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The Emory Center for Injury Control: Vision and Priorities for Reducing Violence and Injuries through Interdisciplinary Collaborations
Houry, Debra,Hankin, Abigail,Swahn, Monica
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2010,
Addressing Injuries in Vulnerable Populations: Research Collaborations and Partnerships
Monica H. Swahn,Abigail Hankin,Debra Houry
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Using Policy to Strengthen the Reach and Impact of Injury Prevention Efforts
Swahn, Monica,Hankin, Aibgail,Houry, Debra
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: West J Emerg Med. 2011;12(3):268-270.
A Macrolevel Examination of County-Level Risk Factors for Underage Drinking Prevention: Intervention Opportunities to Protect Youth in the State of Georgia
Karen E. O'Quin,Sheryl M. Strasser,Monica H. Swahn
Child Development Research , 2011, DOI: 10.1155/2011/982525
Abstract: Introduction. Underage drinking can have profoundly negative impacts on childhood development. This study compares 4 categories of known underage drinking risk factors with alcohol consumption. The social indicators in these categories will be compared in the 10 most-at-risk (MAR) counties and the 10 least-at-risk (LAR) counties identified in Georgia. Methods. Independent 2-tailed t-tests were conducted to compare group means among MAR and LAR counties for all identified risk factors. Results. Significant differences were observed in all factors included in the poverty and alcohol outlet density categories. Discussion. The findings underscore the importance of better understanding youth drinking, poverty, and alcohol outlet density. However, our findings, supported by previous individual and aggregated level research, support strategies for researchers and policy makers to more proactively respond to poverty-stricken and high-density alcohol outlet indicators. The current ecological evaluation of underage drinking risk assessed on a macrolevel offers insights into the demographic features, social structures, and cultural patterns of counties that potentially predispose youth to greater health risks specifically associated with underage drinking. 1. Background Underage drinking can have a profound impact on childhood development. Research shows that early alcohol use initiation increases risk for heavy alcohol use, alcohol dependence, and alcohol-related harm to others and self [1, 2]. Early underage drinking is also linked to peer and dating violence [3], and other negative outcomes such as problems in school, weapon carrying, or recent marijuana use [4]. Furthermore, alcohol consumption is a significant risk factor for unsafe sexual behaviors, unintentional injuries, physical and sexual assaults, various types of illegal activities, and suicide [3, 5–8]. With all the known negative consequences of early alcohol use, adolescents in the United States [US] still use alcohol more than any other substance, including tobacco and marijuana. By the age of 15, nearly one half of American youth have consumed an entire alcoholic beverage, and 18–20-year olds have a higher prevalence of alcohol dependency than any other age group [8]. Despite the volume of research on underage drinking, there is surprisingly very little information about the range of influences at the macrolevel that may contribute to, or exacerbate risk for, underage drinking. In the state of Georgia, a relatively new initiative to assess social indicators across counties has permitted new and
Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala
Monica H. Swahn,Jane B. Palmier,Rogers Kasirye,Huang Yao
International Journal of Environmental Research and Public Health , 2012, DOI: 10.3390/ijerph9020596
Abstract: While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants ( N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed.
Differences in Poisoning Mortality in the United States, 2003–2007: Epidemiology of Poisoning Deaths Classified as Unintentional, Suicide or Homicide
Sana Muazzam,Monica H. Swahn,Hasanat Alamgir,Muazzam Nasrullah
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Abstract: Introduction: Poisoning, specifically unintentional poisoning, is a major public health problem in the United States (U.S.). Published literature that presents epidemiology of all forms of poisoning mortalities (i.e., unintentional, suicide, homicide) together is limited. This report presents data and summarizes the evidence on poisoning mortality by demographic and geographic characteristics to describe the burden of poisoning mortality and the differences among sub-populations in the U.S. for a 5-year period.Methods: Using mortality data from the Center for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System, we presented the age-specific and age-adjusted unintentional and intentional (suicide, homicide) poisoning mortality rates by sex, age, race, and state of residence for the most recent years (2003–2007) of available data. Annual percentage changes in deaths and rates were calculated, and linear regression using natural log were used for time-trend analysis.Results: There were 121,367 (rate 8.18 per 100,000) unintentional poisoning deaths. Overall, the unintentional poisoning mortality rate increased by 46.9%, from 6.7 per 100,000 in 2003 to 9.8 per100.000 in 2007, with the highest mortality rate among those aged 40–59 (rate 15.36), males(rate 11.02) and whites (rate 8.68). New Mexico (rate 18.2) had the highest rate. Unintentional poisoning mortality rate increased significantly among both sexes, and all racial groups except blacks (p,0.05 time-related trend for rate). Among a total of 29,469 (rate 1.97) suicidal poisoning deaths, the rate increased by 9.9%, from 1.9 per 100,000 in 2003 to 2.1 per 100,000 in 2007, with the highest rate among those aged 40–59 (rate 3.92), males (rate 2.20) and whites (rate 2.24). Nevada(rate 3.9) had the highest rate. Mortality rate increased significantly among females and whites only (p,0.05 time-related trend for rate). There were 463 (rate 0.03) homicidal poisoning deaths and the rate remained the same during 2003–2007. The highest rates were among aged 0–19 (rate 0.05), males (rate 0.04) and blacks (rate 0.06).Conclusion: Prevention efforts for poisoning mortalities, especially unintentional poisoning, should be developed, implemented and strengthened. Differences exist in poisoning mortality by age, sex, location, and these findings underscore the urgency of addressing this public health burden as this epidemic continues to grow in the U.S. [West J Emerg Med. 2012;13(3):230–238.]
