Alice J. Hausman

Intentional injuries among children and adolescents in Massachusetts.

We estimated age-specific and sex-specific incidence rates of intentional injuries (assaults or suicide attempts) occurring between 1979 and 1982 in a population of 87,022 Massachusetts children and adolescents under 20 years of age in 14 communities with populations of 100,000 or less. The average annual incidence of intentional injuries treated at a hospital was estimated to be 76.2 per 10,000 person-years. Overall, 1 in 130 children was treated each year for an intentional injury. More than 85 percent of the injuries resulted from assaults, such as fights, rape, and child battering; 11.4 percent were self-inflicted. Intentional injuries were most common among adolescents. Each year, 1 in 42 teenage boys was treated for an assault-related injury, and 1 in 303 teenage girls was seen for a suicide attempt. Repeated episodes of intentional injury were identified in 4.3 percent of the children. In this population, intentional injuries accounted for 3.4 percent of all injuries but 9.8 percent of hospital admissions and 15.7 percent of deaths from injury. The rate of intentional injury was directly correlated with both the degree of urbanization and the poverty level of the community of residence. We conclude that intentional injuries are relatively common in this population and that attempts to prevent them must be directed to the children who are at greatest risk.

Dying Is No Accident: Adolescents, Violence, and Intentional Injury

Violence and its consequences are a major issue to be addressed by the health care community. The magnitude and characteristics of the problem cry out for new, creative approaches and provide for some insight into the direction that needs to be taken. Some of the components related to violence are societal in scope and will require long-term strategies well beyond the immediate realm of the health care system. Others provide direction that more clearly present a role for health providers and public health planners. Although there will be no easy answers or solutions to this problem, it is essential that support be developed for experimental efforts. The health community cannot ignore this problem and can in fact make a real contribution to its resolution through prevention, treatment, and research.

Disaster preparedness of households with special needs in Southeastern Pennsylvania.

BACKGROUND Individuals with disabilities are disproportionately vulnerable in evacuation emergencies, and they face numerous challenges accessing resources for response and recovery. PURPOSE The aim of this study was to compare the preparedness behaviors of households with and without special-needs members. METHODS A random-digit-dial telephone survey was conducted of 501 adults in southeastern Pennsylvania in 2008. The survey instrument gathered data on sociodemographic characteristics, disability status/functional limitations, and preparedness behaviors related to an evacuation emergency. Analyses were conducted in 2009 and included multiple logistic regressions. Data were weighted to correct for unequal probabilities of selection and response. RESULTS Nineteen percent (n=95) of respondents reported living in a household in which someone had a transportation-related special need requiring assistance in case of an emergency. Households with a special-needs member had greater odds of having arranged a place to meet (OR=2.2; 95% CI=1.26, 3.88); located a shelter (OR=1.8; 95% CI=1.05, 3.24); or packed a bag (OR=1.8; 95% CI=1.02, 3.21). No significant differences were identified with respect to awareness of evacuation routes, purchasing of food and water, or creation of an emergency plan to guide evacuation decision-making. CONCLUSIONS Despite both greater vulnerability to disaster and numerous messages by governmental and nongovernmental organizations, households with special-needs members are not more likely to engage in time-consuming preparedness behaviors such as planning and buying. Understanding the motivations and behaviors of special-needs groups is critical to designing informed risk-communication messages and interventions to bolster the preparedness of the most vulnerable populations.

Evaluation of comprehensive violence prevention education: effects on student behavior

PURPOSE This study evaluates the impact on student behavior of violence prevention education in school settings. METHODS School records were obtained for three panels (1985, 1986, and 1987) of urban public high school students (n = 1,523) who were nonrandomly assigned to three different conditions of school-based violence prevention education: (1) in a class-specific comprehensive educational intervention, (2) as part of a school-wide violence prevention initiative, and (3) no exposure. Changes in suspension status from sophomore to junior year were tracked within exposure groups and the risk of junior year suspension was compared across exposure groups, controlling for age, gender, race, absenteeism, and previous year suspension. RESULTS The class-specific exposure, compared to a not-exposed group from the same school showed a significant 71% reduction in suspension rates (RR = .286, CI .12, .66). The school-wide exposure school shows reductions in and maintenance of very low rates of junior year suspension in each cohort year, although these are not always statistically significantly different from not-exposed groups. CONCLUSION Results indicate that violence prevention education can reduce negative school behaviors, particularly when other supportive curricula and activities are added.

Implications of evidence-based practice for community health.

Evidence-based practice, developed in clinical medicine, is being applied to community health programs. Barriers to implementation of evidence-based practice noted in clinical medicine are likely to exist in community health settings and may be complicated by the nature of community health programs. These barriers include accessibility and availability of relevant data, social and political considerations of program decision-making, and conflicting expectations for evaluation research. This paper discusses barriers to both amassing evidence for practice and using evidence for decision-making in community health. The potential for conflict between practice goals set by evidence-based thinking and those set by community health organizations is also discussed. Implications for evaluations of community health programs are raised and recommendations for improving access to and use of evaluation information are made.

