Research Core

The objective of the CICRC Research Core is to conduct high quality research on topics of importance to injury prevention, acute care, rehabilitation, and biomechanics.

Research Projects

The CICRC has had a core of research projects that have been supported for a period of 3 to 5 years. The projects have addresses a wide range of injury topics including; drug use and risky behavior among rural youth, laboratory based research on survival of sensory and motor neurons after injury, motor vehicle mortality in rural and urban areas, rehabilitation care for individuals suffering traumatic brain injuries, risk communication for injuries, community based traumatic brain injury prevention, reduction of driving anger, laboratory based research on protective factors against brain injury, injury among disabled individuals, and development of a registry of alcohol-impaired drivers.

A description of the funded research projects for the period of 2007-2012

Click here for Research Projects

Pilot Research Grants Program

The CICRC has supported a pilot research grants program since 2001. The objective of the program is to attract new investigators to injury related research, to provide a source of funds for graduate student research projects in injury under the direction of a faculty advisor and to provide an opportunity to develop new research directions in acute care, rehabilitation, prevention, or biomechanics.

Click here for Pilot Research Projects  

Research Projects 2007-2012

Marketing Fall Prevention Classes to Older Adults in Faith-Based Congregations: Cluster Randomized Controlled Trial

Principal Investigator: Carolyn DiGuiseppi, MD, MPH, PhD
Institution: University of Colorado at Denver and Health Sciences Center
Injury Category: Prevention
Project Period: 2007-2012

Project Summary
Injuries from falls are a leading cause of emergency visits, hospitalizations, and deaths in older US adults, resulting in total lifetime costs of more than $19 billion in 2000. Fall injuries reduce independence and mobility, and increase the risk of disability and institutionalization. There is good evidence that community-based group exercise classes focusing on strength and balance prevent older adult falls, but uptake by older adults is limited. This study will test a new approach to promote participation in group balance-retraining exercise classes, using social marketing to target older adults in faith-based congregations (FBCs). The proposal addresses national research priorities to evaluate strategies for dissemination and implementation of effective interventions to prevent falls among community-dwelling older adults. Focus groups and key informant interviews will provide a research-based understanding of FBC members aged 60 and older and those who influence them, and explore facilitators and barriers to class participation. With this formative research, a targeted social marketing program, including a ‘marketing toolkit,’ will be developed to motivate participation. The Health Belief and Transtheoretical Models form the theoretical basis for the social marketing planning process and will guide program design. The marketing program aims to increase class attractiveness, usability, and uptake by reducing barriers or costs, and using incentives or other benefits to reinforce participation. Sixty-two FBCs, representing varied denominations and communities, will be randomly allocated to intervention (marketing program implementation) or control (no program) groups. Outreach to diverse FBCs will ensure that materials and strategies target potentially hard-to-reach (e.g., Hispanic, rural) populations. The trial will test whether seniors from intervention FBCs are more likely to join balance retraining classes. Factors that may mediate intervention effects will be examined. Secondary outcomes include 1) baseline fall risk among class participants, assessed by physical function tests; and 2) intensity, diffusion, message penetration and acceptability of the marketing program, and persistent facilitators and barriers to class participation, assessed with focus groups, structured interviews, and process measures. If the marketing program is proven to be effective, the methods for its development can inform the development of similar programs with other target audiences. The program itself, including the marketing toolkit, can be tested in other locales and may be widely implemented. Motivating more older adults to participate in exercise classes targeting balance and strength will help to reduce falls. Reducing falls will decrease fall injuries and their serious adverse consequences, including disability and premature death, among older adults.

Key Words: Accidental Falls; Older Adults; Social Marketing; Exercise; Accident Prevention: Randomized Controlled Trial.

Disability after Non-hospitalized Traumatic Brain Injury (TBI) in Colorado: A Population-Based Study

Principal Investigator: Gale Whiteneck, PhD, FACRM
Institution: Craig Hospital, Englewood, CO
Injury Category: Rehabilitation
Project Period: 2007-2012

Project Summary
Traumatic brain injury (TBI) is well recognized as a major public health concern based on the Centers for Disease Control and Prevention (CDC) estimates of 50,000 TBI deaths and 235,000 TBI hospitalizations in the United States annually and at least 5.3 million people currently living in the US with long-term disability resulting from TBI.1 But these estimates are derived from surveillance systems focusing on people hospitalized with TBI and they fail to capture the full extent and impact of TBI due to the much larger, less documented incidence of mild traumatic brain injury (MTBI) These milder injuries are not treated in hospital inpatient settings, but often result in the same negative outcomes that are encountered in individuals who are actually hospitalized with TBI.2-4 In fact, only one in six of the 1.4 million people CDC estimates sustain a TBI of any severity in the US annually are hospitalized. Approximately one-third of the people hospitalized with TBI have long-term disability,5 but it is unknown what percentage of the 1.1 million people sustaining “mild TBI,” who are seen in an Emergency Department and released without hospitalization each year in the US, also experience long-term disability. If even 10% of non-hospitalized TBI resulted in long-term disability, then the estimate of people with long-term disability after TBI living in the US would more than double.

