The Midwest Injury Prevention Alliance, the Minnesota Department of Health, and the University of Michigan Injury Center joined forces to present a special fall injury conference. The two-day event featured national and regional experts in injury prevention and translation.
See photos from the event at: https://2013regionalinjuryconference.shutterfly.com/
Agenda at a Glance
President/Founder, Weinreich Communications, supporting public health programs with innovative social marketing; lecturer, UCLA School of Public Health
Nedra's keynote address, "Effective Social Media Is No Accident: A Roadmap for Injury Prevention Success," is available for viewing at this link: http://www.youtube.com/watch?v=7wWtbeweGSE.
Director, Unintentional Injury Division, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC)
Dr. Baldwin's plenary address, "By Every Measure -- Opportunities in Injury Prevention Across the Lifespan," is available for viewing at this link: http://www.youtube.com/watch?v=ZVoE3J5YfPg
Statement of Purpose: Approximately 72% of all deaths among U.S. adolescents aged 10-24 years are attributed to four causes: motor vehicle crashes, unintentional injuries, homicide and suicide, which are highly associated with risky behaviors often exacerbated by excessive alcohol use. The purpose of this analysis is to demonstrate the association alcohol consumption with high-risk behaviors reported by Michigan high school students.
Methods/Approach: Data were obtained from the 2011 Michigan Youth Risk Behavior Survey, a biennial anonymous survey of 9-12th grade students that produces representative statewide estimates of health risk behaviors. Descriptive analyses and logistic regressions were conducted to examine the associations between excessive drinking and risky behaviors.
Results: Current drinkers were significantly (p<0.05) more likely to report engaging in violent behavior (getting into a physical fight, being treated by a doctor or nurse for fighting, being hit or slapped by a significant other, being physically forced to have sex), or experiencing depressive feelings (feeling sad or hopeless, making a suicide plan or attempting suicide) than non-drinkers. Odds ratios were two to six times higher for current drinkers than non-drinkers; binge drinkers were at greatest risk for negative outcomes.
Conclusions: These data demonstrate the significant association of alcohol use on negative health behaviors and outcomes.
Innovation & Significance: Greater emphasis needs to be placed on preventing alcohol use to decrease the burden of injury-related morbidity and mortality among adolescents. Prevention and intervention efforts focused primarily on injury reduction should incorporate evidence-based strategies to reduce alcohol use as well.
Purpose: Injury remains the largest cause of childhood mortality in the United States. Violent injury has become a significant public health problem, with rates of pediatric-specific events remaining steady. In order to prevent violent pediatric injury, we must know why, when, and where these injuries occur. Our study objective is to assess the spatiotemporal determinants of urban pediatric violent injury utilizing emergency medical services (EMS) patient data.
Methods: Investigators acquired patient-level data (2009-2011) from a novel EMS computerized system for violent (blunt and penetrating) pediatric injury. Address data for assault and residency location were cleaned and geocoded. Distance from the assault location to home and nearest school was calculated. Time stamps were used to evaluate temporal trends. Event points were examined using ArcGIS 10.0 for spatial clusters. Clustered and non-clustered events were analyzed using R to identify spatiotemporal relationships.
Results: 76% of events occurred within two blocks of home. Additionally, the five identified clusters correlated with areas prone to adult crime and areas with multiple schools in a small radius (less than 200 meters). Approximately 57% of all events occurred between 3 pm and 10pm. Sundays had a significant decreased in events compared to other days of the week.
Conclusion: Pediatric violent injuries occur near home and cluster in areas of adult crime near schools. Peak times are after school and before bedtime, and fewer events occur on Sundays.
Innovation: Locating clusters and temporal trends for violent injury has implications for injury prevention programming to prioritize highest risk areas.
Statement of Purpose: Adolescent dating violence is a key public health concern, with many long term health consequences. Research indicates that technology is used in dating relationships to cause emotional distress; however, very few digital dating violence (DDV) measures are found in published literature. These preliminary analyses aim to aid in the creation of an instrument to measure the use of technology in relationships to control or invoke fear.
Methods: Participants aged 14-20 were recruited at an urban Emergency Department based on their home address, as part of a larger intervention study. Participants self-administered a computerized survey which included standardized measures for dating violence (CADRI) and peer violence (CTS 2), delinquency, self-esteem, and mindfulness. For the purposes of this study, DDV was characterized as using electronic and digital media (cell phones, social media, etc.) to: stalk a partner; make private information public; and send repeated hostile communications. Ten questions were adapted from prior literature to address DDV.
Results: 230 youth were surveyed, of which seventy-one percent reported having a dating relationship in the past 2 months and thus received the DDV measure. [56% (93.4% African American, 59.3% female) reported DDV (victimization (α =.84) or perpetration (α=.86))]. There were no differences in demographics (age, gender, race), or technology use between those reporting DDV and those that did not. Significant differences were found bivariately between those reporting DDV and those youth without DDV including: physical dating violence (64% vs. 15%; p<.001), peer physical violence (74% vs. 31%; p<.001), and delinquent behaviors 58% vs. 25%; p<.001) in the past 2 months. Participants who experience DDV also had lower non-violent self-efficacy (11.8 (4.5) vs. 14.8 (3.8); p<.001) and lower mindfulness (31.8 (8.4) vs. 36.3 (9.6); p<.01) scores than those with no DDV experiences.
Conclusions: Preliminary analyses suggest that DDV is a common occurrence in adolescent relationships and may be an indicator of physical dating violence, and peer violence.
Innovation & Significance to the field: DDV is an emerging area of concern and needs to be addressed in dating violence interventions.
Statement of Purpose: The purpose of this study was to create a comprehensive database of US school shootings between 1980 and 2012. We also examined regional and cross-temporal variations in frequency and severity of US school shootings.
Methods/Approach: School shootings were defined as incidents in which one shot was fired in an elementary school, middle school, high school, or postsecondary schools. All incidents were independently verified via newspapers or the National School Safety Center (N=390 incidents).
Results: The number of incidents, β=.06, p=.26, and the number of wounded, β=.00, p=1.00, did not change over time, but there was a significant increase in the number of deaths per incident between 1980 and 2012, β=.15, p=.004. This amounts to a 70% rise in mortality from 1980 to 2012. ANOVAs revealed no regional differences between major Census regions (West, Northeast, Midwest, South) on the number of incidents or the mortality rate. However, incidents that occurred in the West had significantly more wounded people, F(1,388)=8.72, p=.003.
Conclusions: This study offers a glimpse into the incidents of school shootings to better understand where they may occur and to what degree. Implications for future research and policy can be made from these findings.
Innovation & Significance: To date this is the largest known school shooting database. It will be made available for other researchers, to inspire more research on the potential causes and correlates of school shootings. It may inform policy related to school violence.
Statement of Purpose: As part of an academic-community partnership in the Detroit Metropolitan Area (DMA), we examined how sexual orientation and/or gender identity influenced sexual minority youths’ (SMY) experiences of violence in the prior year.
