longer to get to, that’s certainly something to factor in. So I think that’s something Iowa can be proud of is the trauma system that does exist and how that has impacted our injury survivability and recovery.

The other thing that we were talking about as a group, and this is more of those intentional overdose deaths or unintentional overdose deaths, depending on how you want to look at that. But Maggie mentioned this before the Naloxone Program that exists to be able to assist somebody who has an overdose and how that can be administered rather quickly. So that would be something else to think about in this space. The other thing that we do, I think Maggie alluded to this earlier too, is we do a great job of data surveillance across our state in really keeping tabs on what are the types of issues. So we have an Iowa violent death reporting system here in the state of Iowa, all 50 states report into the system. But we’re keeping an eye on violent deaths, be they homicide, suicide, or undetermined intent, and what we can do by looking at that data is really get the characteristics of what’s occurring around suicide, what’s occurring around homicides and then work with our prevention partners to be able to address those specific issues.

So while we want to prevent all injuries, we know that obviously that’s not going to happen 100% of the time. And so we do have some programs in place that can be part of that whole continuum of care.

Maggie Ferguson:

I’m going to piggyback on that a little bit, just because of the hat I wear with the Brain Injury Services Program. We also are providing tertiary prevention because we contract with the Brain Injury Alliance of Iowa to provide services and supports to individuals who have sustained brain injury to get them connected with supports and resources in their local communities in the hopes that then they have better outcomes from disability related to their injuries.

Alexis Clark:

Maggie, so at what point is someone classified as someone that has had a brain injury? Is it any time after birth? Or if someone is born with a birth defect in the brain, are they classified as someone with a brain injury? Or no?

Maggie Ferguson:

No. Typically, brain injury is solely defined as that injury to the brain after the point of birth.

Alexis Clark:

Thank you for that clarification. So Clare, since you have been completing your practicum this semester, can you tell us about some of the projects you’ve been working on in the Office of Disability, Injury and Violence prevention?

Clare Willey:

Yeah. So I have been working a little bit on the strategic plan, as I think Maggie mentioned earlier, that just formatting that and really getting that ready to be sent out and disseminated to the partners and throughout the state. So that’s been one piece. And the biggest piece though so far this semester has been working on the toolkit for National Injury Prevention Day. And that has really consisted of me making graphics, some fact sheets, the graphics specifically for social media, and then also just bringing in resources to be posted with it. The primary goal of it was just to create a place where resources live for partners to access to promote National Injury Prevention Day and also for the toolkit to be something that the Department of Public Health could build on each year as they move forward in trying to promote this day and work on injury prevention.

I also sat on a committee with Lisa and others from the Injury Prevention Research Center. And then as she mentioned earlier, Pam from the Stead Family Children’s Hospital and some other people from the University of Iowa healthcare or hospitals and clinics. And we just were trying to get a coordinated approach to the day and really trying to move forward. And I guess I forgot to mention, I did write a governor’s proclamation for National Injury Prevention Day as well. That will be signed this week. And that is also going to be used throughout the state for mayors and whatnot to sign. And then going forward, hopefully we’re going to be working on some data briefs for the department as well and around falls for one for sure. So yeah, that’s what’s been going on.

Alexis Clark:

When you think of all the things you’ve gotten to participate in or observed so far, is there anything that there’s no way you would’ve learned this if you had not gotten to do a practicum?

Clare Willey:

Well I certainly don’t think I would’ve written a governor’s proclamation if I hadn’t had this opportunity. And I just think I’ve gotten to work with really great people in this office so far that are very knowledgeable and that’s been a real gift really to get that education and that firsthand experience doing things and collaborating with people, it’s been a really good education so far.

Alexis Clark:

Absolutely. So looking at advice, and the listeners obviously come from a variety of backgrounds, some in public health, some not. But if you three had to give a piece of advice to the listeners in relation to injuries or injury prevention, what advice would you give? Maggie, do you want to start us off?

Maggie Ferguson:

Sure. I think the biggest piece of advice that I would give is to make sure you’re engaging your stakeholders or people with lived experience in the process, getting feedback on what’s important to them? What are the issues that they’re facing? Having them have an actual seat at the table. So using them as a focus group, as an advisory body, however that might look, surveying that population. But I just can’t emphasize enough, you really need to engage the community that you’re working with from the beginning.

