Background:Youth violence is a leading cause of adolescent mortality, underscoring the need to in... more Background:Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine Emergency Department (ED) care.Objectives:To examine the translation of the SafERteens program into clinical care.Methods:Hospital staff provided input on implementation facilitators/barriers to inform toolkit development. Implementation was piloted in a 4-arm effectiveness-implementation trial, with youth (age: 14-18) screening positive for past 3-month aggression randomized to either SafERteens (delivered remotely or in-person) or enhanced usual care (EUC; remote or in-person), with follow-up at post-test and 3-months. During maintenance, ED staff continued in-person SafERteens delivery and external facilitation was provided. Outcomes were measured using the RE-AIM implementation framework.Results:SafERteens completion rates were 77.6% (52/67) for remote and 49.1% (27/55) for in-person delivery. In addition to high acceptability ratings (e.g., helpfulness), post-test data demonstrated increased self-efficacy to avoid fighting among patients receiving remote (IRR=1.22; 95%CI=1.09-1.36) and in-person (IRR=1.23; 95%CI=1.12-1.36) SafERteens, as well as decreased pro-violence attitudes among patients receiving remote (IRR=0.83; 95%CI=0.75-0.91) and in-person (IRR=0.87; 95%CI=0.77-0.99) SafERteens when compared to their respective EUC groups. At 3-months, youth receiving remote SafERteens reported less non-partner aggression (IRR=0.52; 95% CI=0.31-0.87; Cohen’s d=−0.39) and violence consequences (IRR=0.47; 95%CI=0.22-1.00; Cohen’s d=−0.49) compared to remote-EUC; no differences were noted for in-person SafERteens delivery. Barriers to implementation maintenance included limited staff availability and a lack of reimbursement codes.Conclusions:Implementing behavioral interventions such as SafERteens into routine ED care is feasible using remote delivery. Policymakers should consider reimbursement for violence prevention services to sustain long-term implementation.
Annals of The American Academy of Political and Social Science, Nov 1, 2022
Firearm injuries are a leading cause of injury-related deaths in the U.S., but there is a dearth ... more Firearm injuries are a leading cause of injury-related deaths in the U.S., but there is a dearth of federal funding for research on firearm injury prevention, compared to funding for research on other injuries and diseases. University research centers/institutes (C/Is) are in a position to help generate such research: they are multidisciplinary, have the capacity to conduct large-scale research projects, and commonly address complex health and social problems. In this article, we trace the history of research on firearm injury prevention, describe the different kinds of C/Is and C/I networks that have been developed to build knowledge in other areas of critical social concern, and argue for the development of a national coordinated network of firearm injury prevention C/Is.
The journal of trauma and acute care surgery, Jul 1, 2016
for the acquisition of the data, and the technical and material support of the study including st... more for the acquisition of the data, and the technical and material support of the study including study supervision. S.T.C. was responsible for clinical study supervision. P.F.E. was responsible for statistical analysis and data interpretation. All authors were responsible for manuscript draft and critical revisions.
Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for old... more Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019-12/23/2019) of 2048 older adults (age 50-80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%-28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9-73.1]) and safety counseling (63.2% [95%CI = 58.8-67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1-82.3]), comprehensive background checks (85.0% [95%CI = 81.5-87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9-90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8-84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.
Objectives: Violence is one of the leading causes of death among youth ages 14 to 24. Hospital-an... more Objectives: Violence is one of the leading causes of death among youth ages 14 to 24. Hospital-and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. Methods: The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drugusing youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or nonviolence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, and 24 months). Follow-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 follow-up interview completion at 24 months. Results: A total of 599 patients (ages 14-24) were recruited from the ED (mean AE SD age = 20.1 AE 2.4 years, 41.2% female, 58.2% African American), with follow-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 follow-up time frame to complete a followup appointment, and more than 20% of appointments were completed off site at community locations (e.g., participants' homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24month follow-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 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p < 0.01) required more intensive contact efforts.