To address this broader issue, the TBI Act Amendments of 20006 directed the CDC to determine how best to measure the rate at which new cases of MTBI occur (incidence) and the proportion of the U.S. population at any given time that is experiencing the effects of a MTBI (prevalence). In response, the CDC convened external experts in a MTBI Work Group which defined MTBI and recommended methodologies to determine the incidence of MTBI and the prevalence of MTBI effects.4 The goal of this proposal is to utilize one of those recommended methodologies – a general population survey – to estimate the prevalence of disabling outcomes following TBI among people with both mild and more severe injuries.

A general population survey was selected because it is the only methodology capable of identifying individuals who have survived head injuries, of any severity, regardless of whether medical care was sought, and regardless of the setting where treatment may have been received. While TBI surveillance systems document hospitalized cases in several states and, in two states, even document cases treated in Emergency Departments and released;7 there is no full enumeration of those receiving medical care for TBI in physicians’ offices and clinics, and to date there have been no attempts to develop a comprehensive listing of individuals who sustained a MTBI, but did not seek medical care. However, a self-report survey is a reasonable method to identify individuals with TBI, including the full range of severities and care paths.8

The proposed statewide survey will occur in Colorado, following the exact survey methodology as the Colorado Behavioral Risk Factor Surveillance System (BRFSS).9 The questions used to identify individuals who have had a TBI will be based on the questions used in the 1991 National Health Interview Survey Supplement,10 which was used to determine the incidence of non-hospitalized TBI in the U.S.11 The questions that will document the prevalence of functional limitations, disabilities, and persistent symptoms following TBI in the population will be based on the questions used in the 1996-1999 Colorado Traumatic Brain Injury Registry and Follow-up System (CTBIRFS),5,12 which was used to determine the prevalence of disability after hospitalization for TBI. The research team leading the proposed investigation will be the same team that designed and implemented the CTBIRFS, the first statewide, population-based outcome study of TBI.

Key Words: Traumatic Brain Injury, Disability, Outcomes  

EEG and Epileptogenesis after Traumatic Brain Injury

Principal Investigator: Lauren Christine Frey, MD
Institution: University of Colorado at Denver and Health Sciences Center
Injury Category: Injury Rehabilitation
Project Period: 2007-2009

Project Summary
Estimates of the human and economic costs of traumatic brain injury (TBI) are as high as 25 billion dollars per year in this country alone. Up to twenty to 30% of severely brain injured patients develop posttraumatic epilepsy, adding to this substantial cost. Multiple trials of antiepileptic drug (AED) prophylaxis after TBI have been unsuccessful in lowering this percentage, due in part to the fact that current clinical predictors of the occurrence of epilepsy after TBI may not be powerful enough to guide patient selection and, thus, effective targeting of AED prophylaxis.

Published data in humans suggest that the presence and evolution of focal spikes on electroencephalography (EEG) after TBI may be predictive of the subsequent development of epilepsy. Preliminary data in rodents in non-traumatic models of cerebral injury also suggest that EEG spiking patterns can be used to predict the development of epilepsy after acquired experimental cerebral injury. Using clinical features and patterns of interictal spiking on continuous EEG monitoring, we will develop and test a model to predict the occurrence of epilepsy after experimental TBI. Ultimately, the confirmation of the relationship between EEG spiking and risk of epilepsy may offer clues to the pathophysiological processes underlying epileptogenesis and could also guide the development of novel antiepileptic agents. Most importantly, however, prospective estimates of the risk of epilepsy after experimental TBI may help guide targeted interventions after human TBI to halt the development of posttraumatic epilepsy, impacting the health and well-being of many thousands of TBI survivors in the United States each year.

Key Words: Posttraumatic epilepsy, traumatic brain injury, lateral fluid percussion injury, epileptogenesis, EEG  

Evaluating Population-Based Approaches to Suicide Prevention through Systematic Reviews

Principal Investigator: Carolyn DiGuiseppi, MD, MPH, PhD
Institution: University of Colorado at Denver and Health Sciences Center
Injury Category: Prevention
Project Period: 2009-20012

