Using Policy to Strengthen the Reach and Impact of Injury Prevention Efforts

West J Emerg Med. 2011;12(3):268-270

The Emory Center for Injury Control: Vision and Priorities for Reducing Violence and Injuries through Interdisciplinary Collaborations

Injury is the leading cause of death in the United States for persons between the ages of 1 and 44 1. We see evidence of the scope and burden of injuries in the emergency department (ED), where annually an estimated 41.4 million patients are seen with injury-related visits, accounting for over one-third of ED presentations 2. While many disciplines are involved in injuryrelated research, prevention, and practice, emergency physicians are on the frontlines of this epidemic, and they treat patients with preventable injuries as well as those with the sequelae of violence. Emergency physicians are also in a unique position to prevent future injuries and to reduce the consequences of existing injuries especially through screening and brief interventions, and the use of a teachable moment for the benefit and future safety of their patients 2. It is because emergency medicine is so integrated and important for injury prevention and research 3 that we wante

Correlation Between Intimate Partner Violence Victimization and Risk of Substance Abuse and Depression among African-American Women in an Urban Emergency Department

Objective: To assess rates of substance abuse (including tobacco, alcohol, and drug abuse) as well as rates of intimate partner violence (IPV) among African-American women seen in an urban emergency department (ED). Methods: Eligible participants included all African-American women between the ages of 21-55 years old who were seen in an urban ED for any complaint and triaged to the waiting room. Eligible women who consented to participate completed a computer-based survey that focused on demographic information and general health questions, as well as standardized instruments to screen for alcohol abuse, tobacco abuse, and illicit drug use. This analysis uses results from a larger study evaluating the effects of providing patients with targeted educational literature based on the results of their screening. Results: Six-hundred ten women were surveyed; 430 women reported being in a relationship in the past year and among these, 85 women (20%) screened positive for IPV. Women who screened positive for IPV were significantly more likely to also screen positive for tobacco abuse (56 % vs. 37.5%, p< 0.001), alcohol abuse (47.1 % vs. 23.2%, p < 0.001), and drug abuse (44.7 % vs. 9.5%, p<0.001). Women who screened positive for IPV were also more likely to screen positive for depression and report social isolation. Conclusions: African-American women seen in the ED, who screen positive for IPV, are at significantly higher risk of drug, alcohol, tobacco abuse, depression and social isolation than women who do not screen positive for IPV. These findings have important implications for ED-based and community-based social services for women who are victims of intimate partner violence. [West J Emerg Med. 2010; 11(3): 252-256.

Feasibility of Identifying Eligible Trauma Patients for Posttraumatic Stress Disorder Intervention

Objective: This research report examines the feasibility of identifying eligible trauma patients for a study providing an early therapeutic intervention for the prevention of posttraumatic stress disorder (PTSD), and identifies reasons around participation.Methods: This prospective observational study used a convenience sample of acute trauma victims presenting to a university-affiliated Level One trauma center in a large southeastern city. Patients eligible to participate in the early intervention study were adults (18- 65) who experienced a traumatic event within 72 hours of presentation, feared that they might be killed or seriously injured during the event, and were able to return for follow up appointments. Patients were excluded if they were non-English speaking; experienced a loss of consciousness greater than 5 minutes; had a history of a serious mental illness or were currently suicidal; or endorsed current substance dependence. Descriptive statistics were conducted to determine differences in ineligible, eligible, and consenting trauma patients who enrolled in the intervention study.Results: Over a six month period, n =1961 patients presented for treatment of a traumatic injury during study hours. Results showed that eligible patients were significantly younger than ineligible patients. Survivors of assaults (physical and sexual), younger patients, and women were generally more likely to participate in a study offering a psychological intervention in the immediate aftermath of a traumatic event.Conclusion: Fourteen percent of trauma patients were eligible and entered a study offering an early psychological intervention for the prevention of PTSD. Trauma type, age and gender may play a role in determining preference for receiving psychological services immediately after experiencing a traumatic event. [West J Emerg Med. 2010; 11(3): 275-279.

Treatment, Services and Follow-up for Victims of Family Violence in Health Clinics in Maputo, Mozambique

Background: Family violence (FV) is a global health problem that not only impacts the victim, but the family unit, local community and society at large.Objective: To quantitatively and qualitatively evaluate the treatment and follow up provided to victims of violence amongst immediate and extended family units who presented to three health centers in Mozambique for care following violence.Methods: We conducted a verbally-administered survey to self-disclosed victims of FV who presented to one of three health units, each at a different level of service, in Mozambique for treatment of their injuries. Data were entered into SPSS (SPSS, version 13.0) and analyzed for frequencies. Qualitative short answer data were transcribed during the interview, coded and analyzed prior to translation by the principal investigator.Results: One thousand two hundred and six assault victims presented for care during the eight-week study period, of which 216 disclosed the relationship of the assailant, including 92 who were victims of FV. Almost all patients (90%) waited less than one hour to be seen, with most patients (67%) waiting less than 30 minutes. Most patients did not require laboratory or radiographic diagnostics at the primary (70%) and secondary (93%) health facilities, while 44% of patients received a radiograph at the tertiary care center. Among all three hospitals, only 10% were transferred to a higher level of care, 14% were not given any form of follow up or referral information, while 13% required a specialist evaluation. No victims were referred for psychological follow-up or support. Qualitative data revealed that some patients did not disclose violence as the etiology, because they believed the physician was unable to address or treat the violence-related issues and/or had limited time to discuss.Conclusion: Healthcare services for treating the physical injuries of victims of FV were timely and rarely required advanced levels of medical care, but there were no psychological services or follow-up referrals for violence victims. The healthcare environment at all three surveyed health centers in Mozambique does not encourage disclosure or self-report of FV. Policies and strategies need to be implemented to encourage patient disclosure of FV and provide more health system-initiated victim resources. [West J Emerg Med. 2011;12(3):348-353.

Author manuscript; available in PMC

Abstract The current study aims to further our understanding of the applicability of the transtheoretical model (TM) to intimate partner violence (IPV), with particular focus on mental health symptoms (depression, posttraumatic stress disorder symptomatology, suicidal ideation) in a sample of lowincome African American women seeking medical services at an inner city emergency department. Results revealed that of the 121 abused African American women, the majority (95%) were in the precontempla-tion and contemplation stages of the change process. Further, contrary to predictions, bivariate analyses revealed those at further stages of change endorsed more severe mental health symptoms. However, a multivariate analysis of variance examining differences in level of mental health symptoms between women high and low on stages of change was inconclusive due to the small number of women at the higher stages of the TM model. These findings contribute to the growing body of literature supporting the TM as applied to IPV. Results are discussed in terms of applicability to intervention design. Keywords intimate partner violence; African American women; transtheoretical model The transtheoretical model (TM), also known as the stages of change model, describes an individual's readiness to change behavior. The TM suggests that to make a successful behavior change, individuals must go through a process of evaluating and increasing their readiness to change, ultimately making the change and maintaining the behavior. The TM conceptualize