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The authors conducted a household survey and observation to assess carbon monoxide (CO) knowledge and risks as well as prevalence of CO alarms in an urban community prior to the enactment of a mandatory ordinance requiring CO alarms in one U.S. city. From July to December 2009, household surveys and observations were completed in 603 residences. Participants were mostly African-American (61%), women (70%), 25-54 years in age (66%), and with a high school education or less (51%). Most homes visited contained CO-producing appliances, including gas stoves (86%), gas furnaces (82%), and gas water heaters (79%). Participants' overall mean percentage correct knowledge score was 57%. CO alarms were reported by 33% of participants and observed among 28% of households. Low rates of CO knowledge and CO alarm ownership, combined with high rates of CO-producing sources in homes, suggests the need for widespread campaigns to promote CO alarms. Recommendations are also made to integrate the lessons learned from the public health community's experience promoting smoke alarms. [ABSTRACT FROM AUTHOR]

This study aimed to describe the prevalence of preventive safety measures in homes with older, urban- dwelling adults; determine the relationship between sociodemographic variables and injury prevention measures; and describe older adults' knowledge of safety topics. Teams conducted interviews and home observations in 603 homes to confirm preventive safety measures. Households with older adults were rarely observed to have recommended smoke alarm (34%) or carbon monoxide coverage (22%). Water temperature was safe in 64% of homes. Among households headed by someone other than the older adult, odds of having a working smoke alarm on every floor were much lower than in older adult -headed households (95% confidence interval: 0.04-0.35). Few older adults interviewed about safety knowledge correctly answered several items related to fire and carbon monoxide. Effort is needed to improve knowledge and promote the lifesaving benefits of injury countermeasures so that older adults can be adequately protected. [ABSTRACT FROM AUTHOR]

Background Fires and burns are a leading cause of unintentional injury death in the USA. Although it has been anecdotally reported that vacant dwellings are at a higher risk for fire, the association between vacancy and fire risk at the individual household level has not been empirically measured. Methods In this cross-sectional study, geocoded residential vacant properties (VP) and fire events are analysed in Baltimore City at the census tract level and the individual household level. Results On average, a 10% increase in the proportion of vacancies in a census tract was associated with a 9.9% increase in fires (95% CI: 5% to 15%). Random-effects Poisson models, controlling for housing and neighbourhood conditions, found contagion effects. The risk of fire in an occupied dwelling increased by 8% (95% CI: 1% to 10%) for every vacant structure within 10 m, and the risk of fire decreased by half (95% CI: 45% to 62%) for every km between an occupied dwelling and vacant building. Close proximity to VP was associated with trash fires within dwellings (p¼0.039) and structure fires (p¼0.012). Conclusions We believe that this is the first study to demonstrate increased risk posed by nearby VP at the household level, confirming earlier ecological analyses of the role of VP as strong correlates of home fires. Measurement of this risk can motivate property owners, policy makers and insurers to invest in risk reduction measures that include building maintenance and trash removal. INSET: Father charged with firearm offence: son shot by brother. [ABSTRACT FROM AUTHOR]

In the United States, the American Indian and Alaska Native (AI/AN) population has the highest motor vehicle death rate, which is significantly greater than that of any other race or ethnic group. To better understand why this significant disparity exists and how to eliminate it, the authors conducted a systematic review of the published scientific literature. Included studies were published between January 1, 1990, and January 31, 2011, and identified risk factors, or implemented and tested interventions, targeting motor vehicle deaths among the AI/AN population. Only 14 papers met the study’s inclusion criteria. Most of the epidemiologic studies explored alcohol use as a risk factor for deaths of both motor vehicle occupants and pedestrians; few studies addressed risk factors specifically for pedestrians. All of the intervention studies focused on mitigating risks for motor vehicle occupants. On the basis of the authors’ review, injury prevention interventions that are multifaceted and involve partnerships to change policy, the environment, and individual behavior can effectively mitigate motor-vehicle-related deaths among AI/ANs. Priority should be given to implementing interventions that address pedestrian safety and to sound investment in the states with the highest AI/AN motor vehicle death rates because reducing their burden can dramatically reduce the overall disparity. [ABSTRACT FROM PUBLISHER]

