Pandemic-Related Experiences and Stress Among Children's Hospital Staff Predict Psychosocial Risk.

GOAL: COVID-19 has imposed unique challenges for healthcare workers who have faced increased risk of exposure to the virus, heightened work demands, and disruptions in work-life balance. For some healthcare workers, these challenges may have contributed to increased stress, burnout, and psychosocial impairment, including symptoms of depression and anxiety. The current study addresses a knowledge gap of associations between pandemic-related experiences and psychosocial risk among medical and nonmedical pediatric healthcare staff. METHODS: A sample of 369 staff (90% female) employed at an acute care, freestanding pediatric hospital in Connecticut completed an online survey. The survey assessed specific pandemic-related experiences and perceived impact with the Epidemic-Pandemic Impacts Inventory, and depression and anxiety risk with the 2-item Patient Health Questionnaire depression screen and 2-item Generalized Anxiety Disorder screen, respectively. Enrollment and survey completion occurred over a 6-week period during the pandemic (summer 2020). PRINCIPAL FINDINGS: High rates of adverse pandemic-related experiences included workplace experiences (e.g., inadequate support, interpersonal difficulties), home life (e.g., childcare difficulties, partner conflict), and experiences reflecting social isolation and quarantine, child and adult mental health difficulties, increased alcohol or substance use, and unhealthy lifestyle behaviors. Medical relative to nonmedical staff reported significantly more adverse and fewer positive experiences, and a significantly higher perceived negative impact of workplace experiences. A positive screen for depression or anxiety was significantly predicted by cumulative adverse workplace experiences (OR = 1.15), changes in emotional/physical health (OR = 1.35), and perceived negative impact of workplace experiences (OR = 1.32). APPLICATIONS TO PRACTICE: The present study joins recent reports of increased adverse experiences and psychosocial outcomes among healthcare workers during the COVID-19 pandemic. Findings underscore the need for pediatric hospitals to innovate ways to reduce burden and connect staff to mental health services during similar public health crises. Such services might include (1) assisting healthcare staff to navigate disruptions in their home and social lives as a result of new challenges faced at work, (2) adapting the hospital environment and culture to mitigate stress experienced by staff because of these challenges, and (3) bolstering mental health screening and services to address exacerbated or emerging mental health symptoms, such as depression and anxiety.

Effect of Washington State and Colorado's cannabis legalization on death by suicides.

In the U.S., death by suicide is a leading cause of death and was the 2nd leading cause of death for ages 15-to-34 in 2018. Though incomplete, much of the scientific literature has found associations between cannabis use and death by suicide. Several states and the District of Columbia have legalized cannabis for general adult use. We sought to evaluate whether cannabis legalization has impacted suicide rates in Washington State and Colorado, two early adopters. We used a quasi-experimental research design with annual, state-level deaths by suicide to evaluate the legalization of cannabis in Washington State and Colorado. We used synthetic control models to construct policy counterfactuals as our primary method of estimating the effect of legalization, stratified by age, gender, and race/ethnicity. Overall death by suicide rates were not impacted in either state. However, when stratified by age categories, deaths by suicide increased 17.9% among 15-24-year-olds in Washington State, or an additional 2.13 deaths per 100,000 population (p-value ≤0.001). Other age groups did not show similar associations. An ad hoc analysis revealed, when divided into legal and illegal consumption age, 15-20-year olds had an increase in death by suicides of 21.2% (p-value = 0.026) and 21-24-year olds had an increase in death by suicides of 18.6% (p-value ≤0.001) in Washington State. The effect of legalized cannabis on deaths by suicide appears to be heterogeneous. Deaths by suicide among 15-24-year-olds saw significant increases post-implementation in Washington State but not in Colorado.

Initial impact of COVID-19's stay-at-home order on motor vehicle traffic and crash patterns in Connecticut: an interrupted time series analysis.

INTRODUCTION: Understanding how the COVID-19 pandemic has impacted our health and safety is imperative. This study sought to examine the impact of COVID-19's stay-at-home order on daily vehicle miles travelled (VMT) and MVCs in Connecticut. METHODS: Using an interrupted time series design, we analysed daily VMT and MVCs stratified by crash severity and number of vehicles involved from 1 January to 30 April 2017, 2018, 2019 and 2020. MVC data were collected from the Connecticut Crash Data Repository; daily VMT estimates were obtained from StreetLight Insight's database. We used segmented Poisson regression models, controlling for daily temperature and daily precipitation. RESULTS: The mean daily VMT significantly decreased 43% in the post stay-at-home period in 2020. While the mean daily counts of crashes decreased in 2020 after the stay-at-home order was enacted, several types of crash rates increased after accounting for the VMT reductions. Single vehicle crash rates significantly increased 2.29 times, and specifically single vehicle fatal crash rates significantly increased 4.10 times when comparing the pre-stay-at-home and post-stay-at-home periods. DISCUSSION: Despite a decrease in the number of MVCs and VMT, the crash rate of single vehicles increased post stay-at-home order enactment in Connecticut after accounting for reductions in VMT.

