UNIVERSITY OF MICHIGAN INJURY CENTER

Patrick M. Carter, MD

Overview of the UM Injury Center

U-M Injury Center was funded as a CDC ICRC in 2012. Organized into four Cores: Research, Outreach &

Translation, Training & Education, and AdministrativeAdm

inAdm

in

Adm

in

A team approach to injury prevention

Young driver safety

Prescription drug misuse

Other topics:• Suicide• Falls

Violence

Focus TopicsMultidisciplinary Engagement

Working together: Creating greater impact than any single effort.

School of Public Health

Medical School

Transportation Research Institute

Sport concussion

Campus sexual violence

And others:Social WorkEngineeringKinesiology

Nursing& more

Prescription drug misuse

Activities & projects 1 research project

Intervention study 2 pilot studies Full-day summit, 400 attendees (December 2015) Active policy work in Lansing and at CDC

Fact sheet Prescribing guidelines Working to gain access to MAPS data

Issues & Solutions Sheet

Young driver safety

Activities & projects Center research projects

Intervention Study: Testing efficacy of a Parent Guide for Coaching Teen Drivers

Policy Study: Identifying spatial and placed-based teen crash risk factors and examine changes in factors related to GDL policy implementation

5 pilot studies Issues & Solutions sheet

Violence

Activities & projects 1 research project

Translation Study: Developing a packaged safERteens intervention with booster automated text messaging for translation into clinical care Hybrid Effectiveness & Implementation trial at Hurley

Medical Center 4 pilot studies Issues & Solutions sheet Firearm safety on safe storage

New Areas of Focus

Activities & projects 5 pilot studies Full-day summit, 400

attendees (Sept 2015) Policy activity

Working to improve sideline concussion management

Educational video 2 Issues/Solutions sheets

Activities & Projects 1 pilot study Guiding campus-wide

communications campaign

Issues & Solutions sheet Expanding activity in this

area

Sports-related Concussion Campus Sexual Assault Prevention

Stimulating innovative research

Overall – 25 pilot studies to date Approx. 50% go on to external

funding $375K investment for 15 studies =

$1.1+ million in external funding > 8 grants funded

Research roundtable Support /collaboration

Injury Data Index (website) Connecting researchers with data

Online injury curriculum for graduate and medical education 11 topics; hands-on component

Bullying, advocacy, dating violence, & more

Certificate in Injury Science from U-M School of Public Health 12-13 credits w/internship or

research project

Engaging & training the next generation of injury professionals & researchers

Education pipeline

HS & undergrads --contest & UROP program

Grad students -- internships workshops, courses, tuition support

Post-doc/grad medical education -- fellowships, online learning, online curriculum

Junior faculty -- symposia, mentoring, seminars

National reach

100+

16 interns, 3 GSRAs, 25+ MPH students

5 fellows, 50+

residents

25

M-HEALTH TO DECREASE SUBSTANCE USE AND HIGH-RISK FIREARM BEHAVIORS

Patrick M. Carter, MD

NIDA K23DA039341

Firearms are the second leading cause of death among youth populations

WISQARS (2014)

94,451 Motor-Vehicle Crashes

71,240

51,204

Fatalities, 2004-2010, 14-24 years old

Mechanism of Firearm Injuries among Youth

(14-24 y/o)

Suicide

Firearm-related Injuries

Homicides/Assaults65%

Unintentional/Accidental

2%Self-

inflicted/Suicide33%%

WISQARS (2014)

Firearm Injuries among Youth

Substance Use & Firearm Behaviors

Binge Drinking and Illicit Drug Use Firearm Possession and Carriage among Adolescents

Alcohol and Drug use strongly associated with peer and partner aggression and victimization in multiple cross-section, daily, & longitudinal studies

Substance Use associated with high-risk firearm behaviors that are often associated with both peer and partner violence Carrying a weapon while intoxicated Unsafe firearm storage in home Firearm related threats & Use against others

Why? Problem-behavior clustering Acute Intoxication

Epstein-Ngo et al 2012; Epstein-Ngo et al 2012; Chermack and Blow 2002; Chermack et al 2010; Borowsky 2002; Sussman 1999; Vagi et al 2013; Rothman, McNaughton Reyes, Johnson & LaValley 2012; Stoddard 2012, Testa 2002; Testa, Quigley and Leonard 2003, Walton et al 2007, Walton et al 2009; White, Jackson & Loeber, 2009; Whiteside et al 2013; Carter 2013; Loh 2010; Cunningham 2009; Cheng 2003; Miller 1999; Miller 2002; Presley 1997; Bergstein 1996; Hemenway 1996; Diener 1979; Sheley 1994, 1995; Bailey 1997; Kngery 1996; Nelson 1996; Wintemute 2011; Casiano 2008; Rivara 1997; Bailey 1997; Branas 2011; Kellerman 1993

Why study high-risk youth in the ED?

ED’s are a critical access point for urban youth 1 in 4 urban minority youth do not have a primary

care physician Low rates of attendance at school among high-

risk youth with involvement in drug use and violence

In 2011, >900,000 youth (10-24) visited EDs due to violent injury

54% of assault-injured youth seeking ED care have past 6-month substance use

Current standard-of-care inadequate

safERteens RCT of teens (14-18 y/o) with past year h/o fighting and alcohol use SBIRT (Brief Intervention) combining motivational interviewing (MI)

and cognitive skills training (CST) 726 teens randomized into 1 of 3 arms

[CBI] vs. [TBI] vs. [EUC] 84% follow-up; 3,6, and 12 month follow-ups

Outcomes Therapist brief intervention effective decreasing peer violence (severe

aggression) up to 1 year (NNT = 8) Both therapist & CBI effective reducing alcohol consequences @ 6 months

Subsequent Cost Evaluation $70,000 to implement intervention in trauma center $17 per violence or consequence averted

Walton et al. JAMA. 2010.

K23 NIDA Grant Rationale

Single session BI utilizing MI+CBT for lower-level violence and substance use Effects modest and dissipated over time Suggests more intensive multi-session behavioral therapy may be

warranted for higher risk youth (e.g., HRFB) Barriers to multisession interventions

Transport issues, “business” hours Complex behavioral interventions increasingly being delivered

using a remote, mobile health (m-health) approach Substance use, smoking cessation, diabetes, obesity

Not previously tested for violence interventions Youth are comfortable and prefer communication using

emerging technologies (e.g., text, video chat, APPs, etc.)

K23 NIDA Grant Phase #1: Test the feasibility of APP-based daily data collection on

substance use and HRFB among high-risk youth recruited through ED Understanding cognitive factors (e.g., moods, affect, motives),

substance use, and HRFB Phase #2: Develop and Pilot test (pilot RCT) a tailored multisession m-

health intervention to decrease substance use and HRFB Remote therapy sessions = MI+CBT Smartphone APP

Facilitate therapist contact; Automated daily assessments Tailored positive health messages Deliver therapist-guided cognitive skill modules GPS guided feedback on high-risk locations & pro-social support

Outcomes: Substance Use; HRFB; Criminal Justice Outcomes

Questions

Patrick M. Carter, MD UM Injury Center Department of Emergency

Medicine University of Michigan cartpatr@med.umich.edu