Rachel K. Myers

Relationship Violence Among Female and Male College Undergraduate Students

OBJECTIVES To assess prevalence of victimization and perpetration of relationship violence before and during college, to explore variations by gender, and to examine differences by relationship type. DESIGN Anonymously surveyed students in 67 randomly chosen classes. SETTING Three urban college campuses. PARTICIPANTS Nine hundred ten undergraduate college students aged 17 to 22 years. MAIN OUTCOME MEASURES Self-reported victimization and perpetration of physical, emotional, and sexual violence; relationship to the victim or perpetrator. RESULTS Most (57.1%) students were female, and 58.7% were white, 16.4% black, and 15.1% Asian. Of 910 participants, 407 (44.7%) experienced partner or nonpartner violence: 383 (42.1%) reported victimization and 156 (17.1%) reported perpetration. All victimization and perpetration rates were highest before college. Emotional violence was most common before college (21.1%); during college, sexual and emotional violence were equally common (12.0% and 11.8%, respectively). Women reported more victimization than men, but male victimization was considerable (27.2%). More men perpetrated sexual violence; more women perpetrated physical violence. More than half (130 of 227) of the violence experienced during college was partner related. Students experiencing partner violence during college were more likely to experience physical and emotional violence and were less likely to experience sexual violence. CONCLUSIONS Relationship violence is prevalent among college students and frequently occurs before college. Emotional violence was most frequent before college; sexual and emotional violence were equally common during college. Women reported more victimization than men, but male victimization was common. Men perpetrated more sexual violence; women perpetrated more physical violence. Physical violence and emotional violence were most often committed by partners, while sexual violence was less likely to be partner related.

Using community-based participatory research to develop the PARTNERS youth violence prevention program.

Background: School-based violence prevention programs have shown promise for reducing aggression and increasing childrens prosocial behaviors. Prevention interventions within the context of urban after-school programs provide a unique opportunity for academic researchers and community stakeholders to collaborate in the creation of meaningful and sustainable violence prevention initiatives.Objectives: This paper describes the development of a collaborative between academic researchers and community leaders to design a youth violence prevention/leadership promotion program (PARTNERS Program) for urban adolescents. Employing a community-based participatory research (CBPR) model, this project addresses the needs of urban youth, their families, and their community.Methods: Multiple strategies were used to engage community members in the development and implementation of the PARTNERS Program. These included focus groups, pilot testing the program in an after-school venue, and conducting organizational assessments of after-school sites as potential locations for the intervention.Results: Community members and academic researchers successfully worked together in all stages of the project development. Community feedback helped the PARTNERS team redesign the proposed implementation and evaluation of the PARTNERS Program such that the revised study design allows for all sites to obtain the intervention over time and increases the possibility of building community capacity and sustainability of programs.Conclusion: Despite several challenges inherent to CBPR, the current study provides a number of lessons learned for the continued development of relationships and trust among researchers and community members, with particular attention to balancing the demand for systematic implementation of community-based interventions while being responsive to the immediate needs of the community.

Rear seat safety: Variation in protection by occupant, crash and vehicle characteristics.

OBJECTIVES Current information on the safety of rear row occupants of all ages is needed to inform further advances in rear seat restraint system design and testing. The objectives of this study were to describe characteristics of occupants in the front and rear rows of model year 2000 and newer vehicles involved in crashes and determine the risk of serious injury for restrained crash-involved rear row occupants and the relative risk of fatal injury for restrained rear row vs. front passenger seat occupants by age group, impact direction, and vehicle model year. METHOD Data from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and Fatality Analysis Reporting System (FARS) were queried for all crashes during 2007-2012 involving model year 2000 and newer passenger vehicles. Data from NASS-CDS were used to describe characteristics of occupants in the front and rear rows and to determine the risk of serious injury (AIS 3+) for restrained rear row occupants by occupant age, vehicle model year, and impact direction. Using a combined data set containing data on fatalities from FARS and estimates of the total population of occupants in crashes from NASS-CDS, logistic regression modeling was used to compute the relative risk (RR) of death for restrained occupants in the rear vs. front passenger seat by occupant age, impact direction, and vehicle model year. RESULTS Among all vehicle occupants in tow-away crashes during 2007-2012, 12.3% were in the rear row where the overall risk of serious injury was 1.3%. Among restrained rear row occupants, the risk of serious injury varied by occupant age, with older adults at the highest risk of serious injury (2.9%); by impact direction, with rollover crashes associated with the highest risk (1.5%); and by vehicle model year, with model year 2007 and newer vehicles having the lowest risk of serious injury (0.3%). Relative risk of death was lower for restrained children up to age 8 in the rear compared with passengers in the right front seat (RR=0.27, 95% CI 0.12-0.58 for 0-3 years, RR=0.55, 95% CI 0.30-0.98 for 4-8 years) but was higher for restrained 9-12-year-old children (RR=1.83, 95% CI 1.18-2.84). There was no evidence for a difference in risk of death in the rear vs. front seat for occupants ages 13-54, but there was some evidence for an increased relative risk of death for adults age 55 and older in the rear vs. passengers in the right front seat (RR=1.41, 95% CI 0.94-2.13), though we could not exclude the possibility of no difference. After controlling for occupant age and gender, the relative risk of death for restrained rear row occupants was significantly higher than that of front seat occupants in model year 2007 and newer vehicles and significantly higher in rear and right side impact crashes. CONCLUSIONS Results of this study extend prior research on the relative safety of the rear seat compared with the front by examining a more contemporary fleet of vehicles. The rear row is primarily occupied by children and adolescents, but the variable relative risk of death in the rear compared with the front seat for occupants of different age groups highlights the challenges in providing optimal protection to a wide range of rear seat occupants. Findings of an elevated risk of death for rear row occupants, as compared with front row passengers, in the newest model year vehicles provides further evidence that rear seat safety is not keeping pace with advances in the front seat.

