Doctoral Dissertation Awards and New Investigator Awards
2004 New Investigator Abstracts
Nancy Glass PhD, MPH, MSN
Oregon Health & Science University
3181 SW Sam Jackson Park Road
Mailcode: SN-Population Based Nursing
Portland, OR 97239-3098
Phone: 503-494-4670
Fax: 503-494-4678
glassn@ohsu.edu
Project Title: Assessing Risk of Repeat Violence in Abusive
Female Same-Sex Intimate Relationships
Project Period: 8/01/04-7/31/05
DESCRIPTION: Women who experience intimate partner violence (IPV)
are at high risk for repeat victimization. Repeat victimization by
an intimate partner increases women's risk of injuries,
disabilities, and death. Identifying women who are most at risk is
important because it allows for preventive action with both victims
and perpetrators. Among those identification methods most
successfully used is the Danger Assessment 2 (DA 2), a tool that is
both sensitive and specific in identifying women at risk for repeat
violent victimization and homicide in heterosexual intimate
relationships. The extent to which this important risk assessment
tool can predict repeat victimization in female same sex IPV
relationships, however, is unknown. The long range goal is to reduce
the risk of negative health outcomes, including fatal and near fatal
injuries, among women in same sex intimate relationships through the
development and utilization of effective culturally-competent,
community partnered interventions and policies. The objective for
this application is to scientifically evaluate for the first time
the effectiveness of a previously validated, frequently used
instrument to assess the risk of repeat violent victimization of
women in abusive same sex intimate relationships. This new
investigator application is highly dependent on mentorship and
consultation from violence related injury research experts and
collaboration with community agencies. Established partnerships
ensure access to a statewide ethnically diverse sample of 248 adult
female victims and perpetrators in current or past year abusive same
sex intimate relationships to participate in focus groups and
complete survey questionnaires. The knowledge generated from this
pilot study will: 1) provide a validated outcomes instrument for
future intervention studies with sexual minority victims and
perpetrators; 2) assist health care professionals, domestic violence
and victim advocates, law enforcement, the judiciary, and probation
officers to promote the health and safety of women from diverse
communities; and 3) improve access to culturally-appropriate
community resources.
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Joshua B. Kay, PhD
The Regents of the University of Michigan
1500 E. Medical Center Drive
Ann Abor, MI 48109
Phone: 734-647-5195
Fax: 734-615-0995
E-mail: jbkay@umich.edu
mailto:jbkay@umich.edu
Project Title: Pediatric Mild Head Injury: Definition and
Consequences
Project Period: 8/01/04–07/31/05
Description: More than 1 million children in the United States
sustain traumatic brain injury each year. Approximately 90% of
pediatric brain injuries are described as mild, yet mild traumatic
brain injury (MTBI) research is plagued by problems of
classification, measurement, and generalization. This prospective,
longitudinal study seeks to define pediatric MTBI according to
empirically supportable criteria, to measure cognitive and
psychological consequences on multiple occasions, and to account for
the contribution of pre-morbid characteristics to the symptoms
children experience post-injury.
Researchers will recruit 50 children ages 10 to 17 with MTBI who are
treated in the emergency department (ED) but not hospitalized. MTBI
will be defined by blunt trauma or acceleration-deceleration injury
to the head followed by any combination of brief loss of
consciousness (<30 minutes), brief post-traumatic amnesia (<24
hours), alteration in mental state at the time of the accident, and
neurological deficits that may be transient. Glasgow Coma Scale
scores will be 13 to 15 with no intracranial pathology on any
neuroimaging studies. Fifty control children with comparably severe
injuries not involving the head will be recruited in the ED.
Relevant historical and demographic information will be obtained.
Pre-injury psychological, behavioral, and executive functioning will
be assessed via parent checklists. Neurocognitive functioning will
be measured with instruments known to be sensitive to brain injury.
Post-concussion symptoms (PCS) will be assessed using a
questionnaire. The assessments will occur in the ED, 1 week later,
and 1 month thereafter. The MTBI group is expected to demonstrate
more PCS and neurocognitive deficits than controls immediately
post-injury and at the 1 week follow up point. Considering prior
findings, it is not clear whether the MTBI group will have more PCS
and neurocognitive deficits 4 to 5 weeks post-injury. This study
will contribute to the consistent definition of MTBI in children and
set the stage for further investigations of the long-term
consequences of head injury in children.