Methods: We conducted semi-structured interviews (N=50) with stakeholders working in DMA organizations and online surveys with SMY (N=429; ages 18-29; 51% African American; 7.5% trans). Using a mixed-methods approach, we examined participants’ experiences with interpersonal violence and its link to sexual orientation and/or gender identity.
Results: Stakeholders highlighted how bullying, physical and sexual abuse, and self-harm are partly rooted in the stigma SMY face because of their sexual minority status and/or non-conformity to traditional gender norms and sexual identities. SMY echoed these experiences. Almost half of SMY (45.2%) reported one or more forms of violence or victimization in the prior year; 8.6% were physically attacked, 11% were sexually harassed, and 2.8% were assaulted with a weapon. We noted no differences by sexual identity; however, trans-identified participants were more likely to report being physically attacked in the past year compared to non-trans-identified participants.
Conclusions: Efforts to address the causes and effects of violence in the lives of SMY, particularly among trans-identified SMY, are needed. We propose a multi-pronged structural approach ranging from policy changes to hate crime/non-discrimination laws to stronger supportive networks in SMY’s social milieu.
Significance and Innovations: Violence is one of the most pressing public health issues among sexual minority populations. Efforts should focus on reducing violence among SMY populations.
Statement of Purpose: This study examined whether feared delinquent possible selves impacted the relationship between negative peer influence and violent and non-violent delinquency.
Methods/Approach: A sample of 196 7th grade students (60% female; 45% African American) from a Midwestern school completed measures assessing past 30-day violent and non-violent delinquency and negative peer influence. Participants also responded to an open-ended item assessing feared possible selves (i.e., the person I do not want to become). Responses related to fears about engaging in delinquent behavior were used for these analyses.
Results: Hierarchical l multiple regression was used to assess the moderating role of feared delinquent possible selves on the relationship between negative peer influence and violent and non-violent delinquency. More negative peer influence was associated with higher levels of violent and non-violent delinquency. The presence of feared delinquent possible selves was associated with higher levels of violent delinquency and moderated the association between negative peer influence and violence.
Conclusions: Negative peer influence contributes more to violent delinquency when adolescents have a greater fear of becoming delinquent in the future. Peer influence contributed to non-violent delinquency, but did not depend on delinquency fears. Results suggest that engaging in violent compared to non-violent delinquency depends on adolescents' perceived potential to engage in delinquent activity.
Innovation & Significance: Youth violence is a substantial public health issue; thus, understanding factors that my influence its occurrence is important. Intervening on adolescents' fears of becoming delinquent may buffer the negative influence of delinquent peers.
Statement of purpose: As a designated Level I trauma center situated downtown Chicago, Northwestern Memorial Hospital cares for critically injured patients where “trauma deserts” create potential travel distances over five miles and transport times often over 30 minutes. These satellite communities have disproportionately high rates of violence, and geographic distance hinders adequate follow-up care. Addressing the public health crisis of violence and disparity of trauma care distribution, Northwestern participates in community collaboration, namely the LIVID coalition (Lowering the Incidence of Violent Injury and Death.)
Methods/Approach: Comprised of health, research, violence interruption, and faith-based professionals, this southeast Chicago-focused coalition views healthcare systems as critical to help prevent violent death and injury. The LIVID research agenda employs community-based participatory research strategies to help characterize physical, mental, and allied service needs of affected patients, families, and communities. Concurrently using a longitudinal database to track patient outcomes, investigators are constructing a qualitative study of survivors examining self-perceived physical and psychosocial needs post-injury through interviews and focus groups.
Innovation & Significance: LIVID’s collaborative research embodies translation science as research findings lead to immediate community intervention implementation, including planned creation of public service announcements and a resource linkage map/database for patients, families, and providers focused on geographically relevant services. Additionally, LIVID potentially carves new roles for urban trauma centers leading community health assessment and intervention. Such iterative relationships are critical given upcoming healthcare system transformation via the Affordable Care Act.
Statement of Purpose: In several low-and middle-income countries (LMICs), motorcyclists constitute the largest proportion of road traffic deaths. To address this burden, the Global Helmet Vaccine Initiative (GHVI) was started by a coalition of road safety partners to promote helmet use. The GHVI originated in Vietnam, where their multifaceted approach increased helmet use by 90%. The purpose of this study is to examine the effect of the GHVI’s expansion to Uganda with a specific focus on examining the effectiveness of a key intervention strategy applied to Uganda, motorcycle taxi workshops.
Methods/Approach: In 2011-2012, 24 motorcycle taxi stands were selected based on size and location, then randomly assigned as intervention or control stands in a matched pair cluster trial. Drivers from intervention stands attended a day-long motorcycle educational workshop and received free high-quality helmets. Helmet use was observed at intervention and control stands just before the workshops, shortly after, and two months after.
Results: Preliminary results indicated intervention stands had higher percentages of helmet use than control stands. Detailed results will be submitted as soon as possible.
Conclusions: Motorcyclists education and helmet distribution programs hold promise as a successful strategy for increasing motorcycle helmet use in Uganda.
Innovation & Significance to the field: Further research on the effectiveness of this strategy and other GHVI strategies is needed. If proven successful, other LMICs with large populations of motorcyclists and a need for improved motorcyclist safety should consider tailoring and applying these approaches to their own countries.
*Disclaimer-The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Statement of Purpose: During my summer internship, I worked with the Michigan Department of Transportation (MDOT) and the Michigan Department of Community Health (MDCH) on several injury-related projects.
Methods/Approach: I worked with MDOT on their Bicycle Pedestrian Safety Action Plan by developing a matrix to highlight action steps other states have taken to address bicycle and pedestrian safety in their plans. This purpose of the matrix is to help guide Michigan’s goals and action steps for their plan. Also, I developed a document summarizing various bicycle and pedestrian safety campaigns across the country. Depending on funding, the Governor’s Traffic Safety Advisory Commission may develop a bicycle or pedestrian safety campaign that could be used statewide, and this document aims to provide an overview of what has already been done.
I worked with the MDCH in their Cardiovascular Health Section on developing a Complete Streets toolkit for local health departments and health coalitions. Complete Streets are roads designed safely for all users, including cyclists, pedestrians, automobiles, wheelchair users, and more. The purpose is to acquaint health departments and coalitions with Complete Streets policies and aid them in developing their own Complete Streets policy.
Results: I presented the matrix and campaign ideas to the Pedestrian and Bicycle Safety Team (an action group under the Governor’s Traffic Safety Advisory Commission).
Innovation and Significance: This was a great opportunity to become involved in injury-related projects through both the perspectives of public health and transportation planning.
Introduction: Recent data has shown a significant increase in pediatric and adolescent injury secondary to being “struck. We hypothesize this increase may be the result of distraction by digital devices.
