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May 7, 2001
Post-traumatic Stress and Depressive Reactions Among Nicaraguan Adolescents After Hurricane Mitch
Goenjian AK, Molina L, Steinberg AM, Fairbanks LA, Alvarez ML, Goenjian HA Pynoos RS. Am J Psychiatry 2001; 158(5):788-794.
Correspondence: Dr. A K Goenjian, Trauma Psychiatry Program, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, 501 Via La Selva, Redondo Beach, CA 90277; agoenjia@aol.com
This study examined the occurrence and severity of post-traumatic stress and depressive reactions among Nicaraguan adolescents after Hurricane Mitch and the relationship of these reactions to objective and subjective features of hurricane exposure, death of a family member, forced relocation, and thoughts of revenge. Six months after the hurricane, 158 adolescents from three differentially exposed cities were evaluated by using a hurricane exposure questionnaire, the Child Post-traumatic Stress Disorder Reaction Index, and the Depression Self-Rating Scale. The authors report extreme levels of post-traumatic stress and depression among adolescents in the two most severely impacted cities. The authors argue that these results support the need for public mental health assessment and intervention be included within a comprehensive disaster recovery program.
Do parents value drowning prevention information at discharge from the emergency department?
Quan L, Bennett E, Cummings P, Henderson P, Del Beccaro MA. Ann Emerg Med 2001; 37(4):382-385.
Correspondence: Department of Pediatrics, University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Harborview Injury Prevention and Research Center, Seattle WA, USA
The authors evaluated a drowning prevention message for parents within standard computer-generated discharge instructions from a pediatric emergency department. Three messages were provided: wear a life vest, swim in safe areas, and do not drink alcohol while swimming or boating. Parents were telephoned 1 to 2 weeks after the visit and asked to recall the prevention messages and rate the usefulness of the instructions. Patient characteristics and ED visit variables (day and time of visit, duration of ED visit, severity of condition, diagnostic category, number of tests, and treatments) were compared with the parent responses. Of 914 parents who were contacted, 795 were eligible. Of those, 619 (78%) completed the interview. Fifty percent of parents recalled receiving drowning prevention information; of these, 41% recalled unaided the life vest messages and 35% of 155 parents who did not own a life vest stated they would subsequently consider buying their child a life vest. Most (88%) rated the prevention information useful or very useful. No patient or visit variables were associated with usefulness ratings. Although the authors conclude that written injury prevention messages with discharge instructions were well received by parents of children, the proportion of parents who recalled the message was low. The low prevalence of recall notwithstanding, the low cost of routinely providing these messages supports the premise that computer-generated discharge instructions are a productive way to deliver drowning prevention recommendations.
Are no-suicide contracts effective in preventing suicide in suicidal patients seen by primary care physicians?
Kelly KT, Knudson MP. Arch Family Med 2000; 9(10):1119-1121.
Correspondence: Katherine T. Kelly, PhD, Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
This brief review article examines role of the primary care physician in the prevention of suicide prevention and the evidence supporting no-harm or no-suicide contracts success at reducing self harm and suicide. Although the use of these contracts is widely advocated as an important approach in the management of suicidal patients, there is little published research evaluating this intervention. The literature that exists provides no empirical evidence supporting the effectiveness of no-harm contracts in preventing suicide. That notwithstanding, no-harm contracts may serve several useful purposes, including fostering a therapeutic alliance between the clinician and patient and assisting in suicide assessment.
Bicycle helmet efficacy: a meta-analysis.
Attewell RG, Glase K, McFadden M. Accid Anal Prev 2001; 33(3):345-352.
Correspondence: R.G. Attewell, Covance Pty Ltd, PO Box 64, Ainslie, ACT 2602, Australia covance@tpgi.com.au
The authors examined peer-reviewed, published research to quantify bicycle helmet efficacy. Studies conducted in several countries. Using a systematic meta-analytic approach, summary odds ratios were estimated to be 0.40 (95% CI 0.29, 0.55) for head injury, 0.42 (0.26, 0.67) for brain injury, 0.53 (0.39, 0.73) for facial injury and 0.27 (0.10, 0.71) for fatal injury. This indicates that helmets provide a strong protective effect even if the upper bound of the confidence interval is used as the outcome measure.
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The validity of self-reported seatbelt use: Hispanic and non-Hispanic drivers in El Paso.
Parada MA, Cohn LD, Gonzalez E, Byrd T, Cortes M. Accid Anal Prev 2001; 33(1):139-143.
Correspondence: Lawrence D. Cohn, Department of Psychology, University of Texas, El Paso, TX 79968-0553, USA lcohn@miners.utep.edu
The authors assessed the validity of self-reported seatbelt use in 12 randomly generated ZIP Code areas in El Paso, Texas. Drivers (N=612) were recruited from convenience store parking lots. Self-reported seatbelt use was compared with observed seatbelt use. No participant was aware of having their seatbelt use observed. Hispanic (n=388) and white/non-Hispanic (n=126) drivers over reported seatbelt use by 27% and 21%, respectively. These findings suggest that response bias within low belt use populations may be greater than suggested by state and national data.
Changes in young adult offense and crash patterns over time.