Wendy Lane, MD, MPH
University of Maryland School of Medicine
660 West Redwood Street
Howard Hall
Baltimore, MD 21201
Phone: 410-706-7865
Fax: 410-706-4425
E-mail: wlane@epi.umaryland.edu
Project Title: Evaluation of a Program to Prevent Abusive Head
Trauma
Project Period: 8/01/04–7/31/05
Description: Child abuse is the leading cause of serious head injury
in infants and toddlers, and it is the primary cause of infant death
from injury. The incidence of abusive head trauma (AHT) in infants
is more than 30 per 100,000. Approximately 25% of victims die from
their injuries, and the majority of survivors have significant
long-term consequences. Few programs aimed at the prevention of AHT
have been developed, and none has been rigorously evaluated.
The long-term objective of this project is to prevent abusive head
trauma (AHT) in young children. Its specific aims are 1) to
determine the effectiveness of a hospital-based program to reduce
the incidence of AHT in young children, and 2) to examine the extent
to which maternal risk factors affect the risk for AHT. An AHT
prevention program is currently underway at one Baltimore area
hospital. The program educates postpartum parents about AHT and
recommends ways to manage both their infants' crying and their own
possible frustration. In this project, researchers will use a case
control design to systematically evaluate the program’s
effectiveness. Cases will be identified by medical records search at
the two Baltimore metropolitan area hospitals, where AHT cases are
referred, and at the Office of the Chief Medical Examiner. Three
controls will be selected for each case. Both cases and controls
will be matched to birth certificate data to determine birth
hospital and maternal demographics. Rates of exposure to the
intervention program among cases and controls will be compared. In
addition, researchers will compare rates among cases and controls of
risk factors including poverty, teenage pregnancy, late prenatal
care, low birth weight, and single parenthood.
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Dominique Lord, PhD
Texas A&M Research Foundation
Center for Transportation Safety
Texas Transportation Institute
3135 TAMU
Texas A&M University Systems
College Station, TX 77843-3135
Phone: 979-458-1218
Fax: 979-845-4872
E-mail: d-lord@tamu.edu
Project Title: Reducing Older Driver Injuries at Intersections
Project Period: 09/01/03–08/31/04
Description: There is a significant opportunity to reduce motor
vehicle crashes through improved highway design practices,
particularly at intersections, where the highest proportion of
crashes result in serious injuries. Experience in the United States
and in other countries suggests that traffic conflicts and overall
safety at intersections can be dramatically improved through the
installation of modern roundabouts. But in the United States,
subjective data show that drivers, especially older drivers, fear
what they perceive to be elevated demands and risks associated with
roundabouts, and may avoid their use.
The goal of this research is to enhance the safety and mobility of
persons ages 65 and over in the United States through more
elder-friendly designs of roundabouts. This study will be
accomplished in four tasks that focus on (1) problem identification;
(2) selection of potential countermeasures; (3) countermeasure
evaluation; and (4) documentation of research results, citing
anticipated benefits in terms of the prevention of injuries related
to automobile crashes involving older drivers. This research will
result in recommendations for new guidelines for highway design
developed for modern roundabouts, where the overall goal is to
foster the use of these facilities by the groups most at risk of
injury due to intersection crashes.
Lorin Maletsky, PhD
University of Kansas Research Center
3005 Learned Hall
1530 W. 15th Street
Lawrence, KS 66045-7609
Phone: 785-864-2985
Fax: 785-864-5254
E-mail: maletsky@ku.edu
Project Title: Mechanical Simulation to Evaluate Injury Mechanisms
of Ligaments in the Knee
Project Period: 8/01/04–07/31/05
Description: The frequent occurrence of Anterior Cruciate Ligament
(ACL) injury and subsequent surgical reconstruction of the ligament
make ACL failure a prominent national health concern. This
biomechanics research study examines the injury mechanisms of the
ACL in sports, recreation, and exercise activities, with the
ultimate goal of evaluating interventions and reducing the risk of
injury. No study has been found that used combined loading to cause
the ACL to fail or that generated concurrent injuries that often
accompany ACL failure. Therefore, while existing studies have
provided important insights into the normal strain on the ACL and
the effects of ACL injury on the knee, a better model to study the
injury mechanisms of the ACL and bridge the gap between experimental
in vitro strain data and clinical failures is desired.
