Evidence-based practice in school substance use prevention: fidelity of implementation under real-world conditions.

Fidelity of program implementation under real-world conditions is a critical issue in the dissemination of evidence-based school substance use prevention curricula. Program effects are diminished when programs are implemented with poor fidelity. We assessed five domains of fidelity--adherence, exposure (dosage), quality of delivery, participant responsiveness and program differentiation (lack of contamination from other programs)--in a subset of respondents (N = 342) from a national random sample of public schools with middle school grades (N = 1721). Respondents taught 1 of 10 evidence-based universal substance use prevention programs as their primary program during the 2004-05 school year. Their responses to survey questions about their recent implementation practices indicated that fidelity was high for quality of delivery and participant responsiveness, low for program differentiation and modest for adherence and exposure--the two core domains of fidelity. Results suggest the need for continued emphasis on fidelity in program materials, trainings and on-going technical support. Particular attention should be paid to supporting use of interactive delivery strategies.

Social determinants of pediatric residents' injury prevention counseling.

BACKGROUND: Social norms imparted by preceptors and the requirements necessary to pass American Board of Pediatrics' examinations are potentially important contributors to physician behavior. OBJECTIVE: To explore the relationships between perceived professional norms regarding injury prevention and the injury prevention topics discussed, and counseling strategies employed, by pediatric residents. DESIGN: A self-administered survey. SETTING: All 5 North Carolina pediatric residency programs. PARTICIPANTS: Physicians training in pediatrics or medicine-pediatrics in these programs (N = 160, 72% response rate). MAIN OUTCOME MEASURE: Correlation between perceived professional norms and self-reported content of injury prevention counseling and use of behavior change strategies. RESULTS: Although 95% of the pediatric residents reported counseling all or almost all parents with children younger than 1 year about car seat use, only 19% reported counseling this many parents about gun safety. Of the 7 behavior change strategies that residents were asked about, respondents were most likely to report "showing approval for safe behaviors" to all almost all parents (78%). Two thirds reported asking all or almost all parents about the safety of their homes. Pediatric residents' reported injury prevention counseling was correlated with their perceived professional norms regarding such counseling for most of the content areas and behavior change strategies. CONCLUSIONS: Perceived professional norms regarding injury prevention are related to pediatric residents' counseling, Preceptors should be aware that they transmit professional norms to residents. Also, the American Board of Pediatrics can increase residents' attention to injury prevention by informing them that it will be a topic included in the board examination.

The North Carolina High School Athletic Injury Study: design and methodology.

PURPOSE: Organized interscholastic athletics are an integral part of the educational program at almost every school level. With this growing popularity of sports and their inclusion in more public school programs, it becomes increasingly apparent that additional consideration must be given to the injury problem associated with sport. The North Carolina High School Athletic Injury Study (NCHSAIS) was undertaken to identify patterns of injury among male and female athletes in North Carolina high schools participating in any of 12 sports. Specific aims are to measure the incidence, severity and etiology of injuries; to determine the relationship of demographic factors and protective equipment, exposure to play, and school characteristics to injuries; to study the relationship of coaches' training and experience to injury occurrence; and to compare the incidence and severity of injury among female and male athletes in the same or comparable sports. METHODS: A two-stage cluster sample of 100 high schools in North Carolina was selected for this 4-yr prospective study. RESULTS: Participation by the initial sample or a random replacement was achieved for 91 of the 100 schools. Nonresponse occurred at multiple levels of the sample for this study, and the weekly participation form posed the greatest respondent burden. CONCLUSIONS: The NCHSIAS offers a successful methodology for addressing sports injuries. In this paper we describe the design, methodology, and implementation issues that emerge in conducting a large scale epidemiological study in a population of high school athletes.

Pediatric injury prevention counseling: an observational study of process and content.

OBJECTIVES: To describe routine injury prevention counseling; to observe how three visit components - printed prompts, parent remarks, and parent behaviors - affect such counseling; to describe the process and content of discussions about car seats as an example of routine injury prevention. METHODS: A total of 128 well-child visits of children under 7 months of age to a university pediatric clinic were videotaped (76% of eligible visits). RESULTS: Three injury topics were mentioned, on an average, per visit. Parents or caregivers rarely introduced injury topics (5%). Physicians frequently introduced those topics listed on age-specific prompting sheets (73%). Car seat counseling typically began with a physician's question (82%). Most asked simply about ownership or use (93%). Few addressed difficult issues, such as consistency of use (11%). CONCLUSIONS: Physicians bring up the injury topics that are prompted. However, most discussion is superficial. Printed prompts that address counseling process as well as content might be beneficial.

