Hospital-based violence intervention programs (HVIPs) provide assault-injured youth access to comprehensive services at the time of injury. Despite mounting evidence of the benefits of HVIPs, limited information is available about how to best implement HVIPs. In this study, we used qualitative interviews with a purposive sample of multidisciplinary hospital professionals (n = 17) to assess the needs of patients and the service structures important to HVIP implementation. Analysis using a grounded theory approach generated three themes: (1) Patients experiencing assault-related injuries have complex socioeconomic needs that impact recovery requiring intensive case management and service navigation; (2) Assault-injured patients have complex behavioral health needs at the individual, peer, and family levels requiring clinical intervention; and (3) Assault injured youth and their families require care, support, and mentoring. The results highlight the need for innovative hospital-community partnerships designed to expand services to address the long-term psychological and social sequelae of violent injuries.

Support Over Silence for KIDS is a training program that equips bystanders with confidence and skills to defuse challenging moments between caregivers and their children in public. The purpose of this study was to assess the satisfaction with and effectiveness of Support Over Silence for KIDS within three training settings: a community organization, university, and children’s hospital. Participants completed pre-program and follow-up assessments to capture demographic characteristics and change in behaviors, attitudes, self-efficacy, and perceived barriers related to bystander intervention. Participants completed an immediate post-program questionnaire to assess program satisfaction and post-program intentions. Univariate statistics were used to describe the demographic characteristics of the sample, bystander behaviors, and program satisfaction. Wilcoxon signed-rank tests were used to assess change between pre-program and follow-up. Sixty-six adults participated in the training program. Favorable outcomes were demonstrated at post-program for satisfaction with the program, future bystander intentions, and self-efficacy for bystander intervention. At follow-up, participants reported more favorable attitudes toward bystander intervention and significantly increased self-efficacy for intervention despite acknowledged barriers. Participants reported increased bystander intervention; at follow-up, none of the participants reported avoiding a challenging moment between a caregiver and their child in public. Support Over Silence for KIDS was effective in promoting supportive bystander intervention with caregivers navigating challenging interactions with their children in public. A bystander training program may help community members, university students, and hospital personnel respond in a positive way to caregiver struggles and create an environment where caregivers and their children feel supported.

Child maltreatment is a serious public health issue. Bystander models have been applied in sexual violence and bullying prevention, with little application in public child maltreatment. Support Over Silence for KIDS (SOSFK) is a bystander program aimed at addressing public child maltreatment by supporting caregivers and their children. This study describes formative research conducted to inform the development of SOSFK. Data were collected from focus groups with community members (n = 29), hospital personnel (n = 60), and caregivers (n = 23) from aMidwestern city to examine barriers and facilitators to becoming an active bystander in cases of public child maltreatment. Data were analyzed through mixed content analysis. Participants highlighted contextual, situational, and intrapersonal factors that serve as both barriers and facilitators to bystander intervention in cases of public child mistreatment. The lack of and/or fragmented sense of community and perceived situational danger were identified as barriers to intervention. A shared sense of responsibility for caring for children in the community and having a personal relationship with the parent-child dyad were identified as facilitators to bystander intervention. Results from this study provide implications for the development of programs to support caregivers during stressful parenting moments and might reduce public instances of child maltreatment.

Background: Child welfare professionals are charged with protecting children from non-accidental caregiving behaviors resulting in intentional injuries as well as environmental risks and parenting behaviors resulting in unintentional injuries. Yet little is known about unintentional injury prevalence and risk factors by child welfare placement type. Objective: To examine factors related to unintentional child injury requiring medical attention, including child welfare placement type, child behavioral problems, caregiver characteristics, and neighborhood factors. Methods: Data from the second and third wave of the 2010 National Survey of Child and Adolescent Well-Being (NSCAW II) were used. Stable child welfare placements between waves 2 and 3 included investigated biological, reunified, adopted, licensed and unlicensed kin, and nonkin foster homes. Logistic regression analysis modeled injury as a function of placement type while controlling for other covariates. Interaction effects between placement and child behavioral scores were also modeled. Results: Children with more behavioral problems were at greater odds of an injury (OR=1.05, p<.01) compared to children with fewer behavioral problems. However, interaction models showed that children with more behavioral problems were at decreased odds of injury if living with unlicensed kin (OR=.91, p<.05), licensed kin (OR=.92, p<.001), or foster care (OR=.92, p<.001) compared to biological homes. Conclusion: The absence of a behavioral problem was associated with higher risk of injury for children placed in foster care. More research is needed to better understand injury type, prevalence and specific risk factors.

