Drug overdose and child maltreatment across the United States' rural-urban continuum.

This national study of US counties (n = 2963) investigated whether county-level drug overdose mortality is associated with maltreatment report rates, and whether the relationship between overdose mortality and maltreatment reports is moderated by a county's rural, non-metro or metro status. Data included county-level 2015 maltreatment reports from the National Child Abuse and Neglect Data System, modeled drug-overdose mortality from the Centers for Disease Control, United States Department of Agriculture Rural-Urban Continuum Codes, US Census demographic data and crime reports from the Federal Bureau of Investigation. All data were linked across counties. Zero-inflated negative binomial (ZINB) regression was used for county-level analysis. As hypothesized, results from the ZINB model showed a significant and positive relationship between drug overdose mortality and child maltreatment report rates (χ = 101.26, p < .0001). This relationship was moderated by position on the rural-urban continuum (χ=8.76, p = .01). For metro counties, there was a 1.9% increase in maltreatment report rate for each additional increment of overdose deaths (IRR=1.019, CI=[1.010, 1.028]). For non-metro counties, the rate of increase was 1.8% higher than for metro counties (IRR=1.018, CI=[1.006, 1.030]); for rural counties, the rate of increase was 1.2% higher than for metro counties (IRR=1.012, CI=[0.999, 1.026]). Additional research is needed to determine why the relationship between drug overdose mortality and maltreatment reports is stronger in non-metro and rural communities. One potential driver requiring additional inquiry is that access to mental and physical health care and substance use treatment may be more limited outside of metropolitan counties.

A systematic review of socioeconomic status measurement in 13 years of U.S. injury research.

OBJECTIVE: The purpose of this review was to assess the impact of socioeconomic status (SES) on injury and to evaluate how U.S. injury researchers have measured SES over the past 13years in observational research studies. DESIGN & METHODS: This systematic review included 119 US injury studies indexed in PubMed between January 1, 2002 and August 31, 2015 that used one or more individual and/or area-level measures of SES as independent variables. Study findings were compared to the results of a previous review published in 2002. RESULTS: Findings indicate SES remains an important predictor of injury. SES was inversely related to injury in 78 (66%) of the studies; inverse relationships were more consistently found in studies of fatal injury (77.4%) than in studies of non-fatal injury (58%). Approximately two-thirds of the studies (n=73, 61%) measured SES along a gradient and 59% used more than one measure of SES (n=70). Studies that used a gradient measure of SES and/or more than one measure of SES identified significant relationships more often. These findings were essentially equivalent to those of a similar 2002 review (Cubbin & Smith, 2002). CONCLUSIONS: There remains a need to improve measurement of SES in injury research. Public health training programs should include best practices for measurement of SES, which include: measuring SES along a gradient, selecting SES indicators based on the injury mechanism, using the smallest geographic region possible for area-level measures, using multiple indicators when possible, and using both individual and area-level measures as both contribute independently to injury risk. Area-level indicators of SES are not accurate estimates of individual-level SES. PRACTICAL APPLICATIONS: Injury researchers should measure SES along a gradient and incorporate individual and area-level SES measures that are appropriate to the injury outcome under study.

Neighborhood Social Cohesion as a Mediator of Neighborhood Conditions on Mothers' Engagement in Physical Activity: Results From the Geographic Research on Wellbeing Study.

OBJECTIVES: The purpose of this study was to determine if social cohesion mediates the effects of neighborhood and household-level socioeconomic status (SES), perceptions of neighborhood safety, and access to parks on mothers' engagement in physical activity (PA). METHOD: Secondary analyses were conducted on cross-sectional data from The Geographic Research on Wellbeing (GROW) study. GROW includes survey data from a diverse sample of 2,750 California mothers. Structural equation modeling was used to test a conceptual multilevel mediation model, proposing social cohesion as a mediator of known predictors of PA. RESULTS: Social cohesion fully mediated the pathway from perceived neighborhood safety to mothers' PA. Social cohesion also mediated the significant relationship between neighborhood SES and PA; however, this mediation finding was not practically significant when considered in the context of the full model. Household SES was significantly positively related to both social cohesion and PA. Park access contributed significantly to social cohesion but not directly to PA Social cohesion did not significantly mediate relationships between park access or household SES and PA. CONCLUSIONS: There is a need for public health interventions to improve engagement in PA among individuals and neighborhoods with lower levels of socioeconomic resources. Interventions that create social cohesion within neighborhoods may have positive effects on mothers' PA, particularly in neighborhoods perceived as unsafe.

