Funded Injury Control Research Centers (ICRCs)

Project Title: CE 09 001 The Johns Hopkins Injury Control Research Center
Grant Number: 1 R49 CE001507-01
Project Period: 07/31/09-7/30/14
Description: See funded ICRC page for more information.

Project Title: Effects of Formal Danger Assessment on Actions to Prevent Women from Partner Violence
Project Period: 9/01/04-8/31/08
Description: The goal of this project is to determine whether using a standardized, empirically based tool to generate and communicate scores reflecting the level of danger a victim of intimate partner violence (IPV) faces will lead to more or less protective actions taken by the victim and the courts. In addition to educating IPV victims about the dangers they face and effective strategies for preventing further violence, legal advocates will use danger score information in communications with judges and prosecutors to influence legal decisions relevant to victim safety.

The study will examine relationships in a conceptual model that hypothesizes that the intervention will increase the use of effective prevention actions and enhance victim safety by increasing perceived risk and confidence in effective prevention strategies. Study participants will be recruited through a legal clinic for victims of domestic violence in Baltimore City District Court. Investigators will use a quasi-experimental design to contrast a control group that will receive the legal clinic's current practices with an intervention group that will receive the new protocol for danger assessment, risk communication, and education about prevention strategies. Baseline data will be collected via face-to-face interviews with 376 participants (188 in each study group) just after the participants receive a temporary restraining order. A follow-up phone interview will take place 6 months after baseline. Program effects will be estimated using Analysis of Covariance (ANCOVA), Multivariate Analysis of Covariance (MANCOVA), and logistic regression to estimate main effects of the intervention, to test for effect modification and mediation with theoretically relevant variables.

Project Title: Modifying Precipitating Risk Factors for Falls among Nursing Home Residents
Project Period: 9/1/04-8/31/06
Description: Falls among the elderly remain a difficult injury control problem as rehabilitation and exercise may be exchanged with fall risk. The innovative case-crossover design permits the study of transient modifiable risk factors at the time of or just before the fall. Existing intervention strategies often focus on fall risk factor modification (e.g., medication adjustment). This study will test the application of the case-crossover design as an evaluation tool for preventing falls among nursing home residents. If feasible, this methodology may then be applied to settings where linked data are readily available from multiple sources and for planning intervention trials to modify and monitor precipitating risk factors for falls.

Project Title: Self-Managing the Consequences of Major Limb Trauma: A Pilot Study
Project Period: 9/1/04-8/31/06
Description: Evidence from several studies strongly suggests that major improvements in functional outcomes following major lower limb trauma will require greater emphasis on interventions in the early post-acute phase of recovery that directly address the psychosocial needs of the patients and assist them in self-managing the multi-factorial consequences of their injury. Self-management interventions based on cognitive-behavioral theory have gained widespread application with chronic conditions in which pain and disability are common. They have not, however, been broadly applied to acutely injured populations.

The long-term objective of this project is to conduct a large, multicenter trial to evaluate the effectiveness of a group-based self-management program for reducing secondary conditions and improving function following acute trauma to the lower extremities. To assist in the planning of the future trial, this phase of research includes several specific aims:

1. Develop and pilot test the intervention strategies and materials, paying particular attention to developing materials that are sensitive to the needs of underserved populations.
2. Develop an instrument for measuring an individual’s readiness to participate in and benefit from a self-management intervention.
3. Determine the feasibility of an RCT and pilot patient recruitment methods.
4. Design a randomized controlled trial for testing the efficacy of the self-management intervention.

Based on these activities, a protocol will be developed for a randomized controlled trial and submitted for funding. In addition, investigators will contribute to the literature about stages of change post-trauma by developing a measure to identify subgroups of patients who may respond positively to self-management interventions.