Project Summary
Suicide is the most common cause of violent death in the US, and the eleventh leading cause of all deaths. The identification of biological, psychological, and socio-environmental risk factors has prompted many disciplines to develop interventions to prevent suicide. National government objectives include identifying and evaluating the effectiveness of suicide prevention programs. Comprehensive identification of studies in the field of suicide prevention is difficult because of the range of disciplines involved, the publication of many studies as government or other internal reports, and the international body of literature on suicide prevention programs. This proposal aims to comprehensively identify and disseminate controlled evaluations of suicide prevention programs, and use the identified studies to conduct two systematic reviews of suicide prevention strategies targeting the high-risk or general population. A sensitive search strategy will be systematically developed and applied to multiple databases that span disciplines relevant to suicide prevention. Results will be screened to identify controlled evaluations of suicide prevention. Unpublished and international literature will be identified by searching gray literature databases, hand-searching conference proceedings, and contacting organizations and experts. Studies identified as eligible will be transmitted to the Cochrane Injuries Group for inclusion in their specialized register and, where applicable, publication in the Cochrane Central Register of Controlled Trials. Systematic reviews of selected population-based suicide prevention strategies will be performed according to the Cochrane Collaboration's guidelines. Results will be combined quantitatively when possible. Reviews will be published in the Cochrane Library. By making a broader domain of evaluation studies publicly accessible, and by conducting systematic reviews of population-based suicide prevention strategies, this project will contribute to the available evidence base for policy makers and health and other professionals to make appropriate decisions about implementation of effective interventions. Public Health Relevance: Since many people who commit suicide never seek treatment, it is necessary to find effective interventions that target the general population. This project will search for high-quality studies of suicide prevention programs, then evaluate the studies of two population-based suicide prevention programs to determine whether they are effective. Results will help public health professionals decide which suicide prevention programs to use.

Key Words: Suicide; Suicide, Attempted; Prevention; Systematic review; Evidence-based Medicine; Meta-analysis; Information Retrieval.  

Research Projects 2001-2007

Alcohol-impaired Driving: Register of Controlled Studies 

Principal Investigator: Carolyn DiGuiseppi, PhD

Area: Prevention

Alcohol-impaired driving accounts for nearly 40% of road traffic deaths nationwide. Healthy People 2010 includes an objective to reduce deaths from alcohol-related motor vehicle crashes by one-third. It is therefore essential that effective strategies be identified for the prevention of alcohol-impaired driving. A logical first step is to find out what is already known by conducting systematic reviews of controlled evaluation studies in the prevention of alcohol-impaired driving. The main requirement for validity in systematic reviews is that all (or nearly all) relevant studies are included. However, finding all relevant studies is particularly difficult in the field of alcohol-impaired driving prevention because of the range of disciplines involved, the publication of many studies as government or other internal reports, the lack of a recognizable standard terminology for non-medical interventions, and the limited range of indexing terms that describe study methodology in non-medical databases. The aim of this project is to develop a register of controlled evaluation studies in the prevention of alcohol-impaired driving that will facilitate the conduct of systematic reviews, which will in turn inform public policy. The register will be created through searches of a broad range of bibliographic and other resources. The project will identify potentially relevant electronic databases, develop a sensitive search strategy for these databases, and use the strategy to search for relevant controlled evaluation studies. Additional unpublished studies will be identified by contacting state, national and international organizations and agencies and reviewing other sources of unpublished literature such as conference proceedings. A register of relevant studies will be built and maintained using standard bibliographic software and made publicly available through the Cochrane Injuries Group Trial Register, accessible via the Cochrane Library. The feasibility and usefulness of the register will be examined in the context of a systematic review of an intervention to reduce alcohol-impaired driving.

Populations addressed: Systematic Review, Literature Based Research  

Community Readiness and Rehabilitation Services for Individuals with Traumatic Brain Injury (TBI) in Rural Colorado and Wyoming (Completed)

Principal Investigator: Pat Sample, PhD

Area: Rehabilitation

The proposed research project is a five-year ethnographic field study examining rehabilitation services and community re-entry for individuals with TBI in rural Colorado and Wyoming. The proposed study will use the Community Readiness research model to examine the readiness of individuals with TBI (and family members), community members, and health care providers to identify, change and expand the systems of brain injury rehabilitation that are currently in place in their communities. The study will use a variety of qualitative purposive sampling techniques (e.g., key informants, snowball, and typical case sampling). The investigators will conduct interviews with community leader informants and focus groups with survivors (and family members), community members, and health care providers. Data collection will be conducted in participating communities throughout the project and will focus on two areas: 1) identifying weaknesses and strengths of the current system of care available to the community, and 2) assessing the interest and willingness of the community to support changes to improve the access to and quality or rehabilitation care for individuals with TBI. After data collection on the first community is complete, project staff will assist the community in the development of and planning for implementation of a user-friendly pilot system for accessing rehabilitation services. Eight rural counties (six in Colorado, and two in Wyoming) have been targeted for this five-year study. The study will be conducted in three levels. The first level will involve collecting data on each targeted county related to care access and community re-entry for citizens who have sustained brain injury. The second level of the study will involve working closely with one of the communities as it addresses the care access needs of its citizens who have TBI. The third level of study will involve convening and conducting focus groups in all eight counties to discuss actual or potential interventions, and determine which are or might be feasible for success in their respective communities.

