HomeMy WebLinkAboutMINUTES - 12071993 - 1.93 TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director Contra
By: Elizabeth A. Spooner, Contracts Administrator Costa
DATE: November 18, 1993 County
SUBJECT: Approve Submission of Funding Application #28-544 to the State
Department of Health Services
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve submission of Funding Application #28-544 to the State
Department of Health Services, in the amount of $382, 626, for the
period from October 1, 1993 through September 30, 1996, for the
California Bicycle Injury Prevention Project.
II. FINANCIAL IMPACT:
Approval of this application will result in $382, 626 from the State
(Federal funds) during the period from October 1, 1993 through
September 30, 1996, for the California Bicycle Injury Prevention
Project. No County match is required.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
According to the California Highway Patrol, in one year, more than 680
people in Contra Costa County were injured in bicycle-related crashes.
The average cost of treating a severely head-injured bicyclist is $4 . 5
million.
This project will provide a coordinated, system-wide approach to
bicycle injury prevention. The Department's Prevention Program will
work with State and local organizations to promote bicycle helmet
usage, environmental modifications and broad systemic changes.
Locally, the primary goal will be the establishment of comprehensive
bicycle safety efforts in the cities of Pittsburg and Walnut Creek, to
decrease morbidity, mortality, disability and costs related to bicycle
injuries.
In order to meet the deadline for submission, the application has been
forwarded to the State, but subject to Board approval. Four certified
copies of the Board Order authorizing submission of the application,
should be returned to the Contracts and Grants Unit for submission to
the State Department of Health Services.
CONTINUED ON ATTACHMENT; YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMME ATI N OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
Contact: Wendel Brunner, M.D. (313-6712) OF SUPERVISORS ON HE DATE SHOWN.
CC: Health Services (Contracts) ATTESTED
Auditor Controller (Claims) Phil Batchelor, Clerk of the Board of
State Dept. of Health Services SupijlYl;=aWC I1tyAdmini*aW -
M382/7-83 BY ' DEPUTY
OMB APProva(No.03!8.0043
APPLICATION FOR z.DATE Sue"ITTED
FEDERAL ASSISTANCE 7-15-93 "°A''c° Identifier
1. TYPE OF SueM15SIOec 1.DATE RECEIVED BY STATE State Application Identifier
Application PreaWicat%on
❑ Construction ❑ Construction
4.DATE RCCCIYED BY FEDERAL AGENCY f=ederal identifier
in Nonronstruaion ❑ Non-Corawct(on Announcement 1327
L APPLICAIIT INFORMATION
Leal Name: omartizational Unit:
Department of Health Services Maternal & Child Health Rranch
Addm a(give city,county,state,and zip code): Name and telephone number of the person to be contacted on matters involving
714 P Street this application (give area code)
Room 750 Ed Melia (916) 657-1347
Sacramento, CA 95814 Larry Cohen (510) 646-6511
t.CmPWYER MENTIFfCATM NUMBER(EINk 7.TYPE OF APPLICANT:(enter ropmwiste letter in box)
9 4 C-r�0 1 3 4 7 A. State H.Independent School Obt.
B. County L State Controlled Institution of Higher Learning
C. mWicipal J. Private University
t TYPE OF APPLICAT1pN D. Township K Indian Tribe
J New O Continuation ❑ Revision E Interstate L. Individual
F. Mtermunicipal M.Profit Organization
if Revision,enter appropriate letters)in bondes): ❑ ❑ G.Special Oistrict N.Other(Specify).
A.increase Award 8.Decrease Award C.Increase Duration
O.Decrease Ouration Other(specify): a. NAME OF FEDERAL AGENCY-
Health & Human Services
Centers for Disease Control & Prevention
to.�*OF FEDERAL
DOMESTIC11.
3 e 1 3 6 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT:
TITLE: State & Community-Based Programs California Bicycle Injury Prevention
Project
12. AREAS AFFECTED BY PROJECT(cities.counties,states.etc.):
California
q.PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF:
Start Date Ending Date a.Applicant :b.Project
10/1/93 9/30/96 1-45 -45- -
13.ESTIMATED FUNOft1G ft.Is APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12]71 PROCEW7
a. Federal = 250,149 A0 a YES.THIS PREAPPt"TIOWAPPt.ICATiON WAS MADE AVALABLE TO THE
STATE EXECUFMWE ORDER 12372 PROCESS FOR AEVIEW ON:
b. Applicant t 85,801 .Op DATE 7-15-93
c.State = SEE B W b No. ❑ PROGRAM tS NOT COVERED SY E.O. 12372
e.Local i 15,664 -im
[] OR PROGRAM HAS NOT BEEN SELECTEO BY STATE FOR REVIEW
e Other i -0- -00
f. Program Income = —0— .00 17. IS THE APPLICANT DEUNOUEW ON ANY FEDERAL DEBT?
g TOTAL s
351,614 .00 C] YesN"Yes.-attach an vVianation. ® No
i; TOTAL T
It.TO THE BEST OF MY KNOVAMME AND,BELIEF.ALL DATA IN THIS APPLICATIONAPREAPPLICATION ARE TRUE AND CORRECT.THE DOCUMENT NAS BEEN DULY
AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
a.T.mnrl Nw est ArrttwiyM Roorfmantntiva b Tare c Yefephone number
Joseph P. Zlunso Deputy Director (916)657-1347
d Sgnacure of.Authorized Representative a Date Sgned
7-14-93
evaus Not Usable Standard Form ata (REV a•881
Presctd>ed by OM8 Cotuta, A.102
STATE OF CALIFORNIA—HEALTH AND WELFARE AGENCY PETE WILSON, 60WMor .
DEPARTMENT OF HEALTH SERVICES
714/744 P STREET
P.O. BOX 942732
SACRAMENTO, CA 94234.7320
Henry S. Cassell, III
Grants Management Officer
Grants Management Branch
Centers for .Disease Control and Prevention
255 E. Paces Ferry Road, NE
Room 300, Mailstop E=13
Atlanta, GA 30305
Dear Mr. Cassell:
I am enclosing California's application to the Centers for Disease
Control and Prevention (CDC) for funding for "State and Community-Based
Programs to Prevention Bicycle Injuries". Eleven percent of the
nation's residents call California home and, unfortunately, we
represent 14 percent of the nation's serious bicycle injuries .
Bicycling is an extremely popular form of exercise and transportation
in our temperate climate, and we anticipate greater use of bicycles as
a partial solution to traffic congestion and air quality problems.
As a state, we have taken initial steps toward addressing bicycle
injury prevention, and with funding from CDC, we would be able to take
the next steps. Most significantly, we need to establish a focal point
in the Department of Health Services and coordinate a statewide
campaign. Funding would allow us to strengthen our helmet advocacy
efforts and pay special attention to low income populations.
We look forward to implementing a project which can be of tremendous.: - --
benefit to our State's bicyclists, and through our successes, to the
rest of the country.
Thank you, and if you should need additional information, please
contact me at (916) 657-1347.
Sincerely,
L-4�: � ��
Rugmini Shah, M.D. , Chief
Maternal and Child Health Branch
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PHS-5161-1(7M) Page 23
OMB Approval No.0937-0189
c>iMKLtsT Expiration Dace:March 31, 1995
Public Burden Statement;Public reporting burden for this collection of Washington,D.C.20201.and to the office of Management and Budget,
Information is estimated to average 10 minutes per response,inducting Paperwork Reduction Project(0937-0189),Washington,D.C.20503.
the time for reviewing insWctions.searching existing data sources,gathering
and maintaining the data needed.and completing and reviewing the col- NOTE TO APPUCANT.This form must be completed and submitted with
lection of kdomradion.Send corriment8 regarding this burden estimate,or the original of your appficadion.Be sure to complete both sides of this form
any other aspect of this collection of information.including suggestions;for Check the appropriate boxes and provide the infornwffon requested.This
reducing this btxdem to PHS Reports Clearance Officer.ATTR PRA Hubert form should be attached as the last page of the signed original of the appli
H. Humphrey Bldg., Room 721.8. 200 Independence Ave.. S.W., cation.This page is reserved for PHS staff use only.
Noncompeting ung
Type of Application: ® NEIN ❑ Continuation ❑ Continuation ❑ Supplemental
PAF[r A-- The following checklist Is provided to assure that proper signatures,assurances,and oerdffcffUons have been subn*ted.
NOT
Included Applicable
1. Proper Signature and Date for Item 18 on SF 424 (FACE PAGE) .. ....... .. . .. 55
2,' Proper Signature and Date on PHS-5161-1 "Certifications" page. . ... .. .. . ... .. fl
3. Proper Signature and Date on appropriate "Assurances" page, i.e.,
SF 424E (Non-Construction Programs) or SF-424D (Construction Programs) .. .... >gl
4. If your organization currently has on file with DHHS the following individual
assurances, please identify which have been filed by indicating the date of such
filing on the line provided.
❑ Guru Rights Assurance(45 CFA so) .....................
❑ Assurance Concc rming the Handicapped(45 CFR 84) .......
❑ Assurance Concerning Sex Discrimination(45 CFR 86)......
❑ Assurance Concerning Age Discrimination(45 CFR 90&
45 CFR 91) ........................................
5. Human Subjects Certification, when applicable (45 CFR 46) ........ .. .... .... ❑ K
PART B:This part Is provided to assure the pertinent Information has been addressed and included in the apprrcation.
