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Bernardin ME, Cutler KO. Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault. Pediatr Emerg Care 2024; 40:415-420. [PMID: 38048545 DOI: 10.1097/pec.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this study was to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries. METHODS This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW). We compared them with age-, race-, and sex-matched youths presenting for nonviolent medical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2) mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse. We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW. RESULTS The PA and GSW groups used the ED for previous PAs, mental/behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9% of the GSW group returned to the ED with a subsequent GSW in the following 16 to 40 months. CONCLUSIONS Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.
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Affiliation(s)
| | - Keven O Cutler
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO
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Fornari MJ, Badolato GM, Rao K, Goyal MK, McCarter R, Donnelly KA. Violent Injury as a Predictor of Subsequent Assault-Related Emergency Department Visits Among Adolescents. J Adolesc Health 2023; 72:972-976. [PMID: 36737352 DOI: 10.1016/j.jadohealth.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To measure the risk of a subsequent assault-related emergency department (ED) visit in assault injured adolescents as compared to those who initially presented for non-assault related injuries. METHODS This was a historical cohort study of youth (ages 10-18 years) seen at two pediatric EDs between 2016 and 2019. Participants were included if their visit had an International Classification of Diseases-10 code for assaultive injury or accidental injury (motor vehicle collisions (MVC) and sports injuries). We calculated the rate of a subsequent ED visit for an assault-related injury, and then used survival analysis to compare time to subsequent ED visit with an assault-related injury between study and comparison groups. RESULTS A total of 6125 adolescents met inclusion criteria (Assault: n = 2782, 45.4%; MVC: n = 1834, 29.9%; Sports n = 1509, 24.6%). The overall rate per 100 person years of a subsequent assault-related ED visit was 5.6 (n = 344). Patients who initially presented with an assault-related injury had an increased adjusted relative risk (aRR) of return for a subsequent ED visit for an assault-related injury when compared to MVC patients (aRR 17.6 [95% CI: 9.6, 32.2]). Kaplan-Meier time to event analysis found that patients in the assault injury group have a higher probability of a subsequent ED visit for an assault-related injury compared to patients in the MVC injury group (adjusted hazard ratio (aHR): 17.7 [95% CI: 9.67, 32.42]). CONCLUSIONS Adolescents injured by assault are more likely to return to the ED for a subsequent assault-related injury compared to adolescents who initially present with non-assault-related injuries.
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Affiliation(s)
- Marci J Fornari
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | - Gia M Badolato
- Children's National Hospital, Division of Emergency Medicine, Washington, District of Columbia
| | - Krithika Rao
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Monika K Goyal
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Robert McCarter
- Children's National Hospital, Division of Translational Science, George Washington University School of Medicine and Health Sciences (retired), Washington, District of Columbia
| | - Katie A Donnelly
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Kironji AG, Jones V, Cheng T, Johnson SL, Fein JA, Ryan L. Factors Associated With Urban Youth and Parent Perceptions of the Preventability of Assault Injury: An Emergency Department Sample. Pediatr Emerg Care 2021; 37:606-614. [PMID: 31045957 DOI: 10.1097/pec.0000000000001797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to identify factors associated with urban youth and parent's perception of the preventability of medically attended youth assault injuries to guide future violence prevention strategies. METHODS Assault-injured youth (n = 188; ages, 10-15 years; 60% male; 96% black) and their parents were recruited from 2 pediatric emergency departments in 2 cities. Mental health, injury severity, circumstances of injury, and family composition were some of the factors explored as cross-sectional predictors of the perception of the preventability of youth assault injury. Separate models were developed using stepwise regression for youth and parents. RESULTS Sixty-eight (38%) youth and 123 parents (68%) reported that the injury was definitely preventable (χ2 = 9.6250, P < 0.05). For youth, identifying themselves as the aggressor (odds ratio [OR], 0.23, 95% confidence interval [CI], 0.07-0.70) or having been hospitalized for psychiatric illness (OR, 0.21; 95% CI, 0.05-0.85) was associated with lower odds of perceiving their injury as preventable, while being under the care of a mental health professional (OR, 3.87; 95% CI, 1.21-12.39) was associated with higher odds. For parents, being in a household with grandparents (OR, 0.21; 95% CI, 0.04-0.99) or having a child with a learning disability (OR, 0.16; 95% CI, 0.05-0.57) was associated with lower odds of perceiving the injury as preventable. CONCLUSIONS Several factors in youth and parents were identified as being associated with perception of preventability of injuries in this high-risk population of youth. Youth and parents identified different factors. In addition, although most parents reported that the assault injury sustained by their child was preventable, the opposite was true for youth perceptions. Future violence prevention programs should consider youth and parent perspectives and develop unique strategies to address both their needs.