Materials/Methods: We report an observational study of middle school students walking to and from school. The observations took place between October 15 and November 15 , between 8:00 a.m. and 8:30 a.m,, and 2:15p.m and 2:45p.m, at two public middle schools. Distracted walking was defined as 1) talking on phone 2) texting 3) listening to music or other electronic device.
Results: 199 children were observed. There were 101 males and 98 females. Overall n=47 (24%) were defined as distracted. 16 (8%) were talking on the phone, 18 (9%) were texting and 13 (6%) due to other electronic device p>0.05. More distracted walking occurred in the morning N =27(14%) versus N=20 (10%) p=0.065 and female students were more likely to participate in distracting activities while walking than male students n= 28 (60%) versus n=19 (40%) p=0.073, however these differences were not significant.
Discussion: Distracted walking occurred in 24% of middle school children in this observational cohort and may be a significant risk factor contributing to the increase in pedestrians being “struck”. Interventions are needed to change this risk behavior.
Purpose: Although biking is a healthy and sustainable alternative to vehicle-based transportation, motorists present a risk to cyclists operating on roadways. This study utilized automobile simulator technology to measure driver interactions with virtual cyclists under varying roadway conditions, with the goal of identifying crash risk factors.
Methods: Thirty participants (15 men and 15 women, ages 30-50) completed a questionnaire that evaluated driving experience, behaviors, and attitudes. Participants then completed a 10-minute simulator drive where they interacted with virtual cyclists under experimental conditions which included varying road widths and posted speed limits; presence and absence of bike lanes; and presence and absence of bicycle signage. Vehicle-bicycle speed differential and vehicle-bicycle distance were used to evaluate the risk of a vehicle-bicycle crash under various roadway conditions.
Results: Drivers with higher aggression scores drove closer to virtual cyclists than less aggressive drivers. The presence of bicycle lanes resulted in increased distance and reduced speed differentials between drivers and virtual cyclists, while bicycle signage did not influence these relationships.
Conclusion: Our results suggest that the risk of vehicle-bicycle crashes is influenced by driver behaviors as well as by road infrastructure. Further research is needed to evaluate infrastructure alternatives as well as driver-focused behavioral interventions to increase the safety of cyclists on roadways.
Innovation/Significance: Our results demonstrate the potential utility of automobile simulator technology for evaluation and communication of the risk of vehicle-bicycle crashes, and also suggest a number of driver and infrastructure factors that modify the risk of vehicle-bicycle crash.
Statement of Purpose: To describe potentially distracting behaviors among drivers of children and to examine associations between potential distractions and unsafe driving behaviors.
Methods: Cross-sectional survey of parents of 1- to 12-year-old children treated in 2 Michigan emergency departments for any reason from 10/2011-5/2012. Drivers were asked about prior month technology-related (cell phone, text/email, navigation system), child-related (feed, pick up toy/game, change DVD/CD), and driver-related (eat/drink, groom, read map) distracting behaviors while driving their child. Drivers reported child passenger restraint use (analyzed according to Michigan law) and prior motor vehicle collision (MVC). Bivariate analyses were conducted.
Results: Of 618 drivers surveyed, 575 (93%) completed all items. Cell phone use was most common (64%) and grooming least common (6%). Child-related distracting behaviors and text/email were more often reported by drivers of children NOT restrained according to Michigan law than drivers reporting legal restraint use (80% vs. 69%, p=0.016 and 24% vs. 13%, p=0.002, respectively). Drivers EVER in an MVC disclosed more distracting behaviors than drivers never in an MVC.
Conclusions: Drivers of child passengers commonly use technology and engage in child-related distracting behaviors. Child-related distracting behaviors and texting were associated with children not being restrained according to Michigan law. Most distractions were associated with prior MVCs.
Innovation & Significance: Much attention on distracted driving has been focused on inexperienced teen drivers, yet drivers of child passengers indicate a high level of engagement in potentially distracting activities. Distracted driving may place children at risk for MVC-related injuries.
Statement of Purpose: As the leading cause of death among teenagers in the US, motor vehicle collisions account for more than 33% of deaths in teens. Immaturity and lack of experience contribute to the high crash rates among these drivers. Effective interventions are needed to improve driving skills in this population.
Methods/ Approach: 373 drivers between 15.5‐19 years old.
Three phase study:
‐Phase 1: One day advanced driver training course to assess pre- and post‐instruction knowledge and driving skills
‐Phase 2: 3‐6 months after Phase 1, participants return to assess knowledge and skill retention
‐Phase 3: Participants complete driving behavior surveys at 6 and 12 months following enrollment; driving records are also monitored through 18 months after enrollment
‐58% increase between pre‐ and post‐instruction knowledge test scores
‐Substantial decrease in number of cones hit and gates missed between initial and final runs on both ELC and slalom
‐Spin car: 79% increase in number of spin‐saves
‐No improvement in WBS between initial and final runs
‐Data analysis is in final stages and will be available by time of poster session. Data collection and entry completed on July 22.
Conclusion: Our preliminary results indicate that participation in an advanced driving course with instruction and repeated driving drills increases the skill level of teenage participants.
Innovation & Significance: If this instruction proves effective, advanced drivers training can be more widely implemented to decrease rates of crashes and subsequent death and injury for this at‐risk population.
Objective: Injury resulting from motor vehicle crashes is the leading cause of death among teenagers in the US. One effective policy that has been implemented is graduated driver’s licensing (GDL) and its temporal effectiveness has been widely studied. The primary objective of our study is to develop a spatial statistical modeling approach to evaluate and compare the effectiveness of GDL policy across 83 counties in the state Michigan.
Methods: A hierarchical modeling framework is used to analyze the number of fatal teenage-driver car crashes occurred in 83 counties in Michigan. To account for spatial dependence among crash counts from adjacent counties we invoke spatial random effects, which are specified by a Conditionally AutoRegressive (CAR) prior.
Results: The proposed approach improves statistical power by borrowing information from neighboring counties. More importantly, we are able to study and understand how spatial variation in the effectiveness of GDL might be explained by some socio-economic factors.
Conclusions: Our analysis confirms previous findings that GDL in Michigan is an effective policy that significantly reduces the risk of fatal car crashes among novice teenager drivers. In addition, it unveils that rurality is an important contextual variable associated with spatial differences in GDL effectiveness across the state of Michigan, as is the percentage of the populations that is white.
Innovation and Significance: Our model provides an effective way to capture spatial variations on the effectiveness of GDL policy in Michigan and to identify important predictors to such variations by associating the risk with county-level contextual variables.
Injury Prevention activities geared towards relevant mechanisms of injury for our patient population are integral to our planning. Our top mechanism of injury for the 15-44 demographic is motor vehicle collisions which is consistent with national data. In an effort to reduce the occurrences of motor vehicle collisions, and more specifically those related to distracted driving we created a program entitled; Avoid Trauma: Don’t Drive Distracted. This program was developed after a review of our data which demonstrated that a large number of motor vehicle accidents were related to distracted driving, especially in the young driver.
