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Recent Research Publications and Funding
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April 1, 2004 6:00AM
ISSUES AND PURPOSE: Using Andersen's Behavioral Model of Health Care Use, this pilot study was conducted to better understand the experiences of children with asthma as they access an urban healthcare system.
DESIGN AND METHODS: This descriptive study used a convenience sample of 34 families of pediatric asthma patients who participated in semistructured interviews and closed medical record review.
RESULTS: Only one patient reported having a written exacerbation management plan. Beliefs regarding medication addiction and side effects were frequently reported as barriers to medication adherence, and children seeking asthma care in primary care settings saw many care providers.
PRACTICE IMPLICATIONS: Exploring how expanded nursing roles can help address both family and system factors serving as barriers to health care ought to be a key priority for nursing.
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January 1, 2004 6:00AM
Objective: Because children attend school daily, school-based interventions for children with persistent asthma could provide effective disease management for inner- city asthmatic children.The Kunsberg School in Denver, Colorado, enrolls children with chronic diseases including asthma into a daily program of school-based disease management. his study sought to determine the impact of the Kunsberg program on asthma utilization. Methods: Children attending Kunsberg (n= 18) who received primary care at Denver Health were compared with a group of matched control children who also received primary care at Denver Health, but did not attend Kunsberg(n=36). Asthma-related utilization for an average of 2.9 years before and after Kunsberg enrollment was assessed.
Results: The 18 Kunsberg and 36 control subjects were mostly minority children in low-income families, without significant demographic differences between groups. Compared with controls,the Kunsberg cohort experienced fewer hospitalizations (0.5 vs. 0.9 hospitalizations/year, p=0.05), fewer emergency department (ED) visits (1.4 vs. 2.8 ED visits/year,p=0.04), and fewer follow-up visits for asthma (3.7 vs.5.0 visits/year, p=O.Ol) in the time period (mean 2.9 years; range 1-6 years) following the intervention. Hospital and clinic-based asthma utilization costs decreased 80% following enrollment in the school ($8122/year to $1588/year per child), compared to a 19% decrease in the control group. Among the Kunsberg children with hospitalizations prior to school enrollment (n=8), hospital days decreased from 3.5 days to 0.1 days annually (p<0.01), ED visits decreased from 2.1 to 0.6 visits annually(p=0.02), and follow-up visits decreased from 6.8 to 2.1 visits annually (p=0.02). As part of their school program,89% of Kunsberg enrollees received inhaled corticosteroids daily on a monitored basis while at school.
Conclusions: The Kunsberg school program improved asthma control and reduced disease severity for at-risk inner-city asthmatic children, leading to cost reduction for asthma management. Directly observed controller therapy at school can be an important component of a school-based program for children with chronic conditions.
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January 1, 2004 6:00AM
A longitudinal investigation of psychological responses to the September 11, 2001 terrorist attacks was conducted on a U.S. national probability sample. Using an anonymous Web-based survey methodology, data were collected among over 1,900 adults at 2 weeks and 12 months post-9/11 to consider whether direct and proximal exposure were necessary preconditions for high levels of acute and posttraumatic stress symptoms, and whether greater exposure/proximity led to greater traumatic stress symptoms. Results suggest that the requirement of direct and proximal exposure to the attacks and the expectation of a dose-response relationship between exposure and traumatic stress response are myths.
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January 1, 2004 6:00AM
On April 20, 1999, two angry students attacked Columbine High School. The unprecedented murder/suicide resulted in 15 deaths, more than 20 injuries, and thousands of psychologically traumatized individuals. We present a qualitative analysis of interviews conducted two weeks after the incident with 4 Columbine High School students and 7 parents who were directly and indirectly affected. Findings highlight both similarities and variability in immediate emotional, cognitive, and social responses to the mass violence. Helpful and unhelpful support attempts are noted. Implications of the media's heavy involvement in sensational traumas are discussed, emphasizing important considerations for future research on the psychological effects of school violence.
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January 1, 2004 6:00AM
Approximately 2 weeks after September 11th, adolescents from a national sample of households who were indirectly exposed to the terrorist attacks through the media completed a Web-based survey that assessed event-related acute stress symptoms. One year later, these adolescents (N = 142) and a randomly selected parent from their household completed a second survey. On average, adolescents reported mild to moderate acute stress symptoms shortly after the attacks and few trauma-related symptoms, low psychological distress and functional impairment, and moderate levels of positive affect 1 year later. After adjusting for acute stress symptoms reported after the attacks, greater parent-adolescent conflict was positively associated with adolescents' trauma symptoms, distress, and functional impairment at 1 year. Higher levels of adolescent positive affect at 1 year were associated with greater parental positive affect, greater parental support, and higher levels of parenting self-efficacy. Parents may play an important role in adolescents' responses to stressful national events.
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December 1, 2003 6:00AM
The purpose of this study was to evaluate the MORE HEALTH “Respect Not Risk” Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used to determine the effectiveness of the class in increasing student knowledge about firearm safety. The results revealed a significant increase in the mean scores on the posttest compared with the pretest. Qualitative findings showed the lesson was positively received by both students and teachers, and 65% of responding students reported discussing the lesson with family members. School nurses are encouraged to take a leading role in promoting firearm injury prevention to students.
