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Objectives: To increase booster seat use among low income parents. Design/methods: A pre-test/post-test design conducted in nine daycare centers with post-test observations four to eight weeks after the intervention. Intervention: Parents who participated in an educational training received free seats, educational programs were provided to all daycare staff and children, and signs in parking lots informed parents about child restraints. At seven centers, new policies recommended compliance with state restraint laws. Parents at four centers randomly chosen from the seven received financial incentives if observed using booster seats. Main outcome measure: The percent of children aged 4-8 riding in booster seats. Results: Pre-test observations of 185 4-8 year olds found 56% riding unrestrained and fewer than 3% riding in booster seats. After the intervention, observation of 146 children found the number riding in booster seats increased to 38% and the number observed without restraints decreased to 26%. Most booster seat use occurred with 4 and 5 year olds. No 7 or 8 year olds rode in booster seats. Changing center policies to recommend compliance with state restraint laws and an offer of financial incentives appeared to have no additional impact. Conclusions: Booster seat usage among low income families can be increased dramatically, though use decreases with age. Providing free seats accompanied by training may be sufficient without the need for additional intervention.B ooster seats, vehicle child restraints that position small children who have outgrown child safety seats so that standard seatbelts can protect them more effectively, are the recommended restraint system for children over 40 pounds (18.2 kg) in weight and less than 57 inches in height (144.8 cm).1-4 These parameters encompass many children between the ages of 4 and 8 years of age who do not always fit properly in adult lap/shoulder belts unless they are elevated with the assistance of a booster seat. Nonetheless, studies have found that only about 5% of parents with children aged 4-8 use booster seats.5 6 A more recent survey found increased use over the last two years, though the authors caution that their data are based on telephone reports from drivers of vehicles in which children were injured and may be biased by ''over-reporting of restraint use ''. 7 Motor vehicle crashes kill more children in the 4-8 age group-roughly 500 children between 1994 and 1998-than any other source of unintentional injury. 8 In 2000, nearly half of the 4-8 year olds killed in crashes were unrestrained. 9Wearing adult seatbelts in the back seat or using a belt positioning booster seat greatly reduces the risk of fatality to 4-8 year olds. 9 However, a recent survey of parents of 4243 children involved in crashes found that for 4-7 year olds, the odds of injury were 59% lower when riding in belt positioning booster seats than when using seatbelts alone. 10Instances of premature use of adult seatbelts, failure to use booster seats, and the absence of any restra...

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Emergency department (ED) clinicians routinely decide the disposition of patients with suicidal ideation, with potential consequences for patient safety, liability, and system costs and resources. An expert consensus panel recently created a 6-item decision support tool for patients with passive or active suicidal ideation. Individuals scoring a 0 (exhibiting none of the tool's 6 items) are considered "lower risk" and suitable for discharge, while those with non-0 scores are considered "elevated risk" and should receive further evaluation. The current study tested the predictive utility of this tool using existing data from the Emergency Department Safety Assessment and Follow-up Evaluation. ED patients with active suicide ideation (n = 1368) were followed for 12 months after an index visit using telephone assessment and medical chart review. About 1 in 5 patients had attempted suicide during follow-up. Because of the frequency of serious warning signs and risk factors in this population, only three patients met tool criteria for "lower risk" at baseline. The tool had perfect sensitivity, but exceptionally low specificity, in predicting suicidal behavior within 6 weeks and 12 months. In logistic regression analyses, several tool items were significantly associated with suicidal behavior within 6 weeks (suicide plan, past attempt) and 12 months (suicide plan, past attempt, suicide intent, significant mental health condition, irritability/agitation/aggression). Although the tool did not perform well as a binary instrument among those with active suicidal ideation, having a suicide plan identified almost all attempters while suicide plan and past attempt identified over four-fifths of near-term attempts. (PsycINFO Database Record