In 2010 we initiated a program geared towards the 15-20 year olds. We initiated the program in the Spring by sending letters to high schools in hopes of presenting the program prior to proms and graduation. We presented at several local high schools. The presentation includes a 45 minute program that addresses real life scenarios, the texting and driving law and use of a distracted driving simulator.
We were able to purchase the simulator with funds from a grant from our auxiliary after presenting to them the statistics associated with distracted driving and how this simulator would be an adjunct to the program.
We have incorporated the simulator into distracted driving programs in the high schools, at community events where multiple generations can interact and discuss the dangers and see on screen how distracted driving impairs the ability to drive. We expanded the program to the driving schools in four local towns. Here we are able to engage the young driver before they are on the road. It is then reinforced in high school and again when used in community events. It has also been used internally so our own employees could help relay the dangers of distracted driving. Our Injury Prevention Specialist now visits patients in the hospital and they often share their own stories which they allow us to incorporate into the program. In 2013, the program has added a 18 year old girl that lost 2 friends in an accident in which distracted driving played a key role. She herself suffered a traumatic brain injury and she and her mother speak during the program. It is a strong message.
Monitoring success of our programs is also imperative. Using our trauma registry data from the last two years we have demonstrated a 43% reduction in motor vehicle collisions within the 15-20 year old population and a 16% reduction in motor vehicle collisions overall. This is a population-targeted prevention program that has resulted in identifiable improvement. We have added a distracted driving brochure and have added moving messages on billboards, our trucks and city buses to further enforce the dangers of distracted driving in an effort to save lives. We are confident that we can sustain these improvements and will continue to update the program to meet the needs of our community.
PURPOSE: Adolescent drivers are at elevated motor vehicle crash risk due to distracted driving behavior (DDB). Understanding parental and peer influences on adolescent DDB may aid future efforts to decrease crash risk. We examined the influence of risk perception, as well as descriptive and injunctive norms on adolescent DDB using the Theory of Normative Social Behavior.
METHODS: 403 adolescents (16-18 years-old) and their parents were surveyed by telephone. Survey instruments measured socio-demographics, self-reported DDB, sensation seeking, risk perception, descriptive norms (Perceived parent-DDB; Parent self-reported DDB; Perceived peer-DDB), and injunctive norms (Parent approval of DDB; Peer approval of DDB). Hierarchical multiple linear regression was used to predict social normative influences on adolescent DDB.
RESULTS: 92% of adolescents reported regularly engaging in DDB. Adolescents perceived that their parents and peers participated in DDB more frequently than themselves; however, based on parents’ report, adolescents overestimated parental DDB. Adolescent risk perception, parent DDB, perceived parent-DDB, and perceived peer-DDB were predictive of adolescent DDB in the regression model, but parent and peer approval of DDB was not predictive. Risk perception and parental DDB were stronger predictors among males, while perceived parental DDB was stronger for female adolescents.
CONCLUSIONS/SIGNIFICANCE: Adolescent risk perception and descriptive norms are important predictors of adolescent distracted driving. More study is needed to understand the role of injunctive normative influences on adolescent DDB. Effective public health interventions should target parental role modeling, parental monitoring of adolescent driving and social marketing techniques that correct misconceptions around driver distraction and crash risk.
Statement of Purpose:The purpose of the study was to examine normative influences of teenage passengers on the driving performance of teenage novice drivers. The results of this research will lead to a better understanding of normative influences on teenage driver crash risk.
Methods/Approach: Male teenage drivers licensed for 6-9 months navigated a realistic virtual roadway in a high-fidelity driving simulator that exposed all participants to the same scenarios eliciting safety-critical driving responses. These responses were examined as dependent measures. Participants were randomly assigned to either risk-promoting or risk-inhibiting conditions with a confederate peer passenger. Each participant completed a passenger-present and no-passenger drive.
Results: Participants driving with a confederate peer passenger were significantly more likely not to stop at yellow lights at intersections, and to spend more time in intersections while the light was red. These effects were more pronounced in the condition involving risk-promoting norms, and the passenger-present condition.
Conclusion: Peer-passenger presence is associated with an increase in risky driving behavior. This general effect may be a result of increased cognitive load and is enhanced by the presence of peers who are risk-accepting and may promote higher-risk norms.
Innovation & Significance: The results of the study support current peer passenger restriction policies. Injury prevention programs should further explore the role of peer influence and provide guidance for behavioral interventions to mitigate teenage driver crash risk. Peer influence may be utilized to enhance driver training programs and peer- involved interventions to reduce risky driving behaviors.
Statement of Purpose: Learning to drive requires the acquisition of a complex skill set that is essential to safe driving. Most states require parents to supervise their teens’ practice driving. Evidence-based guidance for parents is lacking. This ongoing research used scientific evidence to develop and evaluate a coaching guide (Guide) to help parents teach their teens safe driving skills during supervised practice.
Methods/Approach: Guide development included input from traffic safety experts who identified skills that are critical for safe driving. Drafts of the Guide were reviewed by parents of teens learning to drive to refine the content, format, language, and design.
Parent-teen dyads (n=200) will be recruited through driver education, enrolled before the teen’s Learner license starts, and randomly assigned to receive the Guide (intervention) or state-published material (control). Dyads will then complete required supervised practice driving during the Learner period a pre- and post-test survey and three-month follow-up.
The vehicles used by a random subset of dyads will be instrumented to capture audio/video data during practice driving. These data will be analyzed to evaluate the dyads use of the Guide.
Innovation & Significance:This research is innovative in: 1) developing an evidence-based resource for parents of teens who are learning drivers; and, 2) using in-vehicle technology to monitor parents actual use the Guide, which will provide data to help parents effectively teach their teens safe driving skills to reduce their crash risk as independent drivers.
Statement of Purpose: Effective injury prevention programs for teen drivers that can be broadly disseminated are needed. A university partnered with a state community health department (Study1) and a professional pediatrics association (Study2) to translate an evidence-based, parent-oriented teen driving intervention to a website for dissemination using varied promotional strategies.
Methods/Approach: Study1 evaluated an incremental promotional strategy that included paid and earned media. In Study2, primary care providers (PCPs) promoted the website via brief intervention with parents.
Results: In Study1, 15,278 website visits were logged over 12 months. Paid promotion ($30,000) resulted in a 137.5% increase in visits while the advertisements were active (4 months), yielded average visits of 15 seconds, and 89.5% of visitors bounced (exited homepage without viewing other pages). Earned media yielded a 149.4% increase in website visits while the story was posted/aired/reported (1.5 weeks), average visits of 1:49 minutes, and a bounce rate of 44.8%. PCPs’ promotion in Study2 yielded 1,410 visits over 12 months, average visits of 4:09 minutes, and a 44.6% bounce rate.