Populations addressed: Rural Colorado and Wyoming Traumatic Brain Injury Survivors, Family Members and Health Care Providers 

Insulin-like growth factors (IGFs) and Brain Injury

Principal Investigator: Douglas Ishii, PhD

Area: Acute Care

A major concern of our program is injury prevention and rehabilitation. This project is focused on prevention or amelioration of permanent injury to the brain as a consequence of stroke, trauma, or disease. It is widely believed in medicine that large molecules such as proteins do not cross the blood-brain-barrier. However, it has been shown recently that subcutaneous or intravenous administration of neurotrophic IGFs can ameliorate the consequences of brain injury. For example, clinical outcome is improved by IGF administration to patients with brain trauma, and loss of function as well as neural circuitry is prevented in experimental brain injury. The mechanism is being investigated. If IGFs were taken up from the circulation into cerebrospinal fluid (CSF), the potential for clinical treatment would be greatly increased, because the risks associated with the drilling of an access hole through the skull might be avoided.

The major goal of this Project is to test the hypothesis that circulating IGF’s are taken up into CSF. The Progress Report shows that 125I-IGF-I injected into the carotid artery of rats is taken up into CSF, and migrates together with authentic 125I-IGF-I on SDS PAGE. IGF-I uptake into CSF saturates, suggesting carrier-mediated uptake. This Project will test whether 125I-IGF-II is likewise taken up into CSF, whether the sequestration of IGF to circulating IGF binding proteins is essential for uptake into CSF, and whether IGF analogs (single amino-acid substitutions) that do not bind to the type I IGF receptor can nevertheless be taken up. The result may suggest a previously unknown carrier protein. Brain injury can depress circulating IGF levels perhaps when most needed to support the brain, and the effect of transient middle cerebral artery occlusion (MCAO) on IGF gene expression in rats, half-life of administered IGF, and dose required to normalize plasma IGF levels. Such doses will be administered to measure whether treatment can reduce infarct volume and TUNEL staining following MCAO, as well as prevent loss of learning/memory and motor function. The molecular properties of the IGF uptake carrier will be studied by cross-linking it to 125I-IGF analogs, and subjecting the product to gel electrophoresis. A mobility distinct from the type I IGF receptor may show that the IGF uptake carrier is a heretofore unknown molecular entity. These data will support the emerging model that circulating IGFs normal help support that central nervous system, and has implications for diseases in which reduced plasma IGF levels are associated with encephalopathy. The combined results may help optimize conditions for IGF clinical trials to treat central nervous system injuries including focal hypoxic-ischemic stroke in Colorado and elsewhere.

Populations addressed: Animal Studies

Understanding and Treating High Anger Driving From Rural and Non-Rural Backgrounds

Principal Investigator: Jerry Deffenbacher, PhD

Area: Prevention

Angry drivers, especially young angry drivers, are a significant public health problem. They experience frequent, intense anger on the road, engage in more frequent aggressive and risky behavior, experience more moving violations, and some crash-related outcomes such as close calls and minor accidents. This proposal includes four studies addressing angry drivers. Study 1 collect information on trait driving anger, angry thoughts while driving, forms of expressing anger while driving, and rates of aggressive and risky behavior and crash-related outcomes from university students and their parents. This study furthers research on college students, provides data on an older adult sample, for cross cohort comparisons and an exploration of potential parental influence on the development of driving anger. Study 2 extends this research to a sample of community college students who are more diverse in demographics and who are commuters and drive more frequently. Study 3 is a large scale, secondary prevention trial with high anger, college student drivers. It will compare three, short-term interventions each with a different focus. Relaxation coping skills (RCS) focuses on reducing elevated emotional and physiological arousal, cognitive coping skills (CCS) on altering anger-engendering information processing, and behavioral coping skills (BCS) on developing aggression – and risk-incompatible, safer, non-impulsive ways of responding to provocations and frustrations on the road. Interventions will be compared to a no treatment control. Effects on driving anger, driving anger expression, angry cognitions, aggressive and risky behavior, and crash-related outcomes and on generalization to general anger and general anger expression will be assessed prior to intervention, immediately posttreatment, and at one-month and one-year follow-ups. Sample sizes will have sufficient power to detect absolute and relative effectiveness of interventions. Outcomes will not only provide information about effects of each intervention, but also will provide outcome information on how these intervention components might be combined. Study 4 maps high anger drivers who do not access psycho-educational interventions (i.e., high anger drivers who do not see themselves as having a problem). Information on this group will inform the development of alternative interventions. All projects assess rural background (a prime focus of the Center) as a potential moderator of effects. Such information will not only inform scientific understanding of angry drivers, but also the potential need for tailoring interventions to rural populations.

Populations addressed: Rural and Urban Colorado College Students and Parents

Research Projects 1995 - 2001

Brain Injury Prevention in Rural Populations Using the Community Readiness Model

The specific aims of the project are: 1) to use the Colorado traumatic brain injury surveillance system of data collection and analysis to monitor the magnitude and pattern of brain injuries in four counties selected to represent a range of underserved populations in rura areas with differing population densities and variable head injury rates; 2) to utilize the community readiness model in assessing the state of each community relative to the acceptance of brain injury prevention programs; 3) to develop proposals for intervention strategies targeting important external causes of head injury in each of the four study counties; and 4) to utilize focus groups comprised of interested individuals from each community to evaluate and modify the proposed intervention strategies.

