The application of behavioral science theory is instrumental in advancing nursing research and practice. Nurses can benefit from a thorough understanding of theoretical perspectives related to health behavior change. Behavioral science theory can provide a conceptual context for understanding patient behavior, it can guide research on the determinants of health behavior and health service delivery, and it can offer alternative approaches to nursing practice that may improve the effectiveness of patient care. The aim of this paper is to provide some examples of behavioral theories that can be used in nursing research and practice, and provide an example of how one theory, Stages of Change (Transtheoretical Model), can be applied to older adult fall prevention. Given the critical role behavior plays in premature morbidity and mortality, public health nurses and researchers can benefit by broadening the use of theory in the design and implementation of interventions, using behavioral theory as their guide.

About 1 in 5 child deaths is a result of unintentional injury. The leading causes of unintentional injury death vary by age. This report provides national fatal and nonfatal data for children and teens by age, sex, and race/ethnicity. Prevention strategies for the most common causes are highlighted. Opportunities for lifestyle clinicians to effectively guide their patients and their parents are discussed.

Motor vehicle crashes result in more than 40 000 deaths and 4.3 million nonfatal injuries annually. Many known effective strategies to address these preventable deaths and injuries are closely related to lifestyle factors. Clinicians can play a large part in supporting effective interventions in their practice, for example, by counseling patients about seat belt use. Clinicians can also have an impact in their community by supporting positive public policy change.

Introduction: Each year from 1999 through 2015, residential fires caused between 2,000 and 3,000 deaths in the U.S., totaling approximately 45,000 deaths during this period. A disproportionate number of such deaths are attributable to smoking in the home. This study examines national trends in residential fire death rates, overall and smoking-related, and their relationship to adult cigarette smoking prevalence, over this same period. Methods: Summary data characterizing annual U.S. residential fire deaths and annual prevalence of adult cigarette smoking for the years 1999-2015, drawn from the National Vital Statistics System, the National Fire Protection Association, and the National Health Interview Survey were used to relate trends in overall and smoking-related rates of residential fire death to changes in adult cigarette smoking prevalence. Results: Statistically significant downward trends were identified for both the rate of residential fire death (an average annual decrease of 2.2%- 2.6%) and the rate of residential fire death attributed to smoking (an average annual decrease of 3.5%). The decreasing rate of residential fire death was strongly correlated with a gradually declining year-to-year prevalence of adult cigarette smoking (r = 0.83), as was the decreasing rate of residential fire death attributed to smoking (r = 0.80). Conclusions and practical applications: Decreasing U.S. residential fire death rates, both overall and smoking-related, coincided with a declining prevalence of adult cigarette smoking during 1999-2015. These findings further support tobacco control efforts and fire prevention strategies that include promotion of smoke-free homes. While the general health benefits of refraining from smoking are widely accepted, injury prevention represents a potential benefit that is less recognized. (C) 2018 National Safety Council and Elsevier Ltd. All rights reserved.

Every day in the United States, over 100 people are killed and thousands more injured in motor vehicle crashes. The U.S. Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control works to prevent motor vehicle crash injuries and their resulting public health and economic burden. In traffic safety, translating research findings into actionable products is a top priority. In the U.S., many of the traffic safety strategies are implemented at the state level. One focus of CDC’s Transportation Safety Team is to create tools and products to empower states, decision makers, and partners to make data-driven and evidence-based decisions for prevention. These tools address a range of state needs and include an online cost-effectiveness calculator, implementation guides for community, tribal, and state programs, a mobility planning tool for older adults, and fact sheets covering a range of topics. As one example, the older adult mobility planning tool was created to help older adults, beginning at age 60, plan for future mobility changes that might increase their risk for motor vehicle crashes and falls. The planning tool was developed based on the trans-theoretical stages of change and iterative testing with older adults. The tool helps older adults think through how they will remain injury free and mobile as they age. This presentation will provide an overview of recent trends in motor vehicle crash injuries and deaths in the United States, CDC’s role in road safety, and of the various CDC tools, prevention products, and state implementation efforts. CDC’s Transportation Safety Team encourages the use of proven strategies for motor vehicle crash injury prevention. Supporting motor vehicle injury prevention in the U.S. ultimately supports global road safety targets including the Decade of Action for Road Safety and the 2030 Agenda for Sustainable Development targets 3.6 and 11.2.

