Stakeholder-Engaged Development of a Theory-Driven, Feasible, and Acceptable Approach to Concussion Education

Concussion education is widely mandated and largely ineffective. Recent consensus guidance on concussion education asserts the importance of (1) theory-driven programming that targets the team as a system and (2) working with end users throughout the development process, and considering issues such as feasibility, acceptability, and sustainability. Consistent with this guidance, and in collaboration with youth sport stakeholders in two regions of the United States, we developed a novel approach to concussion education: Pre-game safety huddles. Safety huddles have the following two core components: (1) athletes, coaches, and other stakeholders come together before the start of each game and (2) opinion leaders (coaches, referees) affirm the importance of care seeking for suspected concussion. The aim of this article is to provide an overview of the collaborative process through which we refined the safety huddle concept into an acceptable and feasible intervention with potential for sustainable implementation in diverse youth sports settings with minimal resource demands. In describing our process and discussing challenges and opportunities, we hope to provide an example for others seeking to develop and implement injury prevention interventions in youth sports settings.

Pediatric Residents' Outpatient Firearm Screening and Safety Counseling Practices (Or Lack Thereof): A Retrospective Chart Review

The American Academy of Pediatrics recommends that children and adolescents be universally screened for access to firearms and exposure to violence. The purpose of this study was to characterize how often pediatric residents at one institution document screening for firearm access and violence risk factors and provide risk reduction counseling in the primary care setting. A retrospective chart review was conducted at two primary care clinics in Baltimore, Maryland, for patient ages 10 to 25 years who were seen by resident physicians for well care between October 2019 and December 2020. We reviewed 169 patients' charts meeting the inclusion criteria. Forty (24%) patients had a documented history of exposure to violence or history of suicidal ideation. Based on resident documentation, one (<1%) patient was screened for firearm access or exposure to firearm violence and 10 (6%) were provided risk reduction counseling or any type of firearm safety counseling. Pediatric resident physicians at our institution rarely screen for firearm access or provide violence prevention counseling in the primary care setting. Targeted interventions and quality improvement projects are needed to address screening barriers and design novel interventions to overcome these barriers.

Gender Differences in Older Adults' Perceptions of Falls and Fall Prevention

AIM

To explore gender differences in older adults' perceptions about preventing falls.

BACKGROUND

Falls are a major problem for older adults and health care systems and a challenge to the aging population. Consideration of older adults' perceptions of fall prevention is needed to increase their engagement in evidence-based prevention strategies.

METHOD

A qualitative analysis of secondary data was performed.

RESULTS

Three major themes emerged: We've Seen It, Women Are Caregivers, and Men Are Analyzing Risks and Modifying Behaviors. The men and women in this study shared information about falls and fall prevention in alignment with traditional role expectations. The women learned about falling through their roles as caregivers and prevented falls by controlling extrinsic risk factors indoors such as holding onto handrails on stairs or making home modifications. The men demonstrated an analytical approach to reducing risk such as employing improved safety measures during outdoors activities as a responsibility to maintain independence.

IMPLICATIONS

The different perceptions of men and women influence what they do to engage in fall prevention. Health care professionals need to consider gender differences and take an individualized approach that includes allowing older adults to share their experiences, acknowledging their successful fall prevention behaviors, and validating and addressing their concerns.

The Indirect Influence of Organizational Safety Climate on Football Players' Concussion Reporting Intentions

Most of the health interventions designed to increase athletes' reporting of potential concussion symptoms have focused only on the individual athlete. Unfortunately, interventions targeted at athletes' knowledge and understanding of concussion risk has not reliably increased their reporting behavior, leading to increased calls for "changing the culture of concussion reporting." To date, no studies have examined the role of organizational safety climate has on concussion-symptom reporting behavior. We hypothesized that players' perception of organizational safety climate would be indirectly related to their concussion symptom reporting intentions, via the influence of safety culture on supportive social norms and self-efficacy, two well-known predictors of concussion reporting intentions. We used structural equation modeling techniques to create robust latent measures of our model variables and then examined the indirect influence of football program safety climate on football players' symptom reporting intentions. Surveys were completed by NCAA Division I football players (N = 223) before and after the 2017 football season. We tested a confirmatory factor analysis and hypothesized latent variable model with preseason data, made small adjustments to our model (adding correlated error terms), and then confirmed using postseason data. We also examined a competing, alternative model. Results support the indirect and influence of perceived safety climate on concussion reporting intentions primarily via the relationship between safety climate and social norms, and to a lesser extent between safety climate and self-efficacy. Discussion focuses on the importance of considering the addition of interventions aimed at systems-level influences to facilitate supportive social norms and athlete self-efficacy regarding concussion symptom reporting.

