Diane C. Thompson

The validity of self-reported smoking: a review and meta-analysis.

OBJECTIVES The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates. METHODS Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and biochemical measures. The sensitivity and specificity of self-reports of smoking were calculated for each study as measures of accuracy. RESULTS Sensitivity ranged from 6% to 100% (mean = 87.5%), and specificity ranged from 33% to 100% (mean = 89.2%). Interviewer-administered questionnaires, observational studies, reports by adults, and biochemical validation with cotinine plasma were associated with higher estimates of sensitivity and specificity. CONCLUSIONS Self-reports of smoking are accurate in most studies. To improve accuracy, biochemical assessment, preferably with cotinine plasma, should be considered in intervention studies and student populations.

A Case-Control Study of the Effectiveness of Bicycle Safety Helmets

Bicycling accidents cause many serious injuries and, in the United States, about 1300 deaths per year, mainly from head injuries. Safety helmets are widely recommended for cyclists, but convincing evidence of their effectiveness is lacking. Over one year we conducted a case-control study in which the case patients were 235 persons with head injuries received while bicycling, who sought emergency care at one of five hospitals. One control group consisted of 433 persons who received emergency care at the same hospitals for bicycling injuries not involving the head. A second control group consisted of 558 members of a large health maintenance organization who had had bicycling accidents during the previous year. Seven percent of the case patients were wearing helmets at the time of their head injuries, as compared with 24 percent of the emergency room controls and 23 percent of the second control group. Of the 99 cyclists with serious brain injury only 4 percent wore helmets. In regression analyses to control for age, sex, income, education, cycling experience, and the severity of the accident, we found that riders with helmets had an 85 percent reduction in their risk of head injury (odds ratio, 0.15; 95 percent confidence interval, 0.07 to 0.29) and an 88 percent reduction in their risk of brain injury (odds ratio, 0.12; 95 percent confidence interval, 0.04 to 0.40). We conclude that bicycle safety helmets are highly effective in preventing head injury. Helmets are particularly important for children, since they suffer the majority of serious head injuries from bicycling accidents.

Identification and Management of Domestic Violence A Randomized Trial

Background: Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. Methods: We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. Results: Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67–2.7). Conclusions: The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.BACKGROUND Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. METHODS We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. RESULTS Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67-2.7). CONCLUSIONS The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.

Epidemiology of bicycle injuries and risk factors for serious injury

Objective To determine the risk factors for serious injury to bicyclists, aside from helmet use. Design Prospective case-control study. Setting Seven Seattle area hospital emergency departments and two county medical examiners offices. Patients Individuals treated in the emergency department or dying from bicycle related injuries. Measurements Information collected from injured bicyclists or their parents by questionnaire on circumstances of the crash; abstract of medical records for injury data. Serious injury defined as an injury severity score>8. Analysis Odd ratios computed using the maximum likelihood method, and adjusted using unconditional logistic regression. Results There were 3854 injured cyclists in the three year period; 3390 (88%) completed questionnaires were returned. 51% wore helmets at the time of crash. Only 22.3% of patients had head injuries and 34% had facial injuries. Risk of serious injury was increased by collision with a motor vehicle (odds ratio (OR)=4.6), self reported speed >15 mph (OR=1.2), young age (<6 years), and age >39 years (OR=2.1 and 2.2 respectively, compared with adults 20-39 years). Risk for serious injury was not affected by helmet use (OR=0.9). Risk of neck injury was increased in those struck by motor vehicles (OR=4.0), hospitalized for any injury (OR=2.0), and those who died (OR=15.1), but neck injury was not affected by helmet use. Conclusions Prevention of serious bicycle injuries cannot be accomplished through helmet use alone, and may require separation of cyclists from motor vehicles, and delaying cycling until children are developmentally ready.

Effectiveness of primary and secondary enforced seat belt laws

OBJECTIVE The objective of this study was to determine the relative efficacy of primary and secondary enforced motor vehicle occupant restraint laws on the outcomes of restraint use, crash-related mortality, and crash-related injuries. SEARCH STRATEGY We used the Cochrane Collaboration search strategy to search the following electronic databases: MEDLINE, EMBASE, National Technical Information Service (NTIS), Psyc-INFO, ERIC, Nursing and Allied Health (CINAHL), Transportation Research Information Service (TRIS), and EI Compendex. The reference lists from each potentially eligible study were checked, and knowledgeable people in the field were contacted, for additional leads to published reports. SELECTION CRITERIA Studies had to include a comparison of primary enforcement law to no law, secondary enforcement law to no law, or a primary to a secondary law. Any study design was acceptable. Acceptable outcome measures included observed restraint use, and counts or rates of deaths or serious injuries. DATA COLLECTION Data were collected using a standard abstract reporting from. Relative differences in outcomes and absolute differences were calculated when possible. MAIN RESULTS We identified 48 studies for the review. When places or time periods with primary enforcement laws were compared to those without such laws, the relative prevalence of seat belt use ranged from 1.5 to 4.5; the prevalence differences ranged from 10 to 50 per 100 observed drivers. Secondary laws had smaller effects. Two studies evaluated a change in law from secondary to primary enforcement; this was associated with an increase in belt use 6 months later of 5.3 per 100 observed drivers in Louisiana and 18 per 100 drivers in California. Primary enforcement laws were associated with a relative risk of death in MV crashes of .54 to .97. The reduction in mortality associated with secondary enforcement laws was much more modest, with relative risks estimates of .81 to 1.025. Primary enforcement laws were associated with a relative risk of severe injuries of .20 to .89; the association of secondary enforcement laws with severe injuries was smaller. CONCLUSIONS Our review of existing studies suggests that primary enforcement laws are likely to be more effective than secondary laws. However, few studies are of good quality, and quantitative estimates of the relative effect of primary compared with secondary laws are limited.

