University of Alabama - Birmingham Project Descriptions
Philip R. Fine, PhD, MSPH
University of Alabama at Birmingham
403 Community Health Services Building
Birmingham, AL 35294-2041
Phone: 205 934 7845
Fax: 205 975 8143
E-mail: rfine@uab.edu
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.