Deb Karch, PhD

Guest blogger: Deb Karch, PhD

I wrote my first suicide note when I was 13 years old. I hid it and the many more that followed in my stamp collection, books or other secret hideaways, all places I knew my mom would never look.  For the next 15 years, each time I packed up my belongings for another move, I would find another one I had forgotten about. I would read each one with dismay.  I learned the hard way that an overdose only resulted in having to drink a thick black charcoal concoction with one ankle strapped to a bed frame to keep me from taking off.  Running the car in the garage took far too long and two rounds of Russian roulette proved me to be a very lucky woman.  

By my late 20’s, I’d racked up a number of inpatient psychiatric stays and had gone through more than a couple psychiatrists.  All were missed opportunities for a correct mental health diagnosis, finally culminating in a psychologist telling me “I was too smart to be doing all this.” That was it. I swallowed a lethal dose of prescription medication and waited for the inevitable.  A friend found me under a tree, unconscious.  I was 42 years old.     

A few months later I met the psychiatrist who saved my life.  After one session, he properly diagnosed me with rapid cycling Type 1 bipolar disorder. The proper combination of medications forever changed my life.  Only a few weeks later I was driving down the interstate in a state of peace I had never experienced before. It occurred to me ‘This is what regular people feel like.’  I smiled to myself and began the journey of recovery and learning how to really live. I know I am not alone, that there are many others out there just like me. 

This is why I do what I do.

Suicide is the 10th leading cause of death among Americans. But suicide deaths are only part of the problem. Like me, more people survive suicide attempts than actually die. No one needs to feel the pain I did – and no family ever needs to lose a loved one to suicide. My role at CDC is to collect and analyze surveillance data on violent death, including suicide.  One way I do this is with the National Violent Death Reporting System (NVDRS).  NVDRS captures death certificate, coroner/medical examiner and law enforcement report information on all violent deaths in 18 US states, and combines them in a single data file. NVDRS also includes information on demographics, weapons, toxicology, victim-suspect relationships, precipitating circumstances or risk factors, and a narrative to better understand the violent death incident.  Researchers can then use this information to help inform prevention efforts.

NVDRS is one of many things CDC’s Injury Center is doing to prevent injuries and deaths caused by violence, including suicide. You can learn more about all of our work by visiting www.cdc.gov/violenceprevention/suicide.

And if you or someone you know is in emotional distress or having a suicidal crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). You can also visit them online: www.suicidepreventionlifeline.org.

Life is worth living.

Dr. Karch is Surveillance Team Lead, Etiology and Surveillance Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA.  She is the lead science officer for the National Violent Death Reporting System (NVDRS) and is working on projects linking NVDRS data to the Department of Defense Suicide Event Reports, state Adult Protective Services data, and National Center for Child Death Review records. In addition to NVDRS, her primary area of interest is in preventing elder suicide and elder abuse and neglect.  Dr. Karch received her Ph.D. in 1994 in Social Science from Texas Woman’s University and has published numerous manuscripts on surveillance and violent death prevention.  Prior to coming to CDC, Dr. Karch was a medico-legal death investigator at the state of New Mexico Office of the Medical Investigator. 

You have probably asked yourself, “When should someone step in to protect a child from violence from a parent or caregiver?”  What is your role and when are you overstepping your bounds? I heard a story recently that really made me pause and think about this very issue.

In a recent trip through an airport, a colleague witnessed two moms with young, fussy babies – both navigating a busy airport, and both looking exhausted and frustrated. One mother attempted to quiet her baby down by slapping the baby’s leg while saying, “Shut up. I said, shut up!” This resulted in the baby crying more and the mother becoming more upset. The other took a different approach, “Shhhhh. I know sweetheart. I’m tired too. We’re almost there.”

Replaying this in her mind, my colleague told me, “Both mothers were so similar. Both babies were about the same age and each mom had the same type of stroller and baby equipment.  But their reactions couldn’t have been more different. It makes me wonder about the environments they may have grown up in, and what might have caused them to handle a crying baby the way they each did. I also thought about the lives their babies may have, one growing up in a nurturing environment and one where violence plays a role.”

We know from research done by the Center on the Developing Child at Harvard University that these early childhood experiences are built into our bodies. Child abuse, neglect or violence can actually affect the development of a child’s brain – impacting the child now and for years to come. Our Adverse Childhood Experiences (ACE) study shows a connection between child maltreatment and some of the nation’s worst health problems, including depression and heart disease.

The cost of child maltreatment impacts all of us, whether we are a survivor, personally know someone impacted by it, or have been fortunate enough not to experience violence as a child. In fact, the total lifetime cost of child maltreatment in just one year of confirmed cases (physical, sexual, and psychological abuse, and neglect) is about $124 billion to society at large. This includes costs associated with childhood health care, child welfare, and adult medical costs as well as criminal justice costs and productivity losses.

Each death due to child maltreatment had a lifetime cost of about $1.3 million, almost all of it in money that the child would have earned over a lifetime if he or she had lived. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke or type 2 diabetes.

