Prevalence of working smoke alarms in local authority inner city housing: randomised controlled trial

Objectives To identify which type of smoke alarm is most likely to remain working in local authority inner city housing, and to identify an alarm tolerated in households with smokers. Design Randomised controlled trial. Setting Two local authority housing estates in inner London. Participants 2145 households. Intervention Installation of one of five types of smoke alarm (ionisation sensor with a zinc battery; ionisation sensor with a zinc battery and pause button; ionisation sensor with a lithium battery and pause button; optical sensor with a lithium battery; or optical sensor with a zinc battery). Main outcome measure Percentage of homes with any working alarm and percentage in which the alarm installed for this study was working after 15 months. Results 54.4% (1166/2145) of all households and 45.9% (465/1012) of households occupied by smokers had a working smoke alarm. Ionisation sensor, lithium battery, and there being a smoker in the household were independently associated with whether an alarm was working (adjusted odds ratios 2.24 (95% confidence interval 1.75 to 2.87), 2.20 (1.77 to 2.75), and 0.62 (0.52 to 0.74)). The most common reasons for non-function were missing battery (19%), missing alarm (17%), and battery disconnected (4%). Conclusions Nearly half of the alarms installed were not working when tested 15 months later. Type of alarm and power source are important determinants of whether a household had a working alarm

School-Based Violence Prevention Programs: Systematic Review of Secondary Prevention Trials

Objective: To quantify the effectiveness of school-based violence prevention programsfor children identified as at risk for aggressive behavior.// Design: Systematic review and meta-analysis of randomized controlled trials.Electronic databases and bibliographies were systematically searched and authorsand organizations were contacted to identify randomized controlled trials.Standardized, weighted mean effect sizes were assessed by meta-analysis.// Setting: Elementary, middle, and high schools.// Participants: Children at risk for aggressive behavior.// Main Outcome Measures: Violent injuries, observed or reported aggressive or violent behaviors, and school or agency responses to aggressive behaviors.// Results: Of the 44 trials identified, none reported data on violent injuries. For the 28 trials that assessed aggressive behaviors, the pooled difference between study groups was −0.36 (95% confidence interval, −0.54to −0.19) in favor of a reduction in aggression with intervention. For the 9 trials that reported data on school or agency responses to aggression, the pooled difference was −0.59 (95% confidence interval, −1.18to 0.01). Subgroup analyses suggested greater effectiveness in older students and when administered to mixed-sex groups rather than to boys alone.// Conclusions: School-based violence prevention programs may produce reductions in aggressive and violent behaviors in children who already exhibit such behavior. These results, however, need to be confirmed in large, high-quality trials

Incidence of fires and related injuries after giving out free smoke alarms: cluster randomised controlled trial.

OBJECTIVE: To measure the effect of giving out free smoke alarms on rates of fires and rates of fire related injury in a deprived multiethnic urban population. DESIGN: Cluster randomised controlled trial. SETTING: Forty electoral wards in two boroughs of inner London, United Kingdom. PARTICIPANTS: Primarily households including elderly people or children and households that are in housing rented from the borough council. INTERVENTION: 20 050 smoke alarms, fittings, and educational brochures distributed free and installed on request. MAIN OUTCOME MEASURES: Rates of fires and related injuries during two years after the distribution; alarm ownership, installation, and function. RESULTS: Giving out free smoke alarms did not reduce injuries related to fire (rate ratio 1.3; 95% confidence interval 0.9 to 1.9), admissions to hospital and deaths (1.3; 0.7 to 2.3), or fires attended by the fire brigade (1.1; 0.96 to 1.3). Similar proportions of intervention and control households had installed alarms (36/119 (30%) v 35/109 (32%); odds ratio 0.9; 95% confidence interval 0.5 to 1.7) and working alarms (19/118 (16%) v 18/108 (17%); 0.9; 0.4 to 1.8). CONCLUSIONS: Giving out free smoke alarms in a deprived, multiethnic, urban community did not reduce injuries related to fire, mostly because few alarms had been installed or were maintained

Clinical trial of an AI-augmented intervention for HIV prevention in youth experiencing homelessness

