Georgia action plan for child injury prevention : an agenda to prevent injuries and injury-related fatalities among children in Georgia

[GEORGIA ACTION PLAN FOR CHILD INJURY PREVENTION]

2015

Georgia Action Plan for Child Injury Prevention

An Agenda to Prevent Injuries and Injury-related Fatalities among Children in Georgia

[GEORGIA ACTION PLAN FOR CHILD INJURY PREVENTION]

2015

The Georgia Action Plan for Child Injury Prevention is developed by the Child Injury Prevention Plan Workgroup, and supported and monitored by the Georgia Child Fatality Review Panel.
Georgia Child Fatality Review Panel Chair C. LaTain Kell, Superior Court Judge, Cobb County
Georgia Child Fatality Review Panel Co-Chair Peggy Walker, Juvenile Court Judge, Douglas County
Georgia Child Fatality Review Prevention Specialist Chair, Child Injury Prevention Plan Workgroup Arleymah Gray, MPH

Special thanks to Chinyere Nwamuo for editing and graphic design

Suggested Citation: Georgia Child Fatality Review. (2015). Georgia Action Plan for Child Injury Prevention: An Agenda to Prevent Injuries and Injury-Related Fatalities Among Children in Georgia. Available from gbi.georgia.gov/CFR

[GEORGIA ACTION PLAN FOR CHILD INJURY PREVENTION]

2015

Georgia Action Plan for Child Injury Prevention

An Agenda to Prevent Injuries and Injuryrelated Fatalities among Children in Georgia

May 2015

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May 11, 2015
Honorable Nathan Deal and Members of the Georgia General Assembly:
It is my sincere honor to present to you the 2015 Georgia Action Plan for Child Injury Prevention. This plan summarizes and provides the framework for reducing the number of unintentional injuries, the leading cause of death among children ages 1 to 19 years.
In 2006, a subcommittee of the Child Fatality Review Panel, the Child Injury Prevention Planning (CIPP) workgroup, was tasked with developing the Framework for Child Injury Prevention. Members of the CIPP worked with key agencies and organizations that provided services to children, and in 2008, the first Framework was published and disseminated throughout the state. Georgia's was the first Framework for Child Injury Prevention in the nation, and has been used as a model by other states.
The 2015 Action Plan is an updated, comprehensive plan which reflects new and emerging trends in injury prevention and evidence-based best practices to aid state and local agencies, organizations, community groups and policymakers in educating families and caregivers.
The Panel and I appreciate your time in reviewing this Plan and for the support you have provided to us as we continue our efforts to protect the lives of Georgia's children.
Sincerely,
Judge C. LaTain Kell, Chair Georgia Child Fatality Review Panel

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Table of Contents: Goals ............................................................................................. 1 Background and History .....................................................................4 Sleep Related Infant Deaths ................................................................. 5 Maltreatment ................................................................................... 12 Bullying .......................................................................................... 24 Substance Abuse ................................................................................ 33 Prescription Drug Abuse ..................................................................... 38 Intimate Partner Violence ....................................................................44 Unintentional Injuries .......................................................................... 60
o Motor Vehicle ...................................................................... 60 Passenger ................................................................... 65 Pedestrian ................................................................... 67
o Drowning ............................................................................ 70 o Fire .................................................................................... 79 o Falls ................................................................................... 85 Intentional Injuries ............................................................................ 90 o Homicide ............................................................................ 90 o Suicide ............................................................................... 93 References ....................................................................................... 100 Acknowledgements ........................................................................... 116

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EXECUTIVE SUMMARY
Introduction
Injuries and violence affect everyone, regardless of age, race, or economic status. For Americans 1 to 44 years of age, injuries are the number-one killer. In fact, people in that age group are more likely to die from an injury--such as a motor vehicle crash, fall, or homicide--than from any other cause, including cancer, HIV, or the flu. The consequences of injuries can be extensive and wide ranging. Injuries have physical, emotional, and financial consequences that can impact the lives of individuals, their families, and society. Some injuries can result in temporary or long-term disability. Injuries also place an enormous burden on hospital emergency departments and trauma care systems, accounting for approximately one third of all emergency department visits and 8% of all hospital stays. Childhood unintentional injuries are the leading cause of death among children ages 1 to 19 years in the United States, representing nearly 40 percent of all deaths in this age group. Each year, an estimated 8.7 million children and teens from birth to age 19 are treated in emergency departments for unintentional injuries and more than 9,000 die as a result of their injuries--one every hour. Common causes of fatal and nonfatal unintentional childhood injuries include: drowning, falls, fires or burns, poisoning, suffocation, and transportation-related injuries. Injuries claim the lives of 25 children every day. While tragic, many of these injuries are predictable and preventable. Diverse segments of society are involved in addressing preventable injuries to children; with this Action Plan, Georgia is providing a unified set of goals, strategies, and actions to help guide a coordinated statewide effort.

Burden
Injuries are the leading cause of death among children in Georgia. An average of 3,311 children is treated in hospitals each year in Georgia, and an average of 420 die from sleep-related circumstances and injuries. This is equivalent to losing 23 kindergarten classrooms of children each year! Like diseases, injuries do not strike randomly. Males are at higher risk than females. Infants are injured most often by suffocation. Toddlers most frequently drown. As children age, they become more vulnerable to traffic injuries. Motor vehicle injuries dominate among teens. Poverty, crowding, young maternal age, single parent households, and low maternal educational status all increase risk and make children more vulnerable to injury. Nationally, death rates are highest for American Indians and Alaska Natives and

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lowest for Asians or Pacific Islanders. States with the lowest injury rates are in the northeastern part of the United States.

In Georgia, the average child death rate due to injuries between 2009 and 2013 is 12.5. The death rate due to injuries is higher among African-Americans (rate: 15.3) compared to White non-Hispanics (rate: 13.0) and Hispanics (rate: 6.6). Among rural counties, the average injury death rate is 16.6, and the highest child injury death rates are in Brantley (rate: 33.3), Emanuel (rate: 38.4), Heard (rate: 48.0), McIntosh (rate: 34.2), Pierce (rate: 45.2), and Wilcox (rate: 56.6). Among non-rural counties, the average injury death rate is 11.7, and the highest rates are in Coffee (rate: 25.5), Effingham (rate: 25.7), and Jackson (rate: 24.0).
Framework
One framework for reducing childhood injuries is based on the public health model a model that is used for preventing many other diseases. The public health approach includes identifying the magnitude of the problem through surveillance and data collection, identifying risk and protective factors, and, on the basis of this information, developing, implementing, and evaluating interventions, and promoting widespread adoption of evidence-based practices and policies. Interventions can be implemented during various time frames before, during, or after an adverse event. For example, safety latches on medicine cabinets provide protection before an injury event, child safety seats minimize injury during the injury-causing event, and effective emergency response speeds treatment and improves outcomes after an injury event has occurred.
The Georgia Action Plan for Child Injury Prevention provides a full framework for each of the most significant injury issues affecting Georgia's children.
o The background of the problem o Risk factors and vulnerable populations o Benchmarks and Healthy People 2020 goals, if available o Relevant data and surveillance findings o Opportunities for policy and prevention at the local and statewide level
Improvements within each domain are also recommended. In particular, improvements to surveillance and data collection will lead to more accurate needs assessments, enhanced data quality (that is

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reliable and believable), better decision making, increased effectiveness (doing what works), and efficiency (avoiding waste). Information systems and surveillance programs should make existing data available to those who can use it and share it to support interventions.
The framework of the Action Plan allows for all interested parties state and local agencies, philanthropies, businesses, schools, educators, health care providers, and policymakers to align priorities, capitalize on existing strengths, address needs and gaps, and coordinate resources to the ultimate goal of reducing injuries and injury-related deaths to children. Prevention opportunities presented within the Action Plan reference feasible evidence-based strategies and best practices when possible. A coordinated, consistent message is desirable for ensuring all of Georgia's families receive the information that will help them choose safety for their children and loved ones.

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GOALS
For Researchers and University Partners
For more than four decades, the scientific study of childhood injuries has paid rich dividends. Effective interventions such as bike helmets, four-sided pool fencing, booster seats, smoke alarms, concussion guidelines, and teen driving policies have already saved many lives. Additional research to improve our prevention efforts will be required to further drive down child injury rates and is needed at three different levels: 1) foundational research (how injuries occur), 2) evaluative research (what works and what doesn't work to prevent injuries), and 3) translational research (how to put proven injury prevention strategies into action throughout the nation). Because research is a shared public, academic, and private endeavor, better coordination of research efforts will minimize waste and maximize return. Research can also help reduce health disparities through better understanding of the relationship between injuries and factors such as socioeconomic status, demographics, race and ethnicity.
For Communities, Agencies, and Organizations
Raising awareness about childhood injuries is important at multiple levels. It can often trigger action, or support policies intended to reduce injuries. Better communication will better inform the actions by policy makers (enacting legislation to protect children), organizations (approaching injury prevention in a coordinated way), and by families (implementing evidence-based injury prevention strategies at home, on the road, on the playground, and in the community). A balanced, coordinated communication strategy must be audience-specific and culturally appropriate, and use both traditional and innovative channels ranging from public relations campaigns to social media. Today more than ever, messages must be concise and relevant, and the messengers must be knowledgeable, credible, and relatable. Various strategies can be used to deliver health messages to specific audiences, utilizing the talents of various injury partners. Some of the actions include:
o Creating and implementing local and national campaigns on child safety o Establishing web-based communications tool kits o Finding local young people to be spokespersons for prevention o Using local businesses to support communication efforts to employees and their families

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For Health Care Providers
Health care providers treat injuries, but they are also partners in prevention through health care systems. While responding to and treating trauma, health care providers are critical for accurately documenting external causes of injuries and circumstances. Beyond the clinical setting, health care providers are credible advocates for child safety and can facilitate change in communities and families. Health care systems can address child injury by providing anticipatory guidance to health care providers and collecting clinical data. Trends and changes to health care delivery models, including adoption of electronic medical records, the medical home model, and quality improvement efforts should all be utilized to augment injury reduction goals and objectives by improving data collection while also ensuring quality and continuity of medical care for children. Best practices for delivery of preventive services should be identified and disseminated. Furthermore, opportunities exist for new technologies and information systems to improve injury outcomes. Information systems can equip providers with evidencebased data and protocols to strengthen the quality of clinical decision-making and improve trauma care. Some of the actions suggested include incorporating child injury risk assessment into home visitation programs, creating injury prevention quality measures that apply to the medical home, and using linked data systems to improve treatment decisions.
For Policymakers
The policy arena is important because it is system-based, affecting populations by changing the context in which individuals take actions and make decisions. Historically, policies regarding safe environments and products (swimming pool fences and safe cribs) and safe behaviors (sober driving and bike helmets) have changed norms in communities and nationally, leading to a reduction in injuries and injury-related deaths. Policy includes aspects of law, regulation, or administrative action and can be an effective tool for governments and nongovernmental organizations to change systems with the goal of improving child safety. The Georgia Action Plan informs policymakers about the value of adopting and implementing evidence-based policies. It calls for better compliance and enforcement of existing policies to protect children, such as car seats or four-sided pool fencing where these policies exist. The Georgia Action Plan underscores the importance of documenting and disseminating the effective and cost-saving policies at the broadest level. Some of the actions include developing statewide leadership training in policy analysis for child injury prevention, documenting successful policies that save lives and prevent injuries to

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children, and supporting state capacity building for implementing policy-oriented solutions that reduce childhood injuries.
Conclusion
The successful implementation of the Georgia Action Plan will require bold actions, effective leadership, and strong partnerships. We cannot afford to wait any longer. Child injuries are preventable, and improvements in the safety of children and adolescents can be achieved if there is an effort by various stakeholders to adopt and promote known, effective interventions--strategies that can save lives and money.

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BACKGROUND AND HISTORY
The mission of the Georgia Child Fatality Review Panel is to provide the highest quality child fatality data, training, technical assistance, investigative support services, and resources to any entity dedicated to the well-being and safety of children in order to prevent and reduce incidents of child abuse and fatality in the state. This mission is accomplished by promoting more accurate identification and reporting of child fatalities, evaluating the prevalence and circumstances of both child abuse and child fatalities, and developing and monitoring the statewide child injury prevention plan.
In 2006, the Child Fatality Review panel partnered with the Injury Prevention Section of the Georgia Division of Public Health to lead the process of developing the Framework for Child Injury Prevention. Development of the Framework fell under the direction of the Child Injury Prevention Planning workgroup (CIPP), a subcommittee of the Child Fatality Review Panel. Members of the CIPP represented key agencies and organizations that provided services to children. The first Framework was published in 2008, and disseminated throughout the state. It became the first Framework for Child Injury Prevention in the nation, and has been used as a model by other states. This is the revision document, updated to reflect new and emerging trends in injury and evidence-based best practices for prevention. Again, the members of the CIPP led the effort and worked diligently for more than a year to research, develop, and review the content for this Action Plan. Through their efforts, the state of Georgia now has a comprehensive Action Plan for state and local agencies, organizations, community groups, and policymakers to use in reducing injuries the leading cause of death for children.

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SLEEP RELATED INFANT DEATHS

DEFINITIONS:
SUID: Sudden unexplained infant death: cases for which, after investigation, risk factors are identified that could have contributed to the death, but are not conclusive to have caused the death Sleep-related Asphyxia: Infant death with forensic evidence of:
Suffocation Overlaying (rolling on top of or against baby while sleeping) Wedging or entrapment between mattress, wall, bed frame or furniture Positional asphyxia SIDS: Sudden Infant Death Syndrome: after a thorough case investigation including a death scene investigation, complete autopsy, and review of medical history the cause of death remains unknown Sleep-related Medical Death: When an infant has a serious medical condition but was also placed in an unsafe environment, which exacerbated the medical issues and contributed to the death.
RISK FACTORS

Each year in the United States, about 4,000 infants die suddenly due to no immediately obvious cause. Among infants one to twelve months old, the leading causes for death are sleep-related.
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According to the Georgia Pregnancy Risk Assessment and Monitoring System (PRAMS) survey, which is a state-wide survey of mothers with young infants, from 2006 to 2011, 80.9% of African-American mothers and 53.6% of White mothers reported sharing a bed with their infants. Regarding sleep position, 51.9% of African-American mothers and 36.3% of White mothers reported placing their infants non-supine to sleep (Salm Ward, n.d). Both of these behaviors place infants at a much higher risk of sleep-related infant death. It is clear that prevention efforts are needed to decrease infant deaths.

Figure 1: Sleep Related Deaths with Reported Bed Sharing, by Position when Found, GA, 2013
(n=72)

On side

17%

On stomach

Other

37%

11%

On back 35%

Unknown 10%
Missing 1%

Of all 2013 Sleep-related Deaths reviewed by the Georgia Child Fatality Review Panel, it was found that approximately 59% were reported as sleeping in an unsafe position, whether on the side or on the stomach.
Number of Deaths by position
- On Back: 42 - On Stomach: 66 - On Side: 16 - Unknown: 14 - Missing: 1

SAFE SLEEP RESOURCES
National Action Partnership to Promote Safe Sleep, http://www.nappss.org/ includes safe sleep resources as well as information about promising practices and evidence-based interventions to increase infant sleep safety.
Safe to Sleep Campaign, National Institute for Child Health and Human Development, www.nichd.nih.gov/sts/ maintains free materials to launch a local safe sleep education campaign, including informational materials for health care providers regarding how to answer parents' questions about infant sleep, a safe sleep curriculum for nurses, parent materials such as culturallytailored brochures, door hangers, and posters, and videos.

Infants who were reported specifically as bed sharing were sharing a sleep surface, sHucEhAaLs aTbHeYd, cPoEuOchP, cLhEair2,020 TARGET o-r criIbn,cwreitahseatthleeapsrtoopnoertoitohnerofpeinrsfaonntsatwthheo taimreepouft tdoeastlheep on their backs in a safe sleep environment (F-iguBrea1se).line: 69.0% of infants were put to sleep on their backs in 2007 (G- eorTgaiargCetF:R75A.9n%nual Report, 2013)

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Top Five Locations for Sleep Related Deaths, GA, 2011-2013

Adult Bed Crib Couch Bassinette Carseat

80

85

65

25 19 14 2
2011

23 16 72
2012

26 14 13 6
2013

Sleep environment remains an issue in reviewed fatalities in Georgia. From 155 in 2011 to 139
in 2013, sleep related infant deaths have not shown a significant decrease and adult beds remain the top locations for those deaths in Georgia.

The most commonly identified themes on the barriers for following safe sleep recommendations against bed sharing and stomach sleeping, in peer reviewed literature are:
- Better caregiver and infant sleep - Convenience/comfort - Familial tradition - Perceived child safety/concerns of choking and, - Parent and child emotional needs

Figure 3: Orientation of the Trachea to the Esophagus
Healthy babies naturally cough up or swallow fluids to make sure their airway is kept clear. In the back sleep position, the trachea is on top of the esophagus and babies may clear such fluids better when on their backs. When the baby is sleeping on its stomach, such fluids will exit the esophagus and pool at the opening for the trachea, making choking more likely.

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FOR PARENTS
Sleep Position Always put the baby on his or her back for sleep time. Studies have shown that babies who sleep on their stomach are at a higher risk for sleep-related infant
deaths than babies who sleep on their backs. Sleep Environment Avoid placing soft materials in the infant's sleep environment, over, under or near the infant. This
includes pillows, bumper pads, comforters, quilts, and stuffed animals. These items may increase the risk of suffocation or strangulation. Why not bumper pads? Because they may cause serious injury and death. Keeping them out of the baby's sleep area is the best way to avoid these dangers. Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep; children who sleep on a soft surface, such as a quilt, or a soft blanket are at a greater risk of dying of sleep-related causes. Avoid overheating or over bundling. A one-piece sleeper or sleep sack can be used for sleep clothing. If you notice baby sweating or breathing rapidly, he or she may be too warm. Room Sharing without Bed Sharing The baby should sleep in the same room as the parents this helps to reduce the risk of sleep-related causes of infant deaths. However, the baby should not sleep in the same bed as the caregivers. Pregnant Women Pregnant women should receive preconception and interconception care and should begin prenatal care within the first trimester and regularly throughout the pregnancy. Women should not drink alcohol or smoke during pregnancy and infants should not be exposed to
secondhand smoke. Breastfeed your baby; breastfeeding has many health benefits for both mother and child. Tummy Time Supervised awake tummy time is recommended daily to facilitate development and minimize the
occurrence of positional plagiocephaly (head flattening). Tummy time also helps the baby's neck, shoulder and arm muscles get stronger.
Other Recommendations for Parents
Talk about safe sleep practices with everyone who cares for your baby. Do not use home cardiorespiratory monitors as a strategy for reducing the risk of sleep-related infant
deaths; there is no evidence that these monitors decrease the incidence sleep-related infant deaths. Follow health care provider guidance on your baby's vaccines and regular health checkups.
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Statewide

Childcare Providers and Media

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What Does a Safe Sleep Environment Look Like?