Feasibility and Acceptability of an Electronic Parenting Skills Intervention for Parents of Alcohol-Using Adolescent Trauma Patients.

Background: Identifying problem drinkers and providing brief intervention (BI) for those who screen positive are required within all level I trauma centers. While parent-adolescent relationships impact adolescent alcohol use, parenting skills are rarely included in adolescent alcohol BIs within pediatric trauma centers. Introduction: The primary objective of this study was to examine the feasibility and acceptability of an electronic parenting skills intervention for parents of injured adolescents who report alcohol or drug use. Materials and Methods: Across three pediatric level I trauma centers, admitted trauma patients 12-17 years of age, screening positive for alcohol or drug use, were consented along with one parent. Adolescent-parent dyads were enrolled and assigned to the intervention (Parenting Wisely web-based modules coupled with text messaging) or standard care conditions using a 2:1 allocation ratio. Teens completed 3- and 6-month follow-up surveys; parents completed 3-month follow-up surveys. Results: Thirty-seven dyads were enrolled into the study. Only one-third of parents accessed the web-based Parenting Wisely after baseline. All parents completed the text message program. At 3-month follow-up, 78% of parents endorsed that they would recommend the program to others. There were no significant differences in adolescent substance use or parenting behaviors between groups at follow-up. Discussion: A texting component is well received, but web-based components may be underutilized. Larger studies are necessary to determine if an electronic skills intervention has an effect on parenting skills and adolescent substance use. Conclusions: This study demonstrated accessibility and feasibility of an e-parenting intervention with more utilization of text components than web-based.

Establishing the Prevalence of Intimate Partner Violence Among Hair Salon Clients.

This study determined prevalence of intimate partner violence (IPV) victimization among female clients at three hair salons in Connecticut using an anonymous tablet based screening tool. While many may assume that women receive services at hair salons, victims of IPV are often isolated by their partners and unable to access help. Of the 203 clients who participated, 40 (20%) had experienced IPV in her lifetime. In identifying the prevalence of IPV within the salon setting, this study provides support for community-based programs and supports their legitimacy as an important locus for identifying women experiencing IPV and connecting them to resources.

Practical applications of injury surveillance: a brief 25-year history of the Connecticut Injury Prevention Center.

BACKGROUND: The mission of the Connecticut Injury Prevention Center (CIPC), jointly housed in Connecticut Children's Medical Center and Hartford Hospital, is to reduce unintentional injury and violence among Connecticut residents, with a special focus on translating research into injury prevention programmes and policy. The CIPC engages in four core activities: research, education and training, community outreach programmes and public policy. As surveillance is an essential element of injury prevention, the CIPC has developed a robust statewide fatal and non-fatal injury surveillance system that has guided our prior work and continues to inform our current projects. OBJECTIVE: The purpose of this article is to review the projects, programmes, and collaborative relationships that have made the CIPC successful in reducing unintentional injury and violence in Connecticut throughout the course of its 25 years history. DESIGN, SETTING, PARTICIPANTS: Retrospective review of the application of injury surveillance. RESULTS/CONCLUSIONS: We believe that the application of our surveillance system can serve as a model for others who wish to engage in collaborative, community-based, data-driven injury prevention programmes in their own communities.

Efficacy of Driving Simulator Training for Novice Teen Drivers.

The objective of this study was to determine if driving simulator training lowers motor vehicle crash (MVC) rates for novice teen drivers. We enrolled 215 high school students, and randomly assigned 89 to the control group, and 126 to the intervention group. Twelve months after the intervention, participants completed a survey asking about crash history and driving infractions. Nearly two-thirds (n = 137, 63%) of participants completed the presimulator survey, follow-up survey, and obtained a license. Nearly one-third of the intervention group (n = 42, 33%) completed some of the 12 simulator training modules: 2-5 modules (n = 8, 19%), 6-11 modules (n = 7, 17%), and all 12 modules (n = 27, 64%). Postsimulator training involvement in a MVC (intervention = 19.0% vs control = 12.0%, P > .05) and driving infractions (intervention = 7.1% vs control = 18.0%, P > .05) did not differ significantly. Simulator training did not produce a measurable reduction in self-reported driving infractions and MVCs. Future evaluation of driving simulator training should include approaches that ensure higher completion rates.

