147800 Injury prevention in urban multi-family dwellings: Improving outcomes through incremental enforcement of health laws

Wednesday, November 7, 2007: 9:30 AM

Joyce Pressley, PhD, MPH , Departments of Epidemiology and Health Policy and Management, Columbia University, New York, NY
Lisa Trieu , Department of Epidemiology, Columbia University, New York, NY
Barbara Barlow, MD , Departments of Epidemiology and Surgery, Injury Free Coalition, Columbia University, New York, NY
Tiffany D. Kendig , Department of Epidemiology, Columbia University, New York, NY
Background. Although falls from windows result in serious pediatric trauma, prevention advocates report obstacles to developing policies and regulations sufficiently strong to prevent childhood death and disability associated with this mechanism.

Methods. We reviewed all available data, legal cases and news articles (1965-2005) and categorized the 40-year evolution of the New York City Department of Health and Mental Hygiene's best practices window fall program into 6 programmatic eras: 1) initiation of surveillance with failed regulation; 2) demonstration program with education and free product distribution/installation; 3) legal challenge of passed regulation; 4) regulation with obstacles and minimal enforcement; 5) regulation with intensified enforcement including criminal prosecutions; and 6) expanded responsibility/liability to owners/boards of directors of multi-family dwellings.

Results. Each successive programmatic era was associated with additional improvement in annual preventable window falls (mean±SD) beginning from the baseline legal challenge of passed regulation (129±30.4); regulation with minimal enforcement (59.6±16.8); regulation with intensified enforcement (30.1±8.6); and expanded responsibility/liability (9.8±7.1), (ANOVA 43.86, F=0.0001). Similarly, preventable fatalities declined across the last programmatic eras: 19.5±7.8, 9.5±3.3, 4.0±1.7, 1.2±0.9 (ANOVA 36.01, F=0.0001). Chi square for trends in proportions for preventable injury for the last 3 eras were (14.7, p=0.0001); (7.0, p=0.008); (22.1, p<0.00001).

Conclusions. These findings demonstrate incrementally improved outcomes for window fall injuries achieved through a multi-component prevention program coupled with multi-faceted enforcement strategies. A natural extension of this study raises a politically sensitive policy issue – might an analogous approach to other injury mechanisms produce results not otherwise achievable on limited prevention budgets.

Learning Objectives:
1. Describe the association between evolutionary eras of a 30+ year old window guard injury prevention initiative and incremental improvements in window fall injury and mortality attained with legislation alone and in combination with varying types of enforcement. 2. Discuss the value of and the situations where it is essential to have a mandatory injury reporting system for tracking the impact of health regulations/injury prevention legislation. 3. Explain the potential options for enforcement of injury prevention regulation/legislation (complaints, citations, civil fines, criminal prosecution, and expanded liability). 4. Identify individuals, agencies and governmental groups that can play key roles in optimizing improvements in injury incidence and mortality following passage of injury prevention legislation.

Keywords: Injury Prevention, Health Law

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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