Conclusions: Results demonstrated the trade-offs inherent in various strategies for promoting a web-based injury prevention program. Paid media had high costs and brought high traffic volume, but website use by visitors was limited. Earned media was free and visitors used the website more than paid media, but had a short impact period. Brief intervention by PCPs, had fewer visits but yielded the most desirable website use.
Innovation & Significance: The combined results are encouraging that organizations at all resource levels can identify appropriate, effective promotion strategies.
Purpose: To inform injury prevention interventions, the present study examined the prevalence and correlates of driving after drinking (DD), and riding with a drinking driver (RDD) among youth in the Emergency Department (ED).
Methods: Self-report data were collected from 2150 16-20 year-old ED patients (reason for visit: 32% injury, 68% medical) who reported past-year drinking. Patients were grouped based on past-year DD/RDD: none (n=1131, 53%), RDD-only (n=496, 23%), DD-only (n=189, 9%), and DD+RDD (n=334, 16%). Multinomial logistic regression evaluated relationships between age, gender, race, school enrollment, ED visit reason (medical vs. injury), and past-year substance use (alcohol use severity, marijuana use [yes/no], other illicit drug use [yes/no]) with DD/RDD group (reference group = No DD/RDD).
Results: Those who RDD-only were more likely to be female, minority, and not in school, to report marijuana and other drug use, and had higher alcohol use scores. Those with DD-only were more likely not be in school, to have used marijuana and illicit drugs, and had higher alcohol use scores. Those with DD+RDD were more likely to be minorities, out of school, to report marijuana and other drug use, and had higher alcohol use severity scores. Reason for current ED visit was not associated with DD/RDD.
Conclusions/Significance: Rates of DD and RDD in this sample are concerning and underscore the importance of translating injury/DD prevention efforts in the ED. Such efforts should also address drug and driving high given these findings and societal trends for increased availability and legalization of marijuana.
Statement of Purpose: Unintentional poisoning (or “overdose”) is a significant and growing public health problem in the U.S. Overdoses due to extramedical prescription opioid use (e.g., using more than prescribed, using for reasons other than pain) have accounted for much of the increase in overdoses. The purpose of this pilot study was to develop a brief intervention for those using opioids extramedically and at high risk for overdose.
Methods/Approach: This study was conducted at the Hurley Medical Center Emergency Department (HMC ED) in Flint, Michigan. Patients 18 years of age and older seeking treatment at the HMC ED and who met inclusion criteria for screening were approached. Subjects who provided informed consent for screening were given a brief survey including questions on self-reported past-month extramedical opioid use and lifetime history of overdose to determine eligibility for the second stage of the study. The first phase of the study consisted of qualitative interviews to better understand the phenomenology of overdose experiences, both as victim and as witness of overdose. Based on the findings from the first phase, a brief intervention on unintentional overdose prevention was developed and pilot tested for feasibility.
Results: Examination of pre- and post-test data suggested that the intervention may improve self-efficacy to avoid overdose.
Innovation & Significance: This project was the first, to our knowledge, to develop an overdose prevention intervention specific to prescription opioids. This pilot project led to the development of an ongoing randomized controlled trial of the intervention.
Purpose: The present study was designed to develop and evaluate two tailored BIs among drug-using adults presenting to the Emergency Department (ED).
Methods/Approach: This is a randomized controlled trial of 650 adults recruited in an urban ED who reported past 3-month drug use and randomized to: therapist brief intervention (TBI) assisted by computer, computerized (CBI), or enhanced usual care (EUC). Questions included demographics, drug (illicit and non-medical prescription), HIV risk behaviors, psychological constructs associated with behavior change for drug use and condom use. Participants selected goals, concerns, benefits, challenges, strategies and strengths.
Results: Analyses examined differences between computerized baseline and post-intervention assessments on psychological constructs theoretically related to changes in drug use and HIV risk: importance, readiness, intention, help-seeking, and self-efficacy. Participants receiving the TBI significantly increased in self-efficacy; for the CBI increased importance, readiness, and help-seeking. Benefits of change were most strongly associated with changes in psychological constructs. The CBI only resulted in changes at post-intervention in psychological constructs related to HIV risk reduction.
Conclusions: Research shows that individuals who use drugs are more likely to seek care in the ED than non-drug users. The delivery of BIs targeting drug use and HIV risk behaviors using computers appears promising for implementation in healthcare settings.
Innovation & Significance: Few randomized controlled trials have tested the efficacy of SBIRTs for drugs in the ED. This is one setting in which BIs can be employed during a “teachable moment” in order to reach non-treatment seeking individuals who engage in substance use. NIDA #026029
Statement of purpose: Maternal substance use (SU) is highly related to child maltreatment (Chaffin, 1996). Establishment of sensitive parenting skills may have the potential to prevent child maltreatment. A pilot study of an intervention seeking to increase mother-child attachment was given to substance-abusing women. We hypothesize that increasing parenting sensitivity and attachment to the child will be a link to decreasing self-reported child abuse potential.
Methods/Approach: Substance-abusing mothers were recruited from the University of Michigan High Risk OB clinic into either a 12-week attachment-based intervention (Mom Power (MP)- SU Group Intervention) or a control group. Before and immediately following the completion of the intervention, mothers filled out a mental health battery including information on substance use and child abuse potential. Home visits were conducted to assess maternal parenting and the mother and child attachment.
Results: The 12-week intervention was attended by 4 substance-abusing mothers and their infants. Prior to the intervention, 3 of the women scored above the risk cutoff for the Brief Child Abuse Potential inventory (BCAP). Following the intervention, each of the women decreased slightly in BCAP score.
Conclusions: This study showed the feasibility of providing an attachment-based intervention in a group setting to substance-abusing women recruited from a high-risk OB clinic.
Innovations/Significance: Child abuse is prevalent in the first year of life and is higher among substance-abusing mothers. This pilot study demonstrates the feasibility of intervention to a very high-risk population and indicates the possibility that child abuse potential can be decreased by attachment-based interventions.
Purpose: Mindfulness skills have been linked to higher executive functioning, reduced depression and anxiety, and relapse prevention. Increasing mindfulness skills among youth could alleviate depression, reduce substance use, aggression and intentional injury.
Methods: The sample consisted of 1, 835 Emergency Department patients (ages 14-20; 40% male; 73% Caucasian) who screened positive for alcohol misuse (AUDIT-C score >3 for youth 14-17, >4 for youth 18-24). Participants completed screens including measures of mindfulness, depression, substance use, dating aggression, and injury. Structural equation modeling (SEM) was used to analyze the association of mindfulness and depression, whether these variables were predictive of injury, substance abuse, and aggression, and whether gender was a moderator.
Results: Multi-group SEM indicated gender was not a moderator. Mindfulness was associated with lower depression, injury, and alcohol. Depression was associated with higher prescription and illicit drug abuse as well as dating aggression. Conclusion: Depression is associated with a host of risk behaviors among youth, and mindfulness could be a path to reduce injury, alcohol use, and depression and its associated risk behaviors.
