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

Nonreciprocal and Reciprocal Dating Violence and Injury Occurrence among Urban Youth

Objective: Dating violence is a significant health problem among youth that leads to adverse health outcomes, including injuries. Reciprocal violence (perpetrated by both partners) is associated with increased injury in adults, but very little is known about the prevalence and context for reciprocal violence, as well as injury rates, among youth. We sought to determine the prevalence and scope of reciprocal dating violence and injury occurrence among urban youth in a high-risk community. Methods: Analyses were based on data from the Youth Violence Survey, conducted in 2004, and administered to over 80 % of public school students in grades 7, 9, 11, and 12 (N=4,131) in a highrisk, urban school district. The current analyses were restricted to those who reported dating in the past year and who also reported any dating violence (n=1,158). Dating violence was categorized as reciprocal (the participant reported both violence perpetration and victimization) and non-reciprocal (the participant report either violence perpetration or victimization, but not both). Results: Dating violence reciprocity varied by sex. Girls who reported any dating violence were more likely to report reciprocal dating violence (50.4%) than were boys (38.9%). However, reciprocity did not vary by race/ethnicity or grade level. Reciprocal dating violence was more common among participants who reported more frequent violence experiences. Reciprocal violence was als

Children at Risk for Suicide Attempt and Attempt-related Injuries: Findings from the 2007 Youth Risk Behavior Survey

Purpose: The current study examines the associations between a range of risk factors and reports of suicide attempts and attempts requiring medical care in a nationally representative study of high school students. The goal is to examine sex differences in the risk factors associated with suicide attempts and attempt-related injuries requiring treatment by a health-care provider. Methods: We used data from the 2007 Youth Risk Behavior Survey for students in grades 9-12 to assess the prevalence and risk factors for suicidal behavior, as well as differences in these for boys and girls. Cross-sectional multivariate logistic regression analyses were computed to determine the most important risk factors for suicide attempts and for suicide attempts requiring medical care for the sample overall and also stratified for boys and for girls. Results: Overall, 6.9% of adolescents attempted suicide (9.3% of girls versus 4.6% of boys). Girls were more likely than boys to report a suicide attempt in the past year (Adj.OR=2.89). Among girls, sadness (Adj.OR=5.74), weapon carrying (Adj.OR=1.48), dating violence (Adj.OR=1.60), forced sex (Adj.OR=1.72), and huffing glue (Adj.OR=2.04) were significantly associated with suicide attempts. Among boys, sadness (Adj.OR=10.96), weapon carrying (Adj.OR=1.66), forced sex (Adj.OR=2.60), huffing glue (OR=1.63), hard drug use (Adj.OR=2.18), and sports involvement (Adj.OR=1.52) were significantly associated with suicide attempts. Conclusions: These findings demonstrate similarities and differences in the modifiable risk factors that increase risk for suicide attempts among boys and girls. In terms of the differences between boys and girls, hard drug use and sports involvement may be important factors for suicide-prevention strategies directed specifically towards boys, while dating violence victimization may be an important risk factor to address for girls. Overall, these findings can help guide prevention, clinical practice, and intervention strategies to prevent suicidal behaviors among adolescents

In Reply

A reply to a letter to the editor regarding their article: Swahn MH, Alemdar M, Whitaker DJ. 2009. Nonreciprocal and Reciprocal Dating Violence and Injury Occurrence Among Urban Youth. The Western Journal of Emergency Medicine. 11(3):264-268

In Reply

A reply to a letter to the editor regarding their article: Swahn MH, Alemdar M, Whitaker DJ. 2009. Nonreciprocal and Reciprocal Dating Violence and Injury Occurrence Among Urban Youth. The Western Journal of Emergency Medicine. 11(3):264-268

Alcohol Exposures, Alcohol Marketing, and Their Associations with Problem Drinking and Drunkenness among Youth Living in the Slums of Kampala, Uganda

