Readiness to change in adolescents screening positive for substance use in urban primary care clinics.

Primary care physicians often perceive patients as unlikely to decrease their substance use and suggest this reluctance to change diminishes their willingness to screen and intervene. The literature on readiness to change has primarily focused on adults, and the available studies on adolescents have largely included hospitalized and/or incarcerated youths with severe substance-related difficulties. The present study focused on an urban primary care system's teenage population, which consists of youths typically engaging in less serious forms of substance use. One hundred sixty-eight of these youths ages 11-20 screened positive for substance use on a self-report questionnaire. These youths then completed the Readiness to Change Questionnaire. Nearly 60% of these positive screens were in the Action Stage, with another 16% in the Contemplation Stage. Depressive symptoms and suicidal ideation were positively associated with later stages of change. Implications for screening, prevention, and early intervention programs for adolescent substance use are discussed.

Self-reported disciplinary practices among women in the child welfare system: association with domestic violence victimization.

OBJECTIVE: To examine the association between physical domestic violence victimization (both recent and more than a year in past measured by self-report) and self-reported disciplinary practices among female parents/caregivers in a national sample of families referred to child welfare. METHODS: Cross-sectional survey of more than 3,000 female caregivers in the National Survey of Child and Adolescent Well-being (NSCAW) study, a nationally representative sample of children and their families referred to child welfare agencies for investigation of abuse and neglect. Women reported physical domestic violence victimization and their disciplinary practices for their child on different versions of the Conflict Tactics Scales. RESULTS: Four hundred and forty-three women reported prior year domestic violence, 1,161 reported domestic violence but not in the past 12 months, and 2,025 reported no domestic violence exposure. Any prior domestic violence exposure was associated with higher rates of self-reported psychological aggression, physical aggression and neglectful disciplinary behaviors as compared to those with no domestic violence victimization in bivariate comparisons. After controlling for child behavior, demographic factors, and maternal characteristics, those with remote and recent domestic violence victimization employed more self-reported psychological aggression, while only caregivers with recent DV reported more physical aggression or neglectful behaviors. CONCLUSIONS: In a national child welfare sample, self-reported aggressive and neglectful parenting behaviors were common. In this sample, domestic violence victimization is associated with more self-reported aggressive and neglectful disciplinary behaviors among female caregivers. The mechanism for these associations is not clear. PRACTICE IMPLICATIONS: Rates of aggressive and neglectful disciplinary practices are especially high among female parents/caregivers exposed to domestic violence. Child welfare agencies should plan routine and structured assessments for domestic violence among parents/caregivers and implement parenting interventions to reduce harmful disciplinary practices for those families identified.

Trial of computerized screening for adolescent behavioral concerns.

OBJECTIVE: Injury risk, depressive symptoms, and substance use are the leading causes of adolescent morbidity and death. The goal of this randomized, controlled trial was to determine whether computerized screening with real-time printing of results for pediatricians increased the identification of these adolescent behavioral concerns. METHODS: A total of 878 primary care patients 11 to 20 years of age participated in computerized behavioral screening (the Health eTouch system) in waiting rooms of 9 urban clinics. These clinics all served predominantly low-income patients. The clinics were randomly assigned to have pediatricians receive screening results either just before face-to-face encounters with patients (immediate-results condition) or 2 to 3 business days later (delayed-results condition). RESULTS: Fifty-nine percent of Health eTouch respondents had positive results for >/=1 of the following behavioral concerns: injury risk behaviors, significant depressive symptoms, or substance use. Sixty-eight percent of youths in the immediate-results condition who screened positive were identified as having a problem by their pediatrician. This was significantly higher than the recognition rate of 52% for youths in the delayed-results condition. CONCLUSION: Immediate provision of an adolescent's self-report of behavioral concerns to a pediatrician increased recognition of those problems, compared with the delayed provision of results.

Assessment of Intimate Partner Violence by Child Welfare Services.

The purpose of this study was to describe policy and practice with respect to the assessment of intimate partner violence in a sample of child welfare agencies located throughout the United States and to examine the relationship of contextual characteristics and assessment practices. Telephone interviews were conducted with key informants from child welfare agencies. A snowball interviewing strategy was used to identify the best informant in each agency. Almost all of the participating agencies conducted some assessment of intimate partner violence, with most reporting that the majority of screening or assessment occurred during investigation of referrals. However, only 43.1% reported that all of the families referred to the child welfare system were assessed for intimate partner violence, and 52.8% indicated they had a written policy pertaining to screening and assessment of the problem. There was little relationship between county or agency characteristics and assessment practices. Additional research is needed to determine factors that influence assessment practices and to identify strategies to support and extend efforts to identify intimate partner violence and provide appropriate services for families in the child welfare system.