Youth experiencing homelessness (YEH) are subject to substantially greater risk of HIV infection, compounded both by their lack of access to stable housing and the disproportionate representation of youth of marginalized racial, ethnic, and gender identity groups among YEH. A key goal for health equity is to improve adoption of protective behaviors in this population. One promising strategy for intervention is to recruit peer leaders from the population of YEH to promote behaviors such as condom usage and regular HIV testing to their social contacts. This raises a computational question: which youth should be selected as peer leaders to maximize the overall impact of the intervention? We developed an artificial intelligence system to optimize such social network interventions in a community health setting. We conducted a clinical trial enrolling 713 YEH at drop-in centers in a large US city. The clinical trial compared interventions planned with the algorithm to those where the highest-degree nodes in the youths' social network were recruited as peer leaders (the standard method in public health) and to an observation-only control group. Results from the clinical trial show that youth in the AI group experience statistically significant reductions in key risk behaviors for HIV transmission, while those in the other groups do not. This provides, to our knowledge, the first empirical validation of the usage of AI methods to optimize social network interventions for health. We conclude by discussing lessons learned over the course of the project which may inform future attempts to use AI in community-level interventions

Increased police patrols for preventing alcohol-impaired driving.

BACKGROUND: Road traffic injuries cause 1.2 million deaths worldwide each year. Alcohol consumption increases the risk of traffic crashes, especially fatal crashes. Increased police patrols aim to increase both the perceived and actual likelihood of being caught driving while alcohol-impaired, potentially reducing alcohol-related driving, crashes and injuries. OBJECTIVES: To assess the effects on injuries and crashes of increased police patrols that target alcohol-impaired driving. SEARCH STRATEGY: We searched the Cochrane Injuries Group Specialised Register (5/2006), CENTRAL (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to 5/2006), TRANSPORT (1968 to 5/2006), C2-SPECTR (2/2005), NCJRS (1/1951 to 5/2006), PsycINFO (1872 to 5/2006), Social Science Citation Index (1974 to 5/2006), SIGLE (1980 to 2/2006), Science Citation Index Expanded (1970 to 5/2006), Dissertation Abstracts (1870 to 5/2006), NTIS (1964 to 12/2004), conference proceedings, and reference lists. We contacted authors of eligible studies. SELECTION CRITERIA: Randomized controlled trials, controlled trials, controlled before and after studies, interrupted time series (ITS) studies, and controlled ITS studies evaluating increased police patrols, either alone or combined with other interventions, targeting alcohol-impaired motor vehicle drivers. DATA COLLECTION AND ANALYSIS: Two investigators independently screened citations, extracted data, and assessed quality criteria. We compared intervention and no-intervention geographical areas or time periods. We re-analyzed study data as required. Results are presented narratively. MAIN RESULTS: The 32 eligible studies included one randomized controlled trial, eight controlled before-after studies, 14 controlled ITS studies, six ITS studies, and three studies with both ITS and controlled before-after analyses. Most interventions targeted only alcohol-impaired driving (69%) and included additional interventions such as media campaigns or special training for police officers (91%). Only two studies reported sufficient information to assess study quality completely. Two-thirds of studies were scored 'not adequate' on at least one feature. Five of six studies evaluating traffic fatalities reported reductions with the intervention, but differences were statistically significant in only one study. Effects of intervention on traffic injuries were inconsistent in the six studies evaluating this outcome, and no results were statistically significant. All four controlled studies evaluating fatal crashes reported reductions with the intervention, which were statistically significant in one study. All 12 controlled studies assessing injury crashes reported greater reductions with the intervention, though effects were minimal or not significant in several studies. ITS studies showed less consistent effects on fatal crashes (three studies) and injury crashes (four studies), and effect estimates were typically imprecise. Thirteen of 20 studies showed reductions in total crashes and about two-thirds of these were statistically significant. AUTHORS' CONCLUSIONS: Studies examining increased police patrol programs were generally consistent in reporting beneficial effects on traffic crashes and fatalities, but study quality and reporting were often poor. Methodological limitations included inadequate sample size, dissimilar baseline measures, contamination, and inadequate data analysis. Thus existing evidence, although supportive, does not firmly establish whether increased police patrols, implemented with or without other intervention elements, reduce the adverse consequences of alcohol-impaired driving

Identification and Description of Potentially Influential Social Network Members using the Strategic Player Approach

