Funded Injury Control Research Centers (ICRCs)
University of Alabama - Birmingham
Philip R. (Russ) Fine, PhD, MSPH
1530 Third Ave. South
401 Community Health Services Building (CHSB).
Birmingham, AL 35294-2041
UAB proposes to continue its Injury Control Research Center (ICRC) for at least 5 more years. The Center’s theme, Injury Over the Lifecourse, will be studied through 2 large and 5 small research projects collectively examining causes and consequences of injury from before birth through old age.
The ICRC’s Mission is three-fold:
- to develop new or improved approaches for preventing and controlling death and disability due to injuries;
- to help the nation significantly reduce injury-related morbidity, mortality, and disability, particularly in the Southeast; and
- to reduce human suffering and medical and societal costs resulting from injuries.
The Center’s Goals and Objectives parallel the Program Purpose of Grants for ICRCs and CDC’s Research Agenda Priorities and Performance Goals.
These are to:
- more clearly define the injury problem in Alabama through improved screening, reporting, and tracking systems;
- discern the decision-making process of youths that put them at increased risk for injury or death from violence and transportation injuries;
- evaluate behavior and actions by health care workers, doctors, and point-of-care providers that may improve or impede injury outcomes;
- pioneer use of new technology in helping solve injury problems;
- develop and initiate interventions that reduce injury and injury-related deaths in Alabama, or that improve outcomes of those injured at home and in the community;
- disseminate data and results, and provide technical assistance and tools, to encourage the adoption of effective injury prevention strategies or the study of injury in other jurisdictions; and
- stimulate faculty development, and train health care workers, practitioners, and researchers in the discipline of injury control.
The ICRC’s research program is conducted from within a Research Core and address four (of seven) topic areas defined in CDC’s 2002 Research Agenda:
- Preventing Youth Violence;
- Preventing Intimate Partner Violence, Sexual Violence and Child Maltreatment;
- Preventing Transportation Injuries; and
- Acute Care, Disability and Rehabilitation.
Each proposed project is behaviorally or environmentally oriented, and each falls under one traditional research phase: prevention, acute care, or rehabilitation. UAB’s application achieves comprehensiveness by conducting “phase four” biomechanics research through the Southern Consortium for Injury Biomechanics®. Education, Training, and Public Service activities are conducted from an Administration and Operations Core. Section 9 of the application: Research Plan of the Center is divided into three chapters. Seven individual research project proposals prepared in traditional R-01 format follow Section 9.
Project Title: Preventing Youth Violence in Inner-city Neighborhoods: Evaluation of Youth Violence Intervention in Low-income Neighborhoods in Mobile, Alabama
Project Period: 08/01/04-07/31/09
Description: As the relationship between poverty and violence becomes increasingly clear, metropolitan areas are developing programs designed to help adolescents living in inner-city neighborhoods avoid dangerous situations, manage their anger and resolve conflict peacefully, and otherwise prevent or reduce violent behavior. While success stories abound, few violence prevention or reduction programs (particularly those conducted in neighborhoods rather than schools) have been rigorously evaluated, and there is not a good sense of what works and what does not. Moreover, the developmental etiology of violence among impoverished inner-city youth has been inadequately studied, and it is not well understood why some programs may work or how other less-successful programs may be made more effective.
This project addresses these two knowledge gaps by rigorously evaluating a violence prevention program being conducted in several impoverished neighborhoods in Mobile, Alabama. Conducted by family intervention specialists employed by the Mobile Police Department, this program stresses early intervention for youth identified by police officers and other helping professionals as being at particular risk. A process evaluation of the program will identify how it is being implemented and will facilitate efforts to make it transportable. An outcomes evaluation will use quantitative data generated by the ongoing Mobile Youth Survey (MYS), a longitudinal study of youth living in high-poverty neighborhoods in the Mobile inner city. These latter data will consider the impact of the program both on individual youths and on the neighborhoods where they live. The MYS data will allow the developmental trajectories of violence among inner-city youth to be examined, along with the impact of community and sociocultural factors and individual risk and protective factors on violent behavior. Findings will inform new developmentally appropriate approaches to addressing youth violence.
