Funded Injury Control Research Centers (ICRCs)

UNC Injury Prevention Research Center

FOA Number: CE 09 001
Project Period: 8/01/09-7/31/14
Application/Grant Number: 1 R49 CE001495-01
Principal Investigator: Carol Runyan
University of North Carolina at Chapel Hill
Injury Prevention Research Center
137 E. Franklin Street, Suite 500, CB #7505
Chapel Hill, NC 27599


(Description as provided by applicant) The University of North Carolina Injury Prevention Research Center (UNC IPRC) was created in1987, one of CDC’s original “centers of excellence”. Now in our third decade, UNC IPRC is a mature and highly productive enterprise that is making a difference. Our distinguishing characteristics are: 1) highly diverse and competent researchers conducting cutting-edge research on important topics derived from and well integrated with practice; 2) strong institutional support as a formal part of the infrastructure of a major University that has also invested in our work; 3) more than 20 years of stable and energetic leadership by an internationally recognized scholar; 4) a tradition of successfully bridging research with practice; 5) firm commitment to and internationally recognized leadership in training; 6) state, regional, national and global reach and collaboration; 7) notable impact on the field through changes to policy, programs, and development of human and surveillance resources. Over the next five years, 2009-2014, our proposed work will address six specific aims. This work is varied by topic, by disciplines and seniority of investigators represented, and by research type. It includes two translational research projects and strong emphasis on primary prevention. We employ forward- thinking management and quality assurance measures to accomplish these aims. Aim 1: To advance the science of injury control by conducting and supporting innovative research projects focused on: violence against women, including dating violence; long term consequences of brain injury in professional athletes; ACL injuries among athletes; campus safety; and compliance with fall prevention measures. Aim 2: To support new and existing UNC investigators and their research teams on topics of major national and international significance. Aim 3: To expand and enhance our national and international leadership in training the next generation of researchers and practitioners through on-campus efforts. ‘ Aim 4: To develop, conduct, evaluate, and disseminate injury control program and policy interventions in collaboration with partners at the local, state, tribal, national, and international levels. Aim 5: To enhance the long term sustainability of the Center. Aim 6: To employ sound management practices and continuous quality improvement to facilitate high productivity, quality, and efficiency in our research, education, and outreach efforts.

Large Research Project: Family-Based Dating Abuse Prevention for Latino Teens

Teen dating abuse, including psychological, physical, and sexual abuse, can interfere with the developmental tasks of adolescence, lead to distorted perceptions of normative relationship behaviors, become inappropriate guides for evaluating future relationships, and result in negative psychological and physical consequences. Dating abuse is a pervasive problem among teens in general,11 but several studies suggest that Latino teens specifically are at high risk of being victims and perpetrators of dating abuse.15″17’25 Despite this high risk, little attention has been given to the development and evaluation of dating abuse prevention programs specifically for Latino teens. Latinos are the largest and fastest growing minority group in the United States; between 1995 and 2015, the population of white youth is projected to increase by 3%, as compared to a projected 59% increase in Latino youth.26’27’28 Developing prevention programs designed specifically for Latinos that build on their motivations, norms, and value-systems and determining the effectiveness of such programs are warranted. We propose to develop and evaluate a family-based program for the primary prevention of dating abuse among Latino teens. A cultural adaptation approach will be used to develop the program that involves modifying an evidenced-based prevention program so that it is culturally sensitive and tailored to the cultural group’s traditional world view. The goal of cultural adaptation is to create the culturally equivalent version of the evidenced-based prevention program. The program to be developed and evaluated, Latino Families for Safe Dates, will be culturally adapted from our recently developed and evaluated universal family-based program for the prevention of adolescent dating abuse, Families for Safe Dates (Grant number R49/CCR423115, funded by CDC, PI Vangie A. Foshee). Families for Safe Dates consists of six booklets mailed to caregivers, followed by health educator telephone calls two weeks after each mailing. The booklets include information and interactive exercises for caregivers to do with their teens. The health educator telephone calls are to promote participation, assess program activity completion, and answer questions. This program was chosen for cultural adaptation because, in a national randomized trial, it was found to be effective in preventing abusive dating behaviors and in changing many of the theoretically-based mediating variables that guided the program’s development, it is based on a conceptual model that can be adapted 15 to Latino culture and beliefs, and preliminary feedback from Latino families on Spanish versions of the booklets indicates that the program was consistent with central Latino beliefs such as familismo (the desire to maintain strong family ties, loyalty, solidarity, and reciprocity among family members) and that Latino parents and teens found it valuable and enjoyable.

