Funded Injury Control Research Centers (ICRCs)
Colorado State University
Lorann Stallones, PhD
Colorado State University
Department of Environmental Health
B107 Microbiology Building
Fort Collins, Colorado 80523
In the United States, injuries are the leading cause of death in the first four decades of life and the fourth leading cause of death for all age groups. Incidence of injury-related morbidity and mortality is higher in rural areas; however, there is a lack of research to develop effective injury prevention and control programs in rural areas. The primary focus of the Colorado Injury Control Research Center (CICRC) is to address the prevention and control of injuries among rural and underserved populations in Public Health Service Region VIII. This region includes Colorado, Wyoming, Montana, Utah, South Dakota, and North Dakota, all of which have a large rural population base.
CICRC efforts will be largely concentrated in four specific injury areas: occupational injuries (primarily agricultural-related), head injuries, motor-vehicle crashes, and burns. The specific aims are:
- to use existing surveillance for injuries, disabilities, and behavioral risk factors in Colorado to compare urban and rural differences in injury patterns;
- to identify high-risk populations among rural residents and to identify risk characteristics associated with injuries in rural areas;
- to stimulate basic biomedical research in the pathophysiology and treatment of injury to the nervous system;
- to educate health professionals and the general public about the magnitude and cost of injury; and
- to expand existing community-based activities in injury control and prevention in the state and region.
The work will be accomplished through three core components: administrative/training, communication and public education; and research. The Research Core contains eight research projects: Project 1 (rehabilitation), The Culture of Rural Health Care and Rehabilitation Services for Individuals with Traumatic Brain Injury; Project 2 (prevention), Brain Injury Prevention in Rural Populations Using the Community Readiness Model; Project 3 (prevention), The Reduction of Driving Anger; Project 4 (acute care), Recovery from Ischemic Brain Injury; Project 5 (biomechanics), Biomechanical Assessment of the Effects of Auditory Input on Motor Performance in Individuals with Traumatic Brain Injury; Project 6 (acute care), Rural And Urban Preventable Injury Mortality in Colorado; Project 7 (epidemiology), Measuring Disability, Participation, and Environmental Factors in Rural Colorado; and Project 8 (rehabilitation), Educational Outreach Supporting Rural Burn Survivors.
Project Title: Insulin-like Growth Factors and Brain Injury: Study of Potential Neuroprotective Action of Insulin Growth Factors in Brain Trauma
Project Period: 08/01/01-07/31/06
Description: This project focuses on preventing or reducing permanent injury to the brain as a consequence of stroke, trauma, or disease. It is widely believed in medicine that large molecules such as proteins do not cross the blood-brain-barrier (BBB). However, it has been shown recently that subcutaneous or intravenous administration of neurotrophic insulin-like growth factors (IGF) can lessen the consequences of brain injury. For example, clinical outcome is improved by IGF administration to patients with brain trauma, and loss of function and neural circuitry is prevented in experimental brain injury. The mechanism is being investigated. If IGFs were taken up from the circulation into cerebrospinal fluid (CSF), the potential for clinical treatment would be greatly increased because the risks associated with drilling an access hole through the skull might be avoided. The major goal is to test the hypothesis that circulating IGFs are taken up into CSF. It is hoped the results may help optimize conditions for IGF clinical trials to treat central nervous system (CNS) injuries, including focal hypoxic-ischemic stroke.
Project Title: Community Readiness and Rehabilitation Services for TBI in Rural Colorado and Wyoming
Project Period: 08/01/01-07/31/06
Description: This 5-year ethnographic field study will examine rehabilitation services and community re-entry for individuals with traumatic brain injury (TBI) in rural Colorado and Wyoming. The study will use the Community Readiness Model to examine the readiness of individuals with TBI (and family members), community members, and health-care providers to identify, change, and expand the systems of brain injury rehabilitation that are currently in place in their communities. The study will use a variety of qualitative purposive sampling techniques (e.g., key informants, snowball, and typical case sampling). The investigators will interview community leaders and conduct focus groups with survivors (and family members), community members, and health-care providers. Data collection will be conducted in participating communities throughout the project and will focus on two areas: (1) identifying weaknesses and strengths of the current system of care available to the community, and (2) assessing the interest and willingness of the community to support changes to improve the access to, and quality of, rehabilitation care for individuals with TBI.
After data collection on the first community is complete, project staff will help the community plan, develop, and implement a user-friendly pilot system for accessing rehabilitation services. Eight rural counties (six in Colorado and two in Wyoming) have been targeted for this study. There will be three levels of study: the first will involve collecting data on each targeted county related to care access and community re-entry for citizens who have sustained brain injury; the second will involve working closely with one of the communities as it addresses the care access needs of its citizens who have TBI; and the third level will involve convening and conducting focus groups in all eight counties to discuss actual or potential interventions and to determine which are, or might be, feasible for success in their respective communities.