Project Title: Behavioral Study to Reduce Youth DUI and Risky Driving
Project Period: 08/01/04-07/31/09
Description: A challenging problem in traffic safety is the development of effective interventions to reduce crashes caused by youthful drivers. Young drivers have significantly higher crash rates and crash severity, and motor vehicle deaths are the leading cause of death for every age from 4 to 33. The major objective of this research is to gain insight into two factors that are associated with the underlying attitudes that lead to youth crash involvement: alcohol use (DUI) and risky behavior. While these two factors are neither mutually exclusive nor independent, the interventions to deal with them are quite distinct. This research will be guided by intensive data analysis facilitated by the Critical Analysis Reporting Environment (CARE), a system specifically designed to obtain information from crash databases. The significant attributes found by this analysis will be used to structure the behavioral components of the research. For the first study—social and attitudinal influences on DUI—both norm and attitude accessibility will be evaluated for college students before and after exposure to persuasion methods successfully used by members of the research team in anti-smoking interventions.
The goal is to generate new knowledge upon which an intervention will be based that will motivate young drivers to make firm transportation plans for getting home after their social activities and involve their peer group to make sure these plans are carried out. The development of these interventions and considerations for effective delivery will involve professional traffic safety regional coordinators with the support of the Alabama Traffic Safety Office to ensure effective technology transfer. The risky behavior portion of the research will be similarly guided by data analyses. In the second study, focus groups and phone surveys will be used to gain insight into the attitudes of 16- to 20-year-old drivers to assess their attitudes and normative beliefs that lead to risky driving. These will be followed by experimental tests of communications to change the accessibility of normative beliefs and attitudes, similar to that performed for the DUI study. The interventions will be oriented toward exploiting group dynamics as opposed to relying on individual education. In both the DUI and risk-taking studies, pilot tests of the interventions will be performed first in a laboratory and then in a real-world environment.
Project Title: Pediatric Pedestrian Safety in Virtual Reality: Development of Software to Train Children on Safe Street Crossing
Project Period: 08/01/04-07/31/07
Description: Pedestrian injuries are the second leading cause of death for children ages 5 to 9. This research represents phase 1 of a project to develop and validate virtual reality (VR) software as a tool for training children in pedestrian safety. VR software and hardware will be developed to simulate a street with realistic, computer-controlled traffic patterns. The virtual environment will allow participants to engage in (and investigators to measure) street-crossing behavior in a laboratory or classroom setting. While engaging in the virtual environment, participants will stand on an artificial curb, view traffic on a five-monitor semi-circular display in front of them, and hear traffic through surround-sound speakers. Stepping off the curb will activate a pressure sensor connected to the computer to record when participants begin crossing.
After the software is developed, two validation studies will be conducted: one with adults and a second with children. Adult pedestrian safety will be assessed in three environments: in the VR environment, on a simulated pretend road adjacent to a road with actual traffic, and on the crosswalk of an actual road. All environments will be in the same location, a moderately busy, two-lane, bidirectional road. Validity will be tested initially with Pearson correlations and later tested using two hierarchical multiple regressions predicting safety in the VR task. Potential confounding factors (sex, age, temperament) will be entered in the first step and performance on other pedestrian safety tasks (pretend or actual road task) in the second. Validity of the VR measure will be established if performance in the other pedestrian tasks predicts performance in the VR task. A parallel study will validate the VR task with children ages 7 to 9. Four simulated crossing tasks will be used: the virtual reality environment, the pretend road, the "shout" task whereby children stand next to a street and shout "now" to indicate crossing, and the "two-step" task whereby children stand on the far side of a sidewalk and take two steps toward the road to initiate crossing. Again, validity of the VR environment will be established through correlations and then later through hierarchical multiple regressions—with age, sex, height, parent-report temperament, and verbal intelligence entered in the first step as potential confounding factors. In both studies, participants will report on perceived realism of the VR environment. Subsequent phases of the research will use the VR environment as an intervention tool to train children on pedestrian safety.
Project Title: Endotracheal Intubation in Traumatic Head Injury
Project Period: 08/01/04-07/31/06
Description: Recent literature raises concerns about possible adverse effects of pre-hospital endotracheal intubations in traumatic brain injured patients. The analysis of outcomes by these investigators in a sample of 1,399 patients from a prospective head injury database showed that pre-hospital endotracheal intubation was associated with higher mortality and worse function. Among the possible explanations for why such a differential might exist are: (1) uncontrolled differences in the severity of the patients’ injuries, (2) a subgroup of patients for whom intubation is not helpful, (3) use of endotracheal intubation in inappropriate situations, (4) difficulty intubating, (5) misplaced tubes, (6) hypo/hyperventilation post-intubation, or (7) lack of use of neuromuscular blockade. To date no rigorous analysis of these possible explanations has been performed, although there is a need to understand the relative rank of these explanations to determine how best to intervene. The research will address this knowledge gap by studying a cohort of adult patients with head injury with AIS <5, triaged to the region's sole adult Level 1 Trauma Center from which intra-hospital data will be obtained.
