UM Injury Center is funding four injury research projects from now through 2017, listed below. Click to learn more about each project.
“Parents in the Passenger Seat: A Coaching Guide for Supervising Teens Learning to Drive”
PI: C. Raymond Bingham, PhD
Research Professor, Dept. of Psychiatry, University of Michigan Medical School
Research Professor, University of Michigan Transportation Research institute
Research Professor, Health Behavior & Health Education, University of Michigan School of Public Health
Becoming a licensed driver is a significant event for US teens and their parents. However, driving is a complex and dynamic task, and motor vehicle crashes are the leading cause of death for teens. Graduated driver licensing (GDL) is an effective program that reduces crashes involving teen drivers. GDL typically includes three licensure stages, the first of which is the learner permit or supervised license, which requires parents to supervise their teens’ driving for a minimum number of hours and/or length of time. The second stage allows teens to drive with restrictions that limit exposure to the highest risk conditions. The third stage gives teens full driving privileges.
The most common approach that has been taken to enhance GDL policies is to increase restrictions during the second stage of licensure. Research indicates that increased parental involvement also reduces the crash risk of teen drivers,5-7 but most parents lack the basic understanding needed to supervise their teens’ driving in a manner that reduces their crash risk. The GDL requirement that parents supervise their teens’ driving during the first stage of licensure provides an opportunity for parents to be involved in a manner that increases their teens’ future safety, and supervision that reduces teens’ crash risk would increase GDL’s effectiveness.
To date, no evidence-based guidance has been developed to help parents supervised their teens’ driving in a way that helps them stay safe. At the same time, untested approaches are currently available from various sources, but are typically not theory-based and have been developed by individuals with limited qualifications. Most critically, these materials have not been scientifically evaluated. The proposed research will use the existing scientific evidence base to develop a Parent Coaching Guide to enhance GDL by giving parents easy-to-understand, evidence-based guidelines and information to help them train their teens’ during supervised driving so that they become safe, independent drivers. The guide will be process-evaluated and preliminary efficacy testing will be conducted. In addition to surveys, the evaluation will use state-of-the-art in-vehicle technology to record and observe parents and teens interacting during supervised driving. The results of this study would provide the basis for a larger subsequent evaluation study testing the efficacy of the Guide to enhance teen driver safety.
“Brief Prescription Opioid Overdose Intervention in an Urban Emergency Department”
PI: Amy Bohnert, PhD
Assistant Professor, Dept. of Psychiatry, University of Michigan Medical School
Unintentional poisoning is a developing public health problem in the U.S., with deaths due to unintentional poisoning (or “overdose”) increasing 145% between 1999 and 2007. Prescription opioid-related overdoses have accounted for much of this increase. There have also been increases in both medical and non-medical use of prescription opioids among adults and adolescents, and prescription opioid decedents include both individuals who were prescribed opioids and individuals taking opioids non-medically.
In our recent pilot study in an urban ED, 25% of adults reported recent extramedical opioid use (more than prescribed or for purposes other than pain care) and 3.5% had had a non-fatal overdose on prescription opioids. Currently, little is known about strategies to reduce unintentional prescription opioid overdoses.
An important strategy for drug use reduction (but that has not been yet adapted for overdose prevention) is brief motivational enhancement, a counseling style in which a therapist uses a non-judgmental approach to empower client to enact behavior change. Prior studies on heroin users suggest that witness-based prevention interventions (i.e., interventions that train substance users to take helpful actions when witnessing an overdose) are also a promising prevention strategy. Additionally, interventions with a peer outreach focus (i.e., interventions that train participants to discuss reducing risk behaviors with peers) may be more effective than interventions focusing on the individual. However, to date, there have been no randomized controlled trials of interventions to reduce prescription opioid overdose risk.
The proposed study will test a tailored ~45 minute for adults at high risk of unintentional prescription opioid overdose delivered in an urban ED, with the primary goal of reducing overdose risk behavior via motivational enhancement techniques. Participants who report using opioids with others will receive additional intervention content on responding to others’ overdoses that they witness, and conducting peer outreach. The proposed study will screen for individuals who report a lifetime history of a non-fatal overdose and past three month extramedical use of prescription opioids or a prior prescription opioid overdose. In total, 250 individuals at risk for future prescription opioid overdose will be randomized to either the intervention or an enhanced usual care control condition and reassessed six months later.
The primary specific aims will focus on changes in precursors of overdose risk behavior (e.g., self-efficacy, readiness to change, behavioral intentions, and knowledge of overdose risk behaviors) immediately post-intervention and overdose risk behavior (e.g., use of high dose/quantity of opioids, use of opioids in combinations with certain psychoactive substances, taking multiple types of opioids, type of opioid used, and route of administration) six months post-intervention. Secondary analyses will examine gender and the presence of a substance use disorder as effect modifiers. Additionally, exploratory data will be collected via a pilot study in which we interview a subsample (n = 20) of participants who endorse opioid use with others to explore ways to reach the social network of participants at high risk. Knowledge generated in the proposed study is likely to have broad implications for prescription opioid overdose prevention efforts.
