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Mehr JB, Bennett ER, Price JL, de Souza NL, Buckman JF, Wilde EA, Tate DF, Marshall AD, Dams-O'Connor K, Esopenko C. Intimate partner violence, substance use, and health comorbidities among women: A narrative review. Front Psychol 2023; 13:1028375. [PMID: 36778165 PMCID: PMC9912846 DOI: 10.3389/fpsyg.2022.1028375] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.
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Affiliation(s)
- Jacqueline B. Mehr
- School of Environmental and Biological Sciences, Rutgers University – New Brunswick, New Brunswick, NJ, United States
| | - Esther R. Bennett
- School of Social Work, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Julianne L. Price
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States,Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Nicola L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, United States,Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States,Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Elisabeth A. Wilde
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States,George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - David F. Tate
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States,George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - Amy D. Marshall
- Department of Psychology, College of the Liberal Arts, The Pennsylvania State University, State College, PA, United States
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Carrie Esopenko,
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Furbacher J, Fockele C, Del Buono B, Janneck L, March C, Molina M, Duber H, Doran K, Lin M, Cooper R, Modi P. 2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs. West J Emerg Med 2022; 23:817-822. [DOI: 10.5811/westjem.2022.8.57271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: The Emergency Department (ED) acts as a safety net for our healthcare system. While studies have shown increased prevalence of social risks and needs among ED patients, there are many outstanding questions about the validity and use of social risks and needs screening tools in the ED setting.
Methods: In this paper, we present research gaps and priorities pertaining to social risks and needs screening tools used in the ED, identified through a consensus approach informed by literature review and external expert feedback as part of the 2021 SAEM Consensus Conference -- From Bedside to Policy: Advancing Social Emergency Medicine and Population Health.
Results: Four overarching research gaps were identified: (1) Defining the purpose and ethical implications of ED-based screening; (2) Identifying domains of social risks and needs; (3) Developing and validating screening tools; and (4) Defining the patient population and type of screening performed. Furthermore, the following research questions were determined to be of highest priority: (1) What screening tools should be used to identify social risks and needs? (2) Should individual EDs use a national standard screening tools or customized screening tools? (3) What are the most prevalent social risks and needs in the ED? and (4) Which social risks and needs are most amenable to intervention in the ED setting?
Conclusion: Answering these research questions will facilitate the use of evidence-based social risks and needs screening tools that address knowledge gaps and improve the health of our communities by better understanding the underlying determinants contributing to their presentation and health outcomes.
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Affiliation(s)
- Jacqueline Furbacher
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Callan Fockele
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Ben Del Buono
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Laura Janneck
- University of Oklahoma School of Community Medicine, Department of Emergency Medicine, Tulsa, Oklahoma
| | - Cooper March
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Melanie Molina
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Herbet Duber
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Kelly Doran
- NYU School of Medicine, Departments of Emergency Medicine and Population Health, New York, New York
| | - Michelle Lin
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Richelle Cooper
- UCLA School of Medicine, Department of Emergency Medicine, Los Angeles, California
| | - Payal Modi
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
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3
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Cramer RJ, Johnson KL, Nobles MR, Holley SR, Desmarais SL, Gemberling TM, Wright S, Wilsey CN, Van Dorn RA. Lifetime Suicide-Related Behavior, Violent Victimization, and Behavioral Health Outcomes: Results From a Vulnerable Population Needs Assessment. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:5860-5871. [PMID: 30261811 DOI: 10.1177/0886260518801941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study is concerned with two risk factors that have been independently associated with poor behavioral health: (a) lifetime suicide-related behavior (SRB) and (b) interpersonal violence victimization experiences. The purpose of this article was to assess whether the combination of SRB (ideation, attempt) and violent victimization exacerbates behavioral health symptom risk. This pattern is examined across three vulnerable population samples: community-based adults, college students, and bondage and sadomasochism (BDSM) community members. Data from a community health and sexuality survey (n = 2,175) were collected as a health needs assessment in partnership with the National Coalition for Sexual Freedom; latent class analysis (LCA) was then employed to identify intersectionality. This paper builds on prior findings yielding two distinct violence-related classes: (a) SRB only and (b) violent victimization + SRB. Controlling for demographic covariates, analyses revealed a consistent pattern in which the violent victimization + SRB subgroup displayed significantly worse behavioral health outcomes, including symptoms of depression, anxiety, general distress, and posttraumatic stress. Membership in any of the three available samples did not moderate the latent class-behavioral health associations, suggesting the additive impact of lifetime victimization + SRB is equitable across samples. Results are consistent with social-ecological framing of shared suicide-interpersonal violence falling under the same category of public health concerns sharing risk factors and health outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Susan Wright
- National Coalition for Sexual Freedom, Baltimore, MD, USA
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4
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Cunradi CB, Ponicki WR, Caetano R, Alter HJ. Frequency of Intimate Partner Violence among an Urban Emergency Department Sample: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E222. [PMID: 33396705 PMCID: PMC7796012 DOI: 10.3390/ijerph18010222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022]
Abstract
Intimate partner violence (IPV) is a pervasive public health problem. Within the U.S., urban emergency department (ED) patients have elevated prevalence of IPV, substance use, and other social problems compared to those in the general household population. Using a social-ecological framework, this cross-sectional study analyzes the extent to which individual, household, and neighborhood factors are associated with the frequency of IPV among a socially disadvantaged sample of urban ED patients. Confidential survey interviews were conducted with 1037 married/partnered study participants (46% male; 50% Hispanic; 29% African American) at a public safety-net hospital. Gender-stratified multilevel Tobit regression models were estimated for frequency of past-year physical IPV (perpetration and victimization) and frequency of severe IPV. Approximately 23% of participants reported IPV. Among men and women, impulsivity, adverse childhood experiences, substance use, and their spouse/partner's hazardous drinking were associated with IPV frequency. Additionally, household food insufficiency, being fired or laid off from their job, perceived neighborhood disorder, and neighborhood demographic characteristics were associated with IPV frequency among women. Similar patterns were observed in models of severe IPV frequency. IPV prevention strategies implemented in urban ED settings should address the individual, household, and neighborhood risk factors that are linked with partner aggression among socially disadvantaged couples.
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Affiliation(s)
- Carol B. Cunradi
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, USA; (W.R.P.); (R.C.)
| | - William R. Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, USA; (W.R.P.); (R.C.)
