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AMERICAN JOURNAL OF

PUBLIC HEALTH
EDITOR-IN-CHIEF Mary E. Northridge, PhD, MPH

EDITOR’S CHOICE
DEPUTY EDITOR Farzana Kapadia, PhD
FEATURE EDITOR Gabriel N. Stover, MPA
IMAGE EDITOR Aleisha Kropf
ASSOCIATE EDITORS Mary T. Bassett, MD, MPH
Felipe González Castro, PhD, MSW
Michael R. Greenberg, PhD

Swimming Upstream Sofia Gruskin, JD, MIA


Said Ibrahim, MD, MPH
Robert J. Kim-Farley, MD, MPH
Stewart J. Landers, JD, MCP
Injuries are not accidents, so in public health we search work hours, double-shifts and two jobs are associated
Stella M. Yu, ScD, MPH
for their causes to improve prevention. The best of with a higher level of fatigue that results in less attentive
ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION
these efforts seek to identify root causes, avoiding the driving under any circumstances (Akerstedt T, Philip P,
more limited approach that stops at the level of “the Capelli A, Kecklund G. Sleep loss and accidents: work Roger Vaughan, DrPH, MS
human” responsible for “the error.” Attention is directed hours, life style, and sleep pathology. Prog Brain Res. INTERNATIONAL ASSOCIATE EDITORS
to the variety of systems-related determinants that 2011;190:169-188). Furthermore, some work-related Kenneth Rochel de Camargo Jr, MD, PhD
permit or promote human error—a root cause analysis stress could be leading to increased alcohol consump- (Rio de Janeiro, Brazil)
resulting in a robust understanding of injury causality. tion (Frone MR. Work stress and alcohol use. Alcohol Daniel Tarantola, MD (Sydney, Australia)
As these root cause analyses move further upstream Res Health. 1999;23[4]:284-291; Dawson DA, Grant DEPARTMENT EDITORS Leslie Beitsch, MD, JD
past a focus on individuals into systems, cultures, and BF, Ruan J. The association between stress and drink- Government, Politics, and Law
societies, we have learned that the prevention of the ing: modifying effects of gender and vulnerability. Elizabeth Fee, PhD, and Theodore M. Brown, PhD
majority of injuries depends much more on under- Alcohol Alcohol. 2005;40[5]:453-460) to “relieve” Images of Health
standing organizational rather than individual factors. stress that, in turn, is associated with RTI risk. Elements Public Health Then and Now
The importance of the interaction between the of work-related fatigue, stress-relieving alcohol con- Voices From the Past
environment and the individual at risk in injury pre- sumption, and poor public transportation alternatives all Mark A. Rothstein, JD
vention is clear, particularly in the work environment. need to be incorporated in any systems view of RTI Health Policy and Ethics Forum
Advances in understanding and prevention of occu- prevention. But if we don’t begin by considering Kenneth R. McLeroy, PhD, and
pational injuries have resulted in a reduction in re- commuting a part of “work” then attention to work- Deborah Holtzman, PhD, MSW
ported workplace injuries over the last 20 years in the associated mutable elements of the risk equation will Framing Health Matters
United States. This suggests that intervention efforts continue to be ignored. EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2012), Chair
have made a difference, although uncertainties in Beyond RTIs we should consider what, if anything, Jermane Bond, PhD (2013)
injury counting, underreporting, transformation is gained by drawing a line between work and nonwork Linda Chan, PhD (2013)
to a service-based economy, and increased forms of injuries. Is an injury associated with an accident at Roy Grant, MA (2013)
poorly monitored contract and contingent work home a home injury or a work injury, if analysis of the Thomas Greenfield, PhD (2012)
affect confidence in true progress. injury circumstances identifies work stress or work- Jeffrey Hallam, PhD (2014)
Although much has been gained by classifying and related fatigue as the cause? Is an injury at work a work Alice M. Horowitz, PhD, MA (2012)
studying injuries according to the proximate location or injury or a home injury if analysis of the injury cir- Cassandra L. Joubert, ScD (2012)
event associated with the injury (motor vehicle, home, cumstances identifies distraction due to a sick child as Dio Kavalieratos, BPhil (2012), Student
leisure time, workplace), this focus may limit inquiries a contributing cause of the injury? Although in the Louise-Anne McNutt, PhD (2013)
too narrowly. Rigid classification forces a possibly mis- United States workers’ compensation systems force Joan Reede, MD, MPH (2014)
guided effort to identify only driver or road causes for a determination as to whether an injury is occupational, Brian Saylor, PhD, MPH (2013)
motor vehicle accidents, or only home environment or this artificial creation of a bright line between work
Helena Temkin-Greener, PhD, MPH (2014)
family stressor causes for home-based injuries. This and out-of-work should not be allowed to interfere
David H. Wegman, MD, MSc (2014)
narrow view may inappropriately focus attention on with good research and effective preventive interven-
Lynne S. Wilcox, MD, MPH (2012)
work injury causes exclusively to workplace factors. tions. Ultimately, a comprehensive, integrated approach
STAFF Georges C. Benjamin, MD
Workers, healthy or injured, live and function in to investigation of injury causation will result in more
Executive Director/Publisher
a broader environment than the workplace. Exposures complete knowledge, the identification of promising
Nina Tristani, Publications Director
and conditions at work can have a profound effect on areas for intervention, and more effective prevention. j
Brian Selzer, Publications Editor
out-of-work injury; similarly, home and community David H. Wegman, MD, MSc Ashell Alston, Director of Advertising
factors may increase or reduce the risk of injury at work.
Department of Work Environment Frances Steinlage, Journal Production Coordinator
One example is provided by attention to prevention Michael Henry, Associate Production Editor (Sr)
of road traffic injuries (RTIs). Hyder et al. (p. 1061) report University of Massachusetts Lowell
Maya Ribault, Associate Production Editor (Jr)
that “RTIs will be 1 of the 3 leading contributors to the
Mazin Abdelgader, Graphic Designer
global burden of disease . . . over the next 2 decades.” Gregory R. Wagner, MD Vivian Tinsley, Subscriptions Coordinator
Efforts to address this problem are commendable. National Institute for Occupational Safety FREELANCE STAFF Greg Edmondson,
However, in the United States, RTIs are rarely consid-
and Health Atlanta, GA Michelle Quirk, Gretchen Becker,
ered occupational in origin, yet commuting time should
Trish Weisman, Gary Norton, Eileen Wolfberg,
be tied to work, and RTIs associated with commuting
Kelly Burch, Alisa Riccardi, John Lane, Copyeditors
should be seen in light of increasing commuting time. doi:10.2105/AJPH.2012.300826
Nestor Ashbery, Alex Cook, Marci McGrath,
Patterns of affordable housing distant from employment
Chris Smith, Proofreaders
opportunities in many urban areas directly influence
Vanessa Sifford, Graphic Designer
commute time (Lipman BJ. A Heavy Load: The Com-
bined Housing and Transportation Burdens of Working
Families. Washington, DC: Center for Housing Policy;
2006), increasing exposure to RTI risk. In addition, long

June 2012, Vol 102, No. 6 | American Journal of Public Health Editor's Choice | 1053