ABSTRACT Background A pediatric injury prevention course has not been available as a massive open... more ABSTRACT Background A pediatric injury prevention course has not been available as a massive open online course (MOOC). Creating a comprehensive topic course is particularly challenging because the traditional, week-by-week linear curriculum design is often a barrier to learners interested in only specific topics. We created a novel, flexible course as both a ‘choose your topic’ MOOC for the public learner and a Small Private Online Course (SPOC) for medical students. Methods We describe creating ‘Injury Prevention for Children and Teens’, a course of 59 video learning segments within eight modules taught by a multidisciplinary panel of 25 nationally-recognized experts. Completion tracking and course evaluations were collected. Results In 2.5 years, 4,822 learners from 148 countries have enrolled. Two-thirds of learners were female. Median age of learners was 31 years. For engagement, 19.3% (n = 932) of learners attempted quizzes, and 5.2% (n = 252) participated in online forum discussions. Medical professionals (n = 162) claimed an average of 13 credit hours per learner. Over 200 senior medical students have taken the SPOC. Conclusion ‘Injury Prevention for Children and Teens’ is a novel approach to injury prevention education that is broad, science-based, accessible, and not cost-prohibitive for a diverse group of global learners.
Background and objectivesYouth violence is an alarming public health problem, yet, violence scree... more Background and objectivesYouth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens).MethodsThe study was conducted in two PC clinics: a university-affiliated satellite clinic and a community health centre. In phase 1, we obtained stakeholder feedback to customise the SafERteens package and enrolled a comparison group of adolescents (age 14–18) seeking care in two clinics. In phase 2, clinical staff delivered the SafERteens-PC intervention with adolescents, which is a single, behavioural health therapy session delivered one-on-one from clinic providers to youth patients, followed by text message (TM) reminders. In phase 3, we assessed planned maintenance. All participants reported past-year violent behaviour at intake and completed a 3-month follow-up assessment.ResultsBased on stakeholder interviews (n=13), we created a web-based SafERteens-PC programme package, including a three-item past-year violence screen, 30 min motivational interviewing-based brief intervention delivery tool, training videos and 2 months of TM boosters. We enrolled a comparison group (n=49) first, then an intervention group (n=61). Intervention delivery characteristics varied by clinic, including completion of intervention (75.9%; 62.5%), modality (100% delivered via telehealth; 60% via telehealth/40% in-person) and enrolment in TMs (81.8%; 55.0%); 91.8% completed the follow-up. Using an intention-to-treat approach, the intervention group showed significantly greater reductions in severe peer aggression (p&lt;0.05), anxiety (p&lt;0.05) and substance use consequences (p&lt;0.05) relative to the comparison group. Participant and staff feedback were positive and identified challenges to long-term implementation, such as lack of availability of reimbursement for youth violence prevention.ConclusionsIf these challenges could be addressed, routine provision of behavioural health services for violence prevention in PC could have high impact on health outcomes for adolescents.
American Journal of Preventive Medicine, Dec 1, 2018
Introduction: Violence is a leading cause of morbidity and mortality for youth, with more than 60... more Introduction: Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk assault-injured drug-using youth following emergency department treatment. Methods: Youth (age 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression.
Unmaintained vacant land in urban areas is associated with a number of negative outcomes for resi... more Unmaintained vacant land in urban areas is associated with a number of negative outcomes for residents of urban areas, including mental and physical health, safety, and quality of life. Community programs which promote land parcel maintenance in urban neighborhoods have been found to reverse some of the effects that unmaintained land has on nearby residents. We explored how land parcel maintenance is associated with mental health outcomes using data collected in Flint, MI in 2017–2018. Trained observers assessed the maintenance of approximately 7200 land parcels and surveyed 691 residents (57% Female, 53% Black, M age = 51). We aggregated resident and parcel rating data to 463 street segments and compared three structural equation models (SEM) to estimate the mediating effects of fear of crime on the association of parcel qualities on mental distress for residents. We found that fear of crime mediated the association between parcel maintenance values and mental distress indicating t...
and the unknown; and (4) Easier access and greater protection, threat unspecified. Some parents-l... more and the unknown; and (4) Easier access and greater protection, threat unspecified. Some parents-largely motivated by fear-chose to store firearms in a more accessible manner during the beginning of the COVID-19 pandemic to protect their family against possible external threats. Understanding the fear that motivates parents' decisions regarding storage practices might aid interventions focused on harm reduction and safer storage.