Occurrence of Stalking Victimization Among Female and Male Undergraduate Students

We examined the occurrence of stalking victimization among female and male undergraduate students attending three urban colleges. Specifically, we explored the proportion of students who experienced only stalking victimization and the relationship to the perpetrator identified by victims of stalking. Our findings suggest that stalking victimization is less frequently perpetrated by intimate partners and occurs independent of more commonly measured forms of interpersonal victimization. Given recent changes to the Jeanne Clery Act to include stalking victimization as a mandatorily reportable offense, these results provide insight to college administrators responsible for designing violence-related educational efforts, as well as to health care providers who counsel and provide care to college-aged young adults.

Validation of a parent survey for reporting child injuries

Objective To evaluate the validity of a parent-reported survey to identify childrens moderate and serious injuries in seven specific body regions using medical records as the ‘gold standard’. Methods A prospective validation study was conducted in three urban paediatric emergency departments (EDs). 798 parents of 859 children treated for injuries at participating EDs between August 2010 and July 2011 completed either a telephone interview or self-administered paper survey at 2 weeks post-ED visit. Parents were asked to report child injuries to seven body regions: head, face, neck/spine/back, thorax, abdomen, upper extremities and lower extremities. Injury data were abstracted from medical records using a standardised protocol. Body region injury severity levels of none/minor, moderate or serious were assigned to each subject based on the Abbreviated Injury Scale. Results The overall sensitivity, reflecting parents’ ability to identify a documented moderate or greater severity injury, was 0.95 (95% CI 0.92 to 0.97). Sensitivities were >0.90 for the face, upper extremity and lower extremity regions; 0.80–0.90 for head, abdomen and neck/back/spine regions; and <0.60 for the thorax region. The overall sensitivity for identification of a serious injury was 0.71 (0.60 to 0.80). Conclusions This survey enables parents to accurately identify moderate and greater severity injuries to body regions, though it does not accurately identify serious injuries in most body regions except the extremities. The survey could serve as a screening tool to identify moderate and greater severity injuries in population-based surveillance systems, or as the primary outcome of interest in injury prevention studies.

Extending the value of police crash reports for traffic safety research: collecting supplemental data via surveys of drivers

Background Police crash reports have been used to advance motor vehicle safety research, though their value is limited by their focus on the crash event rather than outcomes of the crash. Objective To develop and evaluate the effect of enhanced recruitment methods, including a monetary incentive, on response rates of drivers identified on police reports in a national MVC surveillance system. Methods The National Automotive Sampling System-General Estimates System (NASS-GES) was used to identify passenger vehicle crashes between 1 July and 30 October 2012 involving drivers ≥16 years old with at least one child occupant ≤17 years old. We collected data from the driver via self-administered hardcopy or interviewer-administered telephone surveys. Within each survey mode, half the drivers were randomly assigned to receive a small monetary incentive. Response rates were calculated overall, and by mode of survey administration and incentive condition. Results 495 drivers were eligible, and 127 completed the survey, yielding an overall response rate of 25.7% (95% CI 21.8% to 29.5%). The response rate across the two modes was higher for those who received an incentive than for those who did not (35.6% vs 15.7%, p<0.01). The highest response rate (45.9%) was for drivers allocated to the telephone survey who received an incentive. Conclusions The NASS-GES provides a surveillance system from which cases of interest can be identified and supplemental data collected via surveys of drivers identified on police reports. We adapted procedures commonly used in public health surveillance systems, including monetary incentives and branded recruitment materials, to improve driver response rates.