Innovation/Significance: Mindfulness research is limited among youth and primarily focused on 1 target risk factor/behavior (reduce depression, increase sleep, reduce stress). There are potentially broader benefits including reducing injury. This research supports efforts to develop and test mindfulness interventions as a potential public health approach to reduce depression, injury, substance use, and violence.
Statement of Purpose: The focus of this project will be on the development and assessment of brief online videos as an innovative mental health intervention for adolescents and young adults with elevated suicide risk factors. The newly produced videos will be an extension of the team's prior work -- a brief video series, called inkblots (www.inkblots.com) -- developed to target and educate the general population of young people on methods of promoting self-management and increasing resiliency.
Methods/Approach: We will produce two new videos, addressing suicide risk factors in the college student population (Aim 1); and conduct a small feasibility trial (Aim 2). The feasibility trial will consist of 60-70 University of Michigan undergraduates with elevated suicide risk factors. Students will be asked to view one or more videos, provide brief feedback, and complete a follow-up online assessment one month later. The following outcome measures will be used to evaluate pre-post changes: use of mental health treatment, perceived need for treatment, and informal sources of support (Eisenberg et al., 2011); help-seeking intentions (Vogel et al., 2007); generalized self-efficacy (Stallman, 2012); and self-esteem (Rosenberg, 1989).
Innovation & Significance: Findings from this study will be used to: refine the videos; develop partnerships; conduct larger studies; and maximize the reach of the intervention once the efficacy is established. By developing and evaluating a highly engaging approach, this research has great promise to expand reach substantially on a population-level, and enhance the impact of effective strategies at an individual level.
Purpose. There has been mounting concern among policy makers and the general public on how to prevent suicide from many of the 900 landmark bridges in the U.S. Given issues of data availability, only nine bridges have been the subject of scholarly research. Much work is descriptive and does not address prevention. While costly safety nets and barriers are known to reduce bridge suicides, there is no systematic evaluation of the effectiveness of a more common, less expensive prevention approach: emergency telephones. The present study addresses this gap and employs data from the #4 bridge suicide hotspot in the U.S.
Methods. Data refer to 219 suicides from the Skyway Bridge, St. Petersburg, Florida. Suicide data are drawn from newspapers, police and coroner files, & crisis center logs for the years 1955-2012 .
Results: Of 27 persons using the phones beginning in 2000, 26 were successfully restrained from jumping. However, overall, suicides significantly increased from 48 in the 13 years before vs. 108 in the 13 years after installation of the crisis phones (p < .001). This increase was largely sustained after a control for the Great Recession.
Conclusion: The unexpected rise in suicide was related to the emergence and heightened usage of a controversial, bridge suicide webpage and blog. These may have increased bridge suicides through suggestion effects.
Policy Significance: The installation of emergency phones was not enough to significantly lower suicides. Bridge suicide prevention may require the construction of costly barriers and/or less coverage of suicide in the media.
Objective: This study examines racial/ethnic disparities in rehospitalization and investigates the determinants of rehospitalization among individuals with SCI.
Design: A retrospective analysis of rehospitalization for adults who self-identified as non-Hispanic White (NHW), non-Hispanic African-American (NHB), or Hispanic was conducted. Rehospitalization was operationalized as 1)the number of rehospitalizations, and 2) the number of days in hospital during the 12 months prior to the first, fifth, and tenth year follow-up interviews. We modeled determinants of both measures of rehospitalization using Generalized Estimating Equations with a Poisson distribution.
Setting: Data from 26 sites in the National Spinal Cord Injury Model Systems (SCIMS) Database (1988-2011).
Results: Our inclusion criteria yielded a sample size of 6,196 (NHW=4089, NHB=1487, Hispanic=620). In comparison with NHWs, Hispanics had 21% lower rate of rehospitalization (p < 0.003) during the first year after SCI, and had 14% lower rate of days-in-hospital (p < 0.005) during the fifth year after SCI. In comparison with NHWs, NHBs had 8% lower rate of days-in-hospital (p < 0.019) during the fifth year after SCI. Longer initial hospitalization in a system’s inpatient rehabilitation unit (p < 0.001), being employed (p < 0.001), being married (p < 0.001), self-reported good-health (p < 0.001), and a higher FIM score (p < 0.001) significantly reduced rates of rehospitalization and days-in-hospital.
Conclusion: Controlling for other variables in our models, in comparison with NHWs, NHBs and Hispanics had significantly lower rates of rehospitalization and days-in-hospital.
Statement of Purpose: This study examines the factors that explain the dynamics of emergency room (ER) visits and hospitalizations among people with chronic spinal cord injuries (SCI) with data collected as part of a pilot study funded by the U-M Injury Center.
Methods/Approach: Interviews were conducted with 100 people living with SCI for at least 5 years. Data was collected on demographics, impairment and function, health conditions experienced during the past year, participation and emotional status. Logistic regressions were conducted. The model to explain hospitalization included prevalence of ER visits. Models included variables from the domains listed above.
Results: The model to explain prevalence of ER visits included seven factors. It was only partially explanatory (Chi-Sq =21.1; p=.004), correctly classifying 67% of subjects. Only two variables, the CHART-SF Occupation Scale and Time Since Injury were independently significant, p<.05. The model to explain hospitalizations was more explanatory, Chi-Sq = 47.5; p<.0005, correctly classifying 80% of subjects. Four variables were independently significant predictors (p<.05): impairment status, SCI-Secondary Conditions Scale scores, Perceived Stress Scale scores and prevalence of ER visits.
Conclusions: While this study provides insight into the dynamics of ER visits and hospitalizations among people with chronic SCI, work with larger samples is needed. As an adjunct to this study a second round of interviews is being conducted, which will allow for conduct of longitudinal analysis.
Innovation & Significance: Few studies have explored these factors. These analyses will provide guidance to future survey and intervention-based studies.
Purpose: To investigate the epidemiology of traumatic brain injuries (TBIs) that occurred at home to children under the age of five in the United States (US).
Methods: Data for children younger than five years treated for a concussion, internal organ injury, or fracture in which the injured body part was head from 1990 through 2012 in US hospital emergency departments (EDs) were analyzed using the National Electronic Injury Surveillance System.
Results: An estimated 2,354,754 patients younger than 5 years were treated in EDs for a TBI during the 23-year study period, which equals an annual average of 102,381 children. The number and rate of TBIs increased significantly by 233.2% and 212.8%, respectively, during the study period. The estimated number of TBIs decreased drastically (70.8%) from children less than 1 year of age to children 4 years of age. Overall, falls from structures were the leading cause of TBI (41.0%), followed by struck by/against events (27.5%), and general falls (19.0%).
Conclusions: One child under the age of five suffers a TBI at home every 5 minutes in the US. With the rate of TBIs rising considerably each year, injury prevention efforts, with a focus on very young children, are necessary now more than ever.