NOT
YES Applicab
1. Has a Public Health System impact Statement for the proposed program/project
been completed and distributed as required? .. ................... .. ....... ❑
2. Has the appropriate box been checked for item #16 on the SF-424(FACE PAGE)
regarding intergovernmental review under E.O. 12372? (45 CFR Part 100) ...... iN
3. Has the entire proposed project period been identified in item #13 of the FACE
PAGE?..... .. . . . ... ................................... ..*. ........ IN
4. Have biogmaphical sketches; with job descriptions) been attached, when
required? .. .. ...... . .......... .... ........................ ...... . ❑
5. Has the "Budget information" page, SF-424A(Non-Construction Programs) or
SF-424C(CAnstruction Programs), been completed and included? .. ........ 12
6. Has the 12 month detailed budget been provided.? . �
.. .... ....... ® ❑
7. Has the budget for the entire proposed project period with sufficient detail been
provided? ...... ..... ..... .... ........... ..................
❑ 10
8. For a Supplemental application, does the detailed budget only address the addi-
tional funds requested? . .............................................. ❑ K)
9. For Competing Continuation and Supplemental applications, has a progress report
been included? ... .... . ....... .. . .........................'.... ...... ❑ 91
PART C in the spaces provided below,Identify the applicant organizationa adn*ftmtf"official to be ratified H an award Is made
and the bn*vidual responsible for directing the proposed pm9raMProject.
Name,title,organization,address and telephone number of the Name,title,organization,address and telephcim number of the pro-
administrative official to be notified If an award Is to be made. gram dredor/project drec todprincipaf Investigator designated to
RuRmini Shah, MD, Chief direct the proposed pr*d or program.
Calif- DpTna tment of Health Servir—es Rugmini Shah.MD. Chief CA Dept of Health Svc:
MatArnal & rh;ld irPalth Rrane-h Maternal & Child Health Branch
714 P Street, Room 750 714 P Street,. Room 750 Sacramento, CA 95814
Sacramento CA 95814 (916) 657-1347
OHHS 12 DW EiN MR APPLICANT ORGANQATM(ff afmadywgreco
SOCIAL SEwfffy NUMBER HIGHEST OEGREE MIEO
3- 3a-7 006 M.D.
rte)
I. ABSTRACT
A Community Based Program to Prevent Bicycle Injuries:
CALIFORNIA BICYCLE INJURY PREVENTION PROJECT
California Department of Health Services
714 P Street, Sacramento CA 94234 (916) 327-8171
Ed Melia, MD,. Section Chief
Each year in California an average of 16,500 people sustain
bicycle-related injuries. Tragic=ally, in 1989 alone, 117 people in
California were killed in bicycle collisions, representing 14
percent of the nation's bicycle related deaths. The average cost
of treating a. severely head injured bicyclist is $4.5 million.
These numbers are only expected to increase as the overall
population explodes and as bicycling becomes a more popular form of
transportation, necessitated by congestion relief and air quality
management requirements in the state.
The problem of bicycle injuries in California is three fold:
regulatory, environmental, and behavioral. Only by addressing each
of these components of the problem can injuries be effectively
prevented. Clearly, a coordinated systems-wide approach is needed
to address all three aspects of the problem.
In order to more effectively address the problem the
California Bicycle Injury Prevention Project will spearhead a
comprehensive, coalition based, state-wide prevention effort aimed
at reducing the number of bicycle injuries and deaths. The target
population for the project will be the large percent of
California's population (29 mi=llion) who ride bicycles. Local
intervention will target those living in Contra Costa County
(population: 836,781) , particularly in the cities of Walnut Creek
and Pittsburg.
This project will address the regulatory, environmental and
behavioral factors known to cause bicycle injuries. Its uniqueness
lies in the fact that it will address these through collaborative
efforts at both the state and loc=al levels. At the state level, a
--Bicycle Injury Prevention Coordyr+
II. THE PROBLEM
Each year in this country more than 800 people die and
approximately one million more are treated in emergency rooms or
other hospital settings as a result of bicycle injuries
(Harborview Injury Prevention and Research Center, 1990) . Sixty
percent of fatalities are due to head injuries (JAMA 12/4/91) .
Head trauma (usually intracranial hemorrhage) is the most
frequent cause of death in fatal bicycle accidents, occurring in
approximately 75 percent of cases. (New York State Journal of
Medicine, 1987) . Survivors of head injuries only have a 33
percent chance of returning to a lifestyle without any permanent
disabilities (Harborview Injury Prevention and Research Center,
1990) .
California's bicycle injury problem must be understood in two
ways: first, through an analysis of the injury threat to the
millions of bicyclists in the state and secondly; as a systemic
problem requiring enhanced coordination among state and local
organizations interested in bicycle safety. Each of these
aspects of the problem are described below, along with specific
information about the local intervention `area, Contra Costa
County.
A) Injuries in California
As bicycling becomes a more appealing and popular form of
transportation, and as congestion relief efforts and air quality
management requirements promote even more riding, public
officials need to make bicycle safety issues a top priority.
The State of California:
♦ Is home to an estimated 29 million people and 20
- - -million bicycles. Both the state population and -the
number of bicyclists is rapidly increasing (Regional
Bicycle Advisory Committee May, 1993) .
♦ Has 11 percent of nation's population but 14 percent of
bicycling fatalities (Census Bureau/SWITRS 1989-91) .
♦ Had 82,152 people injured and 678 people killed in
bicycle related crashes between 1985-1989. In 1989
alone, 117 people were killed and 16,605 were injured
in bicycle collisions (SWITRS) .
♦ Has children under the age of 16 comprising 23 percent
of the population (the population that suffers most
from bicycle injuries and deaths. In 1991, 34 percent
of California's bicycle collision victims were under 15
years of age (SWITRS, 1991) .
2
♦ Has a rapidly increasing population of low income and
immigrant residents. over 40 percent of California's
population is non white.
♦ Has paid dearly for the costs associated with these
injuries. The lifetime average cost of a severely head
injured bicyclist is $4.5 million (National Head Injury
Foundation Fact Sheet) .
♦ Has a particularly lengthy warm season, where outdoor
activity is extended and exposure to the risk of injury
is increased as compared to other states where
temperatures limit the number of bicyclists.
In a state the size of California, the sheer number of
interactions between bicyclists and motor vehicles increases the
number of injuries. An effective solution requires addressing the
problem's multiple causes.
B) California's Need for Enhanced System-wide Collaboration
The literature on bicycle injuries indicates three primary
clusters of contributing factors: regulatory, environmental and
behavioral. Enhancing bicycle safety requires addressing each of
these factors. Clearly a systems-wide response is needed.
Different organizations are critical in addressing each of these
elements. An effective response is possible only through the
collaboration among relevant organizations, on both a statewide
and a local level.
Regulatory Factors:
The major regulatory issues that contribute to the problem of
bicycle injury are the failure to institute simple preventative
regulations and the lack of enforcement- of -existing safety laws: - - -
California currently has no law requiring that bicycle riders
(except those under age four or forty pounds in weight) wear
helmets. In fact, local jurisdictions are currently prohibited
from passing such laws for their community. The CDC estimates
that, in California, 65 deaths and 4,150 head injuries could be
prevented each year if all bicyclists wore their helmets (Jeffery
Sacks, CDC) . Retailers who sell bicycles are not required to
sell helmets. Codes regulating environmental factors such as
bicycle paths, recreational facilities, and trails are weak and
need to be strengthened. Finally, enforcement of current bicycle
safety laws is erratic.
Environmental Factors:
Among environmental factors, lack of structures such as sidewalks
and bicycle lanes to separate people from traffic are the most
serious threats to bicycle safety. A group of traffic safety
3
experts estimated that "traffic safety will be three to five
times greater in areas where principles of traffic
differentiation and separation will be applied. " (Friede, Azzara,
Gallagher, and Guyer, 1985, p.148) . A California study found that
bicycle lanes reduced the number of crashes by 18 percent (City
of Palo Alto, undated) . Road conditions, lighting, weather, and
road signs also are believed to contribute to this injury
problem.
Another contributing issue, described in the literature as an
environmental factor, is socio-economic status. As this
population grows in California, injuries will continue to
increase as well. It is clear that low income communities where
injury incidence is high and helmet use is low, are at high risk
for head injuries and fatalities. Thus any effective
intervention must address the economic factors which affect
helmet use and injury rates.
Behavioral Factors:
Human behavior factors contributing to bicycle injuries include
negligent and careless behavior by both the bicyclist and the
motor vehicle driver, ignorance of road-sharing, primarily by the
motor vehicle driver, and of course, lack of bicycle helmet use.
Several surveys have shown that while helmets are more widely
used by adult bicyclists, merely 5 percent of children wear them
(Harborview Injury Prevention Center, 1987) . For example, in
Contra Costa County, a more recent bicycle helmet observation
study (1991) showed that children were still the least likely to
wear a bicycle helmet, with only 15 percent of elementary school
children wearing helmets. While adult rates were higher (35
percent) they are still low. Parents, lack of knowledge about
helmets contributes to this problem. In addition, gender
behavior has a significant impact on these injuries. Males are
grossly over represented among those injured. They are the
victims of 80 percent of all childhood bicycle injuries (SWITRS,
1989-91) .
C) Current Bicycle Injury Prevention Efforts
The institutions in California which need to address each of
these factors have worked hard to decrease the incidence of
bicycle injury through increased helmet use and the passage of a
helmet law. Unfortunately, without one unifying force at the
state level their efforts have been fragmented and have left them
unable to deal with the problem of bicycle injury prevention as a
whole. For example, many state legislators, city planners, and
traffic commissioners are not even aware of the extent of the
problem and do not recognize their potential role in the
solution. Furthermore, while health professionals may recognize
the problem, they generally do not see themselves as providing
the leadership needed to link groups who are outside the
4
traditional health care delivery system. Even efforts to pass
California's bicycle helmet legislation have been fragmented.
Committees throughout the state work independently, maintaining
some communication but without a mechanism for systematic
planning and coordination.