Numerous studies have demonstrated an association between characteristics of the school environment and the likelihood of school violence. However, little is known about the relative importance of various characteristics of the school environment or their differential impact on multiple violence outcomes. Primarily African-American students (n = 27) from Baltimore City high schools participated in concept mapping sessions, which produced interpretable maps of the school environment's contribution to school violence. Participants generated statements about their school environment's influence on school violence and, with the assistance of quantitative methods, grouped these statements according to their similarity. Participants provided information about the importance of each of these statements for the initiation, cessation, and severity of the violence that occurs at school. More than half of the 132 statements generated by students were rated as school environment characteristics highly important for the initiation, cessation, and/or severity of school violence. Participants identified students' own actions, expectations for disruptive behavior, and the environment outside the school as the characteristics most important for the initiation and increased severity of violence that occurs in school. Participants had a more difficult time identifying school environment characteristics important for the cessation of school violence. This study provides support from students for the role of the school environment in school violence prevention, particularly in preventing the initiation and reducing the severity of school violence. Schools can utilize the information presented in this article to begin discussions with students and staff about prioritizing school environment changes to reduce school violence. [ABSTRACT FROM AUTHOR]

The role of social norms has played an often unrecognized role in the perception of and action to assist low-income urban women who are in violent relationships. Two forms of social norms will be assessed, including descriptive norms-what people typically do to assist women in a violent relationship-and injunctive norms-defined as what people should do to assist women. This study will present our initial findings into the development of measures to assess women's perception of their community's social norms toward assisting women who have experienced intimate partner violence (IPV) and how these norms are related to women's perception of the community, reasons for community assistance toward women experiencing IPV, and women's own experience of IPV. Systematic measurement development processes were applied to reliably and validly develop the social norms measures. A three-phase approach was used to develop eight paired items measuring descriptive and injunctive norms. A total of 176 low-income urban women were interviewed and the scale responses were compared to length of time at the residence, perceptions of their neighborhood, perceived reasons for community involvement and non-involvement in assisting women experiencing IPV, and IPV experienced as an adult. The two developed social norms scales were found to have high internal consistency alpha coefficients of 0.84 for descriptive norms and 0.93 for injunctive norms. Paired t tests were statistically significant, denoting higher injunctive than descriptive social norms. Lowered descriptive norms were found among younger women, women who reported that they did not think their neighborhood was a good place to live, women who had ever experienced intimate partner violence as an adult, and perceived lower reasons for neighbor involvement and higher reasons for neighbor non-involvement toward assisting women experiencing IPV. Higher levels of injunctive social norms were statistically associated with living in a good place and increased perceived reasons for neighbor involvement toward assisting women experiencing IPV. Significant differences between descriptive and injunctive norms suggest that women, especially those who are currently experiencing IPV, would prefer greater support from community neighbors than they are currently providing. The descriptive and injunctive social norms scales demonstrated a high level of internal reliability and significantly associated with other influencing factors thought to be associated with social norms. Overall, the performance of the injunctive and descriptive norms scales support their use as a tool to investigate social norms toward neighbors taking action to assist women experiencing IPV. [ABSTRACT FROM AUTHOR]

Objective: Despite widespread prevention efforts, youth violence persists in many urban communities. This investigation explores the unique perspectives and local capacities to address urban youth violence. Method: Qualitative in-depth interviews were conducted with prominent neighborhood individuals (PNIs) from low-wealth neighborhoods that varied by risk for youth violence. Findings: Findings reveal examples of increased levels of social action in the designated low risk for youth violence neighborhoods. Similar activities were also present, but to a lesser extent, within the high-risk neighborhoods. Results illustrate how PNIs formally and informally share information and take action to address youth violence. Conclusion: PNIs are an often-overlooked resource in gaining local insight for addressing health issues, such as youth violence. The efforts identified exhibit expertise and culturally sensitive opportunities for working together to address youth violence. Understanding such dynamics is essential for informing the development of locally endorsed violence-prevention interventions. [ABSTRACT FROM AUTHOR]

