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Unintentional Injury

CDC-RFA-CE07-007
Dissemination Research on Fall Prevention: “Stepping On” in a U.S. Community Setting

Jane E. Mahoney, M.D.
The Board of Regents of the University of Wisconsin System
2870 University Avenue
Madison, WI  53705
Phone: 608‑262‑8597
E‑mail: jm2@medicine.wisc.edu

Grant Number: CE001288
Project Title: Dissemination Research on Fall Prevention: "Stepping On" in a Wisconsin Community
Project Period: 09/15/2007 ‑ 09/14/2011

Abstract:

“Stepping On” is an effective fall prevention intervention that has been tested in Australia. However, data regarding the use of this intervention in the United States are lacking. This study will examine several questions regarding dissemination including feasibility in rural versus urban settings, feasibility of uptake by different community organizations such as parish nurse, senior housing, or senior center, feasibility and effectiveness of home visit versus phone call following the 7-week class sessions, and effectiveness of the model when delivered by a professional without a health degree. Adherence and outcomes may vary according to different implementation settings, leaders, and populations served.  We propose to develop “Stepping On” for a United States setting, maintaining fidelity with the original program. Our process will begin with focus groups to evaluate existing materials and advise on revisions.  In addition, we will seek input from leaders and learners who have piloted “Stepping On” previously in several Wisconsin sites. Content experts will assist with refinement of materials, and all materials and evaluation tools will again be tested with the focus group. We will pilot implementation in our first setting then revise materials. We will then implement and evaluate “Stepping On” in three community settings in Wisconsin. In all settings, we will evaluate feasibility of implementation, population served, fidelity to the original model, participant attendance, participant adherence with exercise logs and recommendations, and participant outcomes. In the first setting, a senior apartment community, “Stepping On” will be implemented by a health-degree professional leader and then by a non-health-degree professional leader.  The second and third sites will test implementation by a parish nurse and by a senior center, with one location being urban, and one rural. The first group in each setting will receive a home visit following their 7 sessions, and the second a phone call instead of the home visit. Based on our findings from these evaluations, we will produce a final package of “Stepping On” for broad dissemination and use nationwide. This proposal builds on our previous collaboration with Dr. Clemson in implementing “Stepping On” in Wisconsin. In addition, we bring to this proposal a strong history of academic-community partnerships in falls prevention, which has resulted in high quality, fruitful research. Lastly, we bring an established track record in dissemination research in injury prevention through the Injury Research Center in Milwaukee, Wisconsin.

Past Awards

Unintentional Injury Prevention Research 

Grantee Abstracts

Beth Ebel, MD, MSc, MPH
University of Washington
Harborview Injury Prevention and Research Center
325 9th Avenue, Box 359960
Seattle, WA 98104
Phone: 206-521-1550
Fax: 206-521-1562
E-mail: bebel@u.washington.edu

Project Title: Dissemination of Booster Seat Community Intervention
Project Period: 09/30/03–09/29/06

Description: Belt-positioning booster seats are a relatively new technology for better protecting child occupants who have outgrown child seats but do not yet fit into adult seatbelts. However, communities in which children may be at highest risk of injury may be slow to adopt this new technology.
We hypothesize that parents whose children are still not using booster seats face different barriers to their consistent use, including language barriers, cultural beliefs, and economic factors. This project will use ethnographic research methods (i.e., elicitation interviews, focus group studies) to better understand behavioral barriers to booster seat use. These results will be used to develop a tailored community intervention based on theoretical models of health behavior. Intervention components will be based on social marketing methods and the findings from the qualitative research above. We will include elements that were effective in earlier work, including a discount coupon, dissemination of simple and clear messages, media dissemination through channels identified by Latino participants, development of a Latino community advisory council, and participatory research methods. The effectiveness of the intervention will be assessed in a controlled community trial. Booster use and child passenger safety practices will be assessed through direct observation. Secondary outcomes include adult restraint use, measures of message dissemination, and capacity building. The long-term goal of these inter-related projects is to disseminate a proven child safety technology to Latino families in order to better protect children in motor vehicle crashes.
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Susan Scavo Gallagher, MPH
Education Development Center, Inc.
55 Chapel Street
Newton, MA 02458-1060
Phone: 617-618-2206
Fax: 615-969-9186
E-mail: sgallagher@edc.org

Project Title: Childhood Rear Seating among the Hard-to-Reach
Project Period: 10/01/03–09/30/06