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MALTREATMENT
Definition: Any act or series of acts of commission or omission by a parent, other caregiver, or another person in a custodial role that results in harm, potential for harm, or threat of harm to a child under the age of 18 According to Georgia law, child maltreatment includes the following acts:
Physical abuse or death Sexual abuse or sexual exploitation Neglect
RISK FACTORS

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Long-Term Consequences of Child Maltreatment
The adverse consequences of child maltreatment affect all aspects of life, including physical and emotional health as well as social and economic wellbeing, and continue well after the maltreatment ends. The Adverse Childhood Experiences (ACE) Study links ACE to various risk factors that may lead to social and individual health consequences from conception to death. An ACE score is used to assess the total number of stresses a child experiences including child maltreatment; an increase in a child's ACE score is associated with a strong and graded increase in the following health behaviors/conditions: depression, elevated risk of intimate partner violence, chronic health problems, and suicide attempts.
The diagram below represents the conceptual framework for the study:

CDC Childhood Experiences (ACE) Study 2013
ACE in the form of abuse and neglect are linked to various outcomes, including: Mental health problems Early sexual activity Intimate partner violence Delinquency Chronic health problems - heart disease, diabetes, lung disease, hernias, ulcers, kidney and liver disease, as well as neurological disorders Substance Abuse Suicide Risks
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Child Maltreatment Data and Statistics

Rate per 1000 Children

Georgia Child Victim Rates from 2008 to 2012
12

10

8

6

4

2

0
Georgia Victimization Rates National Victimization
Rates

2008 10
9.5

2009 9
9.3

2010 8
9.3

2011 7.5
9.2

2012 7.5
9.2

2008 25,716

Georgia Child Victims, 2008-2012

2009

2010

2011

23,249

19,976

18,541

2012 18,572

Healthy People 2020 Target: 8.5

The Healthy People 2020 target is to reduce nonfatal child maltreatment from 9.4 victims per 1,000 children under 18 (2008) to 8.5 victims per 1,000 children age 17 and under by 2012. According to the DHHS 2013 Maltreatment Report, Georgia victimization rates have decreased from 10 child victims per 1,000 children in 2008 to 7.5 per 1000 children in 2012. Therefore, Georgia child victimization rates have decreased, achieving the Healthy People 2020 target. The 2012 National rates are higher than the rates in Georgia, at 9.2 victims per 1000, but also show a decline from 2008.
While the Georgia rate of child victims from 2011 to 2012 stayed the same, at 7.5 per 1,000 children, there were fluctuations in fatality and type of abuse. From 2011 to 2012, there was a 7% increase in physical abuse, a 4% decrease in neglect, and 9% increase in fatality. While neglect decreased from 2011, it remains the most prevalent type of maltreatment in Georgia. In 2012, neglect represented 68.3% of all forms of maltreatment in Georgia, followed by psychological maltreatment (23.3%), physical abuse (13.6%), sexual abuse (5%), and medical neglect (4.5%). Additionally, the greatest numbers of victims in 2012 were under the age of 4 years old.

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Georgia Risk Factors
Domestic violence, alcohol abuse, and drug abuse were risk factors associated with over half of the victimization cases reported for Georgia in 2012. The majority of reported victims were under the age of four (7,548 victims) and neglect was the top form of abuse in Georgia (68.3% of all reported cases).

Georgia's Victims According to Caregiver Risk Factors, 2012

Risk Factor

Number

Percent

Domestic Violence

6,814

36.3

Alcohol Abuse

598

3.2

Drug Abuse

3855

20.6

This table shows the unique victims with a domestic violence, alcohol abuse, or drug abuse caregiver risk factors, as reported in the NCANDS 2012 maltreatment report. The percentages are calculated against the number of unique victims in Georgia (N = 18,752).

THE COST OF CHILD MALTREATMENT IS ESTIMATED TO BE ABOUT $124 BILLION EACH YEAR IN THE UNITED STATES

Georgia Victims by Age, 2012

13 to 17

3391

9 to 12

3295

5 to 8

4489

Under 4

0

2000

4000

6000

Georgia Victims by Age, 2012

7548 8000

Types of Maltreatment in Georgia, 2012

Sexual Abuse
Psychological Maltreatment
Physical Abuse

5 23.3
13.6

Neglect

68.3

Medical Neglect 4.5

0

20

40

60

80

Types of Maltreatment in Georgia, 2012 (Percents)

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TOP STRATEGIES FOR CHILD MALTREATMENT PREVENTION
Early Intervention (Part C under IDEA) System of services that helps babies and toddlers with developmental delays or disabilities. They focus on helping eligible babies and toddlers learn the basic and brand-new skills that typically develop during the first three years life. These services may include medical services, counseling and training for the child and family,
psychological services, occupational therapy, speech therapy, and nutrition services (CPIR, 2014).
Evidence-Based Home Visitation Program Evidence-based program, implemented in response to findings from a needs assessment, that includes home visiting as a primary service delivery strategy (excluding programs with infrequent or supplemental home
visiting), and is offered on a voluntary basis to target the participant outcomes which include improved maternal and child health, prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits. Home visitation services may also target other outcomes such as improvement in school readiness and achievement, reduction in crime or domestic violence, improvements in family economic self-sufficiency, and improvements in the coordination and referrals for other community resources and
supports.
Parent Education Programs Programs focused on enhancing parenting practices and behaviors, such as developing and practicing positive discipline techniques, learning age-appropriate child development skills and milestones, promoting positive play and interaction between parents and children, and locating and accessing community services and support. The parent education programs are typically delivered in the home by trained progressions coaching parents on
meeting the needs of their children through observation, instruction and demonstration of mastery of skills.
Family Support Services Community-based services that promote the well-being of children and families; they often aim to reduce caregiver and family sense of isolation, stress or self-blame, provide education or information, teach skills, and
empower and activate them so they can more effectively address the needs of their families.

These prevention strategies are interventions that can guide child maltreatment prevention through the following Healthy People 2020 objectives:
EMC-2.1 (Developmental) Increase the proportion of parents who report a close relationship with their child
EMC-2.2 Increase the proportion of parents who use positive communication with their child
EMC -2.3 Increase the proportion of parents who read to their young child
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EMERGING AND PROMISING PRACTICES

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ABUSIVE HEAD TRAUMA: SHAKEN BABY SYNDROME
Definition: Shaken Baby Syndrome (SBS): A form of Abusive Head Trauma (AHT) and Inflicted Brain Injury (ITBI) that is a preventable and severe form of physical child abuse. It results from violently shaking an infant by the shoulders, arms, or legs.
RISK FACTORS

Mechanism of SBS
When a baby is shaken, the brain rotates within the skull cavity, injuring or destroying brain tissue. Blood vessels feeding the brain can be torn, leading to bleeding around the brain. Blood pools within the skull, sometimes creating more pressure in the skull; this may cause additional brain damage and bleeding in the retina (back of the eye).
Why is SBS so damaging?
1. Babies' heads are relatively large and heavy, making up about 25% of their total body weight. Their neck muscles are too weak to support a disproportionately large head
2. Babies' brains are immature and easily injured by shaking 3. Babies' blood vessels around the brain are more susceptible to tearing than older children or
adults
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Immediate & Long-Term Consequences on Overall Well-being

Immediate Consequences Breathing may stop or be compromised Extreme irritability Seizures Limp arms and legs or rigidity/posturing Decreased level of consciousness Vomiting; poor feeding Inability to suck or swallow Heart may stop Death

Long Term Consequences Learning disabilities Physical disabilities Visual disabilities or blindness Hearing impairment Speech disabilities Cerebral Palsy Seizures Behavior disorders Cognitive impairment Death

Did you know?
SBS is a leading cause of child abuse deaths in the United States; at least one of every four infants who are violently shaken dies as a result

Inconsolable crying is a primary trigger for shaking an infant

Very young infants (newborn to 4 months) are at greatest risk of injury from shaking

In the United States, care for SBS victims and their families averages 1.2 billion to 16 million dollars each year.

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PREVENTING SBS

Individual-level Strategies

Strategies aimed at changing parents' or caregivers' knowledge and skills

Relationship-level Strategies Strategies aimed at trying to change the interactions between people parents and children, parents and other caregivers, parents and health
care providers, bystanders and parents

Community-level Strategies

Strategies aimed at modifying characteristics of settings that give rise to violence or that protect against violence (e.g., access to quality child care for working mothers, access to and availability of parental support programs, early child care, social and economic factors, and respite care centers).

Societal-level Strategies

Strategies aimed at changing cultural norms surrounding parenting as well as laws and policies aimed at supporting parents

PROMISING PRACTICE PERIOD OF PURPLE CRYING
The Period of PURPLE Crying is the phrase used to describe the period in a baby's life when crying occurs more often than in any other time. It is a way to help parents understand this time in their baby's life as a normal part of every infant's development.
PURPLE STANDS FOR:
Peak pattern: crying peaks around 2 months, then decreases Unpredictable: crying for long periods can come and go for no reason Resistant to soothing: the baby may keep crying for long periods Pain-like look on Face Long bouts of crying: crying can go on for hours Evening crying: baby cries more in the afternoon and evening

Prevent Child Abuse Georgia Helpline: 1-800-CHILDREN
Call for parenting support, family violence concerns, concerns about the wellbeing of a child or family member, counseling and support needs and more. Open Monday to Friday, from 8am. 7p.m

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Various ways to calm a crying baby include:

Rubbing his or her back

Singing or talking

Gently rocking Offering a pacifier
(CDC, 2004b)

Taking a walk using a stroller or going for a drive with the baby in a properlysecured car seat

PURPLE Crying Framework
Intervention o Exposure 1: Education by RNs through nursery video and take-home booklet o Exposure 2: Education by other healthcare providers during prenatal visits and checkups o Exposure 3: Media Campaign The general public understands the commonality of PURPLE crying and the dangers of shaking Social norms: PURPLE crying is normal and shaking is unacceptable Alternative caregivers able and willing to help
Impacts o Knowledge Changes: parent understands Normalcy of PURPLE crying The dangers of shaking Alternatives to addressing PURPLE crying How to identify other `safe' caretakers o Attitude and Belief Changes: parent believes Crying is normal Shaking is preventable She can educate and train other caregivers in PURPLE crying concepts She can identify good caregivers She prioritizes child's safety from shaking o Skills Change Recognizes frustration and need to approach other coping strategies Parent can identify and apply coping strategies Parent can train other caregivers in PURPLE principles
Outcomes o Outcome 1: Parent displays the following coping behaviors Provides comfort to baby and/or Leaves baby in a safe place to cry (when she feels pushed to the limit, being sure to check on child every 5-10mins.) and/or Chooses quality alternative caregivers and Trains alternative caregivers o Outcome 2: Reduction in shaking incidence
o Ultimate Outcome: Reduction in abusive head trauma
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PARENTS AND CAREGIVERS
Remember that babies cry a lot in the first few months of life and this can be frustrating but it will get better. Remember, you are not a bad parent or caregiver if your baby continues to cry after you have done all you can do to calm him/her. If you have tried various ways to calm your baby and he/she won't stop crying, do the following:
Check for signs of illness or discomfort like diaper rash, teething, or tight clothing
Call the doctor if you suspect your child is injured or ill
Assess whether he/she is hungry or needs to be burped
**If you find yourself pushed to the limit by a crying baby, you may need to focus on calming yourself. Put your baby in a crib on his/her back, make sure he/she is safe, then walk away for a bit and call a friend, relative, neighbor, or parent helpline for support. Be sure to check on him/her every 5-10 minutes**
FRIENDS, FAMILY MEMBERS, HEALTH CARE PROFESSIONALS AND OBSERVERS OF A PARENT OR OTHER CAREGIVER
Be aware of new parents in your family and community who may need help or support. Provide support by offering to give them a break, sharing a parent helpline number, or simply being a friend. Let the parent know that the crying can be frustrating, especially when they're tired and stressed. Reinforce that crying is normal and that it will get better. Tell the parent how to leave his or her baby in a safe place while he or she takes a break. Be sensitive and supportive in situations when parents are trying to calm a crying baby. Think about policies or services that could be resources for new parents in your community and advocate for those that do not exist.
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EDUCATION
School prevention programs for junior high and high school students providing students with an understanding of child maltreatment issues, anger management techniques, teen dating violence prevention programs, and child care skills Babysitting courses as a skill builder for future parents. These are often part of community education offered as local hospitals Educational print and video materials provided at the time of delivery as well as at pediatric offices and prenatal classes
AGENCY
Coordinated hospital-based primary-prevention programs targeting parents of newborns Home visitation programs for new parents; expand the reach of various home visitation programs and additional services to at-risk families. For example, since neglect represents the number one form of maltreatment in Georgia, greater number and dissemination of programs proven to decrease neglect, such as SafeCare may reduce the number of neglect cases In responding to CPS referrals, child welfare agencies should focus on non-serious allegations of abuse and neglect for children 0-5, as well as cases with clear safety threats, and continue implementing early intervention in families where multiple risk factors are present Pay more attention to emotionally detached and disengaged parenting during risk assessments practitioners should focus on the quality of parent-child interactions and pregnant women's hostile attributions about infants during risk assessments Promote partnerships with local community-based organizations (CBOs) that can provide education, training, message dissemination, and follow-up support to parents identified as needing additional resources or information
LAW
Broaden the public policy focus and education on families with or without prior contact with CPS who have children ages 0-3, caretakers with serious substance abuse or mental health problems, domestic violence present during or after pregnancy, or living in impoverished homes
ENFORCEMENT
Enforce the use of evidence-based practices as the foundation for any intervention; conduct more research on effective interventions and gain a better understanding of the fatality and incidence trends in Georgia and the fluctuations in forms of maltreatment over time. Ensure the availability and provision of mandated reporter trainings Persons employed by or volunteering at a business or an organization, whether public, private, for profit, not for profit, or voluntary, that provides care, treatment, education, training, supervision, coaching, counseling, recreational programs, or shelter to children should be educated in Georgia child abuse laws, detecting abuse, and reporting procedures
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BULLYING

Definition: An act which occurs on school property, on school vehicles, at designated school bus stops, or at school related functions or activities, or by use of data or software that is accessed through a computer, computer system, computer network, or other electronic technology of a local school system, that is:
(O.C.G.A. 20-2-751.4):
Any willful attempt or threat to inflict injury on another person, when accompanied by an apparent present ability to do so;
Any intentional display of force such as would give the victim reason to fear or expect immediate bodily harm; or
Any intentional written, verbal, or physical act, which a reasonable person would perceive as being intended to threaten, harass, or intimidate, that:
Causes another person substantial physical harm or visible bodily harm Has the effect of substantially interfering with a student's education Is so severe, persistent, or persuasive that it creates an intimidating or threatening
educational environment; or Has the effect of substantially disrupting the orderly operation of the school

The Healthy People 2020 Goal IVP-35: Reduce bullying among adolescents Baseline: 19.9% of students in grades 9 through 12 reported that they were bullied on school property
in the previous 12 months in 2009. Target: Decrease to 17.9%; at least a 10% improvement by 2020
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WHAT IS NOT BULLYING
Mutual Conflict a disagreement rather than an imbalance of power. Unresolved mutual conflict may escalate into bullying if one of the parties is repeatedly targeted in retaliation Single-episode acts Social rejection or dislike this is not considered bullying unless it involves repeated and deliberate attempts to exclude and create dislike by others or to cause distress Accidently bumping into someone
RISK FACTORS
Some risk factors for engaging in bullying and being a victim of bullying are presented below. However, it is important to recognize that bullies come in all shapes and sizes. Additionally, depending on the environment, some groups including youth with disabilities, socially isolated youth, and lesbian, gay, bisexual, or transgendered (LGBT) youth may be at increased risk of being bullied.

Warning signs of victims
- Comes home with torn, missing, or damaged belongings - Few, if any, friends - Trouble sleeping or frequent bad dreams - Seems afraid of going to school, riding the school bus, walking to and from school, or engaging
in organized activities with peers - Returns from school saddened, depressed, or moody - Frequently complains of physical ailments - Takes long, unexplained routes to and from school - Has unexplained injuries - Appears anxious or shows low self-esteem - Has little or no appetite - Many medical excuses for not going to school (headache, stomach ache, etc.) without any real
medical issues other than psychological distress
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CYBERBULLYING
Definition: Bullying that takes place using electronic technology such as cell phones, computers, and tablets as well as communication tools (social media sites, text messages, chat, and websites).

"What makes cyber bullying so dangerous...is that anyone can practice it without having to confront the victim. You don't have to be strong or fast, simply equipped with a cell phone or computer and a willingness to terrorize" (King, 2006)
Warning signs a child may be a victim of cyberbullying
Upset after being online Upset after viewing a text message Withdrawn from social interaction with peers Possible drop in academic performance Targeted by on-campus bullying
NATIONALLY

Percentage of students age 12-18 who reported being cyber-bullied during the school year, NCES 2011

11.2 6.9

5.7 1.7

0.7 1.5

Male 4
1.5

Female
6.5 2.4

1.1 2.7

2.7 0.2

4 1

Total cyber bullying

Hurtfu l

Private

information on information

internet purposefully

shared on

internet

Subject of harassing
instant messages

Subject of Subject of Subject of

harassing text harassing e- harassment

messages

mails while gaming

Excluded online

The numbers above represent the percentage of students from ages 12 to 18 who reported being victims of cyberbullying anywhere during the 2010-2011 school year. The data above is collected a male student population of 12,857,000 and a female population of 11,824,000.

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According to the CDC 2013 Youth Risk Survey, 14.8% of students, nationwide had been electronically bullied during the 12 months before the survey; forms of bullying include instant messaging, e-mail,
websites, chat rooms, and texting. Overall, the prevalence rate was higher among females (21.0%) than males (8.5%), with the highest prevalence in non-Hispanic white (25.2%) and 9th grade (22.8%) females.