Introduction: Bystander interventions have been successful in changing bystander attitudes and behaviors to prevent sexual violence. This systematic review was performed to summarize and categorize the characteristics of sexual violence bystander intervention programs and analyze bystander intervention training approaches for the primary prevention of sexual violence and assault. Method: From June to July 2017, the authors searched both published and unpublished American and Canadian studies from 2007 to 2017. The published sources included six major electronic databases and the unpublished sources were Google Scholar and the 40 program websites. From the 706 studies that resulted from this initial search, a total of 44 studies (that included a single bystander intervention program and assessments at both pretest and at least one posttest) were included. Results: Thirty-two percent of studies analyzed bystander behavior postintervention, and most found significant beneficial outcomes. The most frequently used training methods were presentation, discussion, and active learning exercises. Bringing in the Bystander and The Men’s Program had the most replicated empirical support for effectiveness. Discussion: There has been a substantive increase in quasi-experimental and randomized controlled trial approaches to assessing the effectiveness of this type of intervention since 2014. The training methods shared between these efficacious programs may translate to bystander interventions for other victimization types, such as child abuse. Conclusion: The use of in-person bystander training can make positive changes in attitudes and behaviors by increasing awareness of a problem and responsibility to solve it.

PURPOSEThe purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy.DESIGN/METHODOLOGY/APPROACHThe intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change.FINDINGSIntervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible.ORIGINALITY/VALUEThe study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy.

The objective of this study was to examine the extent to which a brief tailored parenting program administered in a pediatric clinic can change high-risk parenting behaviors. Parents with a child five years old or younger presenting to a University-based primary care pediatric clinic in a large Midwestern children's hospital were invited to participate in the study. Parents completed RISE UP!, which included an assessment completed on a tablet computer and then received a tailored, printed report that provided recommendations to address the personal high-risk parenting practices identified by the assessment. A follow-up assessment was completed with 125 parents (58%) about six weeks after the pediatric visit. Overall, 75% of parents reported trying at least one of the recommendations included in the report. Analysis of parenting risk indicated that 53% of parents had different highest parenting risk areas after RISE Up! and 33% of identified parenting risk scores decreased after RISE Up! Of the 231 priority unintentional injury risk behaviors identified, 34% were reported as non-risk behaviors at follow-up. Race and education were significantly associated with program effects in bivariate analysis; program effects were also correlated with communication mediators in a strong dose-response relationship. Reducing both child abuse and neglect and pediatric unintentional injuries are global priorities. Several childhood injury prevention frameworks and evidence-based policy recommendations highlight shared etiologies and opportunities for intervention. RISE Up! shows promise for universal prevention to promote the adoption of parenting practices to reduce injury risk and positive parenting behaviors.

Schools often offer injury prevention (IP) programs, but little is known about the types of programs provided or how school nurses decide which to choose. Nurses in the Missouri School Health Services Staffing Survey Database were sent a survey in spring, 2011, to describe school-based IP efforts being offered. A multivariate linear regression was conducted to delineate factors associated with offering IP programs. In total, 522 school nurses participated (33% response rate). The highest priority for selecting an IP program was perceived program effectiveness (92.3% agreement, n = 482). Determinants of offering IP programs included being asked to identify a speaker, being a high school, receiving funding in the last year, prioritizing evidence-based programs, perceiving that administrators support professional development, and knowing how to address patterns of injuries. School nurses should be competent in planning, implementing, and evaluating IP programs, and additional training may be required to accomplish this.

