Tracking Assault‐injured, Drug‐using Youth in Longitudinal Research: Follow‐up Methods

Abstract

Objectives Violence is one of the leading causes of death among youth ages 14–24. Hospital- and ED-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, though little literature exists regarding optimizing follow-up methods for violently-injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. Methods The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 24 months. Results 599 patients (ages 14–24) were recruited from the ED (mean age=20.1 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7%, 84.2%, and 85.3%, respectively. Participant contact efforts ranged from 2 to 53 times per follow-up timeframe to complete a follow-up appointment, and more than 20% of appointments were completed off-site at community locations (e.g., participants’ homes, jail/prison). Participants who were younger (p<.05) and female (p<.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p<.05) and had a substance use disorder (p<.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p<.01) required more intensive contact efforts. Conclusions The FYI study demonstrated that achieving high follow-up rates for a difficult-to-track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.

Predictors of alcohol use transitions among drug-using youth presenting to an urban emergency department

“…Youth were remunerated $20 for the baseline assessment, and $30, $40, $45, and $50 for each of the four respective follow-ups. Attrition was minimal, with ≥83.7% of youth assessed at each follow-up; methods used to achieve those follow-up rates are described elsewhere [38].…”

United States Emergency Department Screening for Drug Use Among Assault-Injured Individuals: A Systematic Review

“…22 The journal categories of the 26 studies included the following: substance use/addiction (10/26); pediatrics (6/26); emergency medicine (5/26); public health (3/26); and medicine (2/26). Seventeen studies were funded by the NIDA, 15,16,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] 13 by the National Institute on Alcohol Abuse and Alcoholism, [22][23][24][25]30,32,35,[37][38][39][40][41] eight by the US Centers for Disease Control and Prevention (CDC), 16,[25][26][27]29,31,34,42,43 one by the National Institute of Mental Health, 21 one by the Department of Surgery at the University of Texas Southwestern Medical School, 44 and one was not listed. 45 Fourteen studies were cross-sectional.…”

“…45 Fourteen studies were cross-sectional. 16,[23][24][25]27,28,33,[36][37][38][39][40][41][42] nine were retrospective cohort, 22,26,[29][30][31][32]34,35,45 two were prospective cohort, 5,44 and one was a case-control. 21…”

“…Of the 26 studies, five studies screened for recent drug use by either survey or in-person interview without a formal screening instrument. 21,37,38,44,45 Of the remaining 21 studies, 14 used a combination of the NIDA Quick Screen Question and Modified Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), 15,16,22,[25][26][27][28][29][30][31][32][34][35][36] three used the Substance Abuse Outcomes Module (SAOM), 23,24,39 two used questions from the Monitoring the Future study to detect prior-year cannabis use, 40,41 one used questions from the Supporting Adolescents with Guidance and Employment survey to detect past 12-month substance use, 42 and one used the Texas Christian University Drug Screen to determine past 30-day substance use. 33…”

“…Other notable challenges in conducting research in this population include participant loss to follow-up by attrition (eg, unable to contact or death), undocumented immigrant status and fear of deportation, and a lack of viable and sustained community resources where patients can be referred for counseling and treatment services. 32,72,73 Additionally, our review highlights several knowledge gaps in the existing literature surrounding drug use in the context of non-partner assault-injury. Little is known about the mutual risk factors, notably socioecological and psychological, that may contribute to the co-occurrence of assault-injury and drug use, both considered to be problem behaviors.…”