Given this substantial economic burden, the benefits of prevention likely outweigh the costs for effective programs which underlie our goal – to stop child abuse and neglect from happening in the first place.  Our key approach to preventing child maltreatment is through promoting safe, stable, and nurturing relationships between children and their parents or caregivers. By doing this, we can have a positive impact on more than just children. We have an opportunity to effect change in families, schools, neighborhoods, and our society. We can do this by fostering communities that support parents and take responsibility for preventing abuse, by helping develop supportive family environments, and by making sure parents have adequate housing and access to health care and social services.

We all have a role in supporting safe, stable and nurturing relationships. Visit www.cdc.gov/violenceprevention/childmaltreatment to learn more about what you can do in our community. And the next time you see a frustrated parent, maybe you can offer some words of encouragement or find another way to help.

Dr. Lee Annest

You see crashes on the roads all of the time, but you don’t ever think it’ll actually happen to you.  My wife and I were driving down a crowded interstate in Atlanta a couple of years ago when a speeding car swerved and crashed into our van, and then we were hit by three other cars going 65 mph.   The fact that we walked away with only stiff necks and minor injuries seemed like a miracle….or was it?  We were wearing our seat belts and our van took the brunt of the impact because of good engineering and front and side air bags.  I do what I do at the CDC Injury Center because I believe that little things like wearing seat belts and air bags really do save lives, and I have good reason to believe.     

My role at CDC is to help people see facts – data and statistics – in ways that reveal how and where injuries and violence happen, and how they can be prevented.  One way we do this is with WISQARS™ (Web-based Injury Statistics Query and Reporting System), a system that compiles injury data from multiple databases.  It produces reports and maps that help people easily identify rates for specific types of injuries, nationally or in certain counties or states, and among specific groups of people.  Once people see what the problems are, where they occur, and who is affected, they can target prevention activities to protect people at highest risk.  I believe one thing that CDC does best is surveillance, and I know that I’ve helped provide a service to the public by putting injury data at their fingertips.  

CDC’s Injury Center is celebrating its 20^th Anniversary this year!  In that time, we’ve accomplished many surveillance milestones in addition to creating WISQARS:  

• Establishing the National Electronic Injury Surveillance System (NEISS) All Injury Program which monitors causes of nonfatal injuries that bring people to U.S. hospital emergency departments.
• Collaborating with national and global injury data experts to develop standard frameworks for reporting fatal and nonfatal injury data using International Classification of Disease (ICD) codes.

I believe that in the future we will be able to make even greater strides in understanding the root causes of injury and violence, how to best work together to prevent them.  With our data collection systems, we can see that geographic and demographic patterns of fatal and nonfatal injury rates for those at high risk are that way for a reason – not by chance – and we all can work together to protect people from injuries and injury deaths.  

Where do you think the most crashes happen in your state?  Take a look at WISQARS™ and find out!  

Dr. Annest is Director, Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC, Atlanta, GA. and has over 33 years of federal public health service.  Over the past two decades, he has been involved in numerous activities aimed at (1) developing national and international injury surveillance guidelines and standards, (2) improving external-cause-of-injury coding in state-based hospital discharge and emergency department data systems and their usefulness for injury surveillance, and (3) improving the availability of injury statistics for their use in priority setting, monitoring trends, and developing and evaluating injury prevention programs at the national, state and local levels.  Most notably, Dr. Annest has provided federal leadership in establishing the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) that provides national estimates of nonfatal injuries treated in U.S. hospital emergency departments and in developing and maintaining the Web-based Injury Statistics Query and Reporting System (WISQARS™)  that provides national and state data on fatal and nonfatal injuries in the United States.

A CT scan of a brain: TBI is sometimes referred to as the “silent epidemic” because the complications from TBI, such as changes affecting thinking, sensation, language, or emotions, may not be readily apparent.

As I finished getting ready for dinner, I heard Bruce tumble down the stairs, while my friend cried out, “Oh no!”  I ran down the stairs saying, “Call 911!” to find Bruce lying unconscious and moaning at the bottom of the stairs. Fortunately, there was a rapid response by emergency medical services, and the 45 minute trip to the nearest hospital was uneventful. Bruce underwent surgery for his injury, was hospitalized for a week, followed by a week of inpatient rehabilitation, and returned home to complete his recovery.

He gradually resumed his work as a Deputy Dean, but was frustrated that he felt as though his thought processes were a bit slower than they had been, and that he tired more easily. One of the medications that he took produced side effects that resulted in depression and some personality differences, but these effects diminished as he was weaned off the drug. His recovery was progressing well when he died suddenly of a cardiac event.

Having worked with many patients who sustained brain injuries, I am very familiar with the symptoms of the injury and the range of paths to recovery. I know that Traumatic Brain Injury (TBI) impacts daily life for survivors, families, friends, co-workers, and the community. Even a seemingly minor TBI can lead to long-term symptoms such as difficulty concentrating, trouble organizing thoughts, fatigue, memory issues, and headaches.