Trends in Fatal Pediatric Injury.

We studied youth injury fatality rates in America, the Northeast region of the US, andinthe state of Connecticut for the years 1990 and 2013 to evaluate the incidence of injury. All areas of injury showed a decrease in mortality rates with the exception of deaths by suffocation and poisoning. Ihe age group most affected by suffocation is infants younger than one year. Adolescents between the ages of 15 and 19 years appear to be at increased risk for poisoning deaths. Injury surveillance provides important guidance for the implementation of community based programs to prevent injury.

Hartford's gun buy-back program: are we on target?

Gunbuy-backprograms have been proposed as away to remove unwanted firearms from circulation, but remain controversial because their ability to prevent firearm injuries remains unproven. The purpose of this study is to describe the demographics of individuals participating in Connecticut's gun buy-backprogram in the context of annual gun sales and the epidemiology of firearm violence in the state. Over four years the buy-back program collected 464 firearms, including 232 handguns. In contrast, 91,602 firearms were sold in Connecticut during 2009 alone. The incidence of gun-related deaths was unchanged in the two years following the inception of the buy-back program. Suicide was associated with older age (mean = 51 +/- 18years) and Caucasian race (n = 539, 90%). Homicide was associated with younger age (mean = 30 +/- 12 years) and minority race (n = 425, 81%). A gun buy-back program alone is not likely to produce a measurable decrease in firearm injuries and deaths.

Impact of Connecticut's graduated driver licensing system on teenage motor vehicle crash rates.

BACKGROUND: In response to high rates of teen motor vehicle crashes (MVCs) many states have enacted graduated driver licensing (GDL) systems. GDL delays full licensure and allows beginners to obtain experience under lower risk conditions. The purpose of this study is to evaluate the impact over the past 10 years to determine its effect on teen MVCs. METHODS: Connecticut MVC data from 1999 to 2008 were analyzed. Percent change (1999 vs. 2008) in MVC rates per 10,000 registered drivers was calculated by age, gender, during the night restriction (11:00 pm and 5:00 am), and MVCs with passengers. Linear regression analysis estimated the decrease of MVC rates each year. RESULTS: The MVC rate decreased by 40% for 16-year-old and 30% for 17-year-old drivers. In comparison, rates among 18-year-old, 19-year-old, 25- to 29-year-old, and 30- to 59-year-old drivers were reduced by 16%, 7%, 8%, and 11%, respectively. The MVC rate for 20- to 24-year-old drivers increased by 1%. During nighttime restricted driving times, MVC rates decreased by 54% among 16-year-old and 49% among 17-year-old drivers. The MVC rate with passengers decreased by 65% for 16-year-old and 53% for 17-year-old drivers. In comparison, rates of nighttime and with passenger MVCs among older drivers were significantly less. CONCLUSIONS: Implementation of Connecticut's GDL system has resulted in significant reductions in MVC rates among novice drivers. This analysis provides a method for other states to examine the impact of their GDL system.

Quantifying Severity of Maltreatment, Adversity, and Trauma From Child Protective Services Case Record Files.

Children referred to child protective services (CPS) for allegations of abuse or neglect often have diverse experiences of maltreatment, adversity, and trauma. Severity of these experiences is associated with greater mental health impairment and increased risk of revictimization and other adversities. Although aspects of these experiences are often captured during CPS investigations and stored in case records as narrative documents, much of this information is underutilized in estimating risk and service planning. The current study extracted case record information from a randomly selected sample of 100 families, with 150 children referred to CPS during a 12-month period. The Yale-Vermont Adversity in Childhood Scale (Y-VACS) was applied to extracted information for quantifying severity of various forms of childhood maltreatment, adversity, and trauma. Study aims were to examine (a) the scope and severity of maltreatment, adversity, and trauma types and their associations; (b) linkages between severity and CPS allegation types and outcomes; and (c) the utility of severity in predicting new allegations of abuse or neglect within 12 months of referral. Results indicated feasibility in quantifying severity of maltreatment and other adversities from case record information and revealed associations between adversity severity and CPS allegation types and outcomes. Severity of psychological intimate partner violence and neglect were predictive of new allegations of abuse or neglect within 12 months of referral. Findings support moving beyond an incident-based CPS strategy to one that better incorporates case record information to assess risk.