The impressive accomplishments within the state underline the
value of uniting these groups and organizations who already
espouse many of the same goals. For example:
♦ A statewide advisory group on injury control has come
together, utilizing CDC support, and integrating governmental,
academic, private, and community perspectives into a
comprehensive injury prevention plan.
♦ The State-wide Injury Prevention Plan identifies bicycle
injury prevention as a major priority for the state of
California.
♦ With bicycle safety put in the context of safety issues
as a whole, its legislative support benefits from the momentum
built by the recent passage of California' s other strong traffic
safety laws -- in the areas of motorcycle helmets, child
passenger seats, and seat belts.
♦ The State Health Department's capacity to focus on injury
prevention has been enhanced, both through the establishment of
its Emergency Preparedness and Injury Control Unit (EPIC) and
through the development of an injury prevention unit within The
Maternal and Child Health Branch.
Currently, the Health Department. works effectively with other
important injury prevention departments statewide, including the
Office of Traffic Safety, which is the Governor's Highway Safety
Representative, the California Highway Patrol, and the Department
of Alcohol and Drug Abuse. Pilot projects have been established
in bicycle safety through the Office of Traffic Safety in local
health departments and police departments. The Health Department
has developed in 800 California schools its MCH/PTA project which
promotes helmet use through volunteer efforts, encourages school
helmet usP policies, and coordinates helmet sales and
distribution. Nationally significant bicycle safety evaluations
have been conducted, including observational surveys,
environmental factor studies, and barriers to helmet use surveys.
California has been selected as a pilot state by the National
Highway Traffic Safety Administration for utilizing HIRLS
software, the Highway Injury Report Linkage System which provides
more integrated and thorough data on injuries than previously
practical.
In. summary, California is on the cutting edge of bicycle injury
prevention and evaluation work. What is now needed to enhance
5
and solidify these efforts is a system which:
♦ Establishes a coordinated, statewide injury prevention
and control program.
♦ Integrates state and local strategies for injury
prevention including helmet usage, and other
environmental behavioral and regulatory changes.
♦ Evaluates this comprehensive approach and provides
empirical data demonstrating its effectiveness for use
in other states and localities nationwide.
D) The Local Intervention site: Contra Costa County
A statewide effort alone will be ineffective in a state as large
and diverse as California. A dynamic interchange must take place
between key state and local efforts to bring about marked change
in injury and mortality rates for bicyclists. Statewide
activities must be complemented by intensive, targeted
interventions at the local level in order to effectively alter
behaviors, policies, and environments and make California a safe
place to ride a bicycle.
On the local level, Contra Costa County has been chosen as the
intervention site to demonstrate the efficacy of bicycle safety
efforts. Contra Costa County's population is representative of
that of California as a whole in its cultural diversity. With a
population approaching one million, the county is a microcosm of
California and much of the United States. Located in the San
Francisco Bay Area, Contra Costa County is one of the fastest
growing counties in the state with a 19 percent growth rate from
1980-90 (ABAG, 1991) . This growth has increased both the motor
vehicle and bicycle traffic sharing the roads.
Based on median income, this county is one of the most affluent
in the state. However, there is a large prosperity gap between
the rich and the poor particularly in "East County" where nearly
30 percent of households have incomes less than 200 percent of
the federal poverty line (1980 census) . Overall, most new job
. growth is occurring in the central region, while the greatest
demand for new housing is in the more affordable adjacent "East
County." These fast-growing "bedroom communities" are comprised
primarily of young families with children who are at-risk for
bicycle injuries. Two target cities, one from each of these
regions, have been selected. Pittsburg and Walnut Creek will be
the sites of intensive intervention and evaluation efforts.
In 1991, there were 386 bicycle related injuries severe enough to
be noted in police traffic collision reports (SWITRS, 1991) .
This does not account for "scoop and run" incidents which are
serious but not reflected in police reporting records because the
6
injured bicyclist is taken for medical treatment immediately,
without reporting the incident to the police. Statistics vary in
the two target cities: the number increased in Pittsburg (a low
to moderate income community with both suburban and inner city
characteristics in the east) from 11 injuries reported in 1989,
to 25 reported in 1991. In Walnut Creek (a more affluent, poorly
planned, overdeveloped suburb in the central area) , the numbers
remained consistent at 55 in 1989, to 53 in 1991 (SWITRS, 1989-
91) . Walnut Creek has the highest number of bicycle injuries of
any municipality in Contra Costa according to SWITRS. Focusing on
these two cities provides the opportunity to study populations
which are manageable in size, which represent bicyclists of ,
varied socioeconomic and cultural backgrounds and whose reasons
for bicycling include business and school commutes, as well as
recreation. Their cultural diversity is marked, with Pittsburg's
population having nearly fifty percent non-white ethnicity, and
with Walnut Creek being more than 90 percent white.
Countermeasures aimed at these diverse populations will be an
important component of this project.
In addition, the County Health Services Department's unique
Prevention Program which will implement the project, is
nationally recognized for its experience in coalition building
and its local orientation to policy development. Recipient of
the U.S. Department of Health and Human Services National Health
Promotion Award (1986) , Society for Public Health Education
Program Excellence Award (1988) , and National Association of
County Health Officials Prevention Award (1988) , the Prevention
Program has over ten years experience designing coalition-based
projects. Its training video "Beyond Brochures" is used
internationally and 118 Steps to Coalition Building" is the base
for the coalition building section of the "Blue Book", Injury
Prevention: Meeting the Challenge.
Contra Costa County's Prevention Program is distinguished by its
successful operation of a three year pilot bicycle safety
project, Safe Roads/Safe Families which utilizes a coalition
model funded by California's Office of Traffic Safety. It has a
proven track record in achieving support from a variety of public
and private organizations, experience in local evaluation,
including bicycle helmet observational and empirical studies, and
experience in translating local success into policy efforts,
including significant contributions towards the state
legislature's current consideration of a bicycle helmet law. A
particular strength of the programs history has been it's work in
multi-cultural communities.
A roadside bicycle helmet observational study conducted by the
Safe Roads/Safe Families Coalition in 1991 and 1992 solidified
the Coalition's commitment to a helmet law. The study showed an
average helmet use increase of three percent for all ages, with a
10 percent increase among the age group targeted for intervention
7
(5-14 year olds) in the year between the observations. Highest
use rate was among the under age four population, corresponding
to the law requiring the usage of helmets for that age group.
Helmet use rates dropped dramatically after that age.
Furthermore, the local effort of Contra Costa County's Prevention
Program has the advantage of a new computer technology -- Highway
Injury Record Linkage System (HIRLS) . This allows the Safe
Roads/Safe Families Coalition to pinpoint bicycle injury
locations and provide statistics on severity, type, and cost of
injuries. This information will be utilized to target sites most
in need of interventions. Further, it will be helpful in public
information campaigns as it provides newsworthy and timely data.
As the evaluation section (below) reflects, HIRLS provides
information on the effectiveness of project interventions.
III. GOALS AND OBJECTIVES
A) Project Goal
The primary goal of this project is to develop a comprehensive
bicycle safety effort for California which will decrease
morbidity, mortality, disability and cost of bicycle injuries.
This goal will be reached through a collaboration of state and
local organizations working to promote helmet usage,
environmental modification, and broad systemic change. The
outcome of such efforts will be a safer environment for the
increasing numbers of bicycle riders of all ages in California.
B) Project objectives
California Objectives:
B.1) To ensure the passage of a California bicycle helmet
law requiring all bicycle riders wider,the age of 16 to
wear helmets. Moreover, this project seeks to advocate for
a broader age or generic helmet law (See Appendix C) .
B.2) To establish a statewide bicycle injury prevention and
control program and information dissemination mechanism at
the California State Department of Health Services.
B.3) To evaluate the statewide pilot test of the Injury
Control and Risk Factor Surveillance System (ICARIS) .
Statewide Aims
B.4) To increase bicycle helmet usage by at least 15 percent
for children and 10 percent for all ages by the end of year
three of the grant period.
B.5) To decrease statewide the rate of fatalities due to
8
bicycle crashes by 10 percent, and decrease the rate of
bicycle related head injuries by 20 percent by the end of
the project period.
Aims of Local Intervention:
B.6) To increase bicycle helmet usage by at least 30 percent
for children and 20 percent for all ages by the end of year
three of the grant period.
B.7) To decrease the rate of injuries due to bicycle crashes
by 15 percent, and decrease the rate of bicycle related head
injuries by 30 percent by the end of the project period.
B.8) To modify at least five hazardous areas per year in
the intervention site.
IV. METHODOLOGY
Clearly, accomplishing the critical changes in environmental,
regulatory, and behavioral factors needed ..-to reduce bicycle
injury and death requires an integration of efforts. California
proposes to establish the California Bicycle Injury Prevention
Project (CBIPP) to integrate and enhance injury prevention
efforts. This integration will be two-fold:
o Statewide and local efforts must be concurrent and
complementary. In a state the size of California (in fact in,
virtually every U.S. state with a significant population)
statewide collaboration is an essential factor, but its results
can only bear fruit with local attention and activity. The chart
below delineates major ways in which the California approach
integrates statewide and local efforts.
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♦ On both the state and local levels, well-coordinated
activities by numerous organizations and institutions will be
required to accomplish the above stated objectives. Virtually no
single change can be made by an organization working in isolation
and, more importantly, the range of' mutually-supporting
activities that need to be accomplished requires commitments from
numerous groups working in concert. Thus, the California Bicycle
Injury Prevention Project will use a coalition-based approach as
its core methodology. This project proposes to coordinate
statewide injury prevention efforts by establishing a new
California State Bicycle Injury Prevention Coordinator within the
Maternal and Child Health Branch of the DHS as well as a
statewide California Bicycle Injury Prevention Committee, and
locally through the enhancement of Contra Costa's Safe Roads/Safe
Families Coalition. The collaboration section later in this
application describes the coalition participants and their roles:
policy-makers in state, county, school district, and city
governments, key businesses, community groups, and other
knowledgeable private and public sector representatives. The
details of the methodology below delineate the components of a
successful strategy to increase bicycle safety.