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, USA; (W.R.P.); (R.C.)
| | - Harrison J. Alter
- Andrew Levitt Center for Social Emergency Medicine, Berkeley, CA 94703, USA;
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Carter PM, Cook LJ, Macy ML, Zonfrillo MR, Stanley RM, Chamberlain JM, Fein JA, Alpern ER, Cunningham RM. Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network. Acad Emerg Med 2017; 24:803-813. [PMID: 28423460 PMCID: PMC5515362 DOI: 10.1111/acem.13200] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective was to describe the characteristics of children seeking emergency care for firearm injuries within the PECARN network and assess the influence of both individual and neighborhood factors on firearm-related injury risk. METHODS This was a retrospective, multicenter cross-sectional analysis of children (<19 years old) presenting to 16 pediatric EDs (2004-2008). ICD-9-CM E-codes were used to identify and categorize firearm injuries by mechanism/intent. Neighborhood variables were derived from home address data. Multivariable analysis examined the influence of individual and neighborhood factors on firearm-related injuries compared to nonfirearm ED visits. Injury recidivism was assessed. RESULTS A total of 1,758 pediatric ED visits for firearm-related injuries were analyzed. Assault (51.4%, n = 904) and unintentional injury (33.2%, n = 584) were the most common injury mechanisms. Among children with firearm injuries, 68.3% were older adolescents (15-19 years old), 82.3% were male, 68.2% were African American, and 76.3% received public insurance/were uninsured. Extremity injuries were most common (75.9%), with 20% sustaining injuries to multiple body regions, 48.1% requiring admission and 1% ED mortality. Multivariable analysis identified firearm injury risk factors, including adolescent age (p < 0.001), male sex (p < 0.001), non-Caucasian race/ethnicity (p < 0.001), public payer/uninsured status (p < 0.001), and higher levels of neighborhood disadvantage (p < 0.001). Among children with firearm injuries, 12-month ED recidivism for any reason was 22.4%, with < 1% returning for another firearm injury. CONCLUSION Among children receiving ED treatment within the PECARN network, there are distinct demographic and neighborhood factors associated with firearm injuries. Among younger children (<10 years old), unintentional injuries predominate, while assault-type injuries were most common among older adolescents. Overall, among this PECARN patient population, male adolescents living in neighborhoods characterized by high levels of concentrated disadvantage had an elevated risk for firearm injury. Public health efforts should focus on developing and implementing initiatives addressing risk factors at both the individual and the community level, including ED-based interventions to reduce the risk for firearm injuries among high-risk pediatric populations.
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Affiliation(s)
- Patrick M Carter
- University of Michigan, Injury Center, Ann Arbor, MI
- Department of Emergency Medicine, School of Medicine, University of Michigan, Ann Arbor, MI
- Youth Violence Prevention Center, School of Public Health, Ann Arbor, MI
| | - Lawrence J Cook
- Department of Pediatrics, Division of Critical Care, University of Utah, School of Medicine, Salt Lake City, UT
| | - Michelle L Macy
- University of Michigan, Injury Center, Ann Arbor, MI
- Department of Emergency Medicine, School of Medicine, University of Michigan, Ann Arbor, MI
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Michigan, School of Medicine, Ann Arbor, MI
- University of Michigan, C.S. Mott Children's Hospital, Child Health Evaluation and Research (CHEAR) Unit, Ann Arbor, MI
| | - Mark R Zonfrillo
- Department of Emergency Medicine and Injury Prevention Center, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
| | - Rachel M Stanley
- Department of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH
| | - James M Chamberlain
- Department of Emergency Medicine and Trauma Services, Children's National Health System, Washington, DC
| | - Joel A Fein
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth R Alpern
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rebecca M Cunningham
- University of Michigan, Injury Center, Ann Arbor, MI
- Department of Emergency Medicine, School of Medicine, University of Michigan, Ann Arbor, MI
- Youth Violence Prevention Center, School of Public Health, Ann Arbor, MI
- Department of Health Behavior & Health Education, University of Michigan, School of Public Health, Ann Arbor, MI
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6
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Ranney ML, Goldstick J, Eisman A, Carter PM, Walton M, Cunningham RM. Effects of a brief ED-based alcohol and violence intervention on depressive symptoms. Gen Hosp Psychiatry 2017; 46:44-48. [PMID: 28622815 PMCID: PMC5474937 DOI: 10.1016/j.genhosppsych.2017.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Depressive symptoms frequently co-exist in adolescents with alcohol use and peer violence. This paper's purpose was to examine the secondary effects of a brief alcohol-and-violence-focused ED intervention on depressive symptoms. METHOD Adolescents (ages 14-18) presenting to an ED for any reason, reporting past year alcohol use and aggression, were enrolled in a randomized control trial (control, therapist-delivered brief intervention [TBI], or computer-delivered brief intervention [CBI]). Depressive symptoms were measured at baseline, 3, 6, and 12months using a modified 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Poisson regression was used (adjusting for baseline age, gender, and depressive symptoms) to compare depressive symptoms at follow-up. RESULTS Among 659 participants, higher baseline depressive symptoms, female gender, and age≥16 were associated with higher depressive symptoms over time. At 3months, CBI and TBI groups had significantly lower CESD-10 scores than the control group; at 6months, intervention and control groups did not differ; at 12months, only CBI had a significantly lower CESD-10 score than control. CONCLUSIONS A single-session brief ED-based intervention focused on alcohol use and violence also reduces depressive symptoms among at-risk youth. Findings also point to the potential efficacy of using technology in future depression interventions.