Outdoor play: A survey of parent's perceptions of their child's safety.

BACKGROUND: Anecdotal reports suggest that parents may be restricting outdoor play in response to a perceived lack of safety and fear of violence and crime in urban environments. The study objective was to determine whether parents who perceived their neighborhood as unsafe would be most likely to restrict their child's outdoor play and report the greatest worries related to neighborhood characteristics. METHODS: A convenience sample of primary caregivers of children aged 5 years to 7 years were recruited from a pediatric primary care center based at an urban academic children's hospital. Study participants completed a 23-question survey available in English and Spanish. RESULTS: Two hundred fifty-four parents completed the survey. Most were English speakers (69%), female (89%), and aged between 21 years and 35 years (76%). Sixty-two percent let their child play outside often or sometimes; whereas 19% reported never allowing their child to play outside. Parents were less likely to allow outside play as their degree of worry increased about traffic (p < 0.0001), rundown parks (p < 0.003), crime (p < 0.0001), witnessing violence (p < 0.0001), being a victim of violence (p < 0.0009), drugs (p < 0.0001), gangs (p < 0.004), and weapons (p < 0.003). Frequency of outdoor play was not correlated with the sex or age of the child or number of children in the family. Spanish speakers were less likely to allow outside play (p < 0.008) but more likely to allow unsupervised play (p < 0.03). CONCLUSIONS: Decreased frequency of outdoor play correlated with increased parental concerns about safety, however, many parents still report allowing outdoor play at least sometimes.

Using trauma registry data to guide injury prevention program activities.

BACKGROUND: Injury prevention programs should be based on objective injury data. This study demonstrates how local injury data can be used to help guide injury prevention programs. METHODS: We reviewed trauma registry data (2004-2006) from a Level I pediatric trauma center. Data included demographic information, anatomic location of injury, mechanism of injury, safety device utilization, Injury Severity Score (ISS), and temporal and geographic variables. The Injury Prevention Priority Score for each mechanism of injury was calculated. RESULTS: There were 1,874 trauma patients. Most admissions were among white males, aged 11 years to 15 years (mean, 7.9 years ± 5.2 years). Most admissions occurred during summertime and on weekend evenings. Blunt injuries (92%) and fractures (56%) predominated (mean ISS, 5.9). A severe ISS >15 was highest among 11 year to 15 year and lowest among patients older than 15 years (p < 0.01). Falls, cut, or pierce, ATV, and off-road motorcycle ranked highest in the Injury Prevention Priority Score. Of the 134 motor vehicle occupants, 52% (n = 70) were restrained in car seats/seat belts. Only 15% of bicyclists, 24% of motorcyclists, and 58% of ATV riders wore helmets. CONCLUSION: A significant percentage of injured children and adolescents were not using proven effective injury prevention devices at the time of their injury. These data identified areas for further study and will help guide community injury prevention programs at our institution.

Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol.

OBJECTIVES: Using available literature, our aim was to design a firearm safety counseling protocol tool for dementia patients. DESIGN: We conducted a literature review on firearm safety counseling by healthcare providers using several databases to inform the creation of our evidence-based protocol. SETTING: Roughly 5.7 million Americans currently live with some form of dementia with approximately 60% of persons with dementia (PWD) owning a firearm. The mental deterioration associated with dementia creates an opportunity for firearm abuse, misuse, and injury. Patient and family safety counseling from a healthcare provider is one potential opportunity for reducing the level of danger. This literature review identifies the available clinical guidelines for firearm safety for PWD and creates a firearm safety counseling protocol based on existing literature. PARTICIPANTS: Persons with dementia and their families or care takers. MEASUREMENTS: Databases were searched using variations of the terms "Firearms," "Dementia," and "Alzheimer's disease." Studies were included for review if they provided either recommendations or guidelines for healthcare provider's counseling around firearm safety for PWD or their families. RESULTS: Search terms yielded 456 articles, of which 12 met inclusion criteria. Using the available literature, we developed a firearm safety counseling protocol that provides measurable means to assess risk and offer harm mitigation strategies for patients and their families. Mitigation strategies are based on Clinical Dementia Rating scale assessment at time of patient interaction and results of risk assessment. CONCLUSION: Providing standardized and effective clinical guidelines to healthcare providers who interact with firearm-owning PWD can act as a means to reduce firearm injury and violence. The protocol proposed in this article needs further testing and validation to determine if it will help reduce firearm-related events in PWD.