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Affiliation(s)
| | - Vanya Jones
- From the Johns Hopkins Bloomberg School of Public Health
| | - Tina Cheng
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Joel A Fein
- Department of Pediatrics, Emergency Medicine, Children's Hospital of Philadelphia, PA
| | - Leticia Ryan
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Ahn KO, Kim J, Shin SD, Park H, Vaca FE, Park JO. The influence of behavioural and socioeconomic factors on the community injury rates of adolescents assessed by the south Korean emergency medical services: an ecological approach. BMC Public Health 2019; 19:830. [PMID: 31242881 PMCID: PMC6595560 DOI: 10.1186/s12889-019-7190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Aim of this study is to determine if peer group risk behaviors and neighbourhood socioeconomic status (SES) would ecologically affect injury incidence according to place and gender among adolescents (aged 13–15) in South Korea. Methods Three variables from the Korea Youth Risk Behavior Survey (2014) were used to represent peer group risk behaviours; current alcohol consumption (cAlc), the experience of violence or bullying (VicVB), and having undergone education for injury prevention (Edu-IP). The Korea Census Data (2010) was used for neighborhood SES; the degree of urbanization, the proportion of high educational attainment, and the proportion of low residential environment. The nationwide and regional Incidence-Rates of Injury assessed by EMS (IRI-EMS) were calculated according to age and gender based on the number of injuries from EMS record (2014). A linear regression model was used to examine associations. Results The nationwide total and inside-school IRI-EMS were 623.8 and 139.3 per 100,000 population, respectively. The range of the regional IRI-EMS showed a maximum of about 4 times the difference from 345 to 1281 per 100,000 population depending on the region. The low residential environment had a significant effect on the increase of total IRI-EMS (β = 7.5, 95% CI 0.78–14.21). In the case of boys, the IRI-EMS inside-school was increased as the percentage of VicVB was higher (β = 17.0, 95% CI 1.09–32.91). In the case of girls, the IRI-EMS outside-school was increased in rural compared to urban location (β = 211.3, 95% CI 19.12–403.57). Conclusion The incidence rate of outside-school was higher than that of inside-school, and incidence rate of boys was higher than that of girls. Peer group risk behaviors were significant only in the injury of boys. Among the SES factors, rural area was a significant factor in girls, especially outside-school injury. Moreover, the rate of households not in an apartment was significant in all outside-school injury and outside-school injury of boys. Our study suggests that among native South Korean adolescents, neighbourhood SES and peer group risk behavior have different effects depending on the injury context such as place of occurrence or gender.
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Affiliation(s)
- Ki Ok Ahn
- Department of Emergency Medicine, Myoungji Hospital, Hanyang University College of Medicine, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of South Korea
| | - Jungeun Kim
- Laboratory of emergency medical services, Bio-medical research institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of South Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of South Korea
| | - Federico E Vaca
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite 260, NewHaven, CT, 06519, USA
| | - Ju Ok Park
- Department of Emergency Medicine, Hallym University College of Medicine, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of South Korea.
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Ranney ML, Patena JV, Dunsiger S, Spirito A, Cunningham RM, Boyer E, Nugent NR. A technology-augmented intervention to prevent peer violence and depressive symptoms among at-risk emergency department adolescents: Protocol for a randomized control trial. Contemp Clin Trials 2019; 82:106-114. [PMID: 31129373 DOI: 10.1016/j.cct.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Peer violence and depressive symptoms are increasingly prevalent among adolescents, and for many, use the emergency department (ED) as their primary source of healthcare. Brief in-person interventions and longitudinal text-message-based interventions are feasible, acceptable, and may be effective in reducing peer violence and depressive symptoms when delivered in the ED setting. This paper presents the study design and protocol for an in-ED brief intervention (BI) and text messaging program (Text). METHODS This study will be conducted in a pediatric ED which serves over 50,000 pediatric patients per year. Recruitment of study participants began in August 2018 and anticipated to continue until October 2021. The study will enroll 800 adolescents (ages13-17) presenting to the ED for any reason who self-report past-year physical peer violence and past-two week mild-to-moderate depressive symptoms. The study will use a factorial randomized trial to test both overall intervention efficacy and determine the optimal combination of intervention components. A full 2 × 2 factorial design randomizes patients at baseline to 1) BI or no BI; and 2) Text or no Text. Peer violence and depressive symptoms improvements will be measured at 2, 4, and 8 months through self-report and medical record review. DISCUSSION This study has important implications for the progress of the greater field of mobile health interventions, as well as for adolescent violence and depression prevention in general. This proposal has high clinical and public health significance with high potential scalability, acceptability, and impact.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street 2nd Floor, Providence, RI 02903, United States; Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - John V Patena
- Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, Box G-5121-4, Providence, RI 02912, United States.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States.
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
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Murphy S, Kruse M, Elklit A, Brink O. Risk factors for violence-related injuries in emergency departments: a Danish linkage study. Eur J Psychotraumatol 2019; 10:1606627. [PMID: 31143409 PMCID: PMC6522947 DOI: 10.1080/20008198.2019.1606627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Interpersonal violence is a pervasive global public health problem associated with myriad health, social and economic consequences. In recent years the rates of interpersonal violence have decreased, however, high numbers of individuals continue to present to emergency departments for non-fatal violence-related injuries. Objective: This study aimed to examine a range of risk factors associated with violence-related injuries in an emergency department in Denmark. Method: A case-control study was conducted on a sample of 3,940 victims of violence collected by the Accident Analysis Center for Aarhus County Municipality. Using the Danish Civil Registry System, controls were matched 10:1 on age, gender and municipality. Risk factors were rendered from Danish health and social registers five years prior to the violent assault. These included marital status, educational qualification, employment status, national origin, involvement with child protective services (CPS), prior convictions, and a diagnosis of adjustment disorder and alcohol and/or substance use disorders. Results: Multivariate logistic regression identified that being male, divorced, unmarried, non-Danish origin, attending compulsory education, being outside the labour force, students, involvement with CPS, prior criminal conviction and a diagnosis of alcohol and/or substance use disorders were associated with an increased likelihood of being exposed to violence. The dominant risk factors were alcohol and/or substance use disorders (OR = 3.62) and prior criminal conviction (OR = 3.54). Attainment of tertiary education was associated with a reduced likelihood of being a victim of violence. Conclusion: These findings highlight that research into effective interventions offered in emergency departments may help the public health effort to reduce the health, social and economic burden of interpersonal violence.