“Translation of an Intervention for Violence Among Adolescents in Emergency Departments”
PI: Maureen Walton, MPH, PhD
Research Associate Professor, Department of Psychiatry, Medical School
There is a tremendous need within public health to transfer and disseminate knowledge gained from efficacy studies into effective, sustainable programs. For public health researchers, the goal of translational research is to disseminate evidenced based interventions to the broader population. Specifically, there has been a lack of translational research in the area of violence prevention and subsequently, programs that are demonstrated efficacious in highly controlled randomized trials have not been disseminated to determine effectiveness in real world settings.
Violent behaviors (i.e., physical aggression) are prevalent among adolescents residing in urban communities and have enormous impacts on morbidity and mortality. The urban emergency department (ED) represents an underutilized venue for delivering violence interventions among adolescents. A recent study demonstrated the efficacy of a BI (SafERteens) on reducing violent behaviors, peer victimization, and violence related consequences (Walton et al., 2010). In order to reduce violence on a broader scale, studies are needed to determine the effectiveness of the SafERteens BI when delivered by clinical staff in real world ED settings.
Using a RE-AIM model framework, we propose a study to determine the reach, effectiveness, adoption, implementation, and maintenance of the SafERteens BI prevention as delivered by ED social workers as part of routine clinical practice at Children’s Hospital of Philadelphia (CHOP). This study will provide standardization and easy access to training to address needs over time from a variety of locations (e.g., Web/DVD-based tools; internet video-based standardized patient skill assessment and supervision). Next, this study will integrate screening questions into computerized ED triage procedures to increase feasibility. Further the use of computers for structuring delivery of tailored SafERteens BI content by ED social workers offers a unique solution to fidelity challenges. Finally, in order to boost intervention effects in a real-world setting, text messaging will be used to provide reminders of key content.
The specific aims of this study are: 1) To refine and package training materials (i.e., manual, tablet computer assessment and standardized tailored BI content elements, web/DVD training, and internet video based standardized patient supervision) essential to translating an efficacious ED based BI for violence (SafERteens); and 2) To conduct a translation study using the RE-AIM model to determine the reach (number of social workers trained) effectiveness (violence outcomes 3 months post intervention), adoption (number of screening assessments and interventions delivered during the effectiveness trial), implementation (quality of intervention delivery during the effectiveness trial and 6 months later), and maintenance (number of screening assessments and interventions delivered over a 6-month period post effectiveness trial) of the modified ED-based BI for violence among adolescents ages 14-18.
This is an innovative project in that it addresses translating an efficacious BI for violence (SafERteens) using state-of-the-art technology for training (i.e., web/DVD, internet video based standardized patient), intervention delivery (i.e., computerized tailored content to structure therapist BI), and reminder boosters (via text messaging) that standardize the delivery and fidelity of BIs for high-intensity urban ED settings. The proposed research is significant because: 1) there is an urgent need to translate efficacious adolescent violence interventions; 2) it addresses a critical unmet need among a high risk group of adolescents, those seeking care at an urban ED who report engaging in violent behaviors who otherwise would not be identified or offered interventions; and, 3) translation of evidence based interventions to determine reach, effectiveness, adoption, implementation, and maintenance in clinical practice is the critical next step to widespread implementation of youth violence prevention protocols in ED settings.
“Factors Associated with Effective Policy: A Geo-spatial Examination of Teen Driver Policies”
PI: Robert Lipton, PhD
Associate Professor, Department of Emergency Medicine, Medical School
Motor vehicle crashes involving at least one teen driver (age 15-19 years) are a major cause of unintentional injury in the US, and approaches that reduce the crash involvement of teen drivers are urgently needed. Parents of teen drivers profess a lack of knowledge of the unique crash risks for teen drivers, and have expressed interest in guidelines to assist them in helping their teens be safer drivers. Graduated driver licensing (GDL) is the single most effective policy to effectively reduce teen driver crash risk to date. A promising approach to further reduce crashes involving teen drivers is to strengthen GDL policies. To do this, a better understanding of the association between crash risk factors and GDL is needed.
Previous research on crash risk factors for teen drivers have focused on temporal approaches, examining a single crash risk factor at a time, and have been limited primarily to fatal crashes. Multivariate spatial analysis of crash risk factors for teens that examines the associations between GDL and those crash risk factors using fatal and non-fatal crash data would provide valuable information for enhancing GDL, and contribute to other policy approaches that provide best practice guidelines for parents and others.
The proposed study will be the first to evaluate GDL policy using multilevel spatial models will provide a comprehensive understanding of crash risk factors, and help to understand the association between GDL and spatially distributed crash risk factors for teen drivers’. To obtain better guidance for strengthening policies to reduce the involvement of teen drivers in crashes, the proposed research will: 1) identify spatially distributed risk factors associated with increased involvement of teen drivers in crashes; and 2) examine how those risk factors change when GDL is implemented using a quasi-experimental pre- post-implementation design with adults drivers as a comparison group. This study will identify spatially distributed crash risk factors for teen drivers and compare risk factors between teen and adult drivers before and after the implementation of GDL.