A) State Strategies
At the state level, there will be three approaches to accomplish
the statewide objectives listed above. Most importantly, a
California bicycle helmet law will be enacted. Secondly, critical
in a state as economically diverse as California, a plan for
funding low income residents' helmets will be developed. Thirdly,
local efforts throughout the state will be enhanced including the
current California Bicycle Helmet Campaign through the PTA's. In
the process of developing support for the law, and the other
efforts described, the project will convene and consult key state
players of the California Bicycle Injury Prevention Committee.
They will develop other strategies and initiatives to improve
bicycle safety statewide. All of these strategies will be
implemented by the state's Bicycle Injury Prevention Coordinator.
1) Legislative Action
Currently, California is considering a law requiring children
under 18 years to wear helmets (AB 2268) . This law has passed
one branch of the legislature to date, an encouraging sign, since
last year's version was less successful despite its weaker
provisions. The fate of this bill is uncertain. However,
support for bicycle helmets is increasing. The passage of
statewide bicycle helmet legislation is a major component of the
California State Injury Prevention Plan of 1993, developed by the
State Injury Control Advisory Task Force.
A concerted campaign among diverse groups such as injury
prevention advocates, health practitioners, schools, and
10
insurance companies would increase the chances of a helmet law
being passed. State actions will. include:
a) Gathering appropriate bicycle injury data to support this
legislation and disseminating it to appropriate state and local
agencies.
b) Linking with local spokespeople and print and electronic
media to ensure that the importance and value of a helmet
campaign is well understood by the public and by legislators.
c) Coordinating with the California Coalition for Children's
Safety and Health as the sponsor and advocate for passage of the
current bicycle helmet legislation.
d) Establishing the CBIP Committee as a Committee of the
State Injury Control Advisory Task Force specifically to
coordinate bicycle injury prevention activities and legislative
efforts. In addition to the groups mentioned above, it will
include the Emergency Medical Services Authority (EMSA) ,
California State Office of Traffic Safety (OTS) , and
representatives of California's injury prevention centers, the
Southern California Injury Prevention Research Center (SCIPRC) ,
the San Francisco Center for Injury Research and Prevention
(SFCIRP) , and the California Center for Childhood Injury
Prevention (CCCIP) , as well as the California Dental Health
Program, which is interested in reducing the impact of bicycle
injuries on dental health, with particular emphasis on
competitive sports, including bicycling.
e) Inviting representatives of all local bicycle safety
projects in California to attend the committee meetings which
will be held at the both annual Statewide Injury Control
Conference and the State Office of Traffic Safety Conference to
ensure opportunities for everyone to participate. In addition,
this committee will teleconference at least six times per year to
exchange information and highlight emerging issues in bicycle
safety.
f) Coordinating with the State Injury Control Advisory Task
Force legislative committee to advocate for the bill's passage.
CBIP would be a Committee of the State Injury Control Advisory
Task :Force and would include many current Advisory Board members.
g) Coordinating with the local intervention site which will
provide critical support to the state effort including:
initiating the intragovernmental process to.get formal
endorsement by the County Board of Supervisors and by city and
school governance, emphasizing the constituent interest in this
bill, providing testimony and media attention with a local
flavor, utilizing the forcefulness of individuals directly
affected by the legislation, and providing persuasive statistics
on need and on potential effectiveness. In fact, the SR/SF
coalition was able to influence the language of the currently
pending helmet legislation through its Bicycle Helmet Policy
Position Paper (See Appendix C) .
2) Providing Helmets For Low-Income Californians
11
Financial status is a barrier to helmet purchase among many
Californians. This is a concern from both the practical
standpoint in that it limits the ability to create this safety
protection as broadly as desirable, and from the ethical
standpoint, that; should a law be passed, its enforcement would
adversely affect low income Californians more than those for who
can afford to buy a helmet. In addition, many of the legislative
supporters of helmet safety, including the current bill's
sponsor, want to ensure that they are not adding to the economic
burden of low income Californian's. By providing helmets for
those who cannot afford them, this project will generate support
from these legislators as well as improve bicycle safety for low
income Californians.
California is committed to ensuring the safety of low income
individuals in the following ways:
a) The pending bill is modeled after the state's most
recent child passenger safety law which provides that fines
accrued will fund car seat purchases for low income Californians.
Like the child passenger safety fund, moneys will be passed along
by the courts to local health departments for helmet subsidies.
b) This funding, while important, will not always be
sufficient, especially in the earlier phases of the law's
implementation when fines will be less common, and later as
compliance with the law increases. Therefore, helmet
manufacturing companies themselves have joined the partnership
and have provided helmets to local bicycle safety programs,
including the local intervention site, for distribution to low
income cyclists. PTA sites have made a commitment to providing a
free helmet for every ten helmets sold, and these helmets are
distributed to lower-income youth.
c) As California moves to a managed care health delivery
system,- where most low-income young children's health care will
be covered, the economic value of helmet give-away and incentive
programs will be increased. Again, the local intervention site is
already exploring this option as part of a comprehensive
prevention component in its local managed care approach.
d)* Other important sources of funding will be explored:
California has recently passed landmark "Kids Plate" legislation,
establishing a new category of license plate, -with all fees
accruing from its sale earmarked for childcare and child safety
programs. It is anticipated that funding earmarked for injury
prevention programming will approach $2.5 million by 1998. While
there are numerous important safety needs, many members of the
committee which developed the "Kids Plate" bill are among the
current leaders promoting the helmet legislation.
e) Funding for helmets must be accompanied by other efforts
to reinforce their use. Typically the adoption rate for safety
devices is slower in low income communities. This is both
because safety campaigns themselves tend to be middle class
oriented and because the devices are competing on a hierarchy of
12
needs with other important and more immediate basic needs.
Therefore, the project's helmet campaign will use public
information materials which are economically sensitive and
culturally competent. The project will explore unique programs
and approaches, and the valuable experience of the local
intervention site in this area as well as lessons and approaches
learned will be disseminated throughout the state. The current
PTA program is being redesigned to assure its reach is extended
by using other school linkages to supplement its efforts in low
income communities where PTA's are not active.
3) Enhancing community Efforts
Requests for bicycle safety program assistance and funding have
risen dramatically in California for the past year. The State's
Office of Traffic Safety provides limited funding for some local
efforts throughout the state, and the California Center for
Childhood Injury Prevention (CCCIP) has been helping to establish
helmet use programs through elementary and middle school PTA's in
much of the state. Although funding in this proposal does not
allow for extensive local work beyond the local intervention
site, an important emphasis will be to provide support and
consultation to community bicycle safety programs already
operational and to assist in the start-up of new community
efforts.
In order to meet this growing need in the state, this project's
actions to build a statewide community response to bicycle injury
will be to:
a) Collect bicycle injury prevention materials from all
appropriate resources and serve as a clearinghouse to
disseminate, through bulletins, information useful to local
projects on relevant articles, studies, data, project reports,
legislation, and details about successful local interventions.
b) Develop a bicycle injury resource guide listing all
statewide and community programs as a reference tool for bicycle
safety advocates.
c) Provide consultation and advice to local programs, based
on successful strategies, to improve local programming for
bicycle safety.
d) On a regular basis provide information to the press
concerning bicycling and bicycle safety in the form of press
releases, interviews, editorials, etc.
e) Assist in the expansion and coordination of the state and
local partnership of the MCH/PTA California Bicycle Helmet
Campaign as an integral in-kind component of the overall project.
This project is a school-based bicycle helmet education and sales
program conducted in partnership with the DHS and the California
State Parents and Teachers Association. The leadership for this
DHS/MCH funded project is provided by the California Center for
Childhood Injury Prevention at San Diego State University. That
project's director will be responsible for all activities of the
13
Campaign. Evaluation of this component's impact on use rate
increases will be integrated with the other helmet use surveys of
the project. Results of the evaluation of the Campaign's
methodology will be disseminated to other bicycle injury
prevention programs in California to encourage effective
interventions.
B) Local Strategies
Local strategies will require three interrelated approaches.
These include fostering new environmental and traffic code
regulations affecting bicycle safety, encouragement of law
enforcement relating to bicyclists, and community wide bicycle
safety education campaigns. The local approaches in Contra Costa
County will be strengthened by more effective targeting of
interventions with the use of HIRLS integrated police and
hospital data and geolocation software.
1) Regulatory
Contra Costa County Health Services Department Prevention Program
has a three year record of experience working on policy and
legislative efforts specifically related to bicycle safety at
both the local and state level. This project will draw on that
experience to develop policy initiatives that impact municipal
and countywide bicycle safety interests as well as addressing key
state legislative efforts. The local intervention site Bicycle
Injury Prevention Coordinator will- be responsible for these
activities which will include:
a) Use of the SR/SF policy position papers on bicycle helmet
legislation and environmental and enforcement issues to influence
bill sponsors or potential sponsors in framing legislation
responsive to local issues.
b) Influencing local municipality, park, and- county policy
makers to provide, adequate signage, bicycle lane designations,
pathways, and modifications of identified environmental hazards
to bicycling that could result in injury and fatality.
