Journal of Primary Prevention最新文献

Hepatitis C virus (HCV) infection is a public health issue that claims the lives of 350,000 individuals globally every year. Primary care providers are increasingly prescribing HCV medications with more modern, simplified administrations. Individuals with HCV are disproportionately affected by behavioral health challenges and substance use disorders. Integrated behavioral health providers can work in concert with their patients' primary care teams to provide innovative treatment programs to help support the needs of HCV care. We used simple and multivariable logistic regression to determine the association between receipt of behavioral health consultation and two outcomes on the care continuum: insurance approval for treatment and initiated HCV treatment regimen. These models were fitted using theoretically hypothesized variables and multivariable regression models included age, sex, and race/ethnicity as potential confounders. From January 2015 to May 2017, 189 patients at health centers were referred for onsite HCV primary care treatment. Of these, 142 were approved for participation, and 132 started treatment. Simple regression revealed a significant association between behavioral health consultation and treatment approval; however, behavioral health consultation was non-significant in the multivariable model for treatment approval. For initiating HCV treatment, onsite behavioral health consultation was significantly associated in both the unadjusted and adjusted regression models. Integrating behavioral health services for patients seeking HCV treatment may improve movement across the care continuum, optimizing patient's HCV health outcomes. Behavioral health consultation in primary care settings should be studied further to improve HCV treatment outcomes for patients with behavioral health and substance use disorders.

Residential relocation (RR) is associated with behavior problems and cognitive delays in school-age children. Little is known regarding effects of RR on early childhood development. The data from this study were collected from 2011 to 2016 through the Cincinnati Home Injury Prevention and Literacy Promotion Trial. The purpose of the current study was to identify factors associated with RR and determine effects of RR on early childhood development in a cohort of mother/child dyads (n = 424). High RR was relocating ≥ 3 times over the 24-month study period. Differences in baseline characteristics and early childhood development, measured by the Ages and Stages Questionnaire (ASQ) and MacArthur Bates Communicative Development Inventory, according to relocations, were estimated by negative binomial regression and logistic regression, respectively. Participants moved on average 1.46 times over 24 months. Relocations decreased by 0.05 for each year of increasing maternal age. Mothers with college degrees moved 0.72 fewer times than those with a high school diploma or less. Mothers living alone moved 0.47 fewer times than their counterparts. Mothers who could not count on someone to loan them $1000 and those with food insecurity more (0.41) than their counterparts (0.50). Odds of scoring in the bottom-tertile for the communication domain of the ASQ was significantly higher in those relocating ≥ 3 times. High RR was associated with concern for delayed language development at 24-month follow-up in some, but not all models. Early intervention may be more successful if primary care physicians and community health professionals collaborate to link families at risk of high RR to relevant community based resources.

The Journal of Primary Prevention is dedicating this special issue to the topic of gun violence and the detrimental effects it has on communities. The papers represent original research articles providing scientific evidence on the unintended consequences of gun violence and exposure to such violence in neighborhoods and communities. These papers also take seriously the role of theory in our understanding of gun violence. Funding for gun violence research is experiencing a resurgence, and these papers substantively contribute to that narrative.

Although researchers have found support for a relationship between temperature and violence and evidence of temporal patterns in violent crime, research on homicide shows less consistent results and no research on mass murder has been conducted. We address this by examining predictive factors in multi-victim shootings (those with four or more victims, including injured), a more general crime category than mass murder, but one with likely similar predictive factors. We used data from the Gun Violence Archive to understand the relationship between multi-victim shootings and temperature as well as other extrinsic factors. To avoid the confound between season and temperature, we employed temperature anomaly (the difference between actual and expected temperature) as a predictor of daily shooting rate. Using a generalized linear model for the daily count of multi-victim shootings in the U.S., we found that these events are significantly more frequent on weekends, some major holidays, hotter seasons, and when the temperature is higher than usual. Like other crimes, rates of multi-victim shooting vary systematically.

With a reduction in primary barriers to healthcare access as a result of the Affordable Care Act, there is an increased need to address secondary barriers faced by low-income young Black male survivors of violent injury. While transportation is often characterized as a barrier for individuals with chronic disease and disability, it also acts as a significant barrier in accessing cognitive behavioral therapy and mentoring services through hospital-based violence intervention programs (HVIPs). These services address the traumatic stress associated with surviving gun violence. Although there are many challenges associated with the current practices of non-emergency medical transportation, participants in HVIPs face additional risk factors. We highlight the application of a digital transportation intervention to increase the use of psychosocial services among low-income young Black male survivors of violent injury participating in an HVIP. Digital non-emergency medical transportation services (DNEMT) address issues concerning financial barriers, personal safety, program credibility, and program participation. We conducted qualitative interviews and a focus group with this population to assess the impact of Uber Health, a DNEMT service, on their participation in an HVIP located in a suburban Maryland hospital immediately outside of Washington, D.C. Survivors identified the use of Uber Health as essential to addressing the multifaceted and interconnected barriers to treatment. These barriers included reluctance to use alternative forms of transportation services (i.e., bus or subway) due to potential encounters with rivals, increased risk of repeat violent victimization, the need to carry a weapon for protection, stigmatization, and symptoms associated with traumatic stress. We found that integrating digital transportation services into the standard practices of HVIPs, as a part of a patient-centered outcomes framework, contributes to a reduction in violent injury and re-traumatization by addressing the multi-layered risks experienced by survivors of gun violence.