Project Title: Policies for Older Driver Safety: Evaluation of older driver policies and practices in other countries and consider options related to driving privileges for older drivers in the USA.
Project Period: 9/01/04-8/31/06
Description: Although safety issues involving older drivers have long been a focus for the disciplines of injury prevention and highway safety, the question of how best to deal with risks posed by older drivers has not been resolved. Problems remain, from a policy perspective, with how to balance the legitimate and compelling interests of mobility and independence of older people against the risk to the public of a possibly safety-compromised driver. While there is a fair amount of uniformity across the states in legislation regarding older drivers, license renewal laws do vary and efforts have been made to evaluate how the different policies affect risk. Policies, programs and practices regarding older drivers go far beyond license renewal, however. Alternative modes of public transportation, land use planning that affects the proximity of needed services to dwelling areas, availability of affordable communal housing for the elderly, conspicuity and legibility of road signage, vehicle design, and many other issues all bear upon the need for the elderly to drive and the risks presented to the elderly and others by their continued driving activity. Other countries, particularly developed nations with high numbers of licensed drivers and advanced highway systems, are facing many of the same issues as the United States concerning older drivers. The manner in which these nations are addressing the issues can cast new light on how this country should approach the problem. But little or no international, comparative policy analysis has been accomplished regarding older drivers and safety. This project, in part, will provide a systematic review of the policies, programs and practices of other nations regarding older drivers, and an analysis of whether those policies, programs and practices might provide the United States with additional options for addressing this topic. It will also specifically examine whether a policy of staged licensing curtailment for older drivers - analogous to graduated licensing for younger drivers - would be appropriate and effective. Policy recommendations will be developed and widespread dissemination of study findings is planned.

Project Title: Intimate Partner Violence: Improving Measures for Intervention Research
Project Period: 9/1/04-8/31/07
Description: The public health significance of intimate partner violence (IPV) is clear. An estimated 3 to 4 million women in the United States may be affected by IPV, with low-income women being at especially high risk. Because abused women are seen frequently in health-care settings, providers continue to search for effective interventions that can be delivered there. The ultimate goal is to address this need by developing and evaluating a theory-based intervention to reduce IPV and thereby improve women's health and quality of life.

Preliminary qualitative research has been completed with low-income urban women in abusive relationships. This research suggests that the Transtheoretical Model (TM) can help explain how women move through the stages of change for ending IPV. Consistent with the model, five stages of ending IPV have been identified in qualitative interviews (precontemplation, contemplation, preparation, action, maintenance). In addition to these stages of change that are core constructs of the TM, the model includes the constructs of self-efficacy (i.e., confidence) and decisional balance (i.e., weighing the pros and cons of changing), and 10 processes of change (e.g., consciousness raising) that facilitate progress. These additional concepts in qualitative work have also been examined and evidence found of their relationship to stages of change for ending IPV. Based on these findings and prior experience in a reproductive health intervention trial, a stage-tailored, peer advocate IPV intervention has been drafted. Intervention research depends on the availability of solid measurement instruments and well-conceived and tested interventions. This research will allow development of these tools for preventing IPV against women.

The specific aims of this research follow:

1. Describe the distribution of abused women across the stages of change for ending IPV among a sample of low-income urban women.
2. Determine the psychometric properties of measures of decisional balance, self-efficacy, and processes of change related to the stages of change for ending IPV.
3. Examine relationships between stages of change for ending IPV and the measures of decisional balance, self-efficacy, and processes of change.
4. Incorporate findings from Aims 1 to 3 into an intervention pilot test and an application for an R01 intervention trial of a stage-based, peer advocate counseling program for low-income urban women experiencing IPV.

A one-time interview will be conducted with a sample of 150 physically abused women to address Aims 1 to 3. Results from the analyses will be used to refine an existing peer advocate counseling manual, and a small pilot test of the counseling program will be undertaken with 10 physically abused women to address Aim 4. Results of this study will add to the theoretical literature on the usefulness of the TM for ending IPV and will contribute new knowledge about the needs of low-income urban women in abusive relationships. Moreover, findings will provide the foundation for an intervention trial evaluating a stage-tailored program to enhance the safety of abused women.

Project Title: Modeling the Course of Disability Post Trauma
Project Period: 9/01/04-8/31/05
Description: The human and economic costs of trauma are exacerbated by the fact that the majority of trauma victims are young, working age adults. Disability accounts for a major portion of the costs of trauma. A causal model for recovery following trauma is an essential step in the development and evaluation of interventions. Unfortunately, the currently accepted theoretical framework of disability primarily describes correlations, with little or no research dedicated to the identification of causal relationships. The proposed project is a secondary analysis of datasets from two longitudinal studies of outcomes following lower extremity trauma conducted by the CIRP. Structural equation modeling and factor analysis will be used to identify causal pathways, as well as to determine the relative contribution of antecedent variables to long-term disability. The primary aim of this project, to develop a causal model of disability following lower extremity trauma, will serve the field of disability and rehabilitation by providing a basis for a general causal model of disability, guiding the development and evaluation of cost effective interventions, and providing a framework for future studies to base selection of outcome measures.