BULLYING ON SCHOOL PROPERTY

Percentage of High School Students who bullied on school property -

United States, Youth Risk Behavior Survey, 2013

27.3 16.2

10.2 15.1

20.7 14.8

Male

Female 29.2 20.8

28.8 15.8

20.3 13.1

11.2 15.5

NonHispanic NonHispanic Hispanic

White

Black

Grade 9 Grade 10 Grade 11 Grade 12

Nationwide, 20.1% of high school students reported that they were bullied on school property during the 12 months before the Youth Risk Behavior Survey (CDC, 2014). The prevalence rate was higher among female students (22.0%) than male students (18.2%), with 25.2% prevalence in non-Hispanic white females compared to 20.7% in non-Hispanic white males, 12.2% in non-Hispanic African-American females compared to 11.1% in non-Hispanic African-American males, and 19.3% in Hispanic females compared to 16% in Hispanic males. A similar pattern is seen across grade levels; in each grade level, the prevalence is higher in females than in males. Overall, a higher prevalence is seen in Grades 9 and 10, than in Grades 11 and 12. The most common location of school bullying is in the hallway or stairwell (45.6%) followed by the classroom (32.8%) and then outside on school grounds (22.1%).

STUDENT SAFETY CONCERNS

High schools students who did not go to school because they felt unsafe - United States, Youth Risk Behavior Survey, 2013
Female Male

Grade 12 Grade 11 Grade 10
Grade 9

5.9 5
5.8 5.3 5.5

8.1 10.7
9.9

Hispanic NonHispanic Black

12.6 6.9 8
7.8

NonHispanic White

7.4 3.8

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GEORGIA STUDENT HEALTH SURVEY DATA
In the 2012-2013 Georgia Student Health Survey 37,529 students reported that they had bullied others within 30 days of taking the survey while 75,201 students reported being victims of bullying within 30 days. When comparing grades 6 to 12, the prevalence rate of bullying was highest in the 6th, 7th, and 8th
grades, above all other grades.

Percentage of students in Georgia who reported being bullied,

2013

22.05

18.95

15.8

12.52

10.83

9.33

8.26

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Georgia Students reporting being picked on or teased at school, 2012-
2013

7%

9%

23%

11%

13%

20%

17%

Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

In the Georgia 2012-2013 Student Health Survey, a total of 62,804 students strongly agreed that they had been picked on or teased at school in the past 30 days prior to taking the survey. More students in 6th and 7th grade (23% and 20% respectively) reported being picked on or teased compared to other grade levels surveyed. Similarly to reports of bulling victimization, reports of experiencing teasing or being picked on decreased as grade level increased.

Percentage of Georgia High School Students who were electronically bullied, bullied on school property, and who did not
go to school because of safety concerns - Youth Risk Behavior Survey, 2013

Male Female

11.2

16.4

17.9

21.1

7.4

6.7

Electronically Bullied

Bullied on school property

Did not go to school because of safety concerns

According to the Youth Risk Behavior Survey (2013), among middle-school students, 18.4% reported being electronically bullied and 41% reported being bullied on school property.

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GEORGIA POLICIES ON BULLYING
Local Board of Education Each local board of education is expected to: 1. Adopt a policy that prohibits bullying between students; this prohibition is required to be included in the student code of conduct for schools in that school system. 2. When a disciplinary hearing officer, panel, or tribunal of school officials finds that a student in grades 6 through 12 has bullied another student for the third time in a school year, require that the student will be assigned to an alternative school. 3. Ensure that parents and students are informed of the prohibition against bullying and the associated penalties, by posting such information at each school and including the information in parent and student handbooks. 4. Establish and publish an approach for notifying the parent, guardian, or other person who has charge or control of a student when such student has committed an offense of bullying or is a victim of bullying.

Department of Education must develop a model policy on bullying that may be

revised periodically. This policy shall be posted on its website and will include:

1. A statement prohibiting bullying.

2. A requirement that teachers or other school employees report cases

of bullying.

3. A requirement that each school have a procedure for the school

administration to promptly investigate in a timely manner and

determine whether bullying has occurred.

\\

4. An age appropriate range of consequences for bullying which shall

include, at a minimum and without limitation, disciplinary

counseling or action as appropriate under the circumstances.

5. A statement prohibiting retaliation following a bullying report

6. A procedure for reporting or providing information on bullying

activity.

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PARENTS

Make sure your child feels (and is) safe and secure, and convey unconditional support. It is important to maintain and cultivate open lines of communication Be aware of what your kids are doing online o Educate your children about appropriate behaviors online; teach and reinforce
positive values and morals about how others should be treated with dignity and respect o Establish rules for technology use and inform your kids that you may review their online communications o Use blocking and filtering software as part of a comprehensive approach to online safety, not as the sole protection option Understand school rules and bullying policies and meet with school administrators, a counselor or trusted teacher as needed When appropriate, contact the police. Law enforcement should be contacted for the following crimes: o Threats of violence o Child pornography or sending sexually explicit messages or photos o Stalking and hate crimes o Taking a photo or video of someone in a place where he or she would expect privacy Talk to other parents through community organizations and through the school. This can be a way to raise awareness, to determine the extent of the problem, and to gain support
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SCHOOLS

Thoroughly investigate all incidents intervene consistently and appropriately in bullying situations Focus on the school environment Enlist the support of a school liaison officer Establish and enforce all school rules and policies related to bullying Increase adult supervision in places where bullying occurs Focus some class time on bullying prevention Form a group to coordinate the school's bullying activities Work with parents to convey to the student that bullying behaviors are taken seriously and not to be tolerated Train school staff in bullying prevention Incorporate anti-bullying school assembly programs Prove newsletters or letters to parents about cyberbullying. Newsletters may include: o Definition and examples of cyberbullying o Tips on responding to cyberbullying o Reporting cyberbullying at school o Safe use of social networking sites and social media o How to report abusive behavior and when to notify the police
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FOR TEENS

I'm Being Bullied
You Are NOT Alone! It's NOT Your Fault! You CAN DO Something about It

RECOMMENDATIONS FOR TEENS TO EDUCATE THEIR COMMUNITY
Teach your younger friends and relatives on safe and responsible online practices
Become a mentor Create informative posters Review your school bullying and cyber bullying policies
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SUBSTANCE ABUSE

Definition: pattern of harmful use of any substance exhibited by persistent and significant adverse consequences related to the repeated use of those substances. Consequences may include social and interpersonal conflicts, legal problems,

RISKS ASSOCIATED WITH SUBSTANCE ABUSE
High-risk behaviors (sexual activity; driving/passenger while intoxicated; failure to wear a seatbelt; self-injurious behaviors) Acute medical complications Social and Interpersonal Conflicts Involvement with the legal system Poor education outcomes Substance dependence
WHY SUBSTANCES ARE ABUSED
Lack of parental supervision Peer pressure Drug availability Poverty Major transitions in a person's life
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Prevention Programs
1. National Substance Abuse Prevention Month a month---long observance in October focused on the role substance abuse prevention plays in promoting safe and healthy communities. Access substance abuse prevention resources and materials for individuals and prevention professionals.
2. Stop Underage Drinking --- a comprehensive portal of Federal resources for information on underage drinking and ideas for combating this issue.
3. The Strategic Prevention Framework (SPF) uses a five---step process known to promote youth development, reduce risk---taking behaviors, build assets and resilience, and prevent problem behaviors across the life span.
4. Find Youth Info --- promotes the goal of positive, healthy outcomes for youth. 5. Safe Schools/Healthy Students --- a grant program designed to prevent violence and substance
abuse among our Nation's youth, schools, and communities. 6. Too Smart to Start --- helps youth, families, educators, and communities prevent underage
alcohol use and itsrelated probl ems . 7. Building Blocks for a Healthy Future --- provides parents, caregivers, and teachers of
children aged 3 to 6 the opportunity to find lots of great tips, materials, and ideas for spending time with their children and learning together. 8. National Registry of Effective Programs and Practices --- a searchable online registry of more than 160 interventions supporting mental health promotion, substance abuse prevention, and mental health and substance abuse treatment. 9. Communities That Care (CTC) --- a coalition---based community prevention operating system that uses a public health approach to prevent youth problem behaviors including underage drinking, tobacco use, violence, delinquency, school dropout and substance abuse. 10. Prevention Management Reporting and Training System --- provides substance abuse prevention resources, data collection, and reporting services. 11. Center for the Application of Prevention Technologies --- provides responsive, tailored, and outcomes---focused training and technical assistance to prevent and reduce substance abuse and associated public health issues across the lifespan. 12. Fetal Alcohol Spectrum Disorders (FASD) information and resources about the prevention and treatment of FASD.
13. Drug---Free Workplace --- addressing substance abuse prevention in the workplace through comprehensive drug---free and health/wellness workplace programs.
14. Native American Center for Excellence --- a national resource center for up---to---date information on American Indian and Alaska Native (AI/AN) substance abuse prevention programs, practices, and policies.
15. Medication Assisted Treatment --- the use of medications, in combination with counseling and behavioral therapies, to provide a whole---patient approach to the treatment of substance use disorders.
16. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital
17. Georgia Council on Substance Abuse Alcohol Prevention efforts: Be the Wall

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Substance Abuse in Georgia
For youth ages 12 to 18, in any given year: (2002-2008)
SUBSTANCES EXAMINED
Alcohol Binge drinking Marijuana Cocaine (all forms) Crack Cocaine Heroine Hallucinogens Inhalants Pain relievers Tranquilizers Stimulants Sedatives "Special Drugs" GBH, Adderall, non-prescription cold and cough medicines, ketamine, DMT, AMT or Foxy, and Salvia divinorum "Illicit drugs" marijuana/hashish, cocaine, heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used non-medically "Illicit drugs" (aggregated) include illicit drugs and special drugs

2015

The Healthy People 2020 Goal
In 2008, over 41,000 people died as a result of poisoning. One of the objectives in Healthy People 2020 is to reduce fatal poisonings in the United States. Poisoning mortality increased during the tracking periods of Healthy People 2010 and drugs (legal and illegal) cause the vast majority of poisoning deaths. Much of the increase in drug poisoning deaths is due to misuse or abuse of prescription drugs (opioid analgesic pain relievers)

The highest risk periods for drug abuse among youth appear during major transitions (elementary to middle school, middle school to high school, and high school to college or work). Strengthening protective factors at these stages of life are important steps towards prevention.

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SUBSTANCE USE AMONG MIDDLE AND HIGH SCHOOL STUDENTS IN GEORGIA, YOUTH BEHAVIORS SURVEY, 2013

Substance
Tobacco Alcohol (any) Marijuana Cocaine Inhalants Prescription drugs (Oxycotin, Percocet, Vicodin, codeine, Adderall, Ritalin, Xanax) without a prescription Ecstasy (MDMA)

% Middle School
Students 19.9% 24.7% 10% 3.2% 9.2% 6.7%

% High School
Students 40.4% 59.2% 35.9% 7% 9.9% 17.7%
7.1%

COSTS
National Institute on Drug Abuse o Abuse of tobacco, alcohol, and illicit drugs cost over $600 billion annually to the United States in costs related to crime, healthcare, and lost work productivity.

Healthcare

Tobacco Alcohol Illicit Drugs

$96 billion $30 billion $11 billion

Overall
$193 billion $235 billion $193 billion

MONITORING THE FUTURE SURVEY (8th, 10th, and 12th GRADERS)
o Cigarette smoking continues to fall to the lowest rate in the survey's history o Five---year trends showed significant decreases in alcohol use among all grades and across
nearly all prevalence periods o The use of Ecstasy showed a significant drop in the past year from 2011 to 2012 o Overall, the use of most illicit drugs has either declined or remained steady from 2011 to 2012 o Significant increases in marijuana use among 10th and 12th graders. o New synthetic marijuana (K2 or Spice) among 8th and 10th graders. Use of bath salts
reported by 0.8% of 8th graders, 0.6% of 10th graders, and 1.3% of 12th graders o Many drugs used by 12th graders are prescription or over---the---counter medications o The percent of 12th graders reporting the nonmedical use of Adderall has increased from 5.4%
in 2009 to 7.6% in 2012

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Establish school and community-based prevention programs that help children, teens, and adolescents: Strengthen their self-esteem and academic skills Resist social pressures to engage in substance abuse Improve decision-making and communication skills Manage stress and anxiety
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PRESCRIPTION DRUG ABUSE

Definition: Taking prescription meds in a way that wasn't prescribed to create an altered sate
Most Abused Prescription Drugs: 1. Opioids narcotic painkillers a. Morphine, Codeine, Oxycodone, Vicodin b. Symptoms of Abuse drowsiness, nausea, constipation, slowed breathing 2. Stimulants treat narcolepsy and attention deficit disorder a. Adderall, Ritalin, Concerta b. Symptoms of Abuse paranoia, increased body temperature, irregular heartbeat 3. CNS depressants treat anxiety and sleep disorders a. Xanax & Valium b. Slowed speech, shallow breathing, fatigue, disorientation, lack of coordination, seizures (with withdrawal of chronic use)
Risks Associated with Prescription Drug Abuse:
1. Immediate effects on your body 2. Could be fatal 3. Can become addictive 4. Gateway to other drugs 5. Wreaks havoc on "brain chemistry" especially in the developing brain (humans 0 to 30 years). 6. Costly monetarily. The cost to the individual, community, and society.
Why Prescription Drugs are Abused?
1. Attitude: a false sense of security; believing prescription drugs aren't as dangerous as illegal drugs
2. Availability: number of prescription drugs on the market and increased prescribing 3. Access: internet; medicine cabinets; receiving from family and friends 4. Awareness: more advertising over the internet, TV, billboards, and radio 5. Peer Pressure 6. Need additional energy or ability to focus (Ritalin and Adderall) 7. Need to cope with academic, social & emotion stress / "manage/regulate" their lives (Oxycotin
and Xanax) 8. To help with weight loss or to gain muscle mass (Amphetamines) 9. Humans insatiable need to experience ever increasing amounts of instant pleasure and avoid or
attempt to minimize all emotional and physical pain. We have a "Demand Problem" not a "Supply Problem". 10. Coping skills to deal with pain and the need for pleasure are not keeping up with the advertising promises of "easy fixes" with this drug or that drug. 11. Pharm parties (fishbowl parties)

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PATS KEY FINDINGS: Release April 23, 2013. 2012 Partnership Attitude Tracking Study, sponsored by MetLife Foundation
1 in 4 teens (24%) report having misused or abused a prescription drug at least once in their lifetime (up from 18% in 2008 to 24% in 2012), which translates to about 5 million teens. This is a 33% increase over a 5-year period
- Of those kids who said they abused Rx medications, 1 in 5 (20%) has done so before age 14
More than a quarter of teens (27%) mistakenly believe that misusing and abusing prescription drugs is safer than using street drugs
33% of teens say they believe "it's okay to use prescription drugs that were not prescribed to them to deal with an injury, illness or physical pain."
Almost 1 in 4 (23%) of teens say their parents don't care as much if they are caught using Rx drugs without a doctor's prescription, compared to getting caught with illegal drugs.
1/8 of teens (about 2.7 million) now report having misused or abused the Rx stimulants Ritalin or Adderall at least once in their lifetime.
9% of teens (about 1.9million) report having misused or abused the Rx stimulants Ritalin or Adderall in the past year (up to 6% in 2008) and 6% of teens (1.3million) report abuse of Ritalin or Adderall in the past month (up to 4% in 2008)
1 in 4 teens (26%) believe that prescription drugs can be used as a study aid.

NATIONALLY
Among persons aged 12 or older in 2009-2010 who used pain relievers non-medically in the past year, 55% reported obtaining the pain relievers they most recently used through a friend or relative for free, 11.4% reported purchasing them from a friend or relative, and 4.8% reporting taking them from a friend or relative without asking. Among 12th graders nationally, prescription and over-the-counter (OTC) medications are the most commonly abused drugs after nicotine, alcohol, and marijuana. Females aged 12-17 were more likely than males aged 12-17 to be current nonmedical users of physiotherapeutic drugs and current nonmedical users of pain relievers. Among 12th graders, whites tend to have the highest rates of use of a number of drugs, including OxyContin, Vicodin, amphetamines, Ritalin, Adderall sedatives and tranquilizers. Among 8th graders, Hispanics had the highest rate of illicit drug use overall and the highest rates for most drugs (though not for amphetamines, Ritalin or Adderall specifically
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2012 - The State of Prescription Drug Use in Georgia: A Needs Assessment

Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol. 61, No. 4. Youth Risk Behavior Surveillance United States, 2011. June 8, 2012

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DID YOU KNOW
An estimated $213 billion in 2012 healthcare spending in the United States was due to improper and unnecessary use of medicines, equivalent to 8% of the nation's total healthcare spending in 2012 according to the Burrill Report from IMS Institute for Healthcare informatics.
According to the Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol 61, No 4 (Youth Risk Behavior Surveillance United States, 2011, June 8, 2012)
a. The prevalence of having ever taken prescription drugs without a doctor's prescription ranged from 12.4% to 22.1% across state surveys (median: 17.6%) and from 7.3% to 18.3% across large urban school district surveys (median: 12.6%)
b. Among students nationwide, the prevalence of having ever taken prescription drugs without a doctor's prescription did not change significantly from 2009 (20.2%) to 2011 (20.7%).