Interaction of project staff and key coalition members with local
engineers, planners, traffic or transportation commissions are
key to this strategy.
c) Utilizing members of the local coalition to provide
testimony during the state legislative process on key bicycle
injury legislation.
d) Use of the HIRLS data and geolocation software as key in
making compelling arguments in favor of environmental
modification. Using this same data will be essential in
encouraging policy makers to pay attention to law enforcement in
the interaction between motorized vehicles and bicycles. (SR/SF
has been successful in getting a number of municipalities to
increase their enforcement of errant bicyclers and speeders)
2) Modification of Behavior
14
Intensive bicycle helmet use promotion and injury prevention
activities in Contra Costa County will be coordinated by a local
site Bicycle Injury Prevention Coordinator. That person will be
assisted by. public information staff who will direct public
information campaigns, coordinate trainings and disseminate
bicycle injury prevention materials locally. The activities will
include:
a) At least six of the elementary and middle schools in
Walnut Creek and Pittsburg will participate in bicycle safety and
helmet promotion incorporating the California Bicycle Helmet
Campaign model, other state of the art school curricula from
National Highway Traffic Safety Administration (NHTSA) , the
California Highway Patrol (CHP) , and California State Automobile
Association (AAA) .
b) Five school and community bicycle safety rodeos will
take place annually.
c) One community-wide "Bik(a Days" event will be coordinated
annually in each pilot city. These events will incorporate the
components of a bicycle rodeo, bicycle repair, professional
bicycle riding safety demonstration, helmet giveaway, and bicycle
club safe trail riding and bicycle commuting information.
d) Contra Costa County's innovative multidisciplinary
bicycle injury prevention coalition, Safe Roads/Safe Families
will be enhanced. This will include increasing members'
responsibilities for local educational activities.
e) "Give Kids a Brake" media campaign will be implemented
to make drivers aware of children's limitations in traffic, and a
"Share the Road" campaign to create awareness on the part of
drivers and bicyclists of each others presence.
f) County Health Services Department's Teen Age Program
(TAP) .workers will be trained to deliver bicycle safety
information to intervention site high schools; and Public Health
Dental Program staff will be trained to incorporate bicycle
related injury prevention specific to dental related facial - - --
injury in their elementary school programs.
g) In order to reach adult bicycle riders, helmet promotion
initiatives will be enacted as part of employer-based alternative
transportation bicycle commute programs at. Shadelands Business
Park in Walnut Creek as well as at least one business with over
100 employees in Pittsburg. Employer based helmet promotion
activities will include bicycle :safety and helmet use education,
helmet giveaways, and equipment seminars with local bicycle
retailers.
3) Law Enforcement
With the facilitation and assistance of the Bicycle Injury
Project Coordinator, local police department and area California
Highway Patrol representatives to the Safe Roads/Safe Families
coalition will be involved in the development and implementation
of the following:
1.5
a) Annual implementation of Safe Roads/Safe Families' noted
"Right Rider! " program in the intervention sites. This program
involves local police department traffic safety units issuing
"citations" for riders who follow the rules of the road and wear
helmets, the "good tickets" being redeemable for prizes and
awards.
b) A training for the County Police Chiefs Association on
their role in bicycle injury reduction aimed at making the
enforcement of laws impacting bicycling safety a priority.
c) Selection and dissemination of appropriate bicycle safety
videos with a share-the-road philosophy to traffic violator
schools.
d) Training officers to observe, while conducting traffic
law enforcement activities, hazardous areas for bicyclists that
may benefit from improved signage, lane designation, or other
regulatory traffic aides and report them to their local traffic
engineering departments.
The attached Time Line delineates the time frame for
accomplishing project activities.
V. EVALUATION
The evaluation of the local and statewide components of this
project will be addressed with the same quality of work and
experienced staff that will apply to the project countermeasures.
Jess Kraus, Ph.D. , Director of the Southern California Injury
Prevention Research Center at the University of California at Los
Angeles will provide the lead in overall state evaluation design,
and will consult on all aspects of the local and state evaluation
components. Roger Trent, Ph.D. Chief of the Injury Surveillance
and Epidemiology Unit of the DHS Office of Emergency Preparedness
and Injury Control will be responsible for the pilot
implementation of, and review the findings of the ICARIS tool and
the statewide evaluation. Evaluation of the MCH/PTA Calitornia - --
Helmet Promotion Campaign will be the responsibility of Sylvia
Micik, MD, Director of the California Center for Childhood Injury
Prevention at San Diego State University. The Contra Costa
County local site intervention evaluation will be the
responsibility of Jennifer Balogh, MA, MPH, Contra Costa County
Health Services Department Research Analyst. All of these
evaluators will work closely to provide a comprehensive picture
of the process and outcomes of California's bicycle injury
countermeasures.
Evaluation of the California Bicycle Injury Prevention Project by
DHS/EPIC and CCCPP will use both primary and secondary data
collection methods. The evaluation of the local intervention
site will focus on obtaining and monitoring rates of helmet use
primarily through observation studies. It will be supplemented
by HIRLS analysis to determine injury rates. A local process
analysis of coalition efforts will also be conducted; these
16
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activities will be conducted by the local site Research Analyst.
At the state level, evaluation efforts will monitor trends in
bicycle-related fatalities and in the incidence of bicycle-
related head injuries requiring hospitalization, using existing
state data systems. This activity will be the responsibility of
the DHS/EPIC epidemiologist. Helmet use will be assessed through
surveys of the California Bicycle Helmet Campaign monitored by
the Campaign epidemiologist. A state process analysis of
coalition efforts will be conducted by the State Coordinator. An
ICARIS survey will be conducted by the DHS/EPIC epidemiologist,
and a process evaluation of ICARIS will be conducted jointly by
the DHS/EPIC epidemiologist and the State Coordinator in concert
with the State Injury Control Task Force.
A) Evaluation of Local Bicycle Helmet Efforts
A.1) Observational Method
The Safe Roads/ Safe Families will conduct a bicycle helmet
observation study in the cities of Walnut Creek and Pittsburg and
in two additional control cities within Contra Costa County. The
observation study will take place once during each year of grant
funding, both to guide and evaluate program activities.
This type of study design allows the project to directly observe
bike riders to determine if they wear helmets. Project staff and
local volunteers will collect environmental, demographic and
behavioral data on bicycle riders while at pre-selected
observation sites identified as high bicycle traffic areas.
"Observational studies offer far greater confidence in the
validity of measures than do surveys which rely on self-reported
data." (New York State Department of Health, 1990)
Methods are modeled after a_ study design by New York. State
Department of Health Injury Control Program. These observational
methods have been successfully modified for use by Safe Roads/
Safe Families during May 1991 & May 1992 to measure the effect of
project efforts on helmet use both by elementary school children
and county residents.
Although trails and commute paths will comprise a portion of the
observation sites, the focus of study will remain on the
neighborhood sites. . Neighborhood observations rather than
observations made on high volume public areas will allow the
residence of the observed rider to be determined. Also, most
bicycle riding and bicycle injuries involving young children
takes place within a short distance of their homes. (SAFEKIDS)
Observational studies will also be conducted at Contra Costa
County's MCH/PTA sites to provide a measure of comparison to the
data gathered in the state evaluation (see below) .
In order to observe a sample which is representative of various
17
types of bike riders and representative of common bicycle trips,
the project will use community key informants to help identify
commute paths of adult riders and to update the school bus routes
used in SR/SF's 1991 & 1992 studies of child riders. Within each
intervention and control city,- observation sites will include: 1)
areas near school and recreation centers; 2) city thoroughfares;
3) residential streets; 4) parks and bicycle paths. The same
sites will be used each year of study.
Observation periods will be chosen to match times when both
adults and children will be likely to be riding. These periods
will include both weekdays between the hours of 3:30 and 7:00 pm
and weekends between the hours of 1:00 and 4:00 pm.
Prior to the days of study, volunteer observers will receive one
hour of training. The training will include review of study
goals, data collection materials, and location of observations.
Each volunteer observer will travel an established route
(comprised of preselected observation sites) and spend a total of
ten minutes per site collecting data on observed bicyclists. The
observer will rotate through all the route's observation sites
until his/her entire hour and a half shift is completed; in most
locations each site will be observed several times. 'Observers
will be instructed to record data on any bicyclist within the
field of vision who is not on a tricycle, big wheels or other
riding toy. The following data will be gathered on bicyclists
observed in the study:
Environmental Variables
• location/observation site
• date
• day of week observed
• time of day observed
• riding alone or in a group
Demographic Variables
• age of rider (pre-school, grade school, high school,
adult)
• gender of rider
Variables of bicycle type & proper use of helmet
• size of bicycle (small, standard, & carrier)
• presence of helmet
• helmet positioned correctly
• helmet strapped on correctly
Earlier observation studies have shown that these elements can be
recorded quickly and accurately even when riders passed by
quickly or when several riders passed by in a group. This did
not prove to be the case with the project's earlier attempt to
collect racial identification of the observed riders. It was too
18
often difficult for the observer to ascertain the race of riders
from a distance, especially if the individual was wearing a
helmet.
Data Analysis
The project anticipates approximately 1,200 bicycle trips to be
observed during each of the study's administrations. The data
will be entered, managed, and analyzed using CDC's Epi Info (v.
5) software.
The rate of helmet use per trip/observation will be calculated
both as a county total and by target city, and then separately
for age groups, and gender, etc. "Conceptually, per trip helmet
use (or non use) is a better indicator of exposure to risk than
helmet ownership or use per rider. " (New York State Department of
Health, 1990) . Statistical comparisons between location and
demographic groups will be made using z-scores.
A.2) Highway Injury Records Linkage (HIRLS)
Contra Costa County Health Services Department has received
funding to implement locally the HIRLS, developed by the National
Association of Governors' Highway Safety Representatives, to link
County crash data, EMS data, and hospital discharge data. Through
implementation of HIRLS, Contra Costa County HSD Prevention
Program will achieve the following goals: 1) enhance and automate
the prehospital data collection and analysis capabilities; 2) use
the improved data collection system to create a set of comparable
indicators of injury rates and EMS response; and 3) use the data
collected to support injury prevention programs countywide.