Examining a Statewide Educational Consulting Program for Pediatric Brain Injury

This study describes characteristics of students with acquired brain injury enrolled in a statewide educational consultation program and the program’s support activities. Utilizing deidentified data from a statewide brain injury school consultation program, descriptive analyses of demographic and injury characteristics, including medical diagnosis (concussion/mild traumatic brain injury [TBI], moderate-severe TBI, and non-TBI), referral characteristics, educational placement, and the types of program activities were undertaken. 70% of students were referred for concussions/mild TBI and students were infrequently referred by medical professionals. Most students with concussion/mild TBI experienced recreational injuries (59%), while students with moderate/severe TBI commonly experienced road traffic injuries (48%). The greatest proportion of program team members’ time was spent in consultation with school personnel (24%), communication with families (20%), and communication with school personnel (16%). Results suggest that the program addresses important communication and coordination needs among families, medical professionals, and educators and identifies opportunities to enhance program utilization.

Witnessing intimate partner violence as a child: How boys and girls model their parents’ behaviors in adolescence

Childhood witnesses of adult violence at home are at risk for future violence. It is unclear how gender of the child and adult perpetrator are related to adolescent relationship violence. We explore how childhood witnessing of same-gender, opposite-gender, and bidirectional violence perpetrated by adults is associated with adolescent relationship violence victimization only, perpetration only, and combined victimization/perpetration for male and female undergraduates. We gathered cross-sectional data from 907 undergraduates attending 67 randomly-selected classes at three distinct East-Coast colleges using pencil-and-paper surveys administered at the end of class time. Multiple imputation with chained equations was used to impute missing data. Multinomial regression models controlling for gender, age, race, school, and community violence predicted adolescent outcomes for each witnessing exposure; relative risk ratios and average adjusted probabilities with 95% confidence intervals are presented. Adolescent relationship violence outcomes vary based on gender of the child witness and adult perpetrator. Witnessing adult males perpetrate is associated with higher perpetration for boys and higher combined victimization/perpetration for girls. Witnessing adult females perpetrate - either as the sole perpetrator or in a mutually violent relationship with an adult male - increases risk for combined victimization/perpetration for boys and girls during adolescence.

12 Overcoming barriers to addressing youth-identified mental health needs following violent injury through multisystem partnerships

Statement of purpose To identify and address barriers to meeting mental health (MH) needs of violently injured youth participating in a post-injury hospital-based case management program. Methods/approach Utilising de-identified case notes from a stratified random sample of youth (n=24) receiving hospital-based case management following violent injury, we applied a social-ecological framework to code recurring themes pertaining to individual, family, and system barriers and facilitators to successful resolution of youth-identified MH needs. Results Common barriers included: school/work schedules; limited transportation; prior negative experiences with MH care; insufficient provider availability; premature termination of care; and challenging communication between program staff, MH providers, and families. Notably, insurance and cost barriers were infrequently documented, as most youth were insured via a widely accepted public payer. Barriers to initiation of MH care were addressed by streamlining referral processes to community-based MH providers and providing a warm-hand off to reduce youth and family hesitancy to initiate care. To promote engagement and adherence, staff highlighted positive MH experiences and validated therapeutic outcomes, provided logistical support such as transportation and, when possible, provided short-term in-home therapy. Staff also routinely communicated with local MH providers to coordinate care, support transition planning, and encourage adherence. Conclusions We observed individual, family, and systems barriers to youths’ ability to engage in MH care. Support of strong, consistent, positive interpersonal relationships between program staff, injured youth, families, and MH providers addressed many barriers and supported resolution of youths’ MH needs. Significance and Contributions to Injury and Violence Prevention Science Access to trauma-focused mental health services for violently injured youth is essential to facilitate recovery. Partnerships between hospital- and community-based programs may be particularly valuable in addressing mental health barriers among youth following violent injury. Further efforts to systematise and replicate multisystem partnerships will be important in promoting well-being and recovery following violent injury.

Validation of Parent-Reported Injuries to Their Children

Objective: Injury is a leading cause of emergency department visits, disability, and death in children. This study examined the sensitivity and specificity of parental report of children’s specific injuries. Methods: A prospective validation study was conducted in 3 urban pediatric emergency departments from August 2010 to July 2011. Parents of injured children completed a survey at 2-weeks following the emergency department visit, and their responses were compared to injury data that were abstracted from medical records. Results: Parent surveys were completed for 516 injured children. Sensitivities were ≥0.75 for all fractures and ≥0.88 for extremity and skull fractures. Internal organ injuries were generally less accurately reported by parents than fractures. Specificity estimates all exceeded 0.95. Conclusions: This telephone-administered and mailed self-administered survey enabled parents to accurately report specific head and extremity injuries. Practical Applications: This survey may be a useful tool for pediatric injury surveillance activities.