Pediatrics

 

Barriers to Personal Flotation Device Use

Investigator: Beth Mueller, D.P.H., M.P.H., B.S.
Funding: Centers for Disease Control and Prevention
8/1/08 – 7/31/09

Recreational boating incidents comprise a major proportion of drowning deaths in many states and Canada.  Most boat-related drowning in the U.S. occurs to those in small, motorized boats, and 95% of recreational boating deaths occur to adults or adolescents.  The majority of boat-related drowning victims were not wearing personal flotation devices (PFDs), also known as life vests.  Although PFDs are thought to prevent drowning, their observed use among adult boaters is low, ranging from about 13% - 25% in recent observational studies. To date, drowning prevention programs have infrequently targeted adults and little is known about why adult boaters do not use PFDs.  There is some evidence that issues related to comfort, and a perception of low risk while boating, may be partly responsible. A fuller knowledge of barriers to PFD use among adults is important in designing targeted interventions for this group.  With a goal of identifying barriers to PFD use by adult boaters, investigators propose to:

  1. Conduct an analysis using existing U.S. Coast Guard data of PFD efficacy.  To date, this has not been demonstrated.  Demonstration of efficacy may address one potential barrier to use.
  2. Conduct focus groups with adult anglers and recreational boaters to identify barriers to PFD use and receptivity to possible future intervention approaches.
  3. Conduct a cross-sectional survey to examine factors associated with PFD use among adult boaters. These will be conducted concurrently with observations of PFD use to obtain more representative prevalence measures for adults.
  4. Work closely with identified community partners currently involved in drowning prevention programs. This work will establish a basis for future collaborative intervention studies.

 

Side Airbags and Children
Investigator: Allan Tencer, P.h.D.
Funding: Centers for Disease Control and Prevention
8/1/08 – 7/31/09

The side impact air bag is a recent safety innovation now appearing in numerous vehicles, but the design is unregulated and children are common rear seat passengers. Yet serious and/or fatal neck and chest injuries may occur in out-of-position occupants. Investigators created a dynamic model of door/sidewall intrusion and airbag deployment resulting from a side impact collision to provide a more realistic assessment of the interaction of the occupant with a rear seat side airbag during a simulated side impact collision. The study first consisted of epidemiological review of NASS-CDS data to determine demographics and risk factors for school age children in side impacts in vehicles with side airbags. Following this, modeling was performed using MADYMO, and the model was verified using a pendulum side impact apparatus, onto which a vehicle door with a side airbag has been mounted impacting a 6 year-old hybrid III impact dummy. Head and neck injury parameters were determined for out-of position, booster, and non-booster seated occupants sitting on the near side with a deployed airbag. Based on observation and measurements of head and neck injury mechanisms, seated positions for child occupants with the least risk of injury are identified.

 

Children and Window Falls
Investigator: Brian Johnston, M.D., M.P.H.
Funding: Centers for Disease Control and Prevention
4/1/09 – 11/30/09

The goal of this project is to test procedures for case identification, subject enrollment, and environmental data collection needed to conduct a case-control study of risk factors for window falls among children 0-9 years old. This is a pilot project that will take place at a single study center. It is expected that 40 cases and 40 controls will be enrolled in the study. Participation in the study lasts from the time of enrollment until the end of the home visit as described in study procedures. The specific aims include:

  • Develop detailed scripts, recruitment strategies, home inspection protocols and alternative data collection methods for use in a case-control study
  • Pilot procedures to identify, contact and enroll eligible case households
  • Pilot procedures to identify, contact and enroll eligible control households
  • To estimate study refusal rates and, among participants, the prevalence of specific risk factors and potential confounding factors in case and control households
  • To use the information above to plan a population-based case-control study to determine important risk factors for falls of children from windows.

 

Injury Prevention in the Pacific Northwest
Investigator: Beth Ebel, M.D., M.P.H., M.Sc.
Funding: National Highway Transportation and Safety Administration
9/30/06 – 9/29/11

The mission of the National Highway Traffic Safety Administration (NHTSA) is to reduce traffic injuries and deaths that result from motor vehicle crashes. To achieve this, NHTSA and policy makers seek to work from data-driven policies, resulting in informed outreach efforts for priority traffic injury prevention and control programs. The Injury Prevention in the Pacific Northwest Region grant is a five-year training program that supports a graduate student with experience in epidemiology and injury prevention in collaborative work with NHTSA colleagues to achieve develop new and traditional partnerships, generate data to guide important policy targets of real-world importance to state governments, and develop new strategies to address the human factors that contribute to motor vehicle crash deaths and injury.

 

Child Safety Seat Intervention for Pacific Northwest Tribes
Investigator: Beth Ebel, M.D., M.P.H., M.Sc.
Funding: National Institutes of Health
5/28/08 – 1/31/13

Motor vehicle crashes are the leading cause of death for American Indian (AI) children. Proper use of age-appropriate child restraint systems can substantially reduce the number of fatal injuries.  However, many children still ride completely unrestrained or improperly restrained when traveling in a vehicle. In a recent vehicle observation study of six Northwestern U.S. tribes, the majority of AI children age 8 or under rode unrestrained (41%) or were improperly restrained (30%). While adult drivers in these tribes were commonly unaware of laws regarding vehicle restraints for children, they were receptive to receiving more information and training on proper use of child safety seats. Tribes in the Northwest have prioritized injury prevention, in particular, reducing morbidity and mortality from motor vehicles crashes among their membership.