Using Child Protective Services Case Record Data to Quantify Family-Level Severity of Adversity Types, Poly-victimization, and Poly-deprivation.

BACKGROUND: Child protective services (CPS) case records contain a vast amount of narrative information that is underutilized for estimating risk, conceptualizing family needs, and planning for services. OBJECTIVE: The current study applied a novel method for quantifying family-level severity of maltreatment and non-maltreatment-related adversity types to narrative information reflecting a family's full CPS history. PARTICIPANTS AND SETTING: Cases were randomly sampled (N = 100) from two regions of Connecticut that were referred over a specified 6-month period. METHODS: De-identified data were extracted through comprehensive chart review of electronic and paper case records. The Yale-Vermont Adversity in Childhood Scale (Y-VACS; Holbrook et al., 2015) was used to quantify adversity severity across a range of intrafamilial and extrafamilial experiences. RESULTS: Several family-level adversity severity ratings were associated with administrative data on allegations and investigative outcomes. Poly-victimization (ß = .47, p < .001) and poly-deprivation (ß = .25, p = .005) significantly predicted total allegation types and total substantiation types (ß = .30, p = .002; ß = .26, p = .008, respectively) across the case history. Poly-victimization significantly predicted the presence of a new allegation within 12 months of the index report, OR = 1.72, SE = .25, p = .027. CONCLUSIONS: Findings support the feasibility of a novel method that uses narrative case record information to quantify severity of maltreatment and non-maltreatment-related adversity types, as well as cumulative measures of threat- and deprivation-based adversities at the family level. Implications for utilizing case record data to inform CPS intervention are discussed.

Improved Concussion Discharge Instructions in a Pediatric Emergency Department.

Pediatric concussions are common and many children seek care in emergency departments. Providing concussion discharge instructions to patients and families is part of routine standard of care. The objective of this study was to determine whether the use of the Acute Concussion Evaluation-Emergency Department Discharge Instructions (ACE-ED DI) improves the caregiver's knowledge of injury management, specifics about returning to school and sports activities, and outpatient follow-up. This was a quasi-experimental study conducted in an urban Level 1 trauma center pediatric emergency department (PED). A convenience sample of caregivers of children aged 5-18 years who presented to the PED with a concussion was recruited and consented to participate. Caregivers completed a 16-item survey to assess overall understanding of concussion management after instructions were given. Caregivers received the standard discharge instructions (SDIs) in Phase 1 and SDIs plus the ACE-ED DI in Phase 2. Descriptive statistics were used for demographic variables and t-test to compare groups. Sixty-three of 68 (93%) caregivers participated; 30 in the SDI group and 33 in the SDI plus ACE-ED DI group. Demographic characteristics were similar between groups. Caregivers who received the ACE-ED DI reported a 24% increase in helpfulness of written materials (p < 0.001), a 25% increase in perceived understanding about concussion injury and management (p < 0.001), a 23% increase in understanding about returning to school activities (p < 0.001), and were 17% more likely to follow up with their primary care provider (p < 0.001). The ACE-ED DI used in a PED was found to be more effective at increasing caregivers' perceived knowledge of concussion management, specifics about returning to school and sports activities, and outpatient follow-up.

Adverse childhood experiences, posttraumatic stress, and FKBP5 methylation patterns in postpartum women and their newborn infants.

BACKGROUND: Genetic variation and epigenetic mechanisms involving the stress-related gene FKBP5 have been implicated in the intergenerational transmission of trauma-related effects in adult offspring of trauma-exposed caregivers, but these processes have not been fully explored in postpartum women and their newborn infants. METHODS: Women recruited from a prenatal care clinic during their third trimester of pregnancy (N = 114) completed a battery of instruments assessing adverse childhood experiences (ACEs), adversity in adulthood, posttraumatic stress disorder (PTSD) symptoms, negative emotional state, and emotion dysregulation. FKBP5 rs1360780 genotype and intron 7 methylation were derived from saliva collected from postpartum mothers and their newborn infants within 24 h of delivery. RESULTS: Allele-specific associations of methylation with maternal ACEs and prenatal trauma-related symptoms were evident; however, relations differed between mothers and newborns. In mothers carrying the stress sensitive T-allele (CT and TT genotypes), maternal FKBP5 methylation negatively correlated with threat-based ACEs and maternal PTSD symptoms during pregnancy, but not deprivation-based ACEs. In infants homozygous for the C allele (CC genotype), infant FKBP5 methylation positively correlated with maternal threat-based ACEs and prenatal PTSD symptom severity, but not deprivation-based ACEs or adversity in adulthood. CONCLUSIONS: Our results provide evidence that links maternal threat-based ACEs and trauma-related symptoms during pregnancy with allele-specific epigenetic patterns in postpartum women and their newborn infants. These findings provide mechanistic insight into the potential intergenerational impact of ACEs and the effect of maternal PTSD symptoms during pregnancy.