Because we cannot see a TBI in the same way that we see a broken arm or leg, and do not always notice the long-term effects of TBI in the way that we would see a limp, or weakness in a limb, TBI is sometimes called a “silent epidemic.” But people who are affected by it are definitely lending their voice to end that “silence.” At CDC’s Injury Center, we are hearing these voices through phone calls, emails, comments on our Heads Up Facebook Page, and video submissions to the recent Heads Up Film Festival.

These stories not only give a clear and powerful voice to the cause, but show that the occurrence of TBI is a very real epidemic that impacts the lives of millions.

CDC Injury Center Science and Program

Heads Up Campaign Logo: The CDC Injury Center works with partners to move science to action through a series of practical, easy to understand programs, called Heads Up.

Since CDC’s Injury Center first began working in TBI, we’ve made great strides in understanding the problem, including knowing who is most at risk and major causes of TBI. Our efforts in injury and violence prevention present opportunities for preventing TBI from occurring in the first place. For example, we know that protective devices such as seatbelts and airbags, as well as bicycle and motorcycle helmets, decrease the risk of TBI. And we know that if a TBI does occur, there are ways to decrease the risks for future TBIs.

To understand the issue better, we have published several reports detailing the incidence and prevalence of TBI in the US, such as:

• Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths, 2002–2006
• Surveillance for Traumatic Brain Injury-Related Deaths—United States, 1997–2007

At the Injury Center, we’ve also worked with partners to move science to action by developing a series of practical, easy to understand programs, called Heads Up. These programs, which focus on sports-related TBI, help educate parents, coaches, teachers, caregivers, and clinicians about the signs and symptoms of TBI; what to do if an athlete has a TBI; and how to prevent further brain damage from repeated TBI. The materials include podcasts, videos, social media tools, and even online training. 

Our Heads Up programs have also led to strong partnerships that raise the visibility of TBI – helping to end the ‘silence.’ We have active partners including national sports organizations, local health departments, and local athletic groups, who have given Heads Up a life of its own by co-branding CDC’s materials and using them in local concussion awareness and prevention programs.

Together, our advances in science and program have helped family members and caregivers take critical steps to reduce the consequences of a TBI.

Looking Toward the Future

The momentum we’ve built continues to drive progress for TBI prevention and treatment.  Our work in the area of preventing the occurrence of TBI continues as we work to prevent falls in older adults, to prevent injuries in motor vehicle crashes, and to prevent violence that can lead to brain injury.  Pediatricians and other clinicians across the country have identified a need to help diagnose and manage concussions in youth; therefore the Injury Center is beginning work with a panel of experts to develop pediatric TBI guidelines.

State and local partners expressed a need for programs to educate players, parents, and coaches about recently passed “return-to-play” laws for youth sports concussion. We are working with them to share more information from our Heads Up program, and to evaluate these policies to ensure they achieve their intended impact. To reach school professionals, we are also adding a Heads Up to Schools initiative to our Heads Up family.

Let’s Hear About Your TBI Story!

Heads Up Film Festival Logo: In recognition of Brain Injury Awareness Month and CDC Injury Center's 20th anniversary, the CDC Foundation in partnership with CDC is launching the Heads Up Film Festival at www.youtube.com/CDCFoundationTBI. YouTube videos can be tagged with “HeadsUpBrainInjury” to be pulled into the film festival.

March is Brain Injury Awareness Month, so we would like to hear your story!

Post your story on the Heads Up Facebook Page. Visit the Heads Up Film Festival to share a video and add to the national conversation on brain injury. Read others’ posts and view others’ videos to learn about facing daily challenges, achieving successes, seeking support, or finding rehabilitation services. Together, we can make some noise about TBI – a once ‘Silent Epidemic.”

"Encouraging safe, stable, and nurturing relationships between children and their parents or caregivers is like a vaccine against maltreatment, and its long-term consequences." - Dr. Linda C. Degutis, DrPH, MSN

Imagine the call – “5 Bravo 12 is coming in with an infant who has been shot.” Just when you think you’ve seen it all in the emergency department (ED), something else happens – something that you could not have imagined.   

The infant arrived at the ED in the arms of the paramedic who had responded to the scene, and who was trying to give him CPR, despite the bleeding from his wounds and the lack of any signs of life.  But, how else can you respond when you find an innocent 7-month-old child who is a victim of shots fired through a window?  The infant was killed, and his grandmother, who was also shot, was paralyzed. While this happened over two decades ago, I still vividly recall the reactions of the ED staff and the paramedics, much as I recall so many other cases in the ED and trauma unit that were the end result of violence.  One spring, we saw a 6-year-old who died on a school bus that was caught in the crossfire of a gang fight.  Another particularly violent summer, we cared for several young men who had been shot and were paralyzed.  We also saw the victims of retaliations – some dead, some injured, but all young men under the age of 25.  Another time, a 14-year-old boy who had been living in the streets arrived at the ED after being shot in his abdomen.  After spending 2 weeks with us in the hospital while his wounds healed and he adjusted to his colostomy, he was taken to jail for his role in gang violence that had recently occurred.   