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Affiliation(s)
- Siobhan Murphy
- National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Marie Kruse
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Ask Elklit
- National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Ole Brink
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Carter PM, Dora-Laskey AD, Goldstick JE, Heinze JE, Walton MA, Zimmerman MA, Roche JS, Cunningham RM. Arrests Among High-Risk Youth Following Emergency Department Treatment for an Assault Injury. Am J Prev Med 2018; 55:812-821. [PMID: 30344036 PMCID: PMC6246796 DOI: 10.1016/j.amepre.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/20/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-using youth following emergency department treatment. METHODS Youth (aged 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression. RESULTS In the longitudinal cohort, 511 youth seeking emergency department care (assault injury group n=299, comparison group n=212) were aged ≥18 years and were included for analysis. Youth in the assault injury group cohort had a 47% higher risk of arrest than the comparison group (38.1% vs 25.9%, RR=1.47, p<0.05). In unadjusted analyses, male sex, assault injury, binge drinking, drug use disorder, and community violence exposure were all associated with increased risk of arrest during the follow-up period. Cox regression identified that male sex (hazard ratio=2.57), drug use disorder diagnosis (hazard ratio=1.42), assault injury at baseline (hazard ratio=1.63), and community violence exposure (hazard ratio=1.35) increased risk for arrest. CONCLUSIONS Drug-using assault-injured youth have high rates of arrest. Emergency department and community interventions addressing substance use and violence involvement may aid in decreasing negative violence and criminal justice outcomes among high-risk youth. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01152970.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Aaron D Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Jason E Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Justin E Heinze
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jessica S Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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8
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Karsberg S, Bramsen RH, Lasgaard M, Elklit A. Prevalence and characteristics of three subtypes of dating violence among Danish seventh-grade students. Scand J Child Adolesc Psychiatr Psychol 2018; 6:16-27. [PMID: 33520748 PMCID: PMC7750701 DOI: 10.21307/sjcapp-2018-004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background A high prevalence of adolescent dating violence (ADV) has been documented in recent years. However, the majority of ADV studies have been conducted in North America and moreover, ADV studies have primarily focused on high school or college populations. Objective To investigate victimization and perpetration of ADV and related gender differences in a sample of Danish seventh-grade students. Method In total, 2934 seventh-grade students (M = 3.5, SD = 0.5) filled out questionnaires at school. Results The prevalence of victimization of emotional, physical and sexual ADV was 32.2%, 11.2% and 10.6%, and the prevalence of perpetration of emotional, physical and sexual ADV was 20.6%, 6% and 2.1%. One out of five students reported both victimization and perpetration of one of the three ADV types and 14.3% and 6% reported multiple forms of ADV victimization and perpetration respectively. Moreover, gender differences in the prevalence of ADV and the co-occurrence of ADV victimization and perpetration were identified. Conclusion The present study highlights that a large proportion of Danish seventh-grade students are experiencing ADV, and that ADV preventive programs are relevant already in early adolescence. Based on the high proportion of students reporting co-occurrence of victimization and perpetration experiences, comprehensive preventive programs that focus on both victimization and perpetration experiences and the transmission of violence are recommended.
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Affiliation(s)
| | - Rikke Holm Bramsen
- Department of Psychology, University of Southern Denmark.,Aarhus Rape Crisis Center, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ask Elklit
- Department of Psychology, University of Southern Denmark
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Thorsen MM, Patena JV, Guthrie KM, Spirito A, Ranney ML. Using High-Risk Adolescents' Voices to Develop a Comprehensible Cognitive Behavioral Therapy-Based Text-Message Program. Behav Med 2018; 44:89-99. [PMID: 27594559 PMCID: PMC5336547 DOI: 10.1080/08964289.2016.1223597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
At-risk adolescents' comprehension of, and preferences for, the content of a text-message (SMS) delivered, cognitive behavioral therapy (CBT)-based depression prevention intervention was investigated using two qualitative studies. Adolescents with depressive symptoms and a history of peer violence were recruited from an urban emergency department. Forty-one participants completed semi-structured qualitative interviews. Thematic analysis using deductive and inductive codes were used to capture a priori and emerging themes. Five major themes were identified: CBT-based messages resonated with at-risk adolescents; high levels of peer violence, comorbid symptoms, and prior exposure to the mental health system were variables affecting preferred content; participants endorsed emotional regulation messages, but found mindfulness content difficult to understand via SMS; cognitive awareness and restructuring content was most acceptable when framed by self-efficacy content; adolescent participants generated applicable CBT content in their own voices. Overall, CBT-informed content was able to be distilled into 160-character text messages without losing its comprehensibility.
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Affiliation(s)
| | - John V. Patena
- School of Public Health, Brown University, Providence, RI
| | - Kate Morrow Guthrie
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - Anthony Spirito
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - Megan L. Ranney
- Emergency Digital Health Innovation Program, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI
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10
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Bell TM, Qiao N, Jenkins PC, Siedlecki CB, Fecher AM. Trends in Emergency Department Visits for Nonfatal Violence-Related Injuries Among Adolescents in the United States, 2009-2013. J Adolesc Health 2016; 58:573-5. [PMID: 26907850 DOI: 10.1016/j.jadohealth.2015.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Violence-related injuries are a major cause of death and disability among adolescents in the United States. The objective of this study was to examine trends in adolescent violence-related injuries between 2009 and 2013. METHODS This study examined data from the National Electronic Injury Surveillance System-All Injury Program for years 2009-2013. Linear regression was used to assess trends in rates of violence-related injuries among adolescents aged between 10 and 19 years. RESULTS We found overall rates of nonfatal violence-related injuries among all adolescents did not change significantly across the study years (p = .502). However, self-harm injury rates have significantly increased among female and younger adolescents during the period (p = .001 and .011, respectively). CONCLUSIONS Our results indicate that the overall intentional injury rates in adolescents have been stable; however, rates of self-injury have significantly increased in younger adolescents and females. Future research should focus on exploring causes of increases in self-harm injuries in these subpopulations.