Principal Investigator: Lorann Stallones, PhD

Area: Prevention

Populations addressed: High-risk populations for Traumatic Brain Injury and Health Care Providers in Colorado

Care Access and Life Outcomes Following Traumatic Brain Injury: A Multi-cultural and Gender Study

The purpose of the study was to examine the differences in care access in Colorado following brain injury related to gender, ethnicity, and urban/rural residency. 

Principal Investigator: Pat Sample, PhD, Department of Occupational Therapy, CSU

Area: Rehabilitation

Populations addressed: Truamatic Brain Injury Survivors

Culture of Rural Health Care and Rehabilitation Services for Individuals with Traumatic Brain Injury

The objectives of this three year ethnographic field study are to develop a model to understand the health and community care culture for persons with traumatic brain injury in selected counties in Colorado. An intervention plan to improve access as well as other issues related to rural health care for people with traumatic brain injuries will be developed and implemented. The study will also include a pediatric component to investigate the culture of school-based services for infants, children, and youth with traumatic brain injuries.

Principal Investigator: Pat Sample, PhD

Area: Rehabilitation

Populations addressed: Traumatic Brain Injury survivors, children and adults, rural counties in Colorado

Drug Use and Other Risky Behaviors among Rural Youth

The purpose of the study was to examine the relationship between drug and alcohol use and victimization and involvement in violence among adolescents in rural communities. 

Principal Investigator: Ruth Edwards, PhD, Tri-Ethnic Center for Prevention Research, CSU

Area: Prevention

Populations addressed: Hispanics, Native Americans, and rural adolescents.

Injury Module in the Colorado Behavioral Risk Factor Surveillance Survey (BRFSS)

The purpose of the study was to add twelve injury-related questions covering child and adult occupant restraint use, impaired driving, fire safety, domestic violence, suicidal behavior, and unsafe gun storage to the Colorado BRFSS to establish baseline data on injury-prone behaviors.

Principal Investigator: Steve Lowenstein, MD

Area: Prevention

Populations addressed: Colorado Adults

Measuring Disability, Participation, and Environmental Factors in Rural Colorado

The goals of this study are to use newly developed measures of social participation and environmental factors in a population based survey to understand how these factors interact with disability to impact the quality of life experienced by those with disabilities.

Principal Investigator: Carol Garrett, PhD, Health Statistics Section, CDPHE

Area: Prevention

Populations addressed: Colorado Residents Living in Rural and Urban Areas

Recovery from Ischemic Brain Injury

This laboratory-based study aims to determine whether the neurotrophic insulin-like growth factors (IGF-I and IGF-II) can protect against injury to the nervous system by testing the hypothesis that subcutaneous IGF administration can preserve the biochemistry of the brain in disease and prevent the secondary death of neurons following hypoxic/ischemic injury.

Principal Investigator: Douglas Ishii, PhD

Area: Acute care

Populations addressed: Animal Studies, Laboratory Based Research 

Recovery from Nerve Injury

The purpose of the study was to determine whether daily subcutaneous administration of insulin-like growth factors could support survival of sensory and motor neurons which otherwise die following nerve transection in neonatal rats.

Principal Investigator: Douglas Ishii, PhD, Department of Physiology, CSU

Area: Acute Care

Populations addressed: Animal Studies, Laboratory Based Research

Rural and Urban Preventable Injury Mortality in Colorado

The purpose of the study was to determine trauma care effectiveness comparing rural and urban counties. The hypothesis was that emergency medical services (EMS) and trauma care in significantly poorer in rural areas in Colorado than in Denver metropolitan area.

 

Principal Investigator: William Marine, MD, MPH, Department of Preventive Medicine and Biometrics, UCHSC

Area: Acute Care

Populations addressed: Rural and urban residents of Colorado involved in a motor vehicle crash.

The Reduction of Driving Anger

This study will assess the short and long-term effects of two intervention techniques on driving anger, driving anger expression, risky and aggressive driving, altercations, and other negative behaviors that increase risk of injury. Relaxation coping skills and cognitive-relaxation coping skills are the two types of intervention that will be applied.