Background: Diffusion of innovations theory posits that ideas and behaviors can be spread through social network ties. In intervention work, intervening upon certain network members may lead to intervention effects “diffusing” into the network to affect the behavior of network members who did not receive the intervention. The strategic players (SP) method, an extension of Borgatti’s Key Players approach, is used to balance the (sometimes) opposing goals of spreading the intervention to as many members of the target group as possible, while preventing the spread of the intervention to others. Objectives: We sought to test whether members of the SP set have network position and non-network differences (such as demographic, attitudinal, or behavioral differences) compared to the remaining members of the target group (non-SPs). Methods: A first-year class at a private residential university (N = 1342) completed network and non-network measures. Analyses were restricted only to heavy drinkers, leading to a final analytic sample of 529. Results: SPs and non-SPs differed on multiple network variables, but did not differ on most demographic, attitudinal, and behavior variables. Conclusions: As designed, the SP program identified participants who were distinguished by their network position. The fact that they did not also differ on other characteristics shows the SPs are not significantly different than heavy drinkers who were not selected

Improving access to high-quality primary care for socioeconomically disadvantaged older people in rural areas: a mixed method study protocol

Introduction: The UK has an ageing population, especially in rural areas, where deprivation is high among older people. Previous research has identified this group as at high risk of poor access to healthcare. The aim of this study is to generate a theory of how socioeconomically disadvantaged older people from rural areas access primary care, to develop an intervention based on this theory and test it in a feasibility trial. Methods and analysis: On the basis of the MRC Framework for Developing and Evaluating Complex Interventions, three methods will be used to generate the theory. First, a realist review will elucidate the patient pathway based on existing literature. Second, an analysis of the English Longitudinal Study of Ageing will be completed using structural equation modelling. Third, 15 semistructured interviews will be undertaken with patients and four focus groups with health professionals. A triangulation protocol will be used to allow each of these methods to inform and be informed by each other, and to integrate data into one overall realist theory. Based on this theory, an intervention will be developed in discussion with stakeholders to ensure that the intervention is feasible and practical. The intervention will be tested within a feasibility trial, the design of which will depend on the intervention. Lessons from the feasibility trial will be used to refine the intervention and gather the information needed for a definitive trial. Ethics and dissemination: Ethics approval from the regional ethics committee has been granted for the focus groups with health professionals and interviews with patients. Ethics approval will be sought for the feasibility trial after the intervention has been designed. Findings will be disseminated to the key stakeholders involved in intervention development, to researchers, clinicians and health planners through peer-reviewed journal articles and conference publications, and locally through a dissemination event

Resistance to Peer influence Moderates the Relationship Between Perceived (But Not Actual) Peer Norms and Binge Drinking in a College Student Social Network

Introduction: Adolescent and young adult binge drinking is strongly associated with perceived social norms and the drinking behavior that occurs within peer networks. The extent to which an individual is influenced by the behavior of others may depend upon that individual’s resistance to peer influence (RPI). Methods: Students in their first semester of college (N = 1323; 54.7% female, 57% White, 15.1% Hispanic) reported on their own binge drinking, and the perceived binge drinking of up to 10 important peers in the first-year class. Using network autocorrelation models, we investigated cross-sectional relationships between participant’s binge drinking frequency and the perceived and actual binge drinking frequency of important peers. We then tested the moderating role of RPI, expecting that greater RPI would weaken the relationship between perceived and actual peer binge drinking on participant binge drinking. Results: Perceived and actual peer binge drinking were statistically significant predictors of participant binge drinking frequency in the past month, after controlling for covariates. RPI significantly moderated the association between perceptions of peer binge drinking and participant’s own binge drinking; this association was weaker among participants with higher RPI compared to those with lower RPI. RPI did not interact with the actual binge drinking behavior of network peers

Enrollment and Assessment of a First-Year College Class Social Network for a Controlled Trial of the Indirect Effect of a Brief Motivational Intervention

Heavy drinking and its consequences among college students represent a serious public health problem, and peer social networks are a robust predictor of drinking-related risk behaviors. In a recent trial, we administered a Brief Motivational Intervention (BMI) to a small number of first-year college students to assess the indirect effects of the intervention on peers not receiving the intervention. Objectives: To present the research design, describe the methods used to successfully enroll a high proportion of a first-year college class network, and document participant characteristics. Methods: Prior to study enrollment, we consulted with a student advisory group and campus stakeholders to aid in the development of study-related procedures. Enrollment and baseline procedures were completed in the first six weeks of the academic semester. Surveys assessed demographics, alcohol use, and social network ties. Individuals were assigned to a BMI or control group according to their dormitory location. Results: The majority of incoming first-year students (1342/1660; 81%) were enrolled (55% female, 52% nonwhite, mean age 18.6 [SD = 0.51]). Differences between the intervention and control group were noted in alcohol use, but were in large part a function of there being more substance-free dormitory floors in the control group. Conclusions: The current study was successful in enrolling a large proportion of a first-year college class and can serve as a template for social network investigations