The goal of the CIEPAC research core is to establish academic excellence in the areas of injury-related policy evaluation, translational research, and research methods. To achieve our goals, CIEPAC investigators are conducting cutting-edge studies on the causes and outcomes of injuries and using multifaceted approaches to reduce the occurrence and mitigate the consequences of injuries. Our research projects address falls in older adults by translating efficacious prevention programs to local communities, the cost-effectiveness of federally funded safe-routes-to-school programs in reducing child pedestrian injuries, and the impact of state medical marijuana laws on drug involvement in fatal motor vehicle crashes. Dr. Charles DiMaggio directs the Center’s Research Core Programs, which consists of two initiatives: Small Research Projects and Exploratory Research Projects.
Small Research Projects
The small research projects will advance injury prevention and control in areas of translation, policy, and methods. There are three independent small projects; each is under the direction of a principal investigator who is a core faculty member of CIEPAC.
Translating a Falls Program to Inner-City Seniors Using a Transportation Program
Principal Investigator: Thelma Mielenz, PhD, Assistant Professor of Epidemiology
Falls and related injuries are a leading cause of morbidity, mortality, economic impacts, and institutionalization among older adults. This project, referred to as “Translating a Falls Program to Inner-City Seniors Using a Transportation Program”, will translate an evidence-based cognitive behavioral falls prevention program to seniors who use a transportation program that provides free door-through-door travel with support from trained mobility facilitators. The falls prevention program, A Matter of Balance/Volunteer Lay Leader model (AMOB/VLL), has demonstrated success in increasing falls efficacy by helping participants see that falls are preventable (e.g., by decreasing hazards in their home). The AMOB/VLL program will be offered in combination with the Coordinated Older-Adult Senior Transportation Services with Mobility Facilitators (COASTS/MF) at a senior center in Washington Heights, New York City.
Impact of the National Safe-Routes-to-School Programs on Pediatric Pedestrian Injuries
Principal Investigator: Charles DiMaggio, PhD, MPH, PA-C, Associate Professor of Anesthesiology and Epidemiology
Pedestrian injury continues to rank among the most important causes of childhood morbidity and mortality. In 2005 the US Congress allocated $612 million for a national Safe Routes to School (SRTS) program to encourage walking and bicycling to schools. While a number of studies have looked at programmatic aspects of SRTS programs and evaluated their impact on children’s physical activity, little is known about the eﬀectiveness of SRTS programs in reducing pedestrian injury risk in school-age children. Building on a prior study of SRTS in New York City, CIEPAC investigators Drs. Charles DiMaggio, Guohua Li and Peter Muennig will evaluate national SRTS efforts to see if they decrease the risk of injury occurrence and severity, and whether SRTS is a cost-effective and worthwhile investment to prevent pediatric pedestrian injury. The evaluation of this large-scale national injury control and prevention initiative will result in the wider dissemination of the best available evidence on cost-effective changes to the built environment to prevent child pedestrian injuries, and the translation of a set of epidemiological tools that communities can use to evaluate their own efforts. The study is responsive to the National Center for Injury Prevention and Control (NCIPC) research priority of preventing motor vehicle injuries and is consistent with NCIPC criteria of addressing severe, high-cost injuries for which potential solutions are available.
Medical Marijuana Laws and Fatal Motor Vehicle Crashes
Principal Investigator: Guohua Li, MD, DrPH, M. Finster Professor of Anesthesiology and Epidemiology
Motor vehicle crashes are the leading cause of injury mortality, claiming about 40,000 lives each year in the United States. While alcohol-related crashes have decreased in recent years, drug-impaired driving has become a major safety concern. About 28% of fatally injured drivers test positive for non-alcohol drugs, with marijuana being the most commonly detected substance. Given the increasing permissibility and availability of marijuana for medical and recreational use, the prevalence of drug-impaired driving may continue to rise. The proposed project aims to assess the impact of state medical marijuana laws on drug involvement in fatal motor vehicle crashes. Investigators will examine the trends and epidemiologic patterns of drug involvement in motor vehicle crashes, and test the hypothesis that implementation of state medical marijuana laws is associated with a significantly increased risk of drug involvement in fatal motor vehicle crashes. This project will provide valuable data for understanding the health consequences of state medical marijuana laws and for facilitating policy development to improve traffic safety.
Exploratory Research Projects
The exploratory research projects funds short-term, preliminary research projects conducted by new researchers entering the field of injury control, and experienced injury researchers taking novel and creative approaches to existing research problems.
Exploratory research projects are chosen through a competitive peer-review process. Current and recent projects include:
Physical Functional Outcomes of Older Adult Trauma Patients Following Falls.
Patricia Ayoung-Chee, Assistant Professor, New York University School of Medicine, Department of Surgery, Division of Acute Care Surgery
Thelma Mielenz, Assistant Professor, Columbia University, Department of Epidemiology
According to the CDC, one in three older adults fall each year and falls has become the leading cause of non-fatal and fatal injury in this population. Many older adult patients have diminished post-injury physical function after a traumatic event, and many older adults require discharge to skilled nursing facilities or inpatient rehab after admission for a traumatic injury. The primary objective of this pilot study is to quantify the change in physical function from pre-injury to post-injury and to identify the pre-injury and treatment factors associated with improved long-term post-injury physical functioning.
Emergency Department Utilization Patterns and Subsequent Prescription Drug Overdose Death: A Cohort Study of Emergency Care Recipients, New York State, 2006-2011.
Principal Investigator: Joanne Brady, Senior Staff Associate, Department of Anesthesiology; Doctoral Candidate, Department of Epidemiology, Columbia University
The current drug overdose crisis in the United States caused the National Center for,Injury Prevention and Control to designate prevention of drug overdose as a research priority,area. In 2010, there were more than 38,000 drug overdose deaths in the United States and, 58% of these deaths involved prescription drugs. Prescription drug overdose (PDO) fatalities,exceed overdose deaths from heroin or cocaine combined, and in 29 states the annual number,of PDO deaths surpasses the annual number of motor vehicle fatalities. The overarching goal,of the proposed project is to predict and prevent fatal unintentional PDO. This goal will be,achieved through 1) the construction of a retrospective cohort study examining how emergency,department (ED) utilization and hospitalization patterns in the years preceding fatal overdose,are associated with PDO death; and 2) the creation of a clinical prediction tool to help identify,patients at high risk for fatal PDO. The results of the project will contribute to more accurately,directing preventive interventions and resources for patients most at risk for fatal PDO. Critical,to addressing the current prescription overdose epidemic are targeting preventive interventions,at the population in greatest risk.
Are Anti-bullying Policies Effective in Reducing School Bullying and Victimization?: A Pilot Project in 14 U.S. States
Mark L. Hatzenbuehler, Assistant Professor, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University
Marizen R. Ramirez, Associate Professor, Department of Occupational and Environmental Health, College of Public Health, University of Iowa
In an effort to address bullying in schools, all states in the U.S., except Montana, have passed anti-bullying statutes that include a wide range of definitions, requirements, and recommendations for schools. Despite the ubiquity of anti-bullying policies, there has been very little systematic examination of the effectiveness of anti-bullying legislation in reducing acts of bullying in schools. To address this gap in the literature, we propose a mixed-methods study, including a legal content analysis of state anti-bullying statutes in 14 states and a quantitative analysis of the 2011 Youth Risk Behavior Surveillance System in these same 14 states. Linking these two datasets, we will use hierarchical Generalized Linear Mixed Models to evaluate the extent to which the level of adherence to best practice recommendations in anti-bullying policies is associated with reductions in bullying victimization in schools. Our proposed research involves a unique collaboration between two CDC-funded injury centers and a multi-disciplinary team with expertise in psychology, law, epidemiology, and community behavioral health. Our research is in line with The National Center for Injury Prevention and Control’s youth violence research focus, specifically determining the extent to which measures aimed at improving the environments of communities effectively reduces youth violence. The findings from this pilot work will provide the foundation for a larger R01 proposal to the National Institutes of Health to examine the effectiveness of anti-bullying policies across the United States, an important public health priority.
Predictors of crash outcomes in and costs associated with rear-seated occupants of passenger vehicles involved in fatal and nonfatal collisions in New York State
Principal Investigator: Joyce Pressley, Associate Professor of Epidemiology and Health Policy and Management at Columbia University Medical Center
Although it is widely believed that riding in the rear seat of a passenger vehicle confers a safety advantage, our national study of fatal collisions suggests there is significant preventable mortality in this population. However, there are large gaps in the scientific literature regarding injury, death and costs associated with being a rear-seated passenger that hampers injury prevention for this population. This study examines the relationship between backseat seatbelt use and injury severity in NYS residents involved in both fatal and nonfatal collisions across the age span. Use of multilevel multivariable modeling is being used to characterize factors associated with backseat belt use across the age span in all of NY State, and separately in NYC and upstate residents, stratifying by hired car/taxi as feasible. Costs/charges and predictors of charges associated with fatal and nonfatal crashes is being examined by select age groups across the age span.
Pedestrian Environment Characteristics Associated with Pedestrian-Motor Vehicle Collisions in New York City
Andrew Rundle, Associate Professor
Stephen Mooney, Doctoral Student, Mailman School of Public Health Department of Epidemiology
Every year 5,000 pedestrians in the U.S. are killed by motor vehicles and orders of magnitude more are injured. To date, research to identify modifiable pedestrian environment features that place pedestrians at elevated risk of injury or death from motor vehicles has been limited by the logistical and resource barriers of conducting in-person audits to characterize street intersections. We have previously demonstrated that “virtual audits” conducted via Google Street View can efficiently capture valid data on built environments, intersection conditions, bike lanes, and pedestrian safety features. We will examine associations between built environment characteristics of intersections and pedestrian injuries in New York City using data on intersection characteristics previously collected via virtual audit. This work will be done in preparation for a large scale nationally representative location-based case-control study of the effect of built environment on pedestrian injury risk.
