The University of Iowa Injury Prevention Center (UI IPRC) has received a two-year award of over $1.6 million in federal grant money to bolster its work. The UI IPRC conducts interdisciplinary injury research, provides training to future injury professionals, and translates its work into practice with the help of local, state, and national partners. In the U.S., injury is the leading cause of death among people ages 1 to 44 years old and accounts for $671 billion annually in medical and work loss costs.
The UI IPRC is one of 10 U.S. injury “centers of excellence” funded by the Centers for Disease Control and Prevention (CDC). Established in 1991, the UI IPRC focuses on preventing injuries and violence, such as those from motor vehicle crashes, older adult falls, prescription opioid overdoses, workplace violence, teen violence, and more.
“Since the beginning, our center has brought together academic, practice, and policy communities to address the public health challenge of reducing the burden of traumatic injuries and violence,” said UI IPRC Director Corinne Peek-Asa. “This grant allows us to leverage the important work of our research teams in many departments across campus.”
“Numbers have an important story to tell. They rely on you to give them a voice.”
– Stephen Few, information design educator and author
There’s no shortage of public health challenges to tackle, from long-standing concerns like heart disease and obesity to more recent issues such as opioid addiction and Zika virus.
To make the best choices about where to allocate limited resources, public health practitioners, policymakers, hospital administrators, and other health providers need solid, well-researched information to help guide decisions. Data is not only essential for deciding where to concentrate efforts, but also to inform and advance health policy in the form of regulations, guidelines, and budget priorities.
Many other professionals rely on public health data to support their work: researchers to track health trends, grant writers to complete their applications, community organizers to plan activities, journalists to highlight health issues, and many others.
Several centers based in the College of Public Health produce rich sources of Iowa-specific health data, the collection and storage of which is carefully managed to maintain confidentiality and security. Three online resources of Iowa health data are spotlighted in the following pages.
Iowa Health Fact Book
What percentage of Iowa’s 11th graders smoke cigarettes? How many family practice physicians are there in Sioux County? Is heart disease mortality rising or falling in the state?
The answers to these and a plethora of other public health questions can be found in the Iowa Health Fact Book, a free online resource compiled by the University of Iowa College of Public Health, Iowa Department of Public Health, and other partners.
The Fact Book web site provides information for each of Iowa’s 99 counties and, where possible, includes demographics and vital statistics, data on disease incidence and mortality, health and social determinants of health, health resources, and environmental factors. The information is searchable and available publicly to researchers, public health practitioners, policymakers, and anyone else needing Iowa-specific health facts.
Previously, the Iowa Health Fact Book had been produced in book form and updated every two years. In its new online form, the information is now updated as new statistics become available and is fully searchable by county or aspects of health, such as cancer, infectious diseases, and health care facilities.
“We’re excited about how this new web site will make it easier for users to browse and summarize the data that is specific to their county,” says Jacob Oleson, director of the Center for Public Health Statistics. “Whenever possible, we’ve included the same types of information in the same tabular and graphical format as in the past.”
With ongoing updates, the Fact Book allows for the presentation of data longitudinally, giving a picture of the changing Iowa health landscape, Oleson adds.
“As we continue this effort over the years, we are in a better position to track changes, measure progress, and identify areas of weakness,” Oleson says.
In addition to the UI College of Public Health and Iowa Department of Public Health, contributors to the Iowa Health Fact Book include the Iowa Department of Inspections and Appeals, Iowa Registry for Congenital and Inherited Disorders, Iowa State Trauma Registry, State Health Registry of Iowa/Iowa Cancer Registry, Office of Statewide Clinical Education Programs, Iowa Health Professions Tracking Center, University of Iowa Information Technology Services, Iowa Consortium for Substance Abuse Research and Evaluation, National Center for Health Statistics – U.S. Centers for Disease Control and Prevention, and U.S. Census Bureau.
Burden of Injury in Iowa
Injuries are a major public health concern that affects all Iowans, regardless of age, race, or gender. However, the distribution of the cause, intent, and type of these injuries varies greatly throughout Iowa’s 99 counties, depending on their population demographics and other factors.
The Burden of Injury in Iowa report, produced as a partnership of the UI Injury Prevention Center (IPRC) and the Iowa Department of Public Health, provides statewide rates of injury deaths and non-fatal hospitalizations for all types of injuries, as well as information on the specific burden of injury in each county of Iowa.
