Engaging staff to improve COVID-19 vaccination response at long-term care facilities (ENSPIRE): A cluster randomized trial of co-designed, tailored vaccine promotion materials.

BACKGROUND: COVID-19 vaccination rates among long-term care center (LTCC) workers are among the lowest of all frontline health care workers. Current efforts to increase COVID-19 vaccine uptake generally focus on strategies that have proven effective for increasing influenza vaccine uptake among health care workers including educational and communication strategies. Experimental evidence is lacking on the comparative advantage of educational strategies to improve vaccine acceptance and uptake, especially in the context of COVID-19. Despite the lack of evidence, education and communication strategies are recommended to improve COVID-19 vaccination rates and decrease vaccine hesitancy (VH), especially strategies using tailored messaging for disproportionately affected populations. METHODS: We describe a cluster-randomized comparative effectiveness trial with 40 LTCCs and approximately 4000 LTCC workers in 2 geographically, culturally, and ethnically distinct states. We compare the effectiveness of two strategies for increasing COVID-19 booster vaccination rates and willingness to promote COVID-19 booster vaccination: co-design processes for tailoring educational messages vs. an enhanced usual care comparator. Our study focuses on the language and/or cultural groups that are most disproportionately affected by VH and low COVID-19 vaccine uptake in these LTCCs. CONCLUSION: Finding effective methods to increase COVID-19 vaccine uptake and decrease VH among LTCC staff is critical. Beyond COVID-19, better approaches are needed to improve vaccine uptake and decrease VH for a variety of existing vaccines as well as vaccines created to address novel viruses as they emerge.

Before and after the trauma bay: the prevention of violent injury among youth.

Despite a decline in the incidence of homicide in recent years, the United States retains the highest youth homicide rate among the 26 wealthiest nations. Homicide is the second leading cause of death overall and the leading cause of death for male blacks aged 15 to 24 years. High rates of health care recidivism for violent injury, along with increasing research that demonstrates the effectiveness of violence prevention strategies in other arenas, dictate that physicians recognize violence as a complex preventable health problem and implement violence prevention activities into current practice rather than relegating violence prevention to the criminal justice arena. The emergency department (ED) and trauma center settings in many ways are uniquely positioned for this role. Exposure to firearm violence doubles the probability that a youth will commit violence within 2 years, and research shows that retaliatory injury risk among violent youth victims is 88 times higher than among those who were never exposed to violence. This article reviews the potential role of the ED in the prevention of youth violence, as well as the growing number of ED- and hospital-based violence prevention programs already in place.

Benefits of a hospital-based peer intervention program for violently injured youth.

BACKGROUND: Exposure to violence predisposes youths to future violent behavior. Breaking the cycle of violence in inner cities is the primary objective of hospital-based violence intervention and prevention programs. An evaluation was undertaken to determine if a hospital-based, peer intervention program, "Caught in the Crossfire," reduces the risk of criminal justice involvement, decreases hospitalizations from traumatic reinjury, diminishes death from intentional violent trauma, and is cost effective. STUDY DESIGN: We designed a retrospective cohort study conducted between January 1998 and June 2003 at a university-based urban trauma center. The duration of followup was 18 months. Patients were 12 to 20 years of age and were hospitalized for intentional violent trauma. The "enrolled" group had a minimum of five interactions with an intervention specialist. The control group was selected from the hospital database by matching age, gender, race or ethnicity, type of injury, and year of admission. All patients came from socioeconomically disadvantaged areas. RESULTS: The total sample size was 154 patients. Participation in the hospital-based peer intervention program lowered the risk of criminal justice involvement (relative risk=0.67; 95% CI, 0.45, 0.99; p=0.04). There was no effect on risks of reinjury and death. Subsequent violent criminal behavior was reduced by 7% (p=0.15). Logistic regression analysis showed age had a confounding effect on the association between program participation and criminal justice involvement (relative risk=0.71; p=0.043). When compared with juvenile detention center costs, the total cost reduction derived from the intervention program annually was $750,000 to $1.5 million. CONCLUSIONS: This hospital-based peer intervention program reduces the risk of criminal justice system involvement, is more effective with younger patients, and is cost effective. Any effect on reinjury and death will require a larger sample size and longer followup.

Caught in the Crossfire: the effects of a peer-based intervention program for violently injured youth.

PURPOSE: To assess the effect of a hospital-based peer intervention program serving youth who have been hospitalized for violent injuries on participant involvement in the criminal justice system and violent reinjury and death after hospital discharge. METHODS: A total of 112 violently injured youth (ages 12-20 years; 80% male; predominantly African-American [60%] and Latino [26%]) hospitalized in Oakland, California participated in a retrospective case-control study. Clients were matched by age and injury severity. Treatment and control youth were followed for 6 months after their individual dates of injury. The outcome variables of rate of entry/reentry into the criminal justice system, rate of rehospitalization for violent injuries and rate of violence-related deaths were compared for treatment and control groups using an odds ratio analysis. RESULTS: Intervention youth were 70% less likely to be arrested for any offense (odds ratio [OR] = 0.257) and 60% less likely to have any criminal involvement (OR = 0.356) when compared with controls. No statistically significant differences were found for rates of reinjury or death. CONCLUSION: A peer-based program that intervenes immediately after, or very soon after, youth are violently injured can directly reduce at-risk youth involvement in the criminal justice system.