Children at Risk for Suicide Attempt and Attempt-related Injuries: Findings from the 2007 Youth Risk Behavior Survey
West, Bethany A,Swahn, Monica H,McCarty, Frances
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2010,
Abstract: Purpose: The current study examines the associations between a range of risk factors and reports of suicide attempts, and attempts requiring medical care in a nationally representative study of high school students. The goal is to examine sex differences in the risk factors that are associated with suicide attempts and attempt-related injuries requiring treatment by a health-care provider. Methods: Data from the 2007 Youth Risk Behavior Survey for students in grades 9-12 were used to assess the prevalence and risk factors for suicidal behavior as well as differences in these for boys and girls. Cross-sectional multivariate logistic regression analyses were computed to determine the most important risk factors for suicide attempts and for suicide attempts requiring medical care for the sample overall and also stratified for boys and for girls. Results: Overall, 6.9% of adolescents attempted suicide (9.3% of girls versus 4.6% of boys). Girls were more likely than boys to report a suicide attempt in the past year (Adj.OR=2.89). Among girls, sadness (Adj.OR=5.74), weapon carrying (Adj.OR=1.48), dating violence (Adj.OR=1.60), forced sex (Adj.OR=1.72), and huffing glue (Adj.OR=2.04) were significantly associated with suicide attempts. Among boys, sadness (Adj.OR=10.96), weapon carrying (Adj.OR=1.66), forced sex (Adj.OR=2.60), huffing glue (OR=1.63), hard drug use (Adj.OR=2.18), and sports involvement (Adj.OR=1.52) were significantly associated with suicide attempts. Conclusions: These findings demonstrate similarities and differences in terms of the modifiable risk factors that increase risk for suicide attempts among boys and girls. In terms of the differences between boys and girls, hard drug use and sports involvement may be important factors for suicide prevention strategies that are directed specifically towards boys, while dating violence victimization may be an important risk factor to address for girls. Overall, these findings can help guide prevention, clinical practice, and intervention strategies to prevent suicidal behaviors among adolescents. [West J Emerg Med. 2010; 11(3): 258-264.]
Associations between Electronic Media Use and Involvement in Violence, Alcohol and Drug Use among United States High School Students
Denniston, Maxine,Swahn, Monica,Hertz, Marci Feldman,Romero, Lisa
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: Objective: We identified associations between time spent watching television and time spent playing video or computer games or using computers and involvement in interpersonal violence, alcohol and drug use in a nationally representative sample of United States high school students.Methods: We analyzed data from the 2007 national Youth Risk Behavior Survey. Exposure variables were time spent watching television and time spent playing computer or video games or using computers (hereafter denoted as “computer/video game use”) on an average school day; outcome variables included multiple measures assessing involvement in violence and alcohol or drug use. Chi-square tests were used to identify statistically significant associations between each exposure variable and each of the outcome variables. We used logistic regression to obtain crude odds ratios for outcome variables with a significant chi-square p-value and to obtain adjusted odds ratios controlling for sex, race, and grade in school.Results: Overall, 35.4% (95% CI=33.1%-37.7%) of students reported frequent television (TV) use and 24.9% (95% CI=22.9%-27.0%) reported frequent computer/video game use. A number of risk behaviors, including involvement in physical fights and initiation of alcohol use before age 13, were significantly associated with frequent TV use or frequent computer/video game use, even after controlling for sex, race/ethnicity and grade.Conclusion: Findings highlight the need for additional research to better understand the mechanisms by which electronic media exposure and health-risk behaviors are associated and for the development of strategies that seek to understand how the content and context (e.g., watching with peers, having computer in common area) of media use influence risk behaviors among youth. [West J Emerg Med. 2011;12(3):310-315.]