With the most recent data presented in an interactive map, users can click on a county to view its corresponding information. Previous reports are also available in PDF format.
“Injuries are preventable,” says Corinne Peek-Asa, director of the IPRC. “The Burden of Injury in Iowa report has been used extensively by both local health departments and agencies to prioritize injury programs and promote the need for injury prevention throughout the state.”
Efforts to reduce the burden of injuries are most effective when they are tailored to the specific injury burden and the needs of the target population, Peek-Asa adds. She encourages communities, health practitioners, and local policymakers to use the report to develop strategies and policies to reduce injuries.
The report is based on death certificate information from the Iowa Department of Public Health, as well as hospitalization data from the Iowa Hospital Association hospital inpatient discharge data.
State Health Registry of Iowa
In 2017, the State Health Registry of Iowa, also known as the Iowa Cancer Registry, will collect data on an estimated 17,400 new cancers among Iowa residents. Investigators at the Iowa Cancer Registry also estimate that 6,200 Iowans will die from cancer in 2017, 18 times the number caused by auto fatalities.
These estimates are based on mortality data the Iowa Cancer Registry receives from the Iowa Department of Public Health. The registry has been gathering cancer incidence and follow-up data for Iowa since 1973 and is one of fourteen population-based registries and three supplementary registries nationwide providing data to the National Cancer Institute.
Each year, the registry releases the Cancer in Iowa report, which provides county-by-county statistics for new cancer cases and cancer deaths, as well as an estimate of the top 10 types of new cancer and cancer deaths for males and females in Iowa for the coming year. Available online, the 2017 report also includes a special section highlighting liver cancer, which is increasing in Iowa, particularly among the “baby-boomer” population; summaries of current research projects; and a selected list of publi-cations produced during the previous year.
The registry web site also houses an interactive map that provides cancer incidence rates and cancer morality in Iowa going back to 1973. The data is searchable by county, cancer site, gender, race/ethnicity, and other parameters.
“The registry makes this data available so health providers, health departments, and cancer organizations can track progress and determine areas of need,” says Mary Charlton, assistant professor of epidemiology and an investigator with the Iowa Cancer Registry.
In addition to reporting on cancer incidence, survival, and mortality among Iowans, the registry responds to requests from individuals and organizations in the state of Iowa for cancer data and analyses, and provides data and expertise for cancer research activities and educational opportunities.
In 2017, the registry is participating in more than 75 studies, including the Agricultural Health Study, a long-term study of agricultural exposures (including pesticides) and chronic disease—especially cancer—among commercial or private pesticide applicators (and their spouses, if married) in Iowa and North Carolina. Now in its 24th year, the study is funded through the National Cancer Institute and involves several federal agencies.
Registry data are also being used to evaluate the treatment received for a first cancer and the risk it places on the patient for development of a second cancer, to monitor the impact of the Human Papillomavirus Virus (HPV) vaccine on HPV types in cancers, and to research the association between organ transplantation and elevated cancer risks.
This story originally appeared in the spring 2017 issue of InSight.
Injury of death on the job is often associated with machinery in the agricultural and manufacturing sectors. What doesn’t come as readily to mind is workplace violence—bullying by a colleague or assault by an angry client are just two examples of violence on the job. And yet American workers experience nearly two million incidents of workplace violence every year.
Researching the causes and prevention of such violence, and then working in the field to establish consistent and affordable practices is at the heart of the work of the University of Iowa’s Injury Prevention Research Center (IPRC).
Established in 1991 with core funding from the Centers for Disease Control and Prevention, the center is multidisciplinary in its scope, and has been involved in bringing together research, policy, and practice to address everything from bullying by school kids to the recent heroin and opioid crisis and from drowsy driving to tractor injuries.
Preventing Armed Robbery
Some of the center’s current work can be traced back to the early 1990s at the University of California, Los Angeles where then assistant professor Corinne Peek-Asa was directing a graduate student named Carri Casteel. As epidemiologists interested in the high rate of fatalities associated with armed robberies, the two women created a study focused on small, independently owned businesses, including convenience stores, motels, late-night restaurants, and liquor stores.
“At the time, armed robbery was responsible for 84 percent of workplace violence,” says Casteel. Casteel and Peek-Asa’s primary goal was to identify affordable prevention measures and to educate business owners about them.