Principal Investigator: Jerry Deffenbacher, PhD

Area: Prevention

Populations addressed: Rural and urban college students in Colorado 

Pilot Research Projects 2005-2007

Sleep Patterns and Farm Work-related Injuries among Middle School Students in China

Principal Investigator: Huiyun Xiang, MD, MPH, PhD
Institution: Center for Injury Research and Policy, Nationwide Children’s Research Institute, College of Medicine and Public Health, The Ohio State University
Injury Catgory: Prevention

Summary
China is one of the developing countries that have experienced rapid modernization and urbanization during the past two decades. As millions of male adults from rural areas in China are seeking temporary jobs in cities, females and adolescents are often left behind to take care of the agricultural work. In addition to time they spend on household chores and farm work, adolescents in China also face intense pressure at school. Also, it has been reported that Chinese children’s have more sleep problems than their U.S. counterparts. More farm activities, with accompanying inadequate or disrupted sleep, may lead to high risk of farm work-related injuries. The overarching goal of this study is to study sleep patterns and farm work-related injuries among middles school students in China. International partner: Wuhan University, The People’s Republic of China

Wife Battering, Injury, and Vietnamese Women in a Globalizing World

Principal Investigator: Lynn Kwiatkowski, PhD
Institution: Department of Anthropology, Colorado State University
Injury Catgory: Prevention

Summary
The goal of this study is to develop a more culturally specific understanding of Vietnamese women’s experiences associated with acquiring and treating injuries and other health problems derived from wife battering in Denver and Vietnam. The achievement of this goal can aid in developing improved health care and other services for battered Vietnamese women. This research project addresses the Colorado Injury Control Research Center’s (CICRC’s) priority topic area of violence, as it proposes to evaluate the health consequences of intimate partner violence, which may include sexual violence, and to learn about cultural ideologies and social norms that support intimate partner violence.

Risk Factors Associated with Severe Injury and Mortality on a Rural American Indian Reservation: 1996-2006

Principal Investigator: Tami Jollie-Trottier, PhD
Institution: Center for Health Promotion and Prevention Research, School of Medicine & Health Sciences University of North Dakota
Injury Catgory: Epidemiology

Summary
This is an epidemiological review of severe injury presentations at an Indian Health Service (IHS) agency located on the Turtle Mountain Indian Reservation in North Dakota. The purpose of this study is to examine a set of significant risk factors associated with injury-related mortality. The proposed project will serve as a preliminary study for characterizing injury patterns, which will provide vital information for a follow-up community-based prevention program.

Factors Affecting Outcome after Traumatic Brain Injury

Principal Investigator: Theresa D. Hernández, PhD
Institution: Department of Psychology, University of Colorado at Boulder
Injury Catgory: Rehabilitation

Summary
The general aim of this research is to determine whether the administration of anticonvulsant drugs following traumatic brain injury (TBI) affects neurobehavioral outcome. Results from basic science studies using animal models suggest that anticonvulsant drug-induced depression of neural activity after TBI is associated with poor outcome. At the same time, clinical studies remain less conclusive. This is likely because data from the basic science have been accumulating for over 6 decades, while the clinical science lags behind by several decades. As well, the apparent disparity between the basic and clinical findings may be due to the careful control of variables within the basic research that is not possible to control in the clinic. Pharmacological influence on recovery is an important issue because anticonvulsant drugs are administered routinely following TBI to prevent post-traumatic epilepsy, yet their administration does not prevent the eventual development of epilepsy and therefore may lead to unnecessary and potentially harmful drug exposure. Thus, clinical research is needed to determine the exact functional consequences of anticonvulsant drug administration following TBI, as well as the parameters associated with these effects. To this end, an analysis of de-identified data from the TBI Data Base Repository at University of Washington is proposed.

Validating the Violence Protection and Risk Screening Tool (VPRS) for Primary Care

Principal Investigator: Eric J Sigel, MD
Institution: The Children's Hospital, University of Colorado at Denver Health Sciences Center
Injury Catgory: Prevention

Summary
Field test and validate a screening tool that identifies youth at risk for current violence perpetration, violence victimization, and violence injury that can be utilized practically by primary care practitioners. The use of a simple, quick screening tool-the Violence Protection and Risk Screening Tool (VPRS)-in the primary care setting will identify youth currently involved and who are at high risk for violence perpetration, violence victimization and injury from violence.

Preventing Pediatric Ambulatory Injury Visits Using A Telephone-Based Intervention: A Feasibility Study

Principal Investigator: Tamara Simon, MD & Patricia Braun, MD
Institution: Colorado Health Outcomes, University of Colorado at Denver Health Sciences Center
Injury Catgory: Prevention

Summary
This goal of this proposal is to develop tools for a telephone-based intervention for effective delivery of injury prevention education to parents of children born at Denver Health Medical Center (DHMC), a population that is predominantly Latino and of low socioeconomic status. The tools derived from this feasibility study will then be used to pilot a larger intervention to improve delivery of injury prevention counseling and test its impact on ambulatory injury visits.

Pilot Research Projects 2004 - 2005

Prevention of falls in Community-Dwelling Older Adults through Environmental Change and Education.

Principal Investigator: David Greens, PhD, OTR
Institution: Department of Occupational Therapy, Colorado State University
Classification: Prevention
Purpose: The purpose of this study is to test an intervention to reduce falls in community-dwelling older adults. The intervention emphasizes evaluation of the physical environment to identify both obvious and situational environmental hazards in older adults homes through multifaceted environmental assessment by occupational therapy student interns supervised by a registered occupational therapist (OTR).