GA State Policies:
1. Georgia Pain Management Clinic Act (Formerly House Bill 178) for the purpose of closing down pill mills in Georgia: requires all pain management clinics to be licensed and regulated by the Georgia Composite Medical Board. Additionally, all pain management clinics opened after June 30, 2013 must be owned by a licensed physician in Georgia.
2. Prescription Drug Monitoring Programs (PDMP), which are staterun electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients and identify problem prescribers and individuals misusing drugs, require mandatory utilization by prescribers
3. ID required: pharmacies are required to request identification prior to dispensing a controlled substance
4. Doctor Shopping Laws: laws to deter and prosecute people obtaining multiple prescriptions for controlled substances from different health care practitioners without their knowledge
5. Physical Exam: healthcare providers have to perform a physical exam of the patient before prescribing a controlled substance
6. Prescriber Education 7. Lock in programs: individuals suspected of misusing
controlled substances must use a single prescriber and pharmacy 8. "Think About It" Program offered by the Medical Association of Georgia Foundation is a campaign for the education about and prevention of prescription drug abuse composed of the following comprehensive initiatives:
Development of a Statewide Comprehensive Drug Policy
Safe storage and disposal of prescription drugs Education of both the public and professionals about the
dangers of and prevention of prescription drug abuse Website: www.rxdrugabuse.org 9. Georgia Prescription Drug Abuse Prevention Initiative (GPDAPI) of The Council on Alcohol and Drugs (TCAD) focuses on education, monitoring, proper medical disposal and enforcement to prevent and reduce prescription drug abuse in Georgia (www.stoprxabuseinga.org) 10. House Bill 965 provides immunities from certain arrests, charges of persecutions of persons seeking medical assistance for a drug overdose

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The Healthy People 2020 Goal
In 2008, over 41,000 people died as a result of poisoning. One of the objectives in Healthy People 2020 is to reduce fatal poisonings in the United States. Poisoning mortality increased during the tracking periods of Healthy People 2010 and drugs (legal and illegal) cause the vast majority of poisoning deaths. Much of the increase in drug poisoning deaths is due to misuse or abuse of prescription drugs (opioid analgesic pain relievers)

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Recommendations for Individuals
- Utilize Drug Drop Boxes to properly dispose medications (local drug dropbox locations can be found online at: www.stroprxabuseinga.org/prescription-drug-disposal) o Mark out information on the bottle only leaving the name of the medication o Take them to the Sheriff's Office o Drop them in the Drug Drop Box o What to Drop: Expired and unused prescriptions or ORC medications, medication samples, pet medications, inhalers, medicated ointment/lotion/drops and unopened epi-pens.
- Store all prescription and over-the-counter prescription medications in a secure place where children cannot acquire them o A "Medicine Safe" may be used to store prescription and over-the counter drugs (www.medicinesafe.com)
- If possible, lock away prescription medications - Keep a running count of how many pills are in each bottle or packet and keep track of refill dates and
amounts - Get help for substance abuse problems (1-800-622-HELP)
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INTIMATE PARTNER VIOLENCE

Definition: A pattern of abusive behavior or coercive control in any relationship that is used by one person to gain or maintain power and control over another (GCADV, 2014b

Emotional Abuse Psychological Abuse Economic Abuse

Sexual Abuse

Physical Abuse

Calling their partner names
Controlling of their partner
Blaming their partner when things go wrong
Preventing their partner from talking to people that can help
Humiliating their partner in public or with friends and family
Manipulating their partner
Acting jealous and isolating their partner from friends and family
Acting in ways that make their partner feel afraid

Brainwashing their partner or trying to make them confused about reality Secretly monitoring their partner through technology or other means
Forcing their partner to stay awake for long hours leading to chronic exhaustion
Using religion or other belief system to promote or defend their abusive behavior
Forcing children to engage in verbal or physical abuse of their partner
Threatening to have their partner deported if they are undocumented
Switching from violent behavior to kind behavior in order to regain partner's trust

Controlling the family money
Forcing their partner to give paychecks to the abuser
Not allowing their partner to work, go to school or attend other activities that would promote economic independence
Depriving their partner of money to pay for basic expenses
Trying to get their partner fired from work by calling repeatedly, showing up or starting conflict with their partner's co-workers
Taking away their partner/s passport, social security card, or other documents so they are unable to establish independence, financial or otherwise

Causing their partner to be hurt during sex Forcing their partner to perform sexual acts
Having affairs outside of the intimate relationship
Forcing their partner to have sex for money
Purposely infecting their partner with HIV/AIDS or a sexually transmitted illness (STI)
Sabotaging birth control

Pinching, poking, slapping, biting, pushing, punching, strangling, burning or cutting their partner Forcing their partner to take drugs
Hurting their partner's pet
Taking away their partner's assistance devices, such as TTY, glasses, medicine or ramp
Forcing partner to obtain an abortion or trying to force a miscarriage

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Common Risk Factors:
Risk factors are associated with a greater likelihood of intimate partner violence (IPV) victimization or perpetration. They are contributing factors and may or may not be direct causes. Not everyone who is identified as "at risk" becomes involved in violence.
A combination of individual, relational, community and societal factors contribute to the risk of becoming a victim or perpetrator of IPV. Understanding these multilevel factors can help identify various opportunities for prevention. Factors may include the following:
RISK FACTORS

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ELEVATED HEALTH CARE COSTS FOR VICTIMS OF IPV CAN PERSIST UP TO 15 YEARS AFTER ABUSE HAS ENDED

Some Possible Consequences

Depression

Traumatic brain injury

Anxiety

Cardiovascular Disease

Insomnia

Bladder/kidney infections

Posttraumatic stress disorder

Digestive Problems

Suicidal behavior

Severe menstrual problems

Sexually transmitted infections

Chronic pain syndromes

Unintended pregnancy

Central nervous system

Death

disorders

IPV NATIONALLY
Nationally, 1 in 4 American women will experience domestic violence at some point in their lifetime.
Most female and male victims of rape, physical violence, and/or stalking by an intimate partner (69% of female victims; 53% of male victims) experienced some form of intimate partner violence for the first
time before 25 years of age.
On average, 24 people per minute are victims of physical violence, rape, or stalking by an intimate partner in the United States.
IPV can occur in same-sex and in opposite-sex couples; it can also range from one incident to an ongoing pattern of violence.
Nearly 1 in 10 women in the United States (9.4%) has been raped by an intimate partner in her lifetime and an estimated 16.9% of women and 8.0% of men have experienced sexual violence other than rape by
an intimate partner at some point in their lifetime.
According to the U.S. Department of Justice, about 4 in 5 victims of intimate partner violence were female from 1994 to 2010. Most intimate partner violence was perpetrated against females . IPV resulted in 2,340 deaths in 2007 nationally; of these IPV victims, 70% were females
Women aged 20-24 years of age are at greatest risk for domestic violence by an intimate partner. Although estimates vary greatly, research indicates that as many as seven million children are exposed to domestic violence each year in the U.S. This is approximately one out of every ten children based on the
U.S. Census Data.

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IPV IN GEORGIA
Georgia in comparison to the U.S:
In 2012 Georgia was ranked 6th in the nation for rate of men killing women.
Intimate Partner Violence is a leading cause of injury for girls and women between the ages of 15 and 44. According to the National Domestic Violence Hotline, 57% of reported victims of dating abuse range from age 13-19 in Georgia.
According to the latest Center for Disease Control and Prevention, Youth Risk Behavior Surveillance (YRBS), Georgia ranks as the worst state in the nation for teens experiencing dating violence: One in six teen respondents to the YRBS (16%) indicates he or she has experienced some form of this abuse.6 Teen dating violence can also have long term consequences. Georgia's most recent Domestic Violence Fatality Review Report7 indicates that over one quarter (30%) of adult DV fatality victims were 15 to 24 years old when they began their relationship with the person who eventually killed them.

Georgia Alone:

According to the National Domestic Violence Hotline, in Georgia, 40% of calls requesting domestic violence services are from victims between the ages of 25-35. 69% of victims reported emotional abuse as the primary type of abuse. In 2013, Georgia had 116 domestic violence related deaths. Georgia is seeing increasing numbers of Domestic Violence fatalities since 2008. From 2003-2013, the counties with the leading number of domestic violence related deaths per 100,000 residents were: Clay, Calhoun and Telfair. By numbers the leading counties were Fulton, Cobb and Gwinnett.
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DDTDGSD
DID YOU KNOW?
The costs of IPV against women exceed an estimated $5.8 billion. These costs include nearly $4.1 billion in the direct costs of medical care and mental health care and nearly $1.8 billion in the indirect costs of lost productivity. Statistically, the overall total cost estimate of $5.8 billion varies from more than $3.9 billion to more than $7.6 billion, as indicated by the 95% confidence interval for the total costs
The largest proportion of the costs is derived from physical assault victimizations because that type of IPV is the most prevalent. The largest component of IPV costs is health care, accounting for nearly $4.1 billion--more than two-thirds of the total costs

Georgia is ranked 10th in the nation for the rate that men kill
women in single-victim homicides, most of which are
domestic violence-related murders.
Domestic violence fatality rates in Georgia have fluctuated from 2006 to 2013 with overall little change; however, there was a decrease from 2012 where there were 131 deaths caused by domestic violence in Georgia to 118 deaths in 2013 (Georgia Commission on Family Violence, 2013). By far, the largest percent of deaths were caused by firearms, followed by stabbing and strangulation.
In 2013: 58,955 crisis calls were made to Georgia's
certified domestic violence agencies
7,807 victims and children were provided refuge in a Georgia domestic violence shelter
Firearms were the cause of death in 72% of the recorded domestic violence fatalities

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DOMESTIC VIOLENCE AND CHILDREN
Children are exposed to domestic violence in many ways such as witnessing homicides, being forced to participate in the abuse, overhearing the abuse, witnessing or being forced to watch the abuse, or being
harmed in the course of a domestic violence assault (GCADV, 2013). Children exposed to domestic violence are at a higher risk of being victims of child maltreatment (Holt et al., 2008). Nearly 30% of domestic violence fatality cases included child maltreatment as reviewed by the Georgia Commission on Family Violence and the Georgia Coalition Against Domestic Violence. However the child is exposed to the violence, there are various implications on the child's behavioral, social, emotional, and cognitive health. The chart below presents some of the lifespan implications of exposure to domestic violence from
infancy to adolescence.

BEHAVIORAL SOCIAL

INFANTS
Fussiness Decreased responsiveness Trouble sleeping Trouble eating

PRESCHOOL AGE
Aggression Behavior problems Regressive behavior Yelling, irritability Trouble Sleeping
Trouble interacting with peers Stranger anxiety

SCHOOL AGE
Extreme and persistent: Aggression Conduct problems Disobedience Regressive behavior Fewer and low quality peer relations

EMOTIONAL/

Attachment

PSYCHOLOGICAL needs not met

Fear/anxiety, sadness, worry PTSD Negative affect Feeling unsafe Separation anxiety

Somatic complaints
Fear and anxiety, depression, low selfesteem, shame
PTSD
Limited emotional response

ADOLESCENTS
Dating violence Delinquency Running away Truancy Early Sexual Activity Dating violence (victim or perpetrator) Increased risk for ten pregnancy
Substance abuse Depression Suicidal ideation PTSD Feeling rage, shame Unresponsive

COGNITIVE PHYSICAL

Becomes learned Self-blame behavior

Self-blame Distracted, inattentive

Short attention span Pro-violent attitude

Academic problems

Defensiveness

Pro-violent attitude

Smaller in size, smaller head circumference, impairment of cognitive development

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CHILDREN ARE OFTEN THE SILENT VICTIMS OF DOMESTIC VIOLENCE. AS MANY AS 275 MILLION CHILDREN WORLDWIDE ARE EXPOSED TO VIOLENCE IN THE HOME

Percentage of DV fatality cases where others witnessed the homicide,

GA 2004-2013
18

10

11

1

2

4

6

Co-workers

New intimate partners

Friends

Family Members Strangers

Acquaintances or neighbors

Children

The Healthy People 2020 target to reduce children's exposure to violence from a baseline of 58.8% of children exposed to any form of violence, crime, and abuse in 2008, to 52.9% by 2020 (8% improvement).

The frequent exposure to domestic violence, whether hearing, experiencing, or seeing the violence, normalizes violence for children and increases their risk of becoming family violence victims and abusers.

Domestic violence can happen to anyone regardless of race, age, gender, sexual orientation, religion, of all socioeconomic backgrounds and education levels. Domestic violence not only affects those who are abused, but also has a substantial effect on family members, friends, co-workers, other witnesses, and the community at large. Children who grow up witnessing domestic violence are among those seriously affected by this crime. Frequent exposure to violence in the home not only predisposes children to numerous social and physical problems, but also teaches them that violence is a normal way of life therefore, increasing their risk of becoming society's next generation of victims and abusers.

Children Exposed to Domestic Violence:
Often, children exposed to domestic violence are the unseen victims of domestic violence because they are not always direct victims. Children are exposed to domestic violence in many ways, including the following:
overhearing the abuse witnessing or being forced to watch the abuse; observing injuries and bruises on a parent; being held hostage in order to force their partner's return home; being forced to participate in the abuse; being interrogated by the abuser about the victim's activities intervening in an assault to protect a parent; intentionally or unintentionally harmed in the course of a domestic violence assault; witnessing homicides, attempted homicides and/or sexual assaults.

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Witnessing domestic violence and experiencing child abuse can have devastating effects on children.

Research indicates children exposed to domestic violence are at an increased risk of being abused or neglected. A majority of studies reveal there are adult and child victims in 30 to 60 percent of families experiencing domestic violence. Children who are exposed to violence undergo lasting physical, mental, and emotional harm. They suffer from difficulties with attachment, regressive behavior, anxiety and depression, and aggression and conduct problems. They may be more prone to dating violence, delinquency, mental illness, further victimization or perpetration of violence, and involvement with the child welfare and juvenile justice systems. Moreover, being exposed to violence may impair a child's capacity for partnering and parenting later in life, continuing the cycle of violence into the next generation.

In 2013, children were in the vicinity and actually witnessed the homicide in 18% of Georgia's domestic violence fatality cases reviewed and in 40% of reviewed cases they were in the vicinity of the homicide but did not witness it.
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Prevention and Primary Intervention in Georgia:
Focus Area: Children Exposed to DV

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For Children:

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TEEN DATING VIOLENCE
Teen Dating Violence or TDV is a pattern of abuse or the threat of abuse against teenaged dating partners. TDV is the physical, sexual, or psychological/emotional violence within a dating relationship, which includes stalking. It can occur in person or electronically and may occur between a current or former dating partner. TDV occurs across diverse groups and cultures. It takes different forms, including verbal, emotional, physical, sexual, and digital abuse. The experience of being a victim of TDV has both immediate and long term effects on young people. Although the dynamics of TDV are similar to domestic violence among adults, the experiences of teen dating violence as well as the challenges in seeking and providing services make the problem of TDV unique.
RISK FACTORS

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AGE WHEN ABUSIVE RELATIONSHIP BEGINS - Georgia
Victim Abuser 51

36

31

26

25

16

13-24

25-34

35-44

66 45-54

12 55-64

00 65+

Georgia has higher rates of teen dating violence compared to the national average for both males and females. National rates of teen dating violence are similar between African-American nonHispanics and Hispanics, and slightly lower in Whites (Youth Risk Behavior Survey, 2011). In reviewed cases, a large number of abusive relationships start when the victim is young between the ages of 13 and 24 years old (Georgia Domestic Violence Fatality Review Project, 2013). Adolescent girls in abusive relationships are approximately six times more likely to become pregnant than girls
in non-abusive relationships (Decker, Silverman & Raj, 2005).

Percentage of high school students who experienced dating violence - Georgia vs. National Data

15.4

Georgia National

16.6

9.5

9.3

Male - Dating Violence

Female - Dating Violence

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In a one-day survey held on September 17, 2013, 35 out of 50 (70%) local domestic violence programs in Georgia were surveyed. These programs reported seeing 1,975 victims on that day.
The services provided by these local programs include: Advocacy related to disability issues Bilingual advocacy Emergency shelter Children's support or advocacy Advocacy related to mental health
Advocacy related to housing office/landlord Transitional housing
Advocacy related to teen victims of dating violence
In that one day, there were 248 unmet requests for services; 185 (65%) of those unmet requests were for housing. As a result, many victims either 1. Return to their abuser, 2. Become homeless, or 3. Live in their cars

Causes of Unmet Requests for Help?
37% reported reduced government funding 14% reported reduced individual donations 14% reported cuts from private funding sources
14% reported not enough staff
(nnedv 2014)

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Prevention and Primary Intervention in Georgia:
Focus Area: Teen Dating Violence (TDV) 1. Increased awareness of TDV and the need for prevention. 2. Increase education for adolescents about healthy relationships and how to recognize and prevent adolescent relationship abuse. 3. Increase school-based opportunities for adolescents to practice healthy relationship and peer behavior.

Recommendations for In-School Dating Violence Prevention
Involve teens in program development Implement programs in middle school and in the early high school years Utilize a comprehensive, ecologically informed approach, engaging all members of the school community Provide programming for the general student population and support for students who have experienced violence Reinforce positive messages and focus on healthy relationship education and skills Address affective, cognitive and behavioral domains and offer various teaching methods that stimulate and involve the active learning process Provide opportunities to teens to develop strong and positive relationships through leadership opportunities and mentoring
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Prevention and Primary Intervention in Georgia:
Focus Area: Public Awareness Campaign
1. Change public beliefs and attitudes about violence and abuse. 2. Increase public knowledge of risks factors, incidence of DV, and available resources. 3. Change public behaviors on disclosure, reporting, and responding to abuse.
Initiatives: Georgia Coalition Against Domestic Violence (GCADV) will obtain funding to pull together partners and experts to design and implement a comprehensive, integrated media campaign, with well promoted community events, seminars and trainings.

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Policy Goals for legislators and partners:

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MOTOR VEHICLE RELATED INJURIES

Under the authority and approval of Governor Nathan Deal, the Governor's Office of Highway Safety (GOHS) produces the annual Highway Safety Plan (HSP), which serves as Georgia's programmatic guide for the implementation of highway safety initiatives and an application for federal grant funding from the National Highway Traffic Safety Administration (NHTSA).
Georgia's Highway Safety Plan is directly aligned with the priorities and strategies in the Georgia Strategic Highway Safety Plan (SHSP) and includes a wide variety of proven strategies and new and innovative countermeasures. The Highway Safety Plan is used to justify, develop, implement, monitor, and evaluate traffic safety activities for improvements throughout the federal fiscal year. National, state and county level crash data along with other information, such as safety belt use rates, are used to ensure that the planned projects are data driven with focus on areas of greatest need. All goals and objectives of the Governor's Office of Highway Safety are driven by the agency's mission statement.

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In 2011, there were 1,223 motor vehicle fatalities in the State of Georgia. This is a 2% decline in roadway fatalities in comparison to the previous year and a 26% decline from 2007 roadway fatalities. Nine (9) counties in Georgia had no roadway fatalities in 2011. This same year (2011), there were 104,524 motor vehicle injuries and 296,349 motor vehicle crashes in Georgia. In 2010, the national average roadway fatality rate was 1.11 fatalities per 100 million vehicle miles traveled (VMT).
That same year, Georgia had a fatality crash rate of 1.12 fatalities per 100 million vehicle miles traveled (VMT). Although the Georgia fatality rate is high in comparison to the national average, this is the lowest fatality rate for Georgia in recorded history. The level of roadway exposure among Georgians has increased over time. The number of licensed drivers has steadily increased since 2003. In 2003, there were 5.5 million licensed drivers and 104 billion vehicle miles traveled in comparison to 2010 when there were 5.7 million drivers and 111 billion vehicle miles traveled.