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Affiliation(s)
- Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical, School, Brown University, Rhode Island Hospital, 593 Eddy St, Claverick 2, Providence, RI 02903,Injury Prevention Center of Rhode Island Hospital, 593 Eddy St., Providence, RI 02903,Corresponding Author: Megan L. Ranney MD MPH, Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, 593 Eddy St, Claverick 2, Providence, RI 02903, Phone: 401-444-2557, Fax: 401-444-2249,
| | - Jason Goldstick
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Injury Research Center, University of Michigan, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109
| | - Andria Eisman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Injury Research Center, University of Michigan, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Maureen Walton
- Injury Research Center, University of Michigan, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Bldg. 16, Ann Arbor, MI 48109-2800
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Injury Research Center, University of Michigan, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
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7
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Ranney ML, Fletcher J, Alter H, Barsotti C, Bebarta VS, Betz ME, Carter PM, Cerdá M, Cunningham RM, Crane P, Fahimi J, Miller MJ, Rowhani-Rahbar A, Vogel JA, Wintemute GJ, Shah MN, Waseem M. A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. Ann Emerg Med 2017; 69:227-240. [PMID: 27998625 PMCID: PMC5272847 DOI: 10.1016/j.annemergmed.2016.08.454] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To identify critical emergency medicine-focused firearm injury research questions and develop an evidence-based research agenda. METHODS National content experts were recruited to a technical advisory group for the American College of Emergency Physicians Research Committee. Nominal group technique was used to identify research questions by consensus. The technical advisory group decided to focus on 5 widely accepted categorizations of firearm injury. Subgroups conducted literature reviews on each topic and developed preliminary lists of emergency medicine-relevant research questions. In-person meetings and conference calls were held to iteratively refine the extensive list of research questions, following nominal group technique guidelines. Feedback from external stakeholders was reviewed and integrated. RESULTS Fifty-nine final emergency medicine-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional ("accidental") injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings. CONCLUSION The technical advisory group identified key emergency medicine-relevant firearm injury research questions. Emergency medicine-specific data are limited for most of these questions. Funders and researchers should consider increasing their attention to firearm injury prevention and control, particularly to the questions identified here and in other recently developed research agendas.
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Affiliation(s)
- Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI
| | - Jonathan Fletcher
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI
| | - Harrison Alter
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | | | - Vikhyat S. Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI; University of Michigan Injury Center, University of Michigan, Ann Arbor, MI
| | - Peter Crane
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jahan Fahimi
- Department of Emergency Medicine, University of California, San Francisco, CA
| | - Matthew J. Miller
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology and Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Jody A. Vogel
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, University of Colorado School of Medicine, Aurora, CO
| | - Garen J. Wintemute
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA
| | - Manish N. Shah
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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Bedi G, Shiffrin L, Vadhan NP, Nunes EV, Foltin RW, Bisaga A. Effects of levodopa-carbidopa-entacapone and smoked cocaine on facial affect recognition in cocaine smokers. J Psychopharmacol 2016; 30:370-7. [PMID: 26921145 PMCID: PMC4794345 DOI: 10.1177/0269881115626308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In addition to difficulties in daily social functioning, regular cocaine users have decrements in social processing (the cognitive and affective processes underlying social behavior) relative to non-users. Little is known, however, about the effects of clinically-relevant pharmacological agents, such as cocaine and potential treatment medications, on social processing in cocaine users. Such drug effects could potentially alleviate or compound baseline social processing decrements in cocaine abusers. Here, we assessed the individual and combined effects of smoked cocaine and a potential treatment medication, levodopa-carbidopa-entacapone (LCE), on facial emotion recognition in cocaine smokers. Healthy non-treatment-seeking cocaine smokers (N = 14; two female) completed this 11-day inpatient within-subjects study. Participants received LCE (titrated to 400mg/100mg/200mg b.i.d.) for five days with the remaining time on placebo. The order of medication administration was counterbalanced. Facial emotion recognition was measured twice during target LCE dosing and twice on placebo: once without cocaine and once after repeated cocaine doses. LCE increased the response threshold for identification of facial fear, biasing responses away from fear identification. Cocaine had no effect on facial emotion recognition. Results highlight the possibility for candidate pharmacotherapies to have unintended impacts on social processing in cocaine users, potentially exacerbating already existing difficulties in this population.
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Affiliation(s)
- Gillinder Bedi
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Laura Shiffrin
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Nehal P. Vadhan
- Department of Psychiatry, Stony Brook University School of Medicine
| | - Edward V. Nunes
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Richard W. Foltin
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Adam Bisaga
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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9
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van der Westhuizen C, Wyatt G, Williams JK, Stein DJ, Sorsdahl K. Validation of the Self Reporting Questionnaire 20-Item (SRQ-20) for Use in a Low- and Middle-Income Country Emergency Centre Setting. Int J Ment Health Addict 2015; 14:37-48. [PMID: 26957953 DOI: 10.1007/s11469-015-9566-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Common mental disorders are highly prevalent in emergency centre (EC) patients, yet few brief screening tools have been validated for low- and middle-income country (LMIC) ECs. This study explored the psychometric properties of the SRQ-20 screening tool in South African ECs using the Mini Neuropsychiatric Interview (MINI) as the gold standard comparison tool. Patients (n=200) from two ECs in Cape Town, South Africa were interviewed using the SRQ-20 and the MINI. Internal consistency, screening properties and factorial validity were examined. The SRQ-20 was effective in identifying participants with major depression, anxiety disorders or suicidality and displayed good internal consistency. The optimal cutoff scores were 4/5 and 6/7 for men and women respectively. The factor structure differed by gender. The SRQ-20 is a useful tool for EC settings in South Africa and holds promise for task-shifted approaches to decreasing the LMIC burden of mental disorders.
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Affiliation(s)
- Claire van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa
| | - Gail Wyatt
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, CA, USA
| | - John K Williams
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa
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10
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Bohnert KM, Walton MA, Ranney M, Bonar EE, Blow FC, Zimmerman MA, Booth BM, Cunningham RM. Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department. Addict Behav 2015; 41:97-105. [PMID: 25452051 PMCID: PMC4324457 DOI: 10.1016/j.addbeh.2014.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/24/2014] [Accepted: 09/17/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Violence is a leading cause of injury among youth 15-24years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs. METHODS At an urban ED, AI youth ages 14-24 endorsing any past six-month substance use (n=350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n=250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI. RESULTS Over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR=2.26; CI=1.28, 3.90) and having PTSD (AOR=1.88; CI=1.01, 3.50) than the CG. CONCLUSIONS AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.
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Affiliation(s)
- Kipling M Bohnert
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI 48105, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA
| | - Megan Ranney
- Brown University, Department of Emergency Medicine, Providence, RI 02903, USA; Brown University, Injury Prevention Center, Providence, RI 02903, USA
| | - Erin E Bonar
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI 48105, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Rebecca M Cunningham
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI 48106, USA; Hurley Medical Center, Flint, MI, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA.