The investigators are currently involved in designing and implementing the Alabama Statewide EMS Database (EMSIS). Dr. Rosko, a consultant on this study, is the state EMS director who trains responders in the use of the EMSIS and maintains a QI program. Dr. Rosko will oversee the addition of the pre-hospital variables needed to be collected (e.g., paramedic training and experience with intubation, intubation efforts, blockade use, transport and scene time, hypotension and hyper/hypoventilation). The pre-hospital data will be combined with detailed information on injury (including first CT scan) extracted from hospital records. It is estimated that 18 months will be required to acquire sufficient numbers (n=700). Multivariate analysis will be employed to determine whether there is an independent effect of endotracheal intubation on hospital mortality (the primary outcome) and which of the possible factors explain most of the effect. These results will be used to influence and improve pre-hospital protocols nationwide to control secondary brain injury, improve functional outcomes, and lower costs due to disability.
Project Title: Problem Solving for Caregivers of Patients with TBI
Project Period: 08/01/04-07/31/07
Description: Family caregivers of persons with traumatic brain injury (TBI) have long-term demands that tax their coping abilities and adversely affect their health and well-being. This project will test the effectiveness of a problem-solving training program tailored to the unique needs of family caregivers of persons with TBI. Over a 3-year period, family caregivers and their care recipients will be recruited and randomly assigned to a problem-solving intervention group (n=40 dyads) or a control group (n=40 dyads). Participants in the problem-solving intervention group will receive four face-to-face problem-solving training sessions and monthly telephone problem-solving sessions over the course of 1 year. Control group participants will receive a handbook of educational materials and a staff member will contact each control group participant monthly by telephone to review these materials and other informational needs. No problem-solving training will be provided to control participants throughout the year.
Caregivers and care recipients will be assessed at four points during their participation: at the initial assessment, at 4 months, at 8 months, and at the completion of the 1-year participation period. All evaluations will be conducted in the participants' homes. Measures of problem-solving ability, caregiver burden, and adjustment (depression, health, satisfaction with life) will be collected. Structural equation modeling and other regression/inferential analyses will be used to determine the effects of problem solving on caregiver adjustment over time after taking into account care recipient adjustment and caregiver ethnicity. This project will: (1) demonstrate how specified physical and emotional outcomes of caregivers and care recipients are related to caregiver problem-solving abilities and how these relationships vary as a function of time; (2) evaluate the effectiveness of a community-based, problem-solving intervention that will be delivered to caregivers; and (3) identify caregivers and care recipients with TBI who are at risk for adverse emotional and health outcomes.
Project Title: A Longitudinal Study of Rehabilitation Outcomes
Project Period: 08/01/04-07/31/09
Description: This project is for the extension and conclusion of the ICRC's original Core Research Program—initiated in 1989—that established a unique, data collection system and analyzed medical record information linked to 12-, 24-, 48-, and 60-month follow-up interviews on 804 persons who had sustained one of four injuries: spinal cord injury (SCI), traumatic brain injury (TBI), intra-articular fractures of the lower extremity (IAF), and severe burns (SB). These injuries often result in residual disability requiring extensive rehabilitation.
There are two specific aims for this research for the 2004–2009 project period:
Aim 1: Identify factors that enhance or inhibit long-term, post-injury psychological, social, and physical functioning. Data will be obtained from an ongoing longitudinal study of persons with injuries, including new data to be collected between 2004 and 2008 on each participant on the 15th anniversary of discharge from acute care. Research questions include: (1) What are the characteristic long-term psychological, social, and physical post-injury outcomes for each injury group? (2) What variables predict these outcomes? (3) How is aging related to psychological, social, and physical outcomes for injured individuals?
Aim 2: Make the longitudinal database public by allowing Internet access to a database that has had identifiers removed. Regression, ANOVA, repeated measures, and epidemiological and statistical methods will be used to examine several hypotheses addressing the relative contribution of age, injury severity, type and amount of rehabilitation, and social variables to current physical, social, and psychological outcomes. This systematic analysis across four selected injury types will permit assessment of the relationships among physical, psychological, and social factors that may enhance or detract from attaining maximum personal autonomy and an independent lifestyle many years after injury.
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