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The CDC has helped support the growth and visibility of injury research and prevention as a legitimate field of research that can have an immediate impact on people's health. Bright young scientists are drawn in because they see the ability to change the world quickly.

In late June, the Centers for Disease Control and Prevention (CDC) released its injury research agenda forecasting the direction for injury research at CDC from 2002 to 2007. According to its press release, injury is the leading cause of death in the United States in the first four decades of life.

"The research agenda has a table showing each age group and the top 10 causes of death in the United States," says Rick Waxweiler, associate director for extramural research at CDC. "Below age one, it is congenital anomalies. From age one to age 34, unintentional injuries are the No. 1 cause of death. If you add homicide and suicide to the unintentional injuries, you come up with even larger numbers so that injuries as a whole are the No. 1 cause of death up to age 44."

Waxweiler refers to an Institute of Medicine (IOM) report that compared years of life lost due to diseases and the amount of money the federal government puts in to researching those diseases. "The ratios are overwhelming when you compare injuries to diseases like cancer and heart disease," he says. "It is out of kilter in terms of the impact on society and the amount of money put in to research to address the topic."

With little money allocated for injury research, Waxweiler says CDC must be very wise and efficient to make sure dollars are spent in high-priority areas. "For the money we do have available, we or other organizations prioritize which problems need to be solved first," he continues. "Injury is a very broad field and CDC targeted 95 priorities. By making these problems visible, it will provide a catalyst for other people to become interested in funding injury research."

The priorities are divided into seven areas, which encompass injury prevention and control.

According to Waxweiler, the agenda does not address occupational injury since the National Institute for Occupational Safety and Health has developed a research agenda for occupational safety and health.

"Within each of these areas, we listed key priorities we think are important," says Waxweiler. "In child maltreatment, our first priority is to evaluate strategies to disseminate and implement science-based parenting interventions. We reviewed literature and scientists told us research exists that shows parenting interventions can reduce and prevent child maltreatment."

CDC anticipates the agenda will encourage researchers in other fields to try the field of injury prevention. "They will see how exciting these problems are and how close we are to solving them," shares Waxweiler. "This is applied research; we only need the last few pieces of research to solve problems and we can begin to save lives."

CDC invites scientists to apply for funding to study subjects in the research agenda. Request for Applications (RFAs) are announced each year on the CDC's Web site at www.cdc.gov.

Proving its commitment to injury research and prevention, CDC funds millions of dollars of research at universities around the country. "We have a suicide research center at the University of Nevada, Las Vegas, 10 centers that focus on youth violence and 11 injury control research centers that focus on all forms of injury. We are actually building a scientific field," says Waxweiler. "We test the scientific knowledge we learn from university research and see if it works in the community. For instance, can we get bicycle helmets on children and see the injury rate go down?"

PhDs Ruth W. Edwards, Pamela Jumper Thurman and Barbara Plested, director and research associates respectively, of the Tri-Ethnic Center for Prevention Research at Colorado State University (CSU) promote a Community Readiness Model that can be used as a research tool to assess readiness across a group of communities or as a tool to guide prevention efforts at the community level.

"The CDC likes the model because it takes effective prevention strategies and works them into a community so they are appropriate for whatever the community is ready to accept," says Edwards. "The first thing we did was the intimate partner violence project, which was useful in understanding different cultures. The model provides an understanding of different prevention strategies for different cultures [and conveys] messages the community is ready to hear."

As Plested explains, when you are looking at the level of readiness, what is the community ready to do? "We are always ready to do something, but a lot of times we implement interventions that are too intense or too far along the continuum if the community is not even aware there is a problem," she says. "We did some work with the Colorado Injury Control Research Center at CSU looking at traumatic brain injury in the Rocky Mountain Region due to skiing, recreational injuries and farming accidents in rural communities. For example, we came up with scores for randomly selected communities and developed [injury prevention] strategies that might be appropriate for a ski resort community."