Storage of household firearms: an examination of the attitudes and beliefs of married women with children.

Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n=185). We examined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon-Mann-Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices.

Cost of injuries from a prospective cohort study of North Carolina high school athletes.

OBJECTIVE: To estimate the economic cost of injuries in a population of US high school varsity athletes. DESIGN AND SETTING: The North Carolina High School Athletic Injury Study, conducted from 1996 to 1999, was a prospective cohort study of injury incidence and severity. A two-stage cluster sampling technique was used to select athletic teams from 100 high schools in North Carolina. An injury cost model was used to estimate the economic cost of injury. PARTICIPANTS: Varsity athletes from 12 sports: football, girls' and boy's soccer, girls' and boys' track, girls' and boy's basketball, baseball, softball, wrestling, volleyball, and cheerleading. MAIN OUTCOME MEASURES: Descriptive data were collected at the time of injury. Three types of costs were estimated: medical, human capital (medical costs plus loss of future earnings), and comprehensive (human capital costs plus lost quality of life). RESULTS: The annual statewide estimates were $9.9 million in medical costs, $44.7 million in human capital costs, and $144.6 million in comprehensive costs. The mean medical cost was $709 per injury (95% CI $542 to $927), $2223 per injury (95% CI $1709 to $2893) in human capital costs, and $10,432 per injury (95% CI $8062 to $13,449) in comprehensive costs. Sport and competition division were significant predictors of injury costs. CONCLUSIONS: Injuries among high school athletes represent a significant economic cost to society. Further research should estimate costs in additional populations to begin to develop cost-effective sports injury prevention programs.

Son preference and its effects on Korean lactation practices.

PIP: Using retrospective data from Korea, multivariate log-linear analyses were used to determine if the sex of a child influences the probability of it being breastfed, or if it influences the number of months he/she was breastfed. In Korea the likelihood of a woman not breastfeeding a child is very small. The fact that a woman is without living sons increased the average odds of not breastfeeding by 1.55 times. The absence of living sons has the strongest effect of any of the predictor variables used. The highest predicted conditional odds of not breastfeeding are for women with female infants, who live in rural areas, have less than 3 children of which none are boys, and who do not use oral contraceptives. The lowest predicted conditional odds of a woman not breastfeeding are for a city dweller, with 3 or more children of which at least 1 is a boy, who uses the pill, and whose infant is a boy. Although oral contraceptive use is significant for deciding how long to breastfeed, the direction of its effect is not what was expected had it affected lactation physiologically. Apparently, social factors are operative which make pill users more likely to breast feed than non-users. 1 possible explanation for this is that Korean women are aware of the fertility-suppressing effects of lactation and are using breastfeeding as a deliberate form of birth control. The fact that the effect of pill use becomes progressively stronger the longer that women breastfeed lends further support to this explanation. The effect of sex of child is not significant in determining the duration he/she will be breastfed. This study indicates support for the contention that Korean women are aware of the contraceptive effects of lactation, and that their decisions of breastfeed are affected by their preference for sons.^ieng

Choosing criteria to screen for specific medical conditions from nonspecific sources: an application to injury surveillance.

The authors examine an approach for identifying which criteria to use when screening for persons with a relatively rare medical condition. They considered various subsets of an inclusive set of criteria by examining the statistical effectiveness per unit cost of deleting various criteria using three statistical measures of effectiveness. An application to injury surveillance, where categories of the patient's chief complaint were used for screening via emergency department logs, illustrates two implications of the approach. First, deletion priorities may differ somewhat by effectiveness measure. When using sensitivity to measure statistical efficiency, the tendency is first to drop the larger categories with the smaller proportions of injury. On the other hand, using specificity to gauge effectiveness calls for large categories with the highest injury rates to be deleted first; while for a measure of effectiveness derived from relative bias, the tendency is first to drop those categories with the fewest injuries. Second, an unequivocal set of criteria may not emerge, thus forcing one to decide among options. The authors suggest several rationales for making this decision.

Emergency department record keeping and the potential for injury surveillance.