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Purpose of Review The field of problem gambling has been historically disconnected from the community experience of gambling and people of color, leading to a lack of integration of those with lived experience into programming. The aim of this article is to describe community-centered efforts to prevent and mitigate harm from problem gambling in Massachusetts—including a pilot program, the Massachusetts Ambassador Project, which is grounded within public health and lived experience frameworks. Recent Findings To engage Massachusetts communities in problem gambling prevention, planning processes were conducted to develop culturally appropriate prevention strategies. One of the recurrent themes was the desire of men in the substance misuse recovery community to share their knowledge with others, specifically, men of color who experience racism and health disparities. This finding informed the development of the Ambassador Project, a novel, peer-based, community-centered, and culturally responsive approach for men of color who have a history of substance misuse to engage other men of color in problem gambling prevention. Two organizations pilot tested the project and reached 4388 individuals. The pilot led to several findings in the design and implementation of related projects. Lessons are shared in three categories: structure, support, and implementation. Summary This article demonstrates an innovative approach to connect the field of problem gambling prevention to the community experience, using a public health and social justice lens. Others in the field should acknowledge the disconnect between problem gambling and the lived experience of those disproportionately impacted by creating opportunities for community voice to be at the center of programming.

ImportanceNonfatal opioid overdose is the leading risk factor for subsequent fatal overdose and represents a critical opportunity to reduce future overdose and mortality. Postoverdose outreach programs emerged in Massachusetts beginning in 2013 with the main purpose of linking opioid overdose survivors to addiction treatment and harm reduction services.ObjectiveTo evaluate whether the implementation of postoverdose outreach programs among Massachusetts municipalities was associated with lower opioid fatality rates compared with municipalities without postoverdose outreach programs.Design, Setting, and ParticipantsThis retrospective interrupted time-series analysis was performed over 26 quarters (from January 1, 2013, through June 30, 2019) across 93 municipalities in Massachusetts. These 93 municipalities were selected based on a threshold of 30 or more opioid-related emergency medical services (EMS) responses in 2015. Data were analyzed from November 2021 to August 2022.ExposuresThe main exposure was municipality postoverdose outreach programs. Municipalities had various program inceptions during the study period.Main Outcomes and MeasuresThe primary outcome was quarterly municipal opioid fatality rate per 100 000 population. The secondary outcome was quarterly municipal opioid-related EMS response (ambulance trips) rates per 100 000 population.ResultsThe mean (SD) population size across 93 municipalities was 47 622 (70 307), the mean (SD) proportion of female individuals was 51.5% (1.5%) and male individuals was 48.5% (1.5%), and the mean (SD) age proportions were 29.7% (4.0%) younger than 25 years, 26.0% (4.8%) aged 25 to 44 years, 14.8% (2.1%) aged 45 to 54 years, 13.4% (2.1%) aged 55 to 64 years, and 16.1% (4.4%) aged 65 years or older. Postoverdose programs were implemented in 58 municipalities (62%). Following implementation, there were no significant level changes in opioid fatality rate (adjusted rate ratio [aRR], 1.07; 95% CI, 0.96-1.19; P = .20). However, there was a significant slope decrease in opioid fatality rate (annualized aRR, 0.94; 95% CI, 0.90-0.98; P = .003) compared with the municipalities without the outreach programs. Similarly, there was a significant slope decrease in opioid-related EMS response rates (annualized aRR, 0.93; 95% CI, 0.89-0.98; P = .007). Several sensitivity analyses yielded similar findings.Conclusions and RelevanceIn this study, among Massachusetts municipalities with high numbers of opioid-related EMS responses, implementation of postoverdose outreach programs was significantly associated with lower opioid fatality rates over time compared with municipalities that did not implement such programs. Program components, including cross-sectoral partnerships, operational best practices, involvement of law enforcement, and related program costs, warrant further evaluation to enhance effectiveness.

This study evaluated the psycho-educational small-group component of the CASPAR Youth Services Student Assistance Program with a randomized-controlled trial. Two cohorts of at-risk sixth graders from six schools in two communities were randomly assigned to intervention or control conditions and tested one and a half years later at the end of the seventh grade. A generalized estimating equations model yielded a significant intervention effect on all three composite outcome variables. The results support the effectiveness of prevention strategies aimed at promoting positive youth development and a social influence process for adolescents that creates trusting relationships as the foundation for helping youth improve key skills, exert greater control over their lives, and make informed decisions about substances. EDITOR'S STRATEGIC IMPLICATIONS: School administrators should be aware of this promising approach (pending replication) of using student assistance counselors to promote children's intrinsic motivation and potential for positive decision making.