Significance: To our knowledge, this is the first nationally representative study to focus solely on TBIs that occurred at home to children younger than five years treated in US EDs over a multiyear period.
Statement of Purpose: National trauma center guidelines for management of childhood NAT do not exist. The purpose of this study is to present an audit of Non Accidental Trauma (NAT) cases from a level—one pediatric trauma center.
Methods: An 11-year (2001-2012) retrospective review of 147 NAT patients (102 male, 45 female; M=17.7 months) admitted to the trauma service was performed. Demographics, injury severity score (ISS), length of stay (LOS), injury types and outcomes are presented. Children with a diagnosis of sexual abuse or neglect were excluded.
Results: Forty-four percent of admitted patients had an ISS score >15, 16% with a score between 10 and 15, and 40% with a score <9. 126 patients were admitted with multiple injuries; 71 with head trauma, 23 with fractures and 25 with thoracic trauma including rib fractures. 26 patients had ophthalmologic findings, 17 had gastrointestinal injuries and 3 sustained burn injuries. 89% of the cases survived their injuries (17% were permanently disabled), 11% were fatal. Females were more likely to become disabled than males (20%vs15.69%, p<0.05). There were no significant differences across gender or geographic location.
Conclusion: Trauma surgeons manage a population of patients with injuries due to NAT characterized by young age, increased length of stay, high ISS score, multiple injuries and high mortality.
Innovation & Significance: The findings from this study will provide a detailed understanding of the complexity of NAT cases in hope that it helps establish NAT guidelines for trauma centers in the future.
Statement of Purpose: Unintentional injury is the leading cause of death and disability for children over the age of one in the US. The majority of injuries for pre-school children occurs while at home, and includes falls, poisonings, and burns.
Methods/Approach: A partnership was established between the African-American community of Lincoln Heights (OH) and Cincinnati Children’s Hospital. Local leadership utilized community specific data to implement an intervention plan that included home safety education and the provision of home safety equipment.
Results: Community engagement proved successful, and nearly 12% of homes in the community with children under the age of five participated in Home Safety Day. Most of the participants were satisfied with the program, learned new knowledge, and continued to use the equipment at 4 months post-intervention.
Conclusions: In attempting to reduce disparities in unintentional injury rates, a one-day community intervention using quality educational materials, providing resources and accessibility for home safety products, and engaging families personally contributed to an increase in home safety practices.
Innovation and Significance: Face to face interaction and community engagement are key drivers to spreading the message of safety in disadvantaged communities. By providing education on specific mechanisms of injury and installing safety equipment in the home, adoption of safety practices could lead to a reduction in child injury rates and mortality.
Purpose: To investigate the epidemiology of non-fatal, non-motor vehicle crash-related injuries among children in the United States.
Methods:\Data for children younger than 18 years treated for a non-fatal, non-motor vehicle crash-related injury from 1990 through 2012 in US hospital emergency departments were analyzed using the National Electronic Injury Surveillance System.
Results: Approximately 121,489,024 (95% CI: 104,226,323 – 138,751,726) patients younger than 18 years were treated for a non-fatal, non-motor vehicle crash-related injury in US hospital EDs from 1990 through 2012. This equals an average of 5,282,131 (95% CI: 4,531,579 – 6,032,684) children annually. There was an average of 74.12 (95% CI: 63.80 – 84.45) injuries per 1,000 children annually, and the annual injury rate decreased by 7.75% during the 23-year study period (m = -0.419, p = 0.001). Patients younger than 1 year of age experienced the lowest frequency of injuries, and 2- and 3-year-olds experienced the greatest frequency. Males accounted for 62.3% of injuries.
Conclusions: In the US, a child sustains a non-fatal, non-motor vehicle crash-related injury every 6 seconds on average. Although the injury rate decreased during the study period, this decrease was far less than the decrease reported for fatal pediatric injuries in other studies.
Significance: To our knowledge, this is the most comprehensive study of the epidemiology of non-fatal, non-motor vehicle crash-related child injuries over a multiyear period. Much attention has been given to motor vehicle crash-related injuries and fatal injuries during childhood; however, understanding non-fatal, non-motor vehicle crash-related injuries is important for an effective approach to the overall prevention of child injuries.
Purpose: Validation of program effectiveness is essential in justifying school-based injury prevention education. Although Risk Watch® (RW) targets burn, fire, and life safety, its effectiveness has not previously been evaluated in medical literature.
Methods: Between 2007-2012, a fire service public educator (FSPE) taught RW to 2nd grade students in one public school district. Curriculum was delivered in 30-minute segments for nine consecutive weeks via presentations, safety smoke house trailer, model-sized hazard house, student workbook, and parent letters. A written pre-test (PT) was given before RW started, post-test (PT#1) was given immediately after RW, and second post-test (PT#2) was administered to the same students the following school year (ranging 12 - 13 months after PT). Students who did not complete PT or at least one post-test were excluded. Comparisons were done by paired t-test, ANOVA, and regression analysis.
Results: After 183 (8.7%) were excluded for missing tests, 1,926 remaining students scored significantly higher (p=0.0001) on PT#1 (mean 14.8) and PT#2 (mean 14.7) than PT (mean 12.1). There was 1 FSPE and 36 school teachers with class size ranging from 10 - 27 (mean 21.4). Class size was not predictive of test score improvement (R2 = 0%), while ANOVA showed individual teachers trended toward some influence.
Conclusions: This 6-year prospective study demonstrated that the RW program delivered by a FSPE effectively increased short-term knowledge and long-term retention of fire/life safety in early elementary students. Collaborative partnerships are critical to preserving community injury prevention education programs.
Significance: Providing evidence-based community injury prevention programs.
Statement of Purpose: To examine the epidemiology and describe the mechanisms of injury of pediatric Nursemaid’s elbow injuries in the United States.
Methods/Approach: 15,151 children younger than 6 years treated in the United States hospital emergency departments for Nursemaid’s elbow injuries from 1990 to 2011 were retrospectively investigated using data from the National Electronic Surveillance System.
Results: An estimated 431,128 pediatric patients were treated for Nursemaid’s elbow injuries during the 22-year study period from 1990-2011. The annual average injury rate has increased 3 fold during the study from 5.26 injuries per 10,000 patients in 1990 to 15.18 per 10,000 in 2011. The mean patient age was 1.94 years and there were slightly more girls (56.4%) injured than boys (43.5%). The most common mechanism of injury was a fall (42.2%) followed by pull (40.6%), struck elbow on object (5.2%), twisted or wedged arm (4.5%), and rolled over (1.3%).
Conclusions: Contrary to previous studies, falls may be an overlooked, but primary cause of injury. Both caregivers and physicians should be aware of the causes of Nursemaid’s elbow to better diagnose the injury and respond with timely treatment. Adopting proper techniques in lifting or carrying children can prevent injury.
Innovation & Significance: There has not been a national population-based study on the mechanisms of injury associated with this injury to our knowledge and this is the first study to challenge the current opinion on the primary causes of Nursemaid’s elbow.