A New Game Plan for Concussion Education

Despite state laws requiring concussion education for youth sport stakeholders and a proliferation of educational programs, there has been little demonstrated impact on concussion reporting behaviors. We propose that this is because of four key limitations to existing approaches to concussion education: (1) deliberative decision making by the injured athlete is assumed, (2) interventions are often targeted at individuals rather than social systems, (3) education occurs once during preseason and is forgotten, and (4) dissemination challenges exacerbate health inequalities. Addressing these limitations, we propose a novel theoretic framework that situates individual behavior within a sport system's culture and their broader structural context. Concussion education programs should seek to facilitate safety-supportive interpersonal communication within and between stakeholder groups and influence attributes of groups that drive behavior, including shared values. Addressing the limitations outlined and drawing on the proposed conceptual framework, we describe a novel approach to concussion education: pregame safety huddles.

Novel Smartphone-Based Measures of Cell Phone Use While Driving in a Sample of Newly Licensed Adolescent Drivers

BACKGROUND

Motor vehicle crashes are the leading cause of adolescent death. Cell phone use while driving is a contributor to adolescent motor vehicle crash risk. Objective and directly observable measures of cell phone use while driving are needed to implement interventions aimed at reducing cell phone-related crash risk.

AIMS

To describe novel smartphone-based measures of cell phone use while driving in a sample of newly licensed male and female adolescent drivers.

METHODS

Newly licensed adolescents in Pennsylvania installed a windshield-mounted device that pairs with a smartphone application to collect data on cell phone use while driving over 2 weeks during June 2016-October 2016. Descriptive statistics, independent t tests, and Wilcoxin Mann-Whitney U test were used to characterize handheld cell phone use ("unlock") and call time while accounting for driving exposure.

RESULTS

Data from 16 adolescents (50% male) resulted in 5,624 miles in 705 trips, 964 cell phone unlocks, and 146.22 minutes of call time. Participants had a mean of 23.96 unlocks/100 miles ( SD = 22.97), 1.23 unlocks/trip ( SD = 0.96), and 4.87 unlocks/hour driven ( SD = 3.93). Males had significantly more unlocks/100 miles, unlocks at speed >25 mph/100 miles, unlocks/hour driven, and unlocks at speed > 25 mph/hour driven ( p < .05).

CONCLUSIONS

Smartphone-based applications are an innovative means by which to collect continuous data on cell phone use while driving that can be used to better understand and intervene on this frequent behavior in newly licensed adolescent drivers.

Wombs and Whippersnappers: Reflections on Health Education Research and Opportunities for the Future

My talk will describe two public health problems facing women and children that were the focus of the work my colleagues and I did over my years as a health behavior change researcher. I start by addressing why a focus on women and children is important from a public health perspective and then provide two mini case studies: (1) identifying needs and interventions for women living with HIV and intimate partner violence and (2) disseminating proven interventions to reduce unintentional injuries in children. The conclusions present thoughts on the contributions of health education to these public health concerns and opportunities for the future.

Preventing Violence: A Public Health Participatory Approach to Homicide Reviews

Death review teams are a common method for assessing preventable deaths, yet they rarely review adult homicides and do not typically include community members. Academic-community partnerships can enhance public health research by encouraging translation of research into practice and support a data-driven approach to improve community health and well-being. We describe the Pittsburgh Homicide Review Group, a community-partnered initiative to prevent future homicides through data review and community dialogue. Group members reviewed all 42 Pittsburgh 2012 homicides informed by three primary data sources: publicly available data, local service databases, and community outreach resources. Thirty-two individuals representing relevant county agencies and community groups participated in eight reviews. Data sharing among partners resulted in a comprehensive understanding of the context of homicides. Review meetings supported a collective discussion around potential contributing factors to homicides, intervention implications, and recommendations. Academic-community homicide review partnerships are a productive approach to inform homicide prevention and interventions that are relevant to communities and should be implemented widely.