Small Research Project – Influence of Hamstring Muscle Stiffness on Kneed Joint Stability

Anterior cruciate ligament (ACL) injury affects as many as 250,000 individuals in the United States annually, resulting in an annual health care cost exceeding $2 billion. This injury typically occurs in the physically active population, and while the incidence of ACL injury is greater in males due to greater exposure to physical activity, the relative risk of injury per exposure is 2 to 8 times greater in females. With increases in the number of individuals routinely involved in purposeful physical activity associated with public health initiatives such as Healthy People 2010, the number of ACL injuries is likely to increase. Furthermore, ACL injury, whether managed surgically or conservatively, substantially increases the risk of developing osteoarthritis, a condition that adversely affects quality of life and may indirectly lead to obesity due to a pain-induced sedentary lifestyle. Prevention, rather than treatment, is the pivotal issue in reducing the public health burden of ACL injury. However, additional research is necessary to establish the appropriate factors to be targeted by injury prevention efforts. Furthermore, the origins of the higher female ACL injury rate have not been clearly established. Muscle stiffness has been suggested as a key contributor to joint stability. This investigation will evaluate the influence of hamstring muscle stiffness on knee joint stability, and how this factor differs across sex. The hamstrings muscles are capable of limiting the load placed on the ACL potentially reducing injury risk. The ACL is loaded and potentially injured during the arthrokinematic (involuntary) knee joint motion of anterior tibial translation. Anterior tibial translation lengthens the hamstrings, and the hamstrings respond by producing tensile force which resists further lengthening, similar to a rubber band. Muscle stiffness refers to the ratio of change in tensile force to change in muscle length associated with joint motion (A Force/A Length), and a stiffer hamstring group would provide a greater increase in resistive tensile force per unit of muscle lengthening caused by anterior tibial translation, thus enhancing knee joint stability. Additionally, hamstring stiffness is greater in males than in females. Given the potential for heightened hamstring stiffness to shield the ACL from excessive loading, the lesser hamstring stiffness noted in females may contribute to the higher female ACL injury rate. The sex difference in hamstring stiffness and the greater incidence of ACL injury in females suggest that hamstring stiffness plays an important role in defining knee joint stability and ACL injury risk.

Small Project: Understanding the Role of Substance Use in Intimate Partner Violence

Intimate partner violence (IPV) during and after pregnancy is associated with harmful maternal, fetal, and neonatal outcomes; and is a leading cause of pregnancy-related death. Both paternal and maternal substance use, including both alcohol and drug use, are primary risk factors for intimate partner violence during and after pregnancy. Despite the potentially serious consequences, there is little known about the prevalence of IPV during and after pregnancy and its relationship to the use of alcohol and other substances. Policies can alter the extent to which alcohol is consumed, providing one possible avenue for intervention. Understanding the extent to which alcohol control policies are associated with intimate partner violence will be important in directing attention to those policy strategies most likely to protect pregnant women from abuse. This study uses a combination of methods to examine the potential role of alcohol and other substance use in intimate partner violence by employing a variety of methods including use of a state-level panel analysis; use of a large number of individual, family, and contextual-level control variables; and instrumental variables where appropriate. In the first part of the analysis, the study will examine the relationship between state-level alcohol control policies and female homicide victimization rates, controlling for state-level relevant control measures. In the latter part of the analysis, this study will thoroughly examine both individual-level and community-level risk and protective factors for intimate partner violence and the pathways through which substance use contributes to IPV. This part of the study capitalizes on the individual-level data already collected as part of the Fragile Families and Child Wellbeing Study. The Fragile Families Study is a stratified sample of hospital births in 20 large U.S. cities which, when weighted, is representative of births in U.S. cities with populations over 200,000. The Fragile Families data focus on vulnerable populations, specifically oversampling unwed mothers. The dataset follows mothers and their partners between birth and age five of a child. It is particularly well suited for this analysis due to its rich set of maternal and parental contextual measures and its focus on mothers and their intimate partners during and after pregnancy. Using data from Fragile Families and by focusing on community level risk and protective factors (especially those pertaining to alcohol taxes and availability) in addition to individual-level factors, we will be able to evaluate the potential role of alcohol policy in preventing intimate partner violence through a reduction in parental alcohol consumption. This research will I therefore demonstrate to what extent alcohol taxation policies can be used to reduce IPV. Additionally, Fragile Families data allow us to not only evaluate IPV against the mother by the mother’s partner, but also to consider violence against the father/partner by the mother and to consider other measures of total violence in a family.

Small Project: Do Criminal Background Checks Improve Safety on college Campuses?