Most childhood injuries can be prevented with the correct use of safety devices and appropriate supervision. Children's hospitals are well positioned to promote these behaviors with evidence-based programming; however, barriers exist to adopting such programs. The purpose of this study was to describe organizational and administrative factors related to the adoption of an efficacious injury prevention (IP) program by children's hospitals in the USA. IP specialists at 232 U.S. children's hospitals were invited to complete a baseline survey, and then offered Safe N' Sound (SNS), an efficacious computer IP program targeting parents of young children. Following this promotion period, specialists were surveyed again to assess their level of SNS adoption. Organizational and administrative factors associated with SNS adoption were identified using conditional random forest models (n = 93). Random forests identified a set of six predictors with potential utility for classifying hospitals as having SNS adoption activity or not; the final pruned classification tree indicated that four of these were best able to differentiate hospitals with and without adoption activity-having a medical director, having other hospital units that provided IP programming, the number of requests the IP unit received within the past year, and the belief of administrative leaders in their responsibility to develop programming all influence decisions. Hospitals without a medical director were most likely to demonstrate adoption activity. Medical directors, or other organizational leaders, can facilitate the adoption process for evidence-based intervention, but may need to be engaged intentionally when disseminating new products, tools, or approaches.

•Evaluating intermediary organizations is challenging because their work has many distinct foci.•Process and impact evaluations may not capture the unique contributions of IOs.•We offer a conceptual model to guide such evaluation work that acknowledges these complexities.

Background: Exposure to particulate matter pollution is associated with various cardiopulmonary diseases, which are closely related with disability. The direct relationship between air pollution and disability, however, has not been fully explored.Methods: We used data from 45,625 participants in the Study on global AGEing and adult health in six low-and middle-income countries. The 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) was used to measure the disability with six domains (cognition, mobility, self-care, getting along, life activities, and participation in society). Participants' community addresses were used to estimate annual concentration of PM2.5 using satellite data. We used linear mixed models to examine the effects of PM2.5 on overall and domain-specific WHODAS scores.Results: Exposure to PM2.5 was significantly associated with greater disability score (a higher score implies a greater disability); each 10 mu g/m(3) increase corresponded to 0.72 (95% CI: 0.22, 1.22) increase in overall disability score. Compared with low PM2.5 level (< 14.33 mu g/m(3)), moderate (14.33-27.83 mu g/m(3)) and high exposure levels (> 27.83 mu g/m(3)) were associated with 3.43 (95% CI: 1.43, 5.43) and 3.72 (95% CI: 1.59, 5.86) increase in disability scores. Among the six domains, cognition, mobility and getting along were found to be associated with PM2.5. Stratified analyses found that women and older subjects were more sensitive to this effect.Conclusion: Exposure to ambient PM2.5 might be one risk factor of disability in the low-and middle-income countries, women and older adults are the vulnerable population; and among the six domains, cognition, mobility and getting along are more relevant to this effect.

INTRODUCTION:More than 9,000 children die annually from various causes of unintentional injury. Of all the pediatric unintentional injuries occurring in the United States, 8.7 million are treated in emergency departments, and 225,000 require hospitalization annually. Health education programs are available to address these injuries. The objective of this research was to examine the distribution of self-reported high priority injury risks in an urban Midwestern pediatric level 1 trauma center and investigate the relationship between parental perceptions and injury-prevention behaviors. Prevalence rates for 3 data sources are compared.METHODS:Missouri Information for Community Assessment (MICA) was categorized to mirror variables corresponding with risks of injury presented in the Safe 'n' Sound (SNS) program. Level 1 trauma center data were examined to determine how the variables were distributed compared with MICA data and with the parent-reported levels.RESULTS:A total of 429 SNS surveys were compared with ED data and MICA data. For SNS users, car crashes were identified as the highest risk, specifically due to the use of incorrect car seats. The injuries seen most often in the emergency department were falls, and falls were also the most prevalent injury captured by MICA. Controlling for demographics, parental perceptions predicted several risks for injury.DISCUSSION:Because parental perceptions are significantly related to risks of injury, prevention programs aiming to decrease injuries could focus on the perceptions. Not only can perceptions be used to tailor health communication materials, these perceptions can be the targets of change. Further work might investigate the extent to which changes in perceptions result in increased adoption of safety practices.