Annually, the teen firearm injury rate for 14-18 year-olds is around 48 per 100,000 teens, and th... more Annually, the teen firearm injury rate for 14-18 year-olds is around 48 per 100,000 teens, and the firearm death rate is around 10.5 per 100,000 teens (WISQARS, 2019a, b). Identifying the conditions underlying firearm purchases is Abstract To describe and identify the correlates of firearm purchasing at the beginning of the COVID-19 pandemic among US families with teenagers. In June-July 2020, we conducted a national survey of 2924 parents and their teenagers in the US. We report results from this survey to describe firearm purchasing behaviors following the start of the COVID-19 pandemic and investigate correlates of purchasing. Between the beginning of the pandemic and July 2020, 10% of households with teenagers purchased a firearm, and 3% became first-time firearm-owning households. Among firearm-owning households, firearm storage was associated with purchasing such that households that stored at least one firearm loaded and unlocked were more likely to purchase a firearm (OR: 2.02[1.07-3.79]) compared to households that stored all firearms unloaded and/or locked. Firearms purchased at the beginning of the pandemic were more likely to go to homes where at least one firearm was stored loaded and unlocked, which may contribute to increased risk for teen firearm injury and death.
Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks under... more Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks underscore the importance of examining the impact of the COVID-19 pandemic in this population. Within a clinical trial (n = 36 received an intervention prior to data collection reported herein), we surveyed cannabis-using emerging adults (ages 18–25) about perceived COVID-19 impacts. Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the past 30) were enrolled and completed online surveys as part of either their baseline or 3 month assessment. COVID-19-related measures included symptoms, substance use, mood, etc. Participants were 57% female (mean age = 21, standard deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African American, and 10% of other races. Most participants (86%) reported quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), but none reported testing COVID-19 positive. Many respondents felt their cannabis use (35%...
Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Litt... more Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations (e.g., while drunk/high), discharge in risky situations (e.g., fleeing police), and firearm aggression (e.g., firearm threats/use against a partner/non-partner), among a sample of A/YAs (age-16-29) seeking medical or injury ☆ Prior presentations: College of Problems on Drug Dependence (CPPD) 2018.
IMPORTANCE Firearm injuries are the second leading cause of death among US children and adolescen... more IMPORTANCE Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is a critical step for reducing pediatric mortality. OBJECTIVE The Firearm Safety Among Children and Teens (FACTS) Consortium, a National Institute for Child Health and Human Development-funded group of scientists and stakeholders, was formed in 2017 to develop research resources for the field, including a pediatric-specific research agenda for firearm injury prevention to assist future researchers and funders, as well as to inform cross-disciplinary evidence-based research on this critical injury prevention topic. EVIDENCE REVIEW A nominal group technique process was used, including 4 key steps (idea generation, round-robin, clarification, and voting and consensus). During idea generation, stakeholders and workgroups generated initial research agenda topics after conducting scoping reviews of the literature to identify existing gaps in knowledge. Agenda topics were refined through 6 rounds of discussion and survey feedback (ie, round-robin, and clarification steps). Final voting (using a 5-point Likert scale) was conducted to achieve consensus (Ն70% of consortium ranking items at 4 or 5 priority for inclusion) around key research priorities for the next 5 years of research in this field. Final agenda questions were reviewed by both the stakeholder group and an external panel of research experts not affiliated with the FACTS Consortium. Feedback was integrated and the final set of agenda items was ratified by the entire FACTS Consortium. FINDINGS Overall, 26 priority agenda items with examples of specific research questions were identified across 5 major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement. CONCLUSIONS AND RELEVANCE These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next 5 years.