The specific aim of this project is to develop and demonstrate a
loading and motion protocol to repeatedly rupture the ACL of a
cadaver by dynamically simulating a loss of control cutting maneuver
that causes similar injuries to the knee as seen clinically. A
better understanding of the mechanism of ACL injury will inform the
development and evaluation of preventive interventions and
post-injury reconstruction strategies. One predisposition that will
be examined is that subjects with smaller femoral notch widths,
independent of gender, will require lower magnitudes of loads to
cause failure of the ACL during a simulated cutting maneuver.
Previous research indicates that the greatest potential for ACL
injury occurs during initial weight acceptance due to the combined
anterior force, internal torque, and valgus moment. A dynamic knee
simulator will be used to apply the tri-axial physiological loading
from a cutting maneuver to eight cadaver knees. To rupture the ACL,
the failure profile will be repeated and increased until the ACL
breaks or the condition of the knee stabilizes, determined by
repeated laxity results. Strain in the ACL will be recorded during
these tests using small transducers attached to the ligament. A
sports medicine physician will evaluate the condition of the knee
and compare it with clinical observations to determine how similar
the injuries are to clinical cases. The broad implications of this
work are that the failure methodology developed will enable
researchers to perform studies not previously possible, specifically
investigations of correlations between ACL injury and knee anatomy
and characteristics.
Karen Ann McDonnell, PhD
The George Washington University
School of Public Health and Health Services
Maternal and Child Health Program
2175 K Street, NW, Room 719
Washington, DC 20037
Phone: 202-467-2282
Fax: 202-416-0433
E-mail: sphkxm@gwumc.edu
Project Title: Concept Mapping: An Innovative Method to Measure
Supervision
Project Period: 8/01/04–7/31/05
Description: Unintentional injuries are the leading causes of
mortality among children under age 5 in the United States. There is
a dearth of information regarding the conceptualization of child
supervision, which is particularly important for young children
whose protection often depends on the actions of their caregivers.
Determining the role supervision plays in preventing injuries is
precluded by methodological challenges in developing appropriate,
responsive, and reliable measures of supervision. Measures of
supervision that are derived from child caregivers themselves are
needed because the concept and the actions that define it may differ
among different population groups, by styles of parenting, and for
different injury mechanisms. Concept mapping, the method of
investigation used in this study, is an innovative technique to
address this need in injury prevention. Concept mapping is an
inductive, structured qualitative/ quantitative methodology that
will be used to explore how caregivers of children under age 5
conceptualize and operationalize child supervision.
As a first step in addressing the role of child supervision, this
study will use the concept mapping process of brainstorming groups,
sorting and rating groups, and discussion/interpretation groups to
conceptualize child supervision's role in injury prevention. Concept
mapping techniques will allow researchers to explore
sociodemographic and parenting style variations in the
identification of behaviors that are central to child supervision,
examine conceptualizations of child supervision with regard to
injury mechanisms, and identify child supervisory styles and
processes that are perceived to be amendable to change.
Kieran J. Phelan, MD
Cincinnati Children’s Hospital Medical Center
3333 Burnet Avenue
MLC 7014
Cincinnati, OH 45229-3039
Phone: 513-636-3231
Fax: 513-636-0171
E-mail: Kieran.phelan@cchmc.org
Project Title: Childhood Residential Injury and Caregiver
Supervision
Project Period: 09/01/03–08/31/04
Description: Unintentional injury is the leading cause of death and
disability in U.S. children, and the home is the single most common
location of injury. The first specific aim of this project is the
design, conduct, and analysis of a prospective 36-month randomized
controlled trial to reduce residential unintentional injury. The
intention-to-treat analyses of the longitudinal data will involve
repeated measures, following children from birth to 36 months, the
group at highest risk for residential injuries. In secondary
analysis, the project will examine the effect of the intervention by
levels of parental supervision to test whether the effect was
greater for households with lower parental supervision.
