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Epidemiology and Costs of Mild Traumatic Brain Injury in Non-Hospitalized Patient Populations
Evaluation Study of Beyond Blame: Challenging Violence in the Media
Helmets, Spinal Cord Injuries and Motorcycle Crashes
Needs Assessment of Emergency Preparedness and Response Activities in California Schools

The Effectiveness of Rumble Strips in Reducing Motor Vehicle Crashes on Rural Highways and Freeways

Epidemiology and Costs of Mild Traumatic Brain Injury in Non-Hospitalized Patient Populations

Jess Kraus, MPH, PhD
Federico Vaca, MD, MPH
Paul Hsu, MPH, PhD

While the negative consequences of traumatic brain injuries have been well-documented, growing evidence suggests that mild traumatic brain injuries (MTBI) also lead to negative outcomes. Often called concussions, mild head injuries, minor head trauma, etc., are a very common neurologic disorder and occur when there is a sudden jolt or blow to the head, resulting in temporary confusion or disorientation, possible transient memory loss, and even momentary loss of consciousness. Generally, the affected person will seek care at an emergency department (ED) and then be discharged. About one in four do not receive any medical attention. Furthermore, according to CDC reports to congress, the number of MTBI cases seen in emergency rooms has almost doubled between 1991 and 1996, while hospitalizations have dropped by more than half between 1980 and 1994, implying that total non-hospitalized cases of mild traumatic brain injuries are substantially increasing. Longer-term outcomes including depression, personality changes and/or mood disorders, problems sleeping, and alcohol/substance abuse have all been noted in the literature.

This longitudinal study seeks to examine the incidence, costs, and consequences of those suffering a mild traumatic brain injury and who were not subsequently hospitalized. Participants were enrolled through the emergency departments or trauma centers of five Southern California hospitals, located in three different counties, and received follow-up interviews at three and six months. At the same time, a “control” group of other injuries were also enrolled and followed to ensure that any outcomes were as a result of the brain injury and not simply any injury, etc. The results of this research will further clarify the epidemiology of this type of injury and perhaps lead to practical, clinical guidelines in the future. Publications are being prepared and the study results will be available soon.

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Evaluation Study of Beyond Blame: Challenging Violence in the Media

Teri Webb PhD
Lucille Jenkins MPH

The goal of this study is to assess whether or not a comprehensive media literacy intervention mitigates the negative effects of exposure to media violence and reduces the risk for aggression and violence among middle school children. To achieve this goal a multiphase evaluation study of the violence-prevention media literacy curriculum entitled, Beyond Blame: Challenging Violence in the Media is currently underway. The Center for Media Literacy developed this curriculum in 1995 and is partnering with the SCIPRC in all phases of this study. For more information about the Center for Media Literacy, visit their website at www.medialiteracy.org.

The pilot intervention was implemented in two middle schools in Los Angeles, a K-8 school in Orange County, and a seventh-grade school in the San Fernando Valley during the 2005-2006 school year. The study included six intervention classrooms (N=245) and one control classroom (N=16). The results of the pilot study look promising as a majority of the intervention students (90.2%) reported an increase in pre-to post-test knowledge scores compared to only 18.8% of control students.

Due to the fact that the curriculum materials were dated and the discipline of media literacy has evolved significantly over the last decade, we revised the curriculum. Currently, Beyond Blame is made up of 10 lessons organized around the five core concepts and key questions of media literacy, which are engaged to interrogate contemporary representations of violence on television, in movies, music and video games.

The impact evaluation will involve school districts in the San Gabriel and San Fernando Valleys, Los Angeles Unified and the Archdiocese of Los Angeles, and be implemented during the winter semester 2007. The specific aims of this phase of the study are to implement Beyond Blame on a large scale (N=1125) employing a quasi-experimental research design to assess the effects of the curriculum on middle school students. In schools predominately serving minority students, the study will compare classrooms led by intervention teachers to those led by control teachers. Outcome measures will be assessed by questionnaires administered one week before the intervention (pretest), one-week immediately after the intervention (posttest), and at two follow-up periods for each group. Pre- and post-test outcome measures will cover knowledge, attitudes, beliefs, behaviors and critical thinking skills.