The Health Services Department currently uses police crash
records analyzed by zip co-de -to-target communities for bicycle
and pedestrian safety programs. However, linked motor vehicle
injury data, in conjunction with mapping/geolocation software,
would greatly increase the specificity of local injury
surveillance. The intervention sites of Walnut Creek and
Pittsburg will be evaluated for cross-sectional traffic exposure
for bicyclists. The Prevention Program will use specific injury
cluster sites to target educational,- law enforcement and
technical strategies to eliminate or reduce hazards. Mapping
motor vehicle injuries will be a valuable tool in monitoring
injury trends in the two cities and the overall county.
By linking computerized EMS prehospital records together with
police crash reports and local hospital discharge data, HIRLS
would provide Contra Costa with a relatively low-cost
comprehensive surveillance system for the most .common and costly
injuries (National Agenda) .
Project staff will analyze the linked data set, beginning with
19
Contra Costa County's bicycle injuries. Using geolocation
software purchased with PHHS block grant funds, staff will map
the locations of all bicycle and pedestrian injuries identified
within police crash reports for the years 1987 to 1991. The
geolocation software will also be used to map the linked
crash/injury data for 1991. This mapping will allow both EMS and
the Prevention Program to identify geographic clusters of bicycle
and/or pedestrian injuries which. indicate "high collision
locations." With the added capability of data linkage, not only
can the frequencies of bicycle injuries for cities or
neighborhoods be calculated, but. also the frequency of helmet use
among injured riders. Additionally, staff can calculate the
direct medical costs incurred through hospital discharge for
bicycle injuries for different areas of the country.
The mapping on injury sites will be an important part of an
overall profile of the County's bicycle injuries. A profile
using linked crash data, EMS data, and hospital data will provide
a tool for both program development and evaluation. The SR/SF
coalition will help determine the content of this profile. This
coalition is interested in injury outcome information, helmet
usage among injured bicyclists, the cost of injuries and the
differences in these variables by age. The Prevention Program
and EMS within the data integration project will respond to the
needs of injury prevention efforts, like those of Safe Roads/Safe
Families. Although certain HIRLS fields have a significant lag
time, it will be a valuable tool in evaluating the effectiveness
of bicycle safety activities.
B) Statewide evaluation of bicycle safety Efforts
B.1) Outcome Data Collection
-Cai-ifornia Departiuent- of -Health Services will assess the
incidence of and trends in bicycle-related fatalities, injuries
and helmet usage statewide. Injury rates will be monitored
throughout the grant period.
1) The number of bicycle fatalities statewide will be
obtained from California Health Services, Vital Statistics
Section as soon as available after each program year.
2) Data on hospitalized head injuries resulting from bicycle
injuries will be obtained from the hospital discharge data,
available from Office of Statewide Health Planning & Development
(OSHPD) . The State of California is fortunate in that mandatory
reporting of E-Codes for all injury hospitalizations began in
1991. The project will have access to the E-Coded hospital
discharge data for Californians.
3) A rate of helmet usage for California children under age
16 will be obtained through school site observation studies
conducted at MCH/PTA bicycle safety intervention sites. There
were 800 school sites participating in 1992-93, and 1200 are
20
anticipated for the school year of 1993-94, giving a significant
sampling statewide of school aged children. These statewide
observation studies will take place only on the grounds of
participating schools. PTA volunteers will observe those
children who ride bicycles to school both pre and post
intervention. Observers will use data collection sheets similar
to those used in Contra Costa County, which include variables of
gender, bicycle size, helmet use, helmet position and strapping,
and whether the child was riding alone or in a group.
Since the helmet purchase/give-away programs and safety curricula
will be school based, rather than community based these site
specific observation studies will provide important information
or the target populations at each school. Although these school
"snapshots" of behavior will not capture the neighborhood play
aspect of bicycle riding, they do allow a close evaluation of a
school-wide behavior change shortly after an intervention.
Although neighborhood use rates tend to be lower than the rates
of youth commuting to schools, observational studies will provide
an indication of the change in use rates overall. These school
site observations will provide valuable information statewide
without the resources required for community-wide/neighborhood
observations.
B.2) Injury Risk Factor Survey (ICARIS)
The California Department of Health Services will implement the
CDC's Injury Risk Factor (ICARIS) statewide survey in year one
and year three of grant funding. The half hour telephone survey
will be administered to a stratified random sample of 400
households statewide. California DHS will utilize its current
research capacity demonstrated through it's success in conducting
Behavioral Risk Factor Surveillance System (BFSS) annually for
.nine --years. DHS will contact respondents and record their-- --
responses using a computer-assisted telephone interview (CATI)
system. DHS will compile the results of the first year's pilot
test into a report to be submitted to CDC and distributed
statewide.
The California State Injury Control Advisory Task Force, in
addition to State DHS/EPIC staff, will compare ICARIS results to
those of the Behavioral Risk Factor Survey. While the ICARIS
instrument is being pilot tested, the Committee will provide
feedback to CDC on problems encountered in the survey's
administration, as well as to its usefulness in California's
strategic program planning and resource development. ICARIS
provides a unique opportunity to collect state-specific injury
risk factor information including residents' attitudes and
behaviors; such injury surveillance data would be invaluable both
in program development and ongoing evaluation. As noted above,
the information specific to helmet use would be significant for
an additional measure of statewide helmet usage.
21
The State will disseminate the results of ICARIS to local injury
control program throughout the state, as well as present the
results at state and national conferences. The findings will also
be used to update California's injury plan in future years.
C) statewide and Local Process Evaluation
In order for the evaluation to meet the needs of program
designers in terms of providing adequate information for
intervention revision and refinement, the summative component is
supplemented by a process evaluation. This will be conducted
utilizing an archival review of coalition records and a
questionnaire designed as a basis for a special study of the
coalition. This questionnaire will be a modified form of one
already utilized with the Safe Roads/Safe Families Coalition.
The coalition records, such as service contracts, correspondence
and meeting minutes will be used to monitor coalition membership
participation, frequency of the occurrence of coalition
activities and the reach of each coalition activity (e.g. number
of people attending a presentation) . These records will also be
used to measure the coalition's success in reaching its policy
and educational objectives.
Archival analysis will be based upon a variety of agency records
including meeting minutes, correspondence, quarterly and annual
reports, conference proceedings newspaper clippings and coalition
member agency records will be used in this study.
Data Analysis
Analysis will identify and summarize important examples, themes
and patterns among the individuals' responses. Findings will
include key issues and events-of the project's history, framed-by—
the review of relevant agency documents and records.
The data collected from the retrospective analysis will
accomplish the following:
1) Create a timeline of important events and milestones
within the project's prevention efforts.
2) Describe the theoretical rationale upon which strategies
were based.
3) Identify barriers encountered in program implementation.
4) Highlight the series of issues that stimulated
program/community efforts.
5) Document "what worked and what did not".
6) Provide information helpful to guide ongoing efforts and
evaluations.
V. COLLABORATION AND COORDINATION
22
A). State of California
Statewide collaboration will be effected through DHS/MCH
convening of a committee of key state agency and state coalition
groups, including private sector, health, traffic safety,
transportation planning and law enforcement groups having a stake
in bicycle injury prevention. This group will be a committee of
the existing EPIC-staffed State Injury Control Advisory Task
Force, (see Appendix E for membership roster) to assure effective
integration of its approaches into statewide strategy.
There are a number of agencies and organizations essential to the
facilitation of statewide change which will be involved in the
membership: the State Injury Control Advisory Task Force whose
1993 State Injury Control Plan includes a bicycle injury
prevention component will represent the Committee's issues to the
Governor through the Director of Health Services; the California
Emergency Medical Services Authority (EMSA) which oversees
statewide trauma service coordination and has subcontracted the
HIRLS integrated injury data project to the Contra Costa County
Prevention Program; State Office of Traffic Safety (OTS) which is
the Governors's Highway Safety Representative, and coordinates a
number of bicycle safety projects; California Department of
Transportation (CALTRANS) Office of Bicycle Facilities which
oversees the implementation of state master plan for bicycling
facilities; the National Highway Traffic Safety Administration
(NHTSA-Region 9) which is in the process of expanding its
programs in California in the field of bicycle safety; the
California Highway Patrol (CHP) which conducts numerous school-
based bicycle safety programs statewide, compiles all police
crash and injury statistics for the Statewide Inventory of
Traffic Reporting Systems (SWITRS) , and would have a significant
role in the enforcement of a California bicycle helmet law; the
California Coalition for Children's Safetv and Health which has
been the co-sponsor of the current pending bicycle helmet
legislation; the university based Injury Prevention Research
Centers at the University of California at San Francisco,
University of California at Los Angeles, and Southern California
Injury Prevention Research Center, each of which will play a role
in implementation or evaluation of the Project; the University of
California at Berkeley, School of Public Health which is
interested in injury curricula and the development and promotion
of community/academic partnerships; the American Academy of
Pediatrics (AAP) which has been involved in helmet promotion
efforts in the state for the past four years; the California
Association of Bicycling Organizations (CABO) which has an
interest in improving the environmental conditions for
bicyclists; and private sector representatives, particularly the
insurance companies of the American Automobile Association (AAA)
and its California State Automobile Association motor club
affiliates in Northern and Southern California, and the Allstate
Insurance Company, both of which have shown their specific
23
interest in and provided resources for efforts to reduce bicycle
related injury. This committee will also involve local bicycle
program staff and coalition members and will expand as other key
advocates are identified.
The philosophy and activities managed through this collaborative
committee structure include:
p Advising the MCH Bicycle Injury Prevention Coordinator
regarding the state bicycle injury prevention
objectives of this project.
p Coordination of sponsorship and advocacy for state
legislation which favorably impacts bicycle injury
reduction.
p Commitment to and sharing of responsibility for:
Specific project method implementation.
Information sharing through the Office of the
State Bicycle Injury Prevention Coordinator.