The second specific aim will examine causal determinants of parental
supervision and its ultimate effects on unintentional residential
injury. Using a theoretical model of supervision, data developed in
the first specific aim—together with validated measures of caregiver
traits such as maternal depression (Beck Depression Inventory),
parental health locus of control, and child injury-risk behavior
(Injury Behavior Checklist)—will be used to examine determinants of
supervision. Unintentional residential injury will be modeled by
integrating the quality of residential hazards, caregiver beliefs
about residential safety, caregiver locus of control and depression,
the quantity and quality of supervision, and child injury-risk
behavior. A structural equation model incorporating parental
supervision, the burden of residential hazards, and children’s
injury-risk behaviors will be developed to explain residential
injury. Maternal depression and other caregiver characteristics will
in turn explain parental supervision.
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Charles W. Pruitt, MD
Eastern Virginia Medical School
Children’s Hospital of The King’s Daughters Health System
Emergency Medical Department
601 Children’s Lane
Norfolk, VA 23507
Phone: 757-668-9222
Fax: 757-668-7568
E-mail: pruittcw@chkd.com
Project Title: Oceanfront Injury Prevention
Project Period: 09/01/03–08/31/04
Description: Drowning is the second leading cause of unintentional
injury and the fourth leading cause of fatal injury among children.
To date, few studies analyze the role of beach-related injuries in
the spectrum of childhood injury and death. Furthermore,
interventions to decrease beach injury have not been evaluated for
efficacy, possibly due to a lack of quantitative measures of beach
safety. The objective of this project is to decrease the overall
childhood morbidity and mortality by creating a community injury
prevention model to reduce beach-related injury risk behavior and
disseminating the model to a national audience. To reduce drowning
and other water-related injuries among children, the investigator
will develop a multifaceted education intervention using a local
working group composed of members of an existing successful
coalition that has experience changing behavior at the community
level. In addition, the investigator will develop quantitative
measures of injury risk that can be used to evaluate the success of
the intervention. Finally, the investigator will conduct a pilot
study of the intervention and safe beach indices by comparing
outcomes before, during, and after implementation of the
intervention at a single oceanfront beach in Virginia Beach,
Virginia.
The project aims follow:
1. Develop a Safe Beach intervention with the goal of decreasing
beach-related injuries and injury risk behavior of children and
their parents;
2. Develop and validate quantifiable measures of beach safety,
including population density, and environmental and behavioral
assessment tools;
3. Disseminate data on the effectiveness of the Safe Beach
intervention to southeastern Virginia and other regions of the
country. The primary outcome is to determine the effectiveness of an
injury prevention model developed by a community-based coalition in
decreasing childhood morbidity and mortality resulting from drowning
and other beach-related injuries.
Alyssa Ann Rheingold, PhD
Medical University of South Carolina
National Violence Against Women Prevention Research Center
P.O. Box 250852
165 Cannon Street
Charleston, SC 29325
Phone: 843-792-2945
Fax: 843-792-3388
E-mail: rheingaa@musc.edu
Project Title: Primary Prevention of Child Sexual Abuse
Project Period: 09/01/03–08/31/04
Description: Changing community attitudes, knowledge, and behavior
is a crucial first step towards primary prevention of child sexual
abuse (CSA). This project consists of two complimentary studies to
increase understanding of the effects of a community-based media
program aimed at raising awareness of the prevalence and
consequences of CSA and educating the public about related
prevention and response strategies. The first study will conduct a
controlled evaluation of mass media products developed by From
Darkness to Light (DTL), a national, non-profit organization seeking
to protect children from sexual abuse. Participants will be assigned
to one of four conditions: public service announcements, educational
booklet, public service announcements plus educational booklet, and
no media exposure. Participants will be surveyed immediately after
exposure to the media products and 1 month later to determine the
efficacy of the various prevention strategies for improving adults’
knowledge, attitudes, and preventive behaviors regarding CSA. The
second study will assess the feasibility of this intervention by
obtaining community members’ perceptions, opinions, and
recommendations about the content and presentation of the media
campaign by conducting six ethnically homogeneous focus groups.