Description: The Education Development Center, Inc. (EDC) and the Harvard Injury Control Research Center (HICRC) will disseminate a successful prevention strategy to increase child rear seating in a low-income, ethnically diverse community (Brockton, MA) with a substantial Cape Verdean population. It has been known for decades that the rear seat is safer than the front seat for child occupants; however, widespread change in seating patterns has not occurred. This project builds on the successful CDC-funded, community-based Niňos Atras program and will be led by the same research team. The theoretical basis for the intervention is rooted in principles of behavioral science, namely diffusion of innovation and social marketing theories, which will guide the design of materials and activities. An incentive program that is compatible with both behavioral models will be a key component. Using formative research (e.g., focus groups, key informant interviews), culturally appropriate materials and activities will be developed and disseminated in collaboration with a community coalition, to be led by a full-time, bilingual community coordinator who is also a Brockton resident. The dissemination strategy will place particular emphasis on ensuring that educational materials and strategies target populations hardest to reach, as informed by the Niňos Atras program: males; minority racial or ethnic groups (i.e., Cape Verdean, Haitian, and Hispanic); and low-income, low-literacy families. The primary outcome, child rear seating, will be assessed by observational study. Adult seat belt use will be a secondary outcome. Additional outcome measures include changes in knowledge and attitude toward child rear seating as assessed by brief driver interviews; intensity and penetration of the intervention as assessed by process measures and interviews; program institutionalization as assessed by key informant interviews; and cost-effectiveness analysis.
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Robert Cole, PhD
University of Rochester
School of Nursing
601 Elmwood Avenue Box SON
Rochester, NY 14642
Phone: 585-275-0508
Fax: 585-273-1270
E-mail: robert_cole@urmc.rochester.edu

Project Title: A Dynamic Model of Supervision and Injury among Children
Project Period: 8/1/04–7/31/07

Description: This project will develop and validate a new, comprehensive, and developmentally sensitive measure of supervision. Supervision is widely believed to be a critical component of injury prevention, yet there is relatively modest empirical support for this position. It is believed current measures are inadequate to capture the complexity of the construct of supervision. This limited support also may result from an over-reliance on maternal self-report. The investigators seek to expand the current focus on how adults structure supervision (through the creation of rules and the direct monitoring of their children) to include how adults assess the risk inherent in a situation and their role in ameliorating this risk, and how they implement their approach to supervision. The Health Belief Model will be employed to establish the factors that influence adults’ assessment of risk and whether or not they need to act to reduce that risk. Children may be injured in situations not because of a failure of supervision per se, but rather because of a failure to appreciate the risk or the opportunity to intervene. In addition, effective supervision has a dynamic aspect requiring sensitivity to subtle cues to changes in the child's location or behavior and a willingness and ability to act quickly. Finally, the supervision framework must facilitate the child's internalization of safety rules and behaviors. As children grow and spend more time in unsupervised settings, it is the internalization of these rules that will provide ongoing injury prevention.

In this project, a new self-report measure will be developed of this expanded conceptualization of supervision as well as an observational measure of supervision for parents of preschool children and a child self-report measure of risk-taking and rule compliance for older children. Content validity will be assessed through an expert panel and racially and sociodemographically diverse focus groups. The value of the observation and child self-reports will be determined by examining (a) predicted developmental changes, (b) concordance among the three sources of data, (c) predicted differences among known groups, and (d) the correlation with self-reported medically attended injuries.
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Andrea C. Gielen, ScD
The Johns Hopkins University
Bloomberg School of Public Health
624 N. Broadway Hampton House, Room 557
Baltimore, MD 21205
Phone: 410-955-2397
Fax: 410-614-2979
E-mail: agielen@jhsph.edu

Project Title: Evaluating Child Safety Product Dissemination and Education
Project Period: 8/1/04–7/31/07

Description: This project builds on previous CDC-funded research involving a Mobile Safety Center (MSC), developed to deliver safety products and education to low-income, urban families. Specific aims of this project are to (1) compare observed safety behaviors, safety knowledge, and prevention beliefs between a sample of MSC visitors and a comparable sample of non-visitors; and (2) using the Precaution Adoption Process Model (PAPM), describe families' readiness to adopt safety behaviors and monitor stage changes over time in a sample of MSC visitors and non-visitors.

