Creating safer environments for children.

Unintentional injury is the leading health threat to America's children. Every year, approximately 7,250 children are killed and another 50,000 are permanently disabled from injuries that could have been prevented (National Center for Health Statistics, 1991; Waller, 1989). The National SAFE KIDS Campaign is the first and only nationwide childhood injury prevention program in the United States that works to protect children from birth through age 14. The Campaign was initiated by Children's National Medical Center in Washington, D.C., and sponsored by Johnson & Johnson with additional support from the private and federal sectors. Former U.S. Surgeon General Dr. C. Everett Koop is the Campaign's Chairman and Vice President and Mrs. Albert Gore, Jr. are Honorary Chairs.

The Campaign conducted a nationwide survey in December 1987 and discovered that parents had little awareness about children's risk of injury. The survey showed that parents were most concerned about kidnapping and keeping their children away from drugs. Childhood injury was not at the top of their lists. A follow-up survey conducted in December 1992 showed that parents still disproportionately fear kidnapping and drugs. Although a number of excellent local and state injury prevention programs did exist at the time, they were scattered, underfunded and lacked broad national impact. The federal injury prevention programs were also underfunded.

The National SAFE KIDS Campaign targets five major unintentional injury risk areas for children: traffic injuries (passenger, pedestrian and bicycle); fire and burns; drownings/near-drownings; poisoning; choking; and falls. The Campaign's long-term goals are to:

* Raise awareness among adults, especially parents and caregivers, that injuries are the leading health threat facing children today

* Build long-term grassroots coalitions to implement childhood injury prevention strategies or plans

* Stimulate changes in environments, products, laws and behaviors that will prevent injuries to children

* Make preventing childhood injury a priority for federal, state and local policymakers, supporting safety mandates such as bike helmet legislation, child restraint laws and smoke detector regulations

* Focus attention on, and design injury prevention strategies for, children of low-income families, who are at highest risk for injuries.

The state and local SAFE KIDS coalitions at the heart of the Campaign share a common goal of making homes, schools and communities safer for children. More than 165 local and state SAFE KIDS coalitions now exist in 47 states and the District of Columbia and the number continues to grow.

In addition, the Campaign coordinates the National Coalition to Prevent Childhood Injury (NCPCI), consisting of more than 80 national organizations that serve children, parents and caregivers. Members include American Academy of Pediatrics, American Public Health Association, Boy and Girl Scouts of America, National PTA and U.S. Public Health Service. NCPCI members help identify local groups interested in launching and sustaining state and local SAFE KIDS coalitions. They also disseminate information on the Campaign and help implement injury prevention strategies.

The 20-member national office staff facilitates the development and maintenance of state and local SAFE KIDS coalitions; initiates public policy advocacy; coordinates outreach to national and local media; secures financial donations and product discounts for the coalitions; provides technical assistance and training conferences for coalition leaders; fosters information-sharing through several publications, including Campaign Update and Public Policy Watch; and researches and develops targeted injury prevention strategies and support materials. The injury prevention strategies are comprehensive, step-by-step guides to implementing multifaceted childhood injury prevention programs. Each injury prevention strategy is intended to give volunteers the necessary tools to progress in the "E's" of injury control: education, engineering/environmental change, enactment/enforcement and evaluation.

Bike Helmet and Bike Safety Awareness Program

Every year, nearly 300 children age 0-14 are killed and another 400,000 are injured in bike-related crashes that require emergency room care (Centers for Disease Control, 1986; NCHS, 1991). Nearly 70 percent of all hospitalized cyclists are treated for head trauma (NCHS, 1985). Studies show that bike helmets reduce the risk of such head injuries by 85 percent (Thompson, 1989). Yet only 15 percent of children in the United States wear bike helmets, up from one percent at the launch of the bike safety program in 1989 (United States Consumer Product Safety Commission, 1993).

The Campaign is committed to raising adults' and children's awareness that bike helmets are extremely effective safety devices. To achieve this, the Campaign disseminated brochures and posters promoting bike helmet use, aired two television public service announcements (PSAs) directed at both parents and children, and sent media kits to both adult and children's media. Such media outreach efforts were highly successful.

In addition, the Campaign has been using schools to promote bike safety. They developed a Teacher's Guide that was disseminated to 100,000 2nd- through 5th-grade teachers in conjunction with Scholastic magazine. Each Teacher's Guide was shared with two to three other educators and achieved a total circulation of over 300,000.

Further, the Campaign's health professionals' outreach kit helps clinicians counsel their patients about the importance of bicycle helmets. This kit includes a waiting room display poster, 100 brochures for parents, 100 prescription pads with coupons for a discounted helmet and 100 pledge cards for children and parents. The kit was distributed through 19 health and medical organizations that are members of the National Coalition to Prevent Childhood Injury.