The Highway Safety Plan (HSP)
Contains Education and Enforcement countermeasures for reducing motor vehicle related crashes, injuries and fatalities on Georgia roads. It also documents strategic, comprehensive, and collaborative efforts with the Engineering and Emergency Medical Services components to roadway safety in the State. This "5-E" approach will result in a balanced and effective strategy to saving lives on Georgia's roadways.
Governor's Office of Highway Safety (GOHS) plans to develop, promote, implement and evaluate projects designed to address those identified major contributing injury and fatal highway safety factors with the latest data available.

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STATEWIDE TRENDS

Although urban areas, such as Atlanta Metropolitan Counties (Clayton, Cobb, DeKalb, Fulton, and Gwinnet) have a higher number of crashes, rural areas have significantly higher fatality rates than urban areas.

Top 10 Counties with the highest motor vehicle fatalities in rank order (2011)

From 2009 to 2010, the fatality rates in rural areas have increased by 4%. In that same time period, overall fatality rates decreased by 5% and urban fatality rates decreased by 13% within the same time period

1. Fulton 2. DeKalb 3. Gwinnett 4. Cobb 5. Richmond 6. Clayton 7. Hall 8. Carroll 9. Chatham 10. Bibb

The total fatality 3-year average has declined by 17% in 2010 from the 2009, an average of 1,344 motor vehicle deaths with the last three years. The rural fatality 3-year average has steadily declined over the 5-year period, with an average annual decrease of 6%. On the other hand, the urban fatality 3-year average remained steady of the past five years

In 2011, 19% of all Georgia motor vehicle fatalities occurred in the top five counties. Although five of the ten counties with the highest 2011 fatalities decreased from the previous year, counties like Richmond, Cobb, Clayton, and DeKalb experienced an increase in fatalities.
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Driving under the influence of drugs and/or alcohol is a problem in Georgia
Over the past five years (from 2007 to 2011), 352 alcohol impaired fatalities occurred per year, representing on average 26% of all roadway fatalities a year. The lowest percentage of alcohol related fatalities occurred in 2009 with 331 deaths representing 25% of all fatalities in that year. In 2011, Georgia experienced the lowest number (277 counts) of alcohol related fatalities.
In 2011, the number of unrestrained fatalities for persons older than 5 years of age riding in passenger vehicles decreased by 2% from 428 unrestrained fatalities in 2010. The percentage of unrestrained fatalities among passengers in a moving vehicle has decreased from 53% in 2008 to 48% in 2011.
The Governor's Office of Highway Safety continues to address the issue of non- use (or gross misuse) of child passenger restraints in rural areas of Georgia. The Thunder Task Force enforcement campaigns indicate citation numbers for child passenger seats have dramatically increased in recent months. To address this issue, the Governor's Office of Highway Safety is continuing the emphasis on collaborations with rural law enforcement agencies through the expansion of the Highway Enforcement of Aggressive Traffic. (H.E.A.T) program, providing public awareness through the annual Child Passenger Safety Caravan, and encouraging increased rural participation in events including National Child Passenger Safety Week.

The HSP goals will be accomplished through several "countermeasures that work" best practices in programs and partnerships. Some goals are achieved through major enforcement and public awareness campaigns in conjunction with the national high--visibility mobilizations including the GOHS Highway Enforcement of Aggressive Traffic (H.E.A.T.) program, and the GOHS Thunder Task Force. Other goals are achieved through continuing partnerships with the Georgia Department of Public Health, the University of Georgia's Traffic Injury Prevention Institute (GTIPI), the Georgia State Patrol, and the Atlanta Fire Department. GOHS collaborates with these agencies in implementing national high---visibility enforcement campaigns, public TheawGeaorerngieassHicgahmwpaayiSganfse,tyasPlwanelcloarsecpheirlfdorpmasasnecnegmeresaasfuerteys fainttdinpgriostraittyiognosaalsnidnctlruadinei:ngs. Decrease traffic fatalities below the 2011 calendar year of 1,223 fatalities by December 31,
2014 to 1,169 fatalities.

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The Georgia Highway Safety Plan core performance measures and priority goals:
The Georgia Highway Safety Plan core performance measures and priority goals include:
Decrease the number of serious traffic injuries below the 2012 calendar base year average of 115,116 to 112,256 by December 31, 2014.
Decrease unrestrained passenger vehicle occupant fatalities in all seating positions by fourpercent (4%) from the 2011 calendar base year of 421 to 402 by December 31, 2014.
Decrease drivers age 20 or younger involved in fatal crashes from the 2011calendar base year of 165 to 152 by December 31, 2014.
Increase the rate of observed safety belt use from baseline 91.5% in 2012 to 92% by the end of FFY 2014 for drivers and front seat outboard passengers.
Maintain statewide observed safety belt use of front seat outboard in passenger from the 2012 calendar base year average usage rate of 91.5% to 92% by December 31, 2014.
Georgia Restraint Use Observational Survey

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MOTOR VEHICLE RELATED INJURIES CHILD PASSENGER SAFETY

Georgia Data relating to child passenger safety

YEAR

2009

2010

2011

2012

2013

Discharges Rate Discharges Rate Discharges Rate Discharges Rate Discharges Rate

MVC 674

27.1 770

30.9 735

29.5 654

26.2 595

23.9

MVC

2009
Deaths
98

2010
Rate Deaths
3.9 127

YEAR

2011

2012

Rate Deaths
5.1 103

Rate Deaths
4.1 78

2013
Rate Deaths Rate
3.1 104 4.2

**The above data was retrieved from OASIS for children 0-17 with measures caused by Motor Vehicle Crashes
Motor vehicle injury related deaths are higher in Georgia than the United States, with the U.S. death rates being 0.81 in 2009 and 0.61 in 2010 compared to the rates above.

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The Healthy People 2020 Goal
IVP---13: "Reduce motor vehicle crash---related deaths"
IVP---13.1: "Reduce motor vehicle crash---related deaths per 100,000 population"
Baseline: 13.8 deaths per 100,000 population Target: 12.4 deaths per 100,000 population
IVP---13.2: "Reduce motor vehicle crash---related deaths per 100 million vehicle miles traveled" Baseline: 1.3 deaths per 100 million miles Target: 1.2 deaths per 100 million miles
IVP---14: "Reduce nonfatal motor vehicle crash--- related injuries"
Baseline: 771.4 injuries per 100,000 population Target: 694.3 injuries per 100,000 population
IVP---15: "Increase use of safety belts" Baseline: 84% use of seat belts Target: 92% use of seat belts
IVP---16: "Increase age---appropriate vehicle restraint system use in children"

Cost Data Annual cost for motor vehicle related
injury/death is over $240 billion Medical costs amounting to $56 million
in 2005 Work loss costs amounting to $8.2 billion
in 2005
Best Practices for Prevention
Midnight driving curfew for teenagers to limit accidents
Provisional licensing for teenagers Child safety seat distribution + education
programs Booster seats for children who have
outgrown car seats Require children 12 years
and younger to sit in the backseat as airbags can harm children during an accident Increasing the age requirement to 7 or 8 years for car seat/booster seat use.
Education alone without distribution of needed car seats or safety equipment is not as effective as education + distribution programs.

Georgia Efforts toward Prevention Road blocks Department of Public Health mini grant program Car seat education and distribution programs (Safe Kids) Booster seat campaigns GOHS caravan

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MOTOR VEHICLE RELATED INJURIES PEDESTRIAN

Healthy People 2020 Goal IVP-18: "Reduce pedestrian deaths on public roads" (10 percent improvement) Baseline: 1.5
deaths per 100,000 population Target: 1.4 deaths per 100,000 population IVP-19: "Reduce nonfatal pedestrian injuries on public roads" (10 percent improvement) Baseline: 22.6 injuries per 100,000 population Target: 20.3 injuries per 100,000 population
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Cost data relating to pedestrian safety

$711 million total lifetime cost of motor---vehicle related fatalities for children in 2005 Medical costs including physical therapy and rehabilitation in the recovery period Emotional stress for the child who underwent trauma as well as the parent(s) Work loss for parents who must care for injured children
Best practices for prevention
Provide constant supervision for young children when they are around motor vehicles (parking lots, driveways, neighborhood streets)
Design safe neighborhoods with sidewalks, crosswalks, and traffic lights Educate older children about safe practices for walking in areas with traffic Education combined with the distribution of safety items
Educate teens about the risks of distracted driving/walking

Georgia Efforts toward Prevention

- Safe Routes to School - Safe Kids Walk this Way - PEDS - GOHS Programs

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**Georgia has a booster seat law until age 8**
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DROWNING

Definition: The process of experiencing respiratory impairment from submersion/immersion in liquid
Drowning can be classified as either fatal or non-fatal
Risk Factors

Costs Due to Drowning Deaths in Georgia, All Ages, 2005
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Outcomes of Drowning
Death Brain injury Damage to lung tissue Hypothermia Paralysis Decreased motor and coordination skills

Children age 5 and older are most likely to drown in natural bodies of water, while children younger than 5 are most likely to drown in swimming pools or bathtubs

Georgia Data for Child Drowning

YEAR

2009

2010

2011

2012

2013

Discharges Rate Discharges Rate Discharges Rate Discharges Rate Discharges Rate

Drowning 17

0.7 50

2.0 55

2.2 41

1.6 39

1.6

YEAR

2009

2010

2011

2012

Deaths Rate Deaths Rate Deaths Rate Deaths Rate

Drowning 36

1.4 39

1.6 32

1.3 27

1.1

2013

Deaths Rate

29

1.2

**The above data was retrieved from OASIS for children 0-17, with measures caused by drowning

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Medical costs amounting to $5.7 million in 2005 (CDC) Work loss costs amounting to $1.2 billion in 2005 (CDC)
Drowning injuries cost over $16 billion in 2000 (PIRE)

Great Lakes Surf Rescue Project, 2013
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Drowning Rates Differ by Age Group and Gender

Males have higher rates of drowning than females. In Georgia for the years 2008-2012, the age-adjusted death rate due to drowning for males aged 0-19 was 2.33 per 100,000, while the age-adjusted drowning rate for females was .65 per 100,000, according to the CDC. The difference in drowning rates between males and females is highest in the 5-19 year age group. This difference seems to stem partly from males engaging in more aquatic activity than females in the 5-19 year age group. These males report engaging in more activities with potential for submersion than females, and also report riskier aquatic behavior, such as alcohol use while swimming or boating, swimming alone, swimming at night, or swimming in natural bodies of water at higher rates than females (Howland et al., 1996).
Children aged 1-4 have the highest drowning rate as compared to other age groups. According to the CDC, unintentional drowning accounted for 23.3% of all injury deaths in children aged 1-4 in the United States in 2012. In Georgia for the years 2010-2012, the crude drowning rate for children aged 0-4 was 2.55 per 100,000. This rate was higher than the drowning rates for the age groups 5-9, 10-14, and 15-19, which were 1.29 per 100,000, .72 per 100,000, and 1.51 per 100,000, respectively. This high drowning rate for children aged 1-4 might be due to increased mobility at that age coupled with a lack of adequate supervision, appropriate flotation devices, or proper pool enclosures. Furthermore, children aged 1-4 tend to have decreased swimming ability as compared to older children and adults; this may contribute to the higher drowning rate (CDC WISQARS, 2012).
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Drowning Rates by Age Group and Drowning Type

The most common locations of drowning differ by age group. Infants less than one year old are more likely to drown in a bathtub, while children between the ages of 1 and 4 are more likely to drown in swimming pools. Children older than 4 are more likely to drown in natural water, such as rivers or lakes (Xu, 2014).
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Drowning Rates over Time

Healthy People 2020 Goal: 1.1 per 100,000

One Healthy People 2020 goal is to reduce the overall national drowning rate to 1.1 per 100,000. This would be a 10% decrease from the national drowning rate in 2007. The aggregate drowning rate in Georgia for the years 2008-2012 was 1.53 per 100,000, while the national rate was 1.28 per 100,000. The national drowning rate did not significantly change from 2008 to 2012.

NONFATAL DROWNING/SUBMERSION INJURIES IN THE U.S., 2009-2013

Age Group
0-4 5-9 10-14 15-19 All Ages 0-19

Number of Non-Fatal Drowning/Submersion Injuries
18,222 4,811 2,469 1,682 27, 184

Crude Rate
18.14 4.72 2.39 1.55 6.56

Age-Adjusted Rate
----6.57

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What is Georgia Doing?

Georgia Policies Aimed at Drowning/Submersion Injury Prevention for Public Swimming Pools
Fencing Regulations
1. The enclosure must be at least 4 feet tall
2. All gates or openings must be selflatching or self-closing
3. There must not be direct access to the pool enclosure from any dwelling
4. Above ground pools must have ladders or steps that can be secured to prevent access

Signage
1. Permanently visible "No Diving" signs for areas that are less than 5 feet deep 2. A "Warning No Lifeguard on Duty" sign if there is no lifeguard on duty 3. A safety rules sign containing the following, among other instructions:
a. Children should not use the pool without an adult in attendance b. Diving area must be clear of patrons before diving is permitted c. No running or rough play allowed

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Free or Low-Cost Prevention Strategies:
Proper supervision Emptying all tubs, buckets, or inflatable pools immediately after use Pool alarms/pool covers Parental or supervisor knowledge of resuscitation methods, such as CPR Limited alcohol use by either the swimmer or supervisor Employing lifeguards at community swimming pools or water recreation areas Proper signage that includes information on the depth of the water, whether or not a lifeguard is on duty, age restrictions, and other safety regulations Adherence by the consumers as well as the manufacturers and owners to any rules, laws or regulations regarding swimming areas

Looking for More Information?
http://oasis.state.ga.us/oasis/ http://www.cdc.gov/homeandrecreationalsafety/watersafety/waterinjuries-factsheet.html http://www.uscg.mil/ http://www.usace.army.mil/

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Recommendations for a Community Prevention Action Plan Education
1. Disseminate information to parents to increase awareness of drowning locations, age trends, and other risk factors through posters or pamphlets
2. Encourage parents, pool owners, and other supervisors to learn resuscitation methods, such as CPR 3. Advocate for universal or free swimming lessons or CPR instruction in the community 4. Develop and release water safety checklists for different aquatic areas, including swimming pools,
beaches, lakes, and water parks 5. Target high risk groups, such as parents of males or children between ages 1 and 4 6. Create partnerships with other health entities and education groups, such as Safekids, RedCross, or
YMCA
Communication
1. Highlight drowning/submersion stories in the news, or create PSAs to illustrate the need to learn CPR, have proper supervision, reduce alcohol use, and other ways to prevent drowning
2. Relay PSAs through several mediums, such as radios, billboards, television, and newspapers. 3. Target summer months and areas that have high recreational aquatic use 4. Put drowning prevention posters or pamphlets in public areas such as schools, libraries, health
departments or doctors' offices with water safety information
Policies
Provide support for laws around evidence-based strategies, such as four sided pool fencing or the use personal flotation devices Evaluate existing policies, such as lifeguard requirements, to determine any improvements or changes could be made to increase their effectiveness Strengthen enforcement of policies regarding the use of personal flotation devices and boating while intoxicated Advocate for swimming ability screening programs at summer camps
Health Care Providers
1. Pediatricians should educate parents and children on drowning prevention strategies 2. Primary care providers and pediatricians should encourage parents and children to learn CPR or
engage in swimming lessons 3. Collaborate with other health entities to provide pamphlets or support PSAs on drowning
prevention
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FIRE/BURNS
4.
Definition: Fatal or non-fatal injury that is a mechanism of fire can include burns or smoke inhalation and is defined as the severe exposure to flames, heat, or chemicals that leads to tissue damage in the skin or places deeper in the body; smoke inhalation to the upper airway, lower airway, or lungs that results in serious injury or death
Burn: An injury to the skin or other organic tissue caused by heat or due to radiation, radioactivity, electricity, friction, or contact with chemicals
Risk Factors

ADVERSE OUTCOMES OF FIRES/BURNS

PHYSICAL

PSYCHOLOGICAL

Death Amputation of one or more limbs Contracture (permanent shortening of a muscle, tendon, ligament, or joint) Scarring Disability Physical outcomes of smoke inhalation: confusion, fainting, seizures, and coma

PTSD Anxiety Phobias Decreased self-esteem

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Georgia Data for Child Hospitalizations due to Fire

YEAR

2009

2010

2011

2012

2013

Discharges Rate Discharges Rate Discharges Rate Discharges Rate Discharges Rate

Fire/Smoke 123

4.9 106

4.2 90

3.6 79

3.2 95

3.8

Exposure

Fire/Smoke Exposure

2009

Deaths Rate

22

0.9

2010

Deaths Rate

9

0.4

YEAR

2011

Deaths Rate

13

0.5

2012

Deaths Rate

7

0.3

2013

Deaths Rate

24

1.0

**The above data was retrieved from OASIS, for children 0-17 with measures with a cause of fire/smoke exposure

COST OF FIRE/BURN DEATHS IN GEORGIA FOR AGES 0-19, 2005

Healthy People 2020 Goal Reduce the national death rate from residential fires to .86 per 100,000. This would be a 10% reduction in the national death rate due to residential fires in 2007, which was .95 per 100,000. The annual death rates due to residential fires in Georgia have consistently been above the national rates since 2008.
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Nearly 75% of burns in young children are from hot liquid, tap water, or steam

Did you know?
Mortality from fire can be caused by smoke inhalation as well as a physical burn

Cooking is the leading cause of house fires

Fire/Burns Data and Statistics
Fire/Burn Death Rates Differ by Age Group and Race

Crdue Death Rate per 100,000

Average Annual Death Rates from Fire/Burns by Age Group and Race, U.S.,
2008-2012

2.5 2
1.5 1
0.5 0 0-4

5-9

10-14

Age Group

15-19

White Black American Indian/Alaskan Native Asian/Pacific Islander

Children between ages 0-4 are at the highest risk for burns. In Georgia in 2008-2012, the crude rate for children ages 0-4 was 1.25 per 100,000. One reason for this increased risk in this age group is that, for children of that age, cognitive development has not yet matched motor development. These children are just becoming able to move around, but do not yet have the mental capacity to know to avoid hot liquids or to escape in the case of a fire. (Warda et al., 1999).
Overall, black children are at higher risk of death from fire/burns than their white counterparts. The ageadjusted death rate for black children in Georgia aged 0-19 is .83 per 100,000 from the years 2008-2012, while the age-adjusted death rate for white children is .44 per 100,000. One factor that might be contributing to this disparity is the lack of the use of smoke alarms in non-white homes (Warda et al., 1999).