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11
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Purtle J, Rich LJ, Bloom SL, Rich JA, Corbin TJ. Cost-benefit analysis simulation of a hospital-based violence intervention program. Am J Prev Med 2015; 48:162-169. [PMID: 25442223 DOI: 10.1016/j.amepre.2014.08.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/20/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Violent injury is a major cause of disability, premature mortality, and health disparities worldwide. Hospital-based violence intervention programs (HVIPs) show promise in preventing violent injury. Little is known, however, about how the impact of HVIPs may translate into monetary figures. PURPOSE To conduct a cost-benefit analysis simulation to estimate the savings an HVIP might produce in healthcare, criminal justice, and lost productivity costs over 5 years in a hypothetical population of 180 violently injured patients, 90 of whom received HVIP intervention and 90 of whom did not. METHODS Primary data from 2012, analyzed in 2013, on annual HVIP costs/number of clients served and secondary data sources were used to estimate the cost, number, and type of violent reinjury incidents (fatal/nonfatal, resulting in hospitalization/not resulting in hospitalization) and violent perpetration incidents (aggravated assault/homicide) that this population might experience over 5 years. Four different models were constructed and three different estimates of HVIP effect size (20%, 25%, and 30%) were used to calculate a range of estimates for HVIP net savings and cost-benefit ratios from different payer perspectives. All benefits were discounted at 5% to adjust for their net present value. RESULTS Estimates of HVIP cost savings at the base effect estimate of 25% ranged from $82,765 (narrowest model) to $4,055,873 (broadest model). CONCLUSIONS HVIPs are likely to produce cost savings. This study provides a systematic framework for the economic evaluation of HVIPs and estimates of HVIP cost savings and cost-benefit ratios that may be useful in informing public policy decisions.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Drexel University School of Public Health and Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
| | - Linda J Rich
- Department of Health Management and Policy, Drexel University School of Public Health and Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Sandra L Bloom
- Department of Health Management and Policy, Drexel University School of Public Health and Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - John A Rich
- Department of Health Management and Policy, Drexel University School of Public Health and Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Theodore J Corbin
- Department of Health Management and Policy, Drexel University School of Public Health and Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
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12
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Choo EK, Benz M, Rybarczyk M, Broderick K, Linden J, Boudreaux ED, Ranney ML. The intersecting roles of violence, gender, and substance use in the emergency department: a research agenda. Acad Emerg Med 2014; 21:1447-52. [PMID: 25421993 PMCID: PMC4393747 DOI: 10.1111/acem.12525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/10/2014] [Accepted: 09/10/2014] [Indexed: 12/29/2022]
Abstract
The relationship between gender, violence, and substance use in the emergency department (ED) is complex. This article examines the role of gender in the intersection of substance use and three types of violence: peer violence, intimate partner violence, and firearm violence. Current approaches to treatment of substance abuse and violence are similar across both genders; however, as patterns of violence and substance abuse differ by gender, interventions may be more effective if they are designed with a specific gender focus.
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Affiliation(s)
- Esther K Choo
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI
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13
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Purtle J, Harris E, Compton R, Baccare R, Morris A, Dibartolo D, Campbell C, Vogel K, Schwartz N, Moront M. The psychological sequelae of violent injury in a pediatric intervention. J Pediatr Surg 2014; 49:1668-72. [PMID: 25475815 DOI: 10.1016/j.jpedsurg.2014.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Pediatric trauma centers have unique potential to prevent violent injury and its psychological sequelae. Hospital-based violence intervention programs (HVIPs) are proliferating across the U.S., but little is known about the psychological needs of pediatric patients who participate in them. The purpose of this study was to describe the prevalence of symptoms of posttraumatic stress and exposure to community violence among pediatric HVIP participants. METHODS We conducted a cross-sectional analysis of psychosocial needs assessment data that were collected for 48 participants. The Child Trauma Screening Questionnaire (CTSQ) and modified Survey of Children's Exposure to Community Violence were used to assess primary outcomes. RESULTS The sample was 62.5% male and had a mean age of 14.5 years. Twenty-three percent reported previously sustaining a violent injury resulting in medical care, and 47.8% had witnessed a shooting. The majority (66.0%) had a CTSQ score at/above the threshold for probable PTSD diagnosis. The mean CTSQ score was 5.9 and hyperarousal (3.3) symptoms were more common than re-experiencing symptoms (2.6). CONCLUSION Pediatric HVIPs and trauma centers should consider integrating PTSD screening and trauma-focused psychoeducation into the practice and protocols. Future research should evaluate the impacts of these interventions.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management & Policy, Drexel University School of Public Health, Philadelphia, PA.
| | - Erica Harris
- Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Rachel Compton
- Department of Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Rich Baccare
- Department of Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Ashley Morris
- Department of Trauma, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Danielle Dibartolo
- Department of Trauma, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Christine Campbell
- Department of Trauma, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Karen Vogel
- Department of Trauma, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Nadine Schwartz
- Department of Psychiatry, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Matthew Moront
- Department of Trauma, St. Christopher's Hospital for Children, Philadelphia, PA
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14
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Epstein-Ngo QM, Walton MA, Sanborn M, Kraus S, Blow F, Cunningham R, Chermack ST. Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment. J Subst Abuse Treat 2014; 47:282-92. [PMID: 25012548 PMCID: PMC4292794 DOI: 10.1016/j.jsat.2014.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 05/14/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
Abstract
Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.
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Affiliation(s)
- Quyen M Epstein-Ngo
- University of Michigan Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA; University of Michigan Injury Center, University of Michigan, Ann Arbor, MI 48105, USA.
