Jonathan Purtle

Hospital-based violence intervention programs save lives and money.

I prevention activities are a defining characteristic of the modern trauma center. Violent injuryVwith a 5-year reinjury rate as high as 45%Vrepresents a priority area for preventive intervention. Advances in trauma care increase the likelihood that a patient will survive violent injury but do nothing to reduce the chances that they will be reinjured after leaving the hospital. The recurrent nature of violent injury strains trauma systems financially, and the absence of preventive intervention is inconsistent with trauma centers’ commitment to providing optimal care. Hospital-based violence intervention programs (HVIPs) offer a strategy to address these issues. HVIPs combine brief in-hospital intervention with intensive community-based case management and provide targeted services to high-risk populations to reduce risk factors for reinjury and retaliation while cultivating protective factors. Rigorous evaluations of HVIPs have demonstrated promising results in preventing violent reinjury, violent crime, and substance misuse. Violent injury, as a focus of HVIPs, is generally defined as any injury intentionally inflicted by another person by any mechanism, excluding family, intimate partner, and sexual violence. The latter are excluded because they generally involve different dynamics and intervention strategies.

The Prevalence of Trauma and Childhood Adversity in an Urban, Hospital-Based Violence Intervention Program

Hospitals represent a promising locus for preventing recurrent interpersonal violence and its psychological sequella. We conducted a cross-sectional analysis to assess the prevalence of post-traumatic stress disorder (PTSD) and adverse childhood experiences (ACEs) among victims of interpersonal violence participating in a hospital-based violence intervention program. Participants completed PTSD and ACE screenings four to six weeks after violent injury, and data were exported from a case management database for analysis. Of the 35 program participants who completed the ACE and/or PTSD screenings, 75.0% met full diagnostic criteria for PTSD, with a larger proportion meeting diagnostic criteria for symptom-specific clusters. For the ACE screening, 56.3% reported three or more ACEs, 34.5% reported five or more ACEs, and 18.8% reported seven or more ACEs. The median ACE score was 3.5. These findings underscore the importance of trauma-informed approaches to violence prevention in urban hospitals and have implications for emergency medicine research and policy.

Felon disenfranchisement in the United States: a health equity perspective.

Approximately 13% of African American men are disqualified from voting because of a felony conviction. I used ecosocial theory to identify how institutionalized racism helps perpetuate health disparities and to explore pathways through which felon disenfranchisement laws may contribute to racial health disparities in the United States. From a literature review, I identified 2 potential pathways: (1) inability to alter inequitable public policies that differentially allocate resources for health; and (2) inability to reintegrate into society by voting, which contributes to allostatic load.

Cost−Benefit Analysis Simulation of a Hospital-Based Violence Intervention Program

BACKGROUND Violent injury is a major cause of disability, premature mortality, and health disparities worldwide. Hospital-based violence intervention programs (HVIPs) show promise in preventing violent injury. Little is known, however, about how the impact of HVIPs may translate into monetary figures. PURPOSE To conduct a cost-benefit analysis simulation to estimate the savings an HVIP might produce in healthcare, criminal justice, and lost productivity costs over 5 years in a hypothetical population of 180 violently injured patients, 90 of whom received HVIP intervention and 90 of whom did not. METHODS Primary data from 2012, analyzed in 2013, on annual HVIP costs/number of clients served and secondary data sources were used to estimate the cost, number, and type of violent reinjury incidents (fatal/nonfatal, resulting in hospitalization/not resulting in hospitalization) and violent perpetration incidents (aggravated assault/homicide) that this population might experience over 5 years. Four different models were constructed and three different estimates of HVIP effect size (20%, 25%, and 30%) were used to calculate a range of estimates for HVIP net savings and cost-benefit ratios from different payer perspectives. All benefits were discounted at 5% to adjust for their net present value. RESULTS Estimates of HVIP cost savings at the base effect estimate of 25% ranged from

Health awareness days: sufficient evidence to support the craze?

82,765 (narrowest model) to

The Legislative Response to PTSD in the United States (1989–2009): A Content Analysis

4,055,873 (broadest model). CONCLUSIONS HVIPs are likely to produce cost savings. This study provides a systematic framework for the economic evaluation of HVIPs and estimates of HVIP cost savings and cost-benefit ratios that may be useful in informing public policy decisions.

