Think First for Kids (TFFK): A Longitudinal Analysis of a School-Based Injury Prevention Curriculum

Despite years of legislative and public health efforts, unintentional injury continues to be a serious public health problem and is identified as a major priority on the national health care agenda. The high incidence of unintentional injury in the middle childhood age group is of particular interest due to immaturity of the cognitive, psychosocial, and neurophysical dimensions of the child. The purpose of this study was to examine the effectiveness of a school-based curriculum on improving knowledge and self-reported safety behaviors over time among ethnically and socioeconomically diverse elementary school aged children. The social, cultural, cognitive, and behavioral learning theory of Constructivism informed the study. The learning theories of Vygotsky, Bruner, and Piaget served as the theoretical frameworks for the constructivism theory and helped professionals understand how, why, and when children are cognitively, psychologically, socially, and developmentally at greatest risk for injury and most receptive to learning. A three-year longitudinal, matched comparative, with repeated measures, cohort design was used to evaluate the effectiveness of TFFK intervention. The data to be analyzed were from a quasi-experimental research design. Culturally diverse elementary schools in high injury-risk areas from San Diego Unified and Cajon Valley during the 1999–2002 academic school years were recruited for the study. Ten schools participated, five schools were identified as intervention schools to receive TFFK and five schools that most closely matched the intervention schools on SES, school defined and grade specific reading scores, race/ethnicity composition, and school district were the controls, thus creating five pairs of matched schools. The original cohort of 1,762 students participating in the paired intervention/control study were followed over the three-year longitudinal study. To determine the effectiveness of the TFFK program, a pre-/post-measure design was employed. The primary outcome was a change in total test score from the pre-test to the post-measure, with the post-measure being administered after the intervention. The analysis of the pre-existing data was conducted using the Statistical Package for the Social Sciences (SPSS) (Version 12.0) and included descriptive, univariate and General Linear Model (GLM), multivariate analysis of variance methods, to assess injury-related knowledge and safety behavior change among elementary school subjects receiving the Think First for Kids (TFFK) curriculum compared to control subjects. The overall effect of the curriculum was tested using a GLM repeated measures, analysis of variance procedure for each Cohort A, B, and C. Data analysis of the posttest measure scores demonstrated that the TFFK curriculum led to a statistically significant increase in knowledge and self-reported safety behaviors. The overall trend was for greater improvement in intervention school students when compared to control school students. It is important to recognize that schools not only have direct access to young children, but also have the unique capacity to affect the lives of staff, parents, and the entire community. This study provides empirical evidence that early school-based theory-driven injury prevention education has a positive effect on young children

A Million Person Household Survey: Understanding the Burden of Injuries in Bangladesh

Ninety percent of lives claimed by injuries occur in low- and middle-income countries. This special issue, A Million Person Household Survey: Understanding the Burden of Injuries in Bangladesh, aims to assess these injuries—including falls, drowning, burns, road traffic injuries — to inform efforts to reduce the burden they cast on millions of people and families in a low income country. This issue offers a unique collection of research on the epidemiology of fatal and non-fatal injuries in Bangladesh. Based on a survey of more than one million people, this research—conducted by the International Injury Research Unit, Department of International Health at the Johns Hopkins Bloomberg School of Public Health and two Bangladesh partners, the Center for Injury Prevention and Research and the International Center for Diarrheal Disease Research, Bangladesh with funding from Bloomberg Philanthropies, was part of a large-scale, population-based, child-drowning prevention project called “Saving of Lives from Drowning in Bangladesh.” The project tested the large-scale effectiveness and cost-effectiveness of evidence-based interventions to reduce drowning related deaths for children less than five years of age (reported elsewhere). We hope this data will be useful to researchers, students, practitioners and national decision makers

Persistent Social-Emotional Symptoms Following a Concussion: Recommendations for School Psychology Practice