In addition, the Campaign supports mandatory safety standards for helmet manufacturers to replace the existing voluntary standards. The Campaign also provides technical assistance to state and local SAFE KIDS coalitions interested in enacting mandatory bike helmet laws in their communities. Every 3 months, the Campaign produces a bike legislation chart to track progress--thus far, 10 states have enacted bike helmet laws. A recent parents' survey conducted by the Campaign showed that 73 percent of parents are now in favor of such laws. The Campaign was also a primary force behind the introduction of federal legislation to require the Consumer Product Safety Commission to set mandatory safety standards for helmet production. The Child Safety Protection Act was passed in May 1994.

The Campaign encouraged manufacturers to reduce the cost of bike helmets through community-based discount programs, thus making them more readily accessible to children. The coalitions have distributed over 15,000 bike helmets through bike safety events, school programs, discount programs and targeted giveaway projects. Further, many coalitions have worked with bike retailers to promote use of bike helmets by placing tags on bicycles that read, "This bike is missing one part . . . a bicycle helmet."

To monitor success of the Campaign at the state and local levels, the national staff targeted 11 coalitions. In the spring and summer of 1989, these coalitions gathered baseline data on local helmet use, helmet sales and bike-related injuries. A year later, they gathered follow-up data and found that the Campaign's grassroots efforts had succeeded. In Flagstaff, Arizona, for example, the number of 4th-through 6th-graders who wore helmets had increased nearly threefold--from 3.5 percent before the coalition's extensive bike helmet campaign to 9.3 percent the following year.

The Campaign has revised its Bike Helmet and Bike Safety Awareness Program. The new program, SAFE KIDS CYCLE SMART, aims to increase the use and prevent the misuse of bicycle helmets, promote safe cycling behaviors and support safer bicycling environments.

Scald Burn Prevention Program

Every year, approximately 30,000 children ages 14 and under are treated in emergency rooms for scald bums (CPSC, 1992). Nearly 86 percent are burned by food and liquids in the kitchen, but a significant number (4,000) are burned by hot water in the bathroom (CPSC, 1992). Almost half of all scalded children are under age 5. The Campaign launched its scald burn prevention program in May 1990.

One of the program's major goals is to educate parents and caregivers about how to prevent scald burns. The Campaign developed an educational slide show, a brochure, television and print public service announcements, and a media kit. Media response has been extensive.

The Campaign also achieved significant success in its efforts to change the plumbing codes that regulate hot water temperatures. Since 1990, Campaign officials have testified numerous times before the five regional and national bodies that establish the U.S. plumbing codes. All of the groups have adopted changes suggested by the Campaign to reduce the probability of tap water scalds. In turn, 28 states have incorporated those changes into their state plumbing codes.

The Campaign has also worked with the plumbing industry to develop low-cost anti-scald devices, which reduce the flow of tap water to a trickle when its temperature reaches 120 degrees F. Unfortunately, numerous technological obstacles have delayed the marketing of these devices. Several coalitions have forged scald prevention partnerships with local housing authorities and utility companies.

PROJECT GET ALARMED:

A Residential Fire Detection Program

Each year, approximately 1,000 children ages 14 and under die in residential fires (NCHS, 1991). Nearly 10 times as many--about 11,000--are seriously injured (CDC, 1986). Approximately 65 percent of the children who die are 4 years old or younger (NCHS, 1991). To address these alarming statistics, the Campaign launched PROJECT GET ALARMED in October 1990 during National Fire Prevention Week.

The primary goal of PROJECT GET ALARMED is to educate parents and caregivers about the importance of preparing home escape plans and installing properly functioning smoke detectors. To help achieve this, the Campaign developed an educational slide show, a brochure, print and television public service announcements, a fire safety magazine for kids and media kits. PROJECT GET ALARMED attracted extensive media attention.

Since the launch of the program, over 50,000 smoke detectors (with batteries) have been installed in the homes of low-income families with young children. The coalitions have developed innovative ways to distribute smoke detectors and replacement batteries by working through WIC programs, Head Start, home health care agencies, fire departments, childbirth education classes, social service agencies and residents of high-risk areas, such as public housing units and mobile homes.

In addition, the Campaign has worked to maintain smoke detectors in good working order through follow-up distribution of batteries to low-income families and by asking local utility companies to include a bill stuffer that encourages parents to test and maintain smoke detectors. Ten coalitions funded by the Campaign are determining the proportion of working smoke detectors in low-income homes six months after installation by SAFE KIDS volunteers and comparing the number to the proportion of working smoke detectors in other homes in the neighborhood.