Although gun control laws are intended to reduce exposure to gun violence in communities across the country, the passage of gun control laws is often linked to a substantial rise in the number of guns sold in the U.S. National polls indicate that most individuals purchase firearms for protection, but some cite the fear of gun-buying restrictions as the main reason for purchasing a gun. It is unclear what impact gun legislation has on patterns of gun sales, as mass shootings continue to bring the U.S. gun debate to the forefront. Using statewide data on gun transactions in Massachusetts from 2006 to 2016, we examined patterns in gun sales following the passage of gun legislation and high profile mass shootings. Specifically, we used three events to test and refine the argument during this time period: (1) the Newtown shooting, (2) the San Bernardino shooting, and (3) the passage of the 2014 Massachusetts Gun Violence Reduction Act. Results from these time-series analyses indicated different patterns in handgun sales, with significantly larger increases occurring among first-time handgun buyers. Our findings complement prior work explaining the impact of mass shootings and gun control laws on the exposure to guns in communities.

In this study, I document how members of the public perceive active shooter risk in their communities and their perceptions of the effectiveness of common efforts to prevent and respond to active shooters. I further investigate how news media exposure shapes these perceptions. I applied Protection Motivation Theory (PMT) to explore how perceptions and news media exposure might shape self-protective actions taken by individuals and their households. Data were obtained in 2019 from a cross-sectional, state-representative sample of 668 Pennsylvania adults who completed a web survey. Those who perceived higher community active shooter risk and those who felt community prevention and preparation efforts were effective were more likely to take self-protective steps themselves. Increased news exposure through apps, social media, family and friends was associated with increased perceived risk and effectiveness of prevention and preparation strategies. These results suggest that self-selected news and news through personal ties are linked to active shooter perceptions while other news mediums, like television or radio broadcasts, are not. News exposure was largely unrelated to self-protection. Those who felt community efforts were effective in prevention or preparation, however, were more likely to take self-protective actions. This finding indicates that community efforts may be more influential than news media in directing personal behavior.

Although there is a plethora of research documenting the relationship between firearms and violence, we know little about the influence of offenders' motivation and premeditation as they relate to the choice of weapon for the commission of a violent crime. In this study, we examined a sample of 375 violent crime inmates incarcerated in the New Jersey Department of Corrections. We addressed two research questions: what variables influence the use of a firearm in a violent crime, and do premeditation and motivation increase the odds that an offender will use a firearm in a violent crime? We found that premeditation and motivation are robust covariates of firearm use, which aligns with Rational Choice Theory; this suggests that firearms are used as tools to gain compliance and facilitate the commission of a crime. As a result, prevention strategies that focus on restricting access to firearms to at-risk populations and those that focus on interrupting the cycle of violence may help reduce firearm-related violence, particularly in premeditated events.

Sexual and dating violence (SDV) are growing public health problems in the United States. Prevention programs have sought to engage potential bystanders so they can safely and effectively intervene in situations involving SDV. However, the ability of these programs to prepare bystanders may be limited if they do not address the possible outcomes of their actions. Few studies have examined positive and negative consequences of bystander action, and only one has examined how various types of action impact these consequences. The purpose of our study was to explore how specific types of bystander actions and their number of actions were related to positive and negative consequences. We recruited participants (N = 615) through Amazon's Mechanical Turk and a university subject pool, all of whom were between the ages of 18 and 24. Participants described the type of action they took in response to risk for SDV (i.e., harassing comments, dating violence, unwanted sexual advances, and controlling behavior). We performed a content analysis on participants' written responses about the type of action taken. New measures of bystander consequences were used to examine bystander feelings and reactions of others (e.g., the victim, perpetrator). A range of action types were identified (i.e., direct, distract, distance, delegate, and physical action). Of note, direct action toward the perpetrator was related to more negative feelings and responses, whereas distract and distance action were associated with more positive feelings and responses from others. Further, taking multiple actions (as opposed to a single one) was related to more positive feelings and responses from others. Implications for research and practice are discussed, with a specific focus on prevention programming.

The safe disposal of unused medications is one primary prevention strategy to reduce nonmedical prescription drug use among adolescents. We sought to identify modifiable risk factors associated with disposal of unused prescription drugs by parents of adolescents residing in ten south central Kentucky counties with disposal programs. In the fall of 2017, 4148 parents of adolescents participated in an anonymous, paper-based survey. We conducted generalized logit mixed models adjusted for within-school clustering to assess the relationship between disposal behaviors and modifiable risk factors while controlling for respondents' sociodemographic characteristics. The analytic sample consisted of parents in households in which someone had been prescribed an opioid medication within the past 12 months (N = 627). Our findings indicated that almost 42% of parents reported disposing of unused prescription medication within the past 12 months, and the majority disposed of medications at home rather than using a disposal program. Parents who perceived that any, compared to none, of their child's close friends engaged in nonmedical prescription opioid use had higher odds of reporting use of a disposal program. Parents who were aware of disposal programs, compared to those who were not aware, had greater odds of using them, rather than not disposing at all or disposing unused prescription medications at home. Compared to parents who perceived prescription drugs to be hard for adolescents to obtain for nonmedical use, parents who believed that prescription drugs were easily accessible to adolescents for nonmedical use had lower odds of using disposal programs than disposing of medications at home. Collectively, our findings suggest that enhancing awareness of disposal programs, while addressing parents' perceptions of their children's peers' use of nonmedical prescription opioids, should be considered to facilitate the disposal of unused medications and optimize current public health prevention efforts related to adolescent nonmedical use of these drugs.