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Affiliation(s)
- Teresa M Bell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Nan Qiao
- Department of Economics, Indiana University, Indianapolis, Indiana
| | - Peter C Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Charles B Siedlecki
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alison M Fecher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Resko SM, Reddock EC, Ranney ML, Epstein-Ngo Q, Mountain SK, Zimmerman MA, Cunningham RM, Walton MA. Reasons for Fighting among Violent Female Adolescents: A Qualitative Investigation from an Urban, Midwestern Community. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:99-112. [PMID: 27018828 PMCID: PMC4933529 DOI: 10.1080/19371918.2015.1087914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This qualitative study examines the self-reported reasons for fighting among female adolescents (N = 72). Data are drawn from brief intervention sessions addressing violent behavior and alcohol use. Young women age 14 to 18 (Mean = 16) were recruited in an urban emergency department (58.3% African American/Black, 31.9% White, and 9.7% other races/ethnicities). Participants identified multiple reasons that they engage in fights including self-protection/self-defense, enhancing social status and respect, safety (e.g., preventing future fights or sexual assaults), revenge/retaliation, social motivations (e.g., defending family or friends, fighting over romantic interests), coping, and enjoyment. Results provide insight into opportunities and challenges in developing interventions addressing aggression among female adolescents.
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Affiliation(s)
- Stella M Resko
- a Merrill Palmer Skillman Institute, Wayne State University , and, Detroit , Michigan , USA
| | - Ebony C Reddock
- b School of Public Health, University of Michigan , Ann Arbor , Michigan , USA
| | - Megan L Ranney
- c Injury Prevention Center, Department of Emergency Medicine , Alpert Medical School, Brown University , Providence , Rhode Island , USA
| | - Quyen Epstein-Ngo
- d Institute for Research on Women and Gender, University of Michigan , Ann Arbor , Michigan , USA
| | | | - Marc A Zimmerman
- b School of Public Health, University of Michigan , Ann Arbor , Michigan , USA
| | - Rebecca M Cunningham
- f School of Public Health and Injury Center, University of Michigan , Ann Arbor , Michigan
- g Department of Emergency Medicine , Hurley Medical Center , Flint , Michigan , USA
| | - Maureen A Walton
- h Injury Center and Addiction Research Center, Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA
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Patton R, Lau CH(J, Blow FC, Ranney M, Cunningham R, Walton M. Prevalence and Correlates of Depression and Drinking Behaviors Among Adolescents and Emerging Adults in a Suburban Emergency Department. Subst Use Misuse 2016; 51:34-40. [PMID: 26669633 PMCID: PMC5137633 DOI: 10.3109/10826084.2015.1074692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both alcohol use and depression are concerning health issues among youth. The Emergency Department (ED) is a critical location to access youth with depressive symptoms and alcohol misuse. OBJECTIVES To inform future interventions in the ED, this study examined the relationship between drinking behaviors and depressive symptoms among youth seeking ED care. METHODS Youth ages 14-20 were recruited from a level-1 trauma ED located in the Midwest as part of a larger ongoing study. Participants completed an electronic screening survey, which included assessment of alcohol use, depressive symptoms, and demographic variables. Two logistic regression models were conducted to assess the relationship between depressive symptoms with alcohol consumption and specific alcohol-related consequences. RESULTS Among 3,659 participants, bivariate analysis indicated that individuals screening positive for depression were more likely to be female, nonwhite, receive public assistance, and report higher scores on both alcohol consumption and alcohol-related consequences. Regression analyses indicated alcohol consumption, inability to stop drinking once starting, and feelings of guilt or remorse after drinking were significantly positively related to screening positive for depression. CONCLUSIONS/IMPORTANCE Current findings support use of the ED as a location for identifying youth who are experiencing co-morbid alcohol use and depressive symptoms. Future research should focus on the effectiveness of brief intervention in the ED that focuses on the co-occurrence of alcohol misuse and depressive symptoms among youth.
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Affiliation(s)
- Rikki Patton
- University of Akron, Counseling, 114 Chima, 27 S. Forge St, Akron, 44325 United States
| | | | - Frederic C Blow
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, 48109 United States
| | - Megan Ranney
- Brown University, Emergency Medicine, Providence, United States
| | | | - Maureen Walton
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, 48109 United States
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Hocagil H, Izci F, Hocagil AC, Findikli E, Korkmaz S, Koc MI. Association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic. Neuropsychiatr Dis Treat 2016; 12:511-6. [PMID: 27013877 PMCID: PMC4777231 DOI: 10.2147/ndt.s91411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic. METHODS This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients. RESULTS Of the patients exposed to violence 63% (n=46) were female and 27% (n=27) were male. Of these patients, 68.5% (n=50) were married, 43.8% (n=25) were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41) were primary school, 21.9% (n=16) were high school, and 21.9% (n=16) were university graduates. Smoking and alcohol use rates were 54.8% (n=40) and 17.8% (n=13), respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57). In addition, anxiety scores were high in 42.5% (n=31) and moderate in 9.6% (n=7) of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13) of the patients and 19.2% (n=14) of the patients' relatives. The correlation between sociodemographic characteristics and anxiety scores revealed that married patients had higher anxiety scores (P<0.01) and patients assaulted by their parents had lower anxiety scores (P<0.00). CONCLUSION A total of 63% of the violence-exposed patients admitted to emergency room were females, 56.2% were primary school graduates, and 43.8% were factory workers; this result shows that low socioeconomical status and education level affect exposure to trauma especially in females. In addition, ~20% of the patients and patients' relatives had a psychiatric disorder and 53.4% of perpetrators were parents, spouses, and children; this result shows that psychiatric history and family relations are one of the issues that should be taken into account and treated.