PROJECT GET ALARMED has also made progress in the legislative arena. SAFE KIDS is continuing to push for smoke detector legislation in the nine states lacking such laws. In addition, the Campaign has successfully advocated for passage of the Federal Fire Safety Act, which mandates smoke detectors in all federal housing; developed model smoke detector legislation for coalitions to use in advocating for state and local laws; and worked with the Children's Sleepwear Coalition to oppose changes in the current federal standards for children's sleepwear fire resistance.

SAFE KIDS BUCKLE UP: A Child Occupant Protection Program

Motor vehicle crashes kill more children and adolescents than any other type of injury (NCHS, 1991). Each year, 1,400 motor vehicle passengers, ages 14 and under, are killed and more than 170,000 are injured (NCHS, 1991; Secretary of Health and Human Services, 1989). Although every state has a law requiring young children to be restrained while riding in motor vehicles, many drivers still do not buckle up their children. Furthermore, even those adults who put children in child safety seats often use the seats incorrectly. In fact, as many as 9 out of 10 safety seats are misused in some way. To increase the number of children who are properly restrained in safety seats and safety belts, the Campaign launched SAFE KIDS BUCKLE UP in February 1992 during National Child Passenger Safety Awareness Week.

SAFE KIDS BUCKLE UP was designed to educate economically disadvantaged parents and caregivers about the need to increase use and reduce misuse of child safety seats and safety belts. To help achieve this, the Campaign developed materials similar to those used for their other awareness programs. In addition, the Campaign has improved economically disadvantaged parents' access to child safety seats through discount programs arranged with a national manufacturer and loan programs arranged with state and local health and social service agencies.

The Campaign is also working to strengthen existing child occupant protection laws and improve their enforcement. Loopholes in many state child restraint laws prompted the Campaign to focus its energies on supporting SAFE KIDS coalitions and others in their efforts to strengthen these laws. The Campaign was among a coalition of organizations that successfully worked for passage of the Intermodal Surface Transportation Efficiency Act (ISTEA) of 1991, the most comprehensive and far-reaching highway safety legislation in 30 years.

Coalitions have used SAFE KIDS BUCKLE UP since its inception to boost existing traffic safety programs and establish new ones. Law enforcement agencies and the traffic safety community became active members of many coalitions as they implemented the program. In turn, the coalitions worked with child passenger safety experts to conduct road blocks and safety seat checks, set up new loan programs and tap into funding sources for local programs. In addition, coalitions have also instituted safety seat programs with taxi companies, conducted roll call training for police officers to improve enforcement of child restraint laws and translated materials into several different languages.

To evaluate the success of SAFE KIDS BUCKLE UP in increasing the use and reducing the misuse of child safety seats and safety belts across the United States, ten coalitions conducted observational surveys before and after the launch of the program. Preliminary analysis of baseline results from 8 coalitions revealed that only 47 percent of the 5,320 children age birth to 9 were correctly restrained. Use at each site ranged from 21 percent to 63 percent. A more detailed analysis of the data from all 10 sites is forthcoming.

Conclusion

Working together, we can continue to build an effective nationwide injury prevention network, encourage supportive public policies, increase our impact through the media and convince Americans that childhood injury is a preventable tragedy. Please contact the National SAFE KIDS Campaign, 111 Michigan Avenue, N.W., Washington, DC 20010, if you would like additional information about joining or starting a SAFE KIDS coalition in your area or obtaining SAFE KIDS materials.

References

Centers for Disease Control. (1986). Mortality data. Atlanta, GA.

National Center for Health Statistics. (1991). National Vital Statistics System. Hyattsville, MD.

National Center for Health Statistics. (1985). Hyattsville, MD.

Secretary of Health and Human Services. (1989). Childhood injury in the United States: A report to Congress. Atlanta, FA.

Thompson, R. S., Rivara, F. P., et al. (1989). A case control study of the effectiveness of bicycle safety helmets. New England Journal of Medicine 320(21), 1361-1367.

United States Consumer Product Safety Commission. (1993). Bicycle use and hazard patterns in the United States, and options for injury reductions. Washington, DC: Author.

United States Consumer Product Safety Commission. (1992). National Electronic Injury Surveillance System. Washington, DC: Author.

Waller, A. E., Baker, S. P., & Szocka, A. (1989). Childhood injury deaths: National analysis and geographic variation. American Journal of Public Health, 79(3), 310-315.

Angela D. Mickalide is Program Director, National SAFE KIDS Campaign.