This study determined the associations between alcohol use exposures, marketing, education, and problem drinking and drunkenness among youth living in the slums of Kampala. This cross-sectional study of youth was conducted in 2011 to quantify and describe high-risk behavior and exposures in a convenience sample (N=457) of urban youth living in the slums, 14–24 years of age, who were participating in a drop-in center for disadvantaged street youth. Logistic regression analyses were computed to determine associations between alcohol use exposures, marketing exposures, alcohol education, and problem drinking and drunkenness while controlling for possible confounders. Among participants, 30.2% reported problem drinking and 32.8% reported drunkenness. In multivariate analyses, obtaining free drinks was associated with problem drinking (AOR: 2.47; 95% CI =  1.23–4.96) and drunkenness (AOR: 2.40; 95% CI = 1.22–4.70) after controlling for potential confounders. Alcohol education measures were not significantly associated with either problem drinking or drunkenness in multivariate analyses. There are important associations between alcohol marketing and drinking among these youth. Moreover, the findings underscore the need for additional research related to the impact of alcohol marketing among vulnerable youth and also the need for policy regulations that restrict alcohol marketing that involve providing free alcohol directly to youth

Childhood Maltreatment and Early Alcohol Use Among High-Risk Adolescents

Objective: Child maltreatment (CM) is prevalent among U.S. youth and has been associated with subsequent maladaptive behaviors, including substance use. The current study examines the associations between early child maltreatment and (1) preteen alcohol-use initiation and (2) heavy episodic drinking among students in a large study of adolescents. Method: The Youth Violence Survey is a cross-sectional survey of public school students enrolled in Grades 7,9, 11, and 12 in a school district in a high-risk community. The analysis sample was limited to students who provided complete data on all relevant variables (N = 3,559). Fifty-two percent of the analysis sample was female. Early child maltreatment was defined as witnessing domestic violence and experiencing physical and/or sexual abuse before the age of 10 years. Outcome variables include ever drinking alcohol, preteen alcohol-use initiation, and heavy episodic drinking. Results: Witnessing domestic violence, experiencing physical abuse, and experiencing sexual abuse were significantly associated with preteen alcohol-use initiation (adjusted odds ratio [AOR] = 1.55, 95% confidence interval [CI]: 1.26-1.91; AOR = 2.10, 95% CI: 1.69-2.63; AOR = 1.57, 95% CI: 1.16-2.14, respectively). Students who experienced one or more types of maltreatment were 1.5-3 times more likely to report preteen alcohol-use initiation. Heavy episodic drinking was associated only with childhood sexual abuse in boys (AOR = 2.62, 95% CI: 1.52-4.50). Conclusions: Prevention and treatment of the negative impact of early child maltreatment may delay and reduce alcohol use

Co-Occurring Physical Fighting and Suicide Attempts among U.S. High School Students: Examining Patterns of Early Alcohol Use Initiation and Current Binge Drinking

Introduction: A growing body of empirical research documents a significant co-occurrence of suicide attempts and interpersonal violence among youth. However, the potential role of early alcohol use initiation and current heavy alcohol use as correlates of this comorbidity has not been examined in a nationally representative sample of high school students. Methods: We based our analyses on cross-sectional data from the 2009 Youth Risk Behavior Survey, which includes a nationally representative sample (n=16,410) of high school students in grades 9 through 12 in the United States. Multinomial logistic regression analyses were conducted to test the associations between measures of alcohol use (early alcohol use initiation and heavy drinking) and comorbid suicidal and violent behavior while controlling for potential confounders. Results: Among high school students, 3.6% reported comorbid physical fighting and suicide attempt in the past year. Early alcohol use (prior to age 13) and heavy drinking (5 or more drinks in a row) were strongly associated with comorbid reports of physical fighting and suicide attempts (Adj. odds ratio [OR]=3.12; 95% confidence interval [CI]:2.49-3.89) and (Adj. OR=3.45; 95%CI:2.63-4.52). Conclusion: These findings underscore the importance of both early alcohol use initiation and heavy drinking as statistically significant correlates of comorbid fighting and suicide attempts among youth. While future research is needed to determine the temporal ordering between problem drinking and violent or suicidal behaviors, existing prevention programs may benefit from including components aimed at reducing and delaying alcohol use. [West J Emerg Med. 2013;14(4):341–346.