Waller PF, Elliott MR, Shope JT, Raghunathan TE, Little RJA. Accid Anal Prev 2001; 33(1):117-128.
Correspondence: Patricia F. Waller, 1779 Crawford Dairy Road, Chapel Hill, NC 27516, USA pwaller@umich.edu
The authors examined the traffic records files of 13,809 young adult drivers in Michigan for offenses and crashes for an average of 7 years after their original license date. During this period, 73% of subjects committed an offense that resulted in a conviction and 58% had a crash that was reported to the police. Forty-two percent had committed an offense classified as 'serious,' and 21% had an 'at-fault' crash. The odds of an offense being serious decreased approximately 8% per year of licensure, independent of gender or age at licensure. Similarly, the odds of a crash being at-fault decreased overall about 6% per year of licensure, but the decline was more than twice as fast for women as for men. Examining the empirical rates directly, it was found that the rate for minor offenses increased somewhat with time and then stabilized, while the rate for serious offenses declined. Also, offenses were less likely to be serious the later they occurred in the sequence of offenses for an individual. For crashes, the risk of having an at-fault crash declined more rapidly than the risk of a not-at-fault crash, although the rate of decrease began to equalize after approximately 5 years of licensure. The proportion of crashes that were at-fault did not decline over the sequence of crashes for an individual. Although crashes and offenses are positively correlated, they follow different trajectories over the early years of licensure.
State gun control advocacy tactics and resources
Zakocs RC, Earp J, Runyan CW. Am J Prevent Med 2001; 20(4): 251-257
Correspondence: Ronda Zakocs, PhD, Department of Social and Behavioral Sciences, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 rzakocs@bu.edu
The authors examined the tactics used by groups that advocate for gun control laws. A 153-item survey was mailed to the leaders of 679 local and state organizations thought to be actively advocating for state-level firearm control legislation. The authors compared advocacy methods with the financial resources available to the groups. Although 79 percent of the groups surveyed responded, many were not eligible (were not engaged in gun control advocacy, etc.). Eighty-one percent of the eligible groups completed questionnaires. Organizations commonly used public education, media, and legislative lobbying tactics, and fewer engaged in electioneering and litigation. Except for lobbying, no associations were found between groups' use of advocacy tactics and their level of financial resources.
Creating a Peaceful School Learning Environment: A Controlled Study of an Elementary School Intervention to Reduce Violence.
Twemlow SW, Fonagy P, Sacco FC, Gies ML, Evans R, Ewbank R. Am J Psychiatry 2001; 158(5):808-810.
Correspondence: Dr. Twemlow, Erikson Institute, Austen Riggs Center, P.O. Box 962, Stockbridge, MA 01262-0962; Stuart.Twemlow@Austenriggs.net
The authors evaluated the impact of a simple antiviolence program on the learning climate in elementary school. Students in two schools (matched on demographic characteristics) were followed for a 4 year period. Students in the experimental school received an intervention based on zero tolerance for bullying behavior. The control school received only regular psychiatric consultation. Disciplinary and academic achievement data were collected in both schools. The experimental school showed significant reductions in discipline referrals and increases in scores on standardized academic achievement measures compared with the control school.
Evaluation of a peaceful conflict resolution and violence prevention curriculum for sixth-grade students.
DuRant RH, Shari Barkin S, Krowchuk DP. J Adol Health 2001; 28(5): 386-393.
Correspondence: Robert H. DuRant, Ph.D., Department of Pediatrics, Brenner Center for Child and Adolescent Health, and Department of Pediatrics, Wake Forest University School of Medicine, One Medical Center Boulevard, Winston-Salem, NC 27157-1081 rdurant@wfubmc.edu
The authors evaluated the Peaceful Conflict Resolution and Violence Prevention Curriculum, a Social Cognitive Theory–based violence prevention curriculum, among sixth-grade students. All sixth graders (88% African-American, 41% living in public housing, and 80% living in homes with an employed head of household) in four schools participated. The 13-module curriculum taught identification of situations that could result in violence; avoidance, confrontation, problem-solving, and communication skills; conflict resolution skills; the conflict cycle; the dynamics of a fight; and how to express anger without fighting. The measures included frequency of fighting, weapon carrying behavior, intention to commit violence in hypothetical situations, exposure to violence, and depression. The data were analyzed with general linear modeling with repeated measures. At the baseline, the intervention and control groups did not differ in gender, age, depression, exposure to violence, or any other demographic variable. From pretest to posttest there was a decrease in the use of violence by students in the intervention group and an increase in the use of violence in the control group (group × time interaction effect p = .029). Most of the changes were accounted for by changes in the frequencies of carrying concealed guns and fighting resulting in injuries requiring medical treatment. A group × time interaction effect (p = .002) was also found for the intention to use violence scale. Students in the intervention group did not change their mean intention-to-commit- violence scores from pretest to posttest, whereas students in the control group increased in their mean intention to use violence scale scores. Neither interaction effect was influenced by gender, exposure to violence, or level of depression. The Peaceful Conflict Resolution and Violence Prevention curriculum appears to have positive short-term effects on self-reported use of violence and intentions to use violence by these middle-school students.
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