To try and figure out how to put a stop to the killing and maiming, many of us met with several of the gang leaders and community organizations.  Ironically, the next morning, one of the gang leaders who was at the meeting was arrested and jailed for ordering the killings of three men in cold blood.  

Twenty years ago, violence had skyrocketed nation-wide, and everyone in my community was feeling its tragic results. Homicide rates among 15–19 year-old boys had increased one-and-a-half times between 1985 and 1991—a dramatic departure from rates in the previous 20 years.  And, suicide rates among young people ages 15–24 had almost tripled between 1950 and 1990.   

While we have come a long way since then, we have such a long way to go.  Violence is still one of the leading causes of death of young people; with homicide the 2^nd leading cause of death for people in the U.S. ages 15-24 and the leading cause of death for black males.  Clearly, we need to do more to stem the tide of violence and increase the potential for young people to have healthy futures.   

During the past 20 years, the CDC Injury Center has identified specific factors that either protect our children or put them at risk—not only for homicide and suicide, but also for other types of violence, including intimate partner violence, sexual violence, and child maltreatment.  We have established programs in schools, neighborhoods, cities, and states that build their knowledge, skills, and capacity to stop violence before it starts.   

We know that violence affects people everywhere, and that the long-term consequences are great. CDC research has shown that:  

• In the United States, on average, 24 people per minute, or 12 million people per year, are victims of rape, physical violence, or stalking by an intimate partner. And, victims of violence are more likely to experience long-term physical and mental health issues.
• The total lifetime cost of child maltreatment in just one year of confirmed cases (physical, sexual, and psychological abuse, and neglect) is about $124 billion. Each death due to child maltreatment had a lifetime cost of about $1.3 million, almost all of it in money that the child would have earned over a lifetime if he or she had lived. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke or type 2 diabetes.
• Exposure to violence early in life is linked to many emotional, behavioral, and physical health problems.  But we also know safe, stable, and nurturing relationships between children and their parents or caregivers are like a vaccine against maltreatment, and its long-term consequences. Healthy relationships are fundamental to the development of the brain and to physical, emotional, social, behavioral, and intellectual abilities.   

And what about bystanders? Our recent study on gang violence shows that between 2003 and 2008, bystander victims were rare among gang homicides. But while bystanders may not be showing up in the ED, young boys still are.   More than 90 percent of gang homicide victims were male and were more likely to be younger than non-gang homicide victims; 92–96 percent of gang homicides involved firearms. This underscores the need to protect our youth by helping them learn how to diffuse and resolve conflict without resorting to violence and to identify ways to prevent them from becoming involved in gangs in the first place.  

Every child deserves to be safe and healthy and to grow up and live a full and productive life. No child should ever be the victim of violence—nor do they have to be. We can prevent violence, and give children and youth health and hope for the future.

Please visit the CDC Injury Center 20th Anniversary web site for toolkits, talking points, and other resources to help us commemorate our 20 years, and to spread the word about injury and violence prevention.

I have many stories that I could tell about injuries and violence, from both my professional and personal lives. One of my nephews was diagnosed with depression when he was in high school.  He was treated, eventually finished school, and graduated from college at the age of 25.  He was accepted to law school, but tragically, he died by suicide shortly after receiving his acceptance letter. Working in trauma and emergency care for many years, I saw the impacts that deaths and injuries had on families like mine.  These experiences compelled me to do something to prevent other families from suffering.  Being at CDC where so many people are dedicated to preventing these kinds of tragedies gives me an opportunity to ensure that fewer families will experience such loss and disruption. 

CDC’s role in public health goes beyond just preventing infectious diseases. We are doing vital work in the field of injury and violence prevention. We know that each year, over 180,000 people die of injuries in the United States, and close to 5.8 million people die around the globe.  Our research shows that injuries are the leading cause of death for peoples ages 1-44 in the US, surpassing other leading causes of death such as heart disease, cancer and infectious diseases. And we are working in your community and communities all around the globe to reduce injuries and violence and their impact on health and society.

This year marks two decades since the founding of CDC’s Injury Center, where we work to bring science and practice together using public health strategies and interventions to minimize the impact of injuries and violence. Throughout this year, we will highlight many of our own injury and violence prevention success stories and some from others in the field of injury and violence prevention – stories about how we can and do make a difference. During this anniversary year, we will also be taking time to review the progress that we have made in preventing injuries and violence, and our vision for the next decade.  

In 2007 in the United States, injuries, including all causes of unintentional and violence-related injuries combined, accounted for 51% of all deaths among persons ages 1-44 years of age – that is more deaths than non-communicable diseases and infectious diseases combined.

