Columbia Study Shows Ethnic Disparities In Injuries Due To Falls From Buildings
NEW YORK, N.Y. – A national study by Columbia University Medical Center (CUMC) researchers shows that young minority children from lower income neighborhoods are far more likely to die or be injured in falls from buildings. The study also shows that in New York City injury rates are nearly half the national average, despite the fact that a higher proportion of New Yorkers live in multi-unit homes. Rates in New York State outside of New York City more closely resemble the national average. The study’s authors attribute these differences to the mandatory use of window guards in New York City, the only major city in the United States with a law mandating the use of window guards.
The study, conducted by researchers affiliated with CUMC’s Center for the Health of Urban Minorities, is the first to look at ethnic differences in building falls among children. CUMC researchers found that Latinos have the highest overall rate of falls, followed by African Americans and then whites. The greatest disparities exist before age 4: Latino rates are more than double those of whites, with African Americans close behind Latinos. The study appears in the May 2004 issue of the journal Applied Environmental Science and Public Health.
“These results demonstrate that the public health community must develop new, culturally appropriate strategies to reach minority parents,” says Barbara A. Barlow, M.D., professor of surgery, Columbia University Medical Center and director, Department of Surgery, Harlem Hospital. “They also demonstrate the need for window guard legislation in urban areas, where most of the affected minority children are injured or killed.” A noted expert on injury prevention, Dr. Barlow is executive director of the Injury Free Coalition for Kids, a Robert Wood Johnson Foundation-funded initiative with 40 injury prevention sites across the U.S. that is based at Columbia’s Mailman School of Public Health.
The study examined statewide hospital discharge data from New York State and a national database of pediatric admissions from 27 states that included 1,091 unintentional and 70 suicidal fall cases. The states were Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Massachusetts, Maryland, Maine, Missouri, North Carolina, New Jersey, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia.
Among African Americans and Latinos, nearly half of hospitalizations due to falls from buildings occurred in the youngest age group, 0-4 years old (48% and 46% respectively). Among whites, one in three falls (33%) occurred in this age group. Most falls occurred at home, but this decreased with age, from 88% in very young children to 41% in 15-18 year olds. Across ethnicities, most falls victims of any age were male: 73% of Latinos, 71% of whites, and 66% of African Americans. Among those injured in an intentional fall or suicide attempt, 81% were associated with mental illness, alcohol or substance abuse.
Window Guards Save Lives
The Columbia researchers credit window guard legislation and enforcement in New York City, aimed at protecting children under eleven from window falls, for dramatically reducing injury or death due to falls. In New York City, 54% of residents live in multi-family dwellings with 10 or more units, compared with 13% of the national population. Forty percent of the state’s children live in New York City. Yet the building fall rate in New York City, which includes falls from roofs and fire escapes as well as windows, is nearly half the national average. New York City, which has had a window guard law in effect since 1976, is the only large city in the nation to mandate that landlords install these safety devices. In a paper published in 1983, Dr. Barlow found that the law and accompanying public education campaign resulted in a 96% decrease in window falls in Harlem. Eighty percent of building falls prior to enactment of the law were from windows.
The New York City law requires that building owners install approved window guards in the home of any family where a child younger than eleven years of age lives. Owners are also responsible for installation of window guards in public areas if a child under age eleven lives in the building. The law also requires the building owner to send every tenant a notification form once a year to identify new needs for window guards. The tenant must complete and return the signed form indicating whether or not children under eleven years of age live in the apartment or if the tenant or occupant wants window guards for any reason. The New York City Department of Health and Mental Hygiene operates the Window Falls Prevention Program, which includes a web site containing public information on the law, its enforcement, a list of approved manufacturers of window guards, installation instructions, and frequently asked questions. The web site can be found at: http://www.nyc.gov/html/doh/html/win/win.html
According to the City, three preventable window falls were reported to the Window Falls Prevention Program in 2002 (NOTE: these data were not used in the Columbia study, which looked at building falls overall and not window falls). “Window guard legislation, in conjunction with public education and enforcement efforts, prevents injuries and saves lives,” says study author Joyce Pressley, Ph.D., M.P.H., assistant professor of health policy and management at the Mailman School of Public Health, Columbia University.
Falls Greatest in Warm Weather
The study uncovered a number of seasonal variations never before reported. Consistently strong peaks in numbers of injured have been observed during warmer months, generally reflecting increased falls from windows left open apparently to regulate temperatures in the home. However, the Columbia study found that previously reported seasonal peaks in falls from buildings appear to be age-related, with a higher year-round risk for older children and adolescents than for younger children. Most building-fall injuries and deaths among 0-4 year olds occur from May to September, with a gradual increase in injuries beginning as early as March and April. In contrast, among 15-18 year olds, injuries due to falls from buildings are more evenly dispersed throughout the year, with injuries in February and December exceeding those in the hot weather months of July and August.
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*Located in New York City, Columbia University Medical Center provides international leadership in basic and clinical research, medical education, and health care. The medical center includes the dedicated work of many physicians, scientists, and other health professionals from the College of Physicians & Surgeons, the School of Dental & Oral Surgery, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University physicians and scientists achieved some of the 20th century's most significant medical breakthroughs, including the first blood test for cancer, the first medical use of the laser, and the first successful transfer of genes from one cell to another. This pioneering tradition continues today through 24 departments and several specialized research centers and institutes acclaimed for work in neuroscience and neurology, emerging infectious diseases, diabetes, community health, and many other areas of expertise.
*The Columbia Center for the Health of Urban Minorities conducts and supports research, training, education, and community partnerships aimed at improving the health of Latinos and African-Americans in northern Manhattan. The center is funded by the National Institutes of Health's National Center on Minority Health and Health Disparities.