Background Falls are projected to be the 17th leading cause of death globally by 2030. Older adults are disproportionately affected. In the United States (U.S.), one in four adults 65+fall annually. By 2030, there will be 49 million falls among older adults and 12 million injuries in the U.S. each year. Description of the problem When not fatal, falls can cause brain injury, hip fracture, and loss of independence. In the U.S., there are more than 3 million emergency department visits, and over 8 00 000 hospitalizations each year due to falls. However, falls can be prevented. This presentation describes the overall cost of older adult falls in the U.S. and innovative approaches the U.S. Centers for Disease Control and Prevention (CDC) is pursuing to address this major health threat. Cost of older adult falls In total, $50 billion was spent to treat nonfatal falls in 2015, with government-funded programs (Medicare, Medicare) paying 75% of the total. Medical spending for fatal falls was $750 million. Most U.S. adults age 65+receive healthcare coverage through Medicare, a federally funded program. On average, Medicare pays approximately $10 000 per emergency department visit and $30 000 per fall-related hospital stay. CDC approach Given the health and economic burden, CDC encourages healthcare providers to screen, assess, and intervene to reduce patient’s multiple fall-risk factors. Interventions that address multiple modifiable risk factors can reduce falls by 24%. The CDC is evaluating the effectiveness of clinical fall prevention in primary care, upon hospital discharge, and within community pharmacies. In primary care, older adults at risk for a fall who received a treatment plan to reduce their fall-risk were 40% less likely to have a fall-related hospitalization compared to those at-risk without a treatment plan. Conclusion Fall interventions offered in clinical settings can reduce healthcare expenditures and prevent falls worldwide.

Purpose The issue of older adult falls combines a problem with high incidence and high injury susceptibility with an increasing population at risk. A firm understanding of both fall risk factors and effective strategies is required to reduce risk and prevent these injuries. Recent Findings Each year, 28.7% of older adults aged ≥65 sustain a fall. At the national level, this represents 29 million falls resulting in 27,000 deaths and 7 million injuries requiring medical treatment or restricted activity for at least 1 day. There are several strategies that have been shown to effectively reduce the risk or the incidence of falls. Summary More than 90% of older adults see a medical provider at least once a year providing an opportunity to identify and address fall risk factors. Comprehensive fall prevention in the primary care setting is both feasible and practical.

Background Ignition interlocks, when installed on vehicles of drivers convicted of alcohol-impaired driving (AID), reduce repeat arrest by 67%. However post-interlock removal, recidivism (AID re-arrest) among previous interlock users equals that of AID-convicted drivers who never used interlocks. Also, the low numbers of offenders installing interlocks limits the impact. Study objectives include determining interlock program characteristics associated with increased interlock use and evaluating including alcohol treatment in the program to reduce post-interlock recidivism. Methods To determine effective program characteristics, eight interlock program keys (e.g. requirement to instal interlocks) were identified and each rated on 1–5 scale for 28 U.S. state interlock programs. Correlation analysis between rate of interlocks in use/10,000 population, and program key rating was conducted. To evaluate treatment in the one state with a treatment program, survival analysis using Cox regression proportional hazards model was performed with post-interlock recidivism as the terminal event. The treatment group (n = 640) were offenders with three or more violations (two alcohol-positive start attempts within four hours) who completed alcohol treatment. A comparison group (n = 806) of those with one or two violations who did not attend alcohol treatment was created by matching to the treatment group on demographic and risk factors. Results The program keys most correlated with higher interlock rates were having a requirement to instal interlocks (r = 0.63), and monitoring to ensure interlocks are installed and used (r = 0.56). Incorporating alcohol treatment into an interlock program was effective with the treatment group experiencing 32% lower recidivism following interlock removal compared with the non-treatment group. Conclusions Strengthening program keys and incorporating treatment into interlock programs increases use of interlocks and reduces AID re-arrest.

Background Children and adolescents account for an estimated 65% of emergency department visits for sports and recreation-related traumatic brain injuries, including concussions. Immediate identification and appropriate response to a concussion can help reduce the risk of short- or long-term health problems that can affect thinking, learning, behaviour, and/or emotions. Description of the Problem Combining innovative and evidence-based communication strategies, CDC created HEADS UP. HEADS UP is a series of educational initiatives grounded in audience preferences for content, design, format, and distribution channels. The content is specifically built to draw attention to what was considered an under-reported and under-identified public health problem and is designed to improve awareness, early identification and management of sports-related concussion. Results In the last decade, CDC's HEADS UP has partnered with over 85 organisations, received over 200 million media impressions, distributed more than 6 million print resources, and obtained over 40 million social-media impressions. In addition, through HEADS UP, CDC has trained over 3 million sports coaches and health care professionals through online training courses required by many state policies and sports programs. Evaluation results indicate improvements in knowledge and attitudes towards concussion after exposure to HEADS UP materials. Conclusion CDC's HEADS UP demonstrates how a health communication initiative can play a critical role in driving the science of an important health issue and can help support implementation of policies on a large-scale. As CDC embarks on the next stage of HEADS UP, continued emphasis will be placed on adapting to the changing landscape of concussion research and awareness and identifying effective approaches for improving both behaviours and the culture of concussion nationwide.