KID conducted research on the current test fixture and found that, in some incidences, it failed to prevent children from playing with hazardous toys because its size allowed for slightly larger products to be used. Tube measures 2.25 inches in height and 1.25 inches in diameter, however products larger than this have still posed choking hazards. We hope this research will allow for enhancements in health and injury prevention by changing children’s product regulations.
Purpose – To enlarge the test tube as its current dimensions fail to properly indicate whether a product can potentially cause choking.
Methods – A set of 60 recalled products were examined, taken from saferproducts.gov from 2003-2013.
Results – Type: 5% Clothing, 25% Nursery, 70% Toys (Chart A)
How Product Caused Choking: 75% Broke-off, 25% Original (Chart B)
Product Size Compared to Test Tube: 27% Smaller/Fit Inside Tube, 73% Larger/Did Not Fit (Chart C)
73% of the products that “passed” the small parts test fixture standard still posed a choking hazard!
Conclusions – The test tube has failed to prevent choking in some incidences, stronger precautions must be enforced.
Quick solution for parents: Use an empty toilet paper tube to test small parts as it allows for a few extra inches in height that the current test fixture lacks. Be weary of long, thin children’s products.
Significance – We are supporting effective injury policy through the proper use of the test tube. By enlarging the dimensions, we are enhancing the safety of its use in order to prevent choking in children.
Purpose: To investigate out-of-hospital medication errors among young US children.
Methods: Using data from the National Poison Database System, a retrospective analysis of out-of-hospital medication errors among children <6 years old from 2002 through 2012 was conducted.
Results: During 2002-2012, 696,937 children <6 years experienced out-of-hospital medication errors, averaging 63,358 episodes per year, or one child every 8 minutes. The average annual rate of medication errors was 26.42 per 10,000 population. The annual number and rate of medication errors increased by 9.2% and 5.1%, respectively, during the 11-year study period. The number and rate of medication error events decreased with increasing child age, with children younger than one year accounting for 25.2% of episodes. Analgesics (25.2%) were most commonly involved in medication errors, followed by cough and cold preparations (24.6%). Ingestion accounted for 96.2% of events, 27.0% of medication errors were attributed to inadvertently taking or being given medication twice, 0.4% (N=2,759) were admitted to a non-critical care unit, 0.3% (N=1,899) were admitted to a critical care unit, and 25 deaths occurred. The average annual medication error rate demonstrated a 2.91-fold variation among states and varied by 44.9% among regions of the US.
Conclusions: Out-of-hospital medication errors represent a major public health problem among young US children. Increased efforts utilizing proven strategies are needed to prevent these events.
Significance: To our knowledge, this is the first comprehensive study to evaluate the epidemiologic characteristics of out-of-hospital medication errors among children younger than 6 years of age on a national level.
Statement of Purpose: Develop an exercise program with internal and external partners to be proactive against high incidence of fall trauma. Target six zip codes with highest rate of fall admissions.
- Funding from the Columbus Foundation and IRB approval
- Exercise physiologists designed initial program, later moved to Tai Chi.
- Church Partnerships Dept. located interested churches who recruited participants.
- Initially participants were assessed by doctor to make sure they could safely participate; Tai Chi participants were not
- Each series lasted 12 weeks.
- No charge to churches or individual participants.
- Participants had pre and post testing with Functional Reach and Get Up and Go.
- Results analyzed by statistician.
- Seventy-one participants involved. Five were disqualified because of high risk. Data from 31 participants were used in results.
- After participating in the program, participants showed statistically significant improvement in Functional Reach and Get Up and Go.
- Coincides with literature--focused exercise improves participants’ strength, flexibility and balance.
- Challenging to motivate seniors to participate.
- Churches are good at motivating non exerciser.
- Liability concerns can hamper traditional hospital staff to carry out group exercise program.
- Tai Chi is easy to offer with no equipment needs; either standing or sitting.
- Tai Chi is readily accepted by both genders of seniors and shows excellent results.
- Challenging for a trauma program to develop/ administer proactive exercise program.
Objective: To describe the circumstances of death and the objects present in the sleeping environment upon death in a cohort of infants who sustained fatal suffocation or strangulation injuries.
Methods: 1,736 cases of accidental suffocation and strangulation in bed (ASSB) between 2000 and 2012 were retrospectively reviewed from four unique databases administered by the Consumer Product Safety Commission.
Results: The mean age of death for infants was 3.76 months (SD: 2.51), and over two-thirds of all fatalities occurred in infants less than five months of age (67.3%). Infants were found in a crib or bassinet less than a third (30.6%) of the time. When documented, the prone sleep position was most common (84.9%). Wedging (43.3%) followed by a position on top of and face down or prone on an object (25.9%) were the most common positions relevant to death. Pillows were associated with death in 425 cases and were present but unrelated to death in an additional 140 cases, thus present at the death scene in nearly a third of all fatalities (32.5%). Other common objects associated with death included mattresses (364 cases), blankets (228 cases), and walls (199 cases). Co-sleeping was documented in 20.2% of all deaths and was associated with ASSB in 112 cases.
Conclusions: Both caregivers and healthcare providers should be aware of the unique dangers that specific objects pose in the sleep environment. Adopting proper sleep practices can prevent the majority of deaths due to accidental suffocation or strangulation.
Attractions and Travel Information
As host of the conference, the University of Michigan Injury Center warmly welcomes you to Ann Arbor. Ann Arbor is known for its rich cultural opportunities, fine dining, and one pretty awesome academic institution.
Many attendees will stay at The Dahlmann Campus Inn, which is located just a few blocks from the conference site. If you would like to reserve a room at The Dahlmann Campus Inn Hotel, please contact the hotel directly to secure your room at 734-769-2200 or 800-666-8693. The Campus Inn will have rooms available at a single rate of $154/night for conference attendees.
Please note that complimentary transportation to and from the conference will be available each morning and after the close of the day's activities for those with mobility issues. Please let us know if you plan to use this service.
You may locate other local hotels here.
Much more information to help you plan your Ann Arbor visit is available at visitannarbor.org.
...can be a particular challenge in downtown Ann Arbor, and we highly recommend that you park in the Palmer Drive Parking Structure, which is adjacent to Palmer Commons.
- From Washtenaw Avenue, turn on Palmer Drive, proceed approximately 100 yards to the 2nd parking entrance on your left that is marked "Visitor Parking."
- Pull a ticket, (which is .55 per half-hour) and park on levels LL (lower level) and P1 (level 1).
- Upon exiting your vehicle, look for large metal Maize and Blue signs that read "East Elevators."
- Proceed towards the East Elevators (there are 3 sets of elevators in the structure: East, North and South) and follow the signs that list Palmer Commons .
- In the elevator, push the PL Level (Plaza Level) and exit onto the outdoor plaza near the Life Science Institute entrance. Continue across the outdoor plaza to Palmer Commons.