Elise Omaki

A systematic review of technology-based interventions for unintentional injury prevention education and behaviour change.

Objective The aims of this literature review are to (1) summarise how computer and mobile technology-based health behaviour change applications have been evaluated in unintentional injury prevention, (2) describe how these successes can be applied to injury-prevention programmes in the future and (3) identify research gaps. Methods Studies included in this systematic review were education and behaviour change intervention trials and programme evaluations in which the intervention was delivered by either a computer or mobile technology and addressed an unintentional injury prevention topic. Articles were limited to those published in English and after 1990. Results Among the 44 technology-based injury-prevention studies included in this review, 16 studies evaluated locally hosted software programmes, 4 studies offered kiosk-based programmes, 11 evaluated remotely hosted internet programmes, 2 studies used mobile technology or portable devices and 11 studies evaluated virtual-reality interventions. Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours. Kiosk programmes showed evidence of modest knowledge and behaviour gains. Both programmes using mobile technology improved behaviours. Virtual-reality programmes consistently improved behaviours, but there were little gains in knowledge. No studies evaluated text-messaging programmes dedicated to injury prevention. Conclusions There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours.

A smartphone app to communicate child passenger safety: an application of theory to practice

Child passenger safety remains an important public health problem because motor vehicle crashes are the leading cause of death for children, and the majority of children ride improperly restrained. Using a mobile app to communicate with parents about injury prevention offers promise but little information is available on how to create such a tool. The purpose of this article is to illustrate a theory-based approach to developing a tailored, smartphone app for communicating child passenger safety information to parents. The theoretical basis for the tailoring is the elaboration likelihood model, and we utilized the precaution adoption process model (PAPM) to reflect the stage-based nature of behavior change. We created assessment items (written at ≤6th grade reading level) to determine the childs proper type of car seat, the parents PAPM stage and beliefs on selected constructs designed to facilitate stage movement according to the theory. A message library and template were created to provide a uniform structure for the tailored feedback. We demonstrate how messages derived in this way can be delivered through new m-health technology and conclude with recommendations for the utility of the methods used here for other m-health, patient education interventions.

The contribution of the emergency department to opioid pain reliever misuse and diversion: A critical review

Prescription opioid pain reliever (OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department (ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. This study critically reviews seven peer‐reviewed studies that specifically identified the ED as a source of OPRs. Of the OPRs prescribed in the ED, approximately 10% are associated with indicators of inappropriate prescribing, and approximately 42% may ultimately be misused; of the OPRs that are diverted, approximately 10% originate from an ED prescription. Among patients who suffer an OPR‐related death, approximately 1.8% of the OPR pills given to the decedents will have come from the ED. In addition to the need for more research, the existing literature suggests an urgent need for interventions in the ED to reduce OPR misuse and diversion.

Results of an RCT in Two Pediatric Emergency Departments to Evaluate the Efficacy of an m-Health Educational App on Car Seat Use

INTRODUCTION The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting. STUDY DESIGN This RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted. SETTING/PARTICIPANTS Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4-7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area. INTERVENTION A theory-based, stage-tailored educational program, Safety in Seconds v2.0TM, delivered on a mobile app. MAIN OUTCOME MEASURES Four car seat behaviors: (1) having the correct restraint for the childs age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the childs restraint inspected by a child passenger safety technician. RESULTS At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p<0.01) for using the correct car seat; 2.37 (p<0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p<0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p<0.01) and having the car seat inspected (OR=1.73, p<0.01). CONCLUSIONS Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education. TRIAL REGISTRATION Clinical Trial Registration # NCT02345941.

Six-month follow-up of lithium-battery smoke alarms and self-reported reasons for disabling

Although smoke alarms with lithium batteries are often marketed as ‘10-year alarms’, on average, these alarms do not remain functional for 10 years. This paper describes self-reported reasons for non-working lithium-battery alarms 6–9 months following a smoke alarm installation programme. Data presented are for a cohort of 754 homes that participated in the installation programme and subsequently completed follow-up. A total of 1487 smoke alarms were installed. At follow-up, 126 alarms (8%) were missing and 37 (3%) were observed to be non-working. Of the non-working alarms, residents reported that they had been disabled 57% of the time. Reasons for disabling the alarms most often included that the battery was chirping (38%) or that it sounded while someone was cooking (24%). Smoke alarm installation programmes using lithium-battery alarms should consider highlighting education about smoke alarm maintenance, the hush feature and resources to replace alarms that malfunction soon after installation.