Supporting Community Health Workers After a Disaster: Findings From a Mixed-Methods Pilot Evaluation Study of a Psychoeducational Intervention.

OBJECTIVE: Community health workers (CHWs) in disaster-affected areas are at risk for emotional distress, as they support others while they may be in the process of rebuilding their own lives. The Resilience and Coping for the Healthcare Community (RCHC) intervention was developed in response to the stress CHWs faced after Hurricane Sandy. The intervention uses psychoeducation to help participants identify common stress responses, recognize signs of job burnout, and utilize healthy coping strategies. METHODS: A mixed-methods pilot of the RCHC intervention was conducted in 2013 with a convenience sample of staff from 6 federally qualified health centers (n=69). Validated measures of stress, coping, compassion fatigue and satisfaction, burnout, stress, and social provisions and a measure of perceived knowledge were administered at baseline, after the workshop, and at a 3-week follow-up. Semi-structured interviews were conducted with 10 randomly selected participants and were analyzed by using content analysis. RESULTS: From baseline to the post-workshop assessment, perceived knowledge scores increased from 24.59 to 30.34, t(62)=5.16 (P<0.001), and acute stress scores decreased significantly from 10.53 to 6.78, t(64)=4.74 (P<0.001). Significant increases from baseline to the 3-week follow-up (n=45) were found for perceived knowledge (24.05 to 27.24; t(40)=5.37; P<0.001), and social provisions (27.34 to 28.39; t(44)=2.15; P<0.05). CONCLUSIONS: Our qualitative findings indicated that the respondents valued learning about common stress responses and incorporating coping as part of a daily routine. Team building and normalization of emotions were seen as ancillary benefits that would reduce stress levels in the workplace. In conclusion, the RCHC intervention shows promise and should be investigated further in experimental studies. (Disaster Med Public Health Preparedness. 2016;page 1 of 8).

Sleep behaviors of infants and young children: associated demographic and acculturation characteristics among Hispanic teen mothers.

Accidental suffocation and strangulation in bed is a leading cause of preventable infant death. Bed sharing, teen motherhood, and Hispanic ethnicity have been associated with infant sleep suffocation death. Fifty-five Hispanic teen mothers were surveyed regarding acculturation/demographic characteristics and their infants' sleep behaviors. Most participants had 2 foreign-born parents from Latin America. Participants with 2 US-born parents were less likely to bed share than their less-acculturated peers. Many participants reported not always placing their infant in a supine sleep position. There is a significant need to reach out to Hispanic teen mothers, particularly from newer immigrant families, with culturally and linguistically appropriate multigenerational clinical messaging on the risks of infant bed sharing and nonsupine sleep positioning.

Risky drinking among parents of pediatric trauma patients.

BACKGROUND: Unintentional injury is the leading cause of death for children in the United States. An association between parental alcohol use and the frequency and severity of childhood injuries has been found; however, research is limited. The purpose of this study was to (1) describe demographics, child safety behaviors, and parental risky behaviors for a pediatric trauma patient population and (2) assess the relationship between positive screen results for risky drinking in parents and demographic and child safety behaviors. METHODS: Data were collected from a sample of parents of a child younger than 15 years who was admitted to an urban children's hospital for treatment for an unintentional injury. Data were analyzed using descriptive statistics, bivariate analyses, and logistic regression. RESULTS: A total of 926 parents of 693 patients were included in this study. Of the families who completed the survey, 37.1% (n = 257) had at least one parent screening positive for risky alcohol use. When looking at patients who ride bicycles, a little more than half (55.1%) were reported as consistently using a helmet. Results showed that inconsistent helmet use was associated with a higher likelihood of at least one parent screening positive for risky drinking (odds ratio, 1.58; 95% confidence interval, 1.06-2.36; p ≤ 0.05). CONCLUSION: Helmet use is a known prevention method of head injuries resulting from bicycle crashes. However, improvements need to be made on how to disseminate this information to parents and how to locate and intervene with the parents who have children that are at an increased risk of injury and injury recidivism. Using screening and brief intervention programs may assist in locating and reducing the potential of recurring visits by at-risk patients such as those in this sample who had at least one parent screening positive for risky drinking. LEVEL OF EVIDENCE: Prognostic study, level III.