Researchers will use a quasi-experimental design to compare a sample of Medicaid families with children ages 0 to 5 from the Johns Hopkins Community Physicians clinics who are recruited when they visit the MSC with a similar sample from the same clinics who have not visited the MSC. A total of 200 families will complete a baseline interview and two follow-up interviews and in-home assessments at 1 to 2 weeks and 6 months after study enrollment. Interviews will measure a parent's safety knowledge, prevention beliefs, injury history, sociodemographic characteristics, exposure to the MSC, and stage in the PAPM for three safety behaviors (smoke alarm use, poison storage, and car safety seat use). The home assessments will document observations of each of these three safety behaviors. Multiple regression analysis, which will allow researchers to adjust for differences between study groups, will be undertaken to address the study aims and test hypotheses regarding the benefits of visiting the MSC. Results of this study will enhance the theory-based and scholarly understanding of parents' safety behaviors. Findings will provide strong evaluation data on the MSC model approach to disseminating safety products. Taken together, the results should be helpful to researchers and practitioners alike who continue to seek ways of effectively disseminating safety products.
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Beth A. Mueller, PhD
University of Washington
Harborview Injury Prevention and Research Center
325 9th Avenue, Box 359960
Seattle, WA 98104-2499
Phone: 206-521-1545
Fax: 206-521-1562
E-mail: bmueller@fhcrc.org

Project Title: Case-control Study of Head Injury in Relation to Ski Helmet Use
Project Period: 8/1/04–7/31/07

Description: This case-control study will investigate the extent to which the use of ski helmets is associated with a reduction in head injury occurrence among individuals who have sustained falls or collisions while skiing or snowboarding. Existing data for all individuals with Ski Patrol-attended injuries as a result of these events will be accessed from Ski Patrol Incident Report Forms from four ski resorts in the two western United States for the years 2001–2005 (four ski seasons). These data, collected for all Ski Patrol-attended injuries and illnesses using a generally standardized form, include information about the injury (body part and injury type), injury event (fall, collision with skier, collision with object, etc.), type of equipment (ski, snowboard, etc.), and helmet use. Other information available to evaluate possible confounding, or to identify subgroups who may benefit most from helmet use, includes age, gender, skier ability, snow conditions, skier skill level and experience, trail rating/location (beginner, advanced, off-trail, etc.), presence of other medical conditions or prior injury, and indicators of injury severity (whether air-lift required, ambulance, returned to skiing, etc.). Cases will be all persons with head injuries (with or without brain injury indicated by the presence of concussion or other indicators of brain injury). Controls will be identified from among the remaining individuals with Ski Patrol-attended injuries sustained as a result of a fall or collision and will consist of persons with injuries below the neck only. Using multivariable methods, helmet use at the time of the fall or collision will be compared among cases and controls to measure the association of ski helmet use with head injury occurrence, and with the occurrence of brain injury. The extent to which any helmet-injury association differs among skiers and snowboarders, or by age group, will also be examined. Results of this study are important to inform skiing and snow safety campaigns aimed at reducing these recreational injuries.
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Carri Casteel, BS, MPH, PhD
University of North Carolina-Injury Prevention Research Center
137 E Franklin St, Suite 500, CB# 7505
Chapel Hill, NC 27599-7508
Email: ccasteel@email.unc.edu

Project Title: Dissemination Evaluation of an Older Adult Falls Prevention Program
Project Period: 9/1/05-8/31/08

Description: Falls are the leading cause of unintentional home injury and death among older adults in the United States. Over 50% of fatal and nonfatal fall injuries occur in the home. Outside of the home, senior centers provide a gathering place for older adults and are common in communities throughout the United States, as 11,500 of them serve as sources of both information and support for their clientele. As such, they are potentially powerful mechanisms for delivering injury control interventions to community-dwelling older adults. This proposed study will identify effective methods of disseminating a falls prevention program to senior centers to increase its likelihood of adoption and implementation among older adults.

Project aims are to assess the perceived needs for, and barriers to, adoption and implementation of Safe Steps, a falls prevention program in senior centers; examine the effectiveness of two enhanced dissemination strategies, compared with a mail-out only strategy to promote senior center and older adult adoption and implementation of Safe Steps; identify organizational-level factors that predict increased adoption and implementation of Safe Steps by senior centers; and to identify individual-level factors that predict increased adoption and implementation of Safe Steps by older adults. The aims of the project will be examined by conducting a needs assessment with a national sample of 510 senior centers. Researchers will also use a randomized controlled trial of 180 senior centers equally randomized into: (1) Safe Steps as a mail-out; (2) Safe Steps with a training component aimed at assisting senior center staff in program delivery; or (3) Safe Steps with a dissemination strategy to address the barriers identified in the needs assessment. Successful project outcomes will lead to more effective dissemination and increased adoption and implementation of the Safe Steps program to prevent older adult falls. Learning about factors that contribute to successful dissemination of an injury program will also prove useful for other injury interventions targeting these adults.
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Ted Nirenberg, PhD
Injury Prevention Center
RI Hospital/POB 3rd Floor, Rm 334
593 Eddy Street
Providence, RI 02903
Email: tnirenberg@lifespan.org

Project Title: Reducing Youthful Dangerous Driving
Project Period: 9/1/05-8/31/08

Description: Motor vehicle crashes (MVC) are the most prevalent causes of fatalities among 16 to 20 year olds. To date, interventions to reduce driving offenses have had an unknown impact on adolescent drivers.