BMI Measurement in Schools

BACKGROUND AND OBJECTIVE: School-based BMI measurement has attracted attention across the nation as a potential approach to address obesity among youth. However, little is known about its impact or effectiveness in changing obesity rates or related physical activity and dietary behaviors that influence obesity. This article describes current BMI-measurement programs and practices, research, and expert recommendations and provides guidance on implementing such an approach. METHODS: An extensive search for scientific articles, position statements, and current state legislation related to BMI-measurement programs was conducted. A literature and policy review was written and presented to a panel of experts. This panel, comprising experts in public health, education, school counseling, school medical care, and parenting, reviewed and provided expertise on this article. RESULTS: School-based BMI-measurement programs are conducted for surveillance or screening purposes. Thirteen states are implementing school-based BMI-measurement programs as required by legislation. Few studies exist that assess the utility of these programs in preventing increases in obesity or the effects these programs may have on weight-related knowledge, attitudes, and behaviors of youth and their families. Typically, expert organizations support school-based BMI surveillance; however, controversy exists over screening. BMI screening does not currently meet all of the American Academy of Pediatrics’ criteria for determining whether screening for specific health conditions should be implemented in schools. CONCLUSION: Schools initiating BMI-measurement programs should adhere to safeguards to minimize potential harms and maximize benefits, establish a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.

II. violence prevention and intervention in health care and community settingsIdentification and management of domestic violence: A randomized trial1

Background: Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. Methods: We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. Results: Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67–2.7). Conclusions: The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.BACKGROUND Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. METHODS We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. RESULTS Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67-2.7). CONCLUSIONS The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.

Prevention of falls in the construction industry: evidence for program effectiveness.

OBJECTIVE The objective of this study was to review the evidence for the effectiveness of different strategies to prevent falls from heights in the construction industry. SEARCH STRATEGY We used the Cochrane Collaboration search strategy to search the following electronic databases: MEDLINE, EMBASE, NIOSHTIC, PsycINFO and Dissertation Abstracts. The reference lists from each potentially eligible study were checked, and knowledgeable people in the field were contacted for additional leads to published reports. SELECTION CRITERIA Studies were included if they (1) examined the effectiveness of an intervention to decrease falls from heights to construction workers, (2) included data on one of the outcomes of interest, and (3) included a comparison group. MAIN RESULTS We identified only three studies for review. An ecologic study found some evidence that regulations with enforcement may decrease falls in construction industry. Two studies on educational efforts suggested that educational programs may decrease falls but methodologic limitations restricted the conclusions that could be drawn. CONCLUSIONS There are few data to support the effectiveness of current programs to decrease fall-related injuries in the construction industry. Rigorous evaluation of these interventions is indicated.

FIT OF BICYCLE SAFETY HELMETS AND RISK OF HEAD INJURIES IN CHILDREN

Background—Although bicycle helmets are effective in preventing head and brain injury, some helmeted individuals nevertheless sustain head injury. One of the possible reasons may be poor fit of the helmet on the head. This study was undertaken to examine the relationship between helmet fit and risk of injury. Methods—1718 individuals who were helmeted riders in a crash were queried on helmet fit and position. A sample of 28 children 2–14 years of age who sustained a head injury while wearing a bicycle helmet and 98 helmeted individuals of the same age treated in the same hospital emergency departments for injuries other than to the head, underwent anthropometric measurements of helmet fit. Measurements were made of the childs head, the helmet, and on a cast made of the childs head. Results—Individuals whose helmets were reported to fit poorly had a 1.96-fold increased risk of head injury compared with those whose helmets fit well. Children with head injuries had helmets which were significantly wider than their heads compared with children without head injuries. Helmet fit was poorer among males and among younger children. Conclusions—Poor fit of helmets may be associated with an increased risk of head injury in children, especially in males. Helmets may not be designed to provide optimal protection.

Management of the injured patient: identification of research topics for systematic review using the delphi technique.

BACKGROUND Systematic reviews of controlled clinical trials in the form of meta-analyses can serve as an important guide to direct clinical practice. This study identifies the most important research questions pertaining to the acute care of the injured patient using a Web-based Delphi technique to achieve consensus of expert opinion. METHODS Experts in trauma care from the United States and Canada (n = 68) were asked to generate structured research questions and were then required to rank these questions in order of importance and estimate the amount of research currently published. RESULTS The questions ranking in the highest tertile are presented along with an estimate of their importance and the amount of research published using an ordinal scale. Only 9 of 16 (56%) questions had some or a substantial amount of research available on which to perform a systematic review. CONCLUSION This study identifies the areas of trauma care in which research efforts might best be directed. In the absence of sufficient data for systematic reviews, these research topics represent important areas for the design and implementation of clinical trials.