Concussions can result in a constellation of physical, cognitive, and social– emotional symptoms, most of which resolve within 1 to 2 weeks following the injury. In some instances, social–emotional difficulties following concussion persist, causing ongoing distress and psychosocial impairments. It is important that school psychologists understand the nature of these symptoms, as well as ways in which they can support students who are recovering from concussions. As part of a collaborative concussion team, school psychologists can provide valuable insight into the complex interaction of symptoms that may present following a concussion. This article summarizes the existing literature on persistent social–emotional effects of concussions and provides recommendations for school psychologists with regard to consultation, assessment, and intervention for this underserved population of students

Tailored Messaging Feedback to Improve Parent Knowledge and Behavior Practices on Pediatric Drowning Prevention

abstract: Introduction and Background: Drowning is the leading cause of preventable injury death in Arizona for children under five years old. Tailored education has demonstrated efficacy in behavior change and knowledge retention. The purpose of this evidence-based project was to evaluate if tailored education improved knowledge and self-reported behaviors related to pediatric drowning. The Elaboration Likelihood Model provided the framework for this project. Methods/Experimental Approach: The prospective pilot project was conducted using the Iowa Model of Evidence Based Practice. Parents with children under five years, presenting with low acuity complaints in a pediatric emergency department were approached. A baseline assessment identified high-risk behaviors and a custom education plan was delivered to parents. Outcome variables were measured at baseline and three weeks after initial assessment. Results: The average parent age was 29 (M = 28.5; SD = 6.35) years. Participant (n=29) responses were analyzed using descriptive statistics. Participants (n = 27, 93%) reported likelihood to change behaviors and 29 (100%) perceived the tailored intervention as relevant. Secondary outcome variables were not measured at three weeks due to a lack of survey response. Conclusions: Parents reported a high likelihood of behavior change when water safety education was tailored and relevant to their child. The tailored intervention evoked positive interaction and receptivity from parents and suggested a high motivation to make a behavior change. The effect of the intervention could not be tested due to the lack of follow-up and post data collection. The design of this evidence-based project is quantifiable and replicable in a low-acuity setting, which allows for future evaluations of self-reported behavior change and knowledge improvement. Funding: No sponsorship or financial conflict of interest

Counting Uncounted Gunshot Injuries: A Capture‐recapture Study Of People Minding Their Own Business

Objectives. To apply a novel statistical method to create a comprehensive estimate of incidence of firearm related injuries. Methods. A database of firearms injuries in New Haven, Connecticut, during a five- month period was created with records from law enforcement, emergency departments, emergency medical services (EMS), news media, and the medical examiner. The overlap of these various sources was operationalized in a capture-recapture model to generate an estimate of uncounted firearms injuries, and log linear modeling was used to control for positive and negative dependencies. Results. The combined data sources revealed 49 firearms injuries occurring during the study period within our defined geographical area. No single source recorded more than 43 of these injuries. Log-linear capture recapture methods estimated that the actual number of injuries was 49.7 (95% CI 49-52.3). Conclusions. No single source reaches complete case ascertainment for firearms injures. Combining multiple sources improves the estimate of injury incidence, but still results in an undercount. Log-linear capture-recapture methods can be used to improve the estimate of firearms injuries

Violence and adolescence in urban settings: A public health approach based on the MLIVEA framework