Using a community-based participatory research model, a research team from Public Health and Preventive Medicine at Oregon Health & Science University, Northwest Portland Area Indian Health Board, Aberdeen Area Tribal Chairmen’s Health Board and the Harborview Injury Prevention and Research Center  propose to plan, implement, and evaluate child safety interventions in six Northwestern tribal communities in a case-crossover design. They will share their expertise in qualitative interviews and focus groups with colleagues at NWPAIHB to assist them in determining barriers to appropriate restraint use. They will work with tribes to design and carry out culturally appropriate interventions, and will help NWPAIHB (what is this?) colleagues to design and plan observational vehicle surveys pre- and post-intervention.

 

Strengthening Injury Control Research in Ghana
Investigator: Beth Ebel, M.D., M.P.H., M.Sc.
Funding: National Institutes of Health
5/1/05 – 2/28/10

The parent grant for this proposal is the CDC core grant for the Harborview Injury Prevention and Research Center at the University of Washington.  The goal of this proposal is to develop a model program to strengthen the training and research capacity for injury control in Ghana.  The program will educate a group of scientists in cutting-edge research methods and training techniques.  This will facilitate the development of successful and sustainable research and training activities across the spectrum of injury control, including surveillance, prevention, and treatment. This effort will build upon a decade-long collaboration on injury research between the Kwame Nkrumah University of Science and Technology in Kumasi and the University of Washington. The aims of this program are:

  1. Provide training through three short courses in Ghana, and short, intermediate, and long-term degree training at the University of Washington for 12 qualified Ghanaian scientists and professionals on methods for injury research and implementation of effective injury control programs. 
  2. Support the development of rigorous research on priority injury-related health problems, the findings of which will be instrumental in strengthening the policies and practice of injury control in Ghana. 
  3. Assist Ghanaian scientists and professionals to participate in international injury research and develop research structures and training programs to further the goals of reducing injury morbidity and mortality in Ghana and other African nations.   

 

Disability from Pediatric Traumatic Brain Injury
Investigator: Frederick  Rivara, M.D., M.P.H.
Funding: Centers for Disease Control and Prevention
9/1/06 – 8/31/11

Population-based studies have estimated the incidence of traumatic brain injury (TBI) in children but have not provided population-based estimates of subsequent disability.  This information is important for the appropriate planning and delivery of services to children disabled by TBI. The objectives of this study will be to:

  1. Determine the incidence of mild, moderate, and severe TBI in children and adolescents 0-18 years of age
  2. Determine the disability from different severities of TBI in children of different age groups
  3. Determine how this disability changes over time after injury
  4. Identify risk and protective factors for disability from TBI.

In this project, investigators will conduct a population-based surveillance of children and adolescents with TBI.  From this they will identify a sample of pediatric patients with TBI who will be recruited and enrolled in the study.  This sample will be stratified by severity and age to allow adequate numbers of individuals at each severity level and each age group for study.  Initial and baseline measurements will be obtained, and patients will be followed over time to determine outcomes from TBI. Subjects will be identified in emergency departments, hospitals and medical examiners in King County, Washington, and Philadelphia County, Pennsylvania.

This study will address many of these unanswered questions surrounding pediatric TBI.  It will provide population-based rates of the incidence and disability from TBI, including mild, moderate and severe based on medical record and interview data. It will follow patients and their families for three years after injury, examining the degree to which recovery plateaus in the months following TBI. It will examine factors which interact with the injury to produce disability, be they positive or negative influences on outcomes..

 

Coalition to Prevent Gun Violence
Investigator: Frederick Rivara, M.D., M.P.H.
Funding: Joyce Foundation
10/1/08 – 9/30/09

The Harborview Injury Prevention and Research Center and the City of Seattle have teamed to build a statewide coalition to prevent gun violence in Washington State. An evidence-based approach providing specific prevention strategies and policies can bring about change and improve the public’s health. Investigators would like to take this same model and apply it to lessen the gun violence problem in the state. They will use specific approaches to focus on research, collection of data, support of specific legislation at the state level to decrease violence, working at the regional and national levels to share information, and advocacy for a public health approach to this issue. Investigators intend to develop baseline polling information that will enable the coalition to convince both policy makers and potential funders of the importance of this issue.

 

Genetics Recovery from TBI
Investigator: Frederick Rivara, M.D., M.P.H.
Funding: Institute of Translational Health Sciences
12/22/08 – 5/31/09

There is wide variation in the recovery from and disability following traumatic brain injury (TBI) occurring to children and adolescents. The reasons for this variation are not completely explained by the nature and severity of the TBI. The goal of this study is to explore correlations of the presence of alleles of specific candidate genes with variations in disability after TBI in children and adolescents. The specific aim of the pilot study is to explore the association of disability in children after moderate and severe TBI with the genotype of specific candidate genes associated with neurological function. Disability for this analysis will be defined using the 12, 24 and 36 month post-TBI parent reported scores on the Pediatric Quality of Life scale (PedsQL).

 

PURPLE Project for Prevention and Education of Shaken Baby Syndrome
Investigator: Frederick Rivara, M.D., M.P.H.
Funding: Center for Children and Families
7/1/09 – 6/30/10

The Period of PURPLE Crying program is designed to educate families of newborns about infant crying, especially inconsolable infant crying, and to provide the means to cope with it.  Prior studies indicate that frustration with crying is probably the most common precipitant of shaken baby syndrome, a form of child abuse in young infants. The Period of PURPLE Crying program was developed to “normalize” infant crying to parents and provides tools to cope with it.  Our recent studies indicate that this program improves knowledge about infant crying, increases sharing of this information with caretakers and has the potential to have a significant impact on the problem of child abuse.