| | - Maureen A Walton
- University of Michigan Injury Center, University of Michigan, Ann Arbor, MI 48105, USA; University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Michelle Sanborn
- University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Shane Kraus
- Mental Illness Research, Education & Clinical Center, VA Connecticut Healthcare System, West Haven, CT 06515, USA
| | - Fred Blow
- University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA; Department of Veterans Affairs, Health Services Research and Development, Ann Arbor, MI 48109, USA
| | - Rebecca Cunningham
- University of Michigan Injury Center, University of Michigan, Ann Arbor, MI 48105, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48105, USA
| | - Stephen T Chermack
- University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA; Department of Veterans Affairs, Health Services Research and Development, Ann Arbor, MI 48109, USA
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15
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Mackelprang JL, Collins SE, Clifasefi SL. Housing First is associated with reduced use of emergency medical services. PREHOSP EMERG CARE 2014; 18:476-82. [PMID: 24878364 PMCID: PMC5102506 DOI: 10.3109/10903127.2014.916020] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronically homeless adults with severe alcohol problems are disproportionately burdened with health-care problems and are high utilizers of emergency medical services (EMS). Single-site Housing First (HF), which provides immediate, permanent, low-barrier, nonabstinence-based, supportive housing, has been associated with reduced publicly funded service utilization. The aims of the current study were to determine whether time spent in single-site HF predicted decreases in EMS contacts 2 years subsequent to single-site HF move-in, and to describe medical conditions and injuries associated with EMS contacts in a sample of chronically homeless individuals with severe alcohol problems. METHODS Participants were 91 chronically homeless adults with severe alcohol problems who were enrolled in a single-site HF program between December 2005 and March 2007 in Seattle, Washington. We obtained administrative data on exposure to HF and EMS utilization for the 2 years prior to and the 2 years subsequent to participants' move-in date. EMS utilization variables included patient type (i.e., primary presenting problem), trauma/injury mechanism (i.e., EMS classification of the cause of the trauma or injury), level of care (i.e., basic life support, advanced life support), and transport destination. RESULTS After controlling for baseline EMS contacts, participants evinced 3% fewer EMS contacts for each additional month of single-site HF exposure. From the baseline to follow-up period, the mean number of EMS contacts declined from 15.85 (SD = 22.96) to 9.54 (SD = 15.08), representing a 54% reduction in the number of EMS contacts. Most calls were responded to by EMTs providing basic life support, and the majority resulted in transport to a local level I trauma center. The most common presenting difficulties were medical illness and trauma. Substance use and psychiatric difficulties were infrequently documented as the primary problem. CONCLUSIONS Our findings support recent assertions that housing is health care and indicate that the amount of time spent in single-site HF is associated with significant reductions in EMS utilization for at least 2 years subsequent to move-in. These findings also underscore the high levels of medical illness and trauma exposure among chronically homeless adults with severe alcohol problems.
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16
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Cochran G, Field C, Caetano R. Injury-related consequences of alcohol misuse among injured patients who received screening and brief intervention for alcohol: a latent class analysis. Subst Abus 2014; 35:153-62. [PMID: 24821352 PMCID: PMC4321896 DOI: 10.1080/08897077.2013.820679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Screening and brief alcohol intervention has demonstrated efficacy in improving drinking and other risk behaviors for some patient populations. However, it is not clear that brief interventions are helpful to all injured patients who drink at risk levels. This paper identifies latent classes of intervention recipients based on injury-related consequences and risks of alcohol misuse and then determines which profiles experienced the greatest improvements in drinking. METHODS A secondary analysis was conducted using data from injured patients (N = 737) who reported heavy drinking and received a brief alcohol intervention in a Level I trauma center. Latent class analysis was used to determine patient profiles, and 7 indicators commonly associated with alcohol-related injury from the Short Inventory of Problems+6 were used to determine the latent class measurement model. Covariates were regressed onto the model to assess factors related to class membership, and drinking outcomes were analyzed to examine improvements in drinking. RESULTS Five classes emerged from the data. The classes that reported the greatest improvements in drinking following discharge were those characterized by multiple alcohol-related risks and those characterized by a history of alcohol-related accidents and injuries. Attributing the current injury to drinking was a significant predictor of class membership among those classes that reported higher levels of improvement. CONCLUSIONS This study provides tentative evidence that subclasses exist among heavy drinking injured patients who received a brief intervention in a Level I trauma center, and some subclasses experience greater drinking improvements than others. Further research is required to substantiate the findings of this secondary analysis.
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Affiliation(s)
- Gerald Cochran
- a Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine , Baltimore Maryland , USA
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17
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Characteristics and treatment interests among individuals with substance use disorders and a history of past six-month violence: findings from an emergency department study. Addict Behav 2014; 39:265-72. [PMID: 24148140 DOI: 10.1016/j.addbeh.2013.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 09/08/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022]
Abstract
The study examined clinical characteristics and treatment interests of individuals identified to have substance use disorders (SUDs) in an urban emergency department (ED) who reported past six-month history of violence or victimization. Specifically, participants were 1441 ED patients enrolled in a randomized controlled trial of interventions designed to link those with SUDs to treatment. To examine factors related to violence type, four groups based on participants' reports of violence toward others were created: no violence (46.8%), partner violence only (17.3%), non-partner violence only (20.2%), and both partner and non-partner violence (15.7%). Four groups based on participants' reports of victimization were also created: no violence (42.1%), victimization from partner only (18.7%), victimization from non-partner only (20.2%), and both partner and non-partner victimization (17.7%). Separate multinomial logistic regression analyses were conducted to examine which variables distinguished the violence and victimization groups from those reporting no violence or victimization. For violence toward others, demographic variables, alcohol and cocaine disorders, and rating treatment for psychological problems were higher for violence groups, with some differences depending on the type of violence. For victimization, demographic variables, having an alcohol disorder, and rating treatment for family/social problems were higher for violence groups, also with some differences depending on the type of violence. Findings from the present study could be useful for designing effective brief interventions and services for ED settings.