Background As we age our transportation options may become more limited due to mobility changes. These mobility changes may include declining driving abilities, or factors related to ageing and health. The objective of this study was to develop and evaluate a mobility assessment tool for older adults that would help them consider their mobility options as they age. Methods A four-page Mobility Assessment Tool was developed that was designed to identify current and future mobility needs and challenges. An evaluation questionnaire that measured mobiltiy-related attitudes, beliefs and opinions was administered by phone to 1000 respondents age 60–74 years, who reported good or very good mobility Respondents were asked initial questions, given the tool for review, and then asked follow-up questions. Also, respondents had the opportunity to comment on the usefulness of the tool as they consider alternative mobility options. Results Mobility-related attitudes increased after reviewing the tool. On a scale of 1–5 (where 1 equals "not at all" and 5 equals "very much"), the average scores increased for thinking about mobility from 2.4 to 3.4 (p < 0.0001), for thinking about protecting mobility from 2.5 to 3.8 (p < 0.0001), and for feeling confident about knowing how to protect mobility from 3.5 to 4.2 (p < 0.0001). The most frequently reported challenges to mobility were driving and other transportation barriers (48%) and physical mobility (18%). Most respondents found the tool understandable (97%) and easy to complete (94%) with two-thirds finding the tool relevant. Reasons given for not liking the tool included that it wasn't applicable to their situation, or gave no new information. Conclusions Administering the Mobility Assessment Tool with older adults resulted in increased awareness of the mobility challenges they could face, and helped them be more confident of being able to protect and preserve mobility options as they age.

BACKGROUND:Each year >32,000 deaths and 2 million nonfatal injuries occur on U.S. roads. METHODS:CDC analyzed 2000 and 2013 data compiled by the World Health Organization and the Organisation for Economic Co-operation and Development (OECD) to determine the number and rate of motor vehicle crash deaths in the United States and 19 other high-income OECD countries and analyzed estimated seat belt use and the percentage of deaths that involved alcohol-impaired driving or speeding, by country. RESULTS:In 2013, the United States motor vehicle crash death rate of 10.3 per 100,000 population had decreased 31% from the rate in 2000; among the 19 comparison countries, the rate had declined an average of 56% during this time. Among all 20 countries, the United States had the highest rate of crash deaths per 100,000 population (10.3); the highest rate of crash deaths per 10,000 registered vehicles (1.24), and the fifth highest rate of motor vehicle crash deaths per 100 million vehicle miles traveled (1.10). Among countries for which information on national seat belt use was available, the United States ranked 18th out of 20 for front seat use, and 13th out of 18 for rear seat use. Among 19 countries, the United States reported the second highest percentage of motor vehicle crash deaths involving alcohol-impaired driving (31%), and among 15, had the eighth highest percentage of crash deaths that involved speeding (29%). CONCLUSIONS AND COMMENTS:Motor vehicle injuries are predictable and preventable. Lower death rates in other high-income countries, as well as a high prevalence of risk factors in the United States, suggest that the United States can make more progress in reducing crash deaths. With a projected increase in U.S. crash deaths in 2015, the time is right to reassess U.S. progress and set new goals. By implementing effective strategies, including those that increase seat belt use and reduce alcohol-impaired driving and speeding, the United States can prevent thousands of motor vehicle crash-related injuries and deaths and hundreds of millions of dollars in direct medical costs every year.