A CDC conference in Denver cited the lack of participatory community research. "This Community Readiness Model really puts participation into play," says Thurman. "It puts the power in the hands of the community and makes certain the community does what it is ready to do, in its own time and in its own context. I think that guarantees more success than if someone goes in and says, 'This is what you have to do.'"

Thurman tells the story of a community in Alaska that experienced 18 youth suicides in six months. "You can image the impact of 18 youth suicides in a community of 600 people," she shares. "One woman came to the center asking us to present a model. We expected 15 to 20 people to attend. Instead, there were more than 100 people from six villages. Each of the six villages assessed their community at the workshop and developed their action plan based on their level of readiness. In the last year, they haven't had a single suicide." Students became peer supporters and educated themselves on the signs of suicide. Alternative activities included the pairings of a youth and an elder who walked together. It improved their health, gave them an alternative activity and mentored a youth with an elder.

"They did creative things that pulled on their strengths and that is the key element," says Thurman.

While the Community Readiness Model was created independently of CDC's injury prevention efforts, it fits in well with CDC's philosophy and method of delivery.

"A number of people at the CDC have embraced it and encouraged it," says Edwards. "We use the model across the United States and in other countries. It is so intuitive that people latch on to it. They use it for just about anything you can think of. There has to be recognition of the problem, ownership of the problem and a groundswell of interest in it. Once you introduce the model, people get it. The average citizen can make a difference."

Proof that it only takes one person comes via an Alaskan woman who decided she didn't like all of the drinking taking place in her village of 80 people.

"She started at the lowest stage [in the model] and now 25 percent of the village is in treatment," says Thurman. "They no longer tolerate drunken behavior on the street. They have activities for youth to prevent them from drinking. They still have problems, but the strides they are making are amazing. That was one woman who decided to make those changes."

As Edwards reiterates, the model is a tool for introducing change. "It is a methodology for implementing programs or a tool for getting the most out of programs," she says.

As a scientist, David Hemenway, PhD, director of the Harvard Injury Control Research Center and the Harvard Youth Violence Prevention Center, believes the more we know, the more we can determine the cause of injuries, think of strategies to reduce injuries and have good science to evaluate what does and doesn't work. "There are things that sound like good ideas but don't necessarily work," he says. "The slogans about buckling up for safety, for instance. A lot of money was spent and it seemed to have no effect at all. The data doesn't seem to show that motor vehicle inspection laws have any effect on safety."

If you die before the age of 40 in the United States, you are more likely to die from an injury rather than a disease. "Until the mid-1980s, the majority of federal interest and research was on diseases and injuries were neglected," says Hemenway. "It is still somewhat neglected, but this is an area where good research can make a big difference. We do a lot of work to understand and prevent youth violence. We are looking at gun violence and evaluating various programs. In Boston, there is an innovative program when a child is injured or arrested by the police, they try to find the correct social services agency to intervene because these kids will be at great risk for perpetration and for being victims of violence and injuries."

Unfortunately, there are many elements that come into play when it comes to injuries and violence: malicious parents, less-than-stellar schools, an unsafe environment or poor expectations. "If it was one simple answer, you could say, 'Do X,' but it is not that way," says Hemenway. "People are very complicated. The solutions are interesting and complicated. You have to figure out the best, most reasonable ways to make changes that will improve society in terms of reducing violence and injuries without hurting society in other ways."

The key thing you learn, continues Hemenway, there is no one cause to injury or a violent act. "What is exciting is that there are lots of places to intervene," he says. "Many possible interventions can reduce the likelihood of violence. In Boston, for example, there is a program that takes inner-city kids in the 6th and 7th grade to Thompson Island to give them a different experience. We are trying to see if that reduces violence among them and their peers. It makes them feel better about themselves and they understand the importance of teamwork."

Says Hemenway, "What you learn in public health is that things don't change quite as rapidly as you hope. If people of good will are able to spend their time and energy to improve things, you make slow and steady progress. Progress has been and can be made."