Lisa Roth:

Mine might be just a little bit more simplistic and probably more direct just to say most injuries are predictable and preventable. There’s some very, very easy and simple things that you can do as an individual to protect yourself, protect your kids, protect your family, protect anybody else around you. That’s simply wearing your seatbelt, wear your bike helmet, don’t text and drive. Those types of things that seem so simple, but we sometimes forget to do can really be the difference between having a major injury that you have to recover from. So very simplistic.

Alexis Clark:

Clare, what about you?

Clare Willey:

Yeah, I would say mine’s more geared towards students. But if there’s an area that you’re interested in, I mean this could be injury related or not I suppose, but just learn as much as you can about it. And if you’re really, really interested in it, seek out resources and people who are working in that area and see how you can be involved. The worst thing that can happen is they say no, and at least you’re trying and people like that I think and like to see that people are passionate about the same issues that they are.

Alexis Clark:

So our final question that we like to ask on the show is what is one thing you thought you knew but were later wrong about? Maggie, I think you have the honor of going first again.

Maggie Ferguson:

Okay, that’s great. Really, Lisa, very similar to what you just talked about. I think for me, before I got into public health, I really didn’t consider… We talk about accidents and you think that accidents are just those things that you have no control over. But really, so many things that we would call accidents and we try to avoid that term in public health because are preventable falls are not a natural part of aging, they are very preventable. Motor vehicle crashes, there are a lot of things that we can do in policy or environmental changes or personal responsibility to make sure that we’re preventing injuries from happening. So that was my big light bulb moment I think is when I realized, “Oh, yeah, accidents aren’t inevitable.”

Alexis Clark:

Lisa, what about you?

Lisa Roth:

That’s awesome, Maggie, because I think mine goes along the same lines. It’s just when I was starting out early in my career and I was doing some work in child passenger safety, so learning how to keep your child appropriate really restrained in a car seat. And I was trying to talk to parents about how to do that. And I really thought it would be very simplistic and very easy to convince a parent to put their child in a car seat. And I found out I was totally wrong. There were a lot of parents out there who had a variety of reasons for doing what they were doing, but I had to take a step back and really approach it from their perspective and try to understand why they weren’t wanting to take a simple step as buckling a seatbelt or putting a child in a car seat.

And so being able to come at it from their perspective, understand their mindset and then being able to relate that whether it’s with somebody who has lived experience, who’s maybe either lost a child in a car crash, or had a significant injury. It was just something I too had to have that light bulb moment or a shift in figuring out how to educate people in a way that was most relatable to them.

Alexis Clark:

Clare, what about you?

Clare Willey:

Mine follows a similar train, but almost the opposite because I feel like I was that person who I didn’t know anything about public health. I didn’t have any experience with it really until I came to college. And then when I learned about it, I was like, “Oh my gosh, these issues that I thought were so simple and should have just an answer, they don’t.” They’re very complex. And when you’re talking about public health and the health of humans and how to protect that, I mean that is not an easy thing to deal with because there’s a lot of variables and humans are individuals and they’re complex. And so the issue, therefore, as a result has to be complex and then the approach has to be complex also sometimes. So I think that was a really big thing that I learned just going through my education and continue to learn all the time is that it is not easy and it will never be easy. But that’s part of the fun is trying to figure out how to solve these problems.

Alexis Clark:

I think that’s a great sentiment to end on. I want to just thank all three of you for coming onto the podcast today and all of the work you all are doing and all of your partners are doing in relation to injury prevention and all of the work you’ve put into National Injury Prevention Day. So thank you all for coming on the show.

Maggie Ferguson:

Thank you for having us. I’m really appreciative of the opportunity to continue to raise awareness around injury prevention, especially on this particular day.

Clare Willey:

Thank you, Alexis, and everybody. Please remember to wear green for National Injury Prevention Day to help promote awareness of the day.

Alexis Clark:

That’s it for our episode this week. Big thanks to Maggie, Lisa, and Clare for coming on with us today. This episode was hosted, written, edited, and produced by Alexis Clark. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy and keep learning.