As I have already mentioned, injuries are the leading cause of death for young people in the U.S., and we know that road traffic related injuries are the leading cause of death for healthy people from the U.S. traveling outside of the country.  While injuries related to violence comprise a part of the death toll, we know that violence causes long term health problems, mental health problems and disruption in the community.  Let’s look at some of the detailed information that we have on injuries and violence:

• Each day in the U.S., over 493 people die of injuries.
• Over 7,500 people are admitted to a hospital for treatment of injuries, and more than 79,000 people are treated in emergency departments.
• 1 out of 5 women reported being raped in their lifetime, while 1 out 4 suffered violence at the hands of a partner.
• Unintentional prescription drug overdoses are increasing across the country, with death rates that are beginning to exceed death rates from motor vehicle crashes.

The nearly $4 billion in injury health care costs and lost work each year only tell part of the story.  The costs of the consequences of violence are more difficult to measure, but we do know that exposure to violence, particularly at an early age, has lifetime impacts on health, work and well-being.  We know that injuries and violence follow patterns, and are often predictable, and therefore, preventable. 

In the CDC Injury Center, we use a public health framework to take the science and use it to inform what happens in practice – in communities, in states, across the country and around the globe.  We use the numbers to help us understand the problem, we use information about circumstances of injuries and violence to develop solutions, and then we test the solutions in the real world.  We know that there are faces behind the numbers, and that the faces don’t come from any one age group, race, ethnicity or sex.  They include young children and older adults, parents, partners, siblings and friends.  Injury and violence don’t discriminate – they affect all of us. 

I started this blog with a story about one of my nephews.  I’ll end with a story that has a different twist – a story about what happens when we prevent an injury or violence from occurring.  

The Smoke Alarm Installation and Fire Safety Education (SAIFE) Program in Georgia has contributed to saving over 150 lives.

Most fatal fires in homes happen during the night, while people are sleeping.  Properly working smoke detectors provide a warning of fire.  In Georgia, local fire departments participate in the SAIFE (Smoke Alarm Installation and Fire Safety Education Program) and help the community by installing smoke alarms in homes.  Over seven years, the program has contributed to saving over 150 lives. Specifically, in Moultrie, Georgia, 20 fires occurred in SAIFE program homes and 56 lives were potentially saved because residents were alerted to a fire and were able to leave the burning home.  

As you can see, we are making progress, but we have a long way to go and many lives that we can save.  We look forward to sharing our injury and violence prevention accomplishments with you and hearing your own success stories from your community, too.  With the efforts of the CDC Injury Center, and our partners in the field, we can do this, and we can join together to make injury and violence prevention the premier public health achievement of the decade. 

Begin sharing your success stories in the comments below!

Guest blogger: Christopher M. Jones, PharmD, MPH, LCDR, U.S. Public Health Service

How big a problem is prescription drug overdose?

We see the country’s surging number of deaths involving prescription drugs as an epidemic. In 2008, the most recent year for which we have national figures, more than 36,000 people died of drug overdoses in the U.S., and more than 20,000 of these overdose deaths were from prescription drugs. We have seen this number steadily increase over the last decade.

A specific class of prescription drugs known as prescription painkillers—also called opioid pain relievers and including drugs such as OxyContin (oxycodone), Vicodin (hydrocodone), and methadone—is driving this increase. In 2008, nearly 15,000 people died from overdoses involving these drugs. This is more than three times the number of people who died from these drugs in 1999.  

Why has the rate of prescription drug overdose risen so sharply?

In the last decade, sales of these drugs have increased 300%. This increase has been paralleled by increases in abuse and overdose of these drugs. These trends are all connected. Last year, nearly one in 20 people in the U.S. age 12 or over reported using prescription painkillers nonmedically—without a prescription, or for the “high” they cause. In 2009, there were nearly half a million emergency department visits due to the misuse or abuse of these drugs. It is this pattern—increased sales and increased abuse—that has lead to the current epidemic.

Are there any groups that are most at-risk for prescription painkiller overdose?

While we have seen prescription painkiller overdoses impacting families and communities across the country, certain groups are especially vulnerable. As is the case with the abuse of other drugs, men are more likely to overdose on prescription painkillers than women. Middle-aged adults, particularly those ages 34-55, have the highest rates of overdose. We also know that whites and American Indians and Alaska Natives, as well as people who have substance abuse or other mental health problems, have higher rates of overdose compared to other groups.

Are all states equally impacted by the drug overdose epidemic?

No. Rates of drug overdose vary significantly between states. For instance, the state with the highest rate of overdose, New Mexico, has a rate nearly five-times higher than the state with the lowest rate, Nebraska. We generally see the highest rates of overdose deaths in the Southwest and in the Appalachian states like Kentucky and West Virginia. We can’t say exactly why there is such variation among states, but we do know people in rural counties are about two times more likely to overdose on prescription painkillers than people in big cities. And our analysis shows that some of the states that saw the largest increases in overdose deaths between 1999 and 2008 were states that had some of the highest poverty levels among non-Hispanic whites. In addition, differences in prescribing habits among states may also be contributing to state variation.