School bus-related injuries among children and teenagers in the United States, 2001-2003.

OBJECTIVE: The purpose of this work was to describe the epidemiology of nonfatal school bus-related injuries among children and teenagers aged < or = 19 years in the United States. DESIGN/METHODS: Nationally representative data from the National Electronic Injury Surveillance System All-Injury Program operated by the US Consumer Product Safety Commission were analyzed. Case subjects included all of the patients in the National Electronic Injury Surveillance System All-Injury Program database who were treated in a hospital emergency department for a nonfatal school bus-related injury from 2001 to 2003. RESULTS: There were an estimated 51,100 school bus-related injuries treated in US emergency departments from 2001 to 2003, for a national estimate of 17,000 injuries (rate: 21.0 per 100,000 population) annually. Ninety-seven percent of children were treated and released from the hospital. Children 10 to 14 years of age accounted for the greatest proportion of injuries (43.0%; rate: 34.7) compared with all other age groups. Motor vehicle crashes accounted for 42.3% of all injuries, followed by injuries that occurred as the child was boarding/alighting/approaching the bus (23.8%). Head injuries accounted for more than half (52.1%) of all injuries among children < 10 years of age, whereas lower extremity injuries predominated among children 10 to 19 years of age (25.5%). Strains and sprains accounted for the highest percentage of all injuries, followed by contusions and abrasions (28.3%) and lacerations (14.9%). More than three quarters (77.7%) of lacerations were to the head. CONCLUSIONS: This is the first study to describe nonfatal school bus-related injuries to US children and teenagers treated in US hospital emergency departments using a national sample. This study identified a much greater annual number of school bus-related injuries to children than reported previously.

Escalator-related injuries among children in the United States, 1990-2002.

OBJECTIVE: We describe the epidemiology of escalator-related injuries among children 0 to 19 years of age in the United States, with a focus on the pediatric population that is younger than 5 years. METHODS: We conducted a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Reported cases were used to project national estimates and rates of escalator-related injuries in the United States. The analysis included all patients who were 0 to 19 years of age in the National Electronic Injury Surveillance System database and were seen in an emergency department for an escalator-related injury during the 13-year period 1990-2002. RESULTS: There were an estimated 26000 escalator-related injuries among children who were 0 to 19 years of age in the United States during 1990-2002, yielding an average of 2000 of these injuries annually (rate = 2.6 per 100,000 population per year). The mean age was 6.5 years at the time of injury, and 53.4% of the patients were male. When comparing cases by 5-year age groups, children who were younger than 5 years had the highest estimated number of injuries (12000), as well as the highest annual escalator-related injury rate (4.8 per 100000). The most common mechanism of injury for all age groups was a fall, accounting for 13000 (51.0%) injuries. Entrapment accounted for 29.3% of all injuries and 36.5% of injuries among children who were younger than 5 years. Six percent (723) of injuries to children who were younger than 5 years involved a stroller, with most injuries occurring when a child fell out of the stroller while on the escalator. The most common body part injured for all ages was the leg, accounting for 27.7% of all injuries. Among children who were younger than 5 years, the hand was the most common injury site (40.6%), with hand injuries frequently occurring as a result of entrapment (72.4%). A laceration was the most common type of injury, accounting for 47.4% of escalator-related injuries. Amputations and avulsions were uncommon; however, 71.4% (595 of 833) occurred among children who were younger than 5 years. CONCLUSIONS: There was a disproportionate number of escalator-related injuries among children who were younger than 5 years. Entrapment occurred more frequently among children who were younger than 5 years than in any other age group, which may explain the increased number of hand injuries in this age group. Escalator designs that reduce the gap between the steps and sidewall or shield against access to the gap may decrease entrapment risk. Young children should be supervised properly and should not be transported in a stroller while riding on an escalator. All passengers should use caution and remain alert when riding an escalator to avoid injuries related to falls or entrapment. Additional research is needed to determine the relationship among passenger behavior, escalator design, and escalator-related injury.

Differences in the risk associated with head injury for pediatric ice skaters, roller skaters, and in-line skaters.