Results from these two studies will provide useful information for
approaching the problem of CSA prevention and identify possible
strategies for refining prevention messages.
Stanley Sciortino, PhD
San Francisco Department of Public Health
Community Health Education Section
30 Van Ness Avenue, Suite 2300
San Francisco, CA 94102
Phone: 415-581-2419
Fax: 415-581-2490
E-mail: Stanley.sciortino@sfdph.org
Project Title: Safe Streets: GIS Analysis and Countermeasure
Evaluation
Project Period: 09/01/03–08/31/04
Description: This project extends the work of the Departments of
Public Health and Parking and Traffic in the County of San Francisco
to better understand pedestrian safety and pursue intervention
strategies. A systematic analysis of pedestrian injury collision
patterns is now needed, along with pilot studies that evaluate the
effectiveness and suitability of countermeasures. This project has
three aims:
Aim 1: Environmental Hazard Analysis for San Francisco. Researchers
will use recently collected multi-source pedestrian data (injuries,
deaths, volume) and environmental data (traffic signals, traffic
volume, street width) in a geographic information system (GIS) to
analyze pedestrian injury outcomes by location. A Poisson regression
analysis will identify environmental risk factors for pedestrian
injuries. Pedestrian counts, Census 2000 residence data, or Census
employment information will be used as the denominator, stratified
by age group, with an emphasis on the young and the elderly. This
analysis will be used to identify intersections, neighborhoods, and
traffic corridors that are the most hazardous to pedestrians and the
environmental risk factors that constitute those hazards.
Aim 2: Evaluation of Countermeasures. An environmental
countermeasure—special pedestrian signals—already or soon to be in
place in San Francisco will be evaluated. Evaluation will include a
before-and-after design for each intervention, where possible, and
the use of comparison intersections, selected through the use of
geographic models developed in Aim 1. Pedestrian behavioral outcomes
and pedestrian-vehicle conflicts, a surrogate measure for
collisions, will be used to evaluate the interventions. Actual
collision data will be used as well, but may not rise to statistical
significance due to the length of this study.
Aim 3: Dissemination of Results. In addition to scientific
peer-reviewed publication, dissemination to the local community
through community-based organizations and city and county government
will be ongoing through the Community Health Education Section of
the Department of Health.
Kelli England Will, PhD
Eastern Virginia Medical School
Center for Pediatric Research
855 W. Brambleton Avenue
Norfolk, VA 23510-1001
Phone: 757-668-6449
Fax: 757-668-6495
E-mail: willke@chkd.org
Project Title: Boost 'em in the Back Seat: A Safe Ride Program
Project Period: 8/01/04–7/31/05
Description: Motor vehicle crashes are the leading cause of death
for children from 1 to 14 years of age. The odds of motor vehicle
crash injury to children ages 4 to 7 are 59% lower when riding in
belt positioning booster seats than when riding in safety belts
alone, and rear seating can reduce the risk of death to child motor
vehicle passengers by as much as 46%. Despite these facts, 90% of
booster-age children are prematurely graduated to adult safety
belts, and 30% of children are permitted to ride in the front seats
of vehicles. This project will develop and evaluate an efficient
process for disseminating preventive messages regarding booster
seats and rear seating to large numbers of parents via partnership
with community preschool and daycare programs.
Considerable research on other health topics indicates that
persuasive and risk communication tactics have a greater likelihood
of motivating the adoption of protective behaviors than do
traditional messages. The current research expands on this premise
by developing a novel 5-minute video that is framed according to
such efficacious risk communication guidelines. Specifically, the
video will include crash test footage, portraying the power of crash
forces and evoking high emotion by means of vivid imaging. Such
communication tactics are known to motivate maximum behavioral
change; however, the literature indicates that this method has not
yet been employed in child passenger safety programming. The
effectiveness of the video-based program will be piloted at two
large, representative preschool/daycare programs, using two similar
control sites for comparison. The program will engage the assistance
of community-based coalitions and will include incentives for
participating preschool/daycare staff. As part of the evaluative
process, caregivers will complete pre-post knowledge and practice
surveys regarding back seat and booster seat use and pre-post risk
estimations related to childhood motor vehicle hazards. In addition,
researchers will observe booster seat and rear seat use in preschool
parking lots before, during, and after program implementation. It is
hypothesized that families exposed to the video-based program,
compared with those in the control schools, will have a) increased
knowledge about causes of injury and reasons for booster seat and
rear seat use; b) a more realistic assessment of personal risk; and
c) greater use of booster seats and rear vehicle seating when age
appropriate. The long-term goal for the program, if effective, is to
package it for district-wide adoption and broad-scale dissemination.
