Comparison of Young Adult Female Cancer Survivors Recruited from a Population-Based Cancer Registry to Eligible Survivors.

BACKGROUND: Population-based cancer registries provide a resource to recruit young adult cancer survivors who may not be easily identified otherwise. METHODS: We compared demographic and cancer-related characteristics of participants in a cohort of female young adult cancer survivors to those of eligible survivors in the Georgia Cancer Registry, a population-based registry in the United States. We examined associations between survivor characteristics and nonparticipation using logistic regression and associations between survivor characteristics and different types of nonparticipation (refusal, unable to contact, or unresolved vs. interviewed) using polytomous regression. RESULTS: The Georgia Cancer Registry was able to contact 60% of eligible women (3,061/5,137). Of those, 78% agreed to study contact (n = 2,378), and of those, 56% were interviewed (n = 1,342). Participation was similar across age at contact and at diagnosis but varied across cancer type from 17% for cervical cancer to 32% for breast cancer. White women were slightly more likely to be interviewed (28%) than African American women (23%), which was mostly attributable to greater difficulty in contacting African American women (odds ratio 1.7, 95% confidence interval: 1.5-2.1). CONCLUSIONS: The greatest challenge to recruiting women was contacting them, which differed across some but not all demographic and cancer-related characteristics. When successfully contacted, most survivors agreed to participate. IMPACT: Population-based cancer registries can serve as an invaluable resource to recruit representative samples of young adult cancer survivors, who are otherwise difficult to identify.

Relationship between Insurance Type and Discharge Disposition From the Emergency Department of Young Children Diagnosed with Physical Abuse.

OBJECTIVES: To describe the disposition of young children diagnosed with physical abuse in the emergency department (ED) setting and identify factors associated with the decision to discharge young abused children. STUDY DESIGN: We performed a retrospective cross-sectional study of children less than 2 years of age diagnosed with physical abuse in the 2006-2012 Nationwide Emergency Department Sample. National estimates were calculated accounting for the complex survey design. We developed a multivariable logistic regression model to evaluate the relationship between payer type and discharge from the ED compared with admission with adjustment for patient and hospital factors. RESULTS: Of the 37 655 ED encounters with a diagnosis of physical abuse among children less than 2 years of age, 51.8% resulted in discharge, 41.2% in admission, 4.3% in transfer, 0.3% in death in the ED, and 2.5% in other. After adjustment for age, sex, injury type, and hospital characteristics (trauma designation, volume of young children, and hospital region), there were differences in discharge decisions by payer and injury severity. The adjusted percentage discharged of publicly insured children with minor/moderate injury severity was 56.2% (95% CI 51.6, 60.7). The adjusted percentages discharged were higher for both privately insured children at 69.9% (95% CI 64.4, 75.5) and self-pay children at 72.9% (95% CI 67.4, 78.4). The adjusted percentages discharged among severely injured children did not differ significantly by payer. CONCLUSIONS: The majority of ED visits for young children diagnosed with abuse resulted in discharge. The notable differences in disposition by payer warrant further investigation.

Emergency Department Visits and Head Computed Tomography Utilization for Concussion Patients From 2006 to 2011.

OBJECTIVES: Concussion is the most common type of mild traumatic brain injury for which patients present to the emergency department (ED). It is critical to understand the contemporary epidemiology of concussion and rates of head computed tomography (CT) use in head-injured patients to inform education of evidence-based clinical practice guidelines to emergency medicine providers. METHODS: This was a cross-sectional analysis of the Nationwide Emergency Department Sample (NEDS) for years 2006 to 2011, representing a stratified probability sample of all U.S. hospital-based EDs. Patients of all ages with concussion diagnoses were included, and those with intracranial hemorrhages or prolonged loss of consciousness were excluded. Descriptive and bivariate statistics were summarized for patient demographics, injury mechanism, Injury Severity Scores (ISS), and concussion incidence rates, based on U.S. Census Bureau population estimates. RESULTS: There were 756,214,762 (weighted) ED visits in the NEDS between 2006 and 2011, of which 0.5% received diagnoses of concussion. The national incidence rate of concussion visits increased 22.6% from 195 visits per 100,000 person-years in 2006 to 239 visits per 100,000 person-years in 2011. The incidence of concussion visits increased by 28.1% from 2006 to 2011 overall (580,573 to 743,994) and within all age group categories. The rate of head CT use in patients diagnosed with concussion increased 35.7% (range = 34.5% to 46.8%) for the entire group from 2006 to 2011 (p < 0.0001). The injury severity of patients' injuries decreased over time (66.4% ISS < 5 in 2006 and 75% in 2011; p < 0.0001), while the proportion of discharged patients increased over time (78.1% in 2006 and 86.6% in 2011; p < 0.0001). CONCLUSIONS: ED visits for concussions have increased over time, with a corresponding increase in head CT utilization despite a decrease in injury severity. Increased visits may be due to more concussion awareness and recognition of subtle injuries. Evidence-based clinical practice guidelines for neuroimaging in head-injured patients and management of concussion should be reinforced to emergency medicine providers.

Young driver licensing: examination of population-level rates using New Jersey's state licensing database.