Background Worldwide falls are a threat to adults 65 and older. In the United States, one in three older adults will fall annually costing the health care system $34 billion. With U.S. fall rates on the rise, and 10,000 older adults turning 65 each day, falls are a major health threat. Description of the problem Falls can be prevented by addressing modifiable risk factors (e.g., medication usage, vitamin D deficiency, vestibular disorders, vision deficits) with effective clinical interventions; however, few older adults talk to their health care provider about falls. Therefore, CDC launched the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative. STEADI uses established clinical guidelines and evidence-based interventions to empower primary care providers to screen, assess, and treat elderly patients' modifiable fall risk factors. This session describes the STEADI implementation process, key implementation steps, and subsequent health outcomes. Results STEADI was implemented in multiple health systems. Critical in implementing STEADI was the proactive leadership of clinical champions embedded within the clinical practice; the identification of relevant quality and financial drivers; the modification of electronic health record tools; and the adoption of a STEADI clinical workflow for patients, staff, and providers that aligned with existing workflows. Preliminary measures in one setting indicate providers have screened upwards of 70 per cent of their older adult patients, and hospitalizations and emergency department visits for fall-related injuries are declining. Conclusion Fall interventions offered in clinical settings can prevent falls among older adults, thereby improving their health, independence, and quality of life. These interventions can reduce medical costs associated with fall injuries, including hospitalisation costs for traumatic brain injuries and hip fractures. Using these data, CDC is disseminating the adoption of STEADI nationwide.

Traffic crashes are the leading cause of death among teens. Health care providers have an opportunity to address what works to keep teens safe on the road during the patient visit. An online survey was conducted of 1088 health care providers who saw patients at or near driving age. The survey assessed which road safety topics were discussed and which types of educational products were used most often. Family and general practice physicians represented 44.3% of the sample, followed by pediatricians (22.5%), nurse practitioners (17.6%), and internists (15.5%). Nearly all respondents (92.9%) reported addressing one or more driving safety factors (seat belt use, nighttime driving, fatigue, teen passengers, alcohol/drug use, speeding/reckless driving, and cell phone use/texting) with adolescent patients and/or their parents. Seat belt use was reported more often (83.7%) than other topics. The use of parent–teen driving agreements, a known effective intervention, was reported by less than 10% of respondents. Since health care providers expressed interest in receiving written resource materials, distribution of parent–teen driving agreements to health care providers might encourage greater uptake and use of this effective intervention.

Background In Botswana, road traffic crashes (RTCs) are a leading cause of death and disability, second only to HIV/AIDS in young adult males. Alcohol has been recognised as one of the principal risk factors for RTCs, particularly for fatal RTCs, globally. Aims/Objectives/Purpose To examine the characteristics of fatal alcohol-related crashes (FARCs) in Botswana from 2006–2010 and to examine changes in rates pre- and post-levy. Methods This study analysed data from Botswana Police Accident Database from 2006 to 2010. Bivariate analyses examined associations between FARCs and other demographic and risk factors (eg, age, sex, injury severity, seat belt use). We calculated rates of FARCs per 10 000 registered vehicles and per 100 000 population and used z-tests to test for statistical significance. Results/Outcome A large percentage of FARCs occurred on weekends (49%), among males (78%), and among 25–34 year-olds (35%). Pedestrians were identified as a high risk group (38%). Comparing changes pre- and post-levy, we found that there was a statistically significant change in FARCs per 10 000 registered vehicles (rate pre-levy=10.4; 95% CI 9.1 to 11.8 vs rate post-levy=8.3; 95% CI 7.3 to 9.3; p=0.01). However, rates per 100 000 population remained stable pre- and post-levy (rate pre-levy: 6.9; 95% CI 6.0 to 7.7 vs rate post-levy: 7.5; 95% CI 6.6 to 8.4; p=0.29). Significance/Contribution to the Field This study identified important characteristics of fatal alcohol-related crashes, which can be used to tailor prevention programmes in Botswana (eg, sobriety checkpoints), and provided an assessment of the impact of the national alcohol levy.

Background Distraction is a risk factor for traffic crashes that is becoming an increasing global concern; however, its prevalence is not well documented. Aims/Objectives/Purpose To examine the prevalence and characteristics of those who talk or text using cellular devices while driving in Belgium, France, Germany, the Netherlands, Portugal, Spain, the UK, and the USA. Methods Online survey of adults aged 18–64 in the USA (N=3294) and seven European countries (N=8955), weighted to the age and sex distributions of each country. Respondents reported how often they talk on their cellular phone while driving and how often they read or send text messages or email while driving. We examined differences in prevalence by country, age group, and sex. Results/Outcomes More than one in four (27.3%, 95% CI 25.1% to 29.4%) US adult drivers aged 18–64 reported they ‘regularly or fairly often’ talk on their cellular phone while driving. In Europe, percentages ranged from 20.4% in Portugal (95% CI 16.5% to 24.3%) to 7.8% in the UK (5.9% to 9.7%). Additionally, 7.7% (6.3% to 9.0%) of US drivers aged 18–64 reported that they ‘regularly or fairly often’ read or send text messages or email while driving. In Europe, percentages ranged from 8.1% (95% CI 6.6% to 9.6%) in Belgium to 2.5% (95% CI 1.3% to 3.7%) in the UK. There were few differences by sex, but there were differences by age group within most countries. Significance/Contribution to the Field This study provides recent prevalence estimates of distracted driving-related behaviours in eight countries, which can be used to target high-risk groups for prevention efforts.