Response to Letter to the Editor The Contribution of the Emergency Department to Opioid Pain Reliever Misuse and Diversion: A Critical Review

To the Editor: Thank you for inviting us to reply to your reader’s response to our review article addressing the impact of the emergency department (ED) on the opioid abuse epidemic. We agree wholeheartedly with the reader that the specialty of emergency medicine has positioned itself as a leader in the field of safer opioid prescribing practices, and it is precisely for this reason that we sought to characterize the impact of ED providers on the opioid epidemic. ED providers will continue to be leaders in opioid pain reliever (OPR) safety innovation, but it is only by understanding our role in the epidemic that we can thoughtfully move forward with further advances in curbing this public health crisis. There is a notable paucity of literature specifically assessing ED OPR prescribing and future opioid misuse and abuse. The data that do exist, although in some cases dated, provide a meaningful starting point for understanding one aspect of this multifaceted epidemic. These data provide an important foundation for developing and implementing evidence-based programs and policies in the ED to reduce opioid misuse and abuse. The reader rightly points out that ED providers typically provide short courses of OPRs; however, multiple studies have demonstrated that initial opioid exposure among opioid-na€ıve patients increases the risk for future opioid use disorders—a phenomenon that develops despite short opioid supply. Further, a recent study by Barnett et al. demonstrates that there is considerable variation in the rate of OPR prescribing among different ED providers, and that patients treated by high-intensity OPR prescribers have a greater probability of becoming long-term opioid users. The currently available literature does not quantify possible differences in the risk for further opioid abuse based on initial prescribing environment. However, if one assumes that the risk remains constant across environments, the conclusion can be made that ED providers’ decision to prescribe an OPR to opioid-na€ıve patients can have significant downstream public health effects, based on the sheer volume of patients exposed to OPRs in the ED. Despite research efforts, there remain significant gaps in our knowledge of the epidemiology of opioid misuse and abuse. Identifying how opioids obtained in the ED contribute to the epidemic is an important step in addressing this challenge.

Predictors of Participation in a Fire Department Community Canvassing Program

An urban fire department has been distributing free smoke alarms for more than 30 years. A community–academic partnership was developed to conduct a community intervention trial as part of the fire department’s home visiting program. The trial comprised 170 canvassing events held across 12 census tracts; half of the census tracts were assigned to the treatment condition and received prepromotion of the home visit events. The objectives of this analysis were to identify environmental and programmatic predictors of 1) whether someone would be at home at the time of a visit, and 2) if at home, whether the resident would participate. A separate multilevel analysis was conducted to address each objective. The canvassing event served as the first level to account for variation in implementation of the program, with the census tract as the second level. All environmental and program characteristics were included as fixed effects in both models. Throughout 170 events, 8080 eligible residential addresses were visited, of which 3216 had someone at home, and 2197 homes participated in the program. Canvassing events held on weekends and during the evening hours was associated with higher odds of a resident being at home. Canvassing events without rain and held in the treatment census tract areas was associated with higher odds of resident participation. Environmental and programmatic factors can impact the reach of home visiting programs. These findings can contribute to emerging best practices for fire department home visiting programs.

Using m-health tools to reduce the misuse of opioid pain relievers

Background Emergency department (ED) patients are among the many groups at risk for prescription drug overdose. There is limited research on how best to communicate with ED patients about options for pain management and the risks of opioids. The aim of this study is to pilot test a web-based, patient-centred educational programme that encourages the patient to have an informed discussion about pain medication options with their ED provider. Methods This multisite, randomised trial will evaluate an m-health programme designed to aid the patient in making an informed decision about their pain treatment. Patients reporting to the ED with an injury-related or pain- related chief complaint who agree to participate are randomised to receive the intervention programme, My Healthy Choices, or an attention-matched control. My Healthy Choices pairs tailored education with a patient decision aid to describe what opioid and non-opioid pain medications are, assess the patients risk factors for opioid-related adverse effects, and produce a tailored report that patients are encouraged to share with their doctor. Data are collected through surveys at three time points during the ED encounter (baseline, immediately after the intervention and just before discharge), and at a 6-week follow-up survey. The primary outcomes are whether the patient prefers an opioid pain reliever (OPR) and whether the patient takes an OPR. Discussion We hope this programme will facilitate patient-provider communication, as well as reduce the number of prescriptions written for OPRs and thus the number of patients exposed to prescription opioids and the associated risks of addiction and overdose. Trial registration number NCT03012087; Pre-results.

334 Using social media to improve participation in a smoke alarm distribution and installation program

Background In 2014, residential fires caused 2745 civilian deaths in the United States (US) and almost 12,000 injuries. Smoke alarms are an effective intervention for reducing residential fire deaths. Innovative strategies are needed to improve the prevalence of working smoke alarms in homes. We used Facebook advertising to encourage participation in a free smoke alarm installation program in one US city. Methods As part of a larger evaluation of an enhancement to a smoke alarm distribution program, we developed three ads that ran on Facebook throughout October 2014 with a US

120 Smart phone app to promote correct car seat use: results from a randomised controlled trial

100 daily budget. The ads included three different images and a motivational message. The ads appeared on the news feeds and mobile news feeds of adult Baltimore City residents. Results The three ads delivered to desktop and mobile device news feeds resulted in 465,666 impressions and reached 130,264 discrete users (43% of those 300,000 users estimated to be eligible). Most users viewed the ads on a mobile device (99%). Of the Facebook users reached, 4,367 different users (3.4% unique click-through rate) clicked the ad. Some users clicked through more than once, resulting in 6,075 total clicks. Mobile devices yielded higher click-through rates than desktops (1.31% and 0.36% respectively). Of the 4,367 unique clicks, nearly all (4,357) came from mobile devices. The cost per impression was less than one cent. We spent two cents to reach each user, and 70 cents on each unique user who clicked on the ad. For those 25 participants who requested a smoke alarm installation and cited Facebook as their information source about the program, we spent