Purpose: The study compared perceptions of state legislative aides about tobacco policymaking in states with strong and weak tobacco control policies. Approach: Qualitative in-depth interviews carried out in 2009. Setting: The US states were ranked on a combination of tobacco prevention funding, taxes, and presence of smoke-free policies. States at the top and bottom of the rankings were chosen. Participants: Interviews were conducted with 10 legislative aides in 5 states with strong tobacco control policies and 10 aides in 7 states with weak policies. Method: Twenty semistructured interviews were conducted, coded, and analyzed using a consensus coding process. Results: Tobacco control was a lower priority in states with weak policies, and respondents from these states listed more barriers to tobacco control policymaking than those from states with strong policies. Successful arguments for tobacco control emphasized operational applications, for example, enhanced revenue from tobacco taxes or safety of children and employees. Conclusion: Our findings support propositions posited in the Advocacy Coalition Framework. They point to the preeminence of contextual factors, notably political leanings and economic climate on success of policy change efforts. Lessons learned from participants from states with strong policy nonetheless show promise for success in states with weak policy.

BACKGROUND:Rates of musculoskeletal disorders in construction remain high. Few studies have described barriers and facilitators to the use of available ergonomic solutions. This paper describes these barriers and facilitators and their relationship to the level of adoption.METHODS:Three analysts rated 16 proposed ergonomic solutions from a participatory ergonomics study and assessed the level of adoption, six adoption characteristics, and identified the category of adoption from a theoretical model.RESULTS:Twelve solutions were always or intermittently used and were rated positively for characteristics of relative advantage, compatibility with existing work processes and trialability. Locus of control (worker vs. contractor) was not related to adoption. Simple solutions faced fewer barriers to adoption than those rated as complex.CONCLUSIONS:Specific adoption characteristics can help predict the use of new ergonomic solutions in construction. Adoption of complex solutions must involve multiple stakeholders, more time, and shifts in culture or work systems. Am. J. Ind. Med. 60:295-305, 2017. © 2017 Wiley Periodicals, Inc.

BACKGROUND:Unintentional injuries are the leading cause of death in children ages 1-18 years. Many of these injuries to young children occur in their own homes. Although research has explored injury risk prevention strategies, historically, much of this research has focused on environmental changes and teaching safety practices. Currently, there appears to be a gap in current research exploring how parenting influences children's risk of injury.METHODS:Mothers (n = 119) of children 5 years and younger were recruited from a paediatric clinic as a part of a larger study and completed measures of parenting challenges, developmentally sensitive parenting, child neglect, parental efficacy, and risk of potential injury situations. Hierarchical logistic regression was used to explore the extent to which developmentally insensitive parenting behaviours put parents at higher risk for behaviours that lead to unintentional injury in children and whether developmentally sensitive parenting behaviours protects children from injury. The association between demographic characteristics and injury risk behaviours was also examined.RESULTS:Parents who reported more frequent insensitive parenting behaviours (i.e., yelling, spanking, and putting child in time out) were more likely to report putting their child in an incorrect car seat or taking their child out of a car seat while the car is still moving. In addition, younger parents were at greater risk of storing cleaners and medications unsafely.CONCLUSION:Results from this study highlight the importance of supporting younger mothers and educating parents on effective parenting strategies when trying to prevent unintentional injury risks.

Background Integrating health literacy into primary care institutional policy and practice is critical to effective, patient centered health care. While attributes of health literate organizations have been proposed, approaches for strengthening them in healthcare systems with limited resources have not been fully detailed. Methods We conducted key informant interviews with individuals from 11 low resourced health care organizations serving uninsured, underinsured, and government-insured patients across Missouri. The qualitative inquiry explored concepts of impetus to transform, leadership commitment, engaging staff, alignment to organization wide goals, and integration of health literacy with current practices. Findings Several health care organizations reported carrying out health literacy related activities including implementing patient portals, selecting easy to read patient materials, offering community education and outreach programs, and improving discharge and medication distribution processes. The need for change presented itself through data or anecdotal staff experience. For any change to be undertaken, administrators and medical directors had to be supportive; most often a champion facilitated these changes in the organization. Staff and providers were often resistant to change and worried they would be saddled with additional work. Lack of time and funding were the most common barriers reported for integration and sustainability. To overcome these barriers, managers supported changes by working one on one with staff, seeking external funding, utilizing existing resources, planning for stepwise implementation, including members from all staff levels and clear communication. Conclusion Even though barriers exist, resource scarce clinical settings can successfully plan, implement, and sustain organizational changes to support health literacy.

This study is a nested case control study from a population-based cohort study conducted in Wuhan, China. The aim is to estimate the association between symptoms of depression during pregnancy (DDP), anxiety during pregnancy(ADP), and depression with anxiety during pregnancy (DADP) and low birth weight (LBW) and to examine the extent to which preterm birth (PTB) moderates these associations. Logistic regression analyses were used to model associations between DDP, ADP, and DADP and LBW. Models were stratified by the presence or absence of PTB to examine moderating effects. From the cohort study, 2853 had a LBW baby (cases); 5457 pregnant women served as controls. Women with DDP or ADP only were not at higher risk of having a LBW baby, but DADP was associated with increased risk of LBW (crude OR 1.41, 95% CI 1.17–1.70; adjusted OR 1.29, 95% CI 1.07–1.57), and the significant association was particularly evident between DADP and LBW in PTB, but not in full-term births. Our data suggests that DADP is related to an increased risk of LBW and that this association is most present in PTBs.

Background Health care providers fill a central role in the prevention of both child abuse and neglect (CA/N) and unintentional childhood injury. Health communication interventions hold promise for promoting attitudes and behaviours among parents that increase positive parenting practices, which may be linked to decreased rates of intentional and unintentional childhood injuries. This manuscript describes the development of `RISE Up', an ambulatory clinic-based childhood injury prevention programme that provides tailored, injury prevention print materials to parents of children ages 0-5.Methods Fifteen semi-structured key informant interviews were conducted with clinic healthcare providers and staff to develop communication strategies and materials for caregivers. Cognitive response testing was then conducted with 20 caregivers of the priority population to assess all materials. Interviews were recorded, transcribed and analyzed using thematic coding methods.Results Formative research revealed that health care providers and caregivers were very responsive to messages and materials. Health care providers reported that abuse and neglect were particularly relevant to their patients and noted several benefits to implementing the RISE Up programme in a health care setting. Caregivers generally found messages on reducing the risks of injuries, as well as the graphics displayed in the RISE Up programme to be helpful.Conclusions Addressing the common determinants of both intentional and unintentional childhood injury through customized print materials may be a useful component of comprehensive prevention efforts to address childhood injury risk with greater impact. Providers and parents responded favourably to this communication strategy.

Widespread adoption and use of the practice of shared decision-making among health-care providers, especially urologists, has been limited. This study explores urologists’ perceptions about their conversational practices leading to decision-making by newly diagnosed prostate cancer patients facing treatment. Semi-structured, in-depth interviews were conducted with 12 community and academic urologists practicing in the St. Louis, MO, region. Data were analyzed using a consensus coding approach. Urologists reported spending 30–60 min with newly diagnosed prostate cancer patients when discussing treatment options. They frequently encouraged family members’ involvement in discussions about treatment, especially patients’ spouses and children. Participants perceived these conversations to be difficult given the emotional burden associated with a cancer diagnosis, and encouraged patients to postpone their decisions or to get a second opinion before finalizing their treatment of choice. Initial discussions included a presentation of treatment options relevant to the patient’s condition, side effects, outcome probabilities, and next steps. Urologists seldom used statistics while talking about treatment outcome probabilities and preferred to explain outcomes in terms of the patient’s practical, emotional, and social experiences. Their styles to elicit the patient’s preferences ranged from explicitly asking questions to making assumptions based on clinical experience and subtle patient cues. In conclusion, urologists’ routine conversations included most elements of shared decision-making. However, shared decision-making required urologists to have nuanced discussions and be skilled in elicitation methods and risk discussions which requires further training. Further research is required to explore roles of family and clinical staff as participants in this process.