This study will test whether reducing youthful dangerous driving (RYDD) (trauma room exposure with motivational interviewing) in comparison to Prototypic Community Service (PCS) will change attitudes toward risky driving behaviors post treatment; reduce alcohol use and high-risk driving behaviors at 6 month follow-up; reduce driving offenses at 12 month follow-up; and reduce the number of MVCs at 24 month follow-up. Court-mandated youth (n=500) convicted of a high-risk driving offense are randomly assigned to one of two 16-hour program interventions (RYDD or PCS) and followed for one to two years. Subsequent infractions are measured through a combination of court records and self-report. To facilitate the dissemination of the RYDD program, the investigators will determine for whom it works best (Aim 2) and how it works (Aim 3) by examining a number of proposed mediators and moderators. Positive results from this study would be embraced by state and national leaders within the judicial and traffic safety communities and implemented in other courts to strengthen efforts to reduce MVCs among young drivers.
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Peek-Asa, Corinne
The University of Iowa
Occupational and Environmental Health
100 Oakdale Campus 114 IREH
Iowa City, IA 52242
E-mail: corinne-peek-asa@uiowa.edu

Project Title: Evaluation of a Parent/Teen Driving Safety Program
Project Period: 9/1/2006 – 8/31/2009

Drivers in their first six months of licensure have the highest crash rates of all drivers, leading to high rates of injury for themselves, their passengers, and those they hit. Parents play a critical role in the driving experience of their children. Policy approaches, such as Graduated Driver's Licensing Systems, and educational programs that encourage parents to define driving rules and restrictions have shown some success in reducing teen risky driving. However, methods to increase parental involvement in teaching driving skills and encouraging safe driving behaviors have not been widely tested. Such interventions can augment existing GDL systems by increasing parental knowledge and involvement in learning to drive. The long-range goal of this research is to develop a sustainable and generalizable intervention that will reduce crashes and related injuries among teen drivers by increasing safe driving practices. We propose to conduct a randomized trial of an educational intervention for parents of newly licensed teenaged drivers to increase parental involvement in teaching driving skills and safe driving behavior. Six schools in small towns in the state of Iowa have agreed to participate. These schools are all within 50 miles of Des Moines, Iowa's largest city, which will lead to driving exposure in rural and town environments. The intervention will have two components: the intervention content and the intervention delivery. The intervention content includes specific driving goals that parents meet with their teen drivers that focus on skills and behavior. This project will be conducted in a rural population, so skills for driving on rural roads will be included. The delivery of the intervention will use motivational interviewing, a successful and age appropriate health behavior communication technique that has shown great success in related health fields. 250 parents and their teens will be individually randomized into intervention and control groups. The intervention group will receive a tailored, in-person intervention with a Traffic Safety Specialist, with follow-up intervention phone calls at one, three, and six months. The control group will be a "usual care" group who will receive driving safety materials available to all new drivers and their parents. Parents and teens will be followed to see if intervention parents meet the intervention's driving goals and to see if the parent and teens report improved driving skills and behaviors in the intervention compared with the control group.
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Morrongiello, Barbara A
University of Guelph
Psychology Dept, MacKinnon Building
College of Social and Applied Health Sciences
Guelph, Ontario, N1G 2W1
E-mail: bmorrong@uoguelph.ca

Project Title: Test of an intervention to increase home supervision of young children
Project Period: 9/15/2006 – 9/14/2009

In the U.S. unintentional injuries rank as the leading cause of death and a major cause of hospitalization and disability for children beyond 1 year of age. Preschool-aged children are frequently injured at home. This fact has led to an increasing focus on the nature and scope of supervision provided by caregivers of young children. The proposed research aims to develop an evidenced-based, theoretically-motivated intervention to improve the quality of supervision provided children by caregivers and to systematically evaluate the impact of this intervention on both parent supervision and children's frequency of home injury.