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Affiliation(s)
- Hilal Hocagil
- Department of Emergency, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Filiz Izci
- Department of Psychiatry, School of Medicine, Istanbul Bilim University, Istanbul, Turkey
| | | | - Ebru Findikli
- Department of Psychiatry, School of Medicine, Sutcu Imam University, Kahramanmaras, Turkey
| | - Sevda Korkmaz
- Department of Psychiatry, School of Medicine, Firat University, Elazig, Turkey
| | - Merve Iris Koc
- Department of Psychiatry, Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul, Turkey
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Góes Junior AMDO, Rodrigues ADV, Braga FB, de Andrade MC, Abib SDCV. Vascular trauma in the Amazon - the challenge of great distances. Rev Col Bras Cir 2015; 42:244-52. [PMID: 26517800 DOI: 10.1590/0100-69912015004009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/05/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the incidence of unfavorable outcomes in vascular trauma patients and their possible correlation to the distance between the city where the injury was sustained and the hospital where the patient received definitive treatment. METHODS descriptive and retrospective study. Data were collected from medical records of patients submitted to surgical procedures for arterial or venous injuries from February 2011 to February 2013 at the only trauma center providing vascular surgery in a vast area of the Amazon region. Trauma date, patient gender and age, mechanism and anatomic topography of injury, surgical management, need for surgical re-intervention, hospitalization period, postoperative complications, mortality and limb amputation rates were analyzed. The incidence of unfavorable outcomes was assessed according to the distance between the city where the vascular injury was sustained and the trauma center. RESULTS One hundred seventy-three patients with 255 vascular injuries were analyzed; 95.95% were male (p<0.05), mean age of 28.92 years; 47.4% were caused by firearm projectiles (p<0.05); topographic distribution: 45.66% lower limbs (p<0.05), 37.57% upper limbs, 6.94% abdominal, 5.2% thoracic and 4.62% were cervical vascular injuries; 51.42% of patients required hospitalization for seven days or less (p<0.05); limb amputation was necessary in 15.6% and the overall mortality was 6.36%. CONCLUSION distances greater than 200 Km were associated to longer hospitalization period; distances greater than 300 Km were associated to increased limb amputation probability; severe vascular trauma have an increased death probability when patients need to travel more than 200 Km for surgical treatment.
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Hassan M, Killion C, Lewin L, Totten V, Gary F. Gender-related sexual abuse experiences reported by children who were examined in an emergency department. Arch Psychiatr Nurs 2015; 29:148-54. [PMID: 26001713 DOI: 10.1016/j.apnu.2015.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 01/20/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to examine the experiences of sexual abuse by 95 children of two gender groups to determine differences in their reported sexual exploits by perpetrators. Significant differences between female and male children were reported. Male child-victims experienced more anal penetration by penis (54.5%, 10.7% respectively) and finger (27.3%, 2.7% respectively), however; female child-victims experienced more mouth contact to their genitalia (22.7%, 10.0% respectively) and body kisses (47.9%, 9.1% respectively). A more gender-specific approach could help to facilitate prevention, and produce better outcomes.
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Affiliation(s)
- Mona Hassan
- College of Nursing, Texas Woman's University, Houston, TX.
| | - Cheryl Killion
- Francis Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.
| | - Linda Lewin
- College of Nursing, Wayne State University, Detroit, MI.
| | - Vicken Totten
- Department of Emergency Medicine, Assistant Professor, Case University School of Medicine, Cleveland OH.
| | - Faye Gary
- The Medical Mutual of Ohio, Kent W. Clapp Chair and Professorship in Nursing, Francis Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.
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16
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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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Mache S, Vitzthum K, Groneberg DA. Prevention of study-related stress symptoms: health-promoting behavior among dental students. Wien Med Wochenschr 2015; 165:100-6. [DOI: 10.1007/s10354-014-0341-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
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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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Ranney ML, Locci N, Adams EJ, Betz M, Burmeister DB, Corbin T, Dalawari P, Jacoby JL, Linden J, Purtle J, North C, Houry DE. Gender-specific research on mental illness in the emergency department: current knowledge and future directions. Acad Emerg Med 2014; 21:1395-402. [PMID: 25413369 PMCID: PMC4271843 DOI: 10.1111/acem.12524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/14/2014] [Accepted: 07/29/2014] [Indexed: 12/31/2022]
Abstract
Mental illness is a growing, and largely unaddressed, problem for the population and for emergency department (ED) patients in particular. Extensive literature outlines sex and gender differences in mental illness' epidemiology and risk and protective factors. Few studies, however, examined sex and gender differences in screening, diagnosis, and management of mental illness in the ED setting. Our consensus group used the nominal group technique to outline major gaps in knowledge and research priorities for these areas, including the influence of violence and other risk factors on the course of mental illness for ED patients. Our consensus group urges the pursuit of this research in general and conscious use of a gender lens when conducting, analyzing, and authoring future ED-based investigations of mental illness.