GDL implementation corresponded to a 34% teen crash rate reduction in Michigan, but the magnitude... more GDL implementation corresponded to a 34% teen crash rate reduction in Michigan, but the magnitude of that reduction varied across space. Some place-based characteristics explained that variation.
Alcohol and alcoholism (Oxford, Oxfordshire), Jan 26, 2018
To examine dual trajectories of anxiety/depression symptoms and alcohol use among drug-using yout... more To examine dual trajectories of anxiety/depression symptoms and alcohol use among drug-using youth seeking care from an urban emergency department (ED), their baseline correlates and co-occurring trajectories of severe violence. There were five characteristic dual trajectories of alcohol use and depression/anxiety symptoms. Community violence exposure was highest among individuals with high-depression/anxiety symptom trajectories. Individuals with concurrently high-alcohol use and depression/anxiety symptom trajectories reported that the most delinquent peer affiliations, and had the highest rates of severe violence over time. We analyzed data from 599 drug-using (primarily marijuana) youth ages 14-24 (349 assault-injured) recruited from December 2009 to September 2011 into a 24-month longitudinal study at a Level-1 ED in Flint, Michigan. Youth self-reported substance use, depression and anxiety symptoms, peer/parental behaviors, and severe violence involvement at baseline and four ...
Objective-Depressive symptoms frequently co-exist in adolescents with alcohol use and peer violen... more Objective-Depressive symptoms frequently co-exist in adolescents with alcohol use and peer violence. This paper's purpose was to examine the secondary effects of a brief alcohol-andviolence-focused ED intervention on depressive symptoms. Method-Adolescents (ages 14-18) presenting to an ED for any reason, reporting past year alcohol use and aggression, were enrolled in a randomized control trial (control, therapistdelivered brief intervention [TBI], or computer-delivered brief intervention [CBI]). Depressive symptoms were measured at baseline, 3, 6, and 12 months using a modified 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Poisson regression was used (adjusting for baseline age, gender, and depressive symptoms) to compare depressive symptoms at follow-up.
Background:Youth violence is a leading cause of adolescent mortality, underscoring the need to in... more Background:Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine Emergency Department (ED) care.Objectives:To examine the translation of the SafERteens program into clinical care.Methods:Hospital staff provided input on implementation facilitators/barriers to inform toolkit development. Implementation was piloted in a 4-arm effectiveness-implementation trial, with youth (age: 14-18) screening positive for past 3-month aggression randomized to either SafERteens (delivered remotely or in-person) or enhanced usual care (EUC; remote or in-person), with follow-up at post-test and 3-months. During maintenance, ED staff continued in-person SafERteens delivery and external facilitation was provided. Outcomes were measured using the RE-AIM implementation framework.Results:SafERteens completion rates were 77.6% (52/67) for remote and 49.1% (27/55) for in-person delivery. In addition to high acceptability ratings (e.g., helpfulness), post-test data demonstrated increased self-efficacy to avoid fighting among patients receiving remote (IRR=1.22; 95%CI=1.09-1.36) and in-person (IRR=1.23; 95%CI=1.12-1.36) SafERteens, as well as decreased pro-violence attitudes among patients receiving remote (IRR=0.83; 95%CI=0.75-0.91) and in-person (IRR=0.87; 95%CI=0.77-0.99) SafERteens when compared to their respective EUC groups. At 3-months, youth receiving remote SafERteens reported less non-partner aggression (IRR=0.52; 95% CI=0.31-0.87; Cohen’s d=−0.39) and violence consequences (IRR=0.47; 95%CI=0.22-1.00; Cohen’s d=−0.49) compared to remote-EUC; no differences were noted for in-person SafERteens delivery. Barriers to implementation maintenance included limited staff availability and a lack of reimbursement codes.Conclusions:Implementing behavioral interventions such as SafERteens into routine ED care is feasible using remote delivery. Policymakers should consider reimbursement for violence prevention services to sustain long-term implementation.