Knowledge, Attitudes, and Predictors of Advance Directive Discussions of Registered Nurses

The purpose of this study was to describe nurses’ knowledge, attitudes, and experiences regarding advance directives. A secondary purpose was to examine predictors of advance directive discussions between nurses and patients. Seven-hundred and nineteen respondents, randomly selected from a list of registered nurses in the state of Ohio, completed mailed questionnaires. Descriptive t test, chi-square, and logistic regression statistics were used in the data analyses. The respondents were knowledgeable and possessed positive attitudes about advance directives. Higher self-perceived confidence in advance directive discussion skills and the experience of caring for at least one patient with a current advance directive were found to be significant predictors of advance directive discussions. These findings suggest that experience with advance directives documents is critical for nurses’ comfort and that developing interventions to further nurses’ confidence in their discussion skills may increase advance directive discussions.

Adolescent interpersonal assault injury admissions in an urban municipal hospital.

To extend the study of the epidemiology of interpersonal violence into the area of nonfatal intentional injury, a retrospective study was undertaken of patients admitted to a major city hospital for intentional injury during a single year (1984–1985). This study focused on interpersonal assaultive injury, excluding sexual assault, child abuse, and self-inflicted injuries. Relevant injuries made up three-quarters of all admitted intentional injuries and represented a total of 671 patients (4.5% of all hospital admissions). The intentionally injured were compared to the catchment area population and to the remaining admitted hospital population, by age, sex, and race. Medical records of intentionally injured adolescents (n = 133) were reviewed and compared to a sample of adolescent homicide victims regarding the circumstance of the event and the relationship of victim to assailant. Relevant findings are that: (1) in the area served by this hospital, male adolescents are at relatively high risk for nonfatal intentional injury; (2) among adolescents, the majority of these intentional injuries are the result of interpersonal conflicts between acquaintances, paralleling the etiology of homicide; (3) a prevalence of missing data in the medical records of older male adolescents is symptomatic of the lack of attention that has been paid to understanding and preventing intentional injury among adolescents. It is concluded that: (1) more area-specific and hospital-based studies of intentional injury are needed as a guide to such preventive efforts; and (2) medical personnel providing acute care to victims of intentional injury are an important resource for this research and prevention effort.

Practitioners' forum: public health and the primary prevention of adolescent violence ― the Violence Prevention Project

The Violence Prevention Project is a community-based outreach and education project directed toward reducing the negative social and medical outcomes of violence among adolescents. Community agency personnel are trained to work with youth on issues of anger and conflict resolution. A mass media campaign advertises the issue to the broader population. Interventions, such as the Violence Prevention Project, can use the public health strategies to increase awareness of the problem and associated risk factors, provide alternative conflict resolution techniques, and generate a new community ethos around violence. This approach holds great promise in an area in which after-the-fact legislative and punitive interventions have not worked.

Developing measures of community-relevant outcomes for violence prevention programs: A community-based participatory research approach to measurement

Community-Based Participatory Research is a research paradigm that encourages community participation in designing and implementing evaluation research, though the actual outcome measures usually reflect the “external” academic researchers’ view of program effect and the policy-makers’ needs for decision-making. This paper describes a replicable process by which existing standardized psychometric scales commonly used in youth-related intervention programs were modified to measure indicators of program success defined by community partners. This study utilizes a secondary analysis of data gathered in the context of a community-based youth violence prevention program. Data were retooled into new measures developed using items from the Alabama Parenting Questionnaire, the Hare Area Specific Self-Esteem Scale, and the Youth Asset Survey. These measures evaluated two community-defined outcome indicators, “More Parental Involvement” and “Showing Kids Love.” Results showed that existing scale items can be re-organized to create measures of community-defined outcomes that are psychometrically reliable and valid. Results also show that the community definitions of parent or parenting caregivers exemplified by the two indicators are similar to how these constructs have been defined in previous research, but they are not synonymous. There are nuanced differences that are important and worthy of better understanding, in part through better measurement.

Access Impediments to Health Care and Social Services Between Anglophone and Francophone African Immigrants Living in Philadelphia with Respect to HIV/AIDS

Objectives To describe the social and cultural differences between Anglophone and Francophone African immigrants which define the impediments that Francophone African immigrants face trying to access health and human services in Philadelphia, Pennsylvania. Methods Surveys and personal interviews were administered to participants in social events, community meetings, and health centers. A Chi-squared analysis was used to contrast the communities. Results Francophone Africans demonstrated less acculturation, education, English fluency, and more legal documentation problems, and thus face greater challenges accessing health care. Anglophone Africans had a higher level of acculturation, fewer language problems, and perceived fewer barriers in accessing health care than Francophone Africans. Conclusions Educating new immigrants, through a more culturally sensitive infectious disease treatment and prevention program, is integral to achieving a higher access and utilization rates of available services; especially in recent Francophone immigrants. A larger study is needed to extend the findings to other cities where immigrants with similar backgrounds or acculturation issues reside.