Diverse literatures (persuasion research, therapeutic intervention strategies, behavioral change theories and evidence) were consulted to determine when the program should be delivered, what should be the focus, and how best to communicate information to maximize effectiveness. The intervention will be timed to coincide with a teachable moment (proximal to a child injury occurrence); will comprise multiple components that target key cognitions (vulnerability for injury, potential injury severity, benefits of close supervision for prevention, self efficacy in supervising) and emotions (fear) that have been linked to risk decisions; and will use a video-exposure format with numerous subsequent activities to promote motivation to change, development of skills necessary for close supervision, and instantiation of this practice as a behavioral habit.

Participants will be primary caregivers of a child in one of two age groups (2-3 years, 4-5 years), randomly assigned to groups, with intervention and control groups matched on key demographic factors. Numerous behavioral, observational, and questionnaire measures of childhood injury and caregiver supervision will be taken pre- and post-intervention (3, 6 and 12 months after).

Regression and ANOVA analyses will determine (1) if the intervention increases supervisory behaviors and reduces children's injury rates; (2) if these effects persist through 3, 6 and 12 months post-intervention, and (3) if other child or parent behavioral attributes that have been related to injury risk in prior research moderate or mediate the extent of effectiveness of the intervention. The research addresses a substantive gap in the injury-prevention literature and the findings will provide a solid foundation for future intervention work on the important topic of how to promote caregiver supervision to reduce child-injury risk.
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Howland, Jonathan
Boston University Medical Campus
715 Albany Street, 560
Boston, Massachusetts 02118-2526
E-mail: jhowl@bu.edu

Project Title: Acute and residual effects of beer vs. caffeinated beer on simulated driving
Project Period: 9/1/2006 – 8/31/2009

Importance: Hingson and Howland (2002) estimated that 1,138 college students die from alcohol-related traffic crashes annually. An additional 307 college students die annually from alcohol-related non-traffic unintentional injuries and 500,000 college students annually sustain alcohol-related injuries (Hingson and Howland 2002). Caffeinated alcoholic beverages target young adults with the promise that the caffeine will counteract the sedating effects of alcohol and thus let the consumer remain alert and active longer, while continuing to drink. If young people erroneously believe that caffeine in beer will protect them from alcohol-related injury, then such beverages may increase mortality and morbidity in this population. Thus, it is important to have accurate information about the extent to which such beverages affect impairment both acutely and residually. Such information could correct misunderstandings young people have about the relative safety of caffeinated beer and thereby reduce injury. The study could have implications for safety-sensitive occupations as well. It is common for people to use caffeine to counteract the sedative effects of alcohol. If, however, the alcohol and caffeine interact to yield greater impairment in next-day performance, workers should be aware of this, particularly if their jobs have low tolerance for error. This study, to our knowledge, will be the first to compare the acute and residual effects of caffeinated and non-caffeinated beer on driving performance.

Objectives: The aim of this study is to develop information about the acute and residual effects of a new product being targeted to young adults. It is important to understand the effects of caffeinated alcoholic beverages early on in the marketing campaign so that if they pose a greater threat to pubic health than traditional alcoholic beverages, (1) consumers can be educated and (2) policy-making can be informed with accurate information. We will compare the acute and residual effects on driving impairment of caffeinated and non-caffeinated beer to each other and to placebo when participants have received sufficient alcoholic beverage to attain a blood alcohol concentration (BAG) of .12%,

Study Design: We will conduct a placebo-controlled trial using a 2 X 2 mixed-model study design. The within-subjects factor will be alcohol vs. placebo; the between-subjects factor will be caffeinated vs. non-caffeinated beer.
Setting: The study will take place at the General Clinical Research Center at Boston Medical Center.

Participants: We will recruit 144 students from Boston area Universities.

Outcome Measures: Acute and residual driving impairment will be assessed using a driving simulator and an objective measure of sustained attention/reaction time, the Psychomotor Vigilance Test (PVT).
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Scott Lephart, PhD
University of Pittsburgh
350 Thackery Hall
Pittsburgh, PA 15260
Phone: 412-383-6747
Fax: 412-383-6636
Email: Lephartsm@upmc.edu

Project Title: Predictors of Dynamic Knee Stability among Female Athletes
Project Period: 9/30/04–9/29/05

 Description: The purpose of this study is to assess the functional capacity for dynamic knee stability in female athletes and to determine if a select group of neuromuscular and biomechanical characteristics significantly predict dynamic knee stability during a single-leg, stop-jump task. Over the last decade, there has been widespread attention on the risk of anterior cruciate ligament (ACL) injuries among females who actively participate in sports and recreational activities. Female athletes are suffering ACL injuries at a significantly higher rate than male athletes in matched sports. Most of these injuries occur through a non-contact mechanism of injury, where no external force is applied directly to the knee joint; instead, the only forces that are applied to the knee joint in such cases are impact-related and internal soft-tissue forces. Many studies have been conducted to determine what risk factors may contribute to noncontact ACL injuries in female athletes. Recent research on female non-contact ACL injury prevention has focused mostly on the neuromuscular and biomechanical factors of joint stability and the potential for modifying these factors through intervention programs. Researchers seek to determine how to change the neuromuscular and biomechanical characteristics of female athletes in ways that will improve their ability to control dynamic knee stability and reduce their risk for noncontact ACL injuries. Dynamic knee stability is essential to the safe performance of physically demanding athletic activities. Without proper dynamic knee stability, athletes are at risk for serious knee injury.
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Gary Raskob, PhD
College of Public Health
University of Oklahoma Health Sciences Center
801 NE 13th St., Room 139
Oklahoma City, OK 73104
Email: Gary-Raskob@ouhsc.edu

Project Title: Oklahoma University Developmental Center for Injury Prevention Research
Project Period: 8/1/05-7/31/06

Description: Motor vehicle accidents are a leading cause of death in the U.S. Oklahoma has a high incidence of motor vehicle injuries and death, and saw an 11 percent increase in motor vehicle fatalities in 2004. This proposal will update the systematic reviews of evidence for strategies to prevent death and injury from motor vehicle accidents, especially among adolescent (ages 16-19) and young adult (ages 20-25) drivers. It will also identify priorities for further research.

This project will establish a developmental center for injury prevention research to conduct initial research and gather preliminary data. Project aims also include providing an updated systematic review of evidence for strategies to prevent injury and death from motor accidents; a scientific review of the evidence for the high risk group of adolescent and young adult drivers, and an updated systematic review of the role of alcohol use in motor vehicle accidents among this group; and white papers outlining priorities for future and potential areas of research. Findings will be presented at the end of the project period.
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Sherrilene Classen, PhD
University of Florida
College of Public Health
Box 100164
101 S. Newell Drive
Gainesville, FL 32610-0164
Phone: 352-273-6062
Fax: 352-273-6042
Email: sclassen@phhp.ufl.edu

Project Title: Public Health Model to Promote Safe Elderly Driving
Project Period: 9/30/2004–9/29/2007

Description: Older driver safety is a complex phenomenon that extends beyond the person level to multiple systems (e.g., regulatory, policy-making, societal, and health care systems). Although many predictors for safe driving have been identified by researchers, these have not been integrated into a meaningful causative model. An integrated approach is needed, grounded in a public health model, to understand how behavioral, ecological, health educational, administrative, policy-based, and regulatory strategies can promote safe elderly driving. A failure to develop such strategies as the "graying of America" takes place could lead to a sharp increase in the number of older people killed, injured, or disabled in crashes. This project aims to develop a unifying public health model for safe elderly driving. The Precede-Proceed model of health promotion will provide the theoretical framework to (1) systematically review the current literature using the descriptive methodology used by the Cochrane Collaborative; (2) test the fit of existing population-based quantitative data, using epidemiological methods and structural equation modeling, (3) test the fit of qualitative data, using content analysis; and (4) refine the public health model to develop an intervention plan for safe elderly driving.
 

Research Cooperative Agreements


Shannon A. Brietzman, MA
Colorado Department of Public
Health and Environment
4330 Cherry Creek Dr. South
Denver, Colorado 80246-1530
Phone: 303-692-2609
Fax: 303-791-7901
Email: Shannon.brietzman@state.co.us

Project Title: Community-Based Interventions to Reduce Motor Vehicle-related Injuries
Project Period: 9/30/04-9/29/07

 Description: The Injury and Suicide Prevention Program at the Colorado Department of Public Health and Environment is developing two community-based interventions to reduce motor vehicle-related injuries: Enhanced Enforcement campaigns to increase safety belt use; and a cluster, randomized control trial at child care centers to increase the possession and use of booster seats.

The Enhanced Enforcement campaign will be conducted in two rural counties, excluding those with metropolitan areas greater than 100,000 or cities with populations of at least 50,000. Colorado’s current Enhancement Enforcement campaign (Click it or Ticket) covers 85 percent of the state’s population, but only 30 percent of the participating law enforcement agencies are in rural counties. Such counties have a lower seat belt use rate compared to urban areas. In Colorado, rural counties have a significantly higher percentage of households with income less than $50,000, which is associated with significantly lower safety belt use rates.

The goal of this project is to increase both seat belt use and booster seat use. It will provide information about how to tailor community-based intervention programs, which will be made available to other communities and states through the development, implementation, and evaluation of these two interventions.
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Linda Hale, RN,BSN
State of Wisconsin, Department of Health and Family Services
Injury Prevention Section
1 West Wilson St.
Madison, WI 53702
Phone: 608-267-7174
Fax: 608-266-8925
E-mail: halelj@dhfs.state.wi.us


Project Title: Assessing Multifaceted Fall Prevention Strategies Among Community Dwelling Adults
Project Period: 9/30/02-9/29/05

 Description: The State of Wisconsin Department of Health and Family Services, as part of a three-year collaborative project, will develop, implement, and test a comprehensive approach to preventing falls among older adults through two complimentary strategies. They include a broad-based program to engage service agencies and health providers through brief multifaceted interventions, and a targeted strategy of individualized multi-factorial assessment and interventions for high-risk adults age 65 and older.

Goals of the project are to:

Year one will include developing training, outreach programs, and other materials in collaboration with community partners. Multi-factorial interventions for high-risk older adults will be implemented and evaluated during years two and three. Research intervention will also be fully integrated into existing health provider and community-based programs to facilitate service consultation during year three.
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Heather W. Hockanson, MA
Michigan Department of Community Health
3423 N. Martin Luther King Jr. Blvd.
Lansing, MI 48906
Phone: 517-335-9519
Fax: 517-335-8893
Email: HockansonH@michigan.gov


Project Title: Community-Based Interventions to Reduce Motor Vehicle Injuries in Michigan
Project Period: 9/30/03-9/29/07

 Description: The University of Michigan Transportation Research Institute (UMTRI) has been contracted by the Michigan Department of Community Health (MDCH) to gather baseline booster seat use data to help tailor community interventions.

Researchers will determine the booster seat use rate in Michigan and parents’ perceptions about barriers to implementation and perceived benefits of booster seat interventions. This study is the first of its kind in Michigan and will provide guidance to other states for developing similar interventions.

A statewide passenger safety coalition has been formed to assist MDCH in developing community-based interventions to reduce motor vehicle-related injuries to children. The coalition will also support efforts to strengthen Michigan’s child passenger safety law. UMTRI will produce a technical report of its research findings that MDCH will disseminate to its partners, including the CPS Coalition, SAFE KIDS coalitions and chapters, the Governer’s Highway Traffic Safety Advisory Committee, and to others upon request.
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Ted R. Miller, Ph.D.
 Pacific Institute for Research and Evaluation
11710 Beltsville Dr. , Suite 300
Calverton, MD 20705-3102
Phone: 301-935-5688
Fax: 301-755-2759
E-mail: miller@pire.org

Project Title: Research to Improve Smoke Alarm Maintenance and Function
Project Period: 9/30/03-9/29/08

 Description: The Pacific Institute for Research and Evaluation will determine the most effective and cost-effective way to improve 9-volt battery smoke alarm maintenance and function over an 18-month period post installation.

The Institute will conduct a four-year trial to evaluate targeted smoke alarm education, general fire safety education with smoke alarm component, and installing or replacing a smoke alarm battery, and providing a brochure about it without comment. The trial will randomize 4500 homes in underserved African American, Asian, and Hispanic neighborhoods in Maryland, equipping each with hushable smoke alarms.

The Institute’s analysis will examine changes in beliefs, alarm testing/cleaning and operability (rates), and relative cost-effectiveness.
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Li Fuzhong, PhD
Senior Research Scientist
Oregon Research Institute
1715 Franklin Boulevard
Eugene, Oregon 97403
Email: fuzhongl@ori.org

Project Title: Dissemination of a Community Tai Chi Program for Falls
Project Period: 9/1/05-8/31/08

Description: Falls are one of the leading causes of injury-related deaths among older adults. Previous research findings from randomized controlled trials have demonstrated the efficacy of Tai Chai exercise in improving balance and decreasing falls among older adults. However, it is not clear whether the general community can readily implement or adopt these training protocols despite evidence of their tested efficacy. Thus, program evaluation research is needed to translate effective fall interventions into a program that can be implemented into a community-based setting.