Project Title: Understanding and Treating High-anger Driving: Studies Addressing Angry Drivers with Rural and Non-rural Backgrounds
Project Period: 08/01/01-07/31/06
Description: Angry drivers, especially young ones, are a significant public health problem. They experience frequent, intense anger on the road, engage in more frequent aggressive and risky behavior, and experience more moving violations and some crash-related outcomes (e.g., close calls and minor accidents). This project includes four studies addressing angry drivers.
Study 1 collects information on trait driving anger, angry thoughts while driving, forms of expressing anger while driving, and rates of aggressive and risky behavior and crash-related outcomes from university students and their parents. It furthers research on college students and provides data on an older adult sample for cross-cohort comparisons and an exploration of potential parental influence on the development of driving anger.
Study 2extends this research to a sample of community college students who are more diverse in demographics and are commuters who drive more frequently.
Study 3 is a large-scale, secondary prevention trial with high-anger, college student drivers. It will compare three, short-term interventions, each with a different focus. Relaxation coping skills (RCS) focus on reducing elevated emotional and physiological arousal; cognitive coping skills (CCS) aim to alter anger-engendering information processing; and behavioral coping skills (BCS) work on developing responses to provocations and frustrations on the road that are incompatible with aggression and risk, are non-impulsive, and are safer. Interventions will be compared with a no-treatment control. Effects on driving anger, expression of driving anger, angry thoughts, aggressive and risky behavior, crash-related outcomes, and effects on general anger and general anger expression will be assessed before intervention, immediately after treatment, and at 1-month and 1-year follow-ups. Sample sizes will have sufficient power to detect absolute and relative effectiveness of interventions. Outcomes will not only provide information about effects of each intervention, but also will provide outcome information about how these intervention components might be combined.
Study 4 maps high-anger drivers who do not access psycho-educational interventions (i.e., high-anger drivers who do not see themselves as having a problem). Information on this group will inform the development of alternative interventions.
All projects assess rural background (a prime focus of the Center) as a potential moderator of effects. Such information will not only inform scientific understanding of angry drivers, but also have the potential need for tailoring interventions to rural populations.
Project Title: Alcohol-impaired Driving: Register of Controlled Studies
Project Period: 08/01/01-07/31/05
Description: Alcohol-impaired driving accounts for nearly 40% of road traffic deaths nationwide. Healthy People 2010 includes an objective to reduce deaths from alcohol-related motor vehicle crashes by one third. It is essential therefore to identify effective strategies for preventing alcohol-impaired driving. A logical first step is to find out what is already known by conducting systematic reviews of controlled evaluation studies in the prevention of alcohol-impaired driving. The main requirement for validity in systematic reviews is that all (or nearly all) relevant studies are included. However, finding all relevant studies is particularly difficult in the field of alcohol-impaired driving prevention because of the range of disciplines involved, the publication of many studies as government or other internal reports, the lack of a recognizable standard terminology for non-medical interventions, and the limited range of indexing terms that describe study methodology in nonmedical databases.
The aim of this project is to develop a register of controlled evaluation studies in the prevention of alcohol-impaired driving that will facilitate systematic reviews, which will in turn inform public policy. The register will be created through searches of a broad range of bibliographic and other resources. The project will identify potentially relevant electronic databases, develop a sensitive search strategy for these databases, and use the strategy to search for relevant controlled evaluation studies. Additional unpublished studies will be identified by contacting state, national, and international organizations and agencies and by reviewing other sources of unpublished literature such as conference proceedings. A register of relevant studies will be built and maintained using standard bibliographic software and made available publicly through the Cochrane Injuries Group Trial Register, accessible via the Cochrane Library. The feasibility and usefulness of the register will be examined in the context of a systematic review of an intervention to reduce alcohol-impaired driving.
Project Title: Evaluation of a Head and Spinal Cord Injury Prevention Program among Migrant Youth
Project Period: 08/01/01-07/31/03
Description: This study evaluates commonly used educational materials about head and spinal cord injuries for use with migrant children and youth. The research implements and evaluates a well-established educational program, THINK FIRST, developed to enhance children's and youth interest in, learning about, and acceptance of safety messages related to the prevention of head and spinal cord injuries. Two specific programs have been developed: one for use with children ages 6 to 8, the second for junior high and high school students. Both programs have been developed for delivery in a school setting. While the programs have been evaluated in a number of settings, they have not been evaluated for use among migrant children and youth during summer migrant school programs, nor has a Spanish version been released or evaluated in the United States, although the program has been used in Mexico and Chile.
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