Injury prevention counseling (IPC) by health care providers is one strategy to reduce injury risk by encouraging people to modify their environment or their personal behaviors to protect themselves or their loved ones. National surveys indicate that few patients are receiving IPC. The evidence of IPC being effective at increasing safety practices is inconsistent. This may be explained partially because counseling recommendations for some injury issues may involve more effort, cost, or inconvenience by the patient. IPC that is based on behavior change theories is more likely to be effective. Physicians and other health care providers can play a critical role in efforts to prevent injuries, but barriers for delivering IPC need to be overcome. [ABSTRACT FROM PUBLISHER]

This paper presents a cross-sectional study examining the influence of neighborhood violence on multiple aspects of mothers’ health. While the influence of neighborhood violence on health is important to understand for all populations, mothers are especially important as they play a key role in protecting their children from the consequences of violence. Three hundred and ninety-two Baltimore City mothers of children 5 years and younger completed a self-administered survey that included questions about perceptions of their safety as well as their personal experiences with neighborhood violence. Separate models were run to compare the relationship between each measurement of neighborhood violence and five diverse health-related determinants and outcomes: self-reported health status, smoking, exercise, average hours of sleep a night, and sleep interruption. Controlling for mother’s age, child’s age, maternal education, and marital status, mothers with high exposure to neighborhood violence were twice as likely to report poorer health, smoking, never exercising, and poor sleep habits. Maternal perception of neighborhood safety was not related to any of the assessed health-related determinants and outcomes. This study emphasizes the importance of measuring exposure to neighborhood violence rather than solely assessing perceived safety. Neighborhood violence was a common experience for mothers in this urban sample, and should be considered by health professionals in trying to understand and intervene to improve the health of mothers and their children. [ABSTRACT FROM AUTHOR]

This longitudinal study examined racial differences in depressive symptoms at three time points among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers at-risk for child maltreatment ( n = 616). The proportion of mothers with depressive symptoms ranged from 28 to 35% at all time points. Adjusted analyses revealed that Asian and NHOPI mothers were significantly more likely than white mothers to have depressive symptoms but this disparity was present only among families at mild/moderate risk for child maltreatment. Future research should identify ways to reduce this disparity and involve the Asian and NHOPI communities in prevention and treatment program design and implementation. [ABSTRACT FROM AUTHOR]

Adolescent academic achievement is closely linked to numerous health outcomes. Studies have demonstrated a positive relationship between parental academic monitoring and adolescent academic achievement. Less is known about factors associated with parental academic monitoring, and research is particularly lacking with low-income, African American young adolescents who are at high risk for school disengagement and underachievement. Data were collected from a sample of incoming urban sixth graders using a computer- assisted questionnaire. Data were analyzed as cross-sectional using the responses of 111 African American adolescents, ages 10-14 years. The median responses of adolescents about perceptions of parental academic monitoring were used to classify adolescents into two groups, lower and higher perceived academic monitoring. Logistic regression and stratified analyses determined factors related to higher parental academic monitoring. Adolescents' perceived parental general support (OR: 2.08, CI: 1.29-3.36) and friends' pro-social behavior (OR: 1.54, CI: 1.03-2.30), were significant factors in the multivariate model. Also, adolescents living with one biological parent and with other adults were more likely to report higher parental academic monitoring, compared to adolescents living with one biological parent and no other adults (OR: 3.58, CI: 1.00-12.83). Perceptions of general parental support and peer groups offer insight into why parental academic monitoring allows only some African American urban youth to succeed academically. Parental support provides a context that influences youths' perceptions of their parents' academic monitoring and should be considered in future research. Results identify factors in a high-risk population that may help explain why some urban youth succeed academically while others do not. [ABSTRACT FROM AUTHOR]

Fires and burns are the fifth most common cause of unintentional injury deaths in the United States. To address fires and fire deaths, the National Fire Data Center (NFDC) established the National Fire Incident Reporting System (NFIRS) as a surveillance system for fires. Delaware implemented NFIRS as the Delaware Fire Incident Reporting System (DFIRS), and is currently capturing all fires reported in the system. The objectives of this study are to: 1) understand the implementation of DFIRS; 2) analyze data from DFIRS to describe fire incidents; and 3) inform other states' fire surveillance efforts. We interviewed Delaware State Fire Marshal's Office personnel to understand the implementation of DFIRS and analyzed DFIRS data from May 2003 to December 2004 to examine data completeness, and characteristics of fires, smoke alarms, and fire injuries and deaths. DFIRS captures 100% of Delaware fires reported to fire departments. Data completeness for the fields examined ranged from 33% to 100%. Fires in which smoke alarms alerted occupants were significantly less likely to result in injury or death than fires in which smoke alarms did not. DFIRS has the potential to serve as a valuable fire prevention and fire analysis tool. For DFIRS to reach its full potential as a surveillance system, increased attention to data completeness is necessary. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk ( n = 491) and not at-risk ( n = 218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women. [ABSTRACT FROM AUTHOR]