Successful design of injury prevention measures relies on understanding the occurrence and circumstances of injuries, which, in turn, necessitates that good quality data be collected about injured persons. The emergency department (ED) is an important source of injury information. This paper reports the results of a survey of all 129 hospital emergency departments in North Carolina to examine record-keeping practices and determine what information is collected and stored in the EDs. The findings demonstrate that there is considerable variability in the types of data that would be available to a researcher attempting to use ED records. Of special note is the absence of information about the external cause of injury.

Pediatric injury prevention counseling priorities.

OBJECTIVE: Child health care providers have a unique opportunity to conduct injury prevention counseling but limited empirical evidence for choosing prevention strategies. Efficient use of time requires that prevention strategies of higher priority be discussed before lower priority strategies. Our aim was to assess consensus among experts about the prioritization of prevention strategies for office based injury prevention counseling for parents of children under age two. DESIGN: We used a modified Delphi technique with 23 childhood injury prevention experts nationwide. Participants were blinded to the identities of each other. MEASURES: The first questionnaire, distributed via facsimile transmission, consisted of open ended questions about prevention strategies participants believe should be included and their prioritization methods. The second questionnaire was closed ended and based on the results of the first. RESULTS: Seventeen injury problems and 21 prevention strategies were suggested for counseling. Participants emphasized environmental strategies over more active, educational ones. Motor vehicle occupant injuries and car seats were given high priority scores by all participants. Smoke detectors, lowering the hot water heater temperature, and pool fencing also received high priority ratings. Participants based their decisions on the severity of the injury, the frequency with which the injury occured, and the availability of environmental strategies. However, they disagreed about the relative importance of these factors. Time constraints and parents' inability to absorb information led them to suggest limiting, to fewer than four, the number of prevention strategies addressed at any one visit. CONCLUSIONS: This study illustrates areas of consensus as well as unresolved dilemmas about pediatric injury prevention counseling. A rational decision making approach to prioritizing elements of clinical counseling is needed. Meanwhile, clinicians can use the findings of this study to derive their own judgments.

Neighboring nucleotide interactions during DNA sequencing gel electrophoresis.

Electrophoretic separation of oligonucleotides in denaturing polyacrylamide gels is primarily a function of length-dependent mobility. The 3' terminal nucleotide sequence of the oligonucleotide is a significant, secondary determinant of mobility and separation. Oligomers with 3'-ddT migrate more slowly than expected on the basis of length alone, and thus are better separated from the preceding, shorter oligomers in the sequencing ladder. Oligomers with 3'-ddC are relatively faster than expected, and are therefore less separated. At the 3' penultimate position, -dC- increases and -dT- reduces separation. Purines at the 3' terminal or penultimate positions of oligonucleotides affect separation less than the pyrimidines. These results suggest specific interactions among neighboring nucleotides with important effects on the conformation of oligonucleotides during electrophoresis. These interactions are compared to compression artifacts, which represent more extreme anomalies of length-dependent separation of oligonucleotides. Knowledge of base-specific effects on electrophoretic behavior of DNA oligomers supplements the usual information available for determination of sequences; additionally it provides an avenue to thermodynamic and hydrodynamic investigations of DNA structure.

Single pulse vibrational Raman scattering by a broadband KrF excimer laser in a hydrogen-air flame.

Spontaneous vibrational Raman scattering (VRS) is produced by a broadband excimer laser at 248 nm (KrF) in a H(2)-air flame and VRS spectra are recorded for lean, stoichiometric, and rich flames. Except at very lean flame conditions, laser-induced fluorescence (LIF) processes interfere with VRS Stokes lines from H(2), H(2)O, and O(2). No interference is found for the N(2) Stokes and N(2) anti-Stokes lines. In a stoichiometric H(2)/air flame, single-pulse measurements of N(2) concentration and temperature (by the VRS Stokes to anti-Stokes ratio) have relative standard deviation of 7.7 and 10%, respectively. These single pulse measurement errors compare well with photon statistics calculations using measured Raman cross sections.

The quality of the new birth certificate data: a validation study in North Carolina.

A random sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records were examined to validate selected items. Reporting was very accurate for birth-weight, Apgar score, and method of delivery; fair to good for tobacco use, prenatal care, weight gain during pregnancy, obstetrical procedures, and events of labor and delivery; and poor for medical history and alcohol use. This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation.