Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: People with disabilities are generally more vulnerable during disasters and publicemergencies than the general population. Physical, sensory and cognitive impairments may result ingreater difficulty in receiving and understanding emergency alert information, and greater difficulty intaking appropriate action. The use of social media in the United States has grown considerably inrecent years. This has generated increasing interest on the part of national, state and localjurisdictions in leveraging these channels to communicate public health and safety information. Howand to what extent people with disabilities use social and other communications media during publicemergencies can help public safety organizations understand the communication needs of thecitizens in their jurisdictions, and plan their social media and other communications strategiesaccordingly.

Methods: This article presents data from a survey on the use of social media and othercommunications media during public emergencies by people with disabilities conducted fromNovember 1, 2012 through March 30, 2013.

Results: The data presented here show four key results. First, levels of use of social media ingeneral are high for people with disabilities, as well as for the general population. Second, use ofsocial media during emergencies is still low for both groups. Third, levels of use of social media arenot associated with income levels, but are significantly and strongly associated with age: youngerpeople use social media at higher rates than older people in both groups (p,0.001). Fourth,differences in the use of social media during emergencies across disability types are slight, with theexception of deaf and hard-of-hearing respondents, the former more likely to have used social mediato receive (p¼0.002), verify (p¼0.092) and share (p¼0.007) emergency information.

Conclusion: These last two results suggest that effective emergency communications strategiesneed to rely on multiple media types and channels to reach the entire community. [West J EmergMed. 2014;15(5):567–574.]

Introduction: Child maltreatment is one of the United States’ most significant public health problems.In efforts to prevent maltreatment experts recommend use of Behavioral Parent Training Programs(BPTs), which focus on teaching skills that will replace and prevent maltreating behavior. While there isresearch to support the effectiveness of BPTs in maltreatment prevention, the reach of such programsis still limited by several barriers, including poor retention of families in services. Recently, newtechnologies have emerged that offer innovative opportunities to improve family engagement. Thesetechnologies include smartphones and social networking; however, very little is known about thepotential of these to aid in maltreatment prevention. The primary goal of this study was to conduct 2pilot exploratory projects.

Methods: The first project administered a survey to parents and providers to gather data about at-riskparents’ use of smartphones and online social networking technologies. The second project tested asocial networking-enhanced brief parenting program with 3 intervention participants and evaluatedparental responses.

Results: Seventy-five percent of parents surveyed reported owning a computer that worked. Eightyninepercent of parents reported that they had reliable Internet access at home, and 67% said theyused the Internet daily. Three parents participated in the intervention with all reporting improvement inparent-child interaction skills and a positive experience participating in the social networking-enhancedSafeCare components.

Conclusion: In general, findings suggest that smartphones, social networking, and Facebook, inparticular, are now being used by individuals who show risk factors formaltreatment. Further, themajorityof parents surveyed in this study said that they like Facebook, and all parents surveyed said that they useFacebook and have a Facebook account. As well, all saw it as a potentially beneficial supplement forfuture parents enrolling in parenting programs. [West J Emerg Med. 2014;15(5):575–581.]

Introduction: Interactions through technology have an important impact on today’s youth. While someof these interactions are positive, there are concerns regarding students engaging in negativeinteractions like cyberbullying behaviors and the negative impact these behaviors have on others. Thepurpose of the current study was to explore participant suggestions for both students and adults forpreventing cyberbullying incidents.

Methods: Forty high school students participated in individual, semi-structured interviews. Participantexperiences and perceptions were coded using constant comparative methods to illustrate ways inwhich students and adults may prevent cyberbullying from occurring within their school and community.

Results: Students reported that peers would benefit from increasing online security, as well asbecoming more aware of their cyber-surroundings. Regarding adult-provided prevention services,participants often discussed that there is little adults can do to reduce cyberbullying. Reasons includedthe difficulties in restricting online behaviors or providing effective consequences. However, somestudents did discuss the use of in-school curricula while suggesting that adults blame people ratherthan technology as potential ways to prevent cyberbullying.

Conclusion: Findings from the current study indicate some potential ways to improve adult efforts toprevent cyberbullying. These strategies include parent/teacher training in technology andcyberbullying, interventions focused more on student behavior than technology restriction, and helpingstudents increase their online safety and awareness. [West J Emerg Med. 2014;15(5):587–592.]

Objectives: This study assessed whether Georgia Senate Bill 360, a statewide law passed in August, 2010, that prohibits text messaging while driving, resulted in a decrease in this behavior among emergency medicine (EM) and general surgery (GS) healthcare providers.