Prevention strategies varied. They discovered that business owners were willing to devote resources to security equipment such as surveillance cameras, but owners were unaware of less expensive and more effective approaches such as cash control, increased visibility and lighting, and employee training. Lack of implementation of the less expensive but more effective strategies clued Casteel and Peek-Asa into the need for research that translated evidence-based practices into small business settings.
For example, they discovered that blocking access to a business after hours via window grates and other structural enhancements reduces visibility and actually leads robbers to prey on the establishment when it is open, putting more people—both employees and customers— in harm’s way. Keeping too much cash on the premises also attracts robbers, whereas announcing that a minimal amount of money is in the register and maintaining a regular deposit schedule also prevents robberies.
Extending the Study
Peek-Asa and Casteel successfully tested the effectiveness of their prevention program with liquor stores in Santa Monica, Calif., before embarking on a larger study of nearly 500 “mom and pop” grocery stores throughout Los Angeles. Tracking businesses for a full year and partnering with the Los Angeles Police Department to receive outcomes of robbery-related injuries, they found that their strategies significantly reduced employees-related assaults.
In 2008, the director of safety and research for the National Institute of Occupational Safety and Health (NIOSH), an agency of the Centers for Disease Control, reached out to the pair to pilot a variation of their program. This time, the program would be delivered by police officers rather than by researchers. Peek-Asa had recently joined the faculty of the University of Iowa College of Public Health, where she is now a professor of occupational and environmental health. Working in conjunction with the International Crime Free Association, she and Casteel — now an associate professor in the same department at the UI — piloted the program in six communities nationally, including Iowa City, Cedar Rapids, and Coralville.
Peek-Asa says the program was a success in that, “we learned a lot about dissemination and working with law enforcement. This is important because after a robbery, one of small businesses’ point of connection is with the police.”
However, the rapid turnover of personnel on police forces also made it difficult to maintain consistency in delivering the material. The project continues and is now disseminated online, with a community leader gathering an advisory team to help identify partners.
Types of Workplace Violence
Robbery is but one example of workplace violence. Casteel and Peek-Asa have created a well-respected and recognized topology of workplace violence. They identify four different kinds of workplace violence:
- the perpetrator has criminal intent against the business, such as in a robbery;
- the main relationship is a service relationship between the perpetrator and the business, such as when a patient becomes angry at his or her treatment in a hospital;
- the perpetrator is a current or former worker who is disgruntled at the business;
- the perpetrator has a personal relationship with a worker, such as in a domestic violence situation.
One industry that has notoriously high rates of assault against workers by clients is health care. Unlike small, independent businesses, however, it is an industry that benefits from strong advocacy groups. One such group, the Emergency Nursing Association, worked with California’s Office of Occupational Safety to create the nation’s first hospital security act in 1995.
To study the effectiveness of this new law, Peek-Asa and Casteel compared security measures and violent event rates in California’s hospitals to those in New Jersey, which did not then have a similar law. They found a 48 percent reduction in assault rates among emergency department and psychiatric unit workers. Based on the success of the California law, the pair worked closely with stakeholders to help advocate for a similar law in New Jersey.
“Seeing our research culminate in policy change was very satisfying,” says Casteel.
IPRC has more recently been involved in a project with one of the world’s largest corporations— The Boeing Company. “Boeing is very proactive in recognizing and responding to the threat of workplace violence,” says Casteel, “particularly in the form of worker-on-worker violence.”
They partnered with Boeing’s threat assessment team to run simulations and assess how important such organized teams and clear protocol are to mitigating workplace violence. The answer? Very. The only scenario that proved challenging despite the protocols was one involving stalking. This is an area that Peek-Asa and Casteel believe most workplaces underestimate as potentially dangerous, and yet it’s also an area where businesses have a surprising degree of ability to help control and diminish potential risk.
“When someone is being stalked or is the victim of domestic violence, they still have to go to work,” notes Peek-Asa. This puts them in danger as the would-be perpetrators know when and where to find them. But what many businesses don’t fully appreciate is that they can control the environment by providing the employee with an escort or working with the police. In some cases, businesses can even take out a restraining order when the individual cannot.
“We really want to take the lessons we learned with Boeing,” says Peek-Asa, “and apply them to mid-size and smaller businesses. We want these lessons to be applicable to the kinds of businesses we have here in Iowa.”
This story originally appeared in the Fall 2016 issue of InSight