Epilepsy after TBI in the Elderly.

Principal Investigator: Lauren Frey, MD
Institution: Departments of Neurology and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center
Classification: Rehabilitation
Purpose: The specific aims are as follows: 1) Describe the clinical syndrome of posttraumatic epilepsy in the elderly, 2) Determine the likelihood of systematic or neurological toxicity related to anti epileptic medication use in elderly patients with posttraumatic epilepsy. 3) Develop a model to predict the occurrence of clinical depression in elderly patience with new –onset epilepsy and determine the predictive value of epilepsy etiology for this model, 4) Determined the value of seizure etiology (such as TBI) in predicting seizure remission or a significant reduction in seizure frequency in elderly patients with new onset epilepsy.

The Moderating Effects of Sensation –Seeking and Self-Esteem on the Relationship Between Substance Use and Violent Behavior Among Rural Middle School Students.

Principal Investigator: Randell Swaim, PhD
Institution: Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University
Classification: Prevention
Purpose: The study will examine the relationship between substance use and violence among youth. The study will use secondary data analysis of data from a study that investigated the efficacy of a peer- delivered anti-violence media campaign among rural middle alcohol children. Structural equation models will be evaluated that examine, in separate models, the moderating effects of sensation- seeking and self-esteem, on the relationship between substance use and violent behavior.

Evaluation of a Youth Suicide Prevention Program.

Principal Investigator: Peter Chen, PhD
Institution: Department of Psychology, Colorado State University
Classification: Prevention
Purpose: There are two specific aims in the proposed study. The first aim is to evaluate a youth suicide prevention program, Raising Awareness of Personal Power (RAPP). RAPP has been conducted by the Suicide Resource Center of Larimer County (SRC) since 1996 for middle schools and high schools in Larimer Country. The current program evaluation is based on a self-report survey asking if the participants (1) Understand the difference between depression and the “blues”, (2) Know some warning signs of depression, (3) Can identify several suicidal warning signs, (4) Know where to go for help. However, no definite conclusion can be drawn at this point without an adequate evaluation design. The second aim of the proposed project is to explore obstacles of utilizing the RAPP.

Epidemiology of Musculosketal Injuries Among Agricultural Workers.

Principal Investigator: John Rosecrance, PhD
Institution: Department of Environmental Health and Radiological Sciences, Colorado State University
Classification: Prevention, Epidemiology
Purpose: The specific aims of this project are to: 1) Identify the most significant (prevalent and severs) types and causes of occupational injuries and illnesses in cattle, dairy, and grain and feed operations in Colorado, 2) Identify the economic costs( medical and indemnity) associated with injuries and illnesses among cattle, dairy, and grain and feed operations in Colorado. This work will lead to primary prevention strategies aimed at reducing the risk factors associated with injuries and illnesses that are present in agricultural operations specific to Colorado and the high plains intermountain region.

Pilot Research Projects: 2003-2004

Pilot Study of Drowning and Near-Drowning in Irrigation Canals, Reservoirs and Drainage Ditches Using Geo-Spatial Techniques of Investigation: A preliminary Investigation to a Proposed Larger Rocky Mountain region Study with International Implications.

Principal Investigator: John Wilkens-Wells, PhD
Institution: Department of Sociology, Colorado State University
Classification: Injury Prevention
Purpose: The focus of this pilot study is to begin thoroughly documenting and investigating the circumstances surrounding drownings and near-drownings in open bodies of water originally developed for irrigated agriculture in the West, including canals, reservoirs and drainage ditches.

A Survey of Resident Aggression toward Certified Nursing Assistants in Long-term Facilities.

Principal Investigator: Tammi Vacha-Haase, PhD & Peter Chen, PhD
Institution: Department of Psychology, Colorado State University
Classification: Injury Surveillance and Injury Prevention
Purpose: The project aims are to identify the prevalence of residents’ violence among CNAs, investigate possible risk factors and adverse consequences, and develop scientifically sound prevention strategies at the individual, management, and organizational levels.

Housing Safety among Immigrant Children in Denver, Colorado: A Pilot Study.

Principal Investigator: Jill Litt, PhD
Institution: University of Colorado Health Sciences Center, Department of Preventive Medicine & Biometrics.
Classification: Epidemiology & Prevention
Purpose: This pilot study will 1) develop, test and refine methods to characterize housing conditions and housing related safety and health hazards, in immigrant communities, and 2) develop partnerships with faith-based and other community organizations serving these communities.

Uncovering Windows of Opportunity after Traumatic Brain Injury: Implications for Neurobehavioral Recovery.

Principal Investigator: Theresa Hernandez, PhD
Institution: Department of Psychology, University of Colorado
Classification: Rehabilitation
Purpose: The general aim of this research is to determine whether there is a temporal pattern to the physical, emotional/psychosocial and cognitive deficits associated with mild traumatic brain injury (TBI).