A Case Study of the Philadelphia Sugar-Sweetened Beverage Tax Policymaking Process: Implications for Policy Development and Advocacy

Health awareness initiatives are a ubiquitous intervention strategy. Nearly 200 health awareness days, weeks, and months are on the US National Health Observances calendar, and more than 145 awareness day bills have been introduced in Congress since 2005. We contend that health awareness days are not held to appropriate scrutiny given the scale at which they have been embraced and are misaligned with research on the social determinants of health and the tenets of ecological models of health promotion. We examined health awareness days from a critical public health perspective and offer empirically supported recommendations to advance the intervention strategy. If left unchecked, health awareness days may do little more than reinforce ideologies of individual responsibility and the false notion that adverse health outcomes are simply the product of misinformed behaviors.

Infusing Science into Politics and Policy: The Importance of Legislators as an Audience in Mental Health Policy Dissemination Research

Although knowledge about posttraumatic stress disorder (PTSD) has grown over the past 40 years, PTSD policy research is undeveloped. This gap in knowledge warrants attention because policy is among the most powerful tools to prevent and mitigate the effects of PTSD. This study provides a content analysis of all bills introduced in U.S. Congress that explicitly mentioned PTSD. All bills and bill sections mentioning PTSD were coded to create a legislative dataset. Bills that addressed traumatic stress, but did not mention PTSD, were also identified as a comparison group. One hundred sixty-one PTSD explicit bills containing 382 sections of legislative text were identified, as were 43 traumatic stress, non-PTSD bills containing 55 sections (the 2 categories were mutually exclusive). Compared to traumatic stress, non-PTSD sections, PTSD explicit sections were far more likely to target military populations (23.6% vs. 91.4%) and combat exposures (14.5% vs. 91.4%). PTSD, as a discrete diagnostic entity, has been largely defined as a problem unique to combat exposure and military populations in federal legislation. Research is needed to understand knowledge and perceptions of PTSD among policy makers and the public to inform science-based advocacy strategies that translate the full spectrum of PTSD research into policy.

Local Health Departments’ Level of Engagement in Population Mental Health Promotion

Context: Policymakers are increasingly proposing sugar-sweetened beverage (SSB) taxes as an evidence-based strategy to reduce chronic disease risk; and local health departments (LHDs) are well-positioned to play a role in SSB policy development and advocacy. However, most SSB tax proposals fail to become law and limited empiric guidance exists to inform advocacy efforts. In June 2016, Philadelphia, Pennsylvania, passed an SSB tax. Objective: To identify features of the Philadelphia SSB tax policymaking process that contributed to the proposals passage. Design: Qualitative case study. Semistructured interviews were conducted with key informants closely involved with the policymaking process. Interviews were audio-recorded and transcribed. Local news media about the SSB tax proposal were analyzed to triangulate interview findings. Analysis was conducted in NVivo 10 using inductive qualitative content analysis. Setting: Philadelphia, Pennsylvania, during the SSB tax policymaking in process. Participants: Nine key informants (2 city councilpersons, 4 city agency officials, 1 community-based advocate, 1 news reporter, and 1 researcher). Results: The Philadelphia SSB tax proposal was introduced with the explicit goal of financing universal prekindergarten and deliberately not framed as a health intervention. This framing shifted contentious debates about government involvement in individual behavior toward discussions about how to finance universal prekindergarten, a goal for which broad support existed. The LHD played an important role in communicating research evidence about potential health benefits of the SSB tax proposal at the end of the policymaking process. Conclusions: During local SSB tax policy development processes, LHD officials and other advocates should encourage policymakers to design SSB tax policies so that revenue is directed toward community investments for which broad public support exists. When communicating with policymakers and the public, LHDs should consider emphasizing how SSB tax revenue will be used in addition to presenting evidence about the potential health benefits of the SSB tax at the local level.

The Psychological Sequelae of Violent Injury in a Pediatric Intervention

Legislators (i.e., elected Senators and House Representatives at the federal- and state-level) are a critically important dissemination audience because they shape the architecture of the US mental health system through budgetary and regulatory decisions. In this Point of View, we argue that legislators are a neglected audience in mental health dissemination research. We synthesize relevant research, discuss its potential implications for dissemination efforts, identify challenges, and outline areas for future study.