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van der Westhuizen C, Sorsdahl K, Wyatt G, Williams J, Siegfried N, Stein DJ. Psychosocial interventions in the emergency centre setting for preventing reinjury due to interpersonal violence. Hippokratia 2013. [DOI: 10.1002/14651858.cd010839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Claire van der Westhuizen
- University of Cape Town; Department of Psychiatry and Mental Health; J Block, Groote Schuur Hospital Observatory Cape Town Western Cape South Africa 7935
| | - Katherine Sorsdahl
- University of Cape Town; Department of Psychiatry and Mental Health; J Block, Groote Schuur Hospital Observatory Cape Town Western Cape South Africa 7935
| | - Gail Wyatt
- Semel Institute, University of California Los Angeles; Department of Psychiatry and Biobehavioral Sciences; 760 Westwood Plaza, NPI 28-231 Los Angeles CA USA 90095-1759
| | - John Williams
- Semel Institute, University of California Los Angeles; Department of Psychiatry and Biobehavioral Sciences; 760 Westwood Plaza, NPI 28-231 Los Angeles CA USA 90095-1759
| | - Nandi Siegfried
- University of Cape Town; Department of Psychiatry and Mental Health; J Block, Groote Schuur Hospital Observatory Cape Town Western Cape South Africa 7935
| | - Dan J Stein
- University of Cape Town; Department of Psychiatry and Mental Health; J Block, Groote Schuur Hospital Observatory Cape Town Western Cape South Africa 7935
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19
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Yau RK, Stayton CD, Davidson LL. Indicators of Intimate Partner Violence: Identification in Emergency Departments. J Emerg Med 2013; 45:441-9. [DOI: 10.1016/j.jemermed.2013.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/30/2012] [Accepted: 05/01/2013] [Indexed: 11/25/2022]
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20
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Carter PM, Walton MA, Newton MF, Clery M, Whiteside LK, Zimmerman MA, Cunningham RM. Firearm possession among adolescents presenting to an urban emergency department for assault. Pediatrics 2013; 132:213-21. [PMID: 23837181 PMCID: PMC3727673 DOI: 10.1542/peds.2013-0163] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Firearm violence is a leading cause of death among youth. The objectives of this study were (1) determine firearm possession rates and associated correlates among youth seeking care for assault in an emergency department (ED); (2) understand differences in risk factors for youth with firearm possession; and (3) identify firearm possession characteristics in this population: type, reason for possession, and source of firearms. METHODS Youth (14 to 24 years old) presenting to a Level 1 ED with assault were administered a computerized screening survey. Validated instruments were administered, measuring demographics, firearm rates and characteristics, attitudes toward aggression, substance use, and previous violence history. RESULTS Among 689 assault-injured youth, 23% reported firearm possession in the past 6 months. Only 17% of those reporting firearm possession obtained the gun from a legal source; 22% reported ownership of highly lethal automatic/semiautomatic weapons and 37.1% reported having a firearm for protection. Logistic regression analysis identified significant correlates of firearm possession, including male gender, higher socioeconomic status, illicit drug use, recent serious fight, and retaliatory attitudes. CONCLUSIONS ED assault-injured youth had high rates of firearm possession (23.1%), most of which were not obtained from legal sources. Youth with firearm possession were more likely to have been in a recent serious fight, and to endorse aggressive attitudes that increase their risk for retaliatory violence. Future prevention efforts should focus on minimizing illegal firearm access among high-risk youth, nonviolent alternatives to retaliatory violence, and substance use prevention.
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Affiliation(s)
- Patrick M. Carter
- Departments of Emergency Medicine, and,University of Michigan Injury Center, and,Hurley Medical Center, Flint, Michigan
| | - Maureen A. Walton
- Psychiatry, School of Medicine,,University of Michigan Injury Center, and
| | - Manya F. Newton
- Departments of Emergency Medicine, and,University of Michigan Injury Center, and,Hurley Medical Center, Flint, Michigan
| | | | - Lauren K. Whiteside
- Division of Emergency Medicine, School of Medicine, University of Washington, Seattle, Washington; and
| | - Marc A. Zimmerman
- University of Michigan Injury Center, and,Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan;,Flint Youth Violence Prevention Center, Flint, Michigan
| | - Rebecca M. Cunningham
- Departments of Emergency Medicine, and,University of Michigan Injury Center, and,Hurley Medical Center, Flint, Michigan;,Flint Youth Violence Prevention Center, Flint, Michigan
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21
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Brecht ML, Herbeck D. Methamphetamine Use and Violent Behavior: User Perceptions and Predictors. JOURNAL OF DRUG ISSUES 2013; 43:468-482. [PMID: 26594058 DOI: 10.1177/0022042613491098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study describes the extent to which methamphetamine users perceive that their methamphetamine use has resulted in violent behavior, and describes the level of self-reported prevalence of specific violent criminal behaviors irrespective of methamphetamine use. Predictors of these two violence-related indicators, in terms of potential correlates from substance use history, criminal history, and health risk domains are examined. Data are from extensive interviews of 350 methamphetamine users who received substance use treatment in a large California county. A majority (56%) perceived that their methamphetamine use resulted in violent behavior; 59% reported specific violent criminal behaviors. For more than half of those reporting violent criminal behavior, this behavior pattern began before methamphetamine initiation. Thus, for a subsample of methamphetamine users, violence may be related to factors other than methamphetamine use. Users' perceptions that their methamphetamine use resulted in violence appears strongest for those with the most severe methamphetamine-related problems, particularly paranoia.
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Affiliation(s)
- Mary-Lynn Brecht
- Research Statistician, Principal Investigator, Integrated Substance Abuse Programs, Department of Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles; 11075 Santa Monica Blvd., Suite 100, Los Angeles, CA 90025
| | - Diane Herbeck
- Staff Research Associate, Integrated Substance Abuse Programs, Department of Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 100, Los Angeles, CA 90025
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22
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Resnick HS, Walsh K, Schumacher JA, Kilpatrick DG, Acierno R. Prior substance abuse and related treatment history reported by recent victims of sexual assault. Addict Behav 2013; 38:2074-9. [PMID: 23396174 DOI: 10.1016/j.addbeh.2012.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/26/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
To inform intervention approaches, the current study examined prevalence and comorbidity of recent use and history of abuse of alcohol, marijuana, and other illicit drugs as well as history of substance treatment among a sample of female victims of sexual assault seeking post-assault medical care. Demographic variables and prior history of assault were also examined to further identify factors relevant to treatment or prevention approaches. Participants were 255 women and adolescent girls seeking post sexual assault medical services who completed an initial follow-up assessment on average within 3 months post-assault. The majority (72.9%) reported recent substance use prior to assault, approximately 40% reported prior substance abuse history, and 12.2% reported prior substance treatment history. Prior history of assault was associated with recent drug use and history of drug abuse as well as substance treatment. Among those with prior histories of substance abuse and assault, assault preceded substance abuse onset in the majority of cases. Almost all those with prior treatment history reported recent drug or alcohol use. A portion of sexual assault survivors seen for acute medical services may benefit from facilitated referral for substance abuse treatment in addition to counseling at the time of screening. Assessment and intervention approaches should target alcohol, marijuana, and other illicit drug use and abuse. Substance use and associated impairment may serve as a rape tactic by perpetrators of assault. Substance use at the time of assault does not imply blame on the part of assault victims. Previous findings indicate that rape poses high risk of PTSD particularly among women with prior history of assault. Screening and intervention related to substance abuse should be done with recognition of the increased vulnerability it may pose with regard to assault and the high risk of PTSD within this population.