In Botswana, increased development and motorization have brought increased road traffic-related death rates. Between 1981 and 2001, the road traffic-related death rate in Botswana more than tripled. The country has taken several steps over the last several years to address the growing burden of road traffic crashes and particularly to address the burden of alcohol-related crashes. This study examines the impact of the implementation of alcohol and road safety-related policies on crash rates, including overall crash rates, fatal crash rates, and single-vehicle nighttime fatal (SVNF) crash rates, in Botswana from 2004 to 2011. The overall crash rate declined significantly in June 2009 and June 2010, such that the overall crash rate from June 2010 to December 2011 was 22% lower than the overall crash rate from January 2004 to May 2009. Additionally, there were significant declines in average fatal crash and SVNF crash rates in early 2010. Botswana's recent crash rate reductions occurred during a time when aggressive policies and other activities (e.g., education, enforcement) were implemented to reduce alcohol consumption and improve road safety. While it is unclear which of the policies or activities contributed to these declines and to what extent, these reductions are likely the result of several, combined efforts.

Motorcycles are an important form of transportation in Uganda, and are involved in more road traffic injuries than any other vehicle. The majority of motorcycles in Uganda are used as motorcycle taxis, better known locally as boda bodas. Research shows that a motorcycle helmet is effective at reducing a rider’s risk of death and head injury. As part of the Uganda Helmet Vaccine Initiative (UHVI), researchers collected baseline and formative evaluation data on boda boda operators’ helmet attitudes, beliefs, and behaviors to inform UHVI activities. Researchers collected data on motorcycle helmet-related attitudes and beliefs through focus group discussions and structured roadside interviews, and researchers conducted roadside observations to collect data on helmet-wearing behaviors. Of the 12,189 motorcycle operators and passengers observed during roadside observations, 30.8% of drivers and <1% of passengers were wearing helmets. The most commonly reported helmet-wearing barriers from the focus group discussions and structured roadside interviews were: (1) ‘Helmet is uncomfortable’, (2) ‘Helmet is too hot’, (3) ‘Helmet is too expensive’, and (4) ‘Helmet is of low quality’. Researchers incorporated findings from the formative research into the UHVI campaign to increase motorcycle helmet use. Radio messages addressing helmet comfort and cost were widely aired throughout Kampala, Uganda. In addition, campaign staff held nine boda boda operator workshops, covering approximately 900 operators, in which the facilitator addressed barriers and facilitators to helmet use. Each workshop participant received a high-quality tropical motorcycle helmet. UHVI will continue to use a data-driven approach to future campaign activities.

Unintentional injuries are the leading cause of deaths among persons aged 0-19 years in the United States. Quantifying years of potential life lost (YPLL) highlights childhood causes of mortality and provides a simple method to identify important causes of premature death and specific groups in need of intervention. Deaths attributed to unintentional injuries among persons aged 0-19 years number approximately 12,000 each year in the United States; another 9 million young persons are treated for nonfatal injuries in emergency departments. To estimate the burden of premature deaths attributed to unintentional injuries among persons aged 0-19 years, CDC calculated state-specific YPLL by sex, age, race, and injury mechanism based on data from the National Vital Statistics System multiple cause of death files for the period 2000-2009. This report summarizes the results of that analysis, which found that an average of 890 years of potential life were lost each year because of unintentional injuries for every 100,000 persons aged 0-19 years. The burden of unintentional injuries was higher among males compared with females, among persons aged <1 year and those aged 15-19 years compared with the other 5-year age groups, among American Indian/Alaska Native (AI/AN) compared with those of any other race/ethnicity, and among those residing in two clusters of adjacent states (the South Central states of Arkansas, Louisiana, Mississippi, and Alabama, and the Mountain states of Montana, Wyoming, and South Dakota) compared with any other region. These estimates can be used to target injury prevention strategies to young persons most at risk.