Case-control study of student-perpetrated physical violence against educators.

PURPOSE: Although prior research focused primarily on student-on-student school violence, educators are also at risk. This study was designed to identify risk factors for assaults against educators. METHODS: Kindergarten-grade 12 educators (n = 26,000), randomly selected from a state license database, were screened for eligibility (6,469, eligible) by mailed questionnaire. Phase 1 (12-month recall) identified eligible assault cases (n = 372) and controls (n = 1,116), June 2004 to December 2005; phase 2 (case-control study; response, 78%) enabled identification of exposures through 1-month recall before student-perpetrated assaults (cases) and randomly selected months (controls). Directed acyclic graphs enabled confounder selection for multivariable logistic regression analyses; reweighting adjusted for potential biases. RESULTS: Risks (odds ratios, 95% confidence intervals) increased for working in: Special Education (5.84; 4.07-8.39) and School Social Work (7.18; 2.72-18.91); kindergarten to second grade (1.81; 1.18-2.77); urban (1.95; 1.38-2.76) schools; schools with less than 50 (8.40; 3.12-22.63), 50-200 (3.67; 1.84-7.34), 201-500 (2.09; 1.32-3.29), and 501-1000 (1.94; 1.25-3.01) students versus more than 1000; schools with inadequate resources always/frequently (1.62; 1.05-2.48) versus infrequently/never; inadequate building safety always/frequently (4.48; 2.54-7.90) versus infrequently/never; and environments with physical barriers (1.50; 1.07-2.10). Risks decreased with routine locker searches (0.49; 0.29-0.85) and accessible exits (0.36; 0.17-0.74). CONCLUSIONS: Identification of assault risk factors provides a basis for further investigation and interventions.

Violence against educators: a population-based study.

OBJECTIVE: Identify the magnitude and risk factors for occupational physical assault (PA) and nonphysical violence (NPV) against Minnesota educators. METHODS: Among 26,000 randomly selected licensed kindergarten to grade 12 educators, 6469 eligible educators reported whether they experienced PA or NPV during the prior year. Multiple logistic regression models were based on directed acyclic graphs. RESULTS: Respective PA and NPV annual rates per 100 educators were 8.3 and 38.4. Work changes resulted among PA (13% to 20%) and NPV (22%) victims. Risks increased for master's prepared or education specialists who worked in public alternative schools and special education. Risks decreased for those working for more than 20 years, part time, and in private schools. Physical assault risk decreased when teaching grades 3 to 12 (vs kindergarten to grade 2), but NPV risk increased. CONCLUSION: Targeted efforts on specific violence risk and protective factors are essential to improve educators' work environments.

Recruitment methods employed in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

BACKGROUND: The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) is a US National Cancer Institute (NCI)-funded randomized controlled trial designed to evaluate whether certain screening tests reduce mortality from prostate, lung, colorectal, and ovarian cancer. To obtain adequate statistical power, it was necessary to enroll over 150,000 healthy volunteers. Recruitment began in 1993 and ended in 2001. PURPOSE: Our goal is to evaluate the success of recruitment methods employed by the 10 PLCO screening centers. We also provide estimates of recruitment yield and cost for our most successful strategy, direct mail. METHODS: Each screening center selected its own methods of recruitment. Methods changed throughout the recruitment period as needed. For this manuscript, representatives from each screening center provided information on methods utilized and their success. RESULTS: In the United States between 1993 and 2001, ten screening centers enrolled 154,934 study participants. Based on participant self-report, an estimated 95% of individuals were recruited by direct mail. Overall, enrollment yield for direct mail was 1.0%. Individual center enrollment yield ranged from 0.7% to 3.8%. Cost per enrolled participant was $9.64-35.38 for direct mail, excluding personnel costs. LIMITATIONS: Numeric data on recruitment processes were not kept consistently at individual screening centers. Numeric data in this manuscript are based on the experiences of 5 of the 10 centers. CONCLUSIONS: Direct mail, using rosters of names and addresses from profit and not-for-profit (including government) organizations, was the most successful and most often used recruitment method. Other recruitment strategies, such as community outreach and use of mass media, can be an important adjunct to direct mail in recruiting minority populations.

Difference in work-related violence by nurse license type.

Nurses are at considerable risk for work-related violence. This study compared the experiences of work-related violence among registered nurses (RNs) and licensed practical nurses (LPNs) to quantify differences in risks and exposures and to gain insight into possible interventions. A random sample (n = 6,300) of licensed Minnesota nurses was surveyed regarding the previous 12-month period. Nurses self-reported violent events and demographic information. After adjustment for potential confounders and nonresponse, LPNs had an increased risk for both physical assault (odds ratio = 1.4; 95% confidence interval = 1.1-1.9) and nonphysical violence (odds ratio = 1.2; 95% confidence interval = 1.0-1.5) compared to RNs. Some exposures resulted in increased risks for both types of violence for RNs and LPNs: working primarily in psychiatric departments and long-term care facilities. In contrast, working in clinics resulted in decreased risks for both license types. Some risks varied by license type. Risk of physical assault was increased for LPNs working with neonatal/pediatric patients, whereas RNs' risk was decreased. RNs' risk of physical violence increased while providing care, whereas LPNs' risk increased while supervising care. A better understanding of how this problem varies by license type and work setting will assist in designing efficacious interventions.