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Gender, violence and brief interventions for alcohol in the emergency department. Drug Alcohol Depend 2013; 127:115-21. [PMID: 22818512 PMCID: PMC4325369 DOI: 10.1016/j.drugalcdep.2012.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/08/2012] [Accepted: 06/20/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The impact of gender and violence on brief interventions (BIs) for alcohol use in the emergency department (ED) has not been studied. Our objective was to examine the effectiveness of alcohol BIs in an ED population stratified by gender and violence. METHODS This was a secondary analysis of datasets pooled from three ED-based randomized controlled studies of alcohol BIs. AUDIT-C was the primary outcome measure; secondary outcomes were binge drinking and achievement of NIAAA safe drinking levels. We conducted univariate comparisons and developed generalized linear models (GLM) for the primary outcome and generalized estimating equation (GEE) models for secondary outcomes to examine the intervention effect on the whole study group, gender-stratified subgroups, and gender- and violence-stratified subgroups. RESULTS Of 1219 participants enrolled, 30% were female; 31% of women and 42% of men reported violence involvement at baseline. In univariate analysis, no differences in outcomes were found between intervention and control groups for any subgroup. However, in multivariable models, men demonstrated an intervention effect for likelihood of safe drinking limits. Stratifying further by violence, only men without violence involvement demonstrated a positive intervention effect for safe drinking limits. There was no evidence of an intervention effect on women. CONCLUSIONS Analyzing the overall effect of ED-based BI may mask its ability to improve alcohol-related outcomes in a subset of the population. Alternatively, interventions may need to be significantly improved in subsets of the ED population, e.g., in women and in men with involvement in violence.
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Davis JS, Pandya RK, Sola JE, Perez EA, Neville HL, Schulman CI. Pediatric trauma recidivism in an urban cohort. J Surg Res 2012; 182:326-30. [PMID: 23312811 DOI: 10.1016/j.jss.2012.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/19/2012] [Accepted: 12/06/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recidivism is a well-known problem in adult trauma patients. Trauma recidivists are a population that warrants further intervention to prevent future trauma. Among pediatric patients, the recidivism rate, demographics, mechanism, and mortality are unknown. We hypothesized that specific groups of pediatric trauma recidivists could be identified for targeted prevention efforts. METHODS All pediatric trauma patients admitted to a level 1 pediatric trauma center in an urban county hospital between 1991 and 2010 were reviewed. Age, sex, Glasgow Coma Scale, injury location, injury cause, disposition, length of stay, and mortality were collected and compared between nonrecidivist and recidivist cohorts. RESULTS The recidivism rate among patients aged 0-19 y was 1.5% compared with 0.9% in those aged 0-16 y. Recidivists were more likely males (P < 0.001) suffering from penetrating injuries. They were less frequently injured in motor vehicle collisions. Two of every three recidivist gunshot wound (GSW) victims were injured by a GSW on their prior admission. CONCLUSIONS The pediatric recidivism rate in our population is small. Nevertheless, recidivists are more than twice as likely to be injured by penetrating trauma, especially GSWs. Targeted screening and counseling in this demographic may be helpful in reducing youth trauma recidivism.
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Affiliation(s)
- James S Davis
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33101, USA
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Resnick HS, Walsh K, McCauley JL, Schumacher JA, Kilpatrick DG, Acierno RE. Assault related substance use as a predictor of substance use over time within a sample of recent victims of sexual assault. Addict Behav 2012; 37:914-21. [PMID: 22521363 DOI: 10.1016/j.addbeh.2012.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/21/2012] [Accepted: 03/12/2012] [Indexed: 11/17/2022]
Abstract
Substance use at time of assault is reported by a significant subgroup of rape victims. This study examined: (1) prevalence of assault related marijuana or alcohol use among women seeking post-rape medical care; (2) sensitivity, specificity, positive and negative predictive power associated with reported use at time of assault in association with use in 6 weeks pre-assault, post-assault use, and post-assault abuse; and (3) trajectories of use and abuse over time as a function of use in 6 weeks pre-assault/assault time frame use, exposure to brief intervention, and interaction of pre-assault/assault time frame use with intervention. Participants were 268 women seeking post-sexual assault medical services completing one or more follow-up assessment at: (1) <3 months post-assault; (2) 3 to 6 months post-assault; and (3) 6 months or longer post-assault. Use of alcohol or marijuana at time of assault was a fairly sensitive and specific indicator respectively, of reported use of specific substance in the 6 weeks preceding assault and use or abuse at follow-up. Growth modeling revealed that use of alcohol or marijuana at the time of the assault or in the 6 weeks prior to assault predicted higher Time 1 follow-up alcohol and marijuana use and abuse. Although there was relatively little change in use or abuse over time, alcohol use at time of the assault or in the 6 weeks prior also predicted a steeper decline in alcohol use over the course of follow-up. Interestingly, women who reported using marijuana at the time of the assault or in the 6 weeks prior who also received a video intervention actually had lower initial marijuana use, a pattern that remained stable over time. Implications for evaluating screening, brief intervention and referral to treatment services among sexual assault victims seeking post-assault medical care are discussed.
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Affiliation(s)
- Heidi S Resnick
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, United States.
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Caputo ND, Shields CP, Ochoa C, Matarlo J, Leber M, Madlinger R, Waseem M. Violent and fatal youth trauma: is there a missed opportunity? West J Emerg Med 2012; 13:146-50. [PMID: 22900103 PMCID: PMC3415801 DOI: 10.5811/westjem.2011.6.6765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 04/29/2011] [Accepted: 06/13/2011] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Accidents and assaults (homicides) are the leading causes of death among the youth of the United States, accounting for 53.3% of deaths among children aged 1 to19 years. Victim recidivism, defined as repeated visits to the emergency department (ED) as a victim of violent trauma, is a significantly growing public health problem. As 5-year mortality rates for recidivism are as high as 20%, it is important to determine whether victims with a history of violent trauma are at increased risk for fatal outcome with their next trauma. We hypothesized that victims of violent trauma who have had 1 prior ED visit for violent trauma will have increased odds of fatal outcome. METHODS A retrospective chart review was conducted for patients presenting with penetrating trauma to the ED from January 1, 1999 to December 31, 2009. All patients between the ages of 15 to 25 years who presented to the ED for any penetrating trauma were included. Patients with prior presentations for penetrating trauma were compared to those patients who were first-time presenters to determine the odds ratio of fatal outcome. RESULTS Overall, 15,395 patients were treated for traumatic presentations. Of these, 1,044 met inclusion criteria. Demographically, 79.4% were Hispanic, 19.4% were African American, and 0.96% were Caucasian. The average age was 21 years, and 98% of the population was male. One hundred and forty-seven (14%) had prior presentations, and 897 (86%) did not. Forty of the 147 patients (27%) with prior presentations had a fatal outcome as compared to 29 patients of the 868 (3%) without prior presentations, with odds ratio of 10.8 (95% confidence interval, 6.4-18.1; Pearson χ(2), P < 0.001). The 5-year mortality rate for those patients with fatal outcomes was calculated at 16.5%. CONCLUSION Patients who had prior ED visits for penetrating trauma were at greater risk for fatal outcomes compared to those with no prior visits. Therefore, trauma-related ED visits might offer an opportunity for education and intervention. This may help to prevent future fatalities.
