Nancy F. Weller

Cultural, social, and intrapersonal factors associated with substance use among alternative high school students

The purpose of this study was to identify cultural, social, and intrapersonal factors associated with tobacco, alcohol, and illicit drug use among students attending dropout prevention/recovery high schools. Four mutually exclusive categories of substance use were used as outcome measures, and religiosity, educational achievement, educational aspiration, family caring, others caring, self-esteem, optimism, coping, depression, loneliness, and self-efficacy were used as predictor variables. In the final multivariate model more family caring and loneliness were inversely associated with marijuana use; young age, more family caring, less coping ability, church attendance, and low educational aspirations were significantly associated with cocaine use. This study demonstrates the importance of health education and health promotion programs for students attending alternative high schools which include prevention of initiation, as well as treatment.

Work-related Injury among South Texas Middle School Students: Prevalence and Patterns

Background Work experiences among early adolescents are largely undocumented. Our purpose was to document the prevalence of work and work-related injury among lower-income Hispanic South Texas middle school students. Methods Anonymous surveys were conducted in classrooms of sixth- through eighth-grade students, and 3,008 students reported current or recent employment. Results The prevalence of work was 56%; mean weekly work hours were 7.7. Increasing weekly work hours were significantly related to work injury (11–20 hours, odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1–1.9; 21+ hours, OR, 2.4; 95% CI, 1.8–3.2, compared with 1–10 hours). The odds of injury were highest for agriculture (OR, 4.4; 95% CI, 3.3–6.0), followed by restaurant (OR, 3.8; 95% CI, 2.7–5.4), construction (OR, 3.6; 95% CI, 2.4–5.2), and yard work (OR, 1.7; 95% CI, 1.4–2.2). Conclusion Working more than 20 hours weekly increased the likelihood of injury among middle school students. Parents and professionals should monitor weekly school-year work hours.

Lifetime inhalant use among alternative high school students in Texas: prevalence and characteristics of users

This cross-sectional study describes the prevalence of lifetime inhalant use and identifies demographic, psychosocial, and other risk behavior characteristics of students reporting lifetime inhalant use. The sample consisted of 354 students attending alternative high schools (dropout prevention/recovery schools) in Texas. The prevalence of lifetime inhalant use was 27.7%. After controlling for potentially confounding factors, students reporting lifetime inhalant use were less likely to be financially supported by their parents/guardians, more likely to use alcohol/tobacco, marijuana, and cocaine, and more likely to carry weapons and consider suicide. Study results may allow school officials, parents, researchers, and health care providers to gain a better understanding of inhalant use among students at risk for dropping out of school, a group which has not been extensively studied by previous researchers.

Cultivating a cycle of trust with diverse communities in practice-based research: A report from PRIME net

PURPOSE Practice-based research networks (PBRNs) are increasingly seen as important vehicles to translate research into practice, although less is known about the process of engaging diverse communities in PBRN research. The objective of this study was to identify strategies for successfully recruiting and retaining diverse racial/ethnic communities into PBRN research studies. METHODS This collaborative, multisite study engaged 5 of the 8 networks of the PRImary care MultiEthnic Network (PRIME Net) consortium that conducts research with traditionally underrepresented/underserved populations. We used a sequential, qualitative research design. We first conducted 1 key informant interview with each of 24 researchers experienced in recruiting research participants from 5 racial/ethnic communities (African American, Arab/Chaldean, Chinese, Hispanic, and Native American). Subsequently, we conducted 18 focus groups with 172 persons from these communities. RESULTS Participants’ comments indicated that successful recruitment and retention of underrepresented populations in PBRN studies is linked to the overall research process. This process, which we termed the cycle of trust, entailed developing and sustaining relationships of trust during 4 interrelated stages: before the study, during study recruitment, throughout study conduct, and after study completion. Participants identified a set of flexible strategies within each stage and called for close engagement with clinic and community partners. CONCLUSIONS Our participants suggest that approaches to research that lay a foundation of trust, demonstrate respect for community members, and extend beyond the enrollment and data collection phases are essential to enhance the participation of diverse populations in PBRN research. These findings offer the PBRN community a guide toward achieving this important goal.

Injuries after Hurricane Katrina Among Gulf Coast Evacuees Sheltered in Houston, Texas

INTRODUCTION After Hurricane Katrina and a decline in the living conditions at a major temporary shelter in New Orleans, Louisiana, residents were offered transport to a Mega-Shelter in Houston, Texas. Approximately 200,000 Gulf Coast residents were transported to Houstons Astrodome/Reliant Center Complex for appropriate triage and transfer to other shelter facilities. The Katrina Clinic was quickly organized to treat evacuees with acute injuries and illnesses as well as chronic medical conditions. Clinic physicians documented 1130 hurricane-related injuries during Katrina Clinics operational interval, September 1-22, 2005. METHODS This article documents the nature, extent, and location of injuries treated at that clinic. We compare the frequency of injury among Katrina evacuees who visited the clinic to that of injuries among clinic outpatient records recorded in a nationally representative database. Using the Barell Matrix system and codes from the International Classification of Diseases, Ninth Revision, we classify Katrina injuries by body region and nature of injury; we also document the large number of hurricane-related immunizations distributed at the temporary outpatient clinic. RESULTS The results show a 42% higher injury proportion among Katrina evacuees and that approximately half of all of the evacuees required immunizations. Lower leg extremity injuries were among the most frequent injuries. DISCUSSION Future planning for hurricanes should take into account nonfatal injuries requiring medical treatment and other supportive care.