Student-perpetrated shootings at five American universities in the last two years have raised fears about safety within college communities and have fueled discussion about how colleges and universities should address those fears, leading many colleges to institute criminal background checks on incoming students. However, there is virtually no evidence about the efficacy of such policies. With enrollment of undergraduates projected to be over 15/4 million in 2008, the impact and cost of these policies is potentially large. As with injury and violence in other settings, these fatal events are likely just the tip of the proverbial iceberg. Between 1995 and 2002, the annual rate of violent victimization among college students aged 18 to 24 has been estimated at 61 per 1000, or about 479,000 per year. Although it is not clear how many of these crimes were student-perpetrated, it is notable that student-victims knew the perpetrator in 42% of all cases. Unintentional injuries have taken an even a greater toll on college students. The National Institute for Alcohol Abuse and Alcoholism estimates that, among college students ranging in from 18 to 24 years of age, approximately 599,000 suffer alcohol-related unintentional injuries and 1700 die from those injuries each year Again, while these injuries and deaths are not always the result of student misconduct, the fact that underage drinkers account for almost half of all the alcohol that is consumed by college students,10 and that an estimated 2.1 million college students drove under ‘the influence of alcohol last year, suggests that many of these events are the result of illegal activity. Conducting research on the efficacy of criminal background checks is complex. Prospective research would be extremely expensive, and argues for a retrospective design that focuses on trying to identify the pre-admission factors that predict which students will be problematic during their college careers. However, to do this research requires identifying campus crime perpetrated by students, obtaining criminal background checks that examine what would have been identifiable at the time of admission, and trying to assess the reliability of this information compared to other sources. Because of these considerable potential complexities, we are proposing a feasibility study to learn more about how data on campus crime are already obtained, how to ask students about their personal histories, and how potential biases associated with asking permission for conducting criminal checks on already enrolled students would affect study enrollment. In addition, we will gather information from a sample of campus officials nationwide to learn how they are approaching issues of campus safety and to explore their interests in participating in a larger study while identifying potential barriers to conducting such research. This feasibility study is guided by three aims, with multiple inter-related parts. The first involves documenting the magnitude and nature of the college misconduct problem, including incidents of physical and sexual assault as well as underage drinking and the illegal use of drugs and/or illegal sale of prescription or illegal drugs. The second involves a series of efforts to understand how to obtain quality information about and from college students. The third focuses on college administrators involved in admissions, student services, and security, asking about their concerns about campus safety and determining their interest in participating in a larger study to examine these questions in more detail.

Small Project: Translational Research to ID Factors Related to Older Adult Use of Evidence-based Fall Prevention

The ultimate objective of this translational study is to decrease the incidence of falls among older adults by: (1) better understanding factors that may limit the potential impact of existing evidence-based falls prevention programs, and (2) using this information to make strategic recommendations concerning the design and marketing of evidence-based programs to achieve greater use and impact. Falls are the leading cause of fatal and nonfatal unintentional injury among adults at least 65 years of age in the United States, accounting for 43% of all unintentional injury deaths and 63% of all nonfatal injuries in this age group. Falls and fall-related injuries can result in decreased or permanent loss of functioning, loss of independence, emotional distress, and increased use of health and social services. Much is already known about how to reduce the risk of falls among older adults. In March of 2008, the CDC published a compendium of falls prevention programs that have been shown, through studies using randomized controlled designs, to be effective in reducing falls among older adults. The compendium, entitled Preventing Falls: What Works. A CDC Compendium of Effective Community-based Interventions from Around the World, includes information about a total of 14 evidence-based programs. These include programs limited either to exercise or home safety as well as multifaceted programs designed to address a broad range of risk factors. Although the efficacy of programs included in the CDC compendium has been demonstrated, the potential impact that such programs could have is compromised by low participation rates. On average, only 54% of older adults invited to participate in the evidence-based falls prevention programs included in the CDC compendium accepted this invitation. Thus, there is a need to better understand the factors that contribute to these low participation rates and to identify potential modifications that could be made in the design and marketing of these programs to increase participation by older adults. It will be impossible for existing evidence-based programs to achieve their maximal impact until higher participation rates are attained. By itself, participating in an evidence-based falls prevention program is unlikely to reduce participants’ risk of ‘ falling. That is, risk reduction can only be achieved if program participants implement at least some of the risk factor abatement strategies recommended by the program. Risk factor abatement strategies typically recommended by the multifaceted programs described in the CDC compendium include: exercise to improve balance and coordination, removal of home safety hazards (e.g., throw rugs) and installation of home safety, equipment (e.g., bathroom grab bars), medication review and modification to eliminate unnecessary high risk medications, and correction of visual impairments. Unfortunately, many of the older adults who participated in the evidence-based programs described in the CDC compendium failed to implement the behaviors recommended. For example, on average, only 53% of program participants implemented recommendations concerning exercise, 56% implemented home safety recommendations, and 53% implemented recommendations concerning vision checks. If these implementation rates could be increased, it is likely that programs would be even more effective. Therefore, there is a need to better understand the factors that influence the likelihood of older adults implementing the risk factor abatement strategies commonly included in existing evidence-based falls prevention programs, and to identify potential strategies that could be incorporated into these programs to increase implementation rates.