Perceptions of injury and prevention practices among pregnant and parenting teenagers.

Injury is a leading cause of death for young children, and the children of teenaged parents may be at increased risk. This qualitative study explored pregnant and parenting teenagers' child safety beliefs and practices related to 4 topics: preventing accidental suffocation via safe sleeping practices, motor vehicle collision safety, prevention of inflicted head trauma, and drowning prevention. Twenty-four focus groups were held with 93 pregnant and/or parenting teenagers. Participants reported variation in their sleeping arrangements, transportation methods, caregivers, and childcare settings. Confusion over safety information was common. Child safety practices were influenced by boyfriends/husbands, parents, grandparents, and teachers.

Screening, brief intervention, and referral for alcohol use in adolescents: a systematic review.

BACKGROUND AND OBJECTIVE: Alcohol use by adolescents is widespread and is connected to a number of negative health and social outcomes. Adolescents receiving emergent care for injuries are often linked with risky use of alcohol. The trauma system has widely adopted the use of screening, brief intervention, and referral to treatment (SBIRT) for preventing alcohol-related injury recidivism and other negative outcomes. The purpose of this article is to review the evidence around SBIRT with adolescent patients in acute care settings. METHODS: This article reviews 7 randomized controlled trials evaluating risky drinking interventions among adolescent patients in acute care settings. All studies took place in the emergency departments of level I trauma centers. RESULTS: Four of the 7 studies reviewed demonstrated a significant intervention effect; however, no one intervention reduced both alcohol consumption and alcohol-related consequences. Two of these 4 studies only included patients ages 18 and older. Subgroup analyses with adolescents engaged in risky alcohol-related behaviors, conducted in 2 of the studies, showed significant intervention effects. Five studies showed positive consumption and/or consequences for all study participants regardless of condition, suggesting that an emergent injury and/or the screening process may have a protective effect. CONCLUSIONS: Based on existing evidence, it is not clear whether SBIRT is an effective approach to risky alcohol use among adolescent patients in acute care. Additional research is needed around interventions and implementation.

Teaching safety at a summer camp: evaluation of a water safety curriculum in an urban community setting.

OBJECTIVES: The purpose of this project was to evaluate a water safety curriculum in a low-income, minority-focused, urban youth summer camp. The curriculum is available to Safe Kids Coalitions across the country; however, it has not previously been evaluated. METHODS: Participants were pre-K to third-grade students (n = 166). Children watched a video and received the curriculum in a classroom setting. Each child was given a pre-, post-, and 3-week retention exam to assess knowledge change. Mean test scores and number of safety rules participants could list were analyzed using paired Student's t tests. Parents were given a baseline survey at the beginning (n = 140) and end of the weeklong curriculum (n = 118). RESULTS: The participants were 50% male, 27.5% Hispanic, 68.7% African American, and 3.8% biracial. Children were divided into three groups: pre-K/kindergarten, first and second grade, and third grade. Children in each of the groups received higher knowledge scores at the posttest (p = .0097, p < .0001, and p < .0001, respectively), with little decline in scores at the 3-week retention exam. Similar results were seen for the ability to list safety rules, though the number fell slightly between the posttest and retention test. CONCLUSION: The study demonstrates that children possessed more knowledge of water safety after receiving this curriculum. This knowledge increase was maintained through the 3-week retention exam. Further evaluation of the curriculum's content and its impact on water safety beliefs, attitudes, and behaviors are needed, as well as evaluation of additional settings, risk areas, and the role of parental involvement.

Under the influence with a child in the car: implications for child safety and caregiver intervention.