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September 1, 2003 4:00AM
Nearly a billion dollars were made available to state health departments through federal grants in the spring of 2002 for public health emergency preparedness plans. Twenty-one states had already been participating for some years in The Robert Wood Johnson Foundation's Turning Point Initiative. This article illustrates how earlier practice and experience in developing cross-sector collaborations and institutionalizing a model of broad-based partnerships for public health decision making can increase effectiveness and efficiency in responding to a call for action around an emergency.
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June 1, 2003 4:00AM
The purpose of this research was to explore the changes in children's bicycle helmet use and motor vehicle bicycle related injuries in Hillsborough County, Florida before and after passage of the Florida's bicycle helmet law for children under the age of 16. The results show a significant increase in bicycle helmet use among children, ages 5-13, in the post-law years compared with the pre-law years. Also, there has been a significant decline in the rates of bicycle related motor vehicle injuries among children in the post-law years compared with the pre-law years. Although there have been complementary educational and outreach activities in the county to support helmet use, it appears that the greatest increase in use occurred after the passage of the helmet law. It is recommended that educational efforts continue to sustain helmet use rates and decreases in injuries.
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September 11, 2002 4:00AM
CONTEXT: The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale.
OBJECTIVE: To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11-related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time.
DESIGN, SETTING, AND PARTICIPANTS: A national probability sample of 3496 adults received a Web-based survey; 2729 individuals (78% participation rate) completed it between 9 and 23 days (75% within 9 to 14 days) after the terrorist attacks. A random sample of 1069 panelists residing outside New York, NY, were drawn from the wave 1 sample (n = 2729) and received a second survey; 933 (87% participation rate) completed it approximately 2 months following the attacks. A third survey (n = 787) was completed approximately 6 months after the attacks.
MAIN OUTCOME MEASURES: September 11-related symptoms of acute stress, posttraumatic stress, and global distress.
RESULTS: Seventeen percent of the US population outside of New York City reported symptoms of September 11-related posttraumatic stress 2 months after the attacks; 5.8% did so at 6 months. High levels of posttraumatic stress symptoms were associated with female sex (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.17-2.31), marital separation (OR, 2.55; 95% CI, 1.06-6.14), pre-September 11 physician-diagnosed depression or anxiety disorder (OR, 1.84; 95% CI, 1.33-2.56) or physical illness (OR, 0.93; 95% CI, 0.88-0.99), severity of exposure to the attacks (OR, 1.31; 95% CI, 1.11-1.55), and early disengagement from coping efforts (eg, giving up: OR, 1.68; 95% CI, 1.27-2.20; denial: OR, 1.33; 95% CI, 1.07-1.64; and self-distraction: OR, 1.31; 95% CI, 1.07-1.59). In addition to demographic and pre-September 11 health variables, global distress was associated with severity of loss due to the attacks (beta =.07; P =.008) and early coping strategies (eg, increased with denial: beta =.08; P =.005; and giving up: beta =.05; P =.04; and decreased with active coping: beta = -.08; P =.002).
CONCLUSIONS: The psychological effects of a major national trauma are not limited to those who experience it directly, and the degree of response is not predicted simply by objective measures of exposure to or loss from the trauma. Instead, use of specific coping strategies shortly after an event is associated with symptoms over time. In particular, disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months after a trauma.
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September 11, 2002 4:00AM
Context The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale.
Objective To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11–related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time.
Design, Setting, and Participants A national probability sample of 3496 adults received a Web-based survey; 2729 individuals (78% participation rate) completed it between 9 and 23 days (75% within 9 to 14 days) after the terrorist attacks. A random sample of 1069 panelists residing outside New York, NY, were drawn from the wave 1 sample (n = 2729) and received a second survey; 933 (87% participation rate) completed it approximately 2 months following the attacks. A third survey (n = 787) was completed approximately 6 months after the attacks.
Main Outcome Measures September 11–related symptoms of acute stress, posttraumatic stress, and global distress.
Results Seventeen percent of the US population outside of New York City reported symptoms of September 11–related posttraumatic stress 2 months after the attacks; 5.8% did so at 6 months. High levels of posttraumatic stress symptoms were associated with female sex (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.17-2.31), marital separation (OR, 2.55; 95% CI, 1.06-6.14), pre–September 11 physician-diagnosed depression or anxiety disorder (OR, 1.84; 95% CI, 1.33-2.56) or physical illness (OR, 0.93; 95% CI, 0.88-0.99), severity of exposure to the attacks (OR, 1.31; 95% CI, 1.11–1.55), and early disengagement from coping efforts (eg, giving up: OR, 1.68; 95% CI, 1.27-2.20; denial: OR, 1.33; 95% CI, 1.07-1.64; and self-distraction: OR, 1.31; 95% CI, 1.07-1.59). In addition to demographic and pre–September 11 health variables, global distress was associated with severity of loss due to the attacks ( = .07; P = .008) and early coping strategies (eg, increased with denial: = .08; P = .005; and giving up: = .05; P = .04; and decreased with active coping: = -.08; P = .002).
Conclusions The psychological effects of a major national trauma are not limited to those who experience it directly, and the degree of response is not predicted simply by objective measures of exposure to or loss from the trauma. Instead, use of specific coping strategies shortly after an event is associated with symptoms over time. In particular, disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months after a trauma.