Johns Hopkins University Project Descriptions
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. 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.
Ellen MacKenzie, PhD
Center for Injury Research and Policy
Johns Hopkins Bloomberg School
of Public Health
624 North Broadway, Room 554
Baltimore, MD 21205
Phone: 410-614-4025
Fax: 410 614 2797
E-mail: emackenz@jhsph.edu
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:
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:
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.