BACKGROUND: Injury is the leading cause of death for those aged 1 year to 44 years in the United States, with motor vehicle collisions (MVCs) the leading cause of injury-related deaths. Little data exist on the relationship between caregiver alcohol and drug use at the time of MVC and child passenger outcomes. We examined the relationship between caregiver substance use in MVCs and a number of demographic, crash severity, and medical outcomes for caregivers and children. METHODS: We identified family groups treated in the emergency department of a regional Level II trauma center after an MVC in a 1-year period from July 1, 2005, to June 30, 2006. The distribution and means of characteristics for substance and nonsubstance users were compared using χ analysis and Student's t tests, respectively. RESULTS: One in 10 vehicles contained an intoxicated caregiver at the time of MVC. In 363 identified caregivers, intoxication was associated with being male (p < 0.001), lack of safety device use (p = 0.003), rollover (p = 0.008), and ejection (p = 0.016). In the 278 family groups, intoxicated caregivers were related to child ejection (p = 0.009), the need for child hospital admission (p < 0.001), and driver intoxication was related to child lack of restraint (p = 0.045). CONCLUSION: These findings suggest a substantial number of child MVC victims arrive at the emergency room after riding with an intoxicated caregiver. Findings support the need for prevention programs focusing on substance use and driving for male caregivers, and further investigation on the need for screening and intervention for caregivers' risky alcohol and drug use after a child's MVC.

Pediatric injuries in Central Texas.

In Texas, more children aged from 1 through 14 years die from injury-related causes than from the next 9 causes of death combined. Injuries to children hospitalized in Central Texas during 2003 and 2004 were caused predominantly by falls and motor vehicle collisions (MVCs) and resulted in a large number of fractures and open wounds. Fifty-six Central Texas children died in 2003 and 2004 after reaching the hospital, out of a total of 175 children killed in injury-related events during this period. Most injury-related deaths were due to a traumatic brain injury. Most of the children suffering injury in MVCs were not restrained at the time of the accident. Injury data are invaluable to injury prevention efforts. These data were gathered from the Public Use Data File maintained by the Injury and EMS/Trauma Registry Group at the Department of State Health Services; limitations of the data set are discussed, and implications for injury prevention are highlighted.

Screening for risky alcohol use among caregivers of pediatric trauma patients: a pilot study.

BACKGROUND: Injury is the leading cause of death for children and has been linked to caregiver drinking. Screening and brief intervention for risky drinking has been successful in adult trauma centers but has not been evaluated in caregivers of pediatric trauma patients. The purpose of this study was to investigate a pilot screening process for risky drinking caregivers, to determine rates of risky alcohol use, and to assess potential relationships between risky drinking and child safety behaviors. METHODS: Caregivers of pediatric trauma patients were screened by trained injury prevention educators. The screening assessed risky drinking, tobacco and illicit drug use, and child safety behaviors. Data were analyzed using descriptive analysis, frequency comparisons, and univariate logistic regression. RESULTS: Over 7 months, 295 caregivers were screened; 32.5% (n = 96) screened positive for risky alcohol use. For 173 injured children, one caregiver was screened, and for 61 children, two caregivers were screened. In the one-caregiver group, 29% (n = 50) screened positive for risky drinking. For the two-caregiver group, in 18% (n = 11) of the cases, both caregivers screened positive, whereas in 39% (n = 24) only one caregiver screened positive. Males were more likely to screen positive (p < 0.01). Relationships between reported child safety behaviors and risky drinking were of interest, but not statistically significant. CONCLUSIONS: The results of our study demonstrate that a substantial number of caregivers of pediatric trauma patients will self-report risky drinking behaviors, and therefore, an opportunity exists for these families to receive the benefits of screening and brief intervention programs in pediatric trauma care settings.

Screening for attention-deficit/hyperactivity disorder in a select sample of injured and uninjured pediatric patients.

PURPOSE: Injury is the leading cause of morbidity and mortality to children. The purpose of this study is to compare attention-deficit/hyperactivity disorder (ADHD) screening results in a select group of injured pediatric patients to noninjured patients. METHODS: Parents of patients 6 to 12 years of age were enrolled in the study. Patients were either admitted for specific injury mechanisms (n = 133) or appendicitis (n = 157). Demographic and medical data were collected, and an ADHD screening tool was administered. Logistic regression models were used to compare screening results between groups. RESULTS: The injured patient group was 3.25 times more likely to screen positive for ADHD (odds ratio, 3.25; 95% confidence interval, 1.57-6.72; P = .002) than the appendicitis group. Among the injured patients who screened positive for ADHD, only 34.0% reported currently receiving treatment. CONCLUSIONS: Our results suggest that pediatric patients with certain injury mechanisms may warrant screening and referral for ADHD. Appropriate identification and treatment of undiagnosed ADHD may reduce the burden of injury recidivism. Screening and referral for ADHD within a trauma service should be evaluated for effectiveness as an injury prevention initiative.