What policies can help reduce deaths from prescription drug overdose?

Efforts to reduce prescription drug overdose must strike a balance between preventing deaths and safeguarding legitimate access to pain medications. Everyone has a role to play in reducing the number of overdoses in the United States including the federal government, state and local governments, health care providers, health insurers, communities, and individuals. CDC believes that if we can improve how these powerful drugs are prescribed, we can reduce the number of people who are abusing and overdosing on prescription painkillers, while ensuring people who have legitimate pain are treated safely and effectively.

Two promising policies are prescription drug monitoring programs and patient review and restriction programs. Prescription drug monitoring programs—which track controlled substance medications in a state—are a tool used by healthcare providers to identify patients who may be at risk for an overdose. Patient review and restriction programs require patients who are inappropriately using controlled substances to receive them only from one physician and one pharmacy. Both of these programs can improve patient care while also helping to reduce abuse and overdose. 

What is CDC doing about prescription drug overdose?

CDC is working with many federal and state partners, as well as stakeholder organizations, to address this epidemic. CDC is specifically focusing on three key areas: enhancing public health surveillance so that we can better understand the epidemic; strengthening policy by identifying, evaluating, and disseminating promising policies designed to reduce overdose; and improving the clinical practice of health care providers.   

What steps can people take to prevent prescription drug overdose?

The most important thing is to take prescription painkillers only as directed by a health care provider. Individuals should not share or sell them to others. More than half of the people in the U.S. who use a prescription pain reliever nonmedically obtained it for free from a friend or relative. People should also make sure to store their prescriptions securely and to dispose of unused medications properly. Finally, people who are struggling with substance abuse problems should get help, for instance by contacting 1-800-662-HELP.

How and where can people learn more?

For more information, people can visit CDC’s unintentional poisoning web site.

Dr. Jones is one of two lead subject matter experts on prescription drug overdose in the Injury Center’s Division of Unintentional Injury Prevention. He is a pharmacist and public health practitioner by training and primarily focuses his prescription drug overdose work on strategic policy development and implementation, engaging national and state partners, and conducting research to improve policy and clinical practice.

I’ve encountered and have had to overcome a lot of obstacles in my life, just as most other people and kids my age have had to do. Beyond the racetrack, I’ve had some experience with being bullied. In the eighth grade, I was just eighty pounds and I stood under five feet tall, so you might say I had a target on my back for bullies. Day in and day out I would be laughed at, pushed around, and taunted. One particular experience that stuck with me came right after I achieved third place in a national championship race in Indianapolis.

When a driver ranks in the top three of a particular championship, in addition to a trophy, you also get a special hat. I was really proud of my hat and as soon as I got back to school I wanted to wear it along with my racing shoes and the event t-shirt that I begged my dad to stop and get for me. Well, in the lunchroom that day, one of the football players snatched the hat right off my head and threw it in the trash. That wasn’t enough to satisfy him, so he went a step further and poured milk on it! At the time I was pretty frustrated. I felt angry and alone

Kids who are being bullied should try to remember these four recommendations from the CDC:

1. Don’t go it alone.  Young people should tell a trusted adult (teacher, parent, coach, etc.) if they are being bullied or know of someone else being bullied.  Adults can help the student cope with the experience and work with the student to find a solution.
2. Victims aren’t alone.  Although victims of bullying may feel like they are the only ones being picked on, the reality is that a lot of kids are bullied.  Victims also have other students, their family, and their teachers who can help.
3. Help is available.  Many schools have prevention programs and policies in place to help and protect kids. These approaches often work to create a school where everyone sees bullying as not acceptable. For example, bystanders would intervene when they see bullying and say “hey, that behavior isn’t cool here.” Teachers also learn how to respond appropriately when it does occur.
4. Bullying is not acceptable.  Many people falsely believe that bullying is just part of growing up and something we must all experience during our childhood.  In reality, bullying can interfere with our school work and hurt the way we feel about ourselves.  It is something we must not accept and something we must prevent.

With these things in mind, and with the support of my parents, teachers, and friends, I remained strong and true to who I am. I also used the discouragement from the bully as motivation to do better the next time I was confronted and to follow my dream to prove them wrong. The following weekend I raced in another championship race, and this time, I placed first and received another hat. The next day, the bully got ahold of the new hat too, although this time, I gave it to him voluntarily.  I even autographed it for him! That was a proud moment for me. It was an action that spoke louder than any words I could’ve said to him. Now, I am not saying that everyone can (or that you even should) stand up to a bully. If you or someone around you is being bullied, tell someone you trust.