Adolescent violence is a public health issue with global relevance and far-reaching health consequences. It impairs the well-being of those involved and makes demands on health services. The review gives insight into the determinants leading to the health effects of urban violence focusing on young people. For this purpose a new comprehensive framework has been developed and applied. The new framework is called MLIVEA framework due to the structure of its components, which are macro level, local setting, individual level, violent act, health effect and action. Determinants of the macro level are forming societal conditions that contribute to the development of violence in cities. The different local settings are all affected by the macro level and are connecting links to the individual level. The individual level shows risk factors of the individual adolescent concerning psychological, social and biological aspects of personality. The violent acts refer to actual violent events leading to the violence-related health effects. Action can be taken to reduce violence at the macro level, at the local setting level and at the individual level. The advantage of the new framework lies in its presentation of the whole process and the interrelations of factors, which lead to adolescent violence in cities. The MLIVEA framework shows: 1. It is necessary to understand the causes of violence at all the different levels for each city. 2. Best results are gained by carrying out interventions at all the levels. 3. Violence and related health consequences are preventable and have relevance for public health science and action. -- In vielen Ländern gefährden Gewalttaten nicht nur den sozialen Zusammenhalt, sie belasten auch die Gesundheit der Bevölkerung. Insbesondere Jugendliche und junge Erwachsene in Städten sind häufig an Gewalttaten beteiligt, entweder als Opfer oder als Täter. Bei ihnen stellen die gesundheitlichen Folgen von Gewalt eine wichtige Ursache von Mortalität und Morbidität dar. Der Artikel gibt einen Einblick in die Determinanten, die zu den Gesundheitsfolgen von städtischer Gewalt führen und konzentriert sich dabei auf Jugendliche. Für diesen Zweck wurde ein umfassendes Modell entwickelt und angewendet. Das neue Modell wird entsprechend seiner Komponenten MLIVEA genannt: Macro Level, Local Setting, Individual Level, Violent Act, Health Effect und Action. Der Vorteil des Modells liegt in der Darstellung des gesamten Prozesses von der Gewaltentstehung über die Gewalttat und seinen gesundheitlichen Folgen bis hin zu geeigneten Interventionen. MLIVEA zeigt, dass Gewalt und damit zusammenhängende Folgen für die Gesundheit nicht unvermeidbar sind, Präventionsmöglichkeiten durchaus existieren und Public Health dazu beitragen kann, sie zu finden und umzusetzen.

The Role of Self-Mutilation Behaviors Among Adolescents Who Are Depressed

Adolescents who are depressed may self-injure themselves. Common methods for non-suicidal self-injury are cutting and burning the skin of one’s own body. Multiple confounding factors of age, gender, race and socio-economic status could lead one to engage in intentional or unintentional self-mutilation acts. The current body of literature on adolescent mental health demonstrates limited understanding of how racial and ethnic identity factors contributes to depression, self-injurious behavior, and suicide. This quantitative study determined if there was a relationship between depression and prevalence of adolescent self-mutilation. The social ecological theory was used to study the intersection of social determinants of depression and why depressed adolescents might perform self-mutilation behavior. Data was analyzed from the Web-Based Injury Statistics Query and Reporting System for the years 2015 through 2017. Results showed there was no difference in self-mutilation and depression, but there was a difference in racial/ethnicity and self-mutilation among depressed adolescents. It is hoped that the findings of this study will advance the practice of mental health care treatment for adolescents by providing a broader understanding of how racial and ethnic identity, depression, and self-injurious behavior may interact and influence each other. The implications for positive social change are to decrease the prevalence of adolescent depression, acts of self-mutilation, and unintentional suicide by providing adolescents with essential resources to learn new coping skills and build positive relationships