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Crude Rate per 100,000

Death Rates from Residential Fires over Time

Age-Adjusted Death Rates for All Ages due to Residential Fires, 2008-2011
1.4

1.2

1

0.8

0.6

0.4

0.2

0
Georgia United States

2008 0.96 0.83

2009 1.16 0.76

2010 1.08 0.73

2011 1.04 0.68

2012 0.82 0.62

Nonfatal Injuries due to Fire/Burns in Ages 0-19, U.S., 2009-2013

Age Group 0-4 5-9 10-14 15-19

Number of Injuries 63,297 21,706 15,654 28,107

Crude Rate per 100,000 318.59 105.52 75.81 132.84

Healthy People 2020 Goal: .86 per 100,000

Locations of Fire Causing Hospitalization in Georgia, 1999-2001

Unspecified, 21%

Other, 4%

Private Building, 22%

Not in Building, 10%
Ignition of Clothing, 10%

Ignition of Inflammable Material, 30%
Other/Unspecified Building, 3%

Most fires that led to hospitalization in Georgia from 1999-2001 were caused by ignition of inflammable material. Inflammable material is any material that is capable of catching fire easily and spreading fire quickly. For example, some clothes are made of inflammable fabrics, which can be dangerous if they catch fire. The second leading location was private buildings, which includes homes. Many locations of fires that led to hospitalizations were unspecified (Yeager et al., 2005).
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Fire/Burn Prevention

Evidence-Based Intervention Practices

Free or Low-Cost Interventions:
Fire extinguishers that are easily accessible Creating and practicing evacuation plans Keeping lighters/candles/matches/hot water out of reach of children Supervise children while they are in the kitchen or bathroom Turning off hot surfaces, such as stoves or ovens Knowledge of first aid to treat burns Stricter building codes and regulations, and enforcement of these regulations Mobile demonstration models used to train children on fire safety and escape methods (look at State Farm site regarding provisions of these models for training)

Georgia Regulations to Prevent Fire/Burn Injuries

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For Parents:
Have a meeting place identified. Do home fire drills. Have emergency numbers posted. Do regular smoke alarm checks Keep it simple. Children learn when the rules are straight forward and easy to remember. If you have preschoolers, you may want to introduce just one or two of the rules at a time. Use teachable moments. Reinforce your discussions about fire safety whenever the topic arises -- for example, when there is a fire in the news or in a book, or when you see a fire, ask your children what they would do if they were in that situation. Do it. Don't just say it! Children learn by doing and by following your example. Make a game of practicing a fast escape from each room in your house, especially at night when most deadly fires occur.

Know two ways out. Use a stopwatch and wait until everyone has gathered at your family's designated meeting place before you stop the timer. Work together to set a family record. Repeat yourself. Children need to hear and do things over and over before they remember them. Practice your family's escape plan 4 times every year Don't scare small children with too much
responsibility. In a dangerous situation, it's normal
for 3-6 year olds to forget things they've learned.
Make a game of practicing fire safety do they
become very comfortable with all of the rules.
Remind them to never hide. Go outside.

Other Recommendations to Prevent Fire/Burns

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FALLS

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Falls are the leading cause of non-fatal injuries for all children ages 0 to 19. In 2010, 127 youth died from a fall. The unintentional fall-related death rate declined from 20012010 (from 0.26 per 100,000 population to 0.15 per 100,000 population).
Falls are the leading cause of emergency room visits for nonfatal injuries. 2.8 million children visited emergency departments for fall-related injuries in 2010; 40 percent of them were toddlers. On average, over 275,000 children suffer traumatic brain injuries annually from falls. Annually, emergency departments treat more than 200,000 children for playground-related injuries.
According to Childstats.gov, in 20092010, there were 65 emergency department visits for falls per 1,000 children ages 1 4 and 31 visits for falls per 1,000 children ages 514. Falls accounted for 42 percent of injury visits for children ages 14 and 28 percent of injury visits for children ages 514. Falls was the leading cause of injury.
According to the CDC, there were 2,634,102 non-fatal fall injuries involving children 0-17 years of age in the US (2012).

According to the American College of Surgeons:
Falls among children and adolescents account for more than three million emergency department visits each year, and more than 40% occur among infants, toddlers, and preschoolers.
In contrast to ground-level falls in the elderly, males and children are more susceptible to falls from heights. Black males under age 5 are at particularly high risk.
Accounting for 5.9% of childhood deaths due to trauma, falls represent the third leading cause of death in children. Death due to falls is generally from a head injury.
Falls in children tend to be from balconies, windows, and trees and most frequently tend to occur in homes, followed by schoolyards and playgrounds.
Nearly three-quarters of falls from a height in children are unintentional. In children under age 5, falls of less than 2 meters rarely result in death, and the proposed
mechanism of injury should be investigated for inflicted trauma.
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Unintentional Fall Nonfatal Injuries and Rates per 100,000 2012, United States, All Races , Both Sexes, Ages 0 to 17
Disposition: All Cases

Race

Number of

Ethnicity

injuries

Population

All Races White Non-Hispanic
African-American Hispanic Other Non-Hispanic Not Stated

2,634,102 1,520,012
306,446 322,799 81,799 403,047

73,728,088 40,300,460
12,233,415 16,534,053
4,660,160 --

Unintentional Fall Nonfatal Injuries and Rates per 100,000

2012, United States, All Races, Both Sexes, Ages 0 to 17

Disposition: All Cases

Age (in Years)

Number of

Population

injuries

0

145,406

3,943,077

1

279,750

3,981,523

2

255,324

3,979,957

3

211,832

3,982,440

4

181,786

4,112,347

5

164,397

4,132,747

6

144,149

4,098,714

7

129,045

4,085,964

8

119,073

4,094,174

9

126,308

4,063,937

10

129,004

4,045,719

11

126,918

4,145,034

12

115,553

4,206,939

13

120,876

4,136,252

14

108,053

4,135,274

15

98,785

4,144,014

16

91,412

4,174,274

17

86,432

4,265,702

Crude Rate
3,687.62 7,026.21 6,415.25 5,319.15 4,420.50 3,977.90 3,516.92 3,158.26 2,908.36 3,108.02 3,188.67 3,061.92 2,746.71 2,922.35 2,612.95 2,383.80 2,189.89 2,026.20

According to OASIS, there were 69,680 emergency department visits due to fall injuries involving children 0---17 years of age in Georgia in 2012, 70,034 in 2011 and 66,589 in 2010.

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Georgia, Falls by County, All Counties, Ages <1 Year-17 Years, 2012

Number
Map Legend Counties

1 - 67 68 - 142 148 - 208 209 - 537 553 - 6,088

Highest incidences of fall-related injuries in Northwestern counties to include Floyd, Cherokee, Bartow, Gordon extending across to metro counties, Cobb, Fulton, Gwinnett.
* This underscores the importance of targeting these areas for localized fall injury prevention outreach.

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HOMICIDE AND VIOLENCE

According to the CDC, there were 340,428 violence-related deaths among children ages 0-17 in the US in 2012. The charts below show the number of non-fatal injuries:

Violence-Related All Injury Causes Nonfatal Injuries and Rates per 100,000 2012, United States, All Races 1, Both Sexes, Ages 0 to 17 Disposition: All Cases

Race/Ethnicity

Number of injuries

Population

All Races White Non-Hispanic Black Hispanic Other Non-Hispanic Not Stated

340,428 141,497 80,592 58,658*
8,119 51,562

73,728,088 40,300,460 12,233,415 16,534,053 4,660,160
-

Violence-Related All Injury Causes Nonfatal Injuries and Rates per 100,000

2012, United States, All Races, Both Sexes, Ages 0 to 17

Disposition: All Cases

Age (in Years)

Number of injuries

Population

Crude Rate

0

4,460

3,943,077

113.10

1

4,236

3,981,523

106.40

2

5,208

3,979,957

130.85

3

7,151

3,982,440

179.57

4

6,274

4,112,347

152.56

5

6,553

4,132,747

158.57

6

5,696

4,098,714

138.97

7

3,736

4,085,964

91.42

8

5,963

4,094,174

145.66

9

6,837

4,063,937

168.24

10

6,908

4,045,719

170.74

11

11,227

4,145,034

270.85

12

19,876

4,206,939

472.45

13

30,650

4,136,252

741.00

14

42,679

4,135,274

1,032.08

15

53,748

4,144,014

1,297.01

16

58,202

4,174,274

1,394.30

17

61,025

4,265,702

1,430.60

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YOUTH VIOLENCE
Youth violence is a public health crisis in the United States. Based on the most recent data available, approximately 20 percent of high school students report being bullied at school, and more than 30 percent report being in a physical fight. More than 656,000 young people ages 10 to 24 were treated in emergency departments for injuries sustained from violence in 2008. Homicide is the second leading cause of death among young people, with an average of 16 youth murdered every day.
In the state of Georgia, among middle school students, 30.4% reported ever carrying a gun, knife, or club, 55.3% reported being a physical fight in the past year, with 5.3% reporting being treated by a health care professional due to an injury from a physical fight (Youth Behavior Survey, 2013). Among high school students, 18.5% reported ever carrying a gun, knife, or club in the past month, 7.2% reported being threatened or injured with a weapon in the past year, 21.4% reported being in a physical fight in the past year, and 2.3% reported being treated by a health care professional due to an injury from a physical fight (Youth Behavior Survey, 2013).

According to the Johns Hopkins Urban Health Institute, homicide is the leading cause of death for African-American males between the ages of 15 to 34 in the United States. Risk factors such as gang activity, arguments, revenge, self-defense, robbery, and drug disputes contribute to the high numbers of homicides among teens and young adults.
In 2012, CFR committees reviewed 58 homicides reviewed in Georgia. Of those 44 were committed with a weapon and the weapon most frequently used was a firearm (21) and a person's body part (13). In 16 of the 58 reviewed homicides (28%), the perpetrator was the biological parent, step-parent, or adoptive parent. In six cases, the perpetrator was another relative, sibling, or grandparent (10%). In seven homicides, the perpetrator was a friend, acquaintance, or paramour of the victim (12%). In nine homicides, the perpetrator is listed as "Other", which includes law enforcement officers, homeowners defending themselves during a robbery, and rival gang members.
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Youth Violence Prevention
Nationally, there are many initiatives in place to address youth violence:
STRYVE, or Striving To Reduce Youth Violence Everywhere, is a national initiative led by the Centers for Disease Control and Prevention (CDC) to prevent youth violence before it
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organizations. The participation of community-based organizations, residents, faith-based groups, local businesses, and youth is also important to successfully prevent violence and to promote health and safety
The National Forum on Youth Violence Prevention is a network of communities and federal agencies that work together, share information and build local capacity to prevent and reduce youth violence. Established at the direction of President Obama in 2010, the Forum brings together people from diverse professions and perspectives to learn from each other about the crisis of youth and gang violence in the U.S and to build comprehensive solutions on the local and national levels

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SUICIDE

Definition:
Suicide: death caused by self-directed injurious behavior with any intent to die as a result of the behavior Suicide Attempt: non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury Suicidal Ideation thinking about, considering, or planning for suicide

The economic cost of suicide death in the U.S. is estimated to be $34.6 billion annually. With the burden of suicide falling most heavily on adults of working age, the cost to the economy results almost entirely from lost wages and work productivity.
No complete count is kept of suicide attempts in the U.S.; however, the CDC gathers data each year from hospitals on non-fatal injuries resulting from self-harm behavior. In 2013, the most recent year for which data is available, 494,169 people visited a hospital for injuries due to self-harm behavior, suggesting that approximately 12 people harm themselves (not necessarily intending to take their lives) for every reported death by suicide. Together, those harming themselves made an estimated total of more than 650,000 hospital visits related to injuries sustained in one or more separate incidents of self-harm behavior.
Because of the way these data are collected, we are not able to distinguish intentional suicide attempts from nonintentional self-harm behaviors. But we know that many suicide attempts go unreported or untreated, and surveys suggest that at least one million people in the U.S. each year engage in intentionally inflicted self-harm.

90% of individuals who complete suicide have a
diagnosable mental illness, 60% of those suffer with depression, and 50-75% of those in
need receive no treatment or inadequate
treatment.

Suicide Ranks 10th leading cause of death nationally but in our young (15 24, it) ranks at 2nd leading cause of death
Our Georgia rate is slightly lower than the national average but relationally our numbers continue to rise.
More than 1 million adults nationally reported attempting suicide in the last year with rates of attempted suicide lowest in Delaware at .1% and highest in Georgia at 1.5%.
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For every one youth suicide there are up to 200 attempts. This is a significant part of the data needed to consider a prevention strategy for youth.

Hospitalizations for suicide attempts from 2002 2006, (16,160 attempts) in Georgia resulted in $20 million dollars in hospital charges per year.

Healthy People 2020 goal: Decrease the suicide rate (age adjusted, per 100,000 population) from a baseline of 11.3 in 2007 to 10.2 in 2020. Georgia status, as of 2012, is 11.8 compared to the national 2012 rate of 12.9.
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Year
2008 2009 2010 2011 2012

National Suicide Deaths
36035
36909
38364
39518
40600

National Youth Deaths 4298
4371
4600
4822
4872

National Rate
11.8 12
12.4 12.7 12.9

GA State Ranking

State Rate

44 10.1 37 11.5 40 11.7 39 11.8 41 11.8

GA Losses

GA Youth Losses

981

124

1134

126

1133

145

1157

132

1168

129

FOR MORE INFORMATION
OASIS Online Analytical Statistical Information System - includes suicide loss data and emergency room visits and overnight stay data. http://oasis.state.ga.us/oasis/
High School and Middle School Youth Behavior Risk Survey Data Sheets and Youth Online System. http://nccd.cdc.gov/youthonline/App/Default.aspx?SID=HS
Georgia Student Health Survey II
http://www.gadoe.org/curriculum-instruction-and-assessment/curriculum-and-instruction/gshsii/Pages/Georgia-Student-Health-Survey-II.aspx
We know that the only way to impact the crisis of suicide is to use multiple strategies implemented simultaneously and sustained. Programming needs to support prevention, intervention and aftercare. The programs that Georgia is using and has found most impactful:
Multileveled School Intervention: including Protocol Development, broad gatekeeper training, resources development, Sources of Strength school based peer program www.sourcesofstrength.org
Lifelines: A Comprehensive Suicide Awareness and Responsiveness Program for Teens http://www.hazelden.org/web/public/lifelines.page. This program includes components for prevention, intervention and postvention.
Broadly training for counselors and support staff in CSSRS - Columbia Suicide Severity Rating Scale and Safety Planning. http://www.cssrs.columbia.edu/ and http://www.suicidesafetyplan.com/
Training on how to help adolescents in crisis: http://www.mentalhealthfirstaid.org/cs/take-acourse/course-types/youth/
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Highlights of what have we have accomplished in Georgia:

Want More Information?

Building Suicide Prevention Coalitions on a local level bringing

GSPIN - Georgia Suicide Prevention Information Network Website created and maintained by SPANGA through a grant with DBHDD, Suicide Prevention Program to create a single location for all prevention, intervention and aftercare network and information statewide. www.gspin.org

awareness, education, resources, support and trainings out into communities across Georgia. Starting at 0, we now have 14 active community coalitions with 4 more communities in the startup planning progress. Some of these coalitions cover multiple counties.

WHO World Health Organization http://www.who.int/mental_ health/suicideprevention/world_report_201 4/en/

Broadly training hundreds of community members, professionals, teachers, parents, pastors and any interested citizens in gatekeeper programs, QPR (Question, Persuade, Refer) and Mental Health First Aid. Implementing Suicide Prevention, Help Seeking and Resiliency Building programs for the middle and high schools throughout the state. Source of

AAS American Association of Suicidology www.suicidology.org
SPRC Suicide Prevention Resource Center, http://www.sprc.org/

Strength www.sourcesofstrength.org Bringing Intervention and Postvention programs to schools to give them a model for building teams within the school and community to help them

Georgia's State Plan: http://gspin.org/system/files/ filedepot/15/2001GAStatePl an.pdf

respond appropriately at the moment of a crisis. Responding to requests for support from local communities when suicide crises and clusters have emerged. Hosting, organizing and executing three Statewide Stakeholders

Sources of Strength (Free curriculum for Suicide Prevention) www.sourcesofstrength.com

Conferences with the last one having more than 400 attendees from all over

the state with representation from a broad variety of participants including professionals, survivors,

military, aging, faith, LBGT, Hispanic, Asian, veterans, and more. This was a three-day conference

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with multiple tracks designed to meet the needs of all participants. Hosting, organizing and executing five Statewide College Conferences to introduce programs and resources, and guide colleges in building teams or task forces to do prevention, intervention and aftercare work on campus to meet the needs of this high risk population. The fifth College Conference will be held in Macon May 16, 2014. Training, assisting and providing ongoing support for peers and professionals in leading Survivors of Suicide Support Groups. We have grown from 9 groups to 32 groups in Georgia with 4 more in progress. And as an extension of this work we have been able to offer families that have lost a loved one to suicide an annual family grief support camp - Camp SOS. May 2014 was the third year for Camp SOS Developed, printed and ongoing distribution of over 10,000 "Purple Packets" which deliver comfort and resource information to survivors of a suicide loss statewide, using the coalitions and support groups around the state as a part of the mass distribution system to funeral directors, hospitals, patients advocates, victims' advocates, first responders, and faith community among others, we have distributed thousands of packets to support survivors who themselves have an up to 5 times higher risk of suicide. While successfully executing the development of SOS Groups for adults, we were constantly asked, "but what about our kids". So we have held consultative meetings to develop a Georgia Model for SOS Groups for Children & Teens, The Starfish Program, and held our first "train the trainer" training in May 2013, with the first pilot program hosted in September 2013. A refresher course and a new train the trainer+ class held in October 2014. Providing training for professionals and those who work closely with families that have lost loved ones to suicide improving and increasing community resources. Built, maintain and grow a statewide suicide prevention information network, www.GSPIN.org with a Broadcast Network to connect all stakeholders: survivors, coalitions, colleges, the prevention community and others to all of the efforts, activities and trainings opportunities around the state. Training for Hospitals in suicide/suicide attempt discharge protocols. Partnering with NAMI GA to train First Responders in Crisis Intervention Team Training arming officers and EMS with skills to work with suicide attempters and survivors of suicide loss. Training for psychological autopsies for coroners and others close to suicide losses. Rolling out CSSRS (Columbia Suicide Severity Rating Scale) and Safety Planning to the provider network statewide. Hosted and/or supported conferences for the Aging Population, Military, Veterans, and others.
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Protective Factors