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Affiliation(s)
- Megan L Ranney
- Injury Prevention Center, Department of Emergency Medicine, Brown University, Providence, RI; Alpert Medical School, Brown University, Providence, RI
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Prevalence and predictors of mental disorders in intentionally and unintentionally injured emergency center patients. J Nerv Ment Dis 2014; 202:638-46. [PMID: 25126754 PMCID: PMC4170144 DOI: 10.1097/nmd.0000000000000176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Little is known about the prevalence and predictors of mental disorders among injured emergency center (EC) patients in low- and middle-income countries (LMICs). Patients presenting with either an intentional or unintentional injury were recruited (N = 200). Mental health, injury, and psychological trauma histories were assessed. Descriptive statistics and logistic regressions were conducted, and predictors of current mental disorder were identified. Diagnostic criteria for a current mental disorder, including substance use disorders, were met by 59.5% of the participants. Compared with those with an unintentional injury, the intentionally injured participants were more likely to be diagnosed with a current mental disorder (66.9% vs. 48.8%, p = .01). High frequencies of previous intentional injuries predicted for current mental disorder (OR = 1.46, 95% CI 1.08-1.98), whereas male gender and witnessed community violence predicted substance use disorder diagnoses. The findings indicate that injured EC patients, particularly those with intentional injuries, are at risk for mental disorders. Psychosocial interventions in the EC context can potentially make an important contribution in reducing the burden of mental disorders and injuries in LMICs.
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Ranney ML, Choo EK, Cunningham RM, Spirito A, Thorsen M, Mello MJ, Morrow K. Acceptability, language, and structure of text message-based behavioral interventions for high-risk adolescent females: a qualitative study. J Adolesc Health 2014; 55:33-40. [PMID: 24559973 PMCID: PMC4065850 DOI: 10.1016/j.jadohealth.2013.12.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/12/2013] [Accepted: 12/16/2013] [Indexed: 01/20/2023]
Abstract
PURPOSE To elucidate key elements surrounding acceptability/feasibility, language, and structure of a text message-based preventive intervention for high-risk adolescent females. METHODS We recruited high-risk 13- to 17-year-old females screening positive for past-year peer violence and depressive symptoms, during emergency department visits for any chief complaint. Participants completed semistructured interviews exploring preferences around text message preventive interventions. Interviews were conducted by trained interviewers, audio-recorded, and transcribed verbatim. A coding structure was iteratively developed using thematic and content analysis. Each transcript was double coded. NVivo 10 was used to facilitate analysis. RESULTS Saturation was reached after 20 interviews (mean age 15.4; 55% white; 40% Hispanic; 85% with cell phone access). (1) Acceptability/feasibility themes: A text-message intervention was felt to support and enhance existing coping strategies. Participants had a few concerns about privacy and cost. Peer endorsement may increase uptake. (2) Language themes: Messages should be simple and positive. Tone should be conversational but not slang filled. (3) Structural themes: Messages may be automated but must be individually tailored on a daily basis. Both predetermined (automatic) and as-needed messages are requested. Dose and timing of content should be varied according to participants' needs. Multimedia may be helpful but is not necessary. CONCLUSIONS High-risk adolescent females seeking emergency department care are enthusiastic about a text message-based preventive intervention. Incorporating thematic results on language and structure can inform development of future text messaging interventions for adolescent girls. Concerns about cost and privacy may be able to be addressed through the process of recruitment and introduction to the intervention.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Injury Prevention Center of Rhode Island Hospital, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island.
| | - Esther K Choo
- Department of Emergency Medicine, Injury Prevention Center of Rhode Island Hospital, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Rebecca M Cunningham
- Injury Control Research Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Michael J Mello
- Department of Emergency Medicine, Injury Prevention Center of Rhode Island Hospital, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kathleen Morrow
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
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Peirce JM, Schacht RL, Brooner RK, King VL, Kidorf MS. Prospective risk factors for traumatic event reexposure in community syringe exchange participants. Drug Alcohol Depend 2014; 138:98-102. [PMID: 24629781 PMCID: PMC4001832 DOI: 10.1016/j.drugalcdep.2014.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/10/2014] [Accepted: 02/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic event reexposure in injecting drug users is associated with increased drug use and potential for psychiatric symptoms. This is the first study to examine fixed and time-varying factors that are prospectively associated with new traumatic event reexposure in injecting drug users. METHODS Injecting drug users registered in a syringe exchange program were enrolled in a 16-month parent study comparing strategies to increase drug abuse treatment enrollment. Participants (N=162) completed baseline measures of demographics, psychiatric treatment history, and lifetime traumatic event exposure. Monthly follow-ups assessed past-month traumatic event exposure, days of heroin and cocaine use, criminal activity, and drug abuse treatment participation. Generalized estimating equations models tested the influence of fixed baseline and time-varying factors on traumatic event reexposure in the same month, the following month, and two months later. RESULTS Significant fixed risk factors for traumatic event reexposure include female gender and past psychiatric treatment. In addition, each past traumatic event exposure was associated with an increased likelihood of reexposure. After accounting for all other factors, each day of cocaine use was associated with a small but persistent increased risk of traumatic event reexposure. Reexposure to a traumatic event in the prior month more than doubled the risk of subsequent reexposure. CONCLUSIONS Injecting drug users experience a pattern in which drug use is associated with increased risk of subsequent traumatic event reexposure, and traumatic event reexposure is associated with further drug use and continued reexposure. Implications for addressing these concerns in injecting drug users are presented.