Risk factors for work-related assaults on nurses.

BACKGROUND: Work-related homicides have been the subject of considerable study, but little is known about nonfatal violence and relevant risk factors. METHODS: We surveyed 6300 Minnesota nurses who were selected randomly from the 1998 licensing database and determined their employment and occupational violence experience. In a nested case-control study, we examined environmental exposures and physical assault. Cases of assault in the previous 12 months and controls randomly selected from assault-free months were surveyed about prior-month exposures. RESULTS: After adjustment by multiple logistic regression, incidence of physical assault was 13.2 per 100 persons per year (95% confidence interval = 12.2-14.3). Among 310 cases and 946 control subjects, odds ratios for assault were increased: in nursing homes or long-term care facilities (2.6; 1.9-3.6), emergency departments (4.2; 1.3-12.8), and psychiatric departments (2.0; 1.1-3.7); in environments not "bright as daylight" (2.2; 1.6-2.8); and for each additional hour of shift duration (1.05; 0.99-1.11). Risks were decreased when carrying cellular telephones or personal alarms (0.3; 0.2-0.7). CONCLUSIONS: These results may guide in-depth investigation of ways protective and risk factors can control violence against nurses.

A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening.

BACKGROUND: Although colorectal cancer screening by using a fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, or barium enema x-ray reduces the incidence of and death from colorectal cancer, the rate of colorectal cancer screening in the general population is low. We conducted a randomized trial consisting of direct mailing of FOBT kits to increase colorectal cancer screening among residents of Wright County, Minnesota, a community in which colorectal cancer screening was promoted. METHODS: At baseline, we mailed a questionnaire about colorectal cancer screening to a random sample of Wright County residents aged 50 years or older who were randomly selected from the Minnesota State Driver's License and Identification Card database (estimated N = 1451). The sample was randomly allocated into three equal subgroups: one group (control) received only the questionnaire, one group received FOBT kits by direct mail with reminders, and one group received FOBT kits by direct mail without reminders. Study participants were sent a follow-up questionnaire 1 year after baseline. We used the responses to the questionnaires to estimate the 1-year change in self-reported screening rates in each group and the differences in the changes among the groups, along with the associated bootstrap 95% confidence intervals (CIs). RESULTS: At baseline, the estimated response rate was 86.5%, self-reported adherence to FOBT guidelines was 21.5%, and overall adherence to any colorectal cancer screening test guidelines was 55.8%. The 1-year rate changes in absolute percentage for self-reported adherence to FOBT use were 1.5% (95% CI = -2.9% to 5.9%) for the control group, 16.9% (95% CI = 11.5% to 22.3%) for the direct-mail-FOBT-with-no-reminders group, and 23.2% (95% CI = 17.2% to 29.3%) for the direct-mail-FOBT-with-reminders group. The 1-year rate changes for self-reported adherence to any colorectal cancer screening test were 7.8% (95% CI = 3.2% to 12.0%) for the control group, 13.2% (95% CI = 8.4% to 18.2%) for the direct-mail-FOBT-with-no-reminders group, and 14.1% (95% CI = 9.1% to 19.1%) for the direct-mail-FOBT-with-reminders group. CONCLUSION: Direct mailing of FOBT kits combined with follow-up reminders promotes more rapid increases in the use of FOBT and nearly doubles the increase in overall rate of adherence to colorectal cancer screening guidelines in a general population compared with a community-wide screening promotion and awareness campaign.

Colorectal cancer screening adherence in a general population.

BACKGROUND: This article describes the self-reported colorectal cancer (CRC) screening adherence rates of adults, aged 50 years and older, living in five nonurban Minnesota counties. METHODS: During the year 2000, 1693 eligible respondents, aged 50 years and older, from a randomly selected sample completed a survey assessing CRC screening adherence (approximately 86.3% response). The survey allowed differentiation between the four CRC screening modalities but did not differentiate between screening and diagnostic testing. Adjustment for nonresponse was performed using a version of Horvitz-Thompson weighting accounting for unknown eligibility. RESULTS: 24.5% of respondents had a fecal occult blood test within 1 year of the survey, 33.8% had flexible sigmoidoscopy within 5 years, 29.3% had a colonoscopy within 10 years, and 13.7% had a barium enema within the last 5 years. Overall, 55.3% of respondents reported testing by any modality; thus, 44.7% were not adherent to screening guidelines. CONCLUSIONS: This study improves on previous attempts to characterize CRC screening adherence by assessing all four modalities of screening as recommended by current screening guidelines, by focusing on nonadherence, and by rigorously accounting for nonresponse. This study confirms that nearly half of the population remains unscreened by any method.