School and community connectedness

Cultural or religious beliefs discouraging suicide and promoting healthy living

Peer support and close social networks

Easy access to effective medical and mental health resources

Psychological or emotional well-being and strong problem-solving skills

Family support and connectedness to family and parental involvement

Safe school environment

Restricted access to alcohol and over-the-counter and prescription medications

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Each and every county/community in Georgia should organize a Suicide Prevention Coalition. This is the hub for developing, implementing and sustaining suicide prevention, intervention and aftercare work throughout their community (whatever area they choose to include be it an area within a county, a countywide effort, or a combination of counties working together for the entire population of all counties combined). The Suicide Prevention Program supported by SPAN-GA and other vendor agencies is available to help establish, share framework, organize, train and support on an ongoing basis the development and ongoing work of these coalitions. Information on an on-going basis about forming coalitions, organizing this work can be found at www.gspin.org/coalitions The foundation for this work is with the use of a program, Georgia's Suicide Safer Communities and the menu of options for evidence based suicide prevention, intervention, and postvention strategies. Each community should create a strategy to become a Georgia Suicide Safer Community and go to www.gspin.org/coalitions to see how to create a plan to achieve the ranking. This roadmap to community prevention includes pre-planning, awareness, identifying resources, funding, expansion of efforts and sustainability.
Recommended policy goals and partners

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REFERENCES

SAFE SLEEP
American Academy of Pediatrics. Task Force on Sudden Infant Death Syndrome. (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030-1039
American Academy of Pediatrics. (2012). A parent's guide to safe sleep. Retrieved from http://www.healthychildcare.org/PDF/SIDSparentsafesleep.pdf. Accessed 2 October 2014
CDC. (2014). Sudden unexpected infant death and sudden infant death syndrome. Retrieved from: http://www.cdc.gov/sids/index.htm. Accessed 2 October 2014
DHS. (2011). Safe sleep. Retrieved from http://dhs.georgia.gov/safe-sleep. Accessed 24 September, 2014 First Candle. Hospital safe sleep policy template. Retrieved from
http://rwjms.rutgers.edu/departments_institutes/pedspweb/divisions/sids/documents/FirstCandleH ospitalPolicyTemplate.pdf. Accessed 2 October 2014 First Candle. Safe sleep saves lives. Retrieved from http://www.firstcandle.org/cms/wpcontent/uploads/2013/08/SafeSleepSavesLives1.pdf. Accessed 2 October 2014 Fu, L. Y., Colson, E. R., Corwin, M. J., & moon, R. Y. (2008). Infant sleep location: associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations. Journal of Pediatrics, 153, 503-508 Healthy People. (2014). Maternal, infant, and child health data details. Retrieved from http://www.healthypeople.gov/node/3492/data-details Hunt, C. E., & Hauck, F. R. (2006). Sudden infant death syndrome. Canadian Medical Association Journal, 174 (13), 1861-1869 https://dfcs.dhs.georgia.gov/sites/dfcs.dhs.georgia.gov/files/related_files/site_page/Sleep%20Rela ted%20Infant%20Deaths.pdf. Accessed 2 October 2014 OCA. (2014). Georgia child fatality review panel: Annual report-calendar year 2012. Retrieved from https://oca.georgia.gov/sites/oca.georgia.gov/files/related_files/document/2012%20CFR%20Ann ual%20Report.pdf. Accessed 24 September, 2014 Safe to Sleep. (2014). What does a safe sleep environment look like? Retrieved from http://www.nichd.nih.gov/sts/about/environment/Pages/look.aspx Safe to Sleep. (2014). Ways to reduce the risk of SIDS and other sleep-related causes of infant death.
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Retrieved from http://www.nichd.nih.gov/sts/about/risk/Pages/reduce.aspx Salm Ward, T. C. (n.d.). Prevalence and Characteristics of Bed-Sharing Among Black and White Infants
in Georgia, 2004-2011. Manuscript in preparation. Schnitzer, P. G., Covington, T. M., Dykstra, H. K. (2012). Sudden unexpected infant deaths: Sleep
environment and circumstances. American Journal of Public Health, 102(6), 1204 1212 Vennenmann, M. M., Hense, H. W., Bajanowski, T., Blair, P. S., Complojer, C., Moon, R. Y., Kiechl-
Hohlendorfer, U. (2012). Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate? Journal of Pediatrics, 160, 44-48

MALTREATMENT
Afifi, T. O., Boman, J., Fleisher, W., & Sareen, J. (2009). The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample. Child Abuse & Neglect, 33, 139-147
The California Evidence-Based Clearinghouse for Child Welfare. (2014). Parent Partner Programs for Families Involved in the Child Welfare System. Retrieved from http://www.cebc4cw.org/topic/parent-partner-programs-for-families-involved-in-the-childwelfare-system/. Accessed 15 November 2013.
Carbaugh, S. F. (2004) Understanding shaken baby syndrome. Advanced Neonatal Care, 4(2), 105-116 CDC. (2004). Preventing shaken baby syndrome: A guide for health departments and community-based
organizations, a part of CDC's 'Heads Up' series. Retrieved from http://www.cdc.gov/concussion/pdf/preventing_sbs_508-a.pdf. Accessed 15 November 2013 CDC. (2004b). A journalist's guide to shaken baby syndrome: A preventable tragedy a part of CDC's "Heads Up" Series. Retrieved from http://www.cdc.gov/concussion/pdf/sbs_media_guide_508_optimized-a.pdf. Accessed 15 November 2014. CDC. (2014). Child Maltreatment: Definitions. Retrieved from http://www.cdc.gov/ViolencePrevention/childmaltreatment/definitions.html. Accessed 14 September 2014. CDC. (2014). Child Maltreatment: Risk & Protective Factors. Retrieved from http://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html. Accessed 10 September 2014. CPIR. (2014). Overview of early intervention. Retrieved from
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http://www.parentcenterhub.org/repository/ei-overview/. Accessed 1 December 2014 DHHS. (2013). Home visiting evidence of effectiveness review: Executive summary October 2011.
Retrieved http://www.acf.hhs.gov/sites/default/files/opre/homvee_executivesummary_rev10_15_2011.pdf. Accessed 1 December 2014 DHHS. (2013b). Child Maltreatment 2012. Retrieved from http://www.acf.hhs.gov/sites/default/files/cb/cm2012.pdf. Accessed 5 June, 2014. Dodge, K. A., & Coleman, D. L. (2009). Preventing child maltreatment: Community approaches. New York: Guiliford Press Fergusson D. M., Boden J. M., Horwood L. J. (2008). Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse and Neglect, 32(6), 607-619 Finkelhor, D., Jones, L., Shattuck, A., & Seito, D. (2013). Updated trends in child maltreatment, 2012. Crimes Against Children Research Center, 1-4 FRIENDS National Resource Center for CBCAP. (2009). Evidence-based and evidence-informed programs: Prevention program descriptions classified by CBCAP evidence-based and evidenceinformed categories. Retrieved from http://friendsnrc.org/joomdocs/eb_prog_direct.pdf Governor's Office for Children and Families. (2011). Fact sheet Child abuse and neglect prevention. Retrieved from http://children.georgia.gov/sites/children.georgia.gov/files/imported/vgn/images/portal/cit_1210/4 6/2/158972499Child%20Abuse%20and%20Neglect%20Prevention.pdf Governor's Office for Children and Families. (2012). Early Head Start Home Based Option. Retrieved from https://www.greatstartgeorgia.org/home-visiting-resource-center/evidence-based-modelsgeorgia/early-head-start-home-based-option. Accessed 11 November 2013. Governor's Office for Children and Families. (2012). What is HFG? Retrieved from https://www.greatstartgeorgia.org/home-visiting-resource-center/evidence-based-modelsgeorgia/early-head-start-home-based-option. Accessed 11 November 2013. Healthy People. (2014). Early and middle childhood. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/early-and-middle-childhood Krentz, J. (2010). Preventing shaken baby syndrome in North Carolina. North Carolina Medical Journal, 71(6), 584-586. HRSA. (2011). Maternal, infant, and early childhood home visiting. Retrieved from http://mchb.hrsa.gov/programs/homevisiting/. Accessed 5 December 2013 IDEAS. 2014. Family support services: A definition. Retrieved from
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http://www.ideas4kidsmentalhealth.org/definition-of-family-support-services.html. Accessed 14 September 2013 Lutzker, J. R., McGinsey, J. F., McRae, S., Campbell, R. V. (1983). Behavioral Parent Training: There's so much more to do. The Behavior Therapist, 6, 110-112 Min, M., Minnes, S., Kim, H., Singer, L. (2013). Pathways linking childhood maltreatment and adult physical health, Child Abuse & Neglect, 37(6), 361-373. National Center on Shaken Baby Syndrome. Physical consequences of shaking. Retrieved from http://www.dontshake.org/sbs.php?topNavID=3&subNavID=23. Accessed 11 June 2014. New York State Department of Health. (2010). Shaken baby syndrome description of the problem. Retrieved from http://www.health.ny.gov/prevention/injury_prevention/shaken_baby_syndrome/description.htm. Accessed 5 May 2014. Ompad, D. C., Ikeda, R. M., Shah, N., & Fuller, C. M/ (2005). Childhood sexual abuse and age at initiation of injection drug use. American Journal of Public Health, 95(4), 703-709 Oshri, A., Tubman, J., & Burnette, M. L. (2012). Child maltreatment histories, alcohol and other drug use symptoms and sexual risk behavior in a treatment sample of adolescents. American Journal of Public Health, 102 (S2), S250-S257 Prevent Child Abuse GA. (2013). Reducing Risks of Child Abuse and Neglect through Home Visiting Marcia Wessels, MPH [PowerPoint slides]. Retrieved from http://www.slideshare.net/phcomm/marcia-w-reducing-risks-of-child-abuse-and-neglect-throughhome-visiting-9413-1 Taylor, C. A., Guterman, N. B., Lee, S. J., & Rathouz, P. (2009). Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children. American Journal of Public Health, 99(1), 175-183 The Period of Purple Crying. What is the Period of Purple Crying? Retrieved from http://www.purplecrying.info/what-is-the-period-of-purple-crying.php. Accessed 8 July, 2014. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2013). Child maltreatment 2012. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statisticsresearch/child-maltreatment. U.S. Department of Health and Human Services. (2014). Parent Education Programs. Retrieved from https://www.childwelfare.gov/preventing/programs/types/parented.cfm. Accessed 5 December 2013.
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BULLYING
Center for the Study and Prevention of Violence. (2001). An overview of bullying. Retrieved from http://www.colorado.edu/cspv/publications/factsheets/safeschools/FS-SC07.pdf. Accessed 19 September 2014.
CDC. (2014). Youth Risk Behavior Surveillance United States, 2011. Retrieved from http://www.cdc.gov/healthyyouth/yrbs/index.htm. Accessed 5 April 2014
Department of Education and Early Childhood Development. (2013). Bully Stoppers. Retrieved from http://www.education.vic.gov.au/about/programs/bullystoppers/Pages/studentothers.aspx. Accessed 19 September 2014
Erase Bullying. (2012). Bullying...Be in the know. Retrieved from http://www.erasebullying.ca/bullying/bullying-risks.php. Accessed 19 September 2014.
Georgia Department of Education. (2011). Policy for prohibiting bullying, harassment and intimidation. Retrieved from http://archives.gadoe.org/DMGetDocument.aspx/GaDOE%20Bullying%20Policy_August%2020 11.pdf?p=6CC6799F8C1371F629903F3067606F26B2DA4EBDCB1753CDC36BAE8E54C30E C2&Type=D. Accessed 19 September 2014
Georgia Department of Education. (2014). Bullying Prevention Toolkit. Retrieved from http://www.gadoe.org/Curriculum-Instruction-and-Assessment/Curriculum-andInstruction/Pages/Bullying-Prevention-Toolkit.aspx
Goldammer, L., Swahn, M. H., Strasser, S. M., Ashby, J. S., Meyers, J. (2013). An examination of bullying in Georgia schools: Demographic and school climate factors associated with willingness to intervene in bullying situations. Western Journal of Emergency Medicine, 14(4), 324-328
Healthy People. (2014). Injury and Violence Prevention. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/injury-and-violenceprevention/objectives
Hinduja, S., Patchin, J. W. Overview of Cyberbullying. Retrieved from http://people.uwec.edu/patchinj/cyberbullying/white_house_conference_materials_Hinduja&Patc hin.pdf. Access 19 September, 2014
Hinduja, S., Patchin, J. W. (2013). Activities for teens: Ten ideas for youth to educate their community about cyberbullying. Retrieved from http://www.cyberbullying.us/teens_cyberbullying_prevention_activities_tips.pdf. Accessed 19 September 2014
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HRSA. (2011). Best practices in bullying prevention and intervention. Retrieved from http://www.wrightslaw.com/info/best.practices.bullying.pdf. Accessed 1 December 2014.
Kowalski, R. M., Limber, S., & Agaston, P. W. (2012). Cyberbullying: Bullying in the digital age (2nd e.d.). Malden, MA: Wiley-Blackwell
NCES. (2013). Indicators of school crime and safety: 2012. Retrieved from: http://nces.ed.gov/pubs2013/2013036.pdf. Accessed 1 April 2014.
NCES. (2013). Student reports of bullying and cyber-bullying: Results from the 2011 School Crime Supplement to the National Crime Victimization Survey. Retrieved from http://nces.ed.gov/pubs2013/2013329.pdf. Accessed 10 March, 2015
NCVC. (2014). Bulletins for teens: bullying and harassment. Retrieved from http://www.victimsofcrime.org/help-for-crime-victims/get-help-bulletins-for-crimevictims/bulletins-for-teens/bullying-and-harassment. Accessed 23 September 2014.
Olweus, D., Limber, S., & Mihalic, S. (1999). Blueprints for Violence Prevention: Vol. 9. The Bullying Prevention Program. Boulder, CO: Institute of Behavioral Science, University of Colorado.
Safe from Bullies. (2014. Consequences of bullying. Retrieved from http://www.safefrombullies.com/Consequences.aspx. Accessed 19 September 2014
Stop Bullying. Cyberbullying. Retrieved from http://www.stopbullying.gov/cyberbullying/index.html. Accessed 19 September 2014
Stop Bullying. What is bullying? Retrieved from http://www.stopbullying.gov/what-is-bullying/related-topics/early-childhood/index.html. Accessed 19 September 2014
Stop Bullying. Who is at Risk? Retrieved from http://www.stopbullying.gov/at-risk/effects/index.html. Accessed 19 September 2014
Utah State Office of Education. (2013). A model policy for bullying, cyberbullying, harassment, hazing and retaliation. Retrieved from: http://www.schools.utah.gov/law/Model-Policies-andProcedures/USOE-MODEL-POLICY-ON-BULLYING,-CYBERBULLYING,-HARA.aspx
WITS. Wits for Schools. Retrieved from http://web.uvic.ca/wits/schools/media-resources/print.php. Accessed 24 September 2014
Ybarra, M. L., Diener-West, M., & Leaf, P. (2007). Examining the overlap in internet harassment and school bullying: Implications for school intervention. Journal of Adolescent Health, 41, 542-550

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SUBSTANCE ABUSE
Casa Columbia. (2014). Can you prevent addiction? Retrieved from http://www.casacolumbia.org/addiction-prevention
Costs of substance abuse (2014). Trends & Statistics. National Institute on Drug Abuse. Retrieved February 3, 2015, from https://www.drugabuse.gov/related-topics/trends-statistics
Drug facts: High school and youth trends (2012). Monitoring the Future National Results on Drug Use. National Institute on Drug Abuse. Retrieved February 3, 2015, from http://www.drugabuse.gov/publications/drugfacts/high-school-youth-trends
Johnston, L., O'Malley, P., Bachman, J., & Schulenberg, J. (2012, January 1). 2012 Overview key findings on adolescent drug use. Monitoring the Future National Results on Drug Use. Retrieved February 3, 2013, from http://monitoringthefuture.org/pubs/monographs/mtf-overview2012.pdf
Mowry, J., Spyker, D., Cantilena Jr., L., McMillan, N., & Ford, M. (2014). 2013 Annual report of the American association of poison control centers' national poison data system (NPDS): 31st Annual report. Clinical Toxicology, 52, 1032-1283.
Substance Abuse and Mental Health Services Administration. (n.d.). Prevention and Behavioral Health. Retrieved from: http://captus.samhsa.gov/prevention-practice/prevention-and-behavioral-health
The Burruss Institute of Public Service and Research. (2011). Substance abuse in Georgia. Georgia Journal of Public Policy, 1(1), Article 5. Retrieved February 3, 2015, from http://digitalcommons.kennesaw.edu/gjpp/vol1/iss1/5

PRESCRIPTION DRUG ABUSE
Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance-United States, 2011. MMWR 2012;61(4):1-162.
Commonly Abused Prescription Drugs. (2011, October). National Institute on Drug Abuse. Retrieved February 3, 2015, from http://www.drugabuse.gov/sites/default/files/rx_drugs_placemat_508c_10052011.pdf
Executive Office of the President of the United States. (2011). Epidemic: Responding to America's prescription drug abuse crisis. Retrieved from https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf
Healthy Americans. (2013). Prescription drug abuse: strategies to stop the epidemic. Retrieved from
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http://www.healthyamericans.org/assets/files/TFAH2013RxDrugAbuseRpt16.pdf Johnston, L., O'Malley, P., Bachman, J., & Schulenberg, J. (2012, January 1). 2012 Overview key
findings on adolescent drug use. Monitoring the Future National Results on Drug Use. Retrieved February 3, 2013, from http://monitoringthefuture.org/pubs/monographs/mtf-overview2012.pdf Key Findings of 18th Annual: 2013 Partnership/Metlife Foundation Parents Attitude Tracking Study. (2013). Retrieved February 3, 2015, from http://www.drugfree.org/wpcontent/uploads/2013/04/PATS-2012-KEY-FINDINGS.pdf Mowry, J., Spyker, D., Cantilena Jr., L., McMillan, N., & Ford, M. (2014). 2013 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual report. Clinical Toxicology, 52, 1032-1283. National Institute on Drug Abuse. (2003). Preventing drug use among children and adolescents (in brief). Retrieved March 11, 2015 from http://www.drugabuse.gov/publications/preventing-drug-abuseamong-children-adolescents/acknowledgments Strasser, S., & Smith, M. (2012). The State of Prescription Drug Use in Georgia: A Needs Assessment. Retrieved February 3, 2015, from http://www.stoprxabuseinga.org/fileadmin/files/NeedsAssessment2.pdf Think About It. (2012). Advocate, educate, secure. Retrieved from http://www.rxdrugabuse.org/community-education.html

INTIMATE PARTNER VIOLENCE
ACOG. (2012). Intimate partner violence. Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-HealthCare-for-Underserved-Women/Intimate-Partner-Violence. Accessed 5 April, 2014
Black, M. C. (2011). Intimate partner violence and adverse health consequences: Implications for clinicians. American Journal of Lifestyle Medicine, 5(5), 428-439
Black, M. C. (2011). Intimate partner violence and adverse health consequences: Implications for clinicians. American Journal of Lifestyle Medicine, 5(5), 428-439
Campbell, J., Jones, A. S., Dienemann, J., Kub, J., Schollenberger J., O'Campo, P., Gelen, A. C., Wynne, C. (2002). Intimate partner violence and physical health consequences. Archives of Internal Medicine, 162(10), 1157-1163
CDC. (2011). National intimate partner and sexual violence survey: 2010 summary report.