Avoidance of potentially divisive project
component ownership or "turf" issues.
p ° Periodic review of the findings of the methodology and
evaluation of the project objectives.
p Coordination with and encouragement of local level
activity within their individual agency or
organization.
B) Local Intervention Site ----—
The need for a well crafted and strategic coordination effort to
address as difficult an issue as bicycle injury prevention is
dependent largely on bring together, to the same table, key
decision markers and members of the local community who have a
demonstrated concern about this issue. It is a model that has
proven to be extremely successful with regard to any number- of
social/public health issues in Contra Costa County. This project
will use that model to continue to bring together the existing
members of the Safe Roads/Safe ]Families (SR/SF) coalition:
pediatricians, law enforcement officials, insurance company
representatives, schools officials, transportation planners,
trauma unit specialists, bicycle retailers, bicycling club
members, and public health practitioners.
The SR/SF Coalition will continue to collaborate as some of the
following examples illustrate:
24
when the coalition membership plans a community bicycle rodeo,
the participation by various members comes into play. The local
police department brings traffic cones, stop signs and other
needed rodeo course equipment, and then staffs two or three of
the stations. The AAA Motor Club representatives assist with the
"how to" rodeo guide, printed course checklist and overall
coordination of the event. The bicycle retailer and his staff
provide the volunteer instruction, equipment, and oversight of
pre-event bicycle safety inspection and a minor bicycle repair
station. They also provide bicycling prizes such as reflectors,
bells, locks and helmets at cost, paid for by money donated by
the trauma center which is represented on the coalition. The
public health department staff are in charge of the loaner
helmets for the event, loaned to children without helmets. They
have handled the advertisement for the event through their public
information section. The event is a smooth flowing and very
positive event because of the shared responsibility and
enthusiasm for accomplishment of a proven intervention.
At their next meeting, after slides of the event are shown and
their rodeo is evaluated, the membership is updated on the
pending state helmet legislation which was framed in language
developed through the coalition's bicycle helmet policy position
paper. They decide that their next strategy is to get the matter
on the County Board of Supervisors' agenda and then appear
together at that board meeting to get the Board's formal support
for this legislation.
The other main issue that the coalition members cover at their
meeting is the problem of a hazardous site for bicyclists,
determined though the geolocation software of the Prevention
Program. The traffic engineer in attendance knows the staff of
the traffic engineering department of the community where the
site is, and commits to meeting with them to provide information
and offer assistance in developing an environmental modification
to alleviate the problem. The bicycling club representative
knows a member of the of the traffic commission in that city, and
offers to speak to them regarding possible policy changes to
reduce the problem. The progress of the activity around this
issue will be coordinated through the Prevention Program's SR/SF
staff to this coalition--a collaboration that ensures things
happen.
With this project, SR/SF coalition will expand its membership to
include representatives from the PTA Districts in Contra Costa,
effectively building on the California Helmet Promotion Campaign
in schools in the Contra Costa County pilot intervention site
area. It will also develop closer ties with the Teen Age
Pregnancy and California Dental Health Program, two groups eager
to bring bike safety education into the schools. This will
become a direct link with the statewide campaign and will
strengthen intervention strategies for helmet use promotion and
25
injury prevention. It will also expand the campaign's efforts to
include environmental modification and enforcement activity.
In addition, a new emphasis on adult bicyclist safety education
and helmet use promotion will- encourage the State's Air Quality
Management mandated Employee Transportation Coordinators (ETCs)
to participate, as it will assist them in their efforts to reduce
single occupant vehicle commuting. This relatively new movement
towards the encouragement of commute bicycling is a unique
opportunity. Coalition members from the bicycling clubs and
bicycle retailers will collaborate with businesses to promote use
of bicycling safety gear, instructional rides for new commute
cyclists, and helmet raffles and helmet incentive prizes.
Successful strategies of this collaborative model will be
submitted to the MCH/PTA Bicycle Injury Prevention Coordinator
through regular reports to be disseminated to other local
intervention sites in the state.
VII. PROJECT MANAGEMENT & STAFFING PLAN
The project will be administered by the California Health
Services Department (CHSD) , Maternal and Child Health Branch
(MCH) . Ed Melia, M.D. , M.P.H, Section Chief in that Branch and
Larry Cohen, M.S.W. , Director of the Contra Costa County Health
Services Department Prevention Program (CCCHSDPP) will share
oversight responsibilities as Principal Investigators. The
California Bicycle Injury Prevention Coordinator will direct the
state effort under the supervision of Margaret Nelson, M.S.N. ,
P.H.N. The state will subcontract with CCCHSDPP to implement the
local component of the project. The Local Coordinator will
coordinate local efforts under the supervision of Mr. Cohen. The
enhanced California Bicycle Helmet Campaign, managed by the
California Center for Childhood Injury Prevention_ (CCIP) , will
continue to be monitored by MCH. The evaluation component will
include the ICARIS survey under CHSD, Office of Emergency
Preparedness & Injury Control (EPIC) supervised by Roger Trent,
Ph.D. and a subcontract with the Southern California Injury
Prevention Research Center (SCIRP) under the direction of Jess
Kraus, Ph.D. , who will serve in a consulting capacity to all
state and local evaluation efforts. Dr. Melia and- Mr. Cohen
will have overall responsibility for all phases of project
implementation; they, Ms. Nelson and Dr. Trent will be
contributing their time to the project at their existing civil
service compensation rates.
The State Coordinator and Local Coordinator are new positions
which will be added to achieve project goals. The State
Coordinator will staff the California Bicycle Injury Prevention
Committee, implement state intervention strategies, including
providing information and leadership to provide support for
helmet legislation and the efforts of local projects throughout
26
the state. The Local Coordinator will be responsible for
staffing the Safe Roads/Safe Families Coalition, and designing
and implementing local intervention strategies and evaluations.
Both positions will be established within the civil service
systems of the state and county and will require an MPH or
equivalent and one year of relevant experience.
Administrative support will be provided by .2 FTE Administrative
Coordinator who will prepare and monitor project budget and
fiscal reports, negotiate subcontracts, order materials and
handle hiring and other personnel _transactions. .5 FTE Clerk,
experienced level, will provide project support by preparing and
mailing correspondence and other materials to interested parties,
keeping records, arranging meetings, etc. Compensation is within
established civil service standards.
At the local site .25 FTE Media Coordinator will be responsible
for preparing print and electronic materials for public
information, arranging press conferences and publicizing events,
and .5 FTE Evaluator will design and implement the local
evaluation component and analyze and report on collected data in
consultation with Dr. Kraus. Compensation will be at rates
approved in existing contracts negotiated and approved by CCC
Board of Supervisors.
The following organizational Chart illustrates the relationships
among the various project components:
California Bicycle Injury Prevention Project(CBIPP), Organizational Chart
October, 1993
California Department of
Health Services
Southem Card.
Maternal&Child Health Office of Emergency injury Prevention
Branch � Preparedness&Injury < Research Center b-;
Control (Evatuadon)
CBIP Project Coordinator ................... �1111..".' ig§
r
1
afexl"dads#�afhFa rSa
California Bicycle Injury Prevention Committees
MQWPTA Proiect:
California Bicycle Helmet
Campaign
VIII Budget, Year 1
California Bicycle Injury Prevention Project
PERCENT FEDERAL NON-FED AMOUNT SUBTOTAL
A. PERSONNEL $124,350
1. Princ. Investigators 10% 50 $23,980 523,980
E. Melia,MD; L. Cohen, MSW
2. CBIPP Coordinator 100% $36,100 s0 $36,100
Health Ed. Consult. 1I .
3. Local Coordinator 100% $35,000 s0 535,000
Sr. Health Educ. Spec
4. Clerk 50% $14,550 $0 $14,550
Suzanne Stevens
5. Administrative Coord. 20% $7,600 s0 $7,600
Kathleen Martin,MPA
6. State Nrsng Consult II 10% SO $5,200 $5,200
Margaret Nelson, MPN
7. State Epidemiologist 3% $0 51,920 $1,920
Roger Trent, PhD
S. FRINGE BENEFITS $37,012
1. Permanent Employees
(Employees 1,2,6.7 State) $9,908 $1,954 $11,862
(Employees 1,3,4,5 County) $17,717 $7,434 $25,150
C. TRAVEL $13,000
1. Personal Travel Expenses $13,000 $0 $13,000
0. EQUIPMENT $8,500
1, Computer Hardware & Software $8,500 s0 $8,500
E. SUPPLIES $8,000
1. Office Supplies $1,000 $1,000 $2,000
2. Educational/Nedia Materials $2,000 $1,000 $3,000
3. Copying/Printing $1,500 $1,500 $3,000
F. CONTRACTUAL $113,500
1. Media Coordinator $10,500 s0 $10,500
2. MCH/PTA Project s0 $434000 $43,000
3. Evaluation $35,000 $0 $35,000
4. ICARIS $25,000 s0 $25,000
G. CONSTRUCTION s0 s0 s0 s0
H. OTHER $10,000
1. Telephone $500 $1,500 $2,000
2. Rent/Occupancy $2,000 $4,000 $6,000
3. Postage $500 $1,500 $2,000
I. TOTAL DIRECT $220,374 $93,988 $314,362
J. INDIRECT CHARGES $29,775 $7,477 $37,252 $37,252
TOTAL $250,149 $101,465 $351,614 $351,614
VIII. BUDGET JUSTIFICATION
A. PERSONNEL
1. Principal Investigators: (In-kind) Responsible for overall
project design and implementation at the state level and local
intervention site, and for ensuring achievement of project goal
and objectives.
2. CBIP Coordinator: The California Bicycle Injury Prevention
Project Coordinator is responsible for designing and implementing
state intervention strategies and coordinating local efforts
towards bicycle safety throughout -the state.