Concurrent with the impact evaluation, a process evaluation will be conducted to assess issues such as coverage, integrity, delivery and utilization of the program intervention. The goal of the process evaluation is to ascertain as much information as possible about how the curriculum is being implemented to help to account for individual and classroom variability in outcome measures. Thus research questions addressed here include: How much of the 10-lesson curriculum do the teachers actually teach in their classrooms, how many students are engaged in the learning process, how well do teachers deliver the lesson plans to their students, and, overall, how satisfied are teachers and students with the curriculum?

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Helmets, Spinal Cord Injuries and Motorcycle Crashes

Jess Kraus
A.A. Afifi
Leanne Streja

One argument used by anti-helmet groups is that wearing helmets increases cervical spinal cord injuries because of the added weight to the head and neck. The objective of this study was to determine the estimated risk of total and cervical spinal cord injury associated with helmet use in motorcycle crashes. Using the National Trauma Database of 14,500 relevant hospitalizations, odds ratios of spinal cord injury with and without helmet use were derived. Helmets were found to be cervical spinal cord injury sparing and this finding persisted after controlling for age, alcohol use, gender and type of vehicle crash. Publications are being prepared and the study results will be available soon.

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Needs Assessment of Emergency Preparedness and Response Activities in California Schools

Linda B. Bourque PhD
Megumi Kano DrPH

Schools are not immune to the natural, technological and human-induced hazards that pose threats to the health and safety of the population at large. School emergency preparedness is essential to prevent and minimize the impact of hazards on the school community, including children, parents, teachers, staff and the surrounding community. During 2002-2003, we conducted an exploratory study of emergency preparedness in public schools in 12 purposively selected school districts in Los Angeles County. This study is a survey assessment of emergency preparedness in a larger sample of public schools and school districts in California. Survey data are collected using mailed questionnaires and telephone follow-up. The objectives are to describe the current state of school district and school site preparedness for emergencies and disasters in California, and to identify the areas of preparedness that need further improvement.

Survey responses were collected from a total of 98 school districts and 157 school sites from throughout California. The survey respondents’ interest in this topic was high, such that about 40% of the district and school site respondents, respectively, volunteered to participate in future follow-up telephone interviews. Study results are available for download via the citation links below.

Kano, M. & Bourque, L.B. (January 2007). School Emergency Preparedness Survey Report: Improving Coordination is Vital for School Districts. Los Angeles, CA: UCLA Southern California Injury Prevention Research Center.

Kano, M. & Bourque, L.B. (March 2007). School Emergency Preparedness Survey Report: A Written Plan is a Good Start, But Only a Start. Los Angeles, CA: UCLA Southern California Injury Prevention Research Center.

Kano, M. & Bourque, L.B. (March 2007). School Emergency Preparedness Survey Report: It Takes A Village To Prepare Schools for Emergencies. Los Angeles, CA: UCLA Southern California Injury Prevention Research Center.

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The Effectiveness of Rumble Strips in Reducing Motor Vehicle Crashes on Rural Highways and Freeways

Jess Kraus, MPH, PhD (co-lead)
Federico Vaca, MD, MPH (co-lead)
Paul Hsu, MPH, PhD

A rumble strip is a band of texturing that consists of grooves that are raised or pressed into the road surface perpendicular to the direction of travel, usually applied on the shoulder or the centerline of rural roads and highways. Driving over a strip produces both a tactile vibration and an audible “rumble”, serving as a warning that a driver is leaving the travel lane or roadway. While numerous states are incorporating rumble strips into their highway engineering and construction programs, relatively little data exist to verify their effectiveness on reducing the negative consequences of inattentive and drowsy driving.

This study is in the process of assembling a multi-state database from police crash reports and state highway department records. Motor vehicle crash rates along a road segment will be compared before and after rumble strip installation. In addition, crash rates along a matching road segment with no installation will also be compared during the same time periods to account for possible confounding through policy changes, technological advances, vehicle safety improvements, etc. The results will allow state and federal policymakers to better evaluate the benefits and effectiveness of rumble strips, and enable valid cost-benefit analyses to be conducted.

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