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Retrieved from http://www.cdc.gov/violenceprevention/pdf/nisvs_executive_summary-a.pdf. Accessed 5 April 2014 CDC. (2012). Breaking the silence Public health's role in intimate partner violence prevention. Retrieved from http://www.cdc.gov/cdcgrandrounds/archives/2012/june2012.htm. Accessed 19 September 2014 CDC. (2014a). Injury Prevention & Control. Retrieved from http://www.cdc.gov/violenceprevention/nisvs/. Accessed 19 September 2014 CDC. (2014b). Youth Risk Behavior Surveillance United States, 2011. Retrieved from http://www.cdc.gov/healthyyouth/yrbs/index.htm. Accessed 5 April 2014 CDC. (2014c). Intimate Partner Violence. Retrieved fro http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html. Accessed 19 September 2014 CDC. (2014d). Understanding teen dating violence. Retrieved from http://www.cdc.gov/violenceprevention/pdf/teen-dating-violence-2014-a.pdf. Accessed 19 September 2014 Crofford, L. J. (2007). Violence, stress, and somatic syndromes. Trauma Violence Abuse 8, 299313 Decker, M., Silverman, J., Raj, A. (2005). Dating violence and sexually transmitted diseases/HIV testing and diagnosis among adolescent females. Pediatrics, 116, 272-276 Find Youth Info. (2014). Teen Dating Violence. Retrieved from http://findyouthinfo.gov/youth-topics/teen-dating-violence. Accessed 19 September 2014 Fisher, D., Lang, K. S., Wheaton, J. (2010). Training professionals in the primary prevention of sexual and intimate partner violence: A planning guide. Atlanta (GA): Centers for Disease Control and Prevention Georgia commission on family violence, Georgia Coalition Against Domestic Violence. (2014). Domestic violence in Georgia. Retrieved from http://w2.georgiacourts.gov/gcfv/files/DV%20in%20Georgia%20Facts%202014%20Updates(3). pdf. Accessed 19 September 2014. GCADV. (2014) Georgia Domestic Violence Fatality Review Project. Retrieved from: http://gcadv.org/wp-content/uploads/2014/03/2013-Fatality-Review-Report-Final.pdf. Accessed 10 March 2014 GCADV. (2014b). About domestic violence. Retrieved from

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http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html. Accessed 17 September 2014 Georgia Bureau of Investigation. (2014). 2012 summary report: uniform crime reporting (UCR) program Georgia crime information center. Retrieved from http://gbi.georgia.gov/sites/gbi.georgia.gov/files/related_files/site_page/2012%20Crime%20Statis tics%20Summary%20Report.pdf. Accessed 19 September 2014 Healthy People. (2014). Injury and Violence Prevention. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/injury-and-violenceprevention/objectives Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: A review of the literature. Child Abuse & Neglect, 32, 797810. Leserman, J., & Drossman, D. A. (2007). Relationship of abuse history to functional gastrointestinal disorders and symptoms. Trauma Violence Abuse, 8, 331-343 Lockhart, L. L., & Danis, F. S. (2010). Domestic violence: intersectionality and culturally competent practice. New York: Columbia University Press NNEDV. (2014). Domestic violence counts 2013: A 24-hour census of domestic violence shelters and services. Retrieved from: http://nnedv.org/downloads/Census/DVCounts2013/Census13_FullReport_forweb_smallestFileSi zeWhiteMargins.pdf. Accessed 10 July 2014 NNEDV. (2014). 2013 domestic violence counts: A 24-hour census of domestic violence shelters and services. Retrieved from http://nnedv.org/downloads/Census/DVCounts2013/State_Summaries/DVCounts13_StateSumma ry_GA.pdf. Accessed 10 July 2014 Rivara, F. P., Anderson, M. L., Fishman, P., Bonomi, A. E., Reid, R. J., Carrell, D., & Thompson, R. S. (2007). Healthcare utilization and costs for women with a history of intimate partner violence. Roberts, T. A., Klein, J. D., Fisher, S. (2003). Longitudinal effect of intimate partner abuse on high-risk behavior among adolescents. Archives of Pediatrics & Adolescent Medicine, 157 (9), 875 981 Silverman, J. G., Raj, A., Mucci, L., Hathaway, J. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicide. JAMA, 286(5), 572-579 The American Congress of Obstetricians and Gynecologists. (2012). Committee on Health Care
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for Underserved Women. Retrieved from http://www.acog.org/Resources-AndPublications/Committee-Opinions/Committee-on-Health-Care-for-UnderservedWomen/Intimate-Partner-Violence. Accessed 19 September 2014 Unicef. 2006. Behind closed doors: the impact of domestic violence on children. Retrieved form http://www.unicef.org/protection/files/BehindClosedDoors.pdf. Accessed 18 September 2014 Warshaw, C., Brashler, B., & Gill, J. (2009). Mental health consequences of intimate partner violence. In C. Mitchell & D. Anglin (Eds.), Intimate partner violence: A health based perspective (pp. 147-171). New York: Oxford University Press.
MOTOR VEHICLE RELATED INJURIES
2012 Georgia Highway Safety Plan (2012). Governor's Office of Highway Safety. Retrieved February 3, 2015, from http://www.gahighwaysafety.org/docs/2012hsp.pdf
Gray, A., Shakir, M., White, T., Dixon, C., Sanford, R., & Perrin, K. (2012). Georgia Child Fatality Review Panel Annual Report 2011. Retrieved February 3, 2015, from https://oca.georgia.gov/sites/oca.georgia.gov/files/related_files/document/CFR Annual Report 2011.pdf
Healthy People 2020 (2014). Injury and Violence Prevention Retrieved February 5, 2015, from http://www.healthypeople.gov/2020/topics-objectives/topic/injury-and-violenceprevention/objectives
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Webbased Inquiry Statistics Query and Reporting System [database]. Retrieved February 3, 2015, from www.cdc.gov/injury/wisqars/index.html.
National Highway Traffic Safety Administration. Fatality Analysis Reporting System (FARS), Retrieved February 3, 2015, from http://www.nhtsa.gov/FARS
Naumann RB, Beck LF. Motor vehicle traffic-related pedestrian deaths, United States, 2001-2010. Morbidity & Mortality Weekly Report 2013; 62:277-282. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6215a1.htm
Online Analytical Statistical Information System (2014). Georgia Department of Public Health. Retrieved February 3, 2015, from https://oasis.state.ga.us/
Safe Kids Worldwide (2007). Latest Trends in Child Pedestrian Safety: A Five Year Review. Retrieved

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[GEORGIA ACTION PLAN FOR CHILD INJURY PREVENTION]

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February 3, 2015, from http://www.safekids.org/sites/default/files/documents/ResearchReports/Latest Trends in Child Pedestrian Safety A Five-Year Review - October 2007.pdf

DROWNING
Asher, K. N., Rivara, F. P., Felix, D., Vance, L., & Dunne, R. (1995). Water safety training as a potential means of reducing risk of young children's drowning. Injury Prevention, 1(4), 228233. doi:10.1136/ip.1.4.228
Beeck, E. F. van, Branche, C. M., Szpilman, D., Modell, J. H., & Bierens, J. J. L. M. (2005). A new definition of drowning: Towards documentation and prevention of a global public health problem. Bulletin of the World Health Organization, 83, 853856.
Branche CM, Stewart S. (Editors). Lifeguard Effectiveness: A Report of the Working Group. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2001.
Brenner, R. A., Taneja, G. S., Haynie, D. L., Trumble, A. C., Qian, C., Klinger, R. M., & Klebanoff, M. A. (2009). Association between swimming lessons and drowning in childhood: A case-control study. Archives of Pediatrics & Adolescent Medicine, 163(3), 203. doi:10.1001/archpediatrics.2008.563
Cummings, P., Mueller, B.A., & Quan, L. (2011). Association between wearing a personal floatation device and death by drowning among recreational boaters: A matched cohort analysis of United States Cost Guard data. Injury Prevention, 17(3), 156-159.
Diekema, D. S., Quan, L., & Holt, V. L. (1993). Epilepsy as a Risk Factor for Submersion Injury in Children. Pediatrics, 91(3), 612.
Great Lakes Surf Rescue Project. Signs of Drowning. Available at: http://glsrp.org/signs-of-drowning/. Accessed October 2014.
Heap, D. (2014, July 17). State-by-state guide to pool signage and fencing requirements. Retrieved from http://www.signs.com/blog/state-by-state-guide-to-pool-signage-and-fencingrequirements/#georgia
Howland, J., Hingson, R., Mangione, T. W., Bell, N., & Bak, S. (1996). Why are most drowning victims men? Sex differences in aquatic skills and behaviors. American Journal of Public Health, 86(1), 9396.
Kyriacou, D. N., Arcinue, E. L., Peek, C., & Kraus, J. F. (1994). Effect of immediate resuscitation on
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[GEORGIA ACTION PLAN FOR CHILD INJURY PREVENTION]

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children with submersion injury. Pediatrics, 94(2). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Web-
based Inquiry Statistics Query and Reporting System [database]. Available at: www.cdc.gov/injury/wisqars/index.html.Accessed: October 2014. Quan, L., Gore, E. J., Wentz, K., Allen, J., & Novack, A. H. (1989). Ten-year study of pediatric drownings and near-drownings in King County, Washington: Lessons in Injury Prevention. Pediatrics, 83(6), 10351040. Thompson, D.C., & Rivara, F.P. (2000). Pool fencing for preventing drowning in children. The Cochrane Database of Systematic Reviews, (2), CD001047. Xu JQ. Unintentional drowning deaths in the United States, 19992010. NCHS data brief, no 149. Hyattsville, MD: National Center for Health Statistics. 2014.
FIRES/BURNS
Alnababtah, K., Khan, S., & Ashford, R. (2014). Socio-demographic factors and the prevalence of burns in children: an overview of the literature. Paediatrics and International Child Health, 2046905514Y.000. doi:10.1179/2046905514Y.0000000157
Clouatre, E., Pinto, R., Banfield, J., & Jeschke, M. G. (2013). Incidence of hot tap water scalds after the introduction of regulations in Ontario: Journal of Burn Care & Research, 34(2), 243 248. doi:10.1097/BCR.0b013e3182789057
DiGuiseppi, C., Roberts, I., & Li, L. (1998). Smoke alarm ownership and house fire death rates in children. Journal of Epidemiology & Community Health, 52, 760761.
Fire Protection and Safety (2011). Regulation of Fire and Other Hazards to Persons and Property Generally. In Georgia Code (2). Retrieved from http://www.mcs360.com/documents/compliancedoc/CO/Georgia,%20State%20%20Smoke%20Detector.pdf
Fire Safety Handbook (2014). Fire Safety Handbook for Apartment Managers. In Gwinnett County Fire & Emergency Services. Retrieved from https://www.gwinnettcounty.com/static/departments/fire_emergency/pdf/Fire%20Safety%20Han dbook%20for%20Apartment%20Managers.pdf
Fire Safety for Kids (2014). Fire Safety for Parents. Retrieved from http://www.firesafetyforkids.org/parents.html
Forjuoh S., & Gielen A. (2012). Burns. In World Report on Child Injury Prevention (4).
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Retrieved from http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf?ua=1 Georgia Department of Community Affairs (2007). Georgia State Amendments to the
International Fire Code. Retrieved from http://www.dca.state.ga.us/development/constructioncodes/programs/downloads/codespdf/IFC%2 02007.pdf Hwang, V., Duchossois, G. P., Garcia-Espana, J. F., & Durbin, D. R. (2006). Impact of a community based fire prevention intervention on fire safety knowledge and behavior in elementary school children. Injury Prevention, 12(5), 344346. doi:10.1136/ip.2005.011197 National Fire Protection Association (2014). Fast Facts About Fire. Retrieved from http://www.nfpa.org/safety-information/fire-prevention-week/fast-facts-about-fire Warda, L., Tenenbein, M., & Moffatt, M. E. K. (1999). House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury. Injury Prevention, 5, 145150. White, M. G. (2014). Free Fire Safety Posters. Love to know safety. Retrieved from http://safety.lovetoknow.com/Free_Fire_Safety_Poster World Health Organization (2014). Burns. Violence and injury prevention. Retrieved from http://www.who.int/violence_injury_prevention/other_injury/burns/en/ Yeager DM, Wu M, Mertz KJ, Dawson L, Mesfin J, Lindemer K, & Powell KE. Profile of injuries in Georgia 2005. Georgia department of human resources; Division of Public Health; Injury prevention section and chronic disease, injury, and environmental epidemiology section, 2005. Publication number DPH05-044HW.
FALLS
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. National Action Plan for Child Injury Prevention. Atlanta (GA): CDC, NCIPC; 2012. Retrieved from http://www.cdc.gov/safechild/pdf/National_Action_Plan_for_Child_Injury_Prevention.pdf
Childstats.gov Forum on Child and Family Statistics. Child Injury and Mortality. Retrieved from http://www.childstats.gov/americaschildren13/phenviro7.asp
Online Analytical Statistical Information System. Georgia Department of Public Health. Retrieved from https://oasis.state.ga.us/
Parachute. Child Injury Prevention (Ages 0-6) Images Fall Prevention. Retrieved from http://www.parachutecanada.org/child-injury-prevention/gallery/fall-prevention-images
Safe Kids Worldwide. (2014). Falls Prevention Tips. Retrieved from http://www.safekids.org/tip/falls-
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prevention-tips Schermer, C. (2002, October 17). Injuries Due to Falls from Heights. American College of Surgeons.
Retrieved from https://www.facs.org/quality-programs/trauma/ipc/falls
HOMICIDE and Violence
2011_Violent Deaths in GA Report-GVDRS.pdf. (n.d.). Retrieved from https://dph.georgia.gov/sites/dph.georgia.gov/files/2011_Violent%20Deaths%20in%20 GA%20Report-GVDRS.pdf
CDC Features - STRYVE to Prevent Youth Violence. (2012, October 15). Retrieved from http://www.cdc.gov/features/youthviolence/
David-Ferdon, C., Simon, T. R. Taking Action to Prevent Youth Violence: A Companion Guide to Preventing Youth Violence: Opportunities for Action. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2014
Georgia. Division of Family and Children Services. (2012). Child fatality review annual report. Retrieved from Georgia Dept. of Human Resources, Division of Family and Children Services website: https://oca.georgia.gov/sites/oca.georgia.gov/files/related_files/document/2012%20CFR %20Annual%20Report.pdf
About the National Forum | FindYouthInfo. (2014, April 8). Retrieved from http://findyouthinfo.gov/youth-topics/preventing-youth-violence/about-national-forum
SUICIDE

American Association of Suicidology: Facts and Statistics. (2015, January). Retrieved from http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2013datapgsv2alt.pdf
American Foundation for Suicide Prevention: Facts and Figures. (n.d.). Retrieved from https://www.afsp.org/understanding-suicide/facts-and-figures
Center for Disease Control. (n.d.). Retrieved from http://www.cdc.gov/violenceprevention/pdf/Suicide-DataSheet-a.pdf
Center for Disease Control and Prevention. (2013). High School YRBS - Questions. Retrieved from http://nccd.cdc.gov/youthonline/App/QuestionsOrLocations.aspx?CategoryId=C1
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Center for Disease Control and Prevention. (2013). Middle School YRBS - Questions. Retrieved from http://nccd.cdc.gov/youthonline/App/QuestionsOrLocations.aspx?CategoryId=C 1
Data Chart | Healthy People 2020. (2015, February 3). Retrieved from http://www.healthypeople.gov/2020/data/Chart/4804
McNeill, Paul, editor. (2012). National suicide prevention strategy: Goals, objectives, resources. Retrieved from http://www.surgeongeneral.gov/library/reports/national-strategy-suicideprevention/full_report-rev.pdf
Mental Health and Mental Disorders | Healthy People 2020. (n.d.). Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mentaldisorders/objectives
NASP Resources. (n.d). Preventing Youth Suicide Tips for Parents and Educators. Retrieved from: http://www.nasponline.org/resources/crisis_safety/suicideprevention.aspx
Substance Abuse and Mental Health Services Administration. Preventing Suicide: A Toolkit for High Schools. HHS Publication No. SMA-12-4669. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2012.
Suicide Prevention Coalitions in Georgia | GSPIN. (2007). Retrieved from http://www.gspin.org/CoalitionsInGeorgia

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ACKNOWLEDGEMENTS

The following individuals contributed to the research, development, or review of this Action Plan. Their efforts are greatly appreciated.

Randy Clayton, Georgia Governor's Office of Highway Safety
Malaika Shakir, Georgia Child Fatality Review
Kristen Sanderson, Safe Kids Georgia
Morgan Barnett, Safe Kids Georgia
Britni Overall, Georgia Poison Control Center
Julia Neighbors, Prevent Child Abuse Georgia
Emily Paynter, Georgia State University
Lisa Dawson, Georgia Department of Public Health
Sherri McGuinness, Georgia Suicide Prevention Action Network

Kim Washington, Georgia Division of Family and Children's Services
Deborah Chosewood, Georgia Department of Public Health
Peggy Walker, Judge, Douglas County Juvenile Court
Chinyere Nwamuo, Georgia Child Fatality Review
Jyll Walsh, Prevent Child Abuse Georgia
Arleymah Gray, Georgia Child Fatality Review
Injury Prevention Program, Georgia Department of Public Health
Terri Miller, Georgia Department of Public Health

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