Huiyun Xiang MD, MPH, PhD
Children’s Research Institute
700 Children’s Drive
Columbus, OH 43205
Phone: 614-722-5961
Fax: 614-722-2448
E-mail: xiangh@pediatrics.ohio-state.edu
Project Title: Injury Diagnosis Code Accuracy in Medicaid Claims
Data
Project Period: 8/01/04–7/31/05
Description: This project will validate the childhood injury
diagnosis codes in Medicaid emergency department (ED) claims data.
Medicaid claims data are readily available for injury research and
program evaluation due to mandatory submission of such data by all
states to the Center for Medicare and Medicaid Services. However,
little is known about the accuracy of the injury diagnosis codes in
those data. The specific aims of this study are to 1) examine the
quality of key demographic variables in Medicaid claims data, (2)
investigate the accuracy and sensitivity of injury diagnosis codes
to identify children's injuries, and 3) evaluate comparability of
the NEISS and the ICD 9 CM injury diagnosis codes. A stratified
sample from 21,554 injury cases captured by the NEISS in 2003 at the
study site will result in 851 Medicaid injury cases. This study will
link injury data captured by the NEISS with Medicaid claims data.
The investigator will use standards in CDC’s Data Elements for
Emergency Department Systems to examine the data quality of key
demographic variables (e.g., date of birth and gender) in Medicaid
claims data. Medical records review will investigate the accuracy
and sensitivity of ICD 9 CM injury diagnosis codes. An innovative
bridging scheme will evaluate the comparability of the NEISS injury
diagnosis codes and ICD 9 CM injury diagnosis codes. This project is
the first part of a multi-component research program developed by
the applicant to investigate injuries among poor children and those
with disabilities. If proved valid and reliable, funding will be
sought next by the applicant to use Medicaid claims data to study
the injury medical care costs among Medicaid children and the injury
risk among children with mental health problems.
Jiangyue Zhang, PhD
Medical College of Wisconsin
Department of Neurosurgery
9200 West Wisconsin Avenue
Milwaukee, WI 53226
Phone: 414-384-2000
Fax: 414-384-3493
E-mail: Jy-zhang@mcw.edu
Project Title: Patient-specific Modeling for Pediatric Head Injury
Biomechanics
Project Period: 10/01/03–09/30/04
Description: Head injuries in pediatric patients is poorly
understood from a biomechanical perspective. These injuries are
intrinsically linked to geometry and material properties of the
brain and skull. This project will use patient-specific finite
element models (FEMs), reconstructed from patient computer
tomography (CT) scans, to study impact response and injury
mechanisms in pediatric patients. The tissue-level head injury
criteria will be identified by comparing results from
patient-specific FEMs with brain injuries in actual patients as
found on CT scans. Parametric studies will also be performed to
study the effects of head geometry and site of impact on impact
response and injury mechanisms.
The long-term objective of this project is to use a patient-specific
FEM to investigate the brain injury of a specific pediatric patient
at all ages. A family of patient-specific FEMs will be built for a
pediatric population as a function of age. Patient-specific head
injury studies will not only help clinicians understand how injuries
occur in specific patients, but also help in the development and
evaluation of safety protection devices for this population. As a
short-term (1-year) goal, 10 patients (ages 5 to 7 months) will be
selected and patient-specific FEMs will be reconstructed from
patient CT scans by using MIMICS software and I-DEAS. Each model
will be exercised under the known impact scenario obtained from the
clinical history of the patient. The tissue-level head injury
criteria are obtained by comparing results from FEMs with brain
injuries found in CT scans. The models will then be applied with the
same traumatic loading to study injury differences because of
geometry between these models. The difference in brain injury
resulting from site of impact will also be studied by applying the
load at different anatomic sites.