Internet-based Training in a Practice-based Research Network Consortium: A Report from the Primary Care Multiethnic Network (PRIME Net)

Background: Continuing growth of the research spectrum of practice-based research networks (PBRNs) creates a need (1) for new approaches to training clinicians in research protocols and (2) to standardize clinician data collection. Each existing training method has shortcomings when used in geographically dispersed PBRNs. We describe here the use and costs of Internet-based training in support of a research protocol across a PBRN consortium. Methods: Clinicians in 4 PBRNs in the PRIME Net consortium participated in training for a study of acanthosis nigricans (AN). We compared results of pre- and posttraining assessments of knowledge and ability to correctly diagnosis AN. We also calculated costs for placement of the training on the Internet. Results: Among 103 participating clinicians, statistically significant increases in knowledge acquisition were demonstrated for all but 2 of the individual topics and in total scores on the assessments. AN diagnostic sensitivity increased from 52% to 99% to 96% to 100%, whereas specificity increased from 70% to 96% to 74% to 97%. Total costs for the web aspects of the training were

Use of Community Engagement Strategies to Increase Research Participation in Practice-based Research Networks (PBRNs)

3732. Conclusion: The Internet can be an effective and feasible alternative method for training clinicians in support of PBRN research.

Weapon carrying prevention: Should adults spend more time with youth?

Purpose: Practice-based research networks (PBRNs) are increasingly encouraged to use community engagement approaches. The extent to which PBRNs engage clinic and community partners in strategies to recruit and retain participants from their local communities (specifically racial/ethnic communities) is the focus of this study. Methods: The design was a cross-sectional survey of PBRN directors in the United States. Survey respondents indicated whether their research network planned for, implemented, and has capacity for activities that engage clinic and community partners in 7 recommended strategies organized into study phases, called the cycle of trust. The objectives of the national survey were to (1) describe the extent to which PBRNs across the United States routinely implement the strategies recommended for recruiting diverse patient groups and (2) identify factors associated with implementing the recommended strategies. Results: The survey response rate was 63%. Activities that build trust often are used more with clinic partners than with community partners. PBRNs that adopt engagement strategies when working with clinic and community partners have less difficulty in recruiting diverse populations. Multivariate analysis showed that the targeting racial/ethnic communities for study recruitment, Clinical and Translational Science Award affiliation, and planning to use community engagement strategies were independent correlates of PBRN implementation of the recommended strategies. Conclusion: PBRNs that successfully engage racial/ethnic communities as research partners use community engagement strategies. New commitments are needed to support PBRN researchers in developing relationships with the communities in which their patients live. Stable PBRN infrastructure funding that appreciates the value of maintaining community engagement between funded studies is critical to the research enterprise that values translating research findings into generalizable care models for patients in the community.

Labor and related injuries among schoolchildren in Palestine: findings from the National Study of Palestinian Schoolchildren (HBSC-WBG2006)

Positive youth involvement with any adult—not just parents—may be protective against adolescent participation in risk behaviors. This cross-sectional study examines the association between adult involvement and weapon carrying among predominantly low-income African American and Hispanic urban high school students. Adult involvement was measured using a 6-item scale that assessed frequency of student participation in activities with an adult; weapon carrying was measured using questions from the Youth Risk Behavior Survey. Almost 20% of high school students reported carrying a weapon at least once during the past month. In the adjusted model, adult involvement was protective against student participation in weapon carrying. School absenteeism caused by safety concerns, threats at school, and substance use were also associated with weapon carrying. Interventions that aim to increase the amount of time youth spend with adults may be beneficial for the prevention of weapon carrying behaviors. Future longitudinal studies are needed to confirm the temporal association between variables.

A cohort study of injuries in migrant farm worker families in South Texas.

Background. Labor related injuries among Palestinian schoolchildren are a significant undocumented public health concern. This study aimed at documenting the prevalence and nature of work related injuries among schoolchildren as well as identifying sociodemographic factors that predict these injuries. Methods. A cross-sectional survey included 15,963 children of whom 6458 (40.8%) completed an optional package related to labor. Students aged 12–18 years self-completed the international WHO collaborative HBSC valid questionnaires between April and May of 2006. Results. Approximately 73.8% of the students who filled the optional package reported working during the last 12 months, of whom 79.1% sustained a work related injury. Work injuries were significantly higher among boys, younger children, and children enrolled in UNRWA schools and living in Gaza Strip (P < 0.05). Children working ≥3 hours/day were more likely to experience injuries, 1.73 (95% CI, 1.53–1.95), than those working ≤3/day. About half of the children worked in retail trade (51.5%), agriculture (20.0%), and cleaning (11.4%). Injury type was related to the type of work performed. Conclusions. The high prevalence of injuries among working Palestinian schoolchildren confirms its severity as a public health problem. To reduce occupational injuries, policymakers and professionals should develop intervention programs that target the public and health providers.