Deliberate Self-Harm in Young Children

Indiana University-Purdue University Indianapolis (IUPUI)While deliberate self-harm (DSH) in adolescents and adults has been established as a reliable predictor of future suicidal behavior and attempts, whether the same is true for younger children has rarely been studied. Two separate articles will address issues regarding intentional self-injury in young children. The first identified describes the demographic profile of young children who engage in NSSI and evaluated whether predictors of adolescent NSSI are also associated with NSSI in children. The second manuscript analyzed NSSI behaviors to see if they can be correctly predicted from knowledge of a child's history of maltreatment to identify which trauma variables are central in prediction of NSSI status. A Chi-square and logistic regression were run on data from 16,271 records of children ages 5-9 years who received services from the IDMHA in 2018. NSSI was significantly (p < .000) associated with trauma history (x2 = 75.54, df = 1), anxiety (x2 = 107.59, df = 1), depression (x2 = 217.011, df = 1), suicide risk (x2= 993, df = 1), and impulsivity (x2 = 122.49, df = 1. Presence of a caregiver mental health problem (x2 =38.29, df = 1), age (x2 = 14.18, df = 4), being male (x2 = 11.59, df = 1), and being Caucasian (x2 = 23.29, df = 6) at p < .05. Regression results indicated the overall model of seven predictors (sexual abuse [OR 1.14], physical abuse [OR 1.26], emotional abuse [OR1.3], neglect [OR .895], medical trauma [OR 1.34], exposure to natural disaster [OR 1.81] and victim of a crime [1.14] was statistically reliable in distinguishing between children who self-injure and those who do not. [-2 Log Likelihood = 6228.78, x2(6) = 105.416, p < .000]. NSSI does occur in preadolescent children and while there is some indication that the risk factors and co-variates are like those of adolescents, there are some differences which need further study. Training clinicians to inquire about self-injury during assessment of younger children is a simple step. The variables of age and sex throughout development as well as identifying protective as well as risk factors with children should be studied

Improving Data Infrastructure to Reduce Firearms Violence

In the fall of 2020, Arnold Ventures, a philanthropy dedicated to maximizing opportunity and minimizing injustice, and NORC at University of Chicago, an objective nonpartisan research institution, released the Blueprint for a US Firearms Infrastructure (Roman, 2020). The Blueprint is the consensus report of an expert panel of distinguished academics, trailblazing practitioners, and government leaders. It describes 17 critical reforms required to modernize how data about firearms violence of all types (intentional, accidental, and self-inflicted) are collected, integrated and disseminated. This project, which is also supported by Arnold Ventures, takes the conceptual priorities described in the Blueprint and proposes specific new steps for implementation.The first step in building a better firearms data infrastructure is to acknowledge where we currently stand. In The State of Firearm Data in 2019 (Roman, 2019), the expert panel found that while there are a substantial number of data sources that collect data on firearms violence, existing datasets and data collections are limited, particularly around intentional injuries. There is some surveillance data, but health data on firearms injuries are kept separately from data on crimes, and there are few straightforward ways to link those data. Data that provide context for a shooting--where the event took place, and what the relationship was between victim and shooter--are not available alongside data on the nature of injuries. Valuable data collections have been discontinued, data are restricted by policy, important data are not collected, data are often difficult to access, and contemporary data are often not released in a timely fashion or not available outside of specialized settings. As a result, researchers face vast gaps in knowledge and are unable to leverage existing data to build the evidence base necessary to adequately answer key policy questions and inform firearms policymaking.In the Blueprint, the expert panel developed a set of recommendations organized around a reconceptualization of how data are collected and who collects data. The broad themes from the Blueprint are as follows:Almost all surveillance data in health and criminal justice is generated locally. It is a high priority to provide information, technical assistance, implementation supports, and funding to state and local governments to improve their collections.Comprehensive monitoring of all federal data collections is needed to ensure that important data elements are being collected, data gaps are being addressed, and quality issues are quickly resolved.Timely dissemination of key data is important, including the development of guidelines to ensure consistency across collections and that resources are made available to speed reporting for collections with historical delays.Improvement is needed in strategic communication about the purpose and use of data to federal agencies, researchers and to the general public.The current report builds on the Blueprint by developing implementation guidance for key recommendations. Where the Blueprint included actionable recommendations, such as naming discontinued surveys that should be resurrected, this report develops specific recommendations for implementation. The report is centered on three topics that were the highest priority for the expert panel but that required additional research before guidance could be disseminated. The research findings from that additional investigation are reported here, and recommendations to facilitate implementation are described. The three topic areas are as follows:The creation of a nonfatal firearms injury databaseIncreasing the quality, availability, and usefulness of firearms data for research and policyPractical steps for building state capacity and infrastructure to use data for evidence-based decision-makin