The CDC has also outlined some things that educators, parents, and coaches can do to prevent bullying. They can:

• Improve supervision of students in areas where bullying frequently occurs, in bathrooms, cafeterias, and hallways.
• Use school rules and behavior management tech­niques in the classroom and throughout the school to detect and address bullying, providing consequences for bullying
• Have a whole school anti-bullying policy, and enforc­e that policy consistently
• Promote cooperation among different professionals and between school staff and parents

Though I’ve had some experience with bullies, being a race car driver at Andretti Autosport, alongside racing greats like Michael and Mario Andretti and even Danica Patrick, I’m really only in the “teen world” part-time. Having time with adults in the racing world gives me the opportunity to reflect on my life as a kid and learn from the adults around me. Recently, I recognized this and I decided to write a book called 99 Things Teens Wish They Knew Before Turning 16 and I’ve even had the opportunity to go on The Today Show to talk about it. The book takes on issues that kids deal with on a daily basis, including dating, homework, and especially bullying. I used my life’s experiences, combined with what I’ve learned from those around me, to create a concise how-to guide for kids my own age.

Bullying is no joke. It is something I take very seriously. If you feel bullied or mistreated, and think you have no place to turn, know that you are not alone and there is hope.  Remain strong and true to yourself. Reach out to someone you trust, ask for help, and remember that bullying is just not acceptable.

*Disclaimer:  The views expressed in this blog are those of Zach Veach, and do not necessarily reflect the views and opinions of CDC.  Any products or companies named in this blog are for informational purposes only, and do not imply endorsement by CDC. 

Related Resources

Understanding Bullying, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Atlanta, GA 2011.

Measuring Bullying Victimization, Perpetration, and Bystander Experiences: A Compendium of Assessment Tools, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Atlanta, GA 2011.

StopBullying.gov, Department of Health & Human Services in partnership with the Department of Education and Department of Justice.

• Myths about Bullying
• Best Practices in Bullying Prevention and Intervention

Educational Forum on Adolescent Health: Youth Bullying, American Medical Association. Chicago, IL, 2002.

Bullying Prevention is Crime Prevention, a report by Fight Crime: Invest in Kids. Washington, DC, 2003

It may seem rather unusual to talk about injuries and weather in the same context, but extreme weather can pose significant risks for many kinds of injury.  Currently, many parts of the United States are experiencing a major heat wave, with record-setting heat and heat indices over the next few weeks.  As we have seen in the recent past, deaths are occurring from heat-related and possibly from participation in outside activities that increase the risk of heat-related illness.

During the month of August, many athletes train for the fall sports season, sometimes participating in two practices a day over the course of a few weeks.  While training is necessary and important for athletes to build up their stamina and to improve their performance, health consequences can be deadly if proper precautions are not taken.  Athletes who do not participate in organized sports events, but remain active outdoors also need to exercise caution and make decisions about what will keep them healthy.  Even people who perform everyday outdoor activities are at risk and need to ensure that they are taking steps to prevent illness.  In addition to athletes, those at risk for heat-related illness include the older adults and the very young.

When temperatures are extreme, outdoor exercise should take place during the cooler times of the day—in the early morning or late evening.  Hydration is critical—drinking water at regular intervals will help to replace fluid lost through perspiration, and will also help to keep the body temperature cooler.  Perspiring is one of the body’s natural cooling methods, but to provide this cooling; the body must be well hydrated. Wear lightweight, light-colored clothing.  

Hot weather also places children in cars at risk.  Every year, approximately 40–50 children die because they are left in cars that become too hot while in the sun. Children should not be left alone in cars or other vehicles for many reasons, but hot weather poses a particular risk. 

At the first signs of heat related illness, stop exercising and find a way to cool down.  If possible, continue to drink fluids, preferably water or non-carbonated drinks.  Do not drink alcohol.  Find a cool place to rest.  Know the signs of heat-related illness and follow the recommendations at: 

Extreme Heat Media Toolkit           

Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety

Heat is not the only weather event that increases risk.  We are now in the middle of hurricane season, which runs through November 30th.  In addition, summer thunderstorms can pose similar risks.  Lightning can strike a person or an object, high winds can knock down trees and electrical lines or blow objects through the air, and heavy rains can flood streets and underpasses. In addition to the precautions that you take to protect your property during these events, there are things that you can do to protect yourself and your family. 

If you can hear thunder, you are close enough for lightning to strike.  Stay indoors, and if you are outdoors, find shelter in a building or a vehicle if there is no building nearby. Do not seek safety under a tree.  Do not walk or drive through water that is flooding an underpass or road, or a river or stream that is rising rapidly—you can get swept away with fast-moving currents.  After a storm has passed, exercise caution during the clean-up to prevent injuries. 

Wear protective clothing and be sure that you stay away from downed wires.  If you need to use tools such as saws or chainsaws to cut downed trees, be sure that you are using the right sized tool for the job and that you know how to use it properly.  Keep children away from the clean- up site.  For more ideas about how to stay safe, go to

http://www.cdc.gov/nceh/extremeheat/materials.html

http://www.cdc.gov/niosh/topics/heatstress/   

Finally, we encourage you to stay as active as possible and to enjoy the remaining summer weather and activities safely, despite the heat and storms.  Choose safety!