Pilot Research Projects: 2002-2003

Worker Safety Education: Current Status and Future Needs in the Colorado Dairy Industry.

Principal Investigator: David C. Van Metre, DVM, DACVIM
Institution: Colorado State University, Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences
Classification: Injury Prevention
Purpose: The specific aims of this proposal are: 1. To identify factors in the workplace, including the quality of training in worker safety, that contribute to injury to workers on large Colorado diaries, as perceived by the dairy workers and by the management (the dairy managers/ owners); 2. To compile the needs for training in specific tasks or skills for entry-level dairy workers on large Colorado dairies, as perceived by the dairy workers and by the management (the dairy managers/owners).

Predictors of Workplace Injuries for Union Workers.

Principal Investigator: Autumn Kraus, Graduate student
Institution: Colorado State University, Department of Psychology, College of Natural Sciences
Classification: 
Purpose: The purpose of this study is to develop and test a model to predict workplace injuries of union members in the construction industry.

Muscular Contributions to Cycling: A Comparison of the Recumbent and Standard Cycling Positions at Sub-maximal Levels of Effort.

Principal Investigator: Raoul F. Reiser, II, PhD, CSCS
Institution: Colorado State University, Department of Health and Exercise Science, College of Applied Human Sciences
Classification: 
Purpose: The goal of this research effort is to quantify individual muscle activity through surface EMG in both recumbent and standard cycling positions at three levels of resistance that may be encountered in a clinical setting. This research will help create a solid knowledge base that will both be useful immediately for practitioners as well as a foundation for further studies that might access the changes in cycling when injured.

Childhood Injury Prevention Concerns of Migrant and seasonal Farm Workers in Weld County.

Principal Investigator: Kathryn Clark, MD
Institution: The Children’s Hospital, Denver
Classification: 
Purpose: The objective of this project is to identify knowledge, behavior and attitudes about childhood injury prevention issues in migrant and seasonal farm workers (MSFW) in Weld County, Colorado. To serve as a pilot to identify a childhood injury prevention intervention for this population.

Investigating Symptoms of Post-Traumatic Stress Disorder in Orthopedic Trauma Patients.

Principal Investigator: Wade Smith, MD, Director
Institution: Denver Health Medical Center, Department of Orthopedic Surgery
Classification: 
Purpose: This study seeks to determine the prevalence of the symptoms of posttraumatic stress disorder in a population of patients who have sustained an orthopedic injury. In addition the study seeks to analyze demographic and injury data to determine if the risk of posttraumatic stress disorder can be predicted based on these factors.

Development of a Module on the Colorado Health Information Dataset.

Principal Investigator: Huiyun Xiang
Institution: Colorado Department of Public Health and Environment
Classification: 
Purpose: To develop a new module on the Colorado Health Information Dataset on the World Wide Web that provides data on the incidence of injury, the most common types of injury, risk factors for Colorado regions and counties in Colorado.

Pilot Research Projects: 2001-2002

Early Childhood Injuries in Primary Care Settings among Disadvantaged Children.

Principal Investigator: John F. Steiner, MD, MPH
Institution: University of Colorado Health Sciences Center
Classification: Prevention
Purpose: This project has two goals. The rationale for the first goal is that the vast majority of injury epidemiology in children is based on patients receiving care in hospital or emergency department settings; little is known about the incidence or characteristics of young children treated for injuries exclusively in primary care settings. The rationale for the second goal is that a better understanding of the risk factors for any injury, and for a potentially high-risk subset of children with multiple injuries, can be gained from comparison of demographic and maternal characteristics and utilization of health services by those children for other reasons.

Suicidality among American Indians: Prevalence and Risk.

Principal Investigator: Pamela L. LeMaster, RN, PhD
Institution: University of Colorado Health Sciences Center
Classification: Prevention
Purpose: This study examined the prevalence of suicidal behaviors among 1,638 Northern Plains Indians ages 15-57. The specific aims of the project were 1) to determine the prevalence of suicidal ideation and attempts within two American Indian tribes representing one cultural group, and 2) to identify the demographic, social, cultural, and physical and mental health conditions associated with the suicidal ideation and related behaviors. For the resulting paper, age and 11 gender patterns were investigated as was co morbidity with psychiatric and substance use disorders.

The Impact of an Intervention to Improve Early Childhood Preventive Service Delivery on Injury Counseling and the Incidence of Injuries.

Principal Investigator: John Steiner, MD, MPH
Institution: University of Colorado Health Sciences Center
Classification: Prevention
Purpose: This project has two goals. The rationale for the first goal is that injury prevention is an important component of well-child care visits for children, and that effective strategies of improving well-child care visit completion should result in enhanced opportunities for injury counseling. The rationale for the second goal is that enhanced injury counseling, if effective, targeted, and sufficiently common, might reduce injuries in this age group, since findings from our previous pilot study are likely to suggest that such injuries are common.