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Affiliation(s)
- Jessica M. Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Rebecca L. Schacht
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Math/Psychology Building, Room 312, Baltimore, MD 21250
| | - Robert K. Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Van L. King
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Michael S. Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224
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Amanullah S, Heneghan JA, Steele DW, Mello MJ, Linakis JG. Emergency department visits resulting from intentional injury in and out of school. Pediatrics 2014; 133:254-61. [PMID: 24420809 DOI: 10.1542/peds.2013-2155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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 OBJECTIVE Previous studies have reported concerning numbers of injuries to children in the school setting. The objective was to understand temporal and demographic trends in intentional injuries in the school setting and to compare these with intentional injuries outside the school setting. METHODS Data from the National Electronic Injury Surveillance System-All Injury Program from 2001 to 2008 were analyzed to assess emergency department visits (EDVs) after an intentional injury. RESULTS There were an estimated 7,397,301 total EDVs due to injuries sustained at school from 2001 to 2008. Of these, an estimated 736,014 (10%) were reported as intentional (range: 8.5%-10.7% for the study time period). The overall risk of an EDV after an intentional injury in school was 2.33 (95% confidence interval [CI]: 1.93-2.82) when compared with an EDV after an intentional injury outside the school setting. For intentional injury-related EDVs originating in the school setting, multivariate regression identified several demographic risk factors: 10- to 14-year-old (odds ratio [OR]: 1.58; 95% CI: 1.10-2.27) and 15- to 19-year-old (OR: 1.69; 95% CI: 1.01-2.82) age group, black (OR: 4.14; 95% CI: 2.94-5.83) and American Indian (OR: 2.48; 95% CI: 2.06-2.99) race, and Hispanic ethnicity (OR: 3.67; 95% CI: 2.02-6.69). The odds of hospitalization resulting from intentional injury-related EDV compared with unintentional injury-related EDVs was 2.01 (95% CI: 1.50-2.69) in the school setting. These odds were found to be 5.85 (95% CI: 4.76-7.19) in the outside school setting. CONCLUSIONS The findings of this study suggest a need for additional prevention strategies addressing school-based intentional injuries.
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de Oliveira Góes Jr. AM, Rodrigues ADV, Braga FB, de Andrade MC, de Campos Vieira Abib S. VASCULAR TRAUMA IN THE AMAZON REGION: A TWO YEARS CASES REVIEW FROM A SINGLE INSTITUTION. Health (London) 2014. [DOI: 10.4236/health.2014.66071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cunningham RM, Ranney M, Newton M, Woodhull W, Zimmerman M, Walton MA. Characteristics of youth seeking emergency care for assault injuries. Pediatrics 2014; 133:e96-105. [PMID: 24323994 PMCID: PMC3876183 DOI: 10.1542/peds.2013-1864] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To characterize youth seeking care for assault injuries, the context of violence, and previous emergency department (ED) service utilization to inform ED-based injury prevention. METHODS A consecutive sample of youth (14-24) presenting to an urban ED with an assault injury completed a survey of partner violence, gun/knife victimization, gang membership, and context of the fight. RESULTS A total of 925 youth entered the ED with an assault injury; 718 completed the survey (15.4% refused); 730 comparison youth were sampled. The fights leading to the ED visit occurred at home (37.6%) or on streets (30.4%), and were commonly with a known person (68.3%). Fights were caused by issues of territory (23.3%) and retaliation (8.9%); 20.8% of youth reported substance use before the fight. The assault-injured group reported more peer/partner violence and more gun experiences. Assault-injured youth reported higher past ED utilization for assault (odds ratio [OR]: 2.16) or mental health reasons (OR: 7.98). Regression analysis found the assault-injured youth had more frequent weapon use (OR: 1.25) and substance misuse (OR: 1.41). CONCLUSIONS Assault-injured youth seeking ED care report higher levels of previous violence, weapon experience, and substance use compared with a comparison group seeking care for other complaints. Almost 10% of assault-injured youth had another fight-related ED visit in the previous year, and ~5% had an ED visit for mental health. Most fights were with people known to them and for well-defined reasons, and were therefore likely preventable. The ED is a critical time to interact with youth to prevent future morbidity.
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Affiliation(s)
- Rebecca M. Cunningham
- School of Public Health,,Departments of Emergency Medicine and,Injury Center, University of Michigan, Ann Arbor, Michigan;,Hurley Medical Center, Flint, Michigan;,Michigan Youth Violence Prevention Center, Flint, Michigan; and
| | - Megan Ranney
- Department of Emergency Medicine and,Injury Prevention Center, Brown University, Providence, Rhode Island
| | - Manya Newton
- Departments of Emergency Medicine and,Injury Center, University of Michigan, Ann Arbor, Michigan;,Hurley Medical Center, Flint, Michigan
| | | | - Marc Zimmerman
- School of Public Health,,Injury Center, University of Michigan, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, Flint, Michigan; and
| | - Maureen A. Walton
- Psychiatry, and,Injury Center, University of Michigan, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, Flint, Michigan; and
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Cunningham RM, Whiteside LK, Chermack ST, Zimmerman MA, Shope JT, Bingham CR, Blow FC, Walton MA. Dating violence: outcomes following a brief motivational interviewing intervention among at-risk adolescents in an urban emergency department. Acad Emerg Med 2013; 20:562-9. [PMID: 23758302 DOI: 10.1111/acem.12151] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/27/2012] [Accepted: 01/01/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVES A recent study demonstrated the efficacy of the SafERteens intervention in reducing peer violence among adolescents presenting to the emergency department (ED). The objective of this study was to determine the efficacy of this ED-based brief intervention (BI) on dating violence 1 year following the ED visit among the subsample of adolescents in the original randomized controlled trial reporting past-year dating violence. METHODS Patients (aged 14 to 18 years) at an ED were eligible for inclusion if they had past-year violence and alcohol use. Participants were randomized to one of three conditions (BI delivered by a computer [CBI], BI delivered by a therapist and a computer (T+CBI), or control) and completed follow-ups at 3, 6, and 12 months. In addition to content on alcohol misuse and peer violence, adolescents reporting dating violence received a tailored module on dating violence. The outcome of interest was frequency of moderate and severe dating violence victimization and aggression (baseline and 3, 6, and 12 months after ED visit). RESULTS Among eligible adolescents, 55% (n = 397) reported dating violence and were included in these analyses. Compared to the control group (who received a resource brochure only), participants in the CBI showed reductions in moderate dating victimization at 3 months (inter-rater reliability [IRR] = 0.71; 95% confidence interval [CI] = 0.51 to 0.99; p < 0.05) and 6 months (IRR = 0.56; 95% CI = 0.38 to 0.83; p < 0.01). Models examining interaction effects were significant for the CBI on moderate dating victimization at 3 months (IRR = 0.81; 95% CI = 0.67 to 0.98; p < 0.05) and 6 months (IRR = 0.81; 95% CI = 0.66 to 0.99; p < 0.05). Significant interaction effects were found for the T+CBI on moderate dating violence victimization at 6 months (IRR = 0.81; 95% CI = 0.69 to 0.96; p < 0.01) and 12 months (IRR = 0.76; 95% CI = 0.63 to 0.90; p < 0.001) and severe dating violence victimization at 3 months (IRR = 0.76; 95% CI = 0.59 to 0.96; p < 0.05). CONCLUSIONS ED-based BIs tailored to address multiple risk behaviors (i.e., peer violence, alcohol use, and dating violence) show promise for reducing moderate and severe dating victimization for up to 1 year following an ED visit.