The DELTA PREP Initiative: Accelerating Coalition Capacity for Intimate Partner Violence Prevention

BACKGROUND

The DELTA PREP Project aimed to build the prevention capacity of 19 state domestic violence coalitions by offering eight supports designed to promote prevention integration over a 3-year period: modest grant awards, training events, technical assistance, action planning, coaching hubs, the Coalition Prevention Capacity Assessment, an online workstation, and the online documentation support system.

OBJECTIVES

Using quantitative and qualitative data, we sought to explain how coalitions integrated prevention within their structures and functions and document how DELTA PREP supports contributed to coalitions' integration process.

RESULTS

We found that coalitions followed a common pathway to integrate prevention. First, coalitions exhibited precursors of organizational readiness, especially having prevention champions. Second, coalitions engaged in five critical actions: engaging in dialogue, learning about prevention, forming teams, soliciting input from the coalition, and action planning. Last, by engaging in these critical actions, coalitions enhanced two key organizational readiness factors-developing a common understanding of prevention and an organizational commitment to prevention. We also found that DELTA PREP supports contributed to coalitions' abilities to integrate prevention by supporting learning about prevention, fostering a prevention team, and engaging in action planning by leveraging existing opportunities. Two DELTA PREP supports-coaching hubs and the workstation-did not work as initially intended. From the DELTA PREP experience, we offer several lessons to consider when designing future prevention capacity-building initiatives.

Concussion Education in U.S. Collegiate Sport: What Is Happening and What Do Athletes Want?

Concussion education for athletes has the potential to play a role in reducing the health burden of concussions from sport by modifying individual risk-related behaviors. In U.S. collegiate sport, decisions about content and delivery of concussion education are left up to the individual institution. This may result in a high degree of variability in what educational materials athletes receive and is particularly problematic as few concussion education programs have demonstrated efficacy. Health educators can play an important role in working collaboratively with sports medicine clinicians to design and evaluate evidence-based concussion education materials for athletes that meet their learning needs. As a first step in this process, the present study characterizes the content, source, and delivery modalities of concussion currently being provided to U.S. collegiate athletes. It also describes the reported concussion education preferences of a sample of U.S. collegiate athletes. Participants were 789 athletic trainers from 276 schools and 325 athletes from four schools. Results indicated that education is most frequently provided by athletic trainers but that many athletes would also like coaches and physicians to be involved in this process. Athletes also indicated a preference for content provision across a range of topics, including athletic and academic consequences of continued play with a concussion. Implications for the design and delivery of concussion education for athletes are discussed.

Evaluation of DELTA PREP: A Project Aimed at Integrating Primary Prevention of Intimate Partner Violence Within State Domestic Violence Coalitions

BACKGROUND

Intimate partner violence (IPV) has been recognized as a public health problem since the late 20th century. To spur IPV prevention efforts nationwide, the DELTA PREP Project selected 19 state domestic violence coalitions to build organizational prevention capacity and catalyze IPV primary prevention strategies within their states.

OBJECTIVE

DELTA PREP's summative evaluation addressed four major questions: (1) Did coalitions improve their prevention capacity during the project period? (2) Did coalitions serve as catalysts for prevention activities within their states during the project period? (3) Was initial prevention capacity associated with the number of prevention activity types initiated by coalitions by the end of the project? (4) Did coalitions sustain their prevention activities 6 months after the end of the project period?

RESULTS

DELTA PREP achieved its capacity-building goal, with all 19 participant coalitions integrating prevention within their organizations and serving as catalysts for prevention activities in their states. At 6 months follow up, coalitions had sustained almost all prevention activities they initiated during the project. Baseline prevention capacity (Beginner vs. Intermediate) was not associated with the number of prevention activity types coalitions implemented by the end of the project.

CONCLUSION

Service and treatment organizations are increasingly asked to integrate a full spectrum of prevention strategies. Selecting organizations that have high levels of general capacity and readiness for an innovation like integrating a public health approach to IPV prevention will likely increase success in building an innovation-specific capacity, and in turn implementing an innovation.