Serious Violence Victimization and Perpetration among Youth Living in the Slums of Kampala, Uganda
Monica H. Swahn,Lindsay Gressard,Jane B. Palmier,Rogers Kasirye
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Abstract: Introduction: Violence among youth is a major public health issue globally. Despite these concerns, youth violence surveillance and prevention research are either scarce or non-existent, particularly in developing regions, such as sub-Saharan Africa. The purpose of this study is to quantitatively determine the prevalence of violence involving weapons in a convenience sample of service-seeking youth in Kampala. Moreover, the study will seek to determine the overlap between violence victimization and perpetration among these youth and the potentially shared risk factors for these experiences.Methods: We conducted this study of youth in May and June of 2011 to quantify and describe high-risk behaviors and exposures in a convenience sample (N 457) of urban youth, 14–24 years of age, living on the streets or in the slums and who were participating in a Uganda Youth Development Link drop-incenter for disadvantaged street youth. We computed bivariate and multivariate logistic regression analyses to determine associations between psychosocial factors and violence victimization and perpetration.Results: The overall prevalence of reporting violence victimization involving a weapon was 36%, and violence perpetration with a weapon was 19%. In terms of the overlap between victimization and perpetration, 16.6% of youth (11.6% of boys and 24.1% of girls) reported both. In multivariate analyses, parental neglect due to alcohol use (Adj.OR 2.28;95%CI: 1.12—4.62) and sadness (Adj.OR=4.36 ;95%CI: 1.81—10.53) were the statistically significant correlates of victimization only. Reportinghunger (Adj.OR=2.87 ;95%CI:1.30—6.33), any drunkenness (Adj.OR=2.35 ;95%CI:1.12—4.92) and any drug use (Adj.OR=3.02 ;95%CI:1.16—7.82) were significantly associated with both perpetration and victimization.Conclusion: The findings underscore the differential experiences associated with victimization and perpetration of violence involving weapons among these vulnerable youth. In particular, reporting hunger, drunkenness and drug use were specifically associated with victimization and perpetration. These are all modifiable risk factors that can be prevented. It is clear that these vulnerable youth are in need of additional services and guidance to ameliorate their adverse childhood experiences, current health risk behaviors and disadvantaged living context. [West J Emerg Med. 2012;13(3):253–259.]
Pre-Teen Alcohol Use as a Risk Factor for Victimization and Perpetration of Bullying among Middle and High School Students in Georgia
Swahn, Monica,Topalli, Volkan,Ali, Bina,Strasser, Sheryl
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: Objective: We examined the association between pre-teen alcohol use initiation and the victimization and perpetration of bullying among middle and high school students in Georgia.Methods: We computed analyses using data from the 2006 Georgia Student Health Survey (N=175,311) of students in grades 6, 8, 10 and 12. The current analyses were limited to students in grades 8, 10 and 12 (n=122,434). We used multilogistic regression analyses to determine the associations between early alcohol use and reports of both victimization and perpetration of bullying, perpetration only, victimization only, and neither victimization or perpetration, while controlling for demographic characteristics, other substance use, peer drinking and weapon carrying.Results: Pre-teen alcohol use initiation was significantly associated with both bullying perpetration and victimization relative to non drinkers in bivariate analyses (OR=3.20 95%CI:3.03-3.39). The association was also significant between pre-teen alcohol use initiation and perpetration and victimization of bullying in analyses adjusted for confounders (Adj.OR=1.74; 95%CI:1.61-1.89). Overall, findings were similar for boys and girls.Conclusion: Pre-teen alcohol use initiation is an important risk factor for both the perpetration and victimization of bullying among boys and girls in Georgia. Increased efforts to delay and reduce early alcohol use through clinical interventions, education and policies may also positively impact other health risk behaviors, including bullying. [West J Emerg Med. 2011;12(3):305-309.]
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