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Whiteside LK, Ranney ML, Chermack ST, Zimmerman MA, Cunningham RM, Walton MA. The overlap of youth violence among aggressive adolescents with past-year alcohol use-A latent class analysis: aggression and victimization in peer and dating violence in an inner city emergency department sample. J Stud Alcohol Drugs 2013. [PMID: 23200158 DOI: 10.15288/jsad.2013.74.125] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify overlap and violence types between peer and dating aggression and victimization using latent class analysis (LCA) among a sample of aggressive adolescents with a history of alcohol use and to identify risk and protective factors associated with each violence class. METHOD From September 2006 to September 2009, a systematic sample of patients (14-18 years old) seeking care in an urban emergency department were approached. Adolescents reporting any past-year alcohol use and aggression completed a survey using validated measures including types of violence (severe and moderate aggression, severe and moderate victimization with both peers and dating partners). Using LCA, violence classes were identified; correlates of membership in each LCA class were determined. RESULTS Among this sample (n = 694), LCA identified three classes described as (a) peer aggression (PA) (52.2%), (b) peer aggression + peer victimization (PAPV) (18.6%), and (c) multiple domains of violence (MDV) (29.3%). Compared with those in the PA class, those in the PAPV class were more likely to be male, report injury in a fight, and have delinquent peers. Compared with the PA class, those in the MDV class were more likely to be female, African American, report injury in a fight, carry a weapon, experience negative consequences from alcohol use, and have delinquent peers and more family conflict. Compared with the PAPV class, those in the MDV class were likely to be female, African American, receive public assistance, carry a weapon, experience negative consequences from alcohol use, and use marijuana. CONCLUSIONS There is extensive overlap of victimization and aggression in both peer and dating relationships. Also, those with high rates of violence across relationships have increased alcohol misuse and marijuana use. Thus, violence-prevention efforts should consider addressing concomitant substance use.
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Affiliation(s)
- Lauren K Whiteside
- Division of Emergency Medicine, University of Washington, Seattle, WA 98104, USA.
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The Assault-Injured Youth and the Emergency Medical System: What Can We Do? CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013. [DOI: 10.1016/j.cpem.2013.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ranney ML, Walton M, Whiteside L, Epstein-Ngo Q, Patton R, Chermack S, Blow F, Cunningham RM. Correlates of depressive symptoms among at-risk youth presenting to the emergency department. Gen Hosp Psychiatry 2013; 35:537-44. [PMID: 23810465 PMCID: PMC3775848 DOI: 10.1016/j.genhosppsych.2013.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/20/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The study's objective was to identify correlates of depressive symptoms among at-risk youth in an urban emergency department (ED). METHOD A systematic sample of adolescents (ages 14-18) in the ED were recruited as part of a larger study. Participants reporting past-year alcohol use and peer aggression self-administered a survey assessing: demographics, depressive symptoms and risk/protective factors. Logistic regression identified factors associated with depressive symptoms. RESULTS Among 624 adolescents (88% response rate) meeting eligibility criteria, 22.8% (n=142) screened positive for depressive symptoms. In logistic regression, depressive symptoms were positively associated with female gender [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.78-4.51], poor academic performance (OR: 1.57, 95% CI: 1.01-2.44), binge drinking (OR: 1.88, 95% CI: 1.21-2.91), community violence exposure (OR: 2.25, 95% CI: 1.59-3.18) and dating violence (OR: 2.14, 95% CI: 1.36-3.38) and were negatively associated with same-sex mentorship (OR: 0.52, 95% CI: 0.29-0.91) and older age (OR: 0.55, 95% CI 0.34-0.89). Including gender interaction terms did not significantly change findings. CONCLUSIONS Screening and intervention approaches for youth in the urban ED should address the co-occurrence of depressive symptoms with peer and dating violence, alcohol and nonmarijuana illicit drug use.
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Affiliation(s)
- Megan L. Ranney
- Injury Prevention Center, Department of Emergency Medicine, Alpert Medical School, Brown University, Ann Arbor, Michigan, USA
| | - Maureen Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA,Injury Control Research Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Quyen Epstein-Ngo
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rikki Patton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen Chermack
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA,Department of Veterans Affairs, Health Services Research and Development, Ann Arbor, Michigan, USA
| | - Fred Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA,Department of Veterans Affairs, Health Services Research and Development, Ann Arbor, Michigan, USA
| | - Rebecca M. Cunningham
- Injury Control Research Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA,School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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