Screening adolescents in the emergency department for weapon carriage.

OBJECTIVES: The objective was to describe the prevalence and correlates of past-year weapon involvement among adolescents seeking care in an inner-city emergency department (ED). METHODS: This cross-sectional study administered a computerized survey to all eligible adolescents (age 14-18 years), 7 days a week, who were seeking care over an 18-month period at an inner-city Level 1 ED. Validated measures were administered, including measures of demographics, sexual activity, substance use, injury, violent behavior, weapon carriage, and/or weapon use. Zero-inflated Poisson (ZIP) regression models were used to identify correlates of the occurrence and past-year frequency of these weapons variables. RESULTS: Adolescents (n = 2069, 86% response rate) completed the computerized survey. Fifty-five percent were female; 56.5% were African American. In the past year, 20% of adolescents reported knife or razor carriage, 7% reported gun carriage, and 6% pulled a knife or gun on someone. Although gun carriage was more frequent among males, females were as likely to carry a knife or pull a weapon in the past year. CONCLUSIONS: One-fifth of all adolescents seeking care in this inner-city ED have carried a weapon. Understanding weapon carriage among teens seeking ED care is a critical first step to future ED-based injury prevention initiatives.

Prevalence and correlates of handgun access among adolescents seeking care in an urban emergency department.

OBJECTIVE: To determine prevalence and correlates of handgun access among adolescents seeking care in an urban Emergency Department (ED) in order to inform future injury prevention strategies. METHODS: In this observational cross-sectional study performed in the ED of a large urban hospital, 14- to 18-year-old adolescents completed a computerized survey of risk behaviors. Adolescents seeking ED care (for injury or medical complaint) were approached seven days a week over a 22-month period. Validated measures included measures of demographics, sexual activity, substance use, injury, violent behavior, and handgun access. A logistic regression model predicting handgun access was performed. RESULTS: A total of 3050 adolescents completed the survey (44% male, 58.9% African-American), with 417 (12%) refusing to participate. One-third of the sample (n=1003) reported access to a handgun, and of those 54% were males (n=542). Logistic regression results indicated that older age (AOR: 1.58; 95% CI: 1.30-1.94), African-American race (AOR: 1.34; 95% CI: 1.11-1.61), male gender (AOR: 1.99; 95% CI: 1.66-2.37), and being employed (AOR: 1.35; 95% CI: 1.11-1.65), as well as seeking ED care for a medical complaint as compared to intentional injury (AOR: 1.69; 95% CI 1.62-2.50) predicted handgun access. Binge drinking (AOR: 1.75; 95% CI: 1.37-2.27), marijuana use (AOR: 1.93; 95% CI: 1.58-2.36), sexual activity (AOR: 1.64; 95% CI: 1.32-2.02), prior injury by a gun (AOR: 1.80; 95% CI: 1.32-2.46), serious physical violence (AOR: 1.37; 95% CI: 1.13-1.66) and group fighting (AOR: 2.07; 95% CI: 1.68-2.56) also predicted access. CONCLUSIONS: High rates of handgun access were evident among adolescents presenting in an inner city ED, including those seeking care for non-injury related reasons. Adolescents with access to handguns were more likely to report risk behaviors and past injury, providing clinicians with an opportunity for injury prevention initiatives.

Continuity of prescribers of short-acting beta agonists among children with asthma.

OBJECTIVE: To determine whether short-acting beta-agonist (SABA) prescriber continuity was associated with emergency department visits among children with asthma. STUDY DESIGN: An analysis of Michigan Medicaid administrative claims (2004-2005) for children ages 5 to 18 with asthma. Logistic regression models assessed the effect of SABA prescriber continuity (the number and site of prescribers) on emergency department visits, controlling for demographics, historical (2004) asthma use and SABA prescription frequency (2-5 low; > or = 6 high). RESULTS: Most children had one SABA prescriber (62%); 13% had multiple prescribers in the same practice as the primary care provider and 25% had multiple prescribers in different practices. Children with multiple prescribers in different practices had increased odds of an emergency department visit compared with those with 1 prescriber, among those with high SABA prescription frequency (AOR: 2.7, 95% CI: 1.9, 3.9), as well as those with low prescription frequency (AOR: 1.7, 95% CI: 1.3, 2.2). CONCLUSIONS: Children with discontinuity of SABA prescribers have an increased risk of asthma emergency department visits, irrespective of their SABA prescription frequency. Primary care providers may have difficulty identifying patients at high risk with asthma solely on the basis of SABAs prescribed within their own practices.

The impact of a brief induction on short-term continuation in a therapeutic community.

Continuation in substance abuse treatment is one of the strongest predictors of successful post-treatment outcomes across all major treatment modalities. However, since rates of attrition are highest within the first month of treatment, many clients drop out before these positive outcomes are realized. The impact of organizational and therapeutic factors on treatment continuation in therapeutic communities has received little attention in the literature. This study was conducted to determine whether a brief induction to treatment was associated with improved treatment continuation in a therapeutic community. Multivariable logistic regression analysis indicated that induction was associated with 30-day continuation. Prior treatment and court-mandated treatment were also associated with continuation.