Recent surveys have provided insight on the primary reasons why US teens delay licensure but are limited in their ability to estimate licensing rates and trends. State administrative licensing data are the ideal source to provide this information but have not yet been analyzed for this purpose. Our objective was to analyze New Jersey's (NJ) licensing database to: (1) describe population-based rates of licensure among 17- to 20-year-olds, overall and by gender and zip code level indicators of household income, population density, and race/ethnicity; and (2) examine recent trends in licensure. We obtained records on all licensed NJ drivers through June 2012 from the NJ Motor Vehicle Commission's licensing database and determined each young driver's age at the time of intermediate and full licensure. Data from the US Census and American Community Survey were used to estimate a fixed cohort of NJ residents who turned 17 years old in 2006-2007 (n=255,833). Licensing data were used to estimate the number of these drivers who obtained an intermediate license by each month of age (numerators) and, among those who obtained an intermediate license, time to graduation to full licensure. Overall, 40% of NJ residents-and half of those who ultimately obtained a license by age 21-were licensed within a month of NJ's minimum licensing age of 17, 64% by their 18th birthday, and 81% by their 21st birthday. Starkly different patterns of licensure were observed by socioeconomic indicators; for example, 65% of 17-year-olds residing in the highest-income zip codes were licensed in the first month of eligibility compared with 13% of residents living in the lowest-income zip codes. The younger an individual obtained their intermediate license, the earlier they graduated to a full license. Finally, the rate and timing of licensure in NJ has been relatively stable from 2006 to 2012, with at most a 1-3% point decline in rates. These findings support the growing body of literature suggesting that teens delay licensure primarily for economic reasons and that a substantial proportion of potentially high-risk teens may be obtaining licenses outside the auspices of a graduated driver licensing system. Finally, our finding of a relatively stable trend in licensure in recent years is in contrast to national-level reports of a substantial decline in licensure rates.

Long-term changes in crash rates after introduction of a Graduated Driver Licensing decal provision.

BACKGROUND: New Jersey (NJ) implemented the first Graduated Driver Licensing (GDL) decal provision in the U.S. in May 2010. An initial study reported a 1-year post-decal decrease in the crash rate among NJ intermediate drivers aged <21 years. Longer-term analysis is critical for policymakers in other states considering whether to implement a decal provision. PURPOSE: To evaluate the longer-term (2-year) effect of NJ's decal provision on overall and age-specific crash rates of young drivers with intermediate licenses. METHODS: Monthly per-driver police-reported crash rates during January 2006-June 2012 were estimated. Specific crash types included injury, midnight-4:59am, single-vehicle, multiple-vehicle, and peer passenger crashes. Negative binomial modeling compared pre- versus post-decal crash rates, adjusting for age, gender, calendar month, gas price, and 21- to 24-year-old licensed driver crash rates; piecewise negative binomial regression models accounted for pre-decal crash trends among intermediate drivers. Analyses were conducted in 2013. RESULTS: The adjusted crash rate for intermediate drivers was 9.5% lower in the 2-year post-decal period than the 4-year pre-decal period (95% CI=0.88, 0.93). Crash rates decreased 1.8% per year before the provision and 7.9% per year in the post-decal period (p<0.001 for difference in slopes). For several crash types, effects appeared to be particularly strong for 18- and 19-year-olds. An estimated 3,197 intermediate drivers had crashes prevented. CONCLUSIONS: NJ's decal provision was associated with a sustained decline in intermediate driver crashes. Future research should aim to better understand the causal mechanism by which NJ's decal provision may have exerted an effect.

Piloting a computer assisted telephone interview: the FUCHSIA Women's Study.

BACKGROUND: Loss of fertility has been reported as an important concern of reproductive age women diagnosed with cancer. The Furthering Understanding of Cancer, Health, and Survivorship In Adult (FUCHSIA) Women's Study examines how cancer treatment affects the fertility of cancer survivors who were diagnosed during their reproductive years. In this paper we discuss the process of developing and pilot testing the FUCHSIA computer assisted telephone interview (CATI). METHODS: The CATI was developed in several phases and pilot tested twice to evaluate several aspects of the instrument including question sequencing, understandability of the questions, and women's comfort with certain questions. Participants were recruited from cancer and infertility support groups and study team contacts. RESULTS: Fifty-two women were recruited and participated in the first pilot. The participants had a mean age of 31.5 years, 17.3% had cancer, and 38.5% experienced a period of infertility. Twenty-four women participated in the second pilot with similar representation. CONCLUSIONS: The collection of detailed information on reproductive outcomes with the CATI may improve the understanding of how cancer treatment during the reproductive years affects female fertility. The pilot studies provided important information to improve the CATI before the full study. Our comprehensive recruitment strategy allowed us to interview a diverse group of women to ensure that questions and answer choices were easily interpreted, check complicated skip patterns and the flow of questions, and evaluate the length of the interview. This experience can be used to help inform others in what steps can be useful for developing telephone interviews for research studies.

Inaccuracy of Federal Highway Administration's licensed driver data: implications on young driver trends.

PURPOSE: The Federal Highway Administration (FHWA) collects and publishes annual state-based counts of licensed drivers, which have been used to estimate per-driver crash rates and document a decline in young licensed drivers. The accuracy of these data has been questioned. METHODS: We compared the number of young licensed drivers as reported by the FHWA (2006-2012) with that generated directly from New Jersey (NJ) administrative licensing data. Census data were used to estimate the proportion of NJ adolescents who were licensed. RESULTS: FHWA data showed a decline in the proportion of licensed 17- to 20-year olds over the 7-year period (77%-63%), whereas analysis of NJ licensing data revealed a more stable trend (75%-74%). CONCLUSIONS: We advise against use of FHWA licensing data for research purposes and encourage FHWA to work with state licensing agencies to review and enhance data collection and quality control procedures with the goal of ensuring the accuracy of licensing data.