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OHSU Study Says Injury Prevention Program Working

   Portland, Ore.

ThinkFirst's efforts correlate with drop in crashes among teen drivers in Oregon.

In spring 1995, John Burns was living life at full throttle.

On April 23 of that year, Burns, then 21, had a gorgeous girlfriend, a lightning-fast motorcycle and a good shot at a job as a cop in Detroit. But on his motorcycle that day, as in life, Burns was in too high of a gear as he barreled toward Mt. Hood just east of Estacada, Ore. By night's end, he would be paralyzed from the chest down as his body and bike lay twisted and broken at the edge of the highway.

After a month in a coma and years of rehabilitation, Burns' life shifted gears again, when he became a volunteer for ThinkFirst, a national brain and spinal cord injury prevention program with its Oregon chapter at Oregon Health & Science University. As a VIP, or Voice for Injury Prevention, Burns now speaks to Portland-area students about the dangers of high-speed living.

"When something happens to you, it's not just you who it affects," Burns said he tells elementary, middle and high school students from his wheelchair. "You don't see the aftermath of this person's head being split wide open. You don't see the grieving family. You don't see the lives that are changed."

Such messages appear to be working, according to a review of the ThinkFirst program in this month's Journal of Neurosurgery. Researchers in the Department of Neurology, OHSU School of Medicine, examined the ThinkFirst National Injury Prevention Foundation, created in 1986, and found it made significant strides in preventing injury by combining education with legislative initiatives, community-wide safety programs and a large public presence nationwide. The study says the program demonstrates the importance of injury prevention as a valuable component of the nation's medical system.

"We wanted to see if ThinkFirst was an efficacious program," said Rae Rosenberg, ThinkFirst Oregon program coordinator and lead study author. "The article shows that ThinkFirst significantly improves knowledge of prevention among program participants."

And that may be affecting the number of young drivers involved in crashes in Oregon. According to the Oregon Department of Transportation, which helps fund ThinkFirst Oregon, fatal crashes among drivers ages 15 to 19 dropped 30.6 percent between 1998 and 2002, and crashes involving alcohol dropped 77.3 percent in the same age group. Traffic-related fatalities and injuries also declined among those 14 and younger.

ThinkFirst was formed in 1986 after the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, concerned about a high incidence of spinal cord and traumatic brain injuries, recruited E. Fletcher Eyster, M.D., of Pensacola, Fla., and Clark Watts, M.D., of Columbia, Mo., to develop a national prevention program based on programs already established in the neurosurgeons' own states.

Edward Neuwelt, M.D., professor of neurology and neurological surgery, OHSU School of Medicine, and director of ThinkFirst Oregon, helped bring the program to the state in the mid-1980s after he worked with Watts at the University of Texas in Parkland. He said that since its inception in Oregon, more than 250,000 children have been educated on injury prevention. At a cost of about $2 per child, its total cost remains lower than the $750,000 spent to treat one child with a spinal cord or traumatic brain injury in the first year.

"This is an enormous public health problem, yet injury is not considered a disease and injury prevention is not considered hard science, so unfortunately it gets brushed under the rug," Neuwelt explained.

Some 1.5 million Americans sustain traumatic brain injuries each year, far more than the number of people affected by breast cancer, HIV and AIDS, and multiple sclerosis combined, according to the Centers for Disease Control and Prevention. About 3,000 children 14 and younger die from traumatic brain injuries, 29,000 are hospitalized and 400,000 are treated in emergency departments at an estimated cost of $56.3 billion a year.

Today, nearly 200,000 Americans live with a disability related to a spinal cord injury, with about 11,000 people hospitalized each year. According to the CDC, more than half of those with spinal injuries are ages 16 to 30, and most are male. Total cost: $9.7 billion.

The researchers reviewed evaluations of ThinkFirst that took place between 1986 and 2002. They include a study of the program's original initiative, ThinkFirst for Teens, which teaches young people about personal vulnerability and risk taking. ThinkFirst for Teens showed a statistically significant increase in knowledge of injury prevention among middle and high school students.

Data from an early form of the program's spinal cord injury prevention program in Missouri indicated an increase in knowledge and improved attitudes and behaviors about spinal cord injuries among schools in which the program was offered. A 2000 study conducted at the University of Toronto identified ThinkFirst as an example of a best practice among comprehensive, community-based prevention strategies. And in 2002, the California Department of Education added the ThinkFirst for Kids program to its Healthy Kids Resource Center, making it available for loan statewide.

Such successes may be attributable to dynamic speakers like those in ThinkFirst Oregon's VIP program. "Research has shown when kids know someone who sustained an injury or was impacted by a traumatic event, they're more likely to take lessons learned and apply them to their own lives," Rosenberg said. "It makes them think."

Burns agreed, adding, "It's a matter of getting good speakers who relate to the audience."

The Journal of Neurosurgery study is the fifth peer-reviewed journal article published by ThinkFirst Oregon. Dorothy Zirkle, R.N., Ph.D., a member of the national ThinkFirst executive committee, was a co-author.

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