This CDC Blog is also featured on Better Health.

Let’s take boating as an example.  Whether you have a sailboat, a power boat, a small skiff, a canoe, a kayak, or a personal watercraft (PWC) it’s likely that you will enjoy many hours on the water.  And, while being on the water is fun, there is a degree of personal responsibility that you take for yourself and others, each time you venture out.  It’s important to understand and respect the risks that the water—whether lakes, rivers or streams, or the ocean—poses. 

Take a look at the data on boating in 2010:

• There were 672 deaths, 3,153 injuries, and approximately $35.5 million in property damage reported to the Coast Guard as a result of recreational boating crashes.
• Alcohol use is the leading contributing factor in fatal boating crashes and is listed as the leading factor in one in five (19%) boating fatalities.
• Operator inattention, improper lookout, operator inexperience, excessive speed, and alcohol rank as the top five primary contributing factors in boating crashes.
• Fewer than 1 in 10 deaths occurred on boats where the operator had taken boating safety instruction.
• Almost three-fourths of all fatal boating accident victims drowned and, of those, 88 percent were not reported as wearing a life jacket.
• Eight out of every ten boaters who drowned were using boats less than 21 feet in length.

As a boater, I have had the opportunity to enjoy many summers on the water.  Creating a safe environment on and around the boat has always been a priority.  I have seen firsthand what happens when someone does not take this responsibility seriously, endangering themselves and others.  I have witnessed several tragic events, all of which were preventable had precautions been taken by the boaters.  While working in the emergency department, I saw a young man who had fallen off of a power boat when he and his friends were fooling around.  His friends did not immediately realize that he had fallen overboard, and he was struck in the head by the boat’s propeller with tragic results.  More recently, on a beautiful sunny day in the area where I have spent the most time boating, a power boat came into the harbor at high speed.  As the operator attempted to turn the boat, he lost control.  The boat flipped over several times, throwing the passengers into the water, fortunately resulting in relatively minor injuries to the passengers, but major damage to the boat.  Fortunately, no other boats were hit on what was a busy Sunday afternoon.  In a situation that occurs all too often, a power boat that was being operated by a young man under the influence of alcohol crashed into a rock wall, killing the young man’s friend and injuring two other passengers.  The operator’s blood alcohol concentration was four times the legal limit to be considered boating while impaired.

Risks on the water are different from risks on land, something that we often forget.  For example, a passenger who is in a car is usually wearing a seatbelt and may also be protected by an airbag.  On a boat, there are no seatbelts—both passengers and operators have far less protection than they do in cars.  So what does this mean for safety on the water?  Basically, it means that there is a high degree of personal responsibility involved in being safe while boating.  Taking a boating safety course, for example, can help you to understand the risks and how to prepare for them, whether you are a boat operator or a passenger.  Ensuring that passengers of all ages wear personal flotation devices (PFDs) while boating is important—and it’s a legal requirement in many locations.  Many states require children under a certain age to wear PFDs, and others require that operators and passengers on personal watercraft wear them.  For all PFDs, it’s important to make sure that the ones you are using are Coast Guard-approved.  Avoiding alcohol before going out on the water and while boating will decrease the risk of alcohol-impaired crashes and drowning.  Becoming familiar with water and weather patterns will help you to navigate safely and to know when to return to shore.

Fortunately, there are many excellent tools and resources available to help you maintain your boating safety knowledge and skills.  Many of these educational resources are free or inexpensive and often no further away than your home computer, local library, community center, or boating group.  The U.S. Coast Guard website, http://www.uscgboating.org/, is one of the most comprehensive resources on boating and water safety and it’s a great place to get started.  You will find links to their Boating Safety Resource Center and many online boating safety training courses.  You’ll also find helpful information about life vests (PFDs), pointers about keeping kids and passengers safe while boating, vessel safety checks, and many other topics that will be useful and informative.

In addition, the USCG site provides links to other boating and water safety organizations that have additional training and information resources.  The Boating Safety Resource Center website (http://www.uscgboating.org/state_boating_laws.aspx) documents federal and state laws and regulations so you can easily find out about your own state’s boating regulations and requirements and those of states you may be visiting.  For example, did you know that in many states “boating under the influence” (BUI) is judged to be the equivalent of operating a motor vehicle while impaired? If you are found to be BUI—which poses a risk for yourself and others on the water—it may affect your driving record, your motor vehicle license, and your automobile insurance coverage.  In some states, routine patrols on the water seek out boaters who are under the influence of alcohol, who do not have sufficient safety equipment (usually PFDs) on their boats, or who are reckless in their boat operation. 

These resources can help you prepare for a safe season on the water.  When you write your report on your summer vacation, I hope that you can say (or tweet) “I had safe and fun boating experiences this summer.”  The care you take to understand boating and water safety will go a long way toward ensuring that the memories you build will be happy ones.

Learn More about Staying Safe While Boating and Drowning Risks in Natural Water Settings.