3. Clerk: Provides support to project staff, preparing letters
and reports, mailing materials, arranging meetings, etc.
4. Administrative Coordinator: Prepares and monitors project
budget, prepares fiscal reports, negotiates subcontracts, handles
project personnel work, etc.
5. Local Coordinator: Designs and implements local intervention
strategies and conducts local evaluations.
6. State Nursing Consultant: (In-kind) Responsible for
supervising the CBIP Coordination and managing the California
Bicycle Helmet Campaign subcontract.
7. State Epidemiologist: (In-kind) Responsible for implementing
the ICARIS study.
B. FRINGE BENEFITS
1. State Employees: The fringe benefit rate is 27 .445 percent
and includes mandated payroll taxes, health and retirement
benefits, etc.
2. County Employees: The fringe benefit rate is 31 percent and
includes mandated payroll taxes, health and retirement benefits,
etc.
C. TRAVEL - - - - - —
1. Personal Travel Expenses: Includes costs of travel by common
carrier and personal auto within California and overnight stays
outside duty station to present at statewide injury prevention
and other relevant conferences and to coordinate local activities
and attend coalition meetings. Lodging and carrier rates are
negotiated by government control agencies and personal mileage is
reimbursed at $.28/mile. This project will require frequent
travel across a large geographic area.
D. EQUIPMENT
1. Computer Hardware and Software: Includes cost of two
computers and software to perform word processing, fiscal
analyses, data analysis and desktop publishing functions,
purchased on government contract at best available rates from
reliable vendors.
29
E. SUPPLIES
1. Office Supplies: Cost of stationary, computer disks, etc.
2. Education/Media Materials: Cost of video tape, slide
production, design and layout .for training materials.
3. Copying/Printing: Cost of reproducing materials in-house and
professionally.
O
F. CONTRACTUAL
1. Media Coordinator: Cost of .25FTE public relations
representative to handle press conferences, arrange and publicize
media events and prepare print and electronic materials.
2. MCH/PTA Project: (In-kind) Contract with California Center
for Childhood Injury Prevention -to implement California Bicycle
Helmet Campaign in school districts throughout California. This
contract is negotiated through California control agency
processes.
3. Evaluators: Cost of contract with SCIPRC to design and
oversee evaluation and .SFTE research analyst to implement
research component of project and analyze target area data.
Additional in-kind evaluation will be provided by the State
Epidemiologist.
3. ICARIS: Cost of baseline ICARIS telephone survey to be
overseen by EPIC under interdivisional agreement. Dollar figure
is based on CDC input; depending on sampling technique, at least
400 surveys will be conducted.
G. CONSTRUCTION
H. OTHER
1. Telephone: Cost of local and long distance phone calls and
faxes.
- -- 2.- -Rent/Occupancy: Cost of rental space allocated to project
staff at actual cost negotiated by state and local government
control agencies.
3. Postage: Cost of mailing materials to state and local project
participants.
I. TOTAL DIRECT
J. INDIRECT CHARGES
1. Indirect Costs are calculated at 27.6 percent of personnel
costs for State Employees and $7300 per FTE for CCC County
employees, see attached justifications. Much of the Indirect is
contributed in-kind.
�t 0
_ r CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
PUBLIC HEALTH DIVISION
�4
To: Section Chiefs/Cost center Date: March 7, 1990
Managers
From: Alan G. Abreu Subject: Overhead Rates
Public Health Controller FY 1989-90
The figures below detail the $6,900 in overheads to be allocated to each Full=
Time Equivalent.(FTE) employee or contractor for FY 1989-90. A share of these
costs should be included with all program/grant proposed budgets unless expressly
forbidden by the funding source.
Internal Overhead - $4,340 per FTE
This figure includes a Departmental allocation of the expenses'of the
Health Serlices Director, Health Services Administration, Finance and Personnel:
It also includes an allocation of Public Health Division Administration, cost
center 5761, which includes -the Public Health Director, Administiation, Finance/
Accounting, Personnel and Purchasing.
External Overhead - *2,560 per FTE _
The external overhead is comprised of•Couaty overheads (A-87) allocated
to Departmeats by the Countywide Cost Allocation Plan. This plan is audited
yearly by the State Coatioller`s Office as the cognizant agency for the -
Federal Govesument.
If you or your funding sources have any •quesiious, please call me at (415)
646-4416, Ext. 247.
AGA:ssb
a -9 S!Rd Cnt
89IC44tEV Final Indirect Cast Retel EXX.ISI7 C
G A Department of Htalth Services 1989/90 Fiscat Year
Divisions/Branches Div i RR SIWCAP USE Lagat oe%=r% mint tndirict
Office Allow- Services "Mead Rr:e
tNerhaad at�ca
Directors office
Appeals Secti'm 0.079 0.008 0.008 O.I33 0.227
Administration Division
finenciat 149M Branch 0.078 0.006 0.008 0.133 0.225
Data Processing 0.047 0.022 0.004 0.133 0.206
Iiedi-Cat Operations Division 0.079 0.004 0.018 0.133 O.Z34
organized Heetth System Division O.W2 0.011 0.066 0.133 0.292
fiscal Inter K9M Division 0.078 0.013 0.046 0.133 0.270
licdi-Cat Paticy i Std Division 0.091 0.010 0.067 0.133 0.301 ,
Audits 4 investigations Division 0.078 0.007 0.037 0.133 0.255
Licensing t tartificsttal Division 0.044 0.049 0.007 0.028 0.136 0.265
Rural i Comnstlity Hlth Division
Rural i Coammity Mgatth 0.069 0.049 0.010 0.010 0.138 0.276
R L C federst Projeets 0.070 0.049 0.000 0.009 0.138 0.266
family Neaith Division
family Health 0.064 0.051 0.020 0.022 0.138 0.295
Genetic Disease 0.049 0.051 0.027: 0.019 0.137 0.733
CHOP 0.049 0.051 0.005 0.01a 0.138 0.261
FRO federal Projects 0.065 0.051 0.000 0.022 0.139 0.276•a�"'
Division of Laboratories
Laboratory tervicss 0.023 0.054 0.061 0.008 0.135 O.U6
Lab gar federal Projects 0_029 0.OS2 0.000 0.006 0.136 0.223
Environmental Health Division
EnvirarVwntal Htelth 0.053 0.050 0.012 0-025 0.136 0.276
Env Hlth Ftdant Projects 0.053 0.050 0.000 0.026 0.136 0.264
Aids Division
Aids 0.048 0.019 0.011 0.133 0.212
Aids federal ProJer"s 0.04$ 0.000 0.012 0.133 0.193
Taxics Substance Division
Toxic SWstatre 0.001 0.048 0.009 0.002 0.061 0.121
Pravtntive Medical Services Division - - -
Infectious Oiaesss 0.134 0.051 0.012 0.016 0.143 0.356
PNS federal Projects 0.087 4.050 0.000 0.017 0.143 0.2%
Health Hazard Assas~t Oiviston
H.alth Hazard Asse2smi+t 0.000 0.047 0.024 0.007 0.133 0.211
Dapartmntwide Rata 0.023 0.060 0.015 0.019 0.123 0.239
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Center, Seattle,WA; 1990.
Sacks J., Holmgreen P., Smith S., Sosin D. Bicycle-associated head injuries and deaths in the
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Weiss, B.D. Preventing Bicycle-Related Head Injuries. New York State Journal of Medicine,
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Harborview Injury Prevention and Research Center. Facts Sheet. Harborview Medical
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Regional Bicycle Advisory Committee(REBAC). Bicycle Empowerment. Making the Bicycle
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Census Bureau; 1990.
California Highway Patrol Statewide Integrated Trak Records Systems. Annual Report of
Fatal and Injury Motor Vehicle Traffic Accidents. SWITRS; 1989, 1990, 1991.
Cooper K. Analysis of Statewide Integrated Traffic Records System. SWITRS; 1990.
California Highway Patrol Statewide Integrated Traffic Records Systems. Annual Report of
Fatal and Injury Motor Vehicle Traffic Accidents. Personal Communication; 1990.
Census Bureau; 1990.
National Head Injury Foundation.
Sacks, J. Centers for Disease Control: Personal Communication.
Friede, A.M., Azzara, C.V., Gallagher, S.S., and Guyer, B. The Epidemiology of Injuries
to Bicycle Riders. Pediatric Clinics of North America, 32(1); 1985.
City of Palo Alto. City Ground,Plan.
Harborview Injury Prevention and Research Center. Facts Sheet. Harborview Medical
Center, Seattle, WA; 1990.
California Highway Patrol Statewide Integrated Traffic Records Systems. Annual Report of
Fatal and Injury Motor Vehicle Traffic Accidents. SWITRS; 1989, 1990, 1991.
Association of Bay Area Governments Report. Projections '92; 1991.
Census Bureau; 1990.
California Highway Patrol Statewide Integrated Traffic Records Systems. Annual Report of
Fatal and Injury Motor Vehicle Traffic Accidents. SWITRS; 1989, 1990, 1991.
California Highway Patrol Statewide Integrated Traffic Records Systems. Annual Report of
Fatal and Injury Motor Vehicle Traffic Accidents. SVMRS; 1989, 1990, 1991.
New York State Office of Public Health, Epidemiology Division. Epidemiology Notes. New
York State Department of Health, 6(1), January; 1991.
Safe Kids Campaign.
New York State Office of Public Health, Epidemiology Division. Epidemiology Notes. New
York State Department of Health, 6(1), January; 1991.
Position papers from, The Third National Injury Control Conference: "Setting the National
Agenda for Injury Control in the 1990s". Division of Injury Control, National Center for
Environmental Health and Injury Control, 'U.S. Department of Health & Human Services,
Centers For Disease Control, Public Health Service, April; 1992.