Pilot Trial of an Emergency Department–based Intervention to Promote Child Passenger Safety Best Practices

BackgroundDespite demonstrated effectiveness of child restraint systems (CRSs), use remains suboptimal. In this randomized pilot trial, we sought to determine the feasibility, acceptability, and potential efficacy of “Tiny Cargo, Big Deal” an ED‐based intervention to promote guideline‐concordant size‐appropriate CRS use.MethodsParents of children < 11 years old were recruited in two EDs and randomized in a 2 × 2 factorial design to four conditions: 1) generic information sheet, 2) tailored brochure mailed after the ED visit, 3) a single motivational interviewing‐based counseling session in the ED, and 4) full intervention (counseling session plus tailored brochure). We assessed feasibility (recruitment, completion, follow‐up rates) and acceptability (parent attitudes, uptake of information) in the ED, at 1 month and at 6 months. We obtained preliminary estimates of effect sizes of the intervention components on appropriate CRS use at 6‐month follow‐up.ResultsOf the 514 parents assessed for eligibility, 456 met inclusion criteria and 347 consented to participate. Enrolled parents were mostly mothers (88.1%); 48.7% were 18 to 29 years old; 52.5% were non‐Hispanic, white; and 65.2% reported size‐appropriate CRS use. Completion rates were 97.7% for baseline survey, 81.6% for counseling, 51.9% for 1‐month follow‐up, and 59.3% for 6‐month follow‐up. In the ED, 70.5% rated thinking about child passenger safety in the ED as very helpful. At 1 month, 70.0% expressed positive attitudes toward the study. Of 132 parents who reported receiving study mailings, 78.9% reviewed the information. Parents randomized to the full intervention demonstrated an increase (+6.12 percentage points) and other groups a decrease (–1.69 to –9.3 percentage points) in the proportion of children reported to use a size‐appropriate CRS at 6‐month follow‐up.ConclusionsSuboptimal CRS use can be identified and intervened upon during a child’s ED visit. A combined approach with ED‐based counseling and mailed tailored brochures shows promise to improve size‐appropriate CRS use.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150596/1/acem13687_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150596/2/acem13687.pd

Emergency Medicine: Competencies for Youth Violence Prevention and Control

By any standard one wishes to apply, the impact of violence on the health and safety of the public is significant. The expression of violence among children in the United States has increased significantly during the modern era. Homicide and suicide are the second and third leading causes of death in youths 15-24 years of age. The emergency department (ED) is a common site for the care of these victims, and because victims often become assailants, the emergency care provider needs to know the epidemiology, treatment, and methods for prevention of youth violence in order to curtail the cycle. A multidisciplinary task force was convened by the Centers for Disease Control and Prevention (CDC)-funded Southern California Center of Academic Excellence on Youth Violence Prevention and the Keck School of Medicine at the University of Southern California to define competencies for health professionals in youth violence prevention and control. Three levels of competence were identified: the generalist level, which should be obtained by all health professionals; the specialist level, which should be obtained by health professionals such as emergency medicine providers, who frequently work with populations affected by violence; and a third, or scholar level, to be acquired by health professionals who wish to become experts not only in the care, but also in research and advocacy. This article reports the details of this group's efforts and applies them to emergency care provider education. These competencies should shape the development of curricula for the span of emergency medical training from emergency medical services scholastic training to postgraduate continuous medical education.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75259/1/aemj.9.9.947.pd

Increased emergency department use by adolescents and young adults with eating disorders

Objective: This study describes patterns of emergency department (ED) utilization by patients who screen positive for eating disorders. Method: ED patients aged 14–20 years ( n = 1,920) completed a computerized questionnaire. The analyses compared the rates of ED use between patients who screened positive for an eating disorder and those who did not and examined the reasons for ED use amongst patients with eating disorders. Results: ED patients who screened positive for eating disorders were significantly more likely to have previously visited the ED and, on average, utilized the ED at a rate 1.6 times higher than patients who screen negative for eating disorders. The most common chief complaints among patients who screen positive for eating disorders were abdominal pain and other gastrointestinal‐related problems. Discussion: Patients with eating disorders utilize the ED more frequently than those without and commonly present for complaints seemingly unrelated to their eating disorder. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97531/1/22070_ftp.pd

The prevalence and correlates of eating disorders in adult emergency department patients