The proposed research will translate an evidence-based Tai Chai program into a user-friendly resource package for community with adults, ages 60 and over who are physically mobile with or without assistive devices. In collaboration with local nonprofit senior service providers and an expert panel, a process evaluation approach will be used to translate, implement, and evaluate this proposed fall prevention program and evaluation instruments. Targeted end users of the program will be community-dwelling adults ages 60 and over, who will participate fully in all stages of program evaluation. A subsequent 12-weeks program will be implemented in two separate communities in Oregon and will be evaluated by participating older adults and by senior service providers, with respect to reach, adoption, implementation, and maintenance. This project responds to CDC’s call for efforts to disseminate efficacious intervention research that has “real world” impact on decreasing falls in the community. The results of this translation and dissemination research will provide an effective, evidence-based falls prevention package for older adults that can be implemented into the community setting. This research also provides important public health information about dissemination procedures for program reach, adoption, feasibility, and acceptability.
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Frederick Rivara, MPH, MD
University of Washington
Harborview Injury Prevention & Research
Box 359960
325 Ninth Avenue
Seattle, WA 98112
Email: fpr@u.washington.edu

Project Title: Effectiveness of Designated Driver Programs
Project Period: 9/30/05-9/29/08

Description: Twenty-one to thirty-four year olds have the highest rate of alcohol-impaired driving—the majority of which is done in retail establishments. While designated driver and safe ride home programs have been widely used across the country and in other parts of the world, no evaluation of their impact on citations, crashes, injuries and fatalities has been reported. This study will explore the usefulness of these measures.

Researchers will conduct an intervention to include a number of components: a broad public education campaign that will target 21-34 year olds with designated driver or safe rides home when out drinking in bars messages; a focused behavior change intervention in bars in four target neighborhoods; resources to support the desired behavior change.
The outcome measures chosen are based on the investigators’ prior work in the field, and consists of a random-digit-dialing (RDD) survey, a survey of bar patrons, an examination of administrative data on drunk driving citations, motor vehicle crashes, motor vehicle crash-related injuries and fatalities, and blood alcohol concentration (BAC) levels of injured individuals. The data from the intervention communities will be examined over time and compared to two control communities in different cities. The project will also examine many process measures to assess the degree to which the program has been implemented and used. Study findings will be widely disseminated, which will increase the effectiveness of interventions to reduce the number of alcohol-impaired driving in this high-risk age group.
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Juarez, Paul D.
Meharry Medical College
1005 Dr. D.B. Todd Jr., Blvd.
Nashville, TN 37208
Email: juarez@mmc.edu

Project Title: Community-based intervention to increase seat belt use among teens in Jackson, MS
Project Period: 9/1/2006 – 8/31/2010

Context: Mississippi ranks last, at 60.8%, among the 50 states, WA DC, and Puerto Rico, in the overall rate of seat belt use. Within the State of Mississippi, urban African American males, 15-19, have the lowest (18%) seat belt usage rates of all sub-population groups! The proposed project will evaluate the independent and combined effects of a multi-faceted, community-wide campaign to increase seatbelt usage among adolescent motorists ages 15 to 19 in Jackson, Mississippi. Project aims are: 1. To evaluate the impact of a targeted, school-based, peer-to-peer, service learning intervention that promotes seatbelt use by students in Jackson public high schools.; 2. To evaluate the impact of a comprehensive, community-based, educational and media campaign to increase youth awareness and usage of seat belts; and 3: To compare study results with other secondary data sets that reflect changes in teen seat belt use rates.

Objectives: HI: A peer-to-peer, service learning intervention conducted by youth who attend the Jackson Public Schools will result in increased knowledge, attitudes, and rates of seat belt usage as measured through pre/post surveys and observations. H2: The JYSBC will identify and engage community agencies and businesses in close proximity to public high schools to adapt activities that will promote teen seat belt use. H3: The JYSBC will identify and engage major youth-serving businesses and agencies across the community to promote seat belt messaging. H4: The JYSBC will provide education about organizational and public policies that promote teen seat belt use to businesses, organizations, and elected officials in Jackson, MS. H5: A low-cost, community-developed, multi-media campaign will result in improved knowledge and attitudes towards seat belt use by youth 15 to 19 years of age in Jackson, MS. H6: The combined effects of a multi-faceted, community based intervention in Jackson, MS will result in a significant increase in knowledge, awareness and usage of seat belts by teens.

Design: Quasi-experimental and qualitative designs and methods will be used to monitor changes in knowledge, attitudes and behaviors of seat belt use among teens and of changes in organizational and public policies over the course of the project.

Setting: Jackson, Mississippi.

Participants: Teens 15-19 years of age.

Interventions: Two major interventions will be used. The first is a school based service learning intervention in which students will develop and implement an intervention that utilizes principles of service learning. The second intervention utilizes a comprehensive, community based coalition to work with businesses, community organizations, the media, and public officials to promote teen seat belt use.

Main Outcome Measures: Self reports of seat belt knowledge, awareness, and use; community and school parking lot observations; and exposure of teens to business, community, and media seat belt messages.
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