OBJECTIVE: The goals were to describe the epidemiologic features of pediatric skating-related injuries sustained from 1993 to 2003 and to compare ice skating-related injuries with roller skating--and in-line skating-related injuries. METHODS: An analysis of pediatric skating-related injury data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was performed. RESULTS: An estimated 1 235 467 pediatric skating participants presented to hospital emergency departments with injuries between 1993 and 2003. These children had a mean age of 10.9 years (SD: 3.2 years; range: 1-18 years), and 50.0% were male. The most common mechanism of injury was a fall (83.1%). Ice skaters sustained a greater proportion of head injuries (13.3%), compared with roller skaters (4.4%) and in-line skaters (5.0%). Ice skaters also experienced a greater proportion of concussions (4.3%), compared with roller skaters (0.6%) and in-line skaters (0.8%). The proportion of facial injuries among ice skaters was greater than the proportions among roller skaters and in-line skaters. The majority of roller skating-and in-line skating-related injuries were upper-extremity fractures (53.9% and 59.7%, respectively). Children < or = 6 years of age experienced a greater proportion of head and facial injuries than did older children in each skating activity. CONCLUSIONS: The epidemiologic features of pediatric ice skating-related injuries differ from those of roller skating--and in-line skating-related injuries. Children should wear helmets during all recreational skating activities, especially ice skating, because of the risk of serious head injuries. Wrist guards should be worn to protect against the common upper-extremity fractures sustained during skating.

Children should wear helmets while ice-skating: a comparison of skating-related injuries.

OBJECTIVE: This study compares injuries, especially head injuries, among ice-skaters with those among skateboarders, rollerskaters, and in-line skaters, to determine the need for helmet use during recreational ice-skating by children. DESIGN: A comparative study of a consecutive series of patients. SETTING: The emergency department of a large, urban, academic, children's hospital. PARTICIPANTS: Children treated for injuries related to recreational ice-skating, skateboarding, rollerskating, and in-line skating. RESULTS: During a 31-month period, 419 consecutive children were evaluated in the emergency department for skating-related injuries. Children were predominantly male (53.9%), with a mean age of 10.0 years (SD: 3.0 years; median: 10.0 years; range: 1-18 years). The most frequent mechanism of injury was a fall. Overall, 76.5% of children (215 of 281 children) were reported to be wearing no protective equipment, such as a helmet or padding on the elbows or knees, at the time of injury. Ice-skaters were more likely to have adult supervision than were skateboarders (relative risk [RR]: 5.16; 95% confidence interval [CI]: 2.13-12.46), rollerskaters (RR: 1.21; 95% CI: 1.09-1.35), and in-line skaters (RR: 2.08; 95% CI: 1.72-2.51). Ice-skaters were at greater risk of injury to the head (20.0%) than were in-line skaters (4.9%) (RR: 4.09; 95% CI: 1.81-9.23); a weak difference was noted between ice-skaters and rollerskaters (9.9%) (RR: 2.18; 95% CI: 1.04-4.57), with no significant difference in head injuries between ice-skaters and skateboarders (15.9%) (RR: 1.60; 95% CI: 0.54-2.93). Ice-skaters demonstrated lacerations to the head in 68.8% of abnormal head examinations, compared with 37.0% for rollerskaters (RR: 1.86; 95% CI: 1.08-3.20) and 50.0% for in-line skaters (RR: 2.06; 95% CI: 1.35-3.16); however, there was no significant difference in lacerations to the head between ice-skaters and skateboarders (53.3%) (RR: 1.29; 95% CI: 0.76-2.19). Injuries to ice-skaters occurred more often in an indoor skating facility (92.9%, 52 of 56 cases), compared with injuries to skateboarders (3.6%, 1 of 28 cases) (RR: 13.96; 95% CI: 2.01-96.76), rollerskaters (63.4%, 59 of 93 cases) (RR: 1.46; 95% CI: 1.23-1.74), and in-line skaters (10.9%, 15 of 137 cases) (RR: 8.48; 95% CI: 5.23-13.75). CONCLUSIONS: The proportion of head injuries among ice-skaters in this study was greater than that observed for participants in other types of skating, for which helmet use is recommended and often required. Children should wear a helmet during recreational ice-skating. Mandatory helmet use by pediatric ice-skaters at indoor rinks should be implemented. Use of other types of protective equipment, such as wrist guards, knee pads, and elbow pads, should be considered for prevention of injuries to the extremities during ice-skating. Caution should be used when allowing young children to participate in recreational ice-skating. Additional research should be conducted in other populations, to corroborate these findings and to evaluate ice-skating safety recommendations for children.