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Affiliation(s)
- Nicholas D. Caputo
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Christopher P. Shields
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Cesar Ochoa
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Jennifer Matarlo
- Lincoln Medical and Mental Health Center, Department of Surgery, Division of Trauma Surgery, Bronx, New York
| | - Mark Leber
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | - Robert Madlinger
- Lincoln Medical and Mental Health Center, Department of Surgery, Division of Trauma Surgery, Bronx, New York
| | - Muhammed Waseem
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
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Alexandercikova Z, Walton MA, Chermack ST, Cunningham RM, Barry KL, Blow FC. Correlates of partner and non-partner aggression among patients with substance use disorders in an urban ED. JOURNAL OF SUBSTANCE USE 2012. [DOI: 10.3109/14659891.2012.668260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
We compared the prevalence of exposure to violence across different types of alcohol consumed and the association between the type of alcohol consumed and exposure to violence. A cross-sectional analysis of data collected from a sample of 295 Emergency Department (ED) patients identified as having an alcohol problem. Outcome measure include exposure to violence, and the main study predictor was "type of alcoholic drink" including: malt liquor beer (MLB), regular beer, wine cooler, wine, fortified wine or hard liquor. Using logistic regression analysis, ED patients who drank MLB in combination with other types of alcohol increased their odds of being both threatened and physically attacked by 8.5 compared to ED patients who drank other types of alcohol. Being female increased the odds of being both threatened and physically attacked by 2.5 and using illicit drugs increased the odds by 3.8. Analysis of covariance and estimated marginal means revealed that ED patients who only drank MLB had a higher exposure to violence compared to non-MLB drinkers, and that female illicit drug users who drank MLB in combination with other types of alcohol had the highest exposure to violence. MLB was identified as a predictor of the amount of exposure to violence and in particular, that the use of malt liquor beer in combination with other types of alcohol increased the risk of being both threatened and physically attacked. Implications for ED and community interventions are suggested.
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Ranney ML, Mello MJ. A comparison of female and male adolescent victims of violence seen in the emergency department. J Emerg Med 2011; 41:701-6. [PMID: 21536402 DOI: 10.1016/j.jemermed.2011.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/16/2010] [Accepted: 03/20/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Violence is a leading cause of injury and death among adolescents. Reports indicate increasing incidence of violent injuries among adolescent females, but have not described characteristics of or charting completeness for these assault victims in the emergency department (ED). OBJECTIVES To compare demographic and injury-related characteristics of assaulted urban adolescent females and males presenting to an ED; and to compare completeness of hospital coding for intentionality of females' and males' injuries. METHODS Retrospective, cross-sectional analysis of potentially violent injuries (identified by E-codes and chart review) among urban youth presenting to a city's only level I trauma center. Demographics, injury characteristics, and chart- vs. hospital-determined intentionality were described with proportions and relative risks. RESULTS E-code search resulted in 828 charts with injury diagnoses; 385 were determined by chart review to represent violent injuries (150 females, 235 males). Female victims had similar race, age, and socioeconomic status to males. Females' injuries were more likely to be documented as caused by a single person, by someone known to them, and at home. Females were less likely to be injured by weapons or in a public space. Females' charts were more likely to contain information about the circumstances of injury. Intentionality was equally likely to be miscoded for females and males. CONCLUSIONS Adolescent female victims of community violence presenting to an urban ED have different assault characteristics from males. Females' charts have less missing information. A high percentage of all charts have assault intentionality miscoded, suggesting that E-code-based violence surveillance in this population may not be accurate.
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Affiliation(s)
- Megan L Ranney
- Injury Prevention Center, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Walton MA, Murray R, Cunningham RM, Chermack ST, Barry KL, Booth BM, Ilgen MA, Wojnar M, Blow FC. Correlates of intimate partner violence among men and women in an inner city emergency department. J Addict Dis 2010; 28:366-81. [PMID: 20155606 DOI: 10.1080/10550880903183018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study surveyed medical or injured patients (men and women) in an inner city emergency department to examine the rates and correlates of intimate partner violence, including substance use patterns. Over a 2-year period, participants (n = 10,744) self-administered a computerized health survey during their emergency department visit that included screening items regarding past year history of intimate partner violence (including victimization and aggression). Overall, rates of any intimate partner violence involvement in past year were 8.7% (7.3% victimization and 4.4% aggression); however, women were more likely than men to report intimate partner violence. When examining participants' substance use patterns, participants who reported using both alcohol and cocaine were most likely to report intimate partner violence. Predictors of partner aggression and victimization were remarkably similar. This article provides unique data regarding correlates of past year intimate partner violence history among a comprehensive sample of male and female emergency department patients presenting for medical complaints or injury.
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Affiliation(s)
- Maureen A Walton
- University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48105, USA.
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Houry D, Cunningham RM, Hankin A, James T, Bernstein E, Hargarten S. Violence prevention in the emergency department: future research priorities. Acad Emerg Med 2009; 16:1089-95. [PMID: 20053227 DOI: 10.1111/j.1553-2712.2009.00544.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The 2009 Academic Emergency Medicine Consensus Conference working group session participants developed recommendations and research questions for violence prevention in the emergency department (ED). A writing group devised a working draft prior to the meeting and presented this to the breakout session at the consensus conference for input and approval. The recommendations include: 1) promote and facilitate the collection of standardized information related to violence victimization and perpetration in ED settings; 2) develop and validate brief practical screening instruments that can identify those at risk for perpetration of violence toward others or toward self; 3) develop and validate brief practical screening instruments that can identify victims at risk for violent reinjury and mental health sequelae; and 4) conduct efficacy, translational, and dissemination research on interventions for violence prevention. The work group emphasized the critical need and role of ED-based research to impact surveillance and prevention of future violence-related injury.
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Affiliation(s)
- Debra Houry
- Department of Emergency Medicine, Center for Injury Control, Emory University, 49 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, USA.
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