Race and ethnic differences in a multicenter study of home safety with vouchers redeemable for free safety devices.

BACKGROUND: Most injuries to infants occur at home and are known to have a modifiable component. Additional information on safety behaviors, practices, and device ownership could inform prevention programs aimed at reducing injury-related race and ethnic disparities. METHODS: This study is a secondary data analysis of race and ethnic differences in home safety using data collected by the Connecticut, Ohio, Pennsylvania, Minnesota, and New York sites of the Injury Free Coalition for Kids. Study participants were English- and Spanish-speaking parents/guardians of infants aged 4 months to 6 months. All participants received a voucher redeemable for free safety devices and educational materials. RESULTS: Five hundred forty-two study participants were 37.8% black, 41.7% Hispanic, 10.5% white, and 10.0% other race. Whites more frequently owned/had safety devices including cabinet latches (chi2 =28.9, p < 0.0001), drawer latches (chi2 =21.4, p < 0.0001), bath thermometers (chi2 =22.5, p < 0.0001), electric outlet covers (chi2 =15.9, p = 0.0004), and poison control number (chi 2=93.8, p < 0.0001). Practice of unsafe behaviors, such as stomach sleep position, was higher in blacks (29.3%) than whites (15.8%) or Hispanics (17.7%) (chi2 =11.8, p < 0.0083). Overall, 62.1% redeemed vouchers, but this varied significantly by ethnicity: blacks (42.2%), non-Hispanic whites (64.6%), and Hispanics (76.3%) (chi2 = 48.5, p < 0.0001). CONCLUSIONS: Compared with whites, both blacks and Hispanics were less likely to own a variety of safety devices at baseline, but Hispanics were more likely than blacks to redeem vouchers. This one shot voucher program was effective at increasing device ownership, but was not sufficient alone to achieve population saturation of safety devices.

Intervention improves physician counseling on teen driving safety.

BACKGROUND: As part of a statewide campaign, we surveyed physician attitudes and practice regarding teen driving safety before and after a brief intervention designed to facilitate in office counseling. METHODS: A 31-item self-administered survey was mailed to Connecticut physicians, and this was followed by a mailing of teen driving safety materials to physician practices in the state. A postintervention survey was mailed 8 months after the presurvey. RESULTS: A total of 102 physicians completed both the pre and postsurveys. Thirty-nine percent (39%) reported having had a teen in their practice die in a motor vehicle crash in the presurvey, compared with 49% in the postsurvey. Physician counseling increased significantly for a number of issues: driving while impaired from 86% to 94%; restrictions on teen driving from 53% to 64%; teen driving laws from 53% to 63%; safe vehicle from 32% to 42%; parents model safe driving from 29% to 44%; and teen-parent written contract from 15% to 37%. CONCLUSIONS: At baseline, the majority of physicians who provide care to teenagers in Connecticut report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduate driver licensing laws or related issues. After a brief intervention, there was a significant increase in physician counseling of teens on teen driving laws and on the use of teen-parent contracts. Additional interventions targeting physician practices can improve physician counseling to teens and their parents on issues of teen driving safety.

Epidemiology of trauma at a level 1 trauma center.

We reviewed trauma registry data (2004-06) from a Level 1 trauma center to describe the epidemiology of injury. There were 5,900 trauma patients. Most admissions were among white men, age 20-29 years (mean age = 48 years). Most admissions occurred in the summer, on Saturday and Sunday evenings. Blunt injuries (89%) and fractures (49%) predominated. Mean ISS = 9.7. ISS = 9-15 was highest among those 70+ years and lowest among patients 30-39 years (P < 0.01). Motor vehicle crashes and falls were the most common mechanism of injury. Violent assaults ranked highest in the injury prevention priority score. This research identified areas for further study and will help guide community injury prevention programs and policies.