Youth violence is a significant public health problem. Although the relationship between neighborhood-level factors and urban youth violence is recognized, the specific mechanisms of this relationship are often unclear. Prominent neighborhood individuals were identified within four select low-income urban neighborhoods in Baltimore City. In-depth interviews were conducted to explore these individuals' perceptions of the relationship between social and structural neighborhood-level factors and urban youth violence. Employment opportunities, local businesses, trash management, vacant housing, and street lighting were perceived as important neighborhood factors influencing young people's experiences. The relationship between these neighborhood characteristics and the local illicit drug market and youth violence is highlighted. Results provide an enhanced understanding of the importance of using a participatory-based research approach and the mechanisms of the relationship between neighborhood-level factors and youth violence. Both are critical components in designing and implementing multilevel youth violence prevention efforts. [ABSTRACT FROM AUTHOR]

Local-level public health interventions require action from multiple agencies, organizations and individuals, yet little is known about how best to work with stakeholders to facilitate change. We sought local stakeholders' perspectives on how best to address impediments to implementing interventions designed to reduce child pedestrian injury by improving the pedestrian environment. We conducted 20 in-person, key informant interviews with people who would be the likely advocates for environmental change to improve the pedestrian environment in one US city, Baltimore, Maryland. We discuss the importance of reframing child pedestrian injury risk as a livability issue, increasing awareness about the potential impact of environmental changes to improve public safety, and the need for a formal efficient process to facilitate communication between local government and other stakeholders. These findings provide public health professionals and advocates with useful insight into how local stakeholders view the issue and their perspectives on how best to achieve change. [ABSTRACT FROM AUTHOR]

While neighbourhood influences on the risk of intimate partner violence have been reported, this body of research has suffered from a lack of strong theoretical and conceptual guidance, and few studies have examined the potential pathways from neighbourhoods to intimate partner violence. This paper used concept mapping methods with 37 women who were residents of Baltimore City to obtain cluster maps representing the important neighbourhood domains that affect the prevalence, perpetration, severity, and cessation of intimate partner violence. Domains important for intimate partner severity and perpetration differed from those important for cessation of intimate partner violence. Finally, diagrams of the domains, drawn by the concept mapping participants, illustrated the pathways by which neighbourhood characteristics potentially influence intimate partner violence severity, perpetration, and cessation. These results can be used to generate testable hypotheses regarding neighbourhood influences on intimate partner violence in future quantitative research and to inform the design of public health intimate partner violence programmes. [ABSTRACT FROM AUTHOR]

The assessment of a person's quality of life as it relates to health, HIV status and intimate partner violence (IPV) among women has been limited in its scope of investigation. Consequently, little is known about the adjusted and combined effects of IPV and HIV on women's health status and QOL. 445 women (188 HIV + 257 HIV -) residing in an urban low income area were interviewed regarding current IPV experiences (no IPV, IPV more than 1 year ago, IPV in last year), HIV status (positive and negative), use of illicit drugs, and presence of instrumental social support. Health-related QOL (HRQOL) was measured using the MOS-HIV. Stratified bivariate analyses demonstrate that living with HIV or having experienced IPV in the past year was significantly associated with poorer levels of HRQOL. Multiple logistic regression models indicate a robust negative relationship between the experience of IPV in the past year, living with HIV, use of illicit drugs and a protective effect of social support on women's reported HRQOL. The results of the bivariate and multivariate analyses provide evidence that there are independent and adjusted detrimental associations of the experience of IPV and living with HIV with women's HRQOL. As HRQOL is a good indicator of physical and mental health, these findings should alert health care and other service providers to their responsibility to screen and treat women experiencing intimate partner violence and living with HIV. [ABSTRACT FROM AUTHOR]