ObjectiveThis study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders.MethodEmergency department patients aged 21-65-years (n = 1,795) completed a computerized questionnaire that included validated screening tools for eating disorders, risky drinking behavior, other substance use, and depression. Analyses were conducted comparing individuals who screened positive for an eating disorder with those who did not based on demographics (gender, age, race, income, education), body mass index (BMI), risky drinking behavior, other substance use, and depression.ResultsNearly 16% (15.9%) of all patients screened positive for an eating disorder regardless of their reason for presenting to the emergency department. Patients who screened positive for an eating disorder were significantly more likely to have a BMI->-30 (odds ratio [OR] = 2.68, confidence interval [CI] = 1.98, 3.62, p-<-.001), to also screen positive for depression (OR = 3.19, CI = 2.28, 4.47, p-<-.001) and to be female (OR = 2.37, CI = 1.76, 3.19, p-<-.001). No differences in the prevalence of positive screens for eating disorders were seen across age or racial groups, level of education or income, or for any of the included substance use variables.DiscussionEating disorders are common among adult emergency department patients and are associated with high rates of comorbid depression and higher BMI. Given the significant morbidity and mortality associated with eating disorders, targeted screening may be warranted in the emergency department setting.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152020/1/eat23140_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152020/2/eat23140.pd

Examining Measurement Reactivity in Daily Diary Data On Substance Use: Results From a Randomized Experiment

The debate about whether measurement reactivity exists in daily diary research on substance use is still unsettled due to the issues of study design and statistical methodology. This study proposes a time-varying effect model (TVEM) that characterizes the trajectory of substance use behaviors with nonparametric functions determined by the data rather than imposes presumed parametric functions. It also allows researchers to investigate the effect of measurement reactivity on not only the likelihood of using substances but also the amount of substance use. The TVEM was applied to analyze diary data on alcohol and marijuana use collected from an experiment, which randomized 307 participants in Michigan into daily and weekly assessment schedules during 2014-2016. This study found short-term measurement reactivity on alcohol use, but did not find a significant reactivity effect on marijuana use. The daily group had smaller odds of abstinence from drinking but lower expected drinking quantity in the first week of assessment, which dissipated by the second week. The results indicate that although daily self-monitoring could have short-term reactivity on substance use behaviors that tend to fluctuate across days, such as alcohol use, it does not affect substance use behaviors that are quite consistent, such as marijuana use. Our findings imply that although daily monitoring of drinking may motivate people to reduce the quantity consumed once they start to drink, it may also arouse their desire to start drinking. Yet, both effects tend to last only one week, as participants accommodate to the monitoring by the second week

Implementing a State‐Adopted High School Health Curriculum: A Case Study

BACKGROUNDThe Michigan Model for Health™ (MMH) is the official health curriculum for the State of Michigan and prevailing policy and practice has encouraged its adoption. Delivering evidence‐based programs such as MMH with fidelity is essential to program effectiveness. Yet, most schools do meet state‐designated fidelity requirements for implementation (delivering 80% or more of the curriculum).METHODSWe collected online survey (N = 20) and in‐person interview (N = 5) data investigating fidelity and factors related to implementation of the MMH curriculum from high school health teachers across high schools in one socioeconomically challenged Michigan county and key stakeholders.RESULTSWe found that 68% of teachers did not meet state‐identified standards of fidelity for curriculum delivery. Our results indicate that factors related to the context and implementation processes (eg, trainings) may be associated with fidelity. Teachers reported barriers to program delivery, including challenges with adapting the curriculum to suit their context, competing priorities, and meeting students’ needs on key issues such as substance use and mental health issues.CONCLUSIONSMultiple factors influence the fidelity of health curriculum delivery in schools serving low‐income students. Investigating these factors guided by implementation science frameworks can inform use of implementation strategies to support and enhance curriculum delivery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155483/1/josh12892_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155483/2/josh12892.pd

Yeast Miro GTPase, Gem1p, regulates mitochondrial morphology via a novel pathway

Cell signaling events elicit changes in mitochondrial shape and activity. However, few mitochondrial proteins that interact with signaling pathways have been identified. Candidates include the conserved mitochondrial Rho (Miro) family of proteins, which contain two GTPase domains flanking a pair of calcium-binding EF-hand motifs. We show that Gem1p (yeast Miro; encoded by YAL048C) is a tail-anchored outer mitochondrial membrane protein. Cells lacking Gem1p contain collapsed, globular, or grape-like mitochondria. We demonstrate that Gem1p is not an essential component of characterized pathways that regulate mitochondrial dynamics. Genetic studies indicate both GTPase domains and EF-hand motifs, which are exposed to the cytoplasm, are required for Gem1p function. Although overexpression of a mutant human Miro protein caused increased apoptotic activity in cultured cells (Fransson et al., 2003. J. Biol. Chem. 278:6495–6502), Gem1p is not required for pheromone-induced yeast cell death. Thus, Gem1p defines a novel mitochondrial morphology pathway which may integrate cell signaling events with mitochondrial dynamics