Methods: SurveyMonkey was used to create a web-based survey containing up to 28 multiple choice and free-text questions about driving behaviors. EM and GS healthcare providers at a southeastern medical school and its affiliate county hospital received an email inviting them to complete this survey in February, 2011. All analyses were conducted in SPSS (version 19.0, Chicago, IL, 2010), using chi-squared tests and logistic regression models. The primary outcome of interest was a change in participant texting or emailing while driving after passage of the texting ban in Georgia.

Results: Two hundred and twenty-six providers completed the entire survey (response rate 46.8%). Participants ranged in age from 23 to 71 years, with an average age of 38 (SD=10.2; median=35).

Only three-quarters of providers (n=173, 76.6%) were aware of a texting ban in the state. Out of these, 60 providers (36.6%) reported never or rarely sending texts while driving (0 to 2 times per year), and 30 engaged in this behavior almost daily (18.9%). Almost two-thirds of this group reported no change in texting while driving following passage of the texting ban (n=110, 68%), while 53 respondents texted less (31.8%).

Respondents younger than 40 were more than twice as likely to report no change in texting post-ban compared to older participants (OR=2.31, p=0.014). Providers who had been pulled over for speeding in the previous five years were about 2.5 times as likely to not change their texting while driving behavior following legislation passage compared to those without a history of police stops for speeding (OR=2.55, p=0.011). Each additional ticket received in the past 5 years for a moving violation lessened the odds of reporting a decrease in texting by 45%. (OR=0.553, p=0.007).

Conclusion: EM and GS providers, particularly those who are younger, have received more tickets for moving violations, and with a history of police stops for speeding, exhibit limited compliance with distracted driving laws, despite first-hand exposure to the motor vehicle crashes caused by distracted driving.

Introduction: Technology-based interventions offer an opportunity to address high-risk behaviors inthe emergency department (ED). Prior studies suggest behavioral health strategies are more effectivewhen gender differences are considered. However, the role of gender in ED patient preferences fortechnology-based interventions has not been examined. The objective was to assess whether patientpreferences for technology-based interventions varies by gender.

Methods: This was a secondary analysis of data from a systematic survey of adult (18 years of age),English-speaking patients in a large urban academic ED. Subjects were randomly selected during apurposive sample of shifts. The iPad survey included questions on access to technology, preferencesfor receiving health information, and demographics. We defined ‘‘technology-based’’ as web, textmessage, e-mail, social networking, or DVD; ‘‘non-technology-based’’ was defined as in-person,written materials, or landline. We calculated descriptive statistics and used univariate tests to comparemen and women. Gender-stratified multivariable logistic regression models were used to examineassociations between other demographic factors (age, race, ethnicity, income) and technology-basedpreferences for information on specific risky behaviors.

Results: Of 417 participants, 45.1% were male. There were no significant demographic differencesbetween men and women. Women were more likely to use computers (90.8% versus 81.9%; p¼0.03),Internet (66.8% versus 59.0%; p¼0.03), and social networks (53.3% versus 42.6%; p¼0.01). 89% ofmen and 90% of women preferred technology-based formats for at least type of health information;interest in technology-based for individual health topics did not vary by gender. Concern aboutconfidentiality was the most common barrier to technology-based use for both genders. Multivariateanalysis showed that for smoking, depression, drug/alcohol use, and injury prevention, gendermodified the relationship between other demographic factors and preference for technology-basedhealth information; e.g., older age decreases interest in technology-based information for smokingcessation in women but not in men (aOR 0.96, 95% CI 0.93-0.99 versus aOR 1.00, 95% CI 0.97-1.03).

Conclusion: Our findings suggest ED patients’ gender may affect technology preferences. Receptivityto technology-based interventions may be a complex interaction between gender and otherdemographic factors. Considering gender may help target ED patient populations most likely to bereceptive to technology-based interventions. [West J Emerg Med. 2014;15(5):593–599.]

Introduction: Homicide is the second leading cause of death among youth aged 15–24. Prior crosssectionalstudies, in non-healthcare settings, have reported exposure to community violence, peerbehavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies havenot been performed to evaluate the temporal or predictive relationship between these risk factors andemergency department (ED) visits for injuries among at-risk youth. The objective was to assesswhether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period.

Methods: This prospective cohort study was performed in the ED of a Southeastern US Level I traumacenter. Eligible participants were patients aged 18–24, presenting for any chief complaint. We excludedpatients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurredover a 6-month period, by a research assistant in the ED for 3–5 days per week, with shifts scheduledsuch that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initialcontact in the ED, patients were asked to complete a written questionnaire, consisting of previouslyvalidated instruments measuring the following risk factors: a) aggression, b) perceived likelihood ofviolence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f)positive future outlook. At 12 months following the initial ED visit, the participants’ medical records werereviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chisquareand logistic regression analyses.