Annals of The American Academy of Political and Social Science, Nov 1, 2022
Firearm injuries are a leading cause of injury-related deaths in the U.S., but there is a dearth ... more Firearm injuries are a leading cause of injury-related deaths in the U.S., but there is a dearth of federal funding for research on firearm injury prevention, compared to funding for research on other injuries and diseases. University research centers/institutes (C/Is) are in a position to help generate such research: they are multidisciplinary, have the capacity to conduct large-scale research projects, and commonly address complex health and social problems. In this article, we trace the history of research on firearm injury prevention, describe the different kinds of C/Is and C/I networks that have been developed to build knowledge in other areas of critical social concern, and argue for the development of a national coordinated network of firearm injury prevention C/Is.
The journal of trauma and acute care surgery, Jul 1, 2016
for the acquisition of the data, and the technical and material support of the study including st... more for the acquisition of the data, and the technical and material support of the study including study supervision. S.T.C. was responsible for clinical study supervision. P.F.E. was responsible for statistical analysis and data interpretation. All authors were responsible for manuscript draft and critical revisions.
Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for old... more Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019-12/23/2019) of 2048 older adults (age 50-80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%-28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9-73.1]) and safety counseling (63.2% [95%CI = 58.8-67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1-82.3]), comprehensive background checks (85.0% [95%CI = 81.5-87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9-90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8-84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.
Objectives: Violence is one of the leading causes of death among youth ages 14 to 24. Hospital-an... more Objectives: Violence is one of the leading causes of death among youth ages 14 to 24. Hospital-and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. Methods: The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drugusing youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or nonviolence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, and 24 months). Follow-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 follow-up interview completion at 24 months. Results: A total of 599 patients (ages 14-24) were recruited from the ED (mean AE SD age = 20.1 AE 2.4 years, 41.2% female, 58.2% African American), with follow-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 follow-up time frame to complete a followup appointment, and more than 20% of appointments were completed off site at community locations (e.g., participants' homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24month follow-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 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p < 0.01) required more intensive contact efforts.
ABSTRACT Background A pediatric injury prevention course has not been available as a massive open... more ABSTRACT Background A pediatric injury prevention course has not been available as a massive open online course (MOOC). Creating a comprehensive topic course is particularly challenging because the traditional, week-by-week linear curriculum design is often a barrier to learners interested in only specific topics. We created a novel, flexible course as both a ‘choose your topic’ MOOC for the public learner and a Small Private Online Course (SPOC) for medical students. Methods We describe creating ‘Injury Prevention for Children and Teens’, a course of 59 video learning segments within eight modules taught by a multidisciplinary panel of 25 nationally-recognized experts. Completion tracking and course evaluations were collected. Results In 2.5 years, 4,822 learners from 148 countries have enrolled. Two-thirds of learners were female. Median age of learners was 31 years. For engagement, 19.3% (n = 932) of learners attempted quizzes, and 5.2% (n = 252) participated in online forum discussions. Medical professionals (n = 162) claimed an average of 13 credit hours per learner. Over 200 senior medical students have taken the SPOC. Conclusion ‘Injury Prevention for Children and Teens’ is a novel approach to injury prevention education that is broad, science-based, accessible, and not cost-prohibitive for a diverse group of global learners.