Exploring Motor Vehicle Injuries Involving Agricultural and Forestry Hazards in New York
Principal Investigator: Erika E. Scott, Senior Research Coordinator, New York Center for Agricultural Medicine and Health, Northeast Center for Agricultural and Occupational Health
Motor vehicle incidents involving interactions with agricultural/forestry machinery or equipment are an area of increasing concern. Past NYCAMH research identified over 50 agriculturally related roadway incidents in a 10 county region of NY (2007-2011). These incidents comprise an important segment of agriculture and forestry related traumatic injury, both fatal and non-fatal. Research suggests that speed, lighting and signage of vehicles contribute to agricultural and forestry roadway injury incidents. To better quantify agricultural and forestry related roadway incidents, NYCAMH researchers will obtain and analyze electronic records from the NYS DMV Accident Reports (MV-104) for 2008-2011. Agricultural and forestry related cases will be identified using two methods, 1) identifying agricultural and forestry related codes within variables (e.g. vehicle type-FV for farm vehicle, or make-John Deere, Case IH, etc.) and 2) using a keyword search within narrative fields. Testing methods will include converting records into spatial reference points in a Geographic Information System using the GPS coordinates and comparing these points with the location description. A summary of the results will help establish the overall quality of the available locational information, thus enabling subsequent work aimed emergency service response and prevention and farmer/driver education.
Molecular mechanisms of repetitive, mild traumatic brain injury
Principal Investigator: Barclay Morrison, Associate Professor, Columbia University Foundation School of Engineering
Clinical and experimental studies have demonstrated that a first concussion or mild traumatic brain injury (mTBI) increases vulnerability to subsequent mTBI, yet the molecular mechanisms remain unknown. We will test the hypothesis that cell death cascades temporally summate after multiple mild brain injuries and overwhelm survival pathways. By examining their time-course in detail, this research will lay the foundation for safe return-to-play guidelines and preventative therapeutics based on the molecular pathobiology of repetitive mTBI.
Balance, balance confidence, prosthetic function and falls in adults with leg amputations
Principal Investigator: Christopher Kevin Wong, Assistant Professor, Columbia University Medical Center Department of Rehabilitative and Regenerative Medicine
Falls are common among community dwelling older adults and can lead to injury and substantial medical costs. Fall incidence in people with leg amputation living within the community is even higher at 52%, and can increase to 80% per year in adults over 65. While confidence in one’s balance has been associated with falls and prosthetic function in past studies, the relationships between balance ability (measured by the Berg Balance Scale), falls, and prosthetic function remain undetermined. This study will explore the relationships among balance confidence, balance ability, falls, and prosthetic function in people with leg amputations in order to develop a pilot intervention program designed to reduce falls and injury risk.
Safe, Stable and Nurturing Relationships among children suspected of experiencing maltreatment
Principal Investigator: Shakira F Suglia, Assistant Professor, Mailman School of Public Health Department of Epidemiology
Its been widely documented that children who experience maltreatment and neglect are more likely to experience numerous health problems. The National Center for Injury Prevention and Control (NCIPC) has identified, safe, stable and nurturing relationships (SSNR) between caregivers and children as a foundation for the prevention and reduction of child maltreatment and its consequences and has set the study of SSNRs as a research priority. We propose to examine the prevalence and correlates of SSNR behaviors among children referred to the Manhattan Child Advocacy Center at Columbia University for suspicion of child maltreatment. Thus addressing the NCIPC research priority of understanding how SSNRs can prevent and mitigate the effects of child maltreatment.
Incidence and risk factors for injuries among firefighters at the Fire Department of New York (FDNY)
Principal Investigator: Denis Nash, Professor, City University of New York Hunter College School of Public Health
There are approximately 10,000 active firefighters at the Fire Department of New York (FDNY). In 2011, FDNY firefighters responded to roughly 400,000 fires. The overarching objective of this project is to characterize the incidence of and risk factors for severe work-related burn, smoke inhalation, and musculoskeletal injuries through a retrospective cohort analysis of injuries during the last decade, which excludes injuries related to the World Trade Center disaster. Since FDNY is an urban fire department well respected throughout the fire service due to its high call volume, these results should be generalized to other fire departments in urban settings. This project will be carried out by a team of investigators from FDNY, Montefiore Medical Center, the CUNY School of Public Health, and Columbia University’s Mailman School of Public Health.