Results: Three hundred thirty-two patients were approached, of whom 300 patients consented.Participants’ average age was 21.1 years, with 60.1% female, 86.0% African American. Aftercontrolling for participant gender, ethnicity, or injury complaint at time of first visit, return visits forinjuries were significantly associated with: hostile/aggressive feelings (Odds ratio (OR) 3.5, 95%Confidence interval (CI): 1.3, 9.8), self-reported perceived likelihood of violence (OR 10.1, 95% CI: 2.5,40.6), and peer group violence (OR 6.7, 95% CI: 2.0, 22.3).

Conclusion: A brief survey of risk factors for violence is predictive of increased probability of a returnvisit to the ED for injury. These findings identify a potentially important tool for primary prevention ofviolent injuries among at-risk youth seen in the ED for trauma-related and non-traumatic complaints.

Introduction: Youth seen in the emergency department (ED) with injuries from youth violence (YV) have increased risk for future violent injury and death. Pediatric emergency medicine (PEM) physicians rarely receive training in, or perform, YV screening and intervention. Our objective was to examine effects of a Web-based educational module on PEM physicians’ knowledge, attitudes, and behaviors regarding YV screening and interventions in the ED.

Methods: All PEM fellows and attendings at an urban Level I pediatric trauma center were invited to complete an interactive Web-based education module (and 1-month booster) with information on YV’s public health impact and how to screen, counsel and refer YV-involved patients. Consenting subjects completed electronic assessments of YV prevention knowledge and attitudes (using validated measures when possible) before and after the initial module and after the booster. To measure behavior change, chart review identified use of YV-specific discharge instructions in visits by YV-injured PEM patients (age 12-17; identified by E codes) 6 months before and after the intervention. Survey data were analyzed with Fisher’s exact for binary outcomes and Kruskal-Wallis for Likert responses. Proportion of patients given YV discharge instructions before and after the intervention was compared using chi-square.

Results: 18 (67%) of 27 PEM physicians participated; 1 was lost at post-module assessment and 5 at 1 month. Module completion time ranged from 15-30 minutes. At baseline, 50% of subjects could identify victims’ re-injury rate; 28% were aware of ED YV discharge instructions. After the initial module and at 1 month, there were significant increases in knowledge (p<0.001) and level of confidence speaking with patients about avoiding YV (p=0.01,df=2). Almost all (94%) said the module would change future management. In pre-intervention visits, 1.6% of patients with YV injuries were discharged with YV instructions, versus 15.7% in the post-intervention period (p=0.006, 95%CI for difference 3.6% - 24.5%).

Conclusions: A brief Web-based module influenced PEM physicians’ knowledge and attitudes about YV prevention and may have affected behavior changes related to caring for YV victims in the ED. Further research should investigate Web-based educational strategies to improve care of YV victims in a larger population of PEM physicians.

Introduction: The use of mobile phones and other technology for improving health through research and practice is growing quickly, in particular in areas with difficult to reach population or where the research infrastructure is less developed. In Sub-Saharan Africa, there appears to be a dramatic increase in mobile phone ownership and new initiatives that capitalize on this technology to support health promotion campaigns to change behavior and to increase health literacy.  However, the extent to which difficult to reach youth in the slums of Kampala may own and use mobile phones has not been reported despite the burden of injuries, substance use, and HIV that they face. The purpose of this study is to determine the prevalence and correlates of mobile phone ownership and use in this high-risk population.

Methods: This study of youth was conducted in May and June of 2011 to quantify and describe high-risk behaviors and exposures in a convenience sample of urban youth (N=457) living on the streets or in the slums, 14-24 years of age, who were participating in a Uganda Youth Development Link drop-in center for disadvantaged street youth.  Chi-square analyses were computed to determine associations between mobile phone ownership and usage and demographic and psychosocial correlates.

Results: Overall, 46.9% of youth reported owning a mobile phone and ownership did not vary by sex, but was more common among youth older than 18 years of age. Mobile phone ownership was also more common among those who reported taking care of themselves at night, who reported current drug use and who reported trading sex for money, food or other things.

Conclusion: The findings indicate that research using mobile phones may be both feasible and desirable with hard to reach population living in the slums and who use drugs or who are engaged in commercial sex.  Moreover, this technology may also be suitable for injury specific research given that there were few differences with respect to injury-related variables in mobile phone ownership and usage.

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Injury prevention programs can use social media to disseminate information and recruit participants.Non-profit organizations have also used social media for fundraising and donor relationshipmanagement. Non-profit organizations (NPOs) with injury prevention missions often serve vulnerablepopulations. Social media platforms have varied levels of access and control of shared content. Thisvariability can present privacy and outreach challenges that are of particular concern for injuryprevention NPOs. This case report of social media workshops for injury prevention NPOs presentsconcerns and strategies for successfully implementing social media campaigns. [West J Emerg Med.2014;15(5):582–586.]