Background and objectivesYouth violence is an alarming public health problem, yet, violence scree... more Background and objectivesYouth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens).MethodsThe study was conducted in two PC clinics: a university-affiliated satellite clinic and a community health centre. In phase 1, we obtained stakeholder feedback to customise the SafERteens package and enrolled a comparison group of adolescents (age 14–18) seeking care in two clinics. In phase 2, clinical staff delivered the SafERteens-PC intervention with adolescents, which is a single, behavioural health therapy session delivered one-on-one from clinic providers to youth patients, followed by text message (TM) reminders. In phase 3, we assessed planned maintenance. All participants reported past-year violent behaviour at intake and completed a 3-month follow-up assessment.ResultsBased on stakeholder interviews (n=13), we created a web-based SafERteens-PC programme package, including a three-item past-year violence screen, 30 min motivational interviewing-based brief intervention delivery tool, training videos and 2 months of TM boosters. We enrolled a comparison group (n=49) first, then an intervention group (n=61). Intervention delivery characteristics varied by clinic, including completion of intervention (75.9%; 62.5%), modality (100% delivered via telehealth; 60% via telehealth/40% in-person) and enrolment in TMs (81.8%; 55.0%); 91.8% completed the follow-up. Using an intention-to-treat approach, the intervention group showed significantly greater reductions in severe peer aggression (p&lt;0.05), anxiety (p&lt;0.05) and substance use consequences (p&lt;0.05) relative to the comparison group. Participant and staff feedback were positive and identified challenges to long-term implementation, such as lack of availability of reimbursement for youth violence prevention.ConclusionsIf these challenges could be addressed, routine provision of behavioural health services for violence prevention in PC could have high impact on health outcomes for adolescents.
American Journal of Preventive Medicine, Dec 1, 2018
Introduction: Violence is a leading cause of morbidity and mortality for youth, with more than 60... more Introduction: Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk assault-injured drug-using youth following emergency department treatment. Methods: Youth (age 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression.
Unmaintained vacant land in urban areas is associated with a number of negative outcomes for resi... more Unmaintained vacant land in urban areas is associated with a number of negative outcomes for residents of urban areas, including mental and physical health, safety, and quality of life. Community programs which promote land parcel maintenance in urban neighborhoods have been found to reverse some of the effects that unmaintained land has on nearby residents. We explored how land parcel maintenance is associated with mental health outcomes using data collected in Flint, MI in 2017–2018. Trained observers assessed the maintenance of approximately 7200 land parcels and surveyed 691 residents (57% Female, 53% Black, M age = 51). We aggregated resident and parcel rating data to 463 street segments and compared three structural equation models (SEM) to estimate the mediating effects of fear of crime on the association of parcel qualities on mental distress for residents. We found that fear of crime mediated the association between parcel maintenance values and mental distress indicating t...
and the unknown; and (4) Easier access and greater protection, threat unspecified. Some parents-l... more and the unknown; and (4) Easier access and greater protection, threat unspecified. Some parents-largely motivated by fear-chose to store firearms in a more accessible manner during the beginning of the COVID-19 pandemic to protect their family against possible external threats. Understanding the fear that motivates parents' decisions regarding storage practices might aid interventions focused on harm reduction and safer storage.
Annually, the teen firearm injury rate for 14-18 year-olds is around 48 per 100,000 teens, and th... more Annually, the teen firearm injury rate for 14-18 year-olds is around 48 per 100,000 teens, and the firearm death rate is around 10.5 per 100,000 teens (WISQARS, 2019a, b). Identifying the conditions underlying firearm purchases is Abstract To describe and identify the correlates of firearm purchasing at the beginning of the COVID-19 pandemic among US families with teenagers. In June-July 2020, we conducted a national survey of 2924 parents and their teenagers in the US. We report results from this survey to describe firearm purchasing behaviors following the start of the COVID-19 pandemic and investigate correlates of purchasing. Between the beginning of the pandemic and July 2020, 10% of households with teenagers purchased a firearm, and 3% became first-time firearm-owning households. Among firearm-owning households, firearm storage was associated with purchasing such that households that stored at least one firearm loaded and unlocked were more likely to purchase a firearm (OR: 2.02[1.07-3.79]) compared to households that stored all firearms unloaded and/or locked. Firearms purchased at the beginning of the pandemic were more likely to go to homes where at least one firearm was stored loaded and unlocked, which may contribute to increased risk for teen firearm injury and death.
Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks under... more Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks underscore the importance of examining the impact of the COVID-19 pandemic in this population. Within a clinical trial (n = 36 received an intervention prior to data collection reported herein), we surveyed cannabis-using emerging adults (ages 18–25) about perceived COVID-19 impacts. Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the past 30) were enrolled and completed online surveys as part of either their baseline or 3 month assessment. COVID-19-related measures included symptoms, substance use, mood, etc. Participants were 57% female (mean age = 21, standard deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African American, and 10% of other races. Most participants (86%) reported quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), but none reported testing COVID-19 positive. Many respondents felt their cannabis use (35%...
Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Litt... more Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations (e.g., while drunk/high), discharge in risky situations (e.g., fleeing police), and firearm aggression (e.g., firearm threats/use against a partner/non-partner), among a sample of A/YAs (age-16-29) seeking medical or injury ☆ Prior presentations: College of Problems on Drug Dependence (CPPD) 2018.
IMPORTANCE Firearm injuries are the second leading cause of death among US children and adolescen... more IMPORTANCE Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is a critical step for reducing pediatric mortality. OBJECTIVE The Firearm Safety Among Children and Teens (FACTS) Consortium, a National Institute for Child Health and Human Development-funded group of scientists and stakeholders, was formed in 2017 to develop research resources for the field, including a pediatric-specific research agenda for firearm injury prevention to assist future researchers and funders, as well as to inform cross-disciplinary evidence-based research on this critical injury prevention topic. EVIDENCE REVIEW A nominal group technique process was used, including 4 key steps (idea generation, round-robin, clarification, and voting and consensus). During idea generation, stakeholders and workgroups generated initial research agenda topics after conducting scoping reviews of the literature to identify existing gaps in knowledge. Agenda topics were refined through 6 rounds of discussion and survey feedback (ie, round-robin, and clarification steps). Final voting (using a 5-point Likert scale) was conducted to achieve consensus (Ն70% of consortium ranking items at 4 or 5 priority for inclusion) around key research priorities for the next 5 years of research in this field. Final agenda questions were reviewed by both the stakeholder group and an external panel of research experts not affiliated with the FACTS Consortium. Feedback was integrated and the final set of agenda items was ratified by the entire FACTS Consortium. FINDINGS Overall, 26 priority agenda items with examples of specific research questions were identified across 5 major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement. CONCLUSIONS AND RELEVANCE These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next 5 years.
GDL implementation corresponded to a 34% teen crash rate reduction in Michigan, but the magnitude... more GDL implementation corresponded to a 34% teen crash rate reduction in Michigan, but the magnitude of that reduction varied across space. Some place-based characteristics explained that variation.
Alcohol and alcoholism (Oxford, Oxfordshire), Jan 26, 2018
To examine dual trajectories of anxiety/depression symptoms and alcohol use among drug-using yout... more To examine dual trajectories of anxiety/depression symptoms and alcohol use among drug-using youth seeking care from an urban emergency department (ED), their baseline correlates and co-occurring trajectories of severe violence. There were five characteristic dual trajectories of alcohol use and depression/anxiety symptoms. Community violence exposure was highest among individuals with high-depression/anxiety symptom trajectories. Individuals with concurrently high-alcohol use and depression/anxiety symptom trajectories reported that the most delinquent peer affiliations, and had the highest rates of severe violence over time. We analyzed data from 599 drug-using (primarily marijuana) youth ages 14-24 (349 assault-injured) recruited from December 2009 to September 2011 into a 24-month longitudinal study at a Level-1 ED in Flint, Michigan. Youth self-reported substance use, depression and anxiety symptoms, peer/parental behaviors, and severe violence involvement at baseline and four ...
Objective-Depressive symptoms frequently co-exist in adolescents with alcohol use and peer violen... more Objective-Depressive symptoms frequently co-exist in adolescents with alcohol use and peer violence. This paper's purpose was to examine the secondary effects of a brief alcohol-andviolence-focused ED intervention on depressive symptoms. Method-Adolescents (ages 14-18) presenting to an ED for any reason, reporting past year alcohol use and aggression, were enrolled in a randomized control trial (control, therapistdelivered brief intervention [TBI], or computer-delivered brief intervention [CBI]). Depressive symptoms were measured at baseline, 3, 6, and 12 months using a modified 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Poisson regression was used (adjusting for baseline age, gender, and depressive symptoms) to compare depressive symptoms at follow-up.
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