A brief tailored family-centered seat belt intervention for hospitalized trauma patients

Among children 5-19 years, the commonest cause of unintentional injury-related death is being an occupant/driver in a motor vehicle crash (MVC). In 2006 in the United States, there were 568,188 injuries among children (0-18) due to MVC. Of these, 38,039 were severe enough to require hospitalization and there were 6,781 deaths. Seat belts and appropriate child restraints reduce the morbidity and mortality from MVC. Yet studies have shown that less than 50% of children hospitalized from a MVC were restrained at the time of the crash. In 2007, a statewide direct observation survey reported 93.7% of Michigan motorists wore their seat belts in the front seat. In 2007, at the University of Michigan CS Mott Hospital, 120 children were hospitalized due to MVC and only 64% were restrained. The unrestrained children suffered the most severe injuries and had the greater morbidity. A prime factor that influences whether a child uses a safety device is whether a parent uses a seat belt. In focus groups, teens said they used seat belts because of how they were raised. In a prior study, we compared safety attitudes and practices with 800 grade 4-6 children paired with their parents. Matched analysis demonstrated that parents who always wear a seat belt are more likely to have children who sit in the back seat and wear a seat belt (73% vs. 27%, p<0.05). This suggests that the parent/child non-seat belt/restraint users are an ideal target for an intervention. Our hypothesis for this study was that both parents and children are equally important in modifying pediatric safety practices. The specific aim of this study was to develop and test in a randomized controlled study a brief family- centered “seat belt intervention.U.S. Department of Transportation/NHTSA, Office of Behavioral Safety Research (OBSR)http://deepblue.lib.umich.edu/bitstream/2027.42/86092/1/102760.pd

Tracking Assaultâ injured, Drugâ using Youth in Longitudinal Research: Followâ up Methods

ObjectivesViolence is one of the leading causes of death among youth ages 14 to 24. Hospitalâ and emergency department (ED)â based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidenceâ based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing followâ up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hardâ toâ reach participants.MethodsThe Flint Youth Injury (FYI) Study is a prospective study following a cohort of assaultâ injured, drugâ using youth recruited in an urban ED, and a comparison population of drugâ using youth seeking medical or nonâ violenceâ related injury care. Validated survey instruments were administered at baseline and four followâ up time points (6, 12, 18, and 24 months). Followâ up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and followâ up interview completion at 24 months.ResultsA total of 599 patients (ages 14â 24) were recruited from the ED (mean ± SD age = 20.1 ± 2.4 years, 41.2% female, 58.2% African American), with followâ up rates at 6, 12, 18, and 24 months of 85.3%, 83.7% 84.2%, and 85.3%, respectively. Participant contact efforts ranged from two to 53 times per followâ up time frame to complete a followâ up appointment, and more than 20% of appointments were completed off site at community locations (e.g., participantsâ homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24â month followâ up interview. Participants who sought care in the ED for assault injury (p < 0.05) and had a substance use disorder (p < 0.01) at baseline required fewer contact attempts to complete their 24â month followâ up, while participants reporting a fight within the immediate 3 months before their 24â month followâ up (p < 0.01) required more intensive contact efforts.ConclusionsThe FYI study demonstrated that achieving high followâ up rates for a difficultâ toâ track, violentlyâ injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for followâ up strategies planned as part of other violence prevention studies.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146571/1/acem13495_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146571/2/acem13495.pd

The Relationship Between Cumulative Risk and Promotive Factors and Violent Behavior Among Urban Adolescents

Resiliency theory posits that some youth exposed to risk factors do not develop negative behaviors due to the influence of promotive factors. This study examines the effects of cumulative risk and promotive factors on adolescent violent behavior and tests two models of resilience—the compensatory model and the protective model—in a sample of adolescent patients (14–18 years old; n = 726) presenting to an urban emergency department who report violent behavior. Cumulative measures of risk and promotive factors consist of individual characteristics and peer, family, and community influences. Hierarchical multiple regression was used to test the two models of resilience (using cumulative measures of risk and promotive factors) for violent behavior within a sample of youth reporting violent behavior. Higher cumulative risk was associated with higher levels of violent behavior. Higher levels of promotive factors were associated with lower levels of violent behavior and moderated the association between risk and violent behaviors. Our results support the risk‐protective model of resiliency